Sanitation, TB and poor environmental health

The staunch scent of hydrogen sulfide from the sewage drains permeate the air in Mumbai and even worse so  in the slums we visited last week where the smell is enough to make you gag with nausea—especially when suffering from the expected bout of your own digestive issues.  As an environmental health student, I am struck by the overcrowded, poor conditions in the slums and the garbage piles on the streets—often wondering why there is such a lack of planning and sanitation services in the slums and the cities.  Simple int

erventions can prevent the number one cause of morbidity in this country—diarrheal disease.  However, sanitation services are not on anyone’s priority list—not the NGOs, the NIH nor the Indian government and frankly, I don’t get why such a necessary public health issue is being overlooked.   

India currently produces some of the brightest engineering minds in the world and there are innovative, cost effective, efficient sanitation systems out there that can recycle methane and reuse bio-solids as fertilizer—however, none are being used in India—to my knowledge.  Today, we met with Dr. Karin Bedi—Delhi’s famous police chief who restructured the prison system and is currently fighting against corruption in the Indian government.  She said many of the sanitation projects fall short of being implemented because the money allocated to them was consistently syphoned off by “politicians.” While I think corruption may play a significant role in the apathy surrounding this issue, I also think funding priorities often prioritize “sexy” diseases over those that are ubiquitous. 

In addition to lack of sanitation services, there are a number of issues that have some environmental health component to it.  For example, today we also visited Operations ASHA, an NGO providing Tuberculosis medications to identified cases in South Delhi.  OP-ASHA works with community leaders to identify TB cases and uses mobile technology to track and remind patients to take their medication. They receive a portion of their funding from the Indian government to implement the DOTS (Direct Observed Therapy-Short Course) program to reduce transmission of TB.  While OP-ASHA employs a novel strategy for addressing the highest rates of TB in the world and their model is proving to be successful, I felt the problem was not being addressed comprehensively. 

TB is an environmental health problem and when NYC was faced with this very issue in the early 1900s, they created the first public health policy requiring each apartment to contain at least two windows to increase ventilation and light into the dwelling thus reducing the propagation of the TB micro-bacteria.  It was the Light and Air standards that mainly contributed to the decreased in TB rates in NYC.  I am not sure why the Indian government does not try to improve living conditions in the slums—i.e. reduce overcrowded dwellings, increase ventilation and increase sunlight into the dwelling—the very conditions that perpetuate TB.  Even more discouraging is the fact that NGOs typically stay away from addressing sanitation issues because the Indian government is the designated responsible party for providing clean water and sanitation services.  Therefore any funding opportunity for sanitation services is viewed as redundant.    

I can’t pretend to understand the bureaucracy that is the Indian government that is so overburdened it relies on the NGO sector to pick up the slack.  However, it is time to put together the great minds at the various Indian Technical Colleges, some community and urban Planners, civil and chemical engineers and a few public health and health policy professionals to develop an implementation strategy for cleaning up the slums.  For a people that added the zero to the number line, not dealing with the antiquated issues surrounding sanitation only continues to hold India back and that just stinks….literally!