On every trip I took over the past 30 years or so, I always requested – sometimes demanded – patient home visits.
Often times our partner hospitals would push back and question why these home visits were necessary. Many of our surgeons would ask why it mattered where the patients lived. I am sure it was a pain in the neck for them so I can understand their resistance.
But I always insisted.
To be honest, I always enjoyed patient home visits much more than the hospital visits. At the end of the day the hospitals pretty much all look alike. But boy, our patient homes couldn’t be more different
I’ve visited patients that lived in caves, huts made out of sticks, houses made out of cow dung, shacks made out of aluminum, 20 -foot fishing boats turned into homes, tattered tents, round houses made out of dirt with thatched roofs, floating houses tethered to bamboo sticks, you name it.
One of the most memorable patient home visits I ever went on was in the largest slum in Asia, the Dharavi slum, which was featured in the Oscar movie Slumdog Millionaire.
More than a million poor people live here in one of the world’s poorest and most densely packed areas – 869,565 people per square mile. That’s almost 40 times denser than New York City which has a population density is 26,456 per square mile.
With a literacy rate of 69%, Dharavi is the most literate slum in India.
About 30% of the population is Muslim, compared to 13% average population of Muslims in India. The Christian population is estimated to be about 6%, while the rest are predominantly Hindus (63%), with some Buddhists and other minority religions.
Among the Hindus, about 20% work on animal skin production, tanneries and leather goods. Other Hindus specialize in pottery work, textile goods manufacturing, retail and trade, distilleries and other caste professions – all of these as small-scale household operations.
The slum residents are from all over India, people who migrated from rural regions of many different states. The slum has numerous mosques, temples and churches to serve people of Islam, Hindu and Christian faiths; with Badi Masjid, a mosque, as the oldest religious structure in Dharavi.
Dharavi has a GNP has a very large and active informal economy with a GNP of more than $1 billion. Estimates of income per capita per year range from $500 – $2,000. ($1.36 – $5.47 per day.)
In addition to the traditional pottery and textile industries in Dharavi, there is an increasingly large recycling industry, processing recyclable waste from other parts of Mumbai.
Recycling in Dharavi employs approximately 250,000 people. While recycling is a major industry in the neighborhood, it is also reported to be a source of heavy pollution in the area.
There are around 5,000 businesses and 15,000 single-room factories. And believe it or not, workers actually commute to Dharavi for their jobs. Have you ever heard of anyone commuting to a slum to work before?! Two major suburban railways feed into Dharavi, making it an important commuting station for people in the area going to and from work.
Dharavi exports goods around the world. Often these consist of various leather products, jewelry, various accessories, and textiles. Markets for Dharavi’s goods include stores in the United States, Europe, and the Middle East.
Dharavi has severe problems with public health. Water access derives from public standpipes stationed throughout the slum. Additionally, with the limited lavatories they have, they are extremely filthy and broken down to the point of being unsafe.
Mahim Creek is a local river that is widely used by local residents for urination and defecation causing the spread of contagious diseases. The open sewers in the city drain to the creek causing a spike in water pollutants, septic conditions, and foul odors.
Due to the air pollutants, diseases such as lung cancer, tuberculosis, and asthma are common among residents. There are government proposals in regard to improving Dharavi’s sanitation issues. The residents have a section where they wash their clothes in water that people defecate in. This spreads the amount of disease as doctors have to deal with over 4,000 cases of typhoid a day. There is also an average of 1 toilet per 500 people.
Dharavi has experienced a long history of epidemics and natural disasters, sometimes with significant loss of lives. The first plague to devastate Dharavi, along with other settlements of Mumbai happened in 1896, when nearly half of the population died.
A series of plagues and other epidemics continued to affect Dharavi, and Mumbai in general, for the next 25 years, with high rates of mortality. Dysentery epidemics have been common throughout the years and explained by the high population density of Dharavi.
Other reported epidemics include typhoid, cholera, leprosy, amoebiasis and polio. For example, in 1986, a cholera epidemic was reported, where most patients were children of Dharavi. Typical patients to arrive in hospitals were in late and critical care condition, and the mortality rates were abnormally high. In recent years, cases of drug resistant tuberculosis have been reported in Dharavi.
Fires and other disasters are common. In January 2013, a fire destroyed many slum properties and caused injuries. In 2005, massive floods caused deaths and extensive property damage.
“From the main road leading through Dharavi, the place makes a desperate impression. However, once having entered the narrow lanes Dharavi proves that the prejudice of slums as dirty, underdeveloped, and criminal places does not fit real living conditions. Sure, communal sanitation blocks that are mostly in a miserable condition and overcrowded space do not comfort the living. Inside the huts, it is, however, very clean, and some huts share some elements of beauty. Nice curtains at the windows and balconies covered by flowers and plants indicate that people try to arrange their homes as cozy and comfortable as possible.” — Denis Gruber (2005)
