A Plague On All Surats

This is one of those books that scream: "It could happen to anyone (in India)." Ghanshyam Shah does a post-mortem of the plague epidemic in Surat in September-October 1994. There is nothing devastatingly new here. It puts together everything that everyone has always known about the status of public health in India and documents the mechanisms put in place to cope with the epidemic in Surat. Meanwhile the big question persists: Was it really the plague? And if it was, was it perhaps only a very mild strain? Wouldnt the damage have been much worse otherwise?

Gastroenteritis, infectious hepatitis, malaria and dengue take their toll in India each year. But the plague was a different matter altogether. It made a statement about conditions here, and the disease itself could travel across the globe to kindle destruction everywhere.

 

The descriptions of the city of Surat sewage lines mixing with storm water drainage lines, the penury of the diamond cutters and mill workers whose numbers have been increasing steadily, the squalor in their lives as they cram into the little spaces available to them -- could be that of any city. There is luxury too; Surat has the largest per capita ownership of cars in the country.

Health statistics available for the city (before and after the plague) leaves much to be desired. The reason is not hard to seek -- few people would visit a government hospital. The hospitals are themselves severely wanting in the punctiliousness demanded of record-keeping.

Shah builds the pitch to a crescendo -- the first suspected cases of plague, the deaths and the high drama to follow. The government hospital doctors meet to look up the symptoms of plague, the initial vague suspicion backed by caution in handling of patients... and then, word spreads. The symptoms are there for all to see -- fever, vomiting, breathlessness. Noisy ambulances move about the city. For every one person who died, ten are rumoured to have died. There is an exodus of general practitioners in the vicinity of the government hospital. Word spreads that the municipal water supply has been poisoned. Some believe it is Allah's revenge for the communal violence in the city in 1992. Local newspapers relate with relish gory details of plague deaths in the past.

The events enter the realm of the farcical. As the government moves in, the world watches. India is quarantined. Indians are not free to travel. Ministers fly in to assess the situation. A nervous Ficci and Assocham tell the world that this should not affect business. India is well-equipped to handle the situation, says the government. Foreign assistance to study and quell the epidemic are turned down. Speculations abound -- is it a ploy of Pakistan's ISI? Is there a US hand, an attempt at germ warfare?

Ten days after the first death of suspected plague, 33 per cent of the families have deserted Surat. Though the health infrastructure is ill-equipped, the 30 per cent doctors staying back in the city try to do their best. Prophylactic medicines, though scarce, are handed out and cleaning up operations taken up on a war footing.

There was still a large section in Surat, though, with no access to the media, who had only vague notions of what was happening. It was the densely populated areas of Surat that were most affected, where the population had increased eight-fold between 1971 and 1991. The middle social strata was worst hit; the slums escaped.

By the time the epidemic was controlled, the centre was pushing forward to take credit for having quelled the epidemic.

Surat was lucky. And today, INTACH has ranked it the second cleanest city in India, following Chandigarh. But it took a plague to get systems in place. In other cities, as the initial panic waned, so did efforts to clean up. The author rues that the British did not put in place sufficient sanitary systems; that while they forced it down their own countrymen in the last century, they succumbed to local resistance in this country. But why blame the British or orientalist mindsets? Has self-rule done anything better for us?It took a plague to get systems in place. In other cities, as the initial panic waned, so did efforts to clean up.Public Health and Urban Development

Ghanshyam Shah Sage Publications Rs 395/317 pages