Learned Societies Conference 1995, south asia council meeting

Christine Furedy, Urban Studies, Calumet College, York University

INTRODUCTION

On the other hand, historians of plague outbreaks have pointed to silver linings. A major sub-theme in analyses of plague outbreaks has been the possibility of there being positive outcomes (in spite of controversies over their attainment) upon health, sanitation, city planning, and health administration. This point has been made with reference to the epidemics in Europe and Russia, in Sydney in 1900, the pneumonic plague in Manchuria in 1910, and the epidemics in India, particularly in Bombay and Calcutta between 1896 and 1912 ²-(Alexander 1980; Curson & McCracken 1988; Nathan 1967; Arnold 1993; Catanach 1993; Seal 1987).

Accepting that the disease outbreak in Surat in September 1994 was indeed pneumonic plague, in light of past history it is not surprising that the reactions were stronger than subsequently seemed warranted by the number of deaths. It has been estimated that India lost over $1 billion in export earnings, and 40-60% of its anticipated tourism (Steinberg 1995). Several million people lost income when they were unable to work, locally or internationally; many more millions suffered panic, fear or dislocation. Thousands of squatters had their dwellings inspected and condemned. As a nation, India found its modernity, its efficiency, its health administration and local governance called into question.

Will the 1994 plague scare have positive impacts for Indian cities? This paper is not a comprehensive discussion of the impacts of the plague scare but raises the question specifically in relation to solid waste management and examines the immediate reaction to the plague outbreak (expressed in print media, September-November 1994) and the later response of government and the voluntary sector (January-April 1995) to charges that poor waste management was an important factor for both public risk and public fear.

PLAGUE AND CITY CLEANLINESS

Although the precise pathways by which the bubonic form of the disease struck down humans were not known until after 1900, and although even today we cannot assert that there is a direct relation between dirt and plague [except in so far as dirt encourages populations of rats and fleas (Alexander 1980, Catanach 1995)] the disease has always been associated with crowded living conditions (especially houses of wood, thatch and mud and wattle) and accumulated filth (cf. Appendix I).³

Practical efforts to combat plague have always included frenzied efforts to clean up, and in later times to disinfect, sewers, drains, cesspits, and garbage piles. Hence the town "scourings" of late medieval Europe. Rat patrols have sought out places of rodent harbourage. Demolitions have been ordered of buildings lacking sanitation and surrounded by uncollected waste, this often encompassing whole city blocks. Substances believed to be disinfectants and later rodent and insect poisons have been massively applied to suspect areas, and even to people. These operations have necessitated the appointment of special corps of "scavengers" (i.e. city cleaners), rat catchers and inspectors, even when the military were called in to inspect, to quarantine and to control.

The cleansing operations in Sydney in 1900 revealed the shocking conditions in parts of the city, with crowded, dilapidated buildings, lack of disposal of human excreta and accumulations of garbage and filth. Curson and McCracken conclude that combatting the plague formed a "watershed in Australia's social and epidemiological development," bringing important changes in public health, a greater appreciation of sanitation and housing and a "rediscovery¹¹ of the urban poor, as well as advances in disease control (Curson & McCracken 1988, p. 193).

The Plague Prevention Service created to combat the pneumonic plague epidemic in Manchuria in 1911 is regarded as China's first attempt to create a public health service based on modern medical principles, contributing to the advance of medicine and to modernization. (Nathan 1967, p. 78). Earlier, in the late 18th Century, the severe epidemic in Moscow contributed to the evolution of Russia's public health institutions (Alexander 1980, p. 301).

Discussing the socio-medical impact of the plague which began in 1896 in India, Arnold, who emphasizes the opposition of Indians to the plague measures and the immediate reaction against western medicine, nevertheless sees the period as a turning point, a "necessary rite of passage for western medicine in India," after which the importance of India working out its own "sanitary salvation" with people's co­operation was emphasized by government officers (Arnold 1993 pp. 237-239). Catanach points out that the creation of improvement trusts in Bombay and Calcutta were direct consequences of the appearance of plague and fear of it (Catanach, 1993, p. 220).*

While the structures of public health that evolved after epidemics were lasting, however, the awareness of waste problems and the resolve to deal with them through good urban services and public co-operation in most cases were not consistently sustained. Is this to be the situation in India in the late 20th century?

SURAT 1994—THE REACTION: MEDIA COVERAGE AND HIGHLIGHTING OF URBAN ISSUES, SEPTEMBER-NOVEMBER

While media coverage during the plague scare focused on explaining pneumonic plague and tracking suspected or actual cases of disease, there was constant reference to the condition of Surat as a causal factor. Surat was referred to as the dirtiest city in India, the richness of its diamond-cutting industries being contrasted with uncollected garbage in squatter and slum areas (Shah 1994; Stackhouse 1994). Referring to 1000 tonnes of garbage left each day, Dr. Bisharoop Das, of the Centre for Social Studies of South Gujarat University, was quoted as saying, "If plague had to break out, Surat was the perfect place for it." (Associated Press, Dec. 3). There was all-round criticism of the local authorities as complacent or negligent (cf. Statesman 25 Sept.; Times of India 25 Sept.; Hindustan Times 29 Sept.; India Today 15 Oct.). The Economic Times titled its emphatic editorial critical of Surat, "Fiefdoms in squalor."

Soon the scope of discussion broadened to more general comments on the administration of urban services and public health administration (Qadeer et al. 1994; Swami 1994; Karat 1994). That the plague outbreak demonstrated India's failure to address the basic needs of growing cities, while pursuing many forms of modernization was a major theme of international commenters. The editorial in Lancet of 15th October, for instance, said:

Plague is more than a biological disease. It is a symptom of a more cruel social disease— poverty... There is no vaccine that will protect against poverty.

The point was made in various ways in newspapers and magazines such as The Times, The Washington Post, Time, Newsweek, The Economist, Nature, The Far Eastern Economic Review, and so on. In the survey of India in January 1995, The Economist wrote: "India's most visible failure over health is filth" (Economist Jan. 21 1995).

But the most detailed exposes relating to waste management in India prompted by the plague came from Indian magazines. Principal among them was India Today. The long feature article with emphatic photos by Subramanian "Our filthy cities: can we clean the mess?" in the 31 Oct. issue reached a large readership in India and abroad and has been since cited by international magazines such as The Economist. Subramanian argued that:

Explaining the health hazards of poor waste management, the article supplied statistics on sanitation and garbage services in the major cities, with emphasis on the amounts of garbage uncollected every day by municipal services. The main cities were ranked according to "which city is the filthiest?" India Today was severely critical of the limited outlooks of the Ministries of Urban Development, Health and Non-conventional Energy Sources and outlined multiple factors contributing to inefficient waste collection and disposal.

Detailing the major efforts to clear away garbage and filth during the plague scare (the New Delhi Municipal Corporation for instance said it had removed up to 7,000 tonnes of garbage daily compared with the usual 3,880 tonnes) the article said the emergency plague clean-ups were a shocking indication of what could be done under emergency conditions. In an attempt to bring hope to an apparently desperate situation, reference was made to citizens' organizations for community participation and education in waste management (Subraraanian 1994).

Less detailed references to urban conditions were made by, for instance, the environmental magazine Down to Earth. In the leader "Mystifying the plague," decrying the conditions in Indian cities, the magazine criticized not only local government leaders but the pattern of industrial development whereby large cities were encouraged to grow without attention to the basic needs of the urban populations.

It was a notable aspect of reporting on the plague scare that garbage was used as the predominant symbol of poor urban environment. Apart from photos of frightened, masked citizens the most common images used to illustrate plague stories were those of garbage piles or garbage clean-up. The Washington Post began its October 1 report thus:

Before the pneumonic plague and accompanying panic struck India this week, 44-year-old Nasrima seldom saw a garbage truck.

In her Bombay slum neighbourhood of Bychulla, heaps of fetid trash and human waste line streets and rats scarcely wait for her family to finish a meal before they scurry out of dark corners for the crumbs. "We live and die amid the garbage, " said Nasrima, "everybody is always afraid of disease here."

Watching the city garbage crew that ventured into Bychulla today as part of the biggest cleanup effort in recent Bombay history, she asked: "Where were they before?"

As the economic consequences of the flight of a third of Surat's population, the closure of schools and cinemas in Delhi, the boycott of transport from India in the Middle East, and the cancellation of tourists' plans became apparent, there was more emphasis on the price that India would pay if cities could not be rehabilitated. As India Today put it briefly in the Comment section of 15 October: "Nobody wants to invest in the middle ages."

The Economic and Political Weekly published the first attempt to explain the wider context of the plague outbreak and its implications. In an article entitled "Contextualizing plague: a reconstruction and an analysis," three faculty members in Social Medicine and Community Health at Jawaharlal Nehru University argued that a serious decline of public health funding and facilities in India resulted from cutbacks under structural adjustment. They pointed to aspects of the history of public health administration (with emphasis on technology, population planning, privatization, inadequacy of medical education, poor prioritizing), the growth of large urban areas with industrial concentration, and the weakness of municipal government as important for understanding increasing failures to deal with various epidemic diseases effectively. Their concluding sentence — "The real challenge for public health at this juncture is to rise above the garbage."— clearly had a double entendre, as they had criticized the clean-up campaigns as being too focused simply on garbage and not able to see epidemics as a result of the ongoing decay of urban systems (Qadeer et al. 1994, p. 2989).

For the most part, however, the media sought the opinions of the medical establishment, mainly on the topic of the aetiology and treatment of plague. Occasionally the medicos ventured to make broader comments. Meeting on 12 October, the New Delhi branch of the Indian Medical Association was reported as being "hopeful that the plague scare provided the right atmosphere for enactment of strict laws for the disposal of rubbish and vs. spitting." (United News of India Oct. 12 1994).

Amidst the avalanche of stories and comments from reporters and the general public, comments from the government on the subject of urban sanitation and environment were thin on the ground.

Although the deficiencies in waste management brought to light by the media were incontrovertible, damage control seemed to dictate that the government emphasize that deaths were few and much of the international reaction unwarranted. Qadeer, N and Baru commented:

THE RESPONSE: GOVERNMENTAL AND NGO ACTION, LATE 1994 TO EARLY 1995

By November 1994 the dust from the flurry of activity designed to contain the epidemic had settled. The outbreak had mercifully claimed relatively few lives. It is the actions taken since the end of the emergency that must be scrutinized to assess whether larger lessons have been learned from the outbreak.

There were a number of announcements from the Central government. It was reported that the Cabinet had acknowledged the need for large scale clean-ups in the major cities (the main motive cited was to reassure foreign investors)( The Hindu International Edition, Nov. 12). The World Bank was advising on a massive clean-up package for infrastructural improvements in Indian cities (ibid.)- The previous day, a Technical Advisory Committee on Plague had been set up, which included in its terms of reference recommendations on the prevention of further outbreaks.

Next came the news of a "high-power committee" convened under the Planning Commission to consider specifically issues of solid waste management arising from the plague concerns (see below).

In the principal cities, with the exception of Madras, the clean-up drives continued for a month or more. In Delhi, it was felt that there was better co-ordination of the municipal departments involved in solid waste management than had been previously achieved. There was some reporting of local initiatives to improve solid waste management, and discussions of technologies for recycling (Subramanian 1994; Prasannan 1994', Fernandez 1994).

Another encouraging development is that Sulabh International Social Service Organization, whose work has been in basic sanitation, is now branching out into the field of solid waste management, with a view to adopting an integrated approach to waste problems and their solutions. On 11th January the Sulabh International Institute of Technical Research and Training (SIITRAT) hosted a workshop on the topic, which was attended by the director-general of the Municipal Corporation of Delhi, the chief engineer, the director-general and others from the Housing and Urban Development Corporation, the United Nations

Some bilateral and Indian funds are being committed to research into the outbreak of the plague and an understanding of the administrative and socio-environmental context. The University of Amsterdam is funding a large research project in collaboration with the Centre for Social Sciences of the University of South Gujarat into the conditions in Surat prior to the plague's appearance. This Centre has ongoing research on industrialization in Surat and working and living conditions (Shah 1994). The Faculty of Social Medicine and Community Health at Jawaharlal Nehru University is continuing its analysis of public health administration in the light of the plague scare (Baru 1995). The Institute of Social Sciences in New Delhi has undertaken a case study of urban government in Surat (Ghosh, Ahmad & Maitra 1995). We will probably hear of more research projects shortly, as proposals for funding that address the topic of conditions relevant to epidemics are likely to be given priority by national and international funding agencies.

While government task forces and institutional research can be documented, I cannot judge whether the concern of the general public has been channelled into a lasting motivation for overall improvement in environmental sanitation in India's cities. In Surat, citizens' dissatisfaction with city and state officials was expressed in demands for resignations {India Today, 15 Oct.); there have been many letters to the press criticizing India's "abysmal advance in public health" (Rao 1994) and pointing out the need for a concerted effort at clean-up and better management of urban services (cf. India Today, Nov. 15). But, there has been little reporting on the waste management angle since January. When I raised the subject in Delhi, the reaction was that it was now "business as usual," a resigned acceptance that nothing was likely to change in urban affairs.

The response in the first two months of 1995 appeared reasonable enough. There were appropriate statements of concern and resolutions to tackle the root causes of such epidemics. Against this response we have to set some discouraging signs that for the most part central government officers, municipal departments and the citizenry have gone "back to business" and the impetus for concerted action is rapidly dissipating.

BUSINESS AS USUAL?

When I visited Delhi in early January, the media coverage was focusing on the debate as to whether the Surat outbreak actually was pneumonic plague, even though by this time the WHO scientists were sure that the Surat disease was pneumonic plague. The effect of this January phase of media coverage was to shift attention from efforts to address the urban conditions that enabled the disease to find a footing in Surat and that made so many other centres susceptible. While there may have been too much minute attention to daily details of the disease in September and October, it can be argued that there was not sufficient media attention later to the clean-up work and the plans for long-term rehabilitation of urban environments. Over the course of time, there was media hype and un-hype.

Were the media stung by the charge that their initial coverage was "panic-mongering"? (Sarkar 1994). Or was the paucity of follow-up reporting merely a reflection of the fact that substantial reform was not much in evidence?

At the highest levels of government, general statements designed to reassure foreigner investors and international observers were followed by a defensive secrecy about apparently positive steps. For instance, when I got in touch with the chairer of the High Power Committee on Solid Waste Management of the Planning Commission referred to above (Prof. J. S. Bajaj) my enquiry was cut short with the statement that it was "entirely an internal matter" that was not to be discussed with foreigners. Perhaps this reaction came from a realization that nothing of practical importance was likely to be decided by the committee, which met in December without any terms of reference, and among whom there were few specialists in waste management.

Against these reports, one must weigh that of Captain Velu of Civic Exnora, who says that the Surat Municipality has received many proposals from engineering firms and voluntary organizations for assistance in cleaning up the city (Exnora International 1995). Obviously, it takes time for a city of this size to create an effective waste management system. The administrator of Ahmedabad, an IAS officer, has been made administrator of Surat in addition, and spends part of each week there.

In Delhi, most people to whom I spoke pointed out that collection services were reverting to the usual level and illegal throwing of wastes into vacant lots was recurring. Dr. Florian Steinberg has commented that the cleanup efforts came to a halt once the panic had subsided (Steinberg 1995). It should be noted, though, that the Times' article of January 2 did report on improvements in solid waste management in Calcutta, Bombay and some a few other cities. Now, in April, it is difficult to glean any information about action on waste management and sanitation in the major cities.

SIGNS OF AWAKENING —APRIL 1995

After this discouraging period, in early part of 1995 the Ministry of Health, with WHO assistance, hired a consultant to work under a group selected to formulate a "comprehensive national programme on sanitation and environmental hygiene. The Union health secretary was designated as a convenor of this group which consisted of the secretaries of ministries of Rural Development, Urban Development, Environment and Forests and the chief secretaries of Maharashtra, Tamil Nadu, U.P. and West Bengal, the director-general of Health Services and adviser (Health) Planning Commission.

The national consultant assembled reviews of past activities of concerned ministries and prepared a backgrounder for a workshop to formulate a national programme on "sanitation and environmental hygiene along the lines of a technology mission."

Commenting on these recent developments, Mr. Jan Pospisilik, a Canadian member of the Promotion of Environmental Health Programme at the WHO/SEARO in New Delhi cautions patience. He thinks the pessimistic tone of this paper may not be warranted, yet. We may see significant action on environmental health in due course (Pospisilik 1995).

LOW PRIORITY OF SOLID WASTE MANAGEMENT

Many people, however, wonder whether there is the collective will and the leadership necessary to begin a multi-faceted drive for waste management, a sector that has been given very low priority in India since independence.

While India has most of the ingredients necessary to pursue effective urban waste management policies (capacity to organize voluntary groups for local environmental action, habits of reuse and recycling, ability to manufacture low-cost and appropriate equipment, sufficient workforce and supervisory officers, ability to raise revenue locally, private sector interest in supplying services, and so on) there is a serious lack of expertise and leadership in this sphere.

The number of specialists working in urban solid waste management is quite pitiful; the subject is not taught or researched except in a passing way in institutions of higher education. At the national level, practically no attention is paid to the fundamentals of waste management; scarce funds have been allocated to fanciful schemes for energy recovery from waste that have turned researchers in the field away from basic practicalities. Solid waste management remains isolated from relevant specialties in urban management. (The lack of accessible basic data on quantities of wastes and their nature was underlined when reporters sought such information during the plague scare. See The Week, Oct. 9).

Competent local government officers with a practical knowledge of the local waste problems rarely stay in waste management positions for long enough to be effective. Waste management departments are constrained by strongly organized workers on the one hand and lackadaisical elected councillors on the other, in a context of financial constraint. Local voluntary organizations that have taken up solid waste management as a particular cause struggle with very limited funds and so cannot attract much citizen participation. Initiatives from the WHO to assist in the preparation of educational materials have foundered on the defensiveness of the Ministry of Urban Affairs.

In the early years of this century, following the devastating waves of plague which started in Bombay in 1896, one of the moves of the colonial administration was to set up city improvement trusts. Part of the motivation was to by-pass municipal councils which were considered too politicized or too ineffective to take practical action for urban improvement (Furedy 1978). In the 1990s, by-passing is likely to take the form of privatisation to supply services. Nevertheless, a way has to be found to reinvigorate local municipal bodies so that they are able to pursue the amelioration of poverty and the delivery of basic needs to the cities through a variety of strategies.