Written By: Anita Deshmukh
The severe societal and economic shocks of this pandemic have profoundly changed our everyday lives, including those of the vulnerable slum communities of Mumbai. Over 40% of Mumbai’s population lives in informal settlements where living conditions are usually substandard due to high population density and poor water, sanitation and hygiene. People residing in these settlements are unable to isolate themselves when living in small cramped spaces, which pose a major challenge during this pandemic. In this blog post, we share some insights from a qualitative inquiry undertaken between March-June 2020 by Society for Nutrition Education and Health Action (SNEHA). SNEHA works on maternal and child health, adolescent health and sexuality, prevention of violence against women and children, and palliative care in urban informal settlements of Mumbai. Data for the qualitative inquiry were collected from 11 focus group discussions comprising of 55 frontline workers and staff members at SNEHA. In addition, sixty participants from the program team chose to give their responses in writing. The themes explored were community knowledge on the origin of COVID-19, its spread, fears and misconceptions about the disease, and how COVID-19 changed the community health workers’ intervention methods. All data were collated, manually coded and thematically tabulated. The emergent findings are described below.
Panic to acceptance
The announcement of a national lockdown by the Indian government in March 2020 brought the city of Mumbai to a complete standstill. The initial response of the community was panic, which stemmed from a lack of understanding of what was happening around them. People were in denial and did not know how to approach the situation. Any news of death in the community caused fear and anxiety, which led to social stigma. At first, community members feared going to government hospitals for testing and getting quarantined. The image of their neighbors being taken away in an ambulance was very stressful for them. For some, uncertainty, job loss, and health concerns pushed them to return to their hometowns outside of the city. Others intended to return to their villages once train and bus services resumed, but the lockdown severely constrained their mobility.
Gradually, communities developed a better understanding of COVID-19 and learned about symptoms, preventive measures, and modes of transmission. People became aware of the basic preventive measures like wearing a mask, washing hands frequently, maintaining physical distancing, and reducing unnecessary travels. However, their knowledge about the presentation of the disease was mainly limited to common symptoms like cough, cold and fever, although they understood that the disease was highly contagious. Perceptions about the severity of the disease still varied across different geographical areas and age groups that SNEHA works with. For example, younger people thought only older adults are more vulnerable, whereas adults perceived both the elderly and children to be at risk. Some perceived COVID-19 to be life-threatening, while others considered it like any other normal illness.
Media and information
Television and social media played an important role in promoting scientific and public health messages in the communities. People also received information from trusted SNEHA staff and volunteers. Some shared the messages that they received on WhatsApp from others with SNEHA staff and raised concerns about the credibility of the information being circulated. Therefore, sharing credible information based on the government’s advisory announcements became a crucial role for SNEHA during the pandemic.
COVID-19 and public behavior
People in the community started practicing hand washing, using masks, and staying at home except for running essential errands soon after the lockdown was announced. In the beginning, youths in the community did not abide to the lockdown requirement and were often found loitering or treating this period as a holiday. However, adults in the community were taking extra care of children, such as washing their hands before and after feeding them, enforcing regular bathing, wearing clean clothes, washing their hands with soap when they came back home, and engaging children at home. Adherence to hand washing, quarantine measures, and physical distancing remains a significant challenge for people living in urban informal settlements, where water for basic needs is in short supply and space is constrained as joint or extended families often live together.
Myths and misconceptions
There were several prevalent misconceptions regarding both the spread of the disease and preventive measures. Many community members believed that the warm climate of India would be a deterrent for the spread of the virus. Some were agitated as they felt that they were suffering from the pandemic because of the rich people who have travelled from other countries. Moreover, others felt that their immune systems, which had theoretically been strengthened due to malaria, dengue, and weak sanitation systems, would prove to be more resilient than Western ones.
One popular theory was that the virus would not survive in hot temperature and hence would disappear during the summer season. Some also thought sipping hot water or getting exposure to sunlight would protect them from the disease. One of the women from the community said that, “I did not allow my children turning on the fan at night as I want to make them sleep in the heat, hoping that it would cure them of the infection they might have contracted during the daytime.”
Another misconception identified was that people thought that eating non-vegetarian food should be avoided as the virus spread through animals. Some believed that the vibrations generated by clapping hands would destroy coronavirus, while others felt that the disease would be cured by performing prayers. There was even a belief that God had cursed this planet with the virus, saying it is ‘God-given’ or ‘it’s a third world war between God and human beings’. There was also a misconception that people with a cough or cold are infected with the coronavirus – “even a cough or cold means COVID.”
Multiple theories emerged concerning the origin and spread of COVID-19. Some believed that COVID-19 is the seed of the fruits that Chinese have eaten, while others reasoned that people in China ate all possible forms of living creatures and therefore could infect other people. Some community members even stopped buying or even touching Chinese products for the fear of infection: “This virus originated in China…it is a Chinese ploy to destroy the world. We must not touch Chinese Goods!” They perceived it as bioterrorism by China, which has engulfed the world. One community member joked that “this disease is a Chinese product and as usual it won’t last long.”
Identifying community needs
Vulnerable communities faced significant environmental problems during the pandemic. Lack of space and hygiene did not allow them to practice physical distancing and other preventive measures. Larger concerns related to sustenance, food and finance in the community also troubled them. Many wanted to go back to their villages, a decision likely to impact young people, especially girls, who might be compelled to discontinue their education and perhaps get married. Correct and credible information regarding the disease is necessary to clarify myths and misconceptions. From our experience, it is also important to listen to the community’s concerns and come up with solutions by engaging them where possible. Offering them psychosocial support, appropriate guidance, relief aid and referral where needed has helped ease out some of their concerns. Being there for the community in times of crisis has further strengthened SNEHA’s relationship with them and community members have volunteered to work with us especially to carry out relief work at the local level.
This pandemic has been stressful for all, but vulnerable communities need additional support during these uncertain times. While there will be global and national strategies to slow down transmission and reduce mortality, it is very important to understand the local context to be able to strategize appropriately and reach out to the most vulnerable among us.