Toxic childhood

On the evening of December 2, 10-month-old Yuvan became breathless. His nose was blocked, as was his throat. As he started to turn pale, his mother rushed him to Delhi’s Sir Ganga Ram Hospital (SGRH), which offers free emergency care. A nebuliser was used to facilitate inhalation of medicine, but it did not help the baby breathe. A suction pipe was inserted through his throat to send oxygen to the lungs. This only partially stabilised him and he was referred to the hospital’s paediatric intensive care unit (PICU).

“We could not afford that. The ₹60,000 it costs is beyond our means. Later that night, we brought him home even though he had not recovered fully,” says his mother, Chhaya. The 32-year-old single mother is dependent on her parents for the child’s upkeep.

More than two months later, Yuvan has still not recovered and is currently undergoing treatment at the government-run Lady Hardinge Medical College. Doctors at both hospitals stress that Delhi’s air pollution is to blame for the baby’s precarious health condition. A pre-term baby, Yuvan was born before his organs were fully developed.

“Such children already have vulnerable health. When affected by external factors like air pollution, their condition worsens. In the absence of pollution, they can lead a better quality of life,” says Dr Anil Sachdev, director, paediatric critical care and pulmonology, SGRH. Yuvan has been to the hospital’s emergency ward thrice already and there is no proper treatment in sight.

Yuvan’s is not an isolated case. Delhi’s air is choking its denizens, especially its children. Anecdotal evidence suggests that the number of children similarly affected has nearly doubled at SGRH over the past 10-15 years, says Dr Sachdev. “Even among children who do not end up in emergency, there is a sharp increase in instances of respiratory diseases.” The number of children needing a nebuliser has increased dramatically, he says.

The spike starts around Diwali, when fireworks step up air pollution levels, and lasts through the winter months. The affected children develop symptoms such as inflammation of the nose and lungs, reddening sore eyes and prolonged nasal discharge. They have difficulty sleeping, which leads to disorientation during daytime and a long absence from school because of sickness.

In children with asthma, the lungs are inflamed and hypersensitive. Air pollution further damages their airways and increases their dependence on medication for day-to-day functioning.

Recovery, too, takes longer. “Seasonal viruses last 2-5 days. But respiratory conditions borne out of air pollution can take 10-15 days to settle. It is taking 3-4 weeks of nebulisation to bring under control viral infections among young children. For many children, as well as adults, a sore throat has become a part of life,” Dr Sachdev says.

A 2017 study published in the Journal of Paediatrics shows that the lungs of children in Delhi are smaller than those of their counterparts in the US. The lung development is reduced by 10 per cent as they grow into adulthood.

Capital dilemmas

Air pollution does not impact only children and not everyone lands up in emergency, but it affects the day-to-day life of the people in the city. Leena Menghaney, a health rights activist, who is also an asthma patient, explains the challenges: “Air pollution adversely affects my personal as well as professional life. As my wheezing increases, it disrupts my sleep at night. Even after eight hours of sleep, I don’t feel fresh. People are taking preventive medicine to cope with the situation.” Her wheezing aggravates during Diwali and lasts the whole winter. As temperatures dipped in late January and early February this year, her wheezing became unbearable.

Menghaney’s 11-year-old son, Neil, also has asthma and faces the same ordeal. On many days his parents receive a call from his school and they rush him home and put him on a nebuliser. It then takes many days for him to return to school. The family lives in Ghaziabad, which has one of the biggest garbage dumps in the National Capital Region and sees frequent burning of waste.

“As a family we face a daily dilemma — should we send Neil to play in the park or not. We are supposed to encourage kids to go out and play. However, due to the air pollution, we would rather they stayed home, where we have air purifiers,” says Menghaney.

Exercise caution: Youngsters and their families worry about the dangers of playing outdoors as PM 2.5 levels skyrocket

Dr Arvind Kumar, founder, Lung Care Foundation and chairperson, Centre for Chest Surgery, SGRH, says several kinds of illnesses that can be traced to air pollution have spiked in Delhi over the past decade. “Air pollution is a second epidemic after tobacco. I would say September to January is the annual ‘pollution fest’. I have seen an increase in bronchial asthma, Chronic Obstructive Pulmonary Disease (COPD), lung cancers even among people who do not smoke cigarettes, tuberculosis, sinusitis, nasal allergies, throat infections, itchy skin, dry hair and red sore eyes,” he says.

Among the diseases blamed on long-term exposure to air pollution are cardiac attacks and metabolic diseases such as cancer. In the case of ailments linked to lung development, the patient becomes vulnerable when the lungs are smaller than normal, owing to air pollution.

The prevailing conditions are forcing doctors to make tough choices. “Most patients who come for follow-ups after a surgery or other chest-related treatments have a bad cough and congestion,” says Dr Kumar. “We have to give them bronchodilators (medicines for respiratory infections) despite knowing that they will get only temporary relief. We don’t want to over-medicate our patients, but there is no choice in the given circumstances.” These medicines further lead to a higher cost of treatment.

Pointing to the scarcity of Delhi-specific comprehensive studies, he says efforts are underway to collect data on the impact of air pollution on health. In November last year, Kumar’s foundation installed a pair of artificial lungs in SGRH to highlight the severity of the dangers of air pollution. The installation was fitted with filters and a fan that mimics breathing. The white ‘lungs’ turned grey within 48 hours and completely black within five days.

“This is what’s happening to people’s lungs in Delhi. If this doesn’t alarm us, what will,” Kumar asks.

Grim data

Delhi residents greeted the New Year with an air quality index (AQI) that was categorised as ‘poor’ by the Central Pollution Control Board. The following two days worsened to the ‘severe’ category. The categories — good, satisfactory, moderate, poor, very poor and severe — are based on the pollution level and its impact on human health. Till January 29, Delhi had only two ‘moderate’ days, nine ‘poor’, 11 ‘very poor’ and seven ‘severe’ days. Not a single day was ‘good’ or even ‘satisfactory’.

New Year, new lows: Delhi residents greeted 2019 with an air quality index (AQI) that was categorised as ‘poor’ by the Central Pollution Control Board. The following two days fell in the ‘severe’ category

A recent study by the Energy Policy Institute of the University of Chicago shows that life expectancy in Delhi has fallen by 10 years because of air pollution.

Anumita Roy Chowdhury of Delhi-based NGO Centre for Science and Environment puts these findings in perspective by stressing on the importance of local data over the universal. “With regard to data, I would say we don’t have to reinvent the wheel. There are enough global studies that have shown the kind of problems air pollution causes. However, local studies are important to know what our unique risk factors are,” she says. The level of pollution in Delhi, for instance, is not seen in Europe and America. Even the cocktail of pollutants is different.

“We still have high urban poverty. A large number of malnourished people are already coping with many diseases with low immunity. Thus, we need to refine our mitigation strategy, for which we need local data. We need to understand pollution spikes,” Chowdhury says. Delhi is faced with multiple seasonal pollutants. Summer is beset by the problem of ozone, a pollutant that has adverse health impacts on children, the elderly and those who suffer from asthma. Winter, on the other hand, brings with it thick smog.

The need for more robust data has driven private firms into the field. Nita Soans, India CEO of Kaiterra, a technology company that monitors air quality, says collection of data at the micro level is important to determine the exact needs of the city. By locating the hotspots of pollution, we can find out ways to curb it. Kaiterra has installed 30 air pollution monitors across Delhi and the initial observations are quite telling. For example, during peak hours, upmarket Sainik Farms is comparable to, or worse than, the busy Anand Vihar bus terminus, implying that a greener area doesn’t necessarily lead to better air quality, and that the sources of air pollution are many and varied.

An increase in the number of monitors can further help pinpoint the sources of air pollution and the health hazards, says Soans.

Too little, too late

The response of the state and Central governments towards this emergency has been lackadaisical and knee-jerk in nature.

“Banning firecrackers or imposing odd-even days for cars for a few days shows the short-term vision of the government. We need more efforts,” says Dr Sachdev.

Dr Kumar thinks differently on this. “There are short-term, mid-term and long-term solutions. Banning crackers was the lowest-hanging fruit. It did not harm anyone and could significantly lower pollution levels during and after Diwali,” he says. His worry, however, is over the need for long-term measures, including improved public transport and enforcement of construction rules.

Incidentally, the Delhi government recently announced it will buy buses with lower emissions and has earmarked money for it.

The use of air purifiers to combat pollution is a solution riven by class divides. First, poor households cannot afford to buy one. “It is too costly. We have not thought of buying an air purifier yet. But if Yuvan’s condition does not improve, I will try to get one, but I am not sure,” says Chhaya.

Second, air purifiers are no match for the scale of the problem of air pollution.

“Air purifier is a private solution to a public problem, and that too an imperfect one. If the air purifier industry is allowed to shift the narrative to purifiers from reducing the emissions, we will lose the cause,” says Dr Kumar. And equally important, it is not cost-effective, given the need to change filters frequently. “In Delhi, we have very high levels of pollution and the filter should be changed at least every month. But that is not affordable. If a purifier costs ₹30,000, the filter will cost half of that, an expense few can afford,” says Dr Kumar.

Menghaney calls for a deeper understanding of the causes of air pollution and an empathetic response to them, especially when the source is traced to vulnerable sections of society. “Many reasons add to pollution in winters. To keep themselves warm, poor people have to burn tyres, wood, plastic and other such material. That is also a big source of pollution, especially in the evenings. But what can one do when it is so cold? It is the government that has to provide them an alternative mechanism to keep warm,” she says.

Cold comfort: To keep warm during the bitter winter, the poor and the homeless are forced to burn any available material such as tyres, wood or plastic

Jyotsna Singh is a Delhi-based health writer