Battling Cancer from the Roadside

Every day hundreds of patients make their way to Mumbai’s Tata Memorial Hospital, the nation’s premier cancer treatment facility. An acute shortage of hospital beds and lack of funds forces many patients and their families to live on the streets around the hospital during the course of their treatment. This is their story.

Text and Photos by Tanvi Khemani

It has been nine months, but Shiv Shankar Yadav vividly remembers the day he and his starry-eyed wife Savita Devi first landed in Mumbai, hoping to get her cured of cancer. An acquaintance of his had described the sprawling Tata Memorial Hospital (TMH) as a complex spread over seven floors and surrounded by swanky offices and high-rises in Parel. But Shiv Shankar, an acutely poor daily wage-worker who used to earn only Rs. 100 per day in his village in Bihar, made sure he brought along a panni (a thin black colored plastic sheet) and a mattress. He knew that they would have to live on the pavement outside the hospital while she received treatment there. Just like hundreds of other patients and their families belonging to the low-income group Shiv Shankar and his wife migrated to Mumbai, the city that never sleeps – only to sleep on its pavements.

Usha moved to Mumbai in August to battle cancer. Even as she faces daily hardships living on the pavement, her children Sagar and Sonali are just worried about befriending children from other pavement-dwelling families so that they can play games together.

The hospital is part of the Tata Memorial Centre, a comprehensive centre for the prevention, treatment, education and research in cancer. It is estimated that 70% of the patients at the TMH are from the low-income group and most of them are migrants into Mumbai. The hospital’s Handbook for Patients states that the two categories of patients from the low-income group are the Not Charged (NC) patients who only pay for their medicines and the Charged patients who have to pay for their consultation and investigations as well. However, the 576 beds in the hospital are not enough for all. A volunteer working with a non-profit organisation in the area, who did not wish to be named, estimated that there are currently 400-500 patients living on the pavements outside the hospital. She claimed that the number of poor migrant patients to TMH has increased sharply in the last ten years. This is partly due to the shortage of adequate medical facilities in the country, especially in states like Uttar Pradesh and Bihar.

No attempt has been made by the medical fraternity, social sector or government to tackle the housing problem of these patients. The patients and their families occupy half the pavement across the hospital in a seemingly endless row of makeshift tents. One can see their clothes drying on the railings and feet protruding from under lots of ‘pannis’ (plastic sheets used as roofs). Even though they live on the streets, they try and keep their dwellings clean. “I sweep the floor thrice a day and we dispose of garbage in plastic bags. This pavement and panni is going to be our home until the treatment is complete,” says Sunaina Devi, wife and caregiver of Anandi Shah, a patient from Bihar. She has tied their tent to the railing of the pavement on one side and has secured the other side using some bricks she found nearby. She stores drinking water, spices for cooking, and utensils in small cardboard boxes inside her makeshift home. She said, “We brought clothes, a lota (glass) and a stool when we came from our village and begged for other things here. The mat we are sitting on is on loan from another patient who has gone home.”

The hospital authorities claim that TMH allows these patients to fill drinking water and to use the toilets on the hospital premises to help them stay clear of infections. But many of them have to use the ‘Sulabh Sauchalaya’ and drink tap water found nearby. The toughest time of the year for them is the monsoon, when the panni proves powerless against the constant rain and their mattresses get soaked.

Volunteers manning the NGO desk inside TMH said that there are some free dharamshalas such as Gadge Maharaj Dharamshala in Dadar, which charges Rs. 50 per day and also provides meals. Anandi Shah had tried his luck there first. “At the Dharamshala they told us that we would have to stay on their open ground under a panni till our turn for a bed came so we decided that if we had to live under a panni anyway, we’d rather live near TMH,” he said.

According to information in the ‘GLOBCAN Project 2012’ report published by the International Agency for Research on Cancer (IARC) under the World Health Organization (WHO), there were over 1 million people living with cancer in India in 2012. In contrast to the survival rate of 50% for cancer patients in more developed countries, patients in less developed countries like India have an abysmal survival rate of 33%. To match the standards of care for patients set by the WHO, India will have to add 1.7 million hospital beds and double its medical manpower, given its current population.

There is a need to reform the health sector itself. Dr Nitin S, an MD in Clinical Pharmacology at Sion Hospital said, “The hospital may provide subsidized medicines and radiotherapy or chemotherapy for the patients, but this is not enough. Factors such as diet, hygiene, exercise and counseling are equally important in the treatment of cancer.” He added that interventions aimed at decreasing the loneliness and isolation of migrant patients are needed to supplement their treatment.

Shiv Shankar is the sole earning member in his family of ten people. He had saved Rs. 60,000 from majdoori (daily wage labour) over many years, which has already been spent on his wife’s treatment. Like many other patients, he has borrowed extra money for the treatment at a very high rate of interest.

TMH has made arrangements for free meals for these patients on its premises. However, there is a catch: some medical officials at the hospital believe that this food is not sufficiently nutritious for the patients, and they urge them to eat homemade food instead. Savita Devi said, “The doctor told us that I should not eat the food distributed by the Sai Trust as my chemotherapy treatment has made me very weak.”

The hospital authorities claim that TMH allows these patients to fill drinking water and to use the toilets on the hospital premises to help them stay clear of infections. But many of them have to use the ‘Sulabh Sauchalaya’ and drink tap water found nearby. The toughest time of the year for them is the monsoon, when the panni proves powerless against the constant rain and their mattresses get soaked. Living on the pavement renders them especially vulnerable to contagious diseases like influenza, malaria and dengue at this time. Shiv Shankar recalls, “During the monsoon we sat in knee-high water all night, on this pavement.” The mosquitoes are another menace.

The inside of a typical tent ​occupied by a patient on the pavement. ​Besides luggage, patients bring along utensils from their villages to cook food for their families. Their first acquisition in Mumbai is often some plastic bottles, used to store water filled from nearby taps.

Shiv Shankar is the sole earning member in his family of ten people. He had saved Rs. 60,000 from majdoori (daily wage labour) over many years, which has already been spent on his wife’s treatment. Like many other patients, he has borrowed extra money for the treatment at a very high rate of interest. “How can my uncle, who was a daily laborer, pay Rs 2.5 lakhs for his surgery which the hospital is quoting?” wonders Shabir Ahmad, a young mechanic who has accompanied his uncle Kallu mian to a session of chemotherapy.

Bangali Yadav, a 50-year old thoracic cancer patient from Bihar, sits with Shiv Shankar and they watch the traffic thunder past them as reminisce about their villages. They miss their children and hope to bring them to Mumbai one day to see this majestic city. Bangali says, “I had never even dreamed that we would come to Bombay sheher (city) in this lifetime.” Anandi’s love for the city is palpable as he says, “I have roamed many cities, but this is the best city. We are able to survive because of the generosity of big companies and hotels. This doesn’t happen anywhere else.”

“They are very brave”, said Bhano Subramaniam, a social worker who has been working with the patients for over a decade. Chandra, her colleague at the Social Welfare desk in TMH, marvels at the indomitable spirit of these patients. She says, “We’ve seen some patients come, stay on the pavement for months, eat paav bhaji and whatever else they can find, and go home fully cured.”

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You Can Get Help Here

During registration at TMH, each new patient is provided with ​an identity card ​which allows repeated entry into the hospital and access to food and help from NGOs affiliated to ​the hospital.

1. Helpline for patients at TMH: +91 2224177099/ 2224177000
2. Medical Social Workers Dept. of TMH https://tmc.gov.in/medical/departments/as/as.htm
3. Indian Cancer Centre (Parel): 022 2413 9445
4. V Care Foundation helpline: +9198219 49401/02 toll free 18002091101
5. Dr Ernest Borges Memorial Home in Bandra (accommodation through TMH): 02226591404
6. St. Judes Centre for Children (accommodation for children): 022 2417 1614

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Cover picture: A row of temporary housing structures set up by outstation patients directly across the road from Tata Memorial Hospital.

City of God

Ishwar Nagar, a slum in Borivali, represents one of the many clusters of people being left behind as Mumbai makes its tenuous claims to global cityhood.

Text and Photos by Sujata Sarkar

Leelabai Anumangta was a young girl when she came to Mumbai with her husband. She had dreams of a comfortable city life but the bubble soon burst when she realized that all her husband could afford was their one room in the slum. In the 66 years of her life, she has seen many changes around her but the one thing that has never changed is the fact that she still lives in Ishwar Nagar, a slum in Borivali. She looks longingly towards the sky hoping that the incessant showers of rain would abate giving them a little respite from the leaking roof. Shalini, who works as a domestic help, Ranganath, a taxi driver, and Sunita Rathore, a stationery shop owner, are her immediate neighbours with whom she has to share the limited amenities provided.

A closer look into Ishwar Nagar and its neighbouring colony of Abhinav Nagar in suburban Borivali, situated 18 kilometers from the airport, reveals that there are still raging issues regarding housing which include the problems of segregation, legalizing land and illegally constructed structures, connectivity, water issues, sanitation and drainage. In most instances the problems are highlighted only prior to an election and forgotten as soon as the local councilors, MLA’s and MP’s are elected. “We only see them
during election time. They give us assurances and then they disappear. Every time before voting we hope that they will do something but we are disappointed every time. We are under the municipal responsibility of Shilpa Chogle, an MNS leader. We have never seen her after she has been elected,” says Ranganath the taxi driver, who is also secretary of the Ishwar Nagar Rahivasi Sangha housing committee. The block they live in is a series of rooms interconnected by a common passage through which both humans and rodents scurry by and sadly even on a scorching day, sunlight never filters through into their dark homes.

“Often we all, and especially the kids, fall ill because of the mosquitoes. The gutters are not cleaned, waste is dumped around us. The municipal fumigation squad comes on its rounds but to bring them here is an additional hassle for us. They only come after repetitive calling and pleading. But that does not help much because the breeding grounds of mosquitoes and flies are not being cleaned regularly.”

The affluent Abhinav Nagar and the derelict Ishwar Nagar exist side by side, separated only by a boundary wall; the wall almost reiterating the fact that proper housing and living amenities are available only for those who belong to the so called ‘upper class.’ Ironically the slum at Ishwar Nagar exists as a paradox of our times where on the one hand there is talk of India ‘cleaning up her act’ and moving on to become a power to reckon with and on the other hand, we see three-fourths of the population still struggling to live in better conditions. In fact for a long time, Ishwar Nagar did not have proper toilets and open drains were used by inhabitants for their daily ablutions. The local municipal corporation turned a blind eye and it was up to the residents to make their own arrangements for improved living. “We have built a toilet ourselves without any help from the government. We also pay for its maintenance. Not just the toilet, the entire colony’s roads and houses have been constructed by us,” says Ranganath.

Monsoon is a time of heightened struggle with the added challenge of keeping their belongings and homes dry and habitable. In most cases, there is waterlogging, the roofs leak and there is an increase in both water and air borne diseases. Clogged gutters with breeding mosquitoes are yet another cause for worry as both children and old people are vulnerable to diseases such as dengue and malaria. “Often we all, and especially the kids, fall ill because of the mosquitoes. The gutters are not cleaned, waste is dumped around us. The municipal fumigation squad comes on its rounds but to bring them here is an additional hassle for us. They only come after repetitive calling and pleading. But that does not help much because the breeding grounds of mosquitoes and flies are not being cleaned regularly,” says Sunita Rathore who runs the stationery shop. When the Brihanmumbai Municipal Corporation inspectors were contacted to comment on the situation they refused to specifically comment on the matter. The general idea conveyed by them was that though the basic civic amenities are provided, the population and unplanned habitation are a hindrance to proper management.

The journey through Ishwar Nagar is synonymous with struggle and as one walks along, one cannot help but feel anguished at seeing the living conditions in which these slum dwellers reside. While some of them like Sunita Rathore own their own small business establishments and can afford to send their children to school, most of the others such as Shalini are domestic workers who are employed in Abhinav Nagar.

Shalini, Sunita, Ranganath and Leelabai are just a few of the faces which represent the agonizing helplessness and desperation that comes from facing tough circumstances, where everyday life is a battlefield. A new battlefront has now opened – the local government is eyeing the land for further development. As Leelabai says, “We have been living here for decades and each one of us has a voter card, an aadhar card and ration card! Why did the government give us all the cards if they want us to leave now? Yes, we do not get all the facilities but no one can ask us to leave overnight and that too without compensation.”

The struggle to retain their living space and at the same time to make it more habitable continues for the residents of Ishwar Nagar, who hope for better times even as they continue to combat a city that denies their very right to exist.

‘Abudana dhoondta hai…’

Even for middle-class Mumbaikars, a house of their own is an almost unaffordable dream  

Text By Rameshwar Jirwankar

Rajender and Vijaya are happily married and have been living in Mumbai for eight years now. They moved from Nashik, which is about three hours away from Mumbai, looking for better opportunities for work and education. “Life here is fast but it gives us opportunities for learning. The cost one pays for it is to compromise on our house,” says Rajender, who after working for several years is now studying for a master’s degree. “In Nashik, living is very comfortable but in Mumbai, finding a decent flat at an affordable price for common middle-class people like us is next to impossible. Moreover, most rental agreements here allow only an 11-month lease. So, there is a lot of instability.”

The island city of Mumbai has always been the dream destination for those from the hinterland. However its high real estate prices has made it next to impossible for most to own a home here. While for the poor, access to housing and infrastructure is especially challenging, in reality even for middle-class families, earning an average salary of Rs 40 to 50,000 a month, owning an apartment in the city is an unaffordable dream.

In the past Rajender and Vijaya had to change several flats because the brokers would often ask them to leave as getting in new clients would enable them to earn fresh brokerage. They had to often go through the same process year after year – of house hunting, rent agreements, brokerage and even then not finding an ideal place to live.

“We cannot even decorate the house properly as we are not sure if we will get to stay in the same place after the expiry of the eleven month lease,” says Vijaya. Car parking is another important problem as they have to park their cars outside on the side of the road. Rajender says that often the owners as well as neighbours in the society insist on verifying caste, class and religious aspects of the tenant. “Tenants are made to feel as if they are secondary. We have often been looked down upon by neighbours who owned their flats,” he adds.

“We cannot afford a rented house as it takes a huge chunk of our money. If one has a regular salary, then it might still be easier.”

Kundan, aged 23, lives with his family in Mulund. They share a 2BHK flat between eleven members of the household. The family does not only share space but also expenditures and duties. They earn about Rs 30,000 altogether and collectively contribute to run the household. Since it is difficult for so many people to sleep in two rooms, one of his uncle sleeps in his friend’s empty flat nearby. “His friend lives in Dubai, so till the time that flat is empty we use it by paying a small rent,” says Kundan.

To keep the household expenditure at the minimum, Kundan’s joint family does not separate. They want to be there for each other and also they cannot afford to separate. Sometimes, his father does not find employment. At such times, his larger family supports them. “One of my aunts left my uncle as she wanted to separate from the joint family and live in another area. But my uncle did not want to live elsewhere,” explains Kundan.

Buying a 3BHK for the family of eleven is a distant dream as it would require a lot of planning and savings. Renting a 3BHK would affect their monthly budget tremendously. “At least this house belongs to us and no one else can lay claim on this. Owning a house saves a lot of money which would have otherwise gone on rent. So we continue to stay here inspite of living in such a limited space,” reflects Kundan, who earlier worked and is now pursuing higher studies full-time.

The city has failed most of its residents on the promise of affordable housing and services. It relentlessly takes your sweat and labour and gives back not even a decent roof over your head.

Professor Subrato Bakshi* teaches in a well-known Mumbai institute. He lives in a rented apartment in Khar and commutes 20 kms every day to reach his workplace. Five years ago, he took a housing loan to buy an apartment in Vashi for Rs 60 lakhs. Though the building is still under construction, he still has to repay his loan every month. Between rent, loan servicing and daily costs of living, he manages to save very little for other expenses including his son’s higher education expenses.

Vaishali Gite lives with her family in Sion. Her father is an assistant surgeon in a hospital and they live in the staff quarters provided to him by the hospital. But as her father is retiring this year, they need to buy a house almost immediately. “We cannot afford a rented house as it takes a huge chunk of our money. If one has a regular salary, then it might still be easier,” she says. Her father has booked a flat in Panvel and though it is much further from Sion, on the outskirts of Mumbai in fact, Vaishali says that in all their choices “affordability is the first factor.” They consulted relatives who had moved to Panvel earlier and decided that they would just have to adjust to longer commutes.

The city has failed most of its residents on the promise of affordable housing and services. It relentlessly takes your sweat and labour and gives back not even a decent roof over your head. Then, why do millions aspire to make it their home, I wonder. Or is it truly a ‘sapno ka shehar’ (city of dreams) where we are compelled to live more in our dreams just in order to escape the everyday harsh reality of being so dispossessed?

*Names changed on request

Adivasi Mumbaikars

My Slum Story

Not A Nice Place To Live In

SRA Or Land Grab By Another Name?

House of Dreams