Slum-dwellers dumped in tightly-packed towers with poor light and ventilation are susceptible to a higher rate of tuberculosis (TB), a new study commissioned by the Mumbai Metropolitan Region Development Authority’s Environment Improvement Society has revealed. In one such transit settlement in Govandi, the study found that every 10th person has TB.
The MMRDA study, carried out by Doctors For You (DFU) in 4,080 households in three low-income resettlement colonies in Govandi and Mankhurd (MEast ward), proves what housing activists and experts have warned: Mumbai’s development control rules (DCR) push the poor into sub-human existence under the guise of rehabilitation. Ward M-East has the worst health indices in the city, and is home to 10% of TB and 20% of drug-resistant TB cases in the city. While Mumbai has approximately 45,000 TB cases, DFY estimates that 5,500 TB patients live in this ward alone.
In Lallubhai compound, crammed with 36 buildings, and Natwar Parekh Compound (59 buildings) in Govandi, the study found that 8-10% of households had at least one TB patient. PMG Colony in Mankhurd with far fewer buildings (16) and a better layout reported just 1% of households with a TB patient.
The study underlines what is known: Poorly ventilated homes with little or no air circulation are breeding grounds for disease. In Mumbai, this medically-known fact was clearly disregarded while planning resettlements for project-affected people and slum-dwellers. City planners ruled that high-rises for resettlement could be constructed within just three metres of one another. This was done to accommodate more people, no matter the height of the building. In contrast, as per general building regulations, the distance between buildings 24 m (8 floors) in height should be at least 8 m. The change of rule for rehab buildings resulted in a lack of airflow path in living spaces, leading to poor indoor air quality, higher indoor temperature and poor hygiene.
Dr Ravikant Singh of DFY said many homes in these colonies don’t get direct sunlight. Even the noon sun was difficult to notice from homes on the ground and first floors. “We used gadgets to measure airflow within the buildings and found that the liveable area in most homes had inadequate air circulation,” Dr Singh said. Areas where people slept and ate had poorest airflow.
Nerges Mistry, director of Foundation for Medical Research, said poor architecture in slum rehab buildings (as well as health facilities) is a prime driver of transmission of drugsensitive and drug-resistant TB. “Historical evidence shows that improvement in housing was the prime reason for the decline in TB in the West. If India is serious about ending TB in the near future, this powerful approach of TB prevention… as well as reduction in indoor and outdoor pollution must be taken up on a war footing. Mere reliance on technology and drugs will not do,” she told TOI.
MMRDA commissioner UPS Madan admitted that planning norms under which rehab buildings are constructed need to be revisited in the light of these findings. “The recommendations made in this report will be submitted to the government for consideration,” he said.
The study, by a team of ten health experts headed by Dr Singh, found that the percentage of families with TB patients was greater where there were more members in the household. Thus, overcrowding in homes may be associated with the prevalence and spread of TB. The average family size in these tenements was found to be 5.3, which is higher than Mumbai’s average, 4.6. In 40% of households, there is at least one child below five years of age.
“In Lallubhai and Natwar Parekh colonies, most TB patients got infected after starting to live in the colony, indicating that the infection hotspot may be in the colony,” said the report. The house-to-house survey revealed a variety of problems affecting residents. Field visits and informal interviews revealed that both compounds were very filthy and were almost always waterlogged during the rains. The report said, “There was dirty water around the buildings, giving out foul smell, forcing residents to keep their windows shut. This was aggravated by that a large amount of garbage was thrown off windows by people on the upper floors, which accumulated on the narrow spaces between the buildings.”