Chennai slums: health vulnerability, coping mechanism and adaptation behaviour T. Vasantha Kumaran University of Madras, Chennai, India Email: thangavelukumaran@gmail.com Masarykova University Brno, Czech Republic May 10-14, 2009 Major Urban centers in India Urban India and Slums in India Ü Total slum population in India 42.6 million Ü Total number of slums in Chennai 1400 Ü 1.9 million slum population (1,846,817) Chennai and its environs Collaborative Projects Ü York-Madras Collaborative Project on Environmental health and Adaptive Ecosystem Approach to human health in Chennai Slums 2001-07 Ü Bonn-Madras Collaborative Project on Health Vulnerability, Coping Mechanisms and Adaptation Behaviour in Chennai Slums 2007-09 The Context: Chennai Slums Ü Anjukudisai Ü Pallavan Nagar-Kargin Nagar- Tsunami Nagar-VOC Nagar / Thilagar Nagar Ü Kalyanapuram Ü Anjukudisai Slum, Chennai: a narrow street in 2004 – note drainage and restricted space for people’s use Ü Cooum and the slum On the Banks of the Cooum: Anjukudisai Poor and Marginalized Slum People * Anjukudisai is an inner urban slum, at a hazardous site on the bank of the much polluted Cooum river. * It is objectionable and demonstrates the impact of long-term neglect of environment and health issues. * The slum’s 256 households and nearly 1,400 people live in concrete cells and thatched huts. * The slum lacks proper drainage, latrines and sewage and solid waste collection. Rich Picture of the Problem Situation: System Description Problem Identification Exercises 1. What is the Problem?, 2. Why is it a problem?, and 7. Really now, what is the problem? Poor and Marginalized Slum People Pallvan-Kargil Vetri-Tsunami Nagar The name suggests that the slum community that existed in Pallavan Nagar prior to December 26, 2004 was moved to Kargil Vetri Nagar in the aftermath of the Indian Ocean tsunami and then to Tsunami Nagar, after fire and flood hazards that hit the people hard. It was a community of 325 households or about 1,800 people who lived on the shore of the Bay of Bengal in North Chennai, near the fishing harbour and within the Coastal Regulation Zone. This was an objectionable slum. Anjukudisai and Pallavan Nagar- You have a family, with many children but no regular and proper job. But you make money all right, in good measure, but lose it on vices too: gambling, alcohol and what have you. And you live for today, for you don’t know what tomorrow has in store for you and you are not even sure where you will be tomorrow – here or someplace else which is not your own and not your choice. But yet, you have always lived in here since your birth, and some of your people have lived in as long as 60 or 70 years. Visitors to Anjukudisai from abroad Charismatic Women leaders Anjukudisai and Pallavan Nagar- Marginalized people – the poor and the oppressed – are those on the ‘edge of the world’, so to speak. They are indeed our “margins” or edges of learning. And the ‘Margins’ are sometimes the elemental values of life: that is, it is from them we fully understand our space and freedom, sun and clean air, the cold majesty of the mountains and the loneliness of the plains, the gaiety of folk dance, and the easy friendliness of the people. These are the “margins” around the (sometimes) fretful business of earning a living. These are what Thoreau meant when he said, "I love a broad margin to my life". Who wouldn’t love such spaces and freedoms, such friendliness and yearning for a living in the best of the worlds while being alive and kicking in the worst of the worlds? Social Exclusion Social exclusion is about the inability of our society to keep all groups and individuals within reach of what we expect as a society. Self Help Groups of men and women in rural and urban areas of India are a testimony for building economic, cultural and social capitals. Rural and urban development policy makers have now adopted the term ‘exclusion’ to mean the multidimensional nature of the problems facing the people of disadvantaged areas. Social Exclusion… According to Power and Wilson (2000: 1): It isn’t story time. It is indeed a serious time period in which the pro-poor policies are emerging. And ‘there is a ceaseless spatial negotiation which is considerate or cruel, conciliating or dominating, unthinking or calculated’, to borrow the words of John Berger. Inside the homes of the poor, there is the kindly exchange, accommodation, even psychological and physical sharing. Social Exclusion… But, outside of their homes, the space of choices is limited. And in slums of Chennai, every choice is starker. The choices for women and girls are even more starker than those for men and boys: Ü men and boys are relatively better off (after all, a slum is a patriarchal society) and Ü absolutely worse off (because of the vices they are part of and given to, and the violence they inflict on women and girls and, sometimes, on other men and boys too). Sense of Place in Slum people The slum people are awake to realities, possibilities and changes. But the changes they are looking for are both happening and are not happening. As possibilities change, so too must their culture. And their culture is changing. The question is simply: who will direct that change and for what purposes? Sense of place among slum people A fully functioning community provides the experience of beauty for its people, say, in Chennai. But what kind of experience, and what kind of beauty, do I experience in the Chennai slums? And what indeed are the experiences of men, women and children of the slums? I am sure that they are all happy sometime at least in their lives, with full of smiles when there are deep, open wounds in their hearts. It is often a situation that they can’t openly speak of their aches or laugh out loud for the tendency is to hide troubles from others. That’s in their culture too. Community Engagement I derive my creativity from life. Mainstream views of creativity are set in certain norms. If you write, act, make films, sing and do a hundred different things which others feel difficult to do, you are creative. But I think life is creative. Life in the slums is creative too. You need creativity to jump onto a running bus, to hang onto a local train in Chennai, to cook sambar (curry for outsiders) well. All protest is creative, too (K.P. Sasi, a documentary maker from Chennai, as told to Sengupta, 2007). To make an impact, you have to protest in a creative manner. Strategies/ Processes adopted Ü Summer training program for Children Ü Formation of Women Association Ü Identification of Training Modules Ü Awareness Camps on Health and Sanitation Ü Health Camp/Dental Camp/Eye Camp Ü Blood Donation Ü Tree Planting Ü Distribution of Dustbins and vegetable seeds. Ü Street Play Ü Youth Sports Club Ü AIDS Awareness program Ü Psychological counseling Ü Job training for Men and Women Social Movements and Slums The social movements, in a sense, have been group- focused, advocating changes in the socio- economic system and promoting participation in individual-focused events and activities. All of them, colours and shades, began as a reaction to squalor and anti-change, with local scope because they have been based on local, slum objectives. And they have the potential to die. They have a life cycle: they are created, they grow, they achieve successes or failures and, eventually, they disappear or cease to exist. Mothers and children, young families Arriving at the Truth of the Majority I believe that, despite troubles, the slums work dynamically and actively, as narrative machines. The way it works is instructive whereas the absence of the narrative capacity works a kind of violence (see Latham, 1999: 165). Arriving at the Truth of the Majority Several moons and months passed. The community had clearly shown an interruption of illumination. You were able to show that each life had its own propensity for illumination and no two were the same. Illumination arrived by way of tenderness and eagerness for self and community development. Resilience of Slum communities Where vulnerability exists in myriad forms, resilience takes as many forms. Resilience is a component of vulnerability (Gardner and Dekens, 2007:319) and qualities of a community that reduce vulnerability are indicative of resilience. Resilient socio-ecological systems are those that enable livelihood sustainability in the face of adversity (change) through self-organization (Berkes et al., 2003). Resilience of the City Slums and People Even more than Anjukudisai people, the Tsunami Nagar people have shown remarkable resilience in their post-tsunami recovery and rehabilitation. Livelihoods Resilience of the slum communities.. In Anjukudisai, people have shown vibrant leadership (women and youth), shared goals and values (mostly women), established institutions (women and youth) and organisations (Youth Association of Anjukudisai – YAAK, for example), positive socio-economic trends (recent employment of youth and women’s livelihood changes), constructive external partnerships and linkages (with York-Madras project team, NGOs, Apollo hospitals) and the availability and use of resources and skills (again women and youth to a large extent and men to a certain extent), the characteristics that enhance resilience. Toward Solutions Ü Community Meetings Ü Interviews Ü Long hours of discussion Ü Transect walk Ü Community mapping Ü Entertainment activities for and with the community members Young married girls of Anjukudisai, with children A family in Anjukudisai dependent on an informal eating enterprise Livelihoods, sports and future Self Help – slum people cleaning canal Cleaning a roadside drain Health: Seasonality of vulnerability, coping and adaptation in Chennai Kalyanapuram PHYSICAL ASPECTS Ü In Elephant gate slum, 70 % of houses have tiled roof with brick walls Ü 20 % asbestos roof, building and only 5 % huts Ü Average size of houses 10 x 8 feet Ü Only 30 % have own current connection ENVIRONMENTAL CONDITIONS In Kalyanapuram slum: Ü 60% of women work in water points for all household work Ü The garbage is strewn everywhere Ü The canal banks are used for defecations Ü It is a source of breeding centre for mosquitoes and flies SOCIO-ECONOMIC ASPECTS Ü In Elephangate slum, 70 % of men work as loadmen, auto , truck drivers and richshaw men,waste pickers, and beggars. Ü There are unemployed youths and men in both slums. Ü There are 8 petty shops and 10 food shops. Ü The average literacy level for men 8^th grade and for women 5^th grade. Lack of basic services Lack of basic services Substandard housing Overcrowding and high density Unhealthy living conditions Insecure tenure Description of the cohort - inner city slum Cooum Background Ü Stressors specific to the metropolis of Chennai - Water availability - Inadequate investment in infrastructures Objectives Ü In an inner city slum of Chennai: - Describe population of vectors (density, seasonality) - Describe behaviours that favour breeding of vectors - Explore knowledge on disease transmission and protective measures among population Objectives Ü To test whether identified exposures are associated with incidence of combinations of symptoms Methodologies Ü Mosquito collection every 3 days using BG-Traps Ü Traps are operated from 5 pm to 10 am Ü Entomologist identifies species, sex Ü Data logger for temperature and reative humidity Methodologies Methodologies Ü Questionnaire: - Knowledge about diseases and mosquitoes - Mosquito nuisance - Water storage practices - Personal protection methods used Results: Vectors Results: Vectors Results: Breeding sites Results: Breeding sites Frequency of households storing water inside their house, by type of containers, stratified by season (all less than 5 days) Results: breeding sites Frequency of households who reported that water was stored outside their house, by type of containers, stratified by season (all less than 5 days) Results: Knowledge Answers to question « How do you get Chikungunya?" among households in an inner city slum of Chennai, 2007 Results: knowledge Answer to question « Where do mosquitoes lay their eggs?" among 71 households in an inner city slum of Chennai, 2007 Results: protection Use of protective measures in households against mosquitoes in a cohort in an inner city slum of Chennai, dry and rainy seasons 2007 Results: protection Ü Number of people in the cohort who reported to have slept under a mosquito net in the past week: - Dry season: 2 people (0.6%) 95 % CI [0.1-2.5] - Rainy season: 7 people (2%) 95 % CI [1.0-4.7] Results: relating risk factors with ill-health Conclusion Ü Exposed to all three vectors, with seasonal variations Ü Some adaptive behaviour (storage of water) does not appear to be the main breeding sites for Aedes/Anopheles in the slum – rainfall dependent Ü Awareness seems high, protection limited to few methods Ü Future research: larval indices, look for discarded containers Thank you Objectives Ü Water-borne diseases - Describe sources and use of water in the dry and rainy seasons and basic sanitation infrastructure - Describe behaviours that can favour transmission of water-borne pathogens Results Answer to question "Have you heard of Malaria/dengue/Chikungunya?", among 71 households in an inner city slum of Chennai 2007 A Final word In the Indian storytelling tradition, the secret of storytelling amongst the poor is the conviction that stories are told so that they may be listened to elsewhere, where somebody, or perhaps a legion of people, know better than the storyteller or the story’s protagonists, what life means (Berger, 2008: 5). Thanks!! Questions?