Not the same Surat

Four years after the "plague", this Indian city is cleaner. But is it healthier?

This is a new-leaf story. Well, almost. Of how a dirty city that bred a mysterious plague three years ago, went on o become (according to one survey) India´s second cleanest city. Surat, in the western state of Gujarat, is no longer the friendliest of places for garbage or rats, nor should it enthuse those on the lookout for muckraking stories. After the mystery epidemic that spread panic in 1994, the city has cleaned up its act. But in the process, it is learning a few lessons on the difficulty of sustaining cleanliness.

By September-end 1994, Surat had seen the worst of the ´plague´ (see box on following page). A few dozen people had died, a few hundred had been hospitalised, and a few hundred thousand had fled. Panic spread beyond Surat and beyond India. Airlines cut flights, those that did take off were fumigated on arrival, and tourists shunned India. Surat´s workers sought refuge in their native villages in Gujarat and neighbouring Maharashtra, deserting the textile factories and diamond houses that provide the city its wealth. However, during their absence, the municipal corporation got to work. Under an ambitious Action Plan, city workers cleared thousands of metric tons of garbage and sprayed more than 60 metric tons of insecticide. As people trickled back to the city over the next few weeks, they found Surat a changed place. Or, as put in Hindi, Surat ka surat badal gaya – Surat´s appearance has changed.

Once the initial caution subsided, however, the same lame municipal system remained and the dirt returned. An interim administrator instituted a cleanliness campaign, but no substantial change was noted. The only change that came about was political, but then it proved to be a blessing. After the February 1995 state elections in which the Bharatiya Janata Party came to power, it named a new municipal commissioner – Suryadevara Ramachandra Rao, whose previous record belied the kind of dramatic changes he would bring about in Surat.

Into the wastebasket

Rao, or ´Rao Saheb´ as he is better known in Surat now, was appointed Commissioner in May 1995. He says that when he arrived Surat had its neck on the chopping block, "The monsoon was fast approaching, and the city was as dirty as ever." His response was swift: a massive, institutionalised effort to clear the city of garbage. Rao and his team were able to more than double the amount of solid waste collected, from a daily haul of 400 metric tons before May 1995 to 850 metric tons in 1996.

Although not revolutionary, Rao´s changes are effective. Like the increase in the number of municipal sweepers from 3085 in 1995 to 4397 in 1996. And the sweepers, under the eye of more supervisors (and paved footpaths which render their task less difficult) are doing a better job. The roads have been widened too, and are now swept daily. Rao has also added 25 tractors and 445 bins for garbage collection.

It doesn´t stop there. A system of assessing fines is now in place to curb improper waste disposal by individuals, households, factories and others. In 15 months (from September 1995 to December 1996), the municipal corporation extracted fines of more than INR 3.9 million from 27,556 people. The effective penalty system has done wonders in making Suratis give up old habits. For instance, under threat of a 50-rupee fine, fruit vendors now keep wastebaskets under their carts.

The response to all that has been happening, from both inside and outside Surat, has been encouraging. The Indian National Trust for Arts and Culture, a non-profit group based in Bangalore, surveyed 80 cities of the country and chose Surat as the second cleanest city after Chandigarh. In an exhaustive study of the ´plague´ and its aftermath, Ghanshyam Shah, former director of the Centre for Social Studies in Surat, concludes that the city is significantly cleaner, even in the slum areas.

Most Suratis also confirm the difference. "Places which once could not be cleaned in the night, now for the whole night, people from the sanitation department are there," says Satish Tamakuwala, owner of a dry goods shop in the central Chowk area of the old part of the city, where a labyrinth of narrow alleys connects hundreds of tiny storefronts and homes. In the evenings, this area is choked with shoppers. However, considering the volume of foot traffic, the relative absence of trash is remarkable.

The changes extend to the outskirts as well. "The sweeper comes every day in the morning and in the evening," says Sashikala Sonunimai, who works in a medical practitioner´s office and lives in Udhna, an industrial pocket, one among the several localities incorporated into Surat in the late 1980s. The modest concrete house where Sashikala lives with her sister´s family sits in a colony near the Udhna railway station, the first stop on the way from Surat to Bombay. "Before the plague, it was really dirty here," she says. "Now it´s really good, there´s no fear that the plague might strike."

What plague?

The belief that clean streets will somehow prevent the recurrence of plague (if indeed it was one in the first place) is widespread, but it may be rather misplaced. Plague bacteria is usually transmitted from rats to humans via fleas, so while the clearing up of garbage does reduce the risk of infection, it doesn´t wholly prevent it. Laxminagar (picture, right) and Ramnagar, where the earliest cases and most of the deaths were reported, were neither the dirtiest, nor the poorest, nor the most crowded neighbourhoods in Surat. So why were these places so much more affected?

Geography may have been the deciding factor. The land in that part of Surat, on the southern bank of the river Tapti, is bowl-shaped. In 1994, the river overflowed its banks, carrying with it garbage and sewage directly to the bottom of the bowl, where the unlucky residents of Laxminagar and Ramnagar make their home. Dinesh Prajapati, a diamond worker living in the Ved Road area, recalls how he built a raft from empty water containers and paddled around the lake of filth, among carcasses of pigs, dogs and cows. "After three days, the water receded," he says. "The water was gone." But the filth stayed.

Today, this lack of drainage and access to sewer lines is the real challenge, much more difficult than sweeping the streets and collecting garbage. Since Rao took office, access to municipal sewerage has increased by a bare 2 percent, from 50 to 52. To provide sewer and water services to its population for the next seven years, Surat will need INR 11,000 million. In comparison, the city spent only INR 62 million on sanitation services in 1996-97.

For those living outside the flood-prone areas, the lack of municipal drainage doesn´t seem to be a significant problem. Now that the city looks clean, most Suratis point with pride to their new sense of civic responsibility. They have a point there. Rao´s decision to widen the roads could not have come off without public support. About 45,000 shops and a few thousand dwellings were destroyed, mostly with the owners´ consent. Thus, Surat effectively added more than 78,500 square metres of area and 45 km of road space, easing some of its severe congestion. While this may have made the city more habitable, an immediate, and perhaps only-to-be-expected, fallout has been that many now find it irrelevant to trace the origin of the panic four years ago.

Now for consolidation

However, complacency is the last thing Suratis can afford, given the precarious nature of the city´s success. Bad news may just be lurking around the corner. As an IAS officer, Rao serves at the will of the Gujarat state government, and expects to leave office by this spring. Political infighting in the state capital, Gandhinagar, has already prompted the commissioner to request a transfer nine times.

And Rao´s successor may find the going tough. Unlike Rao, he, or she, is likely to face a resource crunch. When Rao took over, Surat municipality had hundreds of millions of rupees in both its revenue and capital accounts. "Before Rao came, the municipal corporation was claiming to be very rich only because whatever they were planning they were not able to spend," says I.J. Desai, a lawyer and accountant, and the President of Surat Citizens´ Council, a local community organisation.

Before May 1995, the corporation spent about INR 300 million per year on capital projects; in 1996, it spent INR 1650 million, even as it went about looking for further large-scale capital projects from the World Bank and USAID. On the revenue side, Rao pumped in money by collecting delinquent property taxes and levying fines. But these are not perennial sources. For any future expansion of municipal services, Surat may well have to raise taxes, an unpopular option in a city where they´ve remained stable for 17 years.

Finally, and rather ironically, the enthusiasm for cleanliness may well be sullying the environment. All that garbage from the streets has to go somewhere, and so far, the only options are crude landfills. One resident of Laxminagar held up a glass of water and angrily insisted that the garbage has contaminated the bore wells they rely on. In Bhesan, a village just south of the city limits, residents blamed an outbreak of gastroenteritis last October on municipal seepage and, in retaliation, beat up a city engineer to within an inch of his life. The gap between those who benefit most from Surat´s new image, the middle-class professionals living in the central areas, and those still standing in line at the municipal taps is wide.

All said and done, Surat has shown that it is possible for a dirty, overcrowded city to come clean. But without adequate municipal services and the long-range investment necessary to sustain them, a clean city does not necessarily mean a healthy one.

Was it or wasn´t it plague?

During the critical epidemiological moment – when patients were streaming in to be examined, tested, and treated – none of the data in the patient charts was correlated or analysed. The doctors could not tell whether or not cases were clustered geographically, nor did they know how many suspected cases tested positive for plague at any given time. "If you want to prove that this is an epidemic, then you have to have this data," says Dr Ketan Jhaveri, the resident in charge at the New Civil Hospital during the outbreak.

Since then, scientists have had to struggle to re-create what happened. A Gujarat state committee, a central government committee, the National Institute of Communicable Diseases, the Centre for Disease Control and Prevention in Atlanta, private laboratories, and the World Health Organisation have analysed samples collected during the outbreak. The results have been inconclusive, mainly because of the difficulty in isolating the plague bacteria from old and sometimes contaminated tissue samples.

Although its findings were not much different from the others, WHO was the first official body to question whether the plague bacteria was present in Surat at all. Its December 1994 report burst open a Pandora´s box of doubts and theories, and bolstered the position of some Indian doctors who suspected that the symptoms in Surat fit the pattern of meliodosis or tularemia. Either of these, as well as malaria or tuberculosis, could have been present among the thousands of patients treated, but without testing all of them, it is impossible to tell for sure.

Later, in 1995, WHO reported that the Surat plague was different from other known strains of the yersinia pestis bacteria. This unleashed speculation that the microbe was a genetically engineered weapon of biological warfare and fuelled the current rumour that Pakistani intelligence agents had planted it (apparently with the cooperation of the local rat population and the river Tapti). In the absence of better epidemiological information, speculation can run wild.