First visit to KEM

Amidst the slowdown, I am reminded of my first visit to KEM Hospital – one of the oldest and largest public hospitals in Mumbai run by the municipal corporation. A senior friend had developed serious complications and had to be admitted to the ICU section. The photos below are from December 2018.

There are talks currently of supporting the government, to not be critical, that no government could handle such a situation, that citizens are not doing their bit, that the poor and uneducated should follow rules.

The below commentary is for the well fed citizenry making this commentary. I am not interested in bring critical of Modi or of the government. I have better things to do than waste my time with them. But this is just to provide perspective for those who are saying that the government cannot do anything in such situations. The time to add more ICU beds and ventilators and testing capacity is during non-epidemic times when the temple is the priority.

The conditions in the ICU section were heart rendering. To imagine that the doctors go through this every single day left me sympathising.

There were a total of 15 (yes 15) ICU beds and there was a steady stream of patients pouring in. It was about 9pm that we had reached and in a poorly lit corridor I could see patients being stabilised on the floor of the corridor, on beds, in arms. Through influence of his family members my friend was able to jump the queue and be provided with a bed but not without final mile challenges in that corridor.

Poor families crowded the corridor, everyone of them shouting out for doctors to attend to their family member, at times pulling at a doctor who was already attending to someone else, leading to heated exchanges and security having to step in.

I could realise that some of those brought in would possibly be taking their last breath on the floor of the corridor awaiting help.

In the reception a large portrait of the founder of Shiv Sena the Late Bal Thackeray and his wife adorned. The political party he founded, Shiv Sena has been in control of the Mumbai municipal corporation since 1995 and under whom this public hospital comes. They and other Hindu right wing party BJP have been in coalition since till only recently.

Outside the hospital were political banners where more pressing were attended to – the Shiv Sena putting the BJP on the mat over the Ram Mandir issue and posturing that they were not hungry for power but deeply felt for an early construction of the temple over their coalition with the BJP.

That coalition had till then been in the saddle for three years at the State government level and 20 years in the municipal corporation running the KEM Hospital. And they could not bring the ICU bed tally to a respectable 100 also. Pehle Mandir, phir sarkar. First temple, then government. ICU beds and adequate ventilators would be way bottom in the list.

Inside patients gasped, doctors overstretched. Overstretched seems mild to describe. I am not sure how they could they be having the frame of mind to make an accurate diagnosis and then administer the right course of action. But miraculously they were. During my short visit (Over following 2-3 days) I could see happy recovering patients in the ICU section including my friend.

The hygiene levels were alarming and a health crisis on their own. Toilet facilities inadequate and repulsive.

The ICU bed equipment had paan spit at the bottom. Though air conditioned, I was not sure of the air quality.

After a few days my friend was shifted to the general ward. That was another experience all together.

The architecture and campuses and the very idea of having so much space in a central part of the city devoted for an essential public service makes me happy.

The highlight of the general ward really was one of the toilets. I could just take the photo from the outside for this particular toilet. Inside on the left the condition of the toilet was beyond nauseating. It just left me without any sensation.

I am used to take photos of garbage and bad sanitary conditions but I have never seen anything like that. It was like somebody had taken a spray gun and filled its container with excreta and just sprayed the whole toilet finely with the shit. The shit was all over. People must have come in a state of diarrhea or desperation and just shat on previous piles of shit and whenever they could make place. This was a government toilet facility of a government running Swachh Bharat Abhiyan.

Air quality on day of Janta Curfew

The biggest impact of the Janta Curfew in my opinion may be in demonstrating to the average Mumbaikar and policy makers and media the efficacy of forcibly shutting down the city (read cars on roads) on days of severe air pollution.

In a television debate a month back on ET Now, which was in response to an exceptionally bad AQI over a few days in Mumbai I had raised a number of important points along with the other panelists. One of the most important was at the end asking for a Graded Response Action Plan being rolled out ASAP to counter such events.

At 12:20 I comment on the terrible coast road project.

17:15 onwards on whether Metro will solve the problem and about Climate Change

What is GRAP? It is a series of decisions to be taken based on the severity of the AQI. Read this article from Delhi where this measure has been first initiated.

In context of Mumbai the first such response would be a radical curtailment of vehicles on the roads on days of bad AQI, thus effectively calling for a partial or total shutdown. This would not hurt the economy as much as it would be made out to be and would not halt the movement of trains and buses. The bottom of the pyramid which has been most impacted during the corona crisis would be least affected in this case since they anyways do not use cars. Those affected would be individuals who only travel by cars and that segment can sit home and relax as they are doing now. And not be impacted financially in anyways.

Why should it require a virus to understand such a point?

Janta curfew adds to the evidence that the economy and the people are so much better off with severe curbs on private vehicles, which are a few peoples convenience and everyone’s (including those few) inconvenience.

Bad AQI in Mumbai is invariably the result of atmospheric conditions. The sum total of emissions spewed out by the 2.5 million odd vehicles on Mumbai’s roads remains a constant on any given day. Whether the emissions will result in bad AQI is a function of temperature, wind, humidity and other such factors.

Beyond the complex details, there are days when the atmospheric conditions support the flushing out of these toxic emissions and there are other days when the atmospheric conditions do not support the flushing out and instead allow the emissions to accumulate over the city thus exposing the whole population to a very deadly cocktail of pollutants.

It is for days like this that a Graded Response Action Plan needs to roll out as per a pre-decided drill which is known to every citizen and agreed upon. The foremost of these measures would be a radical curb on private motorized transport, the number one cause of emissions in the city. What is my data source for this claim? How do I validate? A day like Janta Curfew helps make the point without having to be burdened with counter arguments asking one to validate claims. The same city that sees unsatisfactory to poor range most times saw crisp air quality. The only difference was no vehicles on the roads. I can pull in a lot of data from existing studies but the idea is to keep it simple and common sense.

AQI on 22.03.2020, day of Janta curfew

Atmospheric scientists know with a fair deal of accuracy in advance about days when the conditions will not be viable for a flushing out. It is the role of the policy makers lead by the Mayor and the Municipal Commissioner, which needs to make advance announcement of days when there would be severe curbs on movement of cars on the roads.

https://www.windy.com/-Embed-widget-on-page/widgets?19.119,72.924,11

If impact on the economy is a fear then those days which coincide with a Sunday or close about can easily be considered. There are easily 10 days during the winter when the severity is enough to classify the impact as a severe health risk. A GRAP determined forced shutdown would make a radical difference on those 10 days and give enormous relief to vulnerable segments.

And we do not need much resources to control cars on the roads. Singapore and London have done it all with the considerable support from Indian IT companies. You need ERP gantries on all important junctions and every car which crossed those on the red listed days would be charged Rs. 1000 per crossing or something like that. There are enough in the city for whom that is loose change and instead of that loose change going to alcohol companies and lifestyle it will be made available for a dedicated transport fund which would invest in public transport and overcoming deficits.

How serious is the problem of air pollution for Mumbai?

That question should not need an answer. Other panelists Bhagwan Kesbhat and Vivek Chattopadhyay very well explained but the answer has been available for more than two decades. I am reminded of the Vinay Mohan Lal Committee more than two decades back and the number of measures taken and suggested. Since then a huge growth in vehicles, increased size of the city and an enormous increase in the number of kilometers traveled per day has wiped out and over ridden any gains.

Poor air quality impacts everybody and is a clear and present danger at all times unlike corona situation which is a once in a while passing storm. I have been calling the panic around corona a tamasha. If public health really was of concern then the public and the authorities acting on their behalf would have been doing so much more on real issues which matter. The mortality from poor air quality or more importantly DALY is far more serious an issue.

But GRAP is not enough.

The overall thinking and planning carried out by the government institutions which govern the city makes a difference. MMRDA and MCGM are the two cash rich city bodies which do two things, make policy and spend money. In both these aspects they have taken the worst kind of decisions over the past two decades. Decisions which have only lead to more motorised transport and result in poor AQI, which in turn necessitates GRAP. These are issues which have been discussed threadbare by numerous planners, policy makers and activists over the years. Everyone of them has warned of the consequences of the misdirected thinking of those who govern. Whether the decline of support to the public bus service or investments in projects like the coastal road or absence of UMTA and parking policy and much more.

At moments like the corona virus the Municipal Commissioner is seen and portrayed as a hero by the media. Any questioning at such a point would be (and would be seen as) inappropriate. But I don’t see any such discussions in non-crisis which holds decision makers accountable. Who will analyse the decisions taken over the past two decades? Bureaucrats and Mayors are unapproachable and consider themselves above panelists who appear and contribute for discussions.

The public on its part is a herd by now with little knowledge and inclination. The average educated elite persons political discourse, its vocabulary and syllabus is so limited as to make it impossible to engage them on such issues. They can only bang utensils (or be critical of such measures) and clap for the services of those who address the symptoms and are clueless about those who go after the underlying malaise. And they hold their views with fervour and self-righteousness. The political and administrative class couldn’t be happier.

Essential services?

People only understand post facto measures as essential. Doctors and nurses attending to patients. I would argue that the work I and my limited ilk does is far more essential and important but it goes poorly appreciated and rewarded. A lung physician at a top hospital in the city will rake in crores as income dealing with the problem and have properties and investments but as an activist dealing with preventing the problem I can never be sure of being able to pay myself a stable salary or run my small NGO or salaries of staff, far less own multiple properties as investments.

In 2015 I had written a blog called Equal Budgets for Equal Streets, which was then carried as an article in Times of India, Mumbai Edition. The article was in the context of the Equal Streets event (for which I was one of the early contributor and organiser)

Article in Time of India, December 2014

Urban transport policy has been an integral part of my efforts as an activist over the same past two decades. But that is not the only area of involvement intricately linked with air quality. My successful efforts at saving large tracts of mangrove forests beginning from my immediate neighborhood in the beginning of the last decade was pivoted on the argument of better air quality and flood mitigation.

Then there is the issue of solid waste management. The city has been following a ruinous model of pick and dump soaked in corruption and malpractices. The garbage burns on the dumps and millions of litres of diesel is burnt annually to transport all that waste. Again enormous contributions by some of us but the same Municipal Commissioners (office not individual) who are seen as heroes in such crises take all the wrong decisions and insidiously and invisibly cause slow damage over a decade.

Now on cars

Cars are drawing away the essential vitality of our urban areas. Any arguments to curb their use are seen as anti-development and Luddite in India. All while the world is moving ahead. Instead of designing a next generation of cities we are neither here nor there. Cars are private goods whose profits go to a few while the negative effects are borne by everyone. Those negative effects need to be priced just like one would fine spitting or urinating in public. Road space is a public space owned by everyone and anyone who uses more of it should more for it. Parking policy is scoffed at but people cannot be taking up public space without paying for it. Similarly cars in motion are causing congestion and air pollution and need to be fined for it. In the past few days BEST – the public bus service has seen a rapid improvement in its turnaround time because there is less traffic. If a bus can turn around in 30 mins rather than 60 mins it can do two rounds and transport twice the number of people. We need more people transported per hour not cars.

Cars and air pollution are bigger dangers than corona virus. Hope the Prime Minister and the Chief Minister will be looking into this post the corona storm.