In The Eye of The Cyclone
The occupant of the hottest seat
This Monday, Brihanmumbai Municipal Corporation (BMC) chief Iqbal Singh Chahal woke up at his usual hour of 6am at his stately official bungalow on tree-lined Carmichael Road, but despite his salubrious surroundings, the senior bureaucrat was circumspect.
Four days earlier he had received an alert from the India Meteorological Department (IMD) of the very severe Cyclone Tauktae that would be approaching Mumbai that day. Chahal, who credits his Army officer father for his ethic of never leaving anything to chance, had immediately convened a meeting with his senior colleagues where standard operating procedures (SOPS) to tackle flooding, tree falls and damage to life and property had been established.
The next day, at a four-hour meeting called by Maharashtra chief minister Uddhav Thackeray, these preparations were reviewed and finessed. As a matter of abundant precaution, it was decided to shut the sea link and the airport and shift all 580 Covid patients from jumbo facilities into hospitals.
As soon as he awoke, Chahal began receiving halfhourly updates from his colleagues. Then, at 8am he set off on his rounds to assess the situation himself, first stopping at Worli Koliwada, then Bandra and Andheri.
By 11.30am he was headed back to BMC headquarters, from where he began monitoring developments on the mammoth screen at the central control room adjoining his office. Its 5,500 camera feeds afforded him a real-time, vantage view of the unfolding situation. Despite the gathering storm, things seemed under control, except for a small hiccup at 6pm, when he received a red alert that an 18-kilometre-thick cloud had appeared over Mumbai. Fortunately, the crisis was managed and by 11pm, realising that the worst was over, the father of triplets returned home.
“Despite a wind speed of 130kms and the highest recorded rainfall since 1948, there wasn’t a single fatality in the entire BMC area of 406 square kms with a population of 16 million,” he said when we spoke the next day.
Most importantly, the decision to move the 580 Covid patents had been a crucial one as there had been considerable damage and flooding at the jumbo centres.
Extreme challenges and catastrophes are no stranger to Chahal, who has the distinction of clearing his IAS entrance exam on his first try at the age of 22. Consider his first month as Mumbai’s municipal commissioner: When he took over on May 8 last year, the city was reeling from the blow of the first wave of the pandemic; positivity was at its highest, with Dharavi on fire and corpses being found on footpaths and road dividers.
“My friends and relatives sent me Whatsapp messages asking if they should congratulate or commiserate, as I had inherited a deadly situation in what was considered the most difficult job in the country,” he said.
A lesser man would have been daunted, but not Chahal — a national-level swimmer, half-marathon runner and yoga practitioner.
Realising that Mumbai’s 3,700 beds would be woefully inadequate to service the expected demand, Chahal managed to convince CEOS of private hospitals to surrender 80% of their beds, telling them that their short-term commercial losses would be nothing compared to the longterm pain of losing a foothold of the future medical tourism industry. Their compliance had immediately taken the bed count to almost 9,000. Simultaneously, with support from Thackeray, who he credits for his visionary, empowering leadership, he requisitioned the construction of eight new jumbo centres across the city, taking the bed count to a staggering 23,000.
It was in the same month that Chahal took the controversial decision to scrap BMC’S central Covid control room and instead created war rooms in the city’s 24 wards — a decision that earned him much criticism.
“Every day by 7pm, when about 1,500 patients would be informed by labs that they were Covid positive they would generate around 10 panic calls each,” he explained. “Our 30-line control room would collapse between 7pm and 9pm under their onslaught of 15,000 calls. Then, the media and opposition would begin relaying that Mumbai’s health system had collapsed creating more panic,” he says.
Chahal’s next move was even more controversial. He decided to scrap direct communication between labs and positive patients, making Mumbai the first city in the country to do so. The plan was that the city’s daily results would instead be fed by the labs into a software which would split the list. “If 10,000 cases came in one day, they got divided into roughly 400 cases per ward, and with each war room having 10 dashboards, every doctor would get about 40 names, of which 80% would be asymptomatic, requiring allotment of only seven to eight beds,” he says.
But the plan would only work if Chahal could find 1,000 doctors to man those dashboards. Overnight, he enlisted medical interns from across Maharashtra. “We hiked their stipend from ₹11,000 to ₹50,000 deciding that money was not an issue. And they were housed in five-star hotels, with free boarding and lodging, at walking distance from their ward war rooms,” he says, adding, “And they worked remarkably well.”
With all this in place, Chahal began to get a grip on Mumbai’s out-of-control pandemic. Dharavi was the first to benefit from his strategy, attracting international attention and winning praise from WHO when its positivity rate dropped significantly.
Chahal further explained this “Chase the patient” approach of the now-renowned Mumbai model, “Once the doctors in the war rooms received confirmation of positive patients, they would visit them at their homes, check their markers and find them an appropriate hospital bed for treatment. The same ambulance would then transport them to the hospital, where a universal subsidised rate had been organised.”
Sangitaa Advani, founder-director of Skill Shakti Institute, is one among the many beneficiaries of this strategy. When members of her household tested positive, they were pleasantly surprised to receive daily calls from BMC doctors, enquiring about their condition. “What’s more,” she said, “They were always polite, professional and caring.” The efficiency of Chahal’s plan had been further tested when one Sunday the oxygen level of Advani’s staff member began dropping alarmingly. Recollecting the episode, she describes it as a miracle. “Within 20 minutes, BMC had sent a well-equipped Covid ambulance and transported the patient to a jumbo centre.” That wasn’t all. Once admitted, the patient was made comfortable and received nourishing timely food and medicines. “Most importantly, he received humane, thoughtful care from the entire medical team,” said Advani.
For an organisation notorious for being at the receiving end of the city’s wrath for its apathy and inefficiency, this validation, shared by many, is perhaps among Chahal and Thackeray’s greatest achievements.
But, even as Mumbai’s success at tackling Covid-19 has won it praise and new cases are down to almost three digits, a devastating tragedy is unfolding across the country as the pandemic wreaks havoc across rural India, where 70% of India’s population resides. This surge has been marked by dire shortages of hospital beds, oxygen and medicines, and media reports of hundreds of corpses floating in the Ganges and of thousands of unmarked graves. What’s worse is that many suspect there is a deliberate attempt to undercount and underreport the extent of fatalities.
“It’s as if we are saying these people have not mattered much to us when they were alive, and they don’t matter now that they’re dead,” said Dr Rajesh Parikh, one of the authors of The Coronavirus: What You Need to Know about the Global Pandemic, adding “Future generations will regard it as a genocide as shameful as the Holocaust.”
Who will come to the rescue of India’s rural poor in their hour of dire need? Who will save the loved ones of these simple, hardy, men and women from dying, one by one?
When he was appointed as the head of BMC, Chahal recalls thinking, “A pandemic like this comes once in a century. Hundred years before me and hundred years after me, no municipal commissioner will get this opportunity to serve humanity and save thousands of lives. Maybe I am the blessed one chosen by God.”
If only Chahal’s mother had given birth to another hundred like him.