1. Shri Dilip Patel welcomed all the participants to the webinar and mentioned how the IC Centre for Governance, to improve governance in the country, started the ‘Community of Ethics in Public Service’ as an informal platform. It has now been renamed the ‘Alliance of Change Makers’ to make it more inclusive.
Todays’ speaker is Shri Iqbal Singh Chahal, presently the Municipal Commissioner of BMC, who has done pioneering work in managing the COVID 19 Crisis in Mumbai.Shri Patel gave a brief introduction of Shri Chahal and said that a detailed bio data would be put up on the website of the Alliance.
Shri Chahal is a 1989 IAS office, also an engineer with a B.Tech degree. His crisis management strategy of COVID-19 in Mumbai has received tremendous attention both in India and abroad. He started his career in Nashik, and has held several positions since then, with a consistently positive performance in all his assignments. Today, he would be speaking to us about how he managed the COVID 19 crisis in Mumbai and what are the lessons that others could pick up from it.
3. Shri Chahal said that he was really grateful to Shri Prabhat Kumar and others for giving him the opportunity to present the Mumbai story before such an outstanding audience.
He began by stating how he was made the Municipal Commissioner of the BMC in May 2020 when the COVID crisis was around 50 days old. He joined office on the evening of the 8th of May and called a meeting of his core team of about 120 members. This physical meeting was risky considering the chances of infection, but he felt that eye-to-eye contact was needed in planning the future strategy. He made it clear that his team would have to work on the ground, and if anyone was unwilling to do so because of comorbidities etc., they could walk out immediately; once committed, they would have to work on the ground. The situation was like a war and they had to deal with an invisible enemy; they would have to chase the virus.
Next morning, the team entered the hundreds of slums in Mumbai that were the hotbeds for the virus and started testing people at their homes. If anyone was found positive, his family members and neighbors were shifted to 3 and 4 star hotels and kept in quarantine for 10 days. In the beginning, there was resistance to this, but slowly people started cooperating when they realized that they were well looked after during the quarantine. People were sent back to their homes after aggressive sanitization of their homes. The community toilets, a breeding ground of the infection, were sanitized 5 times a day, a practice that is still continuing. Within 6 weeks, more than 1.46 lakh people from the slums were put in hotels for quarantine.
The situation in Mumbai was initially so bad that there was a mortality rate of 8% due to COVID. This rate, by the end of the second wave, was brought down to 0.8%, which is one of the lowest in the world.Shri Chahal told his team that the virus would not be going away in a hurry, and the preparations to deal with it needed to be long term. The typical response options would not work. It was a war, and wars cannot be won by individuals, but by systems.
Initially, Mumbai had just one control room to deal with COVID, which used to crash by the evening with the sheer load of phone calls made to it. So, he decided to abolish the control room and created 24 War Rooms, one each in all the 24 Wards of Mumbai. Each one had their own dashboard. The number of beds and doctors available in each ward were increased drastically. Interns from Maharashtra medical colleges were arranged to join the management of the War Room, and were given a stipend of Rs. 50,000 monthly, as compared to the Rs.10,000-15,000 that they were getting as interns. Shri Chahal had the entire dashboard on his cell phone (they borrowed the software from Uber). In collaboration with the transport department, they arranged for hundreds of Innova cars to help transport the patients.
He summoned a meeting with the heads of 35 top hospitals of Mumbai, and convinced them to give 80% of their ICU beds to the BMC at government rates. This would mean a loss to them of a few hundred crores, but in the long run, would really establish their reputation and credibility as a prime destination for medical tourism globally. The BMC still maintains very good relations with these hospitals and they have become like a family now. These hospitals also played a major role in doling out the vaccines.
The biggest risk that they took was that no lab report of a COVID positive patient was sent to the patient directly, but it was channeled to the BMC on a daily basis. The same system was followed for the rich and the poor. So far, 7.48 lakh COVID positive reports have been handled by the BMC. This took away the panic to a great extent, as when the BMC approached a COVID positive patient based on the lab report received by it, it did so with preparations for treatment. If symptoms were there, beds were allotted online and ambulances were rushed to the patients in 15-20 minutes. If asymptomatic, even then they received adequate follow up at home. Not one of the 7.48 lakh reports went missing or unattended; otherwise, the BMC could have been sued for negligence if a patient died. The same system is being followed even now and 40,000 tests are being conducted every day even now.
9 Jumbo Hospitals were created in Mumbai with 15,000 oxygen beds and 4000 ICUs. The running of the ICUs was outsourced to professional companies. These hospitals also acted as key centres of vaccination.
Hundreds of iPads along with Wi-Fi facilities were arranged for the patients in these hospitals, to deal with the problem of loneliness and isolation for the patients, since their families could not visit them. The patients could interact with their families regularly through video calls on these iPads. With an investment of only about 1 crore to purchase the iPads, the psychological health of the patients was taken care of. They were also used for telemedicine.
To deal with the piling up of dead bodies at the crematoriums, an online system with dashboards was created. The moment a death happened, the hospital called the relatives and booked a slot online at a crematorium in consultation with the family. This dealt with the issue of dead bodies piling up at crematoriums.
There were cases where people on dialysis were infected with COVID and died due to lack of dialysis. There were also others who required dialysis a few times a week to survive, but could not get that done as the hospitals were overwhelmed with COVID patients and they could not get a COVID negative report each time before dialysis. An online platform was developed with the help of IIT Mumbai to deal with the issue, after which no patient died due to lack of dialysis at least.
IIT Mumbai was their chief technical partner in developing most of these portals and platforms. The systems developed were continuously refined and upgraded as per requirements.
Last year May, Mumbai had the testing capacity of only 4000 tests per day. As a result, the reports came in very late and by that time, the patients’ condition would deteriorate a lot. To deal with this issue, 2000 beds in the Jumbo Hospitals were reserved for people who were experiencing symptoms but their report had not yet come or they could not get the test done due to long waiting list. There was a walk-in system for people feeling unwell without reports and they were tested at these hospitals. This was publicized in the media so that people would be aware about it. 24,500 people were saved due to this system.
A number of BMC employees also passed away in their efforts to contain the crisis. For example, the bus drivers who were transporting healthcare workers, contracted the infection and more than a hundred of them lost their lives. They were not covered in the GoI scheme of compensation as they were technically not frontline healthcare workers, so the BMC announced a scheme of compensation for them of Rs.50 lakhs per loss of live, along with a job in the BMC for the next of kin. The compensation was given in cash within 48 hours of the death, and was instituted with retrospective effect. As a result, the BMC employees were ready to take a bullet for their work. They felt that were being looked after well and that the BMC was standing with them through this crisis.
Arrangements were made for adequate oxygen and Remdesivir. In fact, when 6 private hospitals were running out of oxygen, 168 patients were shifted to the Jumbo Hospitals where they got oxygen and their lives were saved. Much before the county ran out of Remdesivir, Mumbai acquired thousands of vials. For this, Mr. Chahal gave a work order to acquire them urgently even though the rate was 400% higher at the time. Some newspapers reported it as medical scam in BMC, but he did not care. What was important was to save lives, and eventually the work order that he had passed at the high rates turned out to be the lowest in the country, when the prices of Remdesivir went through the roof. The BMC hospitals were so well equipped with all kinds of medicines and oxygen that some patients from private hospitals were also shifted there.
BMC workers, NGOs and thousands of health workers distributed pamphlets to millions of Mumbai families, where the relevant contact details of each of the 24 War Zones of the 24 Municipal Wards were listed, as also the dos and don’ts of COVID, what is COVID appropriate behavior, and more. The huge hoardings in Mumbai were lying idle as all businesses were shut down, and the BMC used them for COVID awareness. Thus, a massive COVID awareness drive was undertaken in Mumbai. People were educated to wear masks, and a fine of 200 rupees was imposed on people not wearing masks. Until now, about 37 lakh people have been fined, and crores of rupees collected by the BMC through such fines. It really made a difference in ensuring that people wear masks in public areas. The provision for a fine for not wearing masks is still going on.
He ensured decentralization at the ward level. He issued orders giving full authority to the Ward Officer for his ward.The highest number of cases that Mumbai recorded in a day was 11,000, much less than other big cities.
Shri Chahal said that recently he was speaking to the young IAS trainees at LBSNAA, where he told them that unless they are willing to take risks and engage in quick positive action, things do not work out in crisis management.
He said that leaders in the civil services need to be very compassionate. The second COVID wave was massive and he had given his personal phone numbers to all the 2700 containment zones. He received about 200 WhatsApp messages from unknown people asking for help (like bed, oxygen, etc.). He had a team of 5 people to whom he forwarded such messages and then they got back to him with the relevant information. He then passed on that information to the unknown people who had messaged him. He said that each response took about 10 seconds of his time but each message was attended to and help given. Some people even sent him messages of thanks for timely support.
5. In response to different queries raised by the participants, Shri Chahal explained the following:
The CM’s Task Force for COVID in Mumbai has warned of a 3rd wave which is likely to affected children in a bad way. Keeping this in mind, 4 new Jumbo Pediatric Hospitals have been built with hundreds of ICUs. Cubicles have been built for young children as their mothers would also have to stay at the hospital with them. A pediatric task force has been set up to groom regular doctors for pediatric care. Patient treatment protocols have been prepared. 35 major oxygen plants have been built in Mumbai with a capacity of 180 metric tonnes. The storage capacity for oxygen has been extended by 400%. Number of beds have been increased to 30,000 from 22,000. The vaccination rate is also good in Mumbai and by the end of December this year, 100% of the adult population of Mumbai is expected to be fully vaccinated.
Along with herd immunity, such a level of vaccination is likely to provide protection against serious illness, hospitalization and mortality. Sero-surveys have shown that above 50% of the children in Mumbai have antibodies. Hopefully, things will be under control in Mumbai, but a cause for worry is the 3rd wave in rural India and smaller towns, with poor rates of vaccination and low herd immunity.
For the replication of what Shri Chahal has been able to do in Mumbai, IAS officers need to be absolutely humble. Unfortunately, humility is lacking in most IAS officers. For example, he addressed the senior doctors in Mumbai as ‘Sir’ and they responded very well- after all, they are the ones who are fighting the war. IAS officers should not just throw their weight around but give due respect to others around them. Also, it is not possible to do much alone. One requires the support of a number of people, including the political leadership.
Shri Uddhav Thackeray told him when he was appointing him as the Municipal Commissioner of BMC, that many people had advised the CM against appointing a young officer like Shri Chahal to the post. However, the CM had faith in him and said that if he succeeded in managing the crisis, the success would be his own, but if he failed, the failure would be of the CM. The moment the CM put so much of faith in him, he had no other option but to do his best. Even previously he had worked for 4 years under David Fadnavis who had also given him a lot of support. He said that he had been lucky in getting the support that he required. He also informed the participants that his Alma Mater, Thapar Institute of Engineering and Technology has decided to award him with a doctorate and he has been invited to Chair a global conference on COVID which will be held in Chicago.
6. Shri Dilip Patel thanked Shri Chahal and said that he was absolutely mesmerized with his presentation. There was so much learning to be picked up from his talk. We would love to have him with us again not to speak about his COVID Mumbai Model, but about other aspects of public life.
7. Shri Prabhat Kumar said that Shri Chahal’s presentation was, indeed, mesmerizing. He is so charged with the spirit of service that Shri Kumar had goose bumps when listening to him. He expressed his felicitations to Shri Chahal for the latter’s brilliant presentation and his path-breaking work in public service. Shri Kumar said that he hopes that Shri Chahal’s work is documented and shared with the civil servants throughout the country. Unfortunately, we find so many people (in the civil services and outside it) who had the power to make a difference, but did not. They did not care enough. There have been civil servants of great talent but limited motivation and ethics. Barack Obama in his book says that there is a hard way in life and there is an easy way.
Many people choose the easy way. But people like Shri Chahal have chosen the hard way, following the Talisman given by Mahatma Gandhi. There are scores of exemplars who care to feel the pain of the common man, the poor and the underprivileged. Such people raise the bar of performance of the Civil Services. This is a time for inflection in the civil services, where their dented legacy can be restored by people like Shri Chahal. They make us see a ray of hope. They are inventing new ways to serve the people. Social media is also lending a helping hand, with sites like Better India and Nexus of Good. This Alliance of Change Makers is our way of celebrating these exemplars.
Shri Prabhat Kumar requested Shri Chahal to speak to the participants in the ICCfG programme on ‘Ethics in Public Service’ for the IAS officers. He also said that we have had a close association with the BMC some years back when Shri Sitaram Kunte was the Commissioner, but he would tell Shri Chahal about it sometime later. At the end, Shri Chahal thanked Shri Prabhat Kumar.
