ONE of India's most outstanding economic jewels has lost its glitter. All that
Surat could do is wait weak-kneed and
groggy for a Pied Piper to slough off its
gigantic army of rats and bandicoots,
which recently sent the world's most
dreaded disease rustling insidiously
through India. One of the highest taxpaying cities in India, Surat should by
rights have been squeaky clean and fortified against a genocidal killer like the
plague.
Shaking off last month's flash floods
in the Tapi river like a drenched rat,
Surat, the somewhat grubby showcase
of Gujarat's eco onomic upsurge, had just
about missedAeath by drowning by a
whisker. But by the end of last month,
the only visitors - and reluctant at that
- to the Diamond City were mediapersons and medics, who found a filthy
ghost town reeking of plague and panic.
Confusion. pounded the streets as
panic-stricken Surtis, faces half-covered
behind masks, kerchiefs, bandannas and
rags of utterly dubious utility, hurried in
every direction but up, riding anything
on wheels. The plague travels fast and
quiet, and instead of clamping a pragmatic quarantine, the administration
virtually abetted an exodus. Suddenly
put under tremendous pressure, the
local administration devoted more
energy to sweeping its sins of criminal
maladministration under the carpet
than to plague control, and chaos
turned the city into an unplanned,
uncontrollable ecological mess. On
trains, and state transport buses and private vehicles, the highly-infectious
human-to-human pneumonic plague
hitch-hiked to other parts of the country, some of which don't have a rat population large enough to feed a small platoon of cats.
K K Dutta, director at the National
Institute of Communicable Diseases
(NICD), Delhi, and also the head of the
most eminent group of troubleshooters
that was rushed to Surat, says, "It's true
that the local
administration
panicked,
Otherwise, perhaps a
few more lives
could have been
saved."
On the night of
September It.
Suresh Tikwade
Bokade, a 20-year-old
millworker from
Surat's Laxmi NaW
(Ved Road) area, was
declared dead ca
arrival at the Surat
Civil Hospital (SCH).
He had been running a
very high fcw
was coughing and had
blood in his
turn. Doctors at the
hospital beni
suspected advanced
pneumonia.
all hell broke loose
- within the
e
12 hours, 8 people
from slums on
Road, and the
Katargarn and Lim
areas died of similar
symptoms.
These were no sudden
deaths,
they caught the
administration na
Nayan Shah, a
35-year-old workeT
kel
one of the thousands
of textile mills
as
give Surat its
economic vitality,
"People had been
dying of what
being called 'Surat
fever' right
September 13."
Along with more cases
came
ing confusion among
doctors and
administration.
Dinesh Shah, med
superintendent at the
SCH, says, "N*4
suspected that the
disease was
plague. Most doctors
in the hospital I
never seen a plague
case in their lit
Initially, they
thought that it i
advanced pneumonia.
On Septesi
19, my own driver
died of blood am
lungs and we still
had no clue."
But patients failed
to resposW
treatment for
pneumonia. Sm
Khandu, resident of
the Shiv Nap
colony in Katargam,
complained
fever and chest pain
before dying
September 17. His
mother Latan
recalls, "We took him
to 4 differewd
ics. Each of them
administered 4W
and gave him some
injections.
condition just kept
worsenin
him to the Civil
Hospital."
Rajeev Gupta, resident doctor at the
6 admits, "There was so much initial
"ion that 7 doctors and a few nursoho unsuspectingly treated the early
itnts without precautions were
cted."
Finally, on the morning of
member 22, Saifi Khadiya, head of the
6ology department at the SCH, "smelt
a", as she puts it, and conducted an
opsy on the body of Mahesh
kraya, a 40-year-old man from the
I Road area. The provisional judge-
ot that Khadiya gave was that the
used had had haemolytic pneu-
nic plague, caused by the bacillus
oinia pestis (see box: Of mice and men).
NICD's Dutta commented later that a
Woe outbreak had been anticipated in
ed district, 500 km away in
duraslitra, and in the adjoining states
Karnataka and Andhra Pradesh.
Kling to this, a senior epidemiologist
& the Surat's Civil Hospital says,
Ibat is the point in simply anticipatIan epidemic? The NICD should have
mWed a nationwide alert and
iKlned doctors, especially in governst hospitals. In this hospital alone,
swWd have managed to save at least 40 lives.
The World Health Organization
that on August 5, local health
authorities in the Beed district began
receiving complaints of a "flea nuisance" and "ratfall" (dead rats en masse)
from 2 villages. Soon there were about
30 patients with suspected plague, but
the Maharashtra government just sat on
the emergency.
The Surat administration, following
10 deaths by September 20, on its part
issued a coy notification in local dailies
declaring the city a "mysterious disease
affected area". City administrator
Kundan Lal says, "We suspected that the
floods had something to do with it.
Thus we resorted to cleaning the city.
The city's garbage backlog had built up
to 5,000 tonnes while the removal
capacity of the municipal corporation is
just 500 tonnes a day."
Surat was sprayed generously with
gamaxene (benzene hexachloride), DDT and malathion. In fact, statutory
discretions in the spraying
of insecticides and pest
control chemicals, formulated after the DDT-happy
overspraying of the '60s
and '70s, were ignored. As
a result, rats started dying
inside the houses in several colonies, complicating
the problem.
Thakorebhai Naik,
state minister for coopera-
tion, was belatedly rushed
in by Gujarat Chief Mini-
ster Chhabildas Mehta to monitor the
crisis. Isolation wards were set up at the
Civil Hospital, guarded against curious
onlookers and desperate relatives by the
blue-camouflaged and incongruously
heavily-armed Rapid Action Force. The
state managed to divert popular attention towaras the garbage pile-up,
which actually had little to do with the
epidemic in the city. (State minister for
health, S Sehlat, still argues that the
plague was n'o't homegrown and had
come from-Maharashtra.). Small groups
of people took on themselves the task of
garbage clearing and incineration, the
administration's reneged responsibility.
Argues Dinesh Shah, "The epidemic in Surat was identified as the
highly- infectious pneumonic plague.
The only nexus between this strain
and squalor is that in
unhygienic conditions,
lots of viruses tend to
thrive. These viruses weaken resistance to diseases
of those living in predominantly poor areas.
Coupled with nutrient
diets of low value, this creates ideal conditions for
the plague baccilli to
make a killing. In reality,
the clean-up operations
ought to be directed
to checking plague of
the contagious bubonic
variety."
By the time it creaked into operation, the spraying was invested with desperate haphazardness. Anand Park
Society saw residents pouring edible salt
over heaps of garbage and open drains
in an effort to sterilise them. A game of
mad musical chairs had garbage being
allegedly lifted from one area and
offloaded in another. And another.
Buses and other inter-city transport
pit-stopping at Surat were let off
unfurnigated.
In the first few days, medicines were
in short supply and blackmarketing
started. Medical vans were looted.
Enraged residents in the focal Katargarn
area set alight the clinics of 2 private
practitioners who had ded the city.
(A quarter of the city's 4,000 private
doctors were among the first to pack
and leave. They face possible prosecution). The distribution of tetracycline
was restricted to certain areas, notwithstanding the fact that there was enough
of the drug for every citizen - by
September 28, medicine worth Rs 1.5
crore had been distributed. Although
chief health officer K Sinha claimed that
260 teams toured the city on a door-to-
door search for patients and disbursing
medication, the worst-affected areas
depended almost exclusively on local
chemists.
The exodus of 5 lakh-odd Surtis
began in right earnest on the afters
of September 22, a full week after
first known fatalities. Plague a
began popping up in neighboud
districts and villages in Surat dis"
Eight other cities were declared piq
threatened.
The flood of people started froon
epicentral, Ved Road and Ka"
areas in the north of the city. Dom
businessmen, leaders of industrv. I
ernment officials and workers joined
panicky migration. But the worst cm
all was the flight of doctors who rm I
vate clinics. Thakorebhai confesses i
it never occurred to the adminis"
to invoke the emergency Essensial
Senices Maintenance Act and order the
&Ltors to stay.
Chandrika Prasad, a worker in the
fwlav Textile Mill in Mota Binsara,
waiting for a train to Delhi at the railway
wation says, " The owner of the factory
Ckosed his unit and fled the city. With no
Job and little chance of being paid in the
wimt 15 days, I decided to leave."
Says Gupta, "Not one death was
worded among the middle or upper
dmses in Surat. The epidemic preyed on
mWant labour. Their resistance to any
jokction is low. Many plague patients
06mitted to the hospital already had
Pobtrculosis or asthma, making them
Pwe vulnerable to the plague."
anti-plague operations. The ruling
Congress party, which faces elections
next year, not wanting the administration to be Held responsible for the epidemic, organised a major cover-up. The
NICD'S team, which reached Surat on
September 23, cut short its study trip,
ostensibly because the Surat administration refused to declare the city "plagueaffected". Only after the Union minister
for health, B Shankaranand, visited the
city on September 25 was Surat declared
plague-threatened".
The anti-plague operations were, in
fact, absurd; a majority of those who
fled the city were non-Gujarati migrants
from other states, while public notifications and campaign posters were in
English and Gujarati.
The city administration hesitantly
asked for assistance from paramilitary
forces and the Central government
rushed in a battalion of the Rapid
Action Force. This anti-riot battalion,
unused to playing guard, failed to prevent over 150 patients - including
23 who had tested positive - from
escaping.
To keep the death record low, the
administration juggled the figures. For
instance, on September 28 at 10.30 am,
health minister Naik said that the toll till
5 am had been 44. An hour later at the
Civil Hospital, briefing the visiting
Union deputy minister for health
C Silvera, doctors said that the toll stood
at 48. In fact, only those who had died in
the hospitals were being included in the
list of fatalities.
The Civil Hospital had deputed just
one micrc,biologist working overtime:
when Rashmiben Patel fainted of
exhaustion on September 29, the
administration refused to depute
another one, leading to inordinate delay
in the confirmation of cases.
Violating the provisions of the
Epidemic Control Act, some who died
of pneumonic plague were not cremated but buried hastily at the Haripura
and Ranadeva burial grounds. Experts
feel this unnecessarily ripens conditions
for an outbreak of bubonic plague.
Finally, the Gujarat government
had to depute S Bhanujan, secretary to
the government, and Gandhinagar's
health commissioner Sudhaben
Anchalia. Three areas were identified as
At the interstate bus terminus, Surat., plagued by panic and
cover-ups high-risk sectors. Armed with panchnamas (legal statement of intent), teams
broke open the houses of those who had
fled and fumigated them. Under the
provisions of the Nuisance Act (Bombay
Police Act, section 181 (A)), the administration was given the right to haul
plague-affected people to the hospitals,
'by force if necessary.
By then, supplies of textiles, potatoes and milk to other parts of the country had become suspect. A businessman
observed, "This damage is going to be
irrecoverable and will have a telling
effect in a month's time."
There are explanations galore for
the Beed epidemic. But how the more
virulent pneumonic form of the plague
popped up in Surat is still a matter of
bitter contention. Argument is divided:
while people like Shah feel that it piggybacked on the transient pop-a
from Beed, there are others who 21
that it was homegrown.
Says NICD's Dutta, "It is possz
some of the Beed victims migran
Surat. It is difficult to chart out the
of the disease because it is just ncv. I
ble to divine human migration '51
we have not been able to conc '
link the outbreak of the disease Lt
with that in Surat."
Naresh Thambe, a residen-
Yed Road area, who is original.
Jalgaon district in Maharashtra,
"Two days before Ganesh visarum.
of my relatives from Sholapur as
came to Surat and left after a 4-das
My cousin Baburam had been runm
high fever right since his arriva
after returning to his village, he died.
Soon after he left, my brother developed
similar symptoms and died 3 days
later."
Two other.families hailing from
south Maharashtra had had relatives
stricken with bubonic plague. One of
them, Shivajirao Mule, recalls that his
father returned from his native village
with a strange fever and cough. He died
on September 18.
Surat has a large Marathi popultion, some of it floating. Ganesh visarjan
is one Of their most important festivals.
Thousands from Maharashtra came to
Surat in early September to celebrate
with their richer cousins. Doctors suspect that when lakhs of people mingled
-go freely, several Surtis contracted the
baccilli.
kgain, during the same period, many
urtis may have visited their relatives in
Ilague-affected areas, or many fleeing
need may have reached Surat. Pointing
this direction is the fact that the first
people who died on September 19-20
Jiled from different regions of
Maharashtra.
Minister Naik, however, maintains
"iat "the recent floods choked the sew
and inundiated large areas. During
-his, lots of rats might have died. This
.0uld have led to the outbreak."
But this would presuppose the pres-
cne of bubonic plague in Surat, not the
ALready established pneumonic variety.
Ihah counters, "No case of bubonic
d in Surat. Even sus
gue was reporte
ted cases tested negative. There is no
.cason to believe that changes in the rat
k,pulation during or after the floods led
the outbreak."
It is another matter that Surat has
always held out a standing invitation to
Ac epidemic. Naik says, "On September
in a meeting of the senior health,
municipal and administration officials,
2rs of an epidemic outbreak were
oox;nded. An action plan was in the off
ox but those who thought that cholera,
93s.roenteritis or typhoid could break
OU! never even imagined that the plague
vw_--uld hit the city."
Balwant Singh, Surat's municipal
sarnmissioner, says, "The floods
,ught municipal activities to a stand
The river entered large areas
,ugh the sewers and flood windows.
,djuthorised colonies like Katargam
imbayat were under 10 feet of
water 5 days running. Because of the
rains, lifting the garbage was a problem,
and the following floods stopped our
operations for about 10 days."
Surat has been prospering since the
late '60s; riding its prosperity were the
thousands of immigrants and businessmen who poured in from the poorer
quarters of the country. Ghettos housing lakhs of job-seekers from
Saurashtra, Bihar, Orissa, Maharashtra,
Karnataka and Andhra Pradesh burgeoned - with no civic amenities at all.
Silk and diamonds kept the cash registers ringing.
The administration, happy with the
"growth", ignored the squalid jhuggijhonpri clusters. With the skyrocketing
demand for land, tree-felling became
rampant, pollution soared, sewers got
choked, and invariably, drains were
clogged with rotting animal carcasses.
The city could go to hell as long as the
money to keep the interiors of houses
glittering came in.
It is jarringly anachronistic that the
2 Indian states of Maharashtra and
Gujarat, with a joint investment to the
tune of Rs 8,000 crore in the past year
have failed miserably to fend off a civic
disaster like an epidemic. By the end
of the first week of October, the killer
epidemic had bloated to take in the
country.
States sharing borders with Gujarat
set up screening posts at all entry
points immediately after the alarurn
was sounded. Patients showing symptoms of pneumonic plague were either
hauled off without ceremony or explanation to hospitals or were simply
turned back.
Soon, the number of patients admitted in isolation wards of hospitals in
cities like Bombay, Baroda, Delhi,
Patna, Calcutta and Ahemedabad started going up and deaths began to be officially registered.
But 45 days after the epidemic
broke, a medical and bureaucratic
search is still on for "the most plausible
explanation". Shah, unimpressed by
the return to " near- normalcy", is not
willing to let his guard down. He says,
"It is a period to watch out for those
who fled the city and never took any
precautionary medicine. We are ready
for a repeat of what happened after
September 20."
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