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 

How Vegetable Gardening is Helping Slum Families tide through the COVID-19 Pandemic

Key messages: Home vegetable gardening promoted by provision of seeds is helping families use tomatoes, brinjals, pumpkins, beans growing in their small slum houses. In 2020 the distribution of seeds was increased from 900 (in 2019) to 1200 families. Since April 2020, during COVID19, sharing of surplus harvest with neighbours is helping over 70000 slum dwellers surmount food insecurity in the #hardtimes. 

UHRC has been promoting vegetable gardening since past five years in slum households in Indore. Seeds are provided by UHRC social facilitators. Facilitators motivate families to tend plants as they grow. Basti (slum) families grew beans, bottle gourds, round gourds, sponge gourds, tomatoes, brinjals, small green peppers, and pumpkins in small spaces and broken buckets. Creepers also helped surmount space constraint. They were motivated, overcome space constraints of small slum houses and enhanced confidence to nurture household vegetable gardens. Diffusion of innovation happened with #earlyadopter families encouraging other families in a demonstration of collective wisdom resulting in efforts of broader benefit.

Bast (slum) families were practicing vegetable gardening were able to avail benefits of their produce during COVID-19 which ravaged livelihoods and savings of many slum dwellers. In 2019 to 2020, 900 families grew 60000 kilogram vegetables. Families were able to cook vegetables which they grew such as bottle guard, tomatoes, cauliflower, brinjals etc. This approach served as lifeline helping many families tide through the acute crisis during the May-July 2020 lockdown and continues to help many families who as they wade through uncertain livelihoods and exhausted savings. 1100 families are sharing their produce with neighbors setting examples of #solidaritynetworks, promoting a sense of psychological well-being and accomplishment crucial to the well-being of urban vulnerable population. During the COVID-19 challenging times in 2020-21, vegetable gardening is helping about 70,000 disadvantaged families surmount nutrition and food insecurity in the hard times.

During 2020, UHRC has increased the distribution of seeds from 900 (in 2019) to 1200 families in 2020. 

Home vegetable gardening in bastis (slums) demonstrates an approach of local resilience promoting food security and inclusive urbanization. Home gardening, a constituent of urban agriculture has the potential to foster crucial elements of healthier, more sustainable cities. This is helping during #COVID-19, and can be helpful in non-COVID times as well. Growing vegetables in small basti (slum) houses is a strategy towards SDG11 (Sustainable Cities and Communities), SDG2 (tackle undernutrition and hunger)

 

Despite each home garden being small, these have the potential to mitigate carbon emissions a key #climatechange challenge affecting the world. Vegetable plants release oxygen, sequester carbon in the soil, and reduce atmospheric carbon. They also contribute to the cooling effect in urban spaces. 

Home-grown vegetables save valuable family income through the provision of vegetables for the family’s consumption. Growing vegetables despite small spaces and sharing with neighbors promote a sense of psychological well-being, accomplishment, and enhances social cooperation all crucial to the well-being of vulnerable city populations. This strategy of motivating slum families has the potential of replication or adaptation in cities of India and other LMICs.

Siddharth Agarwal, Neeraj Verma, Shabnam Verma, Kailash Vishwakarma, Kanupriya Kothiwal

Urban Health Resource Centre, Indore