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Mumbai's Tireless COVID-19 Warrior

By VAIHAYASI PANDE DANIEL
June 03, 2020 09:42 IST
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'These are challenging times and we get energised by that.'
'I don't feel 'I am tired now and I should relax', because even if someone calls us at 12 o'clock I have to answer his call.'

IMAGE: Mumbai's Additional Municipal Commissioner Suresh M Kakani, accompanied by policemen, surveys the situation in one of the many slums in the city. Photograph: Kind courtesy Suresh M Kakani
 

Suresh M Kakani is the additional municipal commissioner of the western suburbs of Mumbai and has 16 years of experience and several awards for administration to his name.

He and his daughter -- a doctor, who also works for the BrihanMumbai Municipal Corporation -- are both COVID-19 warriors, working diligently and determinedly to drive the virus out of the city.

In an interview to Vaihayasi Pande Daniel/Rediff.com, Additional Municipal Commissioner Kakani meticulously explains:

  • Exactly how the battle against COVID-19 is being fought at the ground level by city officials.
  • Why the lockdown was what Mumbai needed and pushed away disaster, even if the still escalating caseload look frightening.
  • Estimates on when cases will peak in Mumbai.
  • The great success of the use of the pulse oximeter across the city.
  • Education of the people is the highest priority.
  • How providing safe transport for all of Mumbai's 20 per cent essential workers is a momentous task.

IMAGE: Workers carry out construction work at India's first open ground quarantine and isolation facility having 1,008 beds at the Bandra Kurla complex, north west Mumbai. Photograph: PTI Photo

On a recent Sunday, Suresh Kakani, 58, crisscrossed Mumbai from nine in the morning to late afternoon.

His morning began at the Bandra Kurla Complex, north west Mumbai, where he visited a field hospital for two hours.

It had come up courtesy the Mumbai Metropolitan Region Development Authority for the Brihanmumbai Municipal Corporation.

The 1,000-bed COVID-19 centre had been built on an open ground, in about 20 days, and was ready to be given into the charge of Kakani and team.

"That facility was being handed over to us and I was there to see what the things are, how the things are moving over there, whether it would be possible to take over that facility."

It was subsequently transferred to the BMC last week and 125 patients were shifted there.

From the BKC, Kakani drove six km to Sion, north central Mumbai, to visit the main BMC hospital of the ward -- the Lokmanya Tilak Municipal General Hospital or Sion Hospital as it is better known.

Although this IAS officer and additional municipal commissioner supervises Mumbai's north west wards, in the western suburbs, from Bandra to Dahisar, Kakani has the extra responsibility of overseeing the BMC's health, solid waste and the fire brigade departments.

And the 1,462-bed Sion hospital, which also serves the crucially-afflicted lower-income Dharavi, and is now largely occupied by the COVID-19 sick, is very much part of his beat.

At Sion, he threw on PPE to tour the isolation wards and the ICU.

"I could discuss with the all the deans, deputy deans and the HODs (heads of departments) how they are fighting the pandemic, how the ICUs and other facilities are functioning. Were there any gaps. I also interacted with some of the patients."

IMAGE: COVID-19 patients at the KEM Hospital in Parel, central Mumbai. Photograph: Sunil Khandare/ANI Photo

A recent newspaper report claimed that beds were being shared at the Sionk Hospital.

Kakani admits that the Sion Hospital is overcrowded and over capacity, but the state of affairs has gotten marginally better since.

If the authorities are able to move out the last of the non-COVID-19 patients, it will free some beds.

So will transferring the milder COVID-stricken to the newer field hospitals.

"Suppose a patient is walking in, it is necessary to stabilise him, so he should not lose his life. So whatever facilities are available, our directions to the medical fraternity is that they should accept the patient, stabilise him, and after stabilisation, he can be shifted to some other facility," he says.

"It is easier to say no. It is difficult to say yes, accommodate him, stabilise him and then transfer him."

Next, that Sunday, after donning a mask and a plastic face shield, he headed to a tightly-packed slum area of Mankhurd, north east Mumbai, that falls in the beleaguered Ward M East.

The population around there is nearly 680,000 and, on an average, household sizes are 5.5 persons per handkerchief-size tenement room, in a neighbourhood where little natural light filters through.

This area of darkness, that in non-COVID-19 times has been plagued by diarrhea, malnutrition and illiteracy, is today an area of even more concern.

IMAGE: Iqbal Singh Chahal, Mumbai's municipal commissioner, visits Dharavi along with Assistant Municipal Commissioner Kiran Dighavkar. Photograph: Ashish Raje/ANI Photo

There are several containment zones in M Ward, with 1,696 COVID-19 cases as of May 27.

Although Mankhurd is not Kakani's area of supervision, he was accompanying the recently appointed Municipal Commissioner Iqbal Singh Chahal as he toured the locality.

They were seeking a fresh understanding of issues residents were encountering and the problems the BMC could face administering the ward in the days ahead during these viral times.

"Municipal Commissioner Sir and I visited the slum area," says Kakani. "We were there for more than two hours discussing with the people what their needs are. And what more needs to be done so the situation should be under control."

Residents were informed about the main BMC helpline and the local one.

Adds Kakani: "We have intimated to our colleagues that a person should be posted 24 by seven, with a police team."

The additionally-appointed BMC coordinator, it was decided, had multiple responsibilities, like emphasising the key COVID-19 lessons (of social distancing, hygiene), assisting anyone having difficulty getting groceries or vegetables during the 9 to 11 am slot at the various containment exit/entry points.

"Or someone may need a medical attention, those requirements should also be taken care of by the coordinator."

Visits to these areas (where nearly 96 per cent of the containment zones are) -- even the most difficult, bleak slums -- is not a depressing or down moment, asserts Kakani, because it is "encouraging to see that strategies are working and therefore they are coming out of the situation."

More medical intervention is required, he says, like the recently- introduced mobile vans.

Post these visits, on the same Sunday, Kakani probably returned to his official residence in Dadar, central Mumbai, and participated in a few online meetings and took a slew of calls; his phone is rarely not busy, even late into the night, but he still manages to finally take a call or call back.

He remembers of that day: "I was focusing on the day-to-day activities like test results -- compiling of it and communicating it to the higher authorities. Then contact tracing, communicating it to the field officers who are undertaking contact tracing, so the spread should be limited. Then (coordinating) the shifting of positive patients to the various facilities, all these things we are doing."

IMAGE: BMC staff arrive at the Shastri Nagar slum after fresh positive cases were reported in the area. Photograph: Vijay Bate/ANI Photo

With an unending list of matters to take care of, in the busiest, till now 92 days he has confronted in his life, Kakani has resorted to a weekly schedule, so he can allocate enough time to each area under his command.

Every hospital needs his special attention. As do all the areas he is looking after.

But Kakani -- a 2004 batch Maharashtra cadre IAS officer, from a farmer's family and educated at a zila parishad school in Kamargaon, Vidharba, near Amravati -- has come through epidemics before.

He helped the city battle an alarming spread of both swine flu in 2009 and the mosquito-borne chikunguniya in 2012-2013.

"Swine flu had a similar kind of scenario. Chikunguniya (which first arose in 1952 in Tanzania, hence its Tanzanian dialect name) was another pandemic kind of situation a few years back. Somehow we could control it," he recalls.

In a practical, matter-of-fact, vein, he continues: "In the Indian Administrative Services, because I am an IAS officer, we have to deal with every disaster. Sometimes drought situations. Sometimes floods. Sometimes outbreaks of swine flu. Now COVID-19 is here."

Kakani, who has done several rural (Nanded, Solapur) and city postings (Mira-Bhayandar, urban development, Maharashtra Airport Development Company Limited), a year-long World Bank stint and earned a postgraduate degree from the University of California, Berkeley, 2006 to 2008, in Asian studies, covering social conflicts ADD, makes clear: "We are already mentally prepared for undertaking or dealing with a similar type of scenarios. Most of the officers and officer machinery really put in all efforts to control or mitigate it."

The measures that are showing results, and have shown in the past with other widespread viral eruptions, in Mumbai's densest and worst-affected areas (Govandi, Shivaji Nagar, Worli Koliwada, Mankhurd, Dharavi, Antop Hill), where there is, in some cases also a system of a single tenement room, Kakani explains, being used by workers in a shift system, are:
A. household visits by BMC staffers;
B. pulse oximeter readings;
C. sending people to fever clinics.

And the pulse oximeter has a been the hero of the Mumbai COVID-19 war, says Kakani, because it has helped to swiftly sift and segregate the infirm and the vulnerable from the healthy.

"It is a very interesting thing. Very cheap thing. But it can record your temperature, it can record your heart beat and it can record your oxygen saturation level."*

Over 5,000 pulse oximeters have been purchased by the BMC and nearly every health worker, in the field, is equipped with this little wonder gadget.

"We have also asked local medical practitioners (in or close to slums) to keep open their dispensaries or clinics, so that in case they come across any person who is symptomatic so they should be able to refer that person to our facility so that further treatment can be undergone."

The top-most strategy, of course, that has been the greatest help in the bitter fight against COVID-19, in spite of the staggering economic costs and the murmurings from naysayers and Mumbaikars frustrated with the long period of indoor life, is the lockdown.

Kakani confirms this, unravelling for us the logic of the authorities, who instituted it, after the first trickle of cases hit the more thickly-populated parts of the city:

"It has been successful and because of the lockdown, we could control the number of cases (more testing has disclosed a larger number too, he says). In other parts of the world, where the lockdown is not being implemented, cases are rising at a much greater rate," he explains.

"Though the cases are rising (here too) the rate of growth is very minimal and the death rate has gone down and the doubling rate also has gone up," he points out.

"Even though the density of population (and with it the inability to implement social distancing) really came into our way, now in the most affected areas, like Worli and Dharavi, the doubling rate is close to 23 to 24 days."

IMAGE: BMC medical staff take samples of policemen who have a cold and cough at the police officers quarters in Borivali, north west Mumbai. Photograph: Santosh Hirlekar/ANI Photo

While Kakani has overall charge of the western suburbs, in order to have a "more focused approach" he was recently asked to narrow his outlook and zoom in on Jogeshwari, Kandivali and Vile Parle, and is getting assistance from other AMCs for some of the other wards for "closer monitoring."

"I have been given areas where cases are more and there should be someone to supervise the work very closely, because in case there are gaps, they can be bridged."

As the additional commissioner taking care of the health department, the BMC hospitals, medical college hospitals, peripheral hospitals and primary health care centres -- all primary, secondary and tertiary centres -- are supervised by him, with assistance from the central BMC medical team.

But "different roles have been assigned to officers who the Maharashtra government deputed to the municipal corporation. There are two or three officers on deputation and they are looking after some of the other issues related to health, but that focus on the pandemic."

Like testing, expansion of medical force, the control room and bed allotment etc.

The only area, where Kakani has had to devote less time, surprisingly, was Dahisar, under Ward R North, which has some of the fewest cases in the city, in spite of a similar mixed slum and middle class make up.

One of the best "monitored wards," Dahisar has fared well, from the beginning, the AMC says, for a combination of two reasons:
1. Its distance -- "farthest" -- from railway terminuses for long distance trains;
2. because of the fact that its population is "dominated by the local population" with not much out-of-state/out-of-country (Dubai, Middle East) connections of any sort.

IMAGE: Suresh M Kakani, Mumbai's additional municipal commissioner. Photograph: Kind courtesy Suresh M Kakani

While till last week much of the IAS officer's attention, in the slum areas of his wards, was on Ramzan and Eid, lest over-exuberant festival spirit should accidentally interfere with social distancing, now his focus has moved.

Though the end of the lockdown is not yet in sight, preparations are constantly on for both a post-easement landscape and for the gradual opening of some facilities, that will take place from June 3 onwards.

To that end, the highest priority is education in all parts of the city, of the rich, poor, educated, supposedly-educated, semi-educated and uneducated.

This education is about tutoring Mumbaikars in the city's new way of life, as its pace mildly normalises in the days to come.

Apart from three cornerstone mantras of social distancing, personal hygiene and reporting symptoms, it's about making them understand that the three are a regular, immoveable "part of life now."

"So IEC activities (Information, Education, Communicate and Counselling) and through that educating the people to maintain the area hygiene and sanitation, so there should not be any outbreak, in case suppose someone tests positive in an area, or someone got infected.

"And we are trying to build the resistance of the common citizens. So that even if the infection is there, there should not be any symptoms, there should not be any problems. And the shareability of the viral load should be at the minimum level."

"This is a blessing in disguise, in the sense that an opportunity has been given to us to educate the people for behavioural change. If you travel across the city -- though garbage is there -- but the overall cleanliness index has gone up like anything and personal hygiene too (how to cough or sneeze and use a mask)," he says.

"It is a gradual process. It won't happen in a day or two, or in a month or two. It will take some time. Over a period, people will understand the importance of personal hygiene or area hygiene. Definitely it will help us in the long run."

Along with hygiene it is about setting up systems that comply with social distancing and educating the public on their use. Kakani says they are "already in place" but will need constant emphasis.

Imaginative ways to constantly achieve crowd thinning in teeming, exploding Mumbai is one of Kakani's main jobs. Like how in markets, shops should open on alternate days or different time slots and ensuring that people don't "crowd" them.

He is, he declares, quite bemused at the speed at which people have made an effort to comply: "They are maintaining social distance even while shopping. They are waiting under the sun for their turn for some vegetables or some groceries. That is a very good sign. And especially in a densely-populated area it is an encouraging thing for us to see, that people are getting educated."

But normalising Mumbai means bringing back the public on buses and trains. It's very hard to imagine how.

"That is more challenging. It won't open in toto. It would open gradually like initially the persons who are involved in essential services or necessary services those would be given preference to board the trains and others would be asked to wait for their turn (and do so at a later date) or they should not use this facility. All staggered methods of opening facilities will be undertaken."

To add back enough trains and buses to carry just essential workers, many of whom have not able to reach their place of duty, because of the total lockdown, is a large load in itself.

Doing a back-of-the-envelope calculation, Kakani estimates that "Twenty per cent of the population is engaged with the essential services like hospitals, solid waste management, firefighting, groceries, milk, vegetables, gas, diesel/petrol/fuel, public transport system, media... A rough calculation."

Astonishingly, given that Mumbai's population is now estimated to be close to 22 million (according to worldpopulationreview.com), nearly 44,00,000, as per the lockdown parameters on who have indispensable jobs, are working in essential services sector.

Managing their transport issues will be a massive task post June 3.

Schools and colleges, which usually commence post monsoon, might seeing a different schedule, he says.

At the moment Mumbai is struggling and muddling through its worst days, as cases pile up and every resource is stretched beyond capacity, even as it attempts to ease the economic strangulation, by rolling up the shutter on the city a crack or so.

As of May 31, Kakani says, "We are inching towards the peak, that is what we can say. It is practically difficult for us to anticipate that, 'Yes, this is the peak' and henceforth after the peak, the rate would be slowing down, stabilising and becoming static. After opening up partially we have to closely observe the situation and then we can decide if we are on the right path or otherwise."

Mumbai might be going through one of its worst historical period ever, perhaps since 26/11, the Partition riots, the 1944 SS Fort Stikine Bombay harbour explosion, the 1918 flu and the 1896 plague, but, Kakani says, there are still heartening signs.

Like the support the local governance gets from Mumbaikars.

"People are supporting it, though they are in the slums. They have realised what the situation is. That the ultimate sufferers would be them though the government is trying its level best and they are supporting our cause. So what's surprising is their understanding, which the have quickly picked up."

Though the peak may not be in sight, Kakani is optimistic: "Very few cases are getting out of the containment zone. Verge of controlling everything, though the cases may go up but I think we will be able to control it."

"Therefore, philosophically, if you ask me, yes, it is a challenging situation, but we should learn something from it and we should move ahead, to face new challenges.

"It is a learning process for us. We feel that this kind of outbreak would definitely be there in future as well, (in spite of that fact) that we are so advanced scientifically. So all of us should be in readiness to face any type of scenario. That is what we learn from each and every disaster for that matter."

There have been some severely discouraging, gloomy points in the campaign, Kakani recalls, like, in the initial, when a doctor tested positive but spread cases by continuing to work.

"His relative was positive, and though he was from the medical fraternity, he operated on two or three patients. That was a really depressing moment because it was not expected from a medical practitioner. It was not expected from the learned class. In the process he also lost his life."

How does he cope with the hours and the stress?

"These are challenging times and we get energised (by that). I don't feel that 'I am tired now and I should relax', because even if someone calls us at 12 o'clock I have to answer his call."

Kakani is not the only one, in his home, putting in sometimes 20 hours a day to defeat COVID-19.

His daughter Gargi is a BMC doctor and he says proudly: "She is also serving COVID patients in (Central Mumbai's B Y L) Nair hospital."

 

*At sea level a healthy person should have oxygen saturation or sats of 96 to 99 per cent and at least above 94 per cent. Less indicates comorbidity of some kind.

 

 

Production: Ashish Narsale/Rediff.com

 

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The War Against Coronavirus

The War Against Coronavirus