Overcoming Denial and Stigma of COVID-19 in Slums: Story of a Gutsy Frontline Health Worker

Urban slums and informal settlements of the Global South are characterized by higher population density, overcrowding and poor education and awareness. Most slums and informal settlements are not in purview of health facilities. They are a neglected section of population largely representing the voiceless. These factors are conducive to an environment which perpetuates myths about certain contagious diseases and illness. 

We describe here instances of stigma and denial as well as a gutsy effort to overcome denial learnt from different slums of Indore.

Residents of Deep Nagar basti in Indore were in denial even when the area was barricaded owing to being in a containment zone. In another slum area Ganeshipura, residents shooed away women’s group members from a neighbouring slum and also put up a defense to reinforce the absence of any cases in the area.  Their false brave acts and defiant body language prevented UHRC mentored women’s group members from making any effort to help the basti families overcome denial. We learnt that at family and society level people prefer to be seen similar to the rest in their immediate society to not be singled out in a negative sense as would be if someone in a family was infected with Coronavirus. The fear of being treated like an outcast in the larger community and possibly loose livelihood opportunities also accentuates stigma and denial as most slum dwellers earn wages in informal work.

We learnt of a positive example where slum dwellers overcame stigma. In Aman Nagar Basti in Indore, 26 year old, Ratna a UHRC trained active Urban ASHA (Accredited Social Health Activist) was able to motivate families which had the first 2-3 COVID-19 positive cases to not consider the infection as stigma. She encouraged their family members and neighbours to get tested. She proactively visited the houses, and families in the vicinity and confidently encouraged them to go in for COVID-19 testing. Ratna, the Urban ASHA urged the Health Department team to visit and test family members and neighbours of those who initially tested positive.

Owing to Ratna’s commitment which she has acquired with UHRC’s training and outreach work since she was an adolescent, the Health Department sent their team regularly for 2-3 days to the basti. Her confidence comes from her mother who herself has been an active women’s group member. Ratna escorted them to the families that were in contact with the initial COVID-19 positive cases and continued to allay fears. Meanwhile, the Health Department team conducted COVID-19 tests and provided counselling to the basti families. Eventually 18-20 people were tested positive within the neighbourhood. Through these efforts basti dwellers were able to act in an informed way and overcome their fears. Most people in the neighbourhood wore masks to prevent them from spreading the infection and from acquiring it.

The examples of denial and stigma and the positive example of overcoming it, reinforce the need of NGOs to train slum community members, strengthen outreach and help vulnerable populations gain correct knowledge, overcome COVID-19 fear and stigma and get themselves tested. The role of community-level health functionaries (ASHAs) in slums also comes to the fore, in proactively addressing stigma, encouraging testing, and motivating preventing behaviours, such as wearing masks; especially in slums which are often the neglected sites for health coverage.

(The names of persons and places featured in this piece have been changed in the interest of privacy.) 

Siddharth Agarwal, Shabnam Verma, Neeraj Verma, Kanupriya Kothiwal

Urban Health Resource Centre