Public Health at the Kumbh Mela

In the Aftermath of the Stampede

– Satchit Balsari, HSPH Kumbh Mela Team Leader

February 11, 2013

It’s 1:30am and we are now in Benaras.  We delayed our morning departure to spend another day at the Kumbh.

Mauni Amavasya was not the uneventful day the organizers had hoped it would be. Officials say that 30 million people (one and a half times Bombay’s population) took a peaceful dip at the Sangam. Hundreds of thousands of pilgrims lined Parade Road to watch the processions roll by – the Naga sadhus, the Shankaracharyas, and the mahants, from Hinduism’s various denominations, and from India’s far flung corners. There were people everywhere – on the pontoons leading up to the Sangam, on the pontoons bringing them back safely after they holy dip, on Triveni Road, and Jagdish Road and Mahavir Road and every road that intersected every other road in the Nagri, on the hill next to the Sangam, inside the Akharas and outside the Akharas, on Shastri Bridge that spanned the wide Ganga, on the roads that led to the Nagri, on the roads that led away from Allahabad, on the 6000 buses waiting to depart from the seven bus stations, in the Ganga, in the Yamuna, in the Sangam and besides the Sangam. And on a footbridge over platform 6 at the railway station. It was the world’s biggest fair. Everyone was invited. And everyone came.

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The atmosphere was festive: the energy palpable, the excitement contagious, and the masses patient. Men, women, children, the elderly and the frail all headed to the Sangam. There was color everywhere: bright reds and greens and yellows and oranges. On the turbans, on the sarees, on the flags, on the walls. And there were songs: incessant, loud and mostly pious. And smells: of incense, and prasad and marigolds and humanity. And the millions walked to the Sangam with a purpose. They were resolute in step, but not hurried; they were carefree but cautious. They were happy. They were accommodating. They were joyous. The sight from 30 feet atop the watch tower at the Kumbh was one to behold:a dense, teeming mass of Snaanarthis (bathers), punctuated by billowing bright sarees drying in the wind. Bathers frolicked in the water. Commuters lounged where they could. Villagers tried to sell their cows for Godaan. The otherwise demure Indian homemakers stripped down to their petticoats to bathe in the river. The sadhus sat atop tractors and chariots and colorfully decked lorries. Commerce flourished. Sins perished.

It was indeed a beautiful day in Prayag. As it has always been for centuries when the Mela arrives at the Triveni Sangam. Except in 1954 – when a rogue elephant barreled into a dense crowd that had gathered to see their beloved Prime Minister Jawaharlal Nehru. The ghost of the resulting stampede has loomed over the Allahabad Kumbh ever since. No Mela adhikari, no Kumbh sevak, no politician, no government servant, no Allahabad nivasi wants another mishap at the Kumbh.

The sun was slipping behind the tent-tops. Everyone breathed a sigh of accomplishment, of satisfaction, and of relief. Another big bathing day had come and gone. And millions had been returned home safely. Almost.

The large notice board in the railway booking office compound in Sector 2 of the Kumbh Mela had 202 train options for people to choose from. Late last evening, when the Rajdhani arrived, thousands of eager commuters rushed up the sole footbridge from platform 1 to platform 6. Police tried to hold back the crowd. Some say a lathi (baton) may have been raised. No one really knows what happened, whose foot slipped first, who toppled next. But several hours later, when the last ambulance pulled by at SRN Hospital at 2:30am, 36 pilgrims were dead, over thirty injured. Three were in critical condition.

Two nights ago, a journalist from one of the world’s leading dailies was lamenting how hard it was to report on the Kumbh. That millions had gathered in India once again for a holy dip in the Ganga wasn’t new. Wasn’t captivating. Wasn’t interesting. The government’s worst nightmare had just come true: the Kumbh had suddenly become interesting.

“Horror at Kumbh” screamed the headlines in one of India’s largest dailies. And we, the HSPH Public Health team, shared the organizers’ disappointment, heart-break and dejection.

Thousands of people work for months on end to make the Kumbh Mela a success. The statistics are staggering, and yet, the Indian bureaucracy, sometimes fatalistic and often times laissez-faire – puts its muscle behind the Kumbh. The Kumbh Mela sees more resources, more planning, more implementation and more goodwill than any other large public project in India. It is tempting, very tempting, to therefore attribute the footbridge stampede to a freak but unfortunate accident that may scar the 2013 Mela forever. But to do so would be erroneous, for we believe that the footbridge accident is a symptom of a more pervasive malaise in the planning process, not unique to the Kumbh. The dismissive, overconfident, exclusive, hierarchical, rigid planning processes so rampant across institutions in the region, are as responsible for the foot-bridge stampede, as they are for the bottlenecks from the main avenues to the pontoon bridges, for hundreds that get traumatized every day running from pillar to post to search for their lost relatives at the Kumbh, for the thousands that get prescribed medications without so much as a cursory glance from their physician and for the oxygen tanks in the ambulances that can’t be unlocked without a key.

We will write more about these and related issues in the coming days.

A child propped up on the Lost and Found dias, waiting for his parents to spot him.

A child propped up on the Lost and Found dias, waiting for his parents to spot him.

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India Today Interviews Kumbh Mela Team

Read the full story here: http://indiatoday.intoday.in/story/2013-maha-kumbh-mela-public-health-research-harvard-university-india-today/1/249649.html

NYTimes Blog Highlights HSPH Research Project

Click here for the blog post: http://bits.blogs.nytimes.com/2013/02/08/can-big-data-from-epic-indian-pilgrimage-help-save-lives/

Counting Down to the Biggest Bathing Day Yet

Allahabad medical students input medical records from Clinic 4 into the custom iPad app.

Allahabad medical students input medical records from Clinic 4 into the custom iPad app.

Barricades on the edge of the Kumbh, designed to slow down foot traffic heading towards the Ganges.
Barricades on the edge of the Kumbh, designed to slow down foot traffic heading towards the Ganges.

India’s regional emergency call number is well advertised at the Kumbh.

India’s regional emergency call number is well advertised at the Kumbh.

The sector clinic’s ICU is prepped and ready.

The sector clinic’s ICU is prepped and ready.

The crowds grow exponentially in the day leading up to the holiest bathing day.

The crowds grow exponentially in the day leading up to the holiest bathing day.

Preparing for an Uneventful Day

– Michael Vortmann

February 9, 2013

The crowds in the Kumbh Nagri have swollen to fill the sandy Gangetic floodplain as the largest bathing day begins tomorrow. Today the roads brimmed with pilgrims on their way to and from the Sangam; the barricades rolled to block all vehicular traffic from entering the City. A great deal of attention has been paid to developing infrastructure that can both accommodate and control the movements of cars, lorries, rickshaws, bicycles, motorcycles, and millions of people.

The streets at the Kumbh Nagri are wider than those in most Indian cites. The major thoroughfares can easily hold four or five standard lanes of traffic. Although the road margins are periodically obstructed by celebrants lining up crossed-legged to receive Prasad or by the ubiquitous informal merchants displaying wares on ground cloths, there is no encroachment of the semi-permanent structures of the camps onto the road. The size and uniform width of these thoroughfares provide an ostensibly bottleneck-free area for the movements of people going to bathe at the Sangam.

At each major intersection moveable metal barricades manned by police can rapidly shunt the flow of traffic away from a particular area and generate unidirectional flow. These barricades typically control auto traffic only, but could in theory be used to move people away from a highly congested area with stampede potential.

Walking to the Sangam from the east bank of the Ganga one crosses the river on a dense network of pontoon bridges. Because the bridges are only wide enough for one lane of auto traffic flanked by two narrow sidewalks, major roads with bidirectional traffic split to traverse the river on 2-3 bridges each. A network of barricades and pikes control flow onto the bridges. Auto traffic is unidirectional but pedestrians so far are allowed to move in both directions. The bridges represent bottlenecks compared to the generous width of the roads. The western bank of the Ganga has a flat and gradual slope but the eastern bank is a 10-20 foot escarpment of sand that drops abruptly into deep and fast moving water. There is obvious potential for drowning in the event of a stampede. Post and rail fences and cuts through the earth of the embankment that funnel the crowds onto the bridges attempt to mitigate the dangers posed by these natural obstacles.

At the heart of the Sangam on the west bank of the Ganga, the land gently slopes into the water. As one nears the bank, straw blankets the ground for approximately 30 meters to provide traction for millions of wet feet as they return from the holy waters. Getting nearer the water, the straw gives way to sandbags lining the river’s edge for 1-3 meters for the length of the major bathing areas. The sandbags are placed to prevent erosion and stabilize the bank, but they also have the effect of solidifying the sand for the crush of people waiting their turn to enter the water.

The river currents are treacherous, swift and changeable as the Ganga merges with the Yamuna and the water deepens precipitously as one walks from the water’s edge into the depths of the river. Periodically positioned spurs of sandbags serve to break the swift current into safer eddies for the bathers. Poles sunk into the mud and connected by cordons demarcate the deep water where hired rescue boats bob in a state of constant alertness.

Outside one of the main entrances into the Kumbh, where city roads meet Nagri roads, crowds are to be diverted into a massive corral spread over five to seven acres, where they will be encouraged to follow winding paths demarcated by bamboo fences.  Some locals fear that the visitors may simply jump through the fences and attempt to cut straight through the field.

All roads leading to the Mela, and for several kilometers around, have been shut to vehicular traffic. The paths to the Sangam are packed, the bridges are full, and the sidewalks lined with sleeping pilgrims. Millions will soon descend upon the confluence for their holy bath. The atmosphere in the administrative offices is tense. The wide roads, the winding corrals, the sturdy bridges, the sandbag spurs, the rescue boats and the mounted police are in a heightened state of readiness. Long months of deliberations, design and implementation have been invested to make this one day as uneventful as possible – as uneventful as the world’s largest human gathering can be.

Sandbags line the river banks.

Sandbags line the river banks.

Crossing the Triveni Bridge.

Crossing the Triveni Bridge.

Bathing by the river banks.

Bathing by the river banks.

A lifeguard keeps a watchful eye on the crowd.

A lifeguard keeps a watchful eye on the crowd.

 

Mapping the Mela – Presenting Complaints at Four Health Clinics

clinic-infographic_020713

This infographic, created by reporter and editor Logan Plaster, demonstrates where people are congregating and the ailments that are prevalent at each clinic.

Dispatches from the Kumbh

– Logan Plaster

February 6, 2013

 

Diya

February 6th was one of the main bathing days for the Kumbh Mela and for once, jet lag came in handy. Dawn is perhaps the best time to witness the ancient ritual of bathing where the Ganga – or Ganges – river meets the Yamuna, and I awoke with time to spare. I descended from the hill where our tent was perched with Dhruv Kazi, a cardiologist from San Francisco who completed our team of four from FXB.

We heard the Kumbh long before we entered its hazy, golden streets. In fact, if you close your eyes anywhere in the river valley where this pop-up mega city has been erected, you can hear the constant, occasionally thunderous hum – car horns, public announcements and sacred song punctuated by the occasional blast of fireworks. But don’t close your eyes for too long. Cars and motorbikes speed down muddy make-shift roads made of endless connections of steel plates. One must keep their wits about them to walk safely on the Mela’s bustling avenues. But whether eyes wide open or shut, one can appreciate the constantly shifting thrum of the Mela and its masses.

The crowds are thick but subdued near the water, some anticipating and others savoring the memory of the morning’s sacred dip. The morning sun is full and low on the horizon, shrouded in a haze of smog. A family gathers at the water’s edge to light a paper diya – a handmade paper boat bearing a small, lit candle. Their prayers complete, they launch the offering into the Sangam – the confluence of the holy rivers. A long-haired Sadhu – or religious ascetic – plunges fastidiously into the shallows again and again, drawing the attention of a gaggle of foreign photographers. A woman squats shivering on the bank and tries to cover her cold, wet shoulders with a dry sari.

The crowds are quiet, attentive to the task at hand. And I, too, keep silent, feeling more than ever that I am in another’s world. I put my camera away and give what I hope is a friendly nod to a boy selling diyas made of large leaves. He knows I am a stranger, but his smile bridges the gap and welcomes me all the same.