viral outbreak

How to create a fever outbreak: Lessons from East Delhi

Almost every home in Rajiv Camp in the Jhilmil Industrial Area has at least one person with fever and chikungunya-like symptoms.

On Wednesday, Rani Sharma, 40, finally became sick from the deadly viral fever that has gripped the Jhilmil Industrial Area in East Delhi for the past month. Everyone else in her family had already had a spell of it. Over the previous weeks, Sharma had already taken several days of leave from the sticker factory at which she works to tend to her husband and her three grown-up children, aged between 17 and 20.

“My bosses cribbed about my leave and said I take a lot of leave," said Sharma. "But I really cannot go to work. I cannot sit, or stand, or lie down without hurting.”

Rajiv Camp, where Rani lives, is bursting with cases of this viral fever. “Knock any door, and you will find a sick person,” said Neelam Chaudhary, the Accredited Social Health Activist or ASHA for the area. There are about 500 families in the slum with a population of approximately 2,500, she said. She herself has been struck by fever and suffers severe body aches.

A few houses from Sharma lives Mustari Khatoon, 35, who lives with her three children aged 20, 18 and 8. When this correspondent went to their home, they were all lying on a cot and watching a movie on television. Asma, the 20-year old who works at a beauty parlour, said that she could not even sit up without her body aching. All of them had chikungunya-like symptoms.

Shabana Khatoon and her daughters suffer from fever and body pain. They were never tested for chikungunya. Photo: Menaka Rao.
Shabana Khatoon and her daughters suffer from fever and body pain. They were never tested for chikungunya. Photo: Menaka Rao.

The viral fever, which has seldom been confirmed as chikungunya among the patients at Rajiv Camp, is debilitating. “I have lived in Delhi for so many decades, but I have not seen a disease like this,” said 70-year-old Jasin Shaikh. His wife Gulshan Khatoon, who also has the fever symptoms, has now resorted to using a walking stick. Three other people in their family are ill.

Unnamed viral fever

The Delhi government and municipal authorities said that the city saw 412 chikungunya cases in the last week of August alone. This was around the time, people in Rajiv Camp started falling sick.

A total of 3,695 cases of chikungunya and 5,982 cases of dengue have been recorded so far in Delhi, the government claimed. Some cases of scrub typhus, a bacterial infection, which also have chikungunya-like symptoms have been recorded in the city. There are also scores of other people diagnosed with chikungunya-like symptoms with high fever for a few days, followed by rash and severe body pain and swelling of joints. There are other people with other kinds of viral fevers doing the rounds in the city, which are equally crippling. People complain of symptoms such as high fever, headache, body ache, cold, cough, among others, which seem to last for over a week sometimes.

“For dengue, we have good diagnostics," said Dr Abhay Chaudhary, the head of the microbiology department at JJ Hospital in Mumbai. "We can detect it even during the illness. However, for chikungunya, the tests are weak and the sensitivity is less.” This would essentially mean that very few fevers would be confirmed chikungunya.

The other viral fevers could be arboviral infections, caused by mosquitoes or ticks. “These viral fevers may not have anything to do with dengue or chikungunya, and could have unique manifestations, including neurological symptoms or encephalitis,” said Chaudhary. He admitted, that often they have no answers for the kind of fevers that are there in the community, especially those which cause sudden deaths.

In August, a fever outbreak in a Noida village killed 10 people. The authorities were not able to explain why those deaths took place, but blamed it on other underlying illnesses. In a similar incident, 12 people in Delhi died after being diagnosed with chikungunya, a disease not known to cause death. What is, however, common to all these outbreaks is the pathetic state of sanitation in areas where people who contracted fevers resided.

Neglect by civic authorities

Residents of the Jhilmil Industrial Area complain of neglect by civic authorities. Their houses are in narrow lines abutting a running open drain. There is a perpetual stench in the area. The big storage drums of water outside each house, apart from coolers, that serve as ideal breeding grounds for mosquitoes.

“Our area was fogged once,"said Murari Singh, referring to the practice of spraying mosquito repellents and larvicide that the Delhi government has undertaken to control mosquito populations this season. "I do not think it has had any impact.”

ASHA worker Neelam Chaudhary with Sukhba Devi who suffers from severe body ache. Photo: Menaka Rao.
ASHA worker Neelam Chaudhary with Sukhba Devi who suffers from severe body ache. Photo: Menaka Rao.

Chaudhary, the ASHA worker, said that she cleaned out three coolers and drums that were swarming with mosquitoes last week. On Friday, she had been distributing posters about mosquito prevention and treatment of dengue and chikungunya.

In a Facebook post, a women-based political organisation, Mehnatkash Mahila Sangathan, a non-profit that works on labour rights, calls out the ineffective measures taken by government authorities. The post also highlights the plight of health workers, three of whom died after high fever last month.

“Looking at the serious condition in the capital as well as in the whole country, it can be said that it is not going to subside only by calling for 'Protect yourself from mosquito bites', a few weeks every year,” said the post.

The organisation made representations seeking to improve the state of sanitation, and healthcare in the area to the state government, the civic body and the local MLA.

Inaccessible healthcare facilities 

There are two tertiary level hospitals near Rajiv camp – the Guru Tegh Bahadur Hospital and a polyclinic – as well as a mohalla clinic in the area. All these are at least two km to four km away from the colony. Not many people about the polyclinic or the mohalla clinic. The latter runs only between 9 am and 1 pm, which is inadequate to serve the needs of the large number of daily labourers who are free to visit a doctor only in the evening.

Healthcare facilities are visibly better at the nearby Dilshad Gardens, a more upmarket neighbourhood.

The lack of primary health care facilities has left very few options for Rajiv Camp residents. Many have visited quack doctors just to get pain relief. “I went to a jholachap nearby," said Sukhbai Devi, who was limping. "The government doctors do not listen to you. The medicine is very weak.”

A doctor without medical qualifications operating out of a slum in Jhilmil Industrial Area. Photo: Menaka Rao
A doctor without medical qualifications operating out of a slum in Jhilmil Industrial Area. Photo: Menaka Rao

Most government hospitals give patients complaining of fever a few doses of paracetamol. Though it is the recommended treatment protocol, it does little to relieve the pains of the Rajiv Camp residents, who stand to lose their daily wages if they do not go to work. That the government doctors did not listen, as people complained, doesn’t help.

Loss of wages

While the fact that ideal treatment is simply taking paracetamol thrice or four times a day, what does a person who wants to go back to work do?

“My sons simply pop pain killers and go to work. We cannot afford to sit at home,” said Shabana Khatoon, whose entire family of six was down with fever.

One of the labourers who attempted to go back to work with severe body pain met with an accident. “My husband who works as a mason fell from the first floor while working,” said Rita Devi. "Now he has stitches."

Devi's entire family of seven people, including her four daughters, and a son, had the same illness. She works in a factory and lost seven days' worth of wages as a result of the sickness.

Each visit to the doctors, including travel, costs at least Rs 200 to Rs 300. Most families have spent about Rs 2,000 to Rs 3,000 on the recent bout illness.

The medical camp organised by Mehnatkash Mahila Sanghatan where doctors spoke about the epidemic and distributed medicines. Photo: Menaka Rao.
The medical camp organised by Mehnatkash Mahila Sanghatan where doctors spoke about the epidemic and distributed medicines. Photo: Menaka Rao.

The government, public health experts feel, needs to do more to reduce the panic among residents.

“We need to be able to tell people that a large number of these cases are not serious, and there is no reason to panic,” said Dr Ritu Priya Mehrotra, from the department of Community Medicine at Jawaharlal Nehru University in Delhi. “Only vulnerable people like the elderly, pregnant women, and children need to be careful. They need to be told that its best to take paracetamol and not any painkillers.”

Mehrotra said that the government may need to do more than spreading messages via radio, television and posters.

“The government needs to have people on the ground who can talk about the epidemic directly to the community," said Mehrotra. "They need to talk about what they are doing about it. The people will then feel that it is tallying with their experience. That will help keep the panic down,” she added.

Epidemic control

Although the government is disseminating information on mosquito control, action may not be feasible. “Once there is an outbreak, the options to control it are limited," said Amit Sengupta from the public health non-profit organisation Jan Swasthya Abhiyaan. "There is not much anyone can do apart from treating patients.”

Health surveillance helps predict an outbreak of this sort. “There has to be disease outbreak sentinel which will identify areas where people need to be screened. This can help anticipate outbreaks of this kind and help control them,” said Sengupta

As this Indian Journal of Medical Ethics article written in response to the 2006-2007 chikungunya epidemic in South India, says, "Health depends, at the barest minimum, on access to adequate food, sufficient safe water, housing and sanitation. The provision of these basic requirements dramatically brought down the occurrence of communicable diseases in the West, long before modern vaccines or antibiotics were discovered. We should address these foundations of public health while we create public health foundations. “

In the context of disease outbreak, urban planning again stands out for its failure. “Delhi is a bad example of city planning. All the poor in the city have been moved out into ghettoes,” said Sengupta. Indeed, just a few kilometers away from Jhilmil Industrial Area are gated communities with paved streets and good sanitation facilities.

“In such a situation, there is no one left to speak up for the poor," said Sengupta. "It is a case of out of sight, out of mind.”

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Swara Bhasker: Sharp objects has to be on the radar of every woman who is tired of being “nice”

The actress weighs in on what she loves about the show.

This article has been written by award-winning actor Swara Bhasker.

All women growing up in India, South Asia, or anywhere in the world frankly; will remember in some form or the other that gentle girlhood admonishing, “Nice girls don’t do that.” I kept recalling that gently reasoned reproach as I watched Sharp Objects (you can catch it on Hotstar Premium). Adapted from the author of Gone Girl, Gillian Flynn’s debut novel Sharp Objects has been directed by Jean-Marc Vallée, who has my heart since he gave us Big Little Lies. It stars the multiple-Oscar nominee Amy Adams, who delivers a searing performance as Camille Preaker; and Patricia Clarkson, who is magnetic as the dominating and dark Adora Crellin. As an actress myself, it felt great to watch a show driven by its female performers.

The series is woven around a troubled, alcohol-dependent, self-harming, female journalist Camille (single and in her thirties incidentally) who returns to the small town of her birth and childhood, Wind Gap, Missouri, to report on two similarly gruesome murders of teenage girls. While the series is a murder mystery, it equally delves into the psychology, not just of the principal characters, but also of the town, and thus a culture as a whole.

There is a lot that impresses in Sharp Objects — the manner in which the storytelling gently unwraps a plot that is dark, disturbing and shocking, the stellar and crafty control that Jean-Marc Vallée exercises on his narrative, the cinematography that is fluid and still manages to suggest that something sinister lurks within Wind Gap, the editing which keeps this narrative languid yet sharp and consistently evokes a haunting sensation.

Sharp Objects is also liberating (apart from its positive performance on Bechdel parameters) as content — for female actors and for audiences in giving us female centric and female driven shows that do not bear the burden of providing either role-models or even uplifting messages. 

Instead, it presents a world where women are dangerous and dysfunctional but very real — a world where women are neither pure victims, nor pure aggressors. A world where they occupy the grey areas, complex and contradictory as agents in a power play, in which they control some reigns too.

But to me personally, and perhaps to many young women viewers across the world, what makes Sharp Objects particularly impactful, perhaps almost poignant, is the manner in which it unravels the whole idea, the culture, the entire psychology of that childhood admonishment “Nice girls don’t do that.” Sharp Objects explores the sinister and dark possibilities of what the corollary of that thinking could be.

“Nice girls don’t do that.”

“Who does?”

“Bad girls.”

“So I’m a bad girl.”

“You shouldn’t be a bad girl.”

“Why not?”

“Bad girls get in trouble.”

“What trouble? What happens to bad girls?”

“Bad things.”

“What bad things?”

“Very bad things.”

“How bad?”

“Terrible!!!”

“Like what?”

“Like….”

A point the show makes early on is that both the victims of the introductory brutal murders were not your typically nice girly-girls. Camille, the traumatised protagonist carrying a burden from her past was herself not a nice girl. Amma, her deceptive half-sister manipulates the nice girl act to defy her controlling mother. But perhaps the most incisive critique on the whole ‘Be a nice girl’ culture, in fact the whole ‘nice’ culture — nice folks, nice manners, nice homes, nice towns — comes in the form of Adora’s character and the manner in which beneath the whole veneer of nice, a whole town is complicit in damning secrets and not-so-nice acts. At one point early on in the show, Adora tells her firstborn Camille, with whom she has a strained relationship (to put it mildly), “I just want things to be nice with us but maybe I don’t know how..” Interestingly it is this very notion of ‘nice’ that becomes the most oppressive and deceptive experience of young Camille, and later Amma’s growing years.

This ‘Culture of Nice’ is in fact the pervasive ‘Culture of Silence’ that women all over the world, particularly in India, are all too familiar with. 

It takes different forms, but always towards the same goal — to silence the not-so-nice details of what the experiences; sometimes intimate experiences of women might be. This Culture of Silence is propagated from the child’s earliest experience of being parented by society in general. Amongst the values that girls receive in our early years — apart from those of being obedient, dutiful, respectful, homely — we also receive the twin headed Chimera in the form of shame and guilt.

“Have some shame!”

“Oh for shame!”

“Shameless!”

“Shameful!”

“Ashamed.”

“Do not bring shame upon…”

Different phrases in different languages, but always with the same implication. Shameful things happen to girls who are not nice and that brings ‘shame’ on the family or everyone associated with the girl. And nice folks do not talk about these things. Nice folks go on as if nothing has happened.

It is this culture of silence that women across the world today, are calling out in many different ways. Whether it is the #MeToo movement or a show like Sharp Objects; or on a lighter and happier note, even a film like Veere Di Wedding punctures this culture of silence, quite simply by refusing to be silenced and saying the not-nice things, or depicting the so called ‘unspeakable’ things that could happen to girls. By talking about the unspeakable, you rob it of the power to shame you; you disallow the ‘Culture of Nice’ to erase your experience. You stand up for yourself and you build your own identity.

And this to me is the most liberating aspect of being an actor, and even just a girl at a time when shows like Sharp Objects and Big Little Lies (another great show on Hotstar Premium), and films like Veere Di Wedding and Anaarkali Of Aarah are being made.

The next time I hear someone say, “Nice girls don’t do that!”, I know what I’m going to say — I don’t give a shit about nice. I’m just a girl! And that’s okay!

Swara is a an award winning actor of the Hindi film industry. Her last few films, including Veere Di Wedding, Anaarkali of Aaraah and Nil Battey Sannata have earned her both critical and commercial success. Swara is an occasional writer of articles and opinion pieces. The occasions are frequent :).

Watch the trailer of Sharp Objects here:

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This article was published by the Scroll marketing team with Swara Bhasker on behalf of Hotstar Premium and not by the Scroll editorial team.