Studying slums

1 Jun 2010

In India, Kenya and other poor countries, slums are part of city life. Residents know where they are, even if they don’t know very much about what goes on in them or how many people live in them. In fact, no one knows much about slums, largely because they are “officially unrecognized” (or “unofficially recognized”) by the government, to quote Stefano Marras, who has been studying Kibera, a large slum adjacent to Nairobi and one where GARP will probably field a project.

To an American outsider, a slum may appear disorganized and impermanent—more like a new refugee camp. But most slums are long-established, complex societies, where people are born, live and die. Along the way, they get sick, especially as infants and children. With some exceptions, slums are without piped water and sewage disposal and they are always crowded—bad for people, but ideal for pathogens. We also know that slum residents are not first on the list for new, or even old, vaccines, which could prevent a large share of childhood infectious disease. And when infectious diseases occur, slum dwellers seek care—though they may have a different threshold for acting (this is not known, in fact). When mortally sick, they may go to a public hospital, but for the everyday illnesses—respiratory infections, diarrhea—they stick closer to home.  In India, they may consult a “Bengali doctor,” basically a self-identified practitioner who sees patients in slums. 

I was told by an anthropologist, a member of the GARP-India National Working Group, that one of the most sought-out and respected practitioners in a New Delhi slum developed his credentials as a cleaner in a city clinic. His own clinic in the slum has grown into a major (though still officially unrecognized) provider of care. We know virtually nothing about the drugs prescribed by this man or any other practitioner or purchased by slum dwellers. A major interest  at CDDEP is antibiotics, which are likely to be among the most frequently purchased, and potentially useful, drugs for people living in such poor conditions.  But in fact, almost no information has been collected on antibiotic use or rates of resistance in any slum population. Would we expect resistance levels to be very high? Probably not, because the amount of antibiotic use might be modest. That, of course, is conjecture. Generally, poorer  areas have lower resistance rates, but those poor areas where at least some research has been conducted tend to be rural.  Whether being in a city makes a difference is a question we’re interested in.

And that brings me to GARP’s possible project in Kibera. Though still in the planning stages, we aim to find out which antibiotics people are using, the doses being purchased, why they’re being used, whether the patient has seen a doctor or other practitioner, and how much the antibiotics cost. We aren’t alone in wanting to know more about people living in slums so that, ultimately, their lives can be improved. But we may be the first studying this particular aspect.  

Image Credit: Flickr: godwin_d

Antibiotic Resistance
prescribing