Will the measles virus cross class boundaries?
A health worker administers a vaccine to a child at a temporary vaccination camp in Govandi, following a measles outbreak. (Vijay Bate/HT Photo)
Measles is much more infective to others than Covid. But its resurgence has been seen across the world in those whose lives and livelihoods were uprooted by Covid.
Sanjay Nagral
Nov 28, 2022, Hindustan Times
During the mandatory internship that medical students do after the MBBS course, they are posted to rural as well as urban primary health centres. This is supposed to be an exposure to the world of primary healthcare in the community as opposed to the big medical colleges where they spend their relatively insulated five years. Those from Mumbai’s municipal medical colleges spend two months in what is called the urban preventive and social medicine term in one of the municipal suburban health posts located in large slum communities of suburban Mumbai. I spent those months at a health post in Malvani, the large slum pocket in Malad.
Today’s interns continue the urban health postings. In health posts across suburban slums which have grown. One such centre serves the population of Deonar and Govandi. Close to the huge artificial hill made by the city’s waste that is dumped round the clock. Around which live one of the city’s poorest and most vulnerable populations. Vulnerable due to their identity, occupation and geography. The community of waste pickers whose lives have been so evocatively described by Saumya Roy in her recent book Mountain Tales; Love and Loss in the Municipality of Castaway Belongings. It is the same Govandi which is at the epicentre of the current measles outbreak in Mumbai, which has already affected a large number of children and claimed more than 15 lives. Govandi, Dharavi, Kurla and Bandra are home to some of Mumbai’s largest slums.
Measles is one of the oldest viral diseases. Before the 1960s, when a vaccine became available, nearly all children got measles by the time they were 15. The measles vaccine is one of the oldest and most effective vaccines in the armamentarium of modern vaccination. A double dose gives a 95% protection and those who escape its protection get a mild illness. However there are two factors which predispose to severe illness and even the occasional mortality; lack of vaccination being one but the other is malnutrition. Malnutrition as a ‘comorbidity’. Now where have we heard that term before?
Measles is much more infective to others than Covid. But its resurgence has been seen across the world in those whose lives and livelihoods were uprooted by Covid. Who may have got the Covid vaccine but missed the measles vaccine in the chaos. Will the measles virus cross class boundaries like Covid did? Unlikely, since most kids born in this period would have hopefully received the vaccine. But there is yet another shocking statistic emerging from the current epidemic; the 15 plus deaths. Even if the unvaccinated kid develops severe measles pneumonia it should not kill. And here is where we are collectively complicit.
In preventive medicine medical students are taught something called ‘social determinants of health’ a term both accurate but reductive. Malnutrition is largely poverty translated for better acceptance. Currently it is also a Covid side effect. The children who died should not have. The potentially fatal form of Covid pneumonia can be treated with quality intensive care, including ventilators. The uncomfortable truth is that these children are unlikely to have got that kind of care at the right time. This is an area where the gap between the private sector and the public sector is huge. Whilst the large population of slums are mutating into SRA buildings to make way for swanky towers the healthcare infrastructure hasn’t changed. Basic family doctors in small clinics often with Ayush degrees conduct what’s called a ‘roaring practice’ well into the night and treat fevers and skin infections. They serve the need for the slum dwellers as they offer services when the day labourers return from work. The MCGM’s health posts are not the first choice for the residents of slums.
The innards of the slums of Mumbai have been the subject of several piercing pieces of writing and cinema. Katherine Boo’s ‘Beyond the Beautiful Forevers’ is one such incisive piece of narrative non-fiction which also relates how the residents face health challenges collectively. The measles epidemic is unlikely to directly touch most of us. It’s an epidemic from the other side.