Merchant Doctor in Dharavi

In his youth as a student at JJ Hospital, Dr SM Merchant had never ventured into or even heard of Dharavi. He lived in Dongri in those days and Dharavi was just the outskirts of the bustling city. The sexagenarian doctor, who has now been practising in Dharavi for 40 years, says it was happenstance that led him to what was then a marshy patch of land.

The story goes that a compounder told him of a locum clinic that needed a substitute doctor to fill in the hours. “He said he would show me the place, which was in Dharavi, and asked me to meet him outside the Sion railway station at 4 pm,” recalls Dr Merchant. After hours of waiting, the compounder did not turn up and a miffed Merchant went home. A few days later, he heard of another locum clinic in Dharavi and was asked to “sit around and read” there until the regular doctor returned.

“But I found myself very busy with the patients and I picked up pace from the very first day,” says Dr Merchant. The compounder who had stood him up outside Sion station happened to pass by and burst into the clinic, saying, “You are here! This is the clinic that I wanted to show you that day!” Dr Merchant’s clinical wisdom was a great hit in the area and what was a temporary job became a passion. He went on to open his own private practice near Bismillah Hotel, complete with a low ceiling and a table fan chained securely to a post. For Dr Merchant, Dharavi was his destiny.

Dr Merchant now works from his dispensary on 90 Feet Road, opposite the Colour Box. It is a narrow room squeezed between a chai shop and an egg distributor. He is unhappy with the number of egg distributors on 90 Feet Road and their business strategy of selling broken eggs for cheap in plastic pouches. Dr Merchant continuously warns his patients – including his compounder, who buy a broken egg or two now and then – of how unhealthy it is to consume these germ-ridden produce.

With four decades of experience in Dharavi, Dr Merchant says that, while people have more buying power, the overall quality of health has declined and people invest in good health only when most required. The most frequent complaints are common colds and fevers, as well as major illnesses like malaria and typhoid. People with tuberculosis used to knock on his doors quite often, but with the intervention of government hospitals and free medicines they have been diverted to larger centres such as Sion Hospital. Dr Merchant says that the number of consultations for cancer has gone up and that diseases like dengue, unheard of some decades ago, are on the rise. “The major reasons for the decline in health would be population, pollution and space. Real estate is so expensive in Dharavi and you will find entire families packed into a 100 sq ft house. Health suffers in such cramped situations,” he observes.

Dr Merchant also points to the endemic problems faced by the Kumbharwada community of potters who live amongst their kilns. Asthma and tuberculosis has been seen in many of them and there are frequent complaints of lung ailments. “I have seen small children use nebulizers here. The government needs to look into these issues and, rather than move them away, needs to consider more tactful means to help the community use its kilns and simultaneously take care of their health.”

At one time Dharavi was infamous for its profusion of illegal country-liquor shops. While the liquor shops have now been pushed into more unmonitored areas, drug use is a major problem, says Dr Merchant. Several teenagers are involved in drug use and drug-related crime, and it is usually their parents who bring them to the clinic. But rehab is an expensive, long-term proposition that most families give up on at a certain a point.

Dr Merchant says that women who come to his clinic are often suffering from a common ailment he calls “male-dominated society.” Some women are pregnant with their fourth child, some are anaemic from fasting, and some cook four times a day for the whole family, but pay no attention to their own nutritional needs.

On most days Dr Merchant has no time to even sit down in his clinic, and says that he often doesn’t tell people where it is. He gives them locations in the vicinity, such as Matunga Labour Camp or Sion, because people tend to raise an eyebrow if he says he works in Dharavi. Nevertheless, clients seek him out from as far away as Virar and Thane. His family lives abroad, but he says he will continue working in his small Dharavi clinic as long as he can. “I cannot imagine a day when I am not working here,” he says, as patients line up outside.

Two Doors, Two Choices

There is a dimly-lit community centre with two rooms at Kumbharwada, Dharavi. You reach it after treading clayey paths where workers labour over sacks of mud meant for the potter community. One room is for visits from an allopathy doctor and in the other is a homeopath. No signs advertise the services available at the community centre, but there is a steady trickle of patients, mostly elderly. They enter in a moment of suspense: which door will they choose? Allopathy or homeopathy?

The clinics are part of a charitable trust, the Pramila and Harishkumar Foundation, set up by homeopath Dr Geeta Punjabi in 2009. The 74-year-old veteran meant them to cater for the poor in Dharavi so that they could get quick relief at subsidised rates. The homeopathy centre is currently attended by Dr Poonam Talreja, who has been there since 2010. Her clinic is painted a bright shade of green and most of the space is taken up by trays of bottles of homeopathic medicines. It’s hard to find her unoccupied. As each patient consults her, the conversation is punctuated by the pitter-patter of raindrops on the asbestos roof. The patients queueing outside grumble impatiently in low voices, but are glad that the doctor gives each of them a decent amount of time.

Dr Talreja says that she has seen some challenging cases cured with homeopathy. “We don’t try to heal just a particular organ, but rather improve the overall immunity of the patient. We won’t claim that all our patients have reached normalcy, but they have surely reached a near-normal state,” says Dr. Talreja.

Sometimes mistaken for a “lady-doctor,” she points out that the commonest health issues she sees in Dharavi are chronic fatigue, joint pains and asthma attacks. “These are mostly female patients. They neglect their health and they hope that if they pop a pill they’ll be fine instantly,” she says, nodding her head. Most of her female patients are daily wage-earners and she says that a quick fix is a must or it could mean losing out on a day’s pay. People also come with digestion problems. “Many Dharavi people have problems such as constipation or diarrhoea, but I am careful before prescribing medicines. I always check to make sure that they have toilets in the vicinity of their homes. Otherwise, it could be a big problem for a patient who has just taken some laxatives.”

With subsidised rates for medicines (globules are free, tinctures and laxatives are half-price), Dr Talreja says that not everyone is Dharavi is poor. There is a donation box in the clinic and more affluent clients are advised to purchase the medicines at retail rates.

When clients enter the community centre, which door do they choose? Have they made an informed decision about which medical recourse will work best for their health issues? Or do they try both allopathy and homeopathy with the hope that something might eventually work?