On December 29, 2017, Srikanth Sahoo, a migrant labourer from Odisha working at the construction site of Sobha Developers in Bengaluru’s Varthur was brought dead to the St John’s Hospital in Koramangala. Along with him came 30 other co-workers, with symptoms like nausea and diarrhoea. On December 30, another worker died. Doctors at the hospital confirmed on that day that the two dead and other ill workers were infected with cholera.
The death of the two men set alarms bell ringing in the department, and the it swung into action to contain the spread of the infectious disease. By the end of the first week of January, at least 7 people tested positive for cholera, and the testing is still ongoing.
Officials of the state health department vehemently deny that there is a cholera outbreak, but doctors at St John’s Hospital insist that there is one. Outbreak or not, officials of the health department say that they have taken action to prevent further spread of the infection. Dr BK Krishnappa, Medical Officer at the Primary Health Centre in Varthur, says that they have conducted awareness camps in the Varthur area, installed water purifiers at the construction site and also changed the source of the water used for consumption.
While health officials clamoured to prevent the spread of the disease, what has clearly emerged as the larger problem is how we treat migrant labourers.
Where did the bacteria originate from?
A preliminary report by the Institute of Public Health has ruled out water contamination as the source of the infection. An official with IPH says that 12 samples of water from Sobha Dream Acres site in Varthur were tested and none of them had traces of vibrio cholerae bacteria as suspected previously. These samples were handed over to the institute by the Department of Health and Family Welfare and the police.
If the water was not contaminated, then where did the cholera come from? The institute suspects that with no cases of cholera outbreaks being reported across Karnataka in the recent past either, one of the labourers from Orissa could have been a carrier of the bacteria which led to infection among the others. “If a person, who is a carrier of the bacteria has not paid enough attention to hygiene or has defecated in the open, the others could be infected as well,” the IPH official added.
The possibility that one the workers could have brought the disease along from another state might help the state government make the case that there isn’t a cholera problem in Bengaluru, but it points to why better living conditions and health camps for migrant labourers are important.
Disease outbreaks and worker conditions
PHI officials say that poor sanitation and hygiene concerns could have pushed Bengaluru towards the possible cholera outbreak. Had the construction labourers been provided better living conditions, the deaths and illness might have been averted.
“The sanitation facilities were inadequate for workers in Varthur. With the number of toilets very few in number, some of them would be forced to defecate in the open,” he said.
Dr Krishnappa agrees. He points out that their inspection found that there were only 45 toilets for about 3,000 labourers. “This is an inadequate number. Also, the ones that we were shown were maintained in poor condition. Ideally, he said that there ought to be one toilet for every 25 people.”
“In such conditions, the contamination would happen through faecal matter in food or from personal contact,” he says.
Officials from the health department also found that even though RO plants have been installed, they were defunct. “We had to ensure that the two existing water purifiers were repaired and an additional one was installed,” said Dr Krishnappa.
Darshana Mitra, a member of the Alternative Law Forum who visited the spot following the incident said that there was no running water at the toilet facilities that were provided for the construction workers and that they had to fetch it from a distance.
“Some of them also told me that an overhead septic tank at the side was overflowing with the sewage water flowing across the camp site,” she said.
Kathyayini Chamaraj, Executive Trustee, CIVIC says that the Karnataka Building and Other Construction Workers Welfare Board collects 1% cess from the builders which ought to be used for the welfare of these workers.
“There are workers from Bihar, Orissa, Rajasthan and other places in the city. Many of them are kept in isolated camps and have no access to healthcare. Many are not even registered with the board,” she said.
She said that the amount accumulated as cess runs into about Rs 5,000 crores. “Ideally, there have to be colonies in every ward which have facilities. Children of these labourers are also at risk within the camps, there is no zoning,” said Chamaraj.
She said that it was unfortunate that the board thought of channelizing the money generated through cess for the construction of convention halls and distribution of mobile phones rather than provide the workers health insurance.
She said that even after a group of citizens submitted a memorandum to minister Santosh Lad, seeking several facilities for the construction laborers, not much changed on ground.
For many migrant labourers, access to healthcare is out of reach. Unable to foot the medical expenses, the laborers are also denied access.
Dr Upendra Bhojani, Member, Institute of Public Health said that the challenges that migrant labourers have with respect to access to healthcare is also dependent on where they come from.
“For instance, if the labourers are from the same region, they would be able to communicate and have support from the community. This is not necessary with those coming from other places. They would have challenges with communication as well,” he said.
Dr Bhojani was part of a study that was conducted in Kadugondanahalli to understand the challenges of migrant population. This study also covered those who lived in the city for a long time now.
He said that even access to healthcare schemes and insurance could be a challenge. “Most of the government schemes are mediated through cards. To avail this, one would need ration cards. For someone wanting to avail access to healthcare at concessional rates, this becomes essential. Most of them do not have the cards,” he said.
Dr Bhojani said that the study conducted in Kadugondanahalli found that 40% of the surveyed population did not have ration cards. “Again, there are multiple challenges associated with it. Some of them would not be able to prove their legal residence,” he said.