– Satchit Balsari, HSPH Kumbh Mela Team Leader
February 5th, 2013
Today, the second team from the FXB Center for Health and Human Rights arrived at the Kumbh Nagri to continue to study the public health implications of the Kumbh Mela. The public health team that visited the Mela along with the rest of the Harvard contingent in January had initiated a disease surveillance system at the sector hospitals serving the pilgrims visiting the Kumbh. This ambitious undertaking piloted at four of the 10 sector hospitals hopes to capture, in real time, the epidemiology of diseases presenting at the healthcare facilities at the Kumbh Mela. The project is implemented locally by a large network of medical students from across India, who, for the past several weeks, have been diligently recording data from patient registries into their iPads. Navigating bumpy roads, traffic jams, long distances, inclement weather, and reticent physicians (sometimes enthusiastic, often times reluctant, and always overworked), our medical students are having “a time of their life.” They said so themselves – over chai and halva – as we exchanged notes against the tintinnabulation of the evening’s aartis rising simultaneously from the many akharas beyond our fence.
We met with Aaron, Ahmed, Ghanshyam, Raunaq, Aditi and Shrunjal. After a 10-hour work day, a stalled motorcycle, and a 10 kilometer walk, they looked upbeat, excited, and were bubbling with ideas. Most of them are on the cusp of graduating from medical college, having just passed their boards, or about to take them. Their interests are diverse, ranging from psychiatry to critical care, yet what brings them here is a spirit of adventure and a commitment to service. “I would never have thought of coming to the Kumbh, were it not for this project,” said Shrunjal, “and I am glad I did.” They did not all know each other before this trip, and now they have learned to share a heating coil to heat up their bath water, learned how many snooze alarms it takes them to get out of their beds in the morning, and learned how to cajole the overworked physicians at the sector hospitals to write more legibly. Aaron, the New Yorker amongst them, and supervisor-at-large, has the best local sense of direction.
This evening, after settling into our rather comfortable tents perched on a small hill overlooking the Nagri (as had several members of this team, in the weeks preceding us), we walked over to the observation patio that overlooked the Sangam. I had visited the Nagri in the early days of December when it was under construction: endless rows of lusterless electricity poles marked a grid on the shifting banks of the Ganga, a few saffron flags fluttered impatiently in the evening breeze, important looking jeeps circled the empty plots unable to decide on a final location to pitch camp, and the final pontoons were being lowered into the water on the far-side. I had imagined what it would be like once the Mela started: saffron robed sadhus, pious pilgrims, loud chanting, incense, beads, flowers, and the holy dips. But I had imagined it in the light. This evening, I saw it in the dark.
From where I stood, all I could see – for as far as I could see – was a sea of golden lights, a million Diwali lamps lighting up the world’s largest fair.
Tomorrow, our team informs us, is an important bathing day: Ekadashi Snaan. Roads may be blocked, and millions may throng to the banks for a holy dip. Unfazed, we plan to venture out to visit the sector hospitals, the fruits of our teams’ labor in hand. The diligent work done by the medical students from Allahabad, Mumbai, Nagpur (and New York and Boston) has allowed us to create daily graphs of the frequency of medical complaints or diagnoses presenting to the hospitals under study. Tracking the frequency of diseases over time will allow us to understand and question deviations from the expected trends. Does an acute rise in incidence indicate a jump in the population or does it portend an epidemic? Can outbreaks be predicted in this setting before they occur? What ailments does this population most suffer from? Is some part of the burden of disease preventable? Tomorrow, we will present our analyses to local physicians hoping that they may pause and reflect on the enormity of their contribution. In ten days, over 12,000 patients have passed through four sector hospitals, as many diagnoses have been made, and over 15,000 medications have been dispensed.
The questions compete in number only with the bustling hordes of Kalpavasis coming to the Nagri: Who protects the health of this population? How effective is the water purification? How effective are the pit latrines? How is the sewage treated? What if there is an outbreak? What about the children? Where do they go if they are lost? Who cares for them? How are they found? Are they found? What about the elderly? The infirm? What if there is a stampede? A fire? A collapse?
The list is long, our time is short, but the opportunity to ask and answer, to seek and find, is priceless – as is the rhythmic beat of distant dumroos rising from the valley as they now lull our jet-lagged souls to sleep.
Tomorrow, will be our first day at the Kumbh Mela. Tomorrow we will see the Sangam.