By Jennifer Thompson
As Indian authorities struggled with an epidemic of pneumonic plague, prostitutes in New Delhi told a reporter that their business continued even while schools and cinemas were being shut. "We were told once that nothing was more deadly than AIDS", one woman said. "So what if something called plague now turns up as an even deadlier disease? We were working for a living then, and we are still doing the same work — to keep hunger at bay. Do we have a choice?"
Crippling poverty remains the key cause of the spread of the disease. "Unless we are able to get rid of the slums in our country, our fight against communicable diseases will remain a losing battle", Indian Vice President K.R. Narayanan said.
By September 29, the National Institute of Communicable Diseases said there were at least 600 confirmed cases of plague in India. Later reports say that more than 1600 people may have tested positive to the killer disease. Most of the approximately 54 deaths at that time had occurred in Gujarat, where the industrial city of Surat is located, the centre of the outbreak.
Plague is primarily a rodent disease; only under the circumstances of an explosion of the rat population does there occur an epidemic among rats. When an outbreak kills a large number of rats in the vicinity of human populations, bacteria-bearing fleas move on to a secondary host — the human population.
Two weeks before the epidemic in Surat, an outbreak in Maharashtra state's Bhid and Latur districts was contained. Maharashtra was where last year's September 30 earthquake killed more than 10,000 people and caused widespread destruction. Rats dislodged from their jungle burrows invaded the rubble.
Surat is one of the industrial boom towns of India's coast, experiencing India's fastest economic growth, particularly in the diamond-cutting, silk and textile industries. The city provided nothing for the migrant workers who flocked into the 600,000-strong industrial work force. Health care, education, planning, rubbish collection were all absent.
In September, heavy monsoon rains forced the opening of a threatened dam on the Tapti River. Several parts of Surat were inundated, including low-lying squatter settlements. Animal carcasses piled up, adding to rubbish accumulated around the city. The conditions for the transfer of the disease from rats to people were set.
The lack of social infrastructure in Surat is a result of the pattern of economic growth in the city, whose population has doubled in the last decade. According to Yoginder K. Alagh, the vice chair of Gujarat State Planning Commission, "Facilities have been unable to keep pace with its rapid economic growth".
There has been a huge increase in private investment in the region. For example, the southern town of Tiruppur is an overnight cotton knit export success story. Its exports rose from US$25 million in 1986 to US$700 million last year.
Tiruppur's rapid rise exemplifies what is happening in India's southern and western states, where the combination of high-tech machinery and abundant cheap, highly adaptable labour is creating a profusion of small to medium scale manufacturers and services.
Alongside Tiruppur's private affluence, there is public squalor. The town reeks of open sewers, the ground water is polluted with dyes and other waste, and water must now be trucked in. There is a dearth of housing. Most infrastructure is the responsibility of the Tamil Nadu state authority, but because it gets little revenue from Tiruppur's tax-free export earnings, the government spends little on the town.
The government encouragement of private investment is part of the strategy demanded by the World Bank's structural adjustment program. Reforms have centred on the floating and devaluation of the rupee, trade liberalisation, business tax cuts, privatisation and a huge growth in foreign investment. The inflow of foreign capital totalling US$4.7 billion in the year ending on March 31, eight times higher than the previous year, has blown inflation out to 11%, which severely affects real wages and living standards.
The World Bank's annual meeting of the India Development Forum in Paris in July called for additional reduction of the budget deficit, which would further cut public spending. Many states are virtually bankrupt, and this has been driving radical cuts in spending on agriculture, irrigation, power, road transport, health and education. The World Bank is especially concerned with agricultural price reform, attacking the provision of subsidised water and electricity to agricultural producers.
The real effects of structural adjustment programs can be seen in the plague outbreak. An earlier outbreak was also in a country regarded as one of the Third World's economic miracles, which was also subject to structural adjustment, Brazil. In 1986 an outbreak of bubonic plague in northern Brazil caused some deaths and much alarm.
Here was the same pattern of a disease that is now easily treated by antibiotics, but could also have been prevented. The only remedy lies in improving living conditions and sanitation, a course totally different from that of World Bank and IMF-imposed austerity.