IN THIS WEEK'S ISSUE

Harvard’s tips for Kumbh organisers

The government’s efforts in managing the millions who throng Allahabad for the festival are commendable but things could be better still

  • By Bobby Naqvi, Editor, XPRESS
  • Published: 21:30 February 28, 2013
  • Gulf News

  • Image Credit: Sankha Kar/Gulf News
  • Participants and observers Pilgrims (left) cross one of the pontoon bridges to take part in the Maha Kumbh festival
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In the next two weeks, when an army of government officials and private contractors begin dismantling the world’s largest pop-up city of Maha Kumbh Nagar, up to 100 million devotees would have performed pilgrimage at one of India’s holiest sites. The Maha Kumbh festival at Sangam, which started on January 14, ends on March 10. Sangam, a confluence of India’s mighty Ganges, Yamuna and mythical Saraswati, is the epicentre of this mass-bathing festival held every 12 years in the city of Allahabad. Tens of millions from far-flung corners of India and abroad gather for this pilgrimage — a simple act of taking a dip in the Sangam waters. During the 55-day festival, the venue is the most crowded during the key bathing days when Hindus believe specific planetary positions make Sangam waters so pure that it can wash sins and help them attain salvation — a break from the cycle of life and death.

Setting up the tent city of Maha Kumbh Nagar that is home to pilgrims, Naga ascetics, officials, policemen, is an organisational feat, baffling Western journalists, academics and experts of urban planning. Stunned by the scale and magnitude of this “city” raised on the sandy riverbed, a team of 50 faculty members and students of Harvard University spent 20 days here, documenting and analysing how this largest gathering of humanity is organised. “I speak for the entire team when I say that we were amazed by the degree of organisation that goes into putting the (Kumbh) Mela together. The electrical grid, wide boulevards, street lights, water supply, sanitation, crowd control, security, hospitals ... would be impressive anywhere but the fact that this is all temporary and will be gone by the end of March makes it an absolutely astounding organisational feat,” Dr Dhruv Kazi of Harvard University’s FXB Centre for Health and Human Rights told Weekend Review.

Since early November, a team of more than 10,000 government employees and thousands of private contractors spent more than 50 days building this pop-up city and their task was humongous: laying over 156 kilometres of asphalt and tiled roads; 160 kilometres of metal plates for pedestrians; 550 kilometres of water pipeline; building 18 large pontoon bridges to connect 13 sectors of Maha Kumbh Nagar; 770 kilometres of electric cables, 130,000 connections drawing power from 73 sub-stations; 40,000 toilet seats; 14 hospitals with a total capacity of 370 beds and 100 ambulances; arranging 750 trains and 4,500 buses to transport pilgrims.

Health care for millions

“The FXB Centre is coordinating and funding a collaborative team composed of faculty from the medical colleges of Harvard, Allahabad, Stanford, and Cornell; medical students from Allahabad, Mumbai, Boston and New York City; and IT and media consultants from Mumbai, Dhaka, and New York,” Dr Kazi said. But what is the purpose of this study? “With the support of the Harvard School of Public Health and the FXB Centre for Health and Human Rights, we hope to empower future Kumbh organisers with the information they need to cost-effectively safeguard the health and wellbeing of the millions.”

The primary objective of the team was to document the outbreak and patterns of disease by mapping complaints, diagnoses, medications and geographical origins of patients flocking to hospitals at the Maha Kumbh Nagar. Volunteer medical students used iPads to collect this information from clinic registries. “Delivering health care to 100 million people is an enormous task anywhere, but it’s even more challenging when the city — and hence its hospitals — must be temporary,” Dr Kazi said. “By the end of March, the entire city will be dismantled. By the time monsoon arrives, almost the entire area of the Kumbh will be reclaimed by the rising rivers.”

Sharing preliminary findings exclusively to Weekend Review, Dr Kazi said: “We noted that the doctors manning the outpatient posts saw up to 800 patients a day — and up to 6,000 on bathing days — and were clearly overstretched. Lines of patients preclude even a cursory medical examination. No vital signs were documented and there were no stethoscopes in sight. On the other hand, inpatient units were almost uniformly unoccupied. Row after row of hospital beds, neatly folded red blankets, and IV poles stand untouched. On our visit two days before the peak bathing day, we saw only the occasional hospitalised patient — a testament to excess capacity in the system.

“This striking contrast between the excess capacity on the inpatient side and extreme shortage of manpower on the outpatient side is the result of an information vacuum about the disease burden and clinical resource utilisation in this patient population. Poor data result in poor planning, and ultimately a lopsided distribution of resources.”

This is just one of many problems. “On the most auspicious bathing day of all — Mauni Amavasya — I joined a procession with one of the akharas and was walking towards the Sangam when I saw a middle-aged man pass out. I rushed to help, and a quick history revealed that he had a history of heart disease and was feeling sweaty and dizzy. As a cardiologist, I immediately recognised that these symptoms could be from a heart attack. We made the patient lie down on a cot and flagged down the cops for help. With the help of the police, we were able to move the patient into the ambulance. But the massive crowds meant that even though the central hospital was less than 5 kilometres away, it took more than 40 minutes to get there. Moreover, although there was an oxygen tank in the ambulance, it was locked and the driver did not have a key! Nevertheless, when we got to the central hospital, the patient’s treatment began right away, and he did OK,” Dr Kazi recalled.

This illustrates the challenges with incomplete planning. Although the authorities had placed ambulances strategically on the big bathing day, they had not thought about how the ambulances would get out of the crowds, Dr Kazi explained.

“We have just started to analyse the results from 30,000 patients and have started to see some interesting patterns emerge. For instance, the predominant medical conditions are respiratory — more than a third of the diagnoses related to cough or upper respiratory infection — which is probably due to the poor air quality at the Kumbh and the challenges with hygiene,” Dr Kazi added.

Crowd control and management

The biggest challenge officials face is the control and management of the tens of millions of devotees who descend into this 2000-hectare tent city. On just one day — Mauni Amavasya, on February 10 — an estimated 35 million men and women arrived in Allahabad, a city of just 1.2 million. To put it mildly, the management of this sea of humanity is a herculean task requiring complex traffic plans, heavy police presence and close co-ordination among multiple government agencies. Because this pilgrimage involves a single act of bathing in the river water at Sangam, all the pilgrims must access the 5.5-kilometre purposely built bathing ghat or slope. This large bathing arena along the banks of the Ganges can hold only half a million people and the challenge was to accommodate all of these 35 million, far above the previously estimated crowd of 30 million, during a 24-hour period. Officials revealed a complex and elaborate traffic management plan in which both Allahabad city and Maha Kumbh Nagar were declared no-vehicle zones. Pilgrims arriving by buses and cars were stopped at specially built bus stations and parking slots located up to 30 kilometres away from the city limits. Those arriving on trains disembarked at three stations — Allahabad, Prayag and Naini. From bus and railway stations, this crowd of millions moved on wide one-way pedestrian-only roads leading to Sangam.

Disaster strikes

Apart from effective traffic management, the crowd control plan included other complex measures: holding pens at railway and bus stations; jigsaw enclosures to trick up to 50,000 people into walking for three hours and regulating incoming traffic at checkpoints hundreds of kilometres away from Allahabad city. This was done by 30,000 policemen at Maha Kumbh Nagar, hundreds of paramilitary troops deployed outside the city limits, and officials who monitored flow of traffic from districts surrounding Allahabad. At Sangam — the epicentre of this mass-bathing ritual — crowd controllers followed a simple rule of thumb: press the panic button when you can’t see the ground.

The biggest test of this plan came on February 10. Given the enormity of this event, it is nearly impossible to prepare for all eventualities, and disaster struck in the evening, when these tens of millions were trying to exit Allahabad after they finished bathing at Sangam. A stampede at the Allahabad Junction railway station’s footbridge No 1 killed 37 people and injured more than a 100. The tragedy came as a rude shock to the officials who had minutely prepared for that day. A minister resigned and an investigation was ordered.

A day after the footbridge tragedy, Weekend Review retraced the steps of the millions who walked from Sangam to the Allahabad Junction station, a distance of roughly ten kilometres. Interviews of senior officials and pilgrims revealed that the footbridge disaster happened after officials made a series of mistakes at Sangam and at several points on the road leading to the train station. At the footbridge on February 11, Lalji Shukla, head of railway police, denied reports in the media that his men baton-charged pilgrims. Also, contrary to reports, there were no sign of damage to the footbridge.

Between 5am and 9am on February 10, it was becoming clear that the crowd density was reaching dangerous levels along the bathing ghats at Sangam. Intersections were choked, forcing police to open emergency lanes reserved for security personnel. Areas reserved for Naga ascetics were also opened to ease pressure. While movement of pilgrims towards Sangam was relatively smooth, overwhelmed officials erred in handling outbound flow of people. Pilgrims who finished bathing were nudged on to Triveni Marg, the road leading to the Allahabad Junction station. Just at the edge of the tent city, railway officials used public address systems to announce names and timings of special trains departing from Allahabad Junction. This had a cascading effect on the crowd and by evening narrow roads in the vicinity of train station were filled with millions of people.

One of the members of the Harvard team, Logan Plaster, who investigated the stampede, said: “… the excellent crowd control techniques deployed at the festival itself didn’t make it to the nearby rail station, suggesting that the event would have benefited from more cross-disciplinary conversations. Had planners taken a bigger-picture perspective, they might have tracked the path the pilgrims would take between sectors and detected choke points.”

Plaster, who visited the footbridge a day after the tragedy, said: “The first time that crowds moving through the narrow streets of Allahabad were given any directions was at the entrance to the rail station itself. By anticipating the surge and stationing traffic coordinators along the well-worn path, rail officials could have gotten an earlier estimate of crowd numbers and guided people accordingly.”

As our team quickly discovered, you didn’t need to flash a ticket to get into the Allahabad rail station, or even get on to the platform. This is for the simple fact that unreserved seats were available on a first-come, first-served basis. These unreserved cars were packed dangerously full, at two or three times safe capacity,” he added.

Satchit Balsari, leader of the team from Harvard School of Public Health, was more direct in his assessment: “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 footbridge stampede as they are for the bottlenecks from the main avenues to the pontoon bridges, for hundreds that get traumatised 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.”

The Harvard team will analyse their data and observations in the next two months and present their findings to Kumbh organisers and India’s National Disaster Management Authority. 

 

The numbers game

To the thousands of government employees involved in organising this festival, Maha Kumbh is a big numbers game. The number-crunching begins early when budgetary allocations are made and resources are mobilised. Budget allocated by federal and state governments is directly proportional to the number of people estimated to arrive for Maha Kumbh — more people means more money. While most journalists, academics and experts agree Maha Kumbh is the biggest gathering of humanity, officials admit their 2013 crowd estimates were based on earlier estimates that were, in turn, based on guesstimates. “I agree our numbers are debatable and an accurate assessment can be made only through a scientific methodology,” Maha Kumbh Nagar’s top boss Mani Prasad Mishra told Weekend Review.

 

However, the official machinery of Maha Kumbh Nagar is too overstretched to bother about the accuracy of numbers. Officials drawn from several wings of the government — water, sanitation, health, transport, police, disaster management, anti-terrorist teams — have gigantic tasks to perform during the 55-day festival. Sample this: Mishra leads a team of more than 10,000 officials; police chief R.K.S. Rathore is responsible for 30,000 police and paramilitary troops; the head of sanitation oversees an army of 10,000 sweepers and janitors to clean 40,000 toilet seats and open-air defecation fields; information department looks after 3,000 journalists from 50 countries; telecom giant BSNL has to handle million of calls originating from Maha Kumbh Nagar every hour; the lost-and-found centre handles thousands of missing people every hour on main bathing days — up to 300,000 people were reported lost during the festival.

 

 

Box

 

Findings and observations of Harvard Team

 

1) Over 58 per cent of the medications dispensed were analgesics (pain medications) and a quarter were anti-histamines, all of which are available over the counter, without requiring the presence of a physician.

 

2) The political will and commitment to making the (Kumbh) Mela a success is unprecedented, yet the staggering crowds that come to the Mela repeatedly overwhelm the system: the 30-120-second window for doctor-patient interaction, as the present data reveals, is far from the ideal that the Mela authorities had aspired to.

 

3) The size of this data set will allow the authorities to examine several seminal issues surrounding health-care delivery: prescription practice, resource allocation, epidemiology and patient behaviour at the sector hospitals in the Mela. Our analysis will hopefully influence planning and resource allocation for future Melas.

 

4) Having successfully demonstrated that it is indeed possible to collect such large quantities of data in this chaotic environment, the Harvard team hopes to work with the National Disaster Management Authority of India to consider piloting digital data collection in future mass gatherings in India.

 

5) The land area for the Kumbh is immense and communication poses a range of challenges. And yet, wired as India is, few phones or handheld radios could be seen at the festival. A proliferation of cheap, simple walkie-talkies coordinated by a communication command centre would have given rail officials a much earlier warning that crowds were reaching dangerous levels. In addition, if rail attendants on the platforms and footbridges had been able to communicate more seamlessly, traffic could have been diverted to an alternate station entrance.

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