Why There Is A Need For A Comprehensive Health Care System For Manual Scavengers

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“Have we ever paused a moment to look at those women and men who have been cleaning all of our human waste with bare hands, irrespective of day and night, compromising their dignity and liberty to keep the city clean?” This is the question posed by Divya Bharathi, the author of the text ‘Kakoos’[2] (which translates to toilet) while showing the deplorable conditions of the manual scavengers. Calling it the worst form of untouchability, she takes us through the lives of many manual scavengers in the state of Tamil Nadu while they engage in their monotonous work. Having the epistemic privilege to talk about this atrocious issue, the manual scavengers reveal the better or rather the complete view of the oppression they face. Having such privilege to some extent herself, Bharathi reserves no qualms in turning the table of the dominant discourse with respect to the- history, identity of the manual scavengers, Caste system in general and more importantly the Government’s attitude towards them. Emphasising that the annihilation of the caste system alone can put an end to this hideous practise she calls upon the Manual scavengers to organise themselves to revolt against it since as Karl Marx rightly put it “men make their own history.”[3]

But the practice which has been prevalent since hundreds of years cannot be annihilated overnight. So what shall be the condition of the Lakhs of manual scavengers who will continue to be working in extremely hazardous environments till then? In light of this question I identified the need to have a comprehensive health care system/policy for Manual scavengers. The reasons for the same shall be discussed as follows.

Before venturing further, a basic idea of Manual scavenging becomes necessary. Manual scavenging refers to the practice of manually cleaning, carrying, disposing or handling in any manner, human excreta from dry latrines and sewers. Over 7 lakh sewerage workers in India are involved in the sanitation and hygiene of our surroundings[4] They have since been responsible for diving into the sewers, unwillingly, devoid of safety gear, cleaning devices and even clothes to clean the faeces, urine, night soil and other chronic waste with their bare hands flushed down by millions of us.

One might wonder why such a practise still prevails today in a country which prides itself on being so technologically advanced to have sent a spacecraft to Mars. The undeniable truth is that the practise of manual scavenging is not a question of capability but of social mores. The practise of manual scavenging can be traced back to 600 AD[5] since when the lowest rungs- not just within the society but within the dalit community itself[6] have been forcibly enslaved to clean the excreta of all the other communities including the animal community. Thus for eking a livelihood they have remained- correction- been made to remain in such dreadful, hazardous and unsafe environment.

But the compelling necessity to work in an industry exposed to health hazards due to indigence (in this case social stigma) and to bread-winning for himself and his dependents should not be at the cost of health and vigour of the workman[7] Hon’ble Judge K. Ramaswamy has rightfully said in the context of the right to health that “To the tillers of the soil…scavengers and hut dwellers, the civil and political rights are ‘mere cosmetic’ rights. Socio-economic and cultural rights are their means and relevant to them to realize the basic aspirations of meaningful right to life.”[8] Overall it highlights how much of a practical necessity it is for the manual scavengers to have a meaningful right to work in a safe environment than any other right.

Article 25(1) of the Universal Declaration of Human Rights, 1948 enumerates that everyone has the right to a standard of living adequate for the health and well being of himself and of his family which includes medical care and necessary social services. The Constitution impliedly enshrines the same through Article 21 which assures the right to live in a clean, hygienic and safe environment and ultimately the right to health. Further this Article vis~a~vis the Articles 39(e & f), 41, 42 safeguard the occupational health and safety. They direct the state to protect the health and strength of the workers and secure humane conditions of work. But when workers are engaged in hazardous and risky jobs, the responsibility and duty of the state is double fold. There then arises a need to formulate a comprehensive health care system which safeguards the health of these workers in these conditions which are unique to their workplace.

“ It is not milk and honey that runs in our ditches”:

Bharathi poses a question[9] in the text mockingly to contrast the sort of substances ranging from faeces to medical waste which reside in the sewers. The manual Scavengers are subjected to various health hazards by virtue of these substances which include:

Exposure to Hazardous gases: (H2S, Methane, Ammonia etc.)

When the sewerage line gets blocked, it produces Hydrogen Sulphide (H2S) which acts as an irritant and asphyxiant affecting Oxygen supply to the brain whose inhalation can result in conjunctivitis, headaches, episodes of blackouts and ultimately deaths[10] From March 2014 to March 2016 alone 1268 deaths have been reported from various states of India due to these harmful gases[11]

2. Infections:

The infections commonly studied among this group of workers include leptospirosis, hepatitis and Helicobacter pylori infection[12] The most common way these infections develop is by hand-to-mouth contact, skin contact, cuts, scratches or penetrating wounds, i.e., from discarded hypodermic needles

Leptospirosis: The urine of rodents and other animals present in that area contaminate these sewers and place the sewer workers at a potential risk of leptospirosis. Without treatment, Leptospirosis can lead to kidney damage, meningitis, liver failure, respiratory distress, and even death[13] In one of the research studies made in Pune which surveyed this disease in manual scavengers, it was found that 16.6% of the total scavenger population had it[14]
Hepatitis : This condition can be self-limiting or can progress to liver cancer.[15] In the absence of appropriate protective gear, a simple scrape or a needle poke could put workers at risk of acquiring bacterial and viral infections like leptospirosis and hepatitis.[16]
Helicobacter pylori: An increased risk for gastric cancer among sewage workers has been described in several studies.

3. Dermatitis:

Chemicals which are present in the sewers generally enter the scavengers’ bodies’ through the skin leading to dermatitis and other skin infections. An outbreak of cases of airborne irritant contact dermatitis has been reported among incinerator workers employed in a sewage treatment facility.17

4. Respiratory System and problems.

It is needless to say that Exposure to chemicals during the removal of excretory waste commonly leads to chronic cough, breathlessness, and a tightening in the chest and development of chronic lung function changes.[18] These symptoms may be due to exposure to endotoxins and airborne bacteria by way of bioaerosols.

5. Musculoskeletal disorders:

These disorders occur in scavengers due to constant stooping in the confined spaces and lifting of heavy wastes. This is due to slipped disc and osteoarthritis — a joint disease that results from a breakdown of joint cartilage and the underlying bone.[19]

Adding to this there is Alcoholism which is deeply rooted in this profession as they believe that only alcohol helps them to dull their senses before entering the filthy pits.

From the above information it can be deduced that the Manual scavengers constitute a sector which requires safety and health care which suits their peculiar hazardous conditions

The inadequacy and the non implementation of the legislations:

However from the perusal of the relevant legislation’s present in India and the implementation thereof, it can be fairly gathered that the hazardous conditions of the manual scavengers are disregarded wholly.

1. The 1993 Act 20 vis-a-vis the 2013 Act 21 & the rules 22 thereunder

“It took 48 Years to even enact a law to make Humans cleaning Humans shit inhumane” These were the exact words used in the text emphasizing the Govt’s attitude towards the scavengers. Following are the two issues persistent in the act which are relevant to our context.

Invisibilizing the manual scavengers: The Transition from the 1993 Act to the 2013 Act resulted in a transition which invisibilized the manual scavengers by not including the scavengers who wear protective gear as manual scavengers itself depriving them of any compensation if met with any accident.

Non implementation: So did the act at least result in strict compliance of rules? Far from it. The 2013 act specifically prohibits and punishes any person from engagement or employment for hazardous cleaning of sewers and septic tanks. “hazardous cleaning” here means cleaning without the protective gear which is to be provided by the Employee. Further the Rules made under the act
- via Section 4 & 5 -compel the Employer to provide 47 different kinds of protective gear,14 kinds of cleaning equipment respectively.
- The rule 6 & 7 further mentions 27 safety precautions that must be taken before, during and after the process of cleaning ranging from regular medical check-up of sewage workers, vaccinations to ensuring the availability of ambulances in the premises.

But the reality paints a completely different picture. The Research Report by Rashtriya Garima Abhiyan[23] surveyed 11 states of India in which they interviewed the families of the deceased manual scavengers and found that there has been

100% violation of Rule 4 and 5 and
Except two sub rules all the other parts of Section 6 and section 7 have been completely violated.

This implies that there has been terrible implementation of the act/rules which inturn means that there is even greater risk of the manual scavengers to be subjected to the aforementioned hazards.

1. Hazardous and Other Wastes (Management & Trans-boundary Movement) Rules, 2016:

“Nuclear plants are a huge hazard to people but a person dying due to shit is it not a huge insult to humanity? If they think huge hazards only are important and not huge insults. Isn’t this a casteist attitude?”

There are various laws which deal with the environment protection in India but none of them speak about the manual scavengers who keep the environment clean.

Section 17 of the rules defines hazardous waste as any waste which by reason of physical, chemical, biological, reactive, toxic, flammable, explosive etc. causes danger to health or environment.

Whatever the waste may be, in whatever form it is, a lot of it ends up reaching the dark pits i.e the sewers, which releases obnoxious gases and generates various kinds of infections, whose victim is the disposer of the hazardous waste. However the rules which are dealing with the hazardous waste management are completely silent about them. The legislation is incomplete in the sense that it places hazardous waste management in the centre but pays no heed to the one who manages it.

But why is there an inadequacy in legislations and non implementation thereof:

Law ultimately represents the subjective wishes of a few privileged people, who create laws which serve their own interests[24]

One cannot talk about Manual scavenging without talking about caste. This Caste in the hands of the orthodox has been a powerful weapon for persecuting the reforms and killing all reform[25]. The Government lacks a political will[26] to make adequate laws since the manual scavengers have always been considered outsiders. For example-

They are not even ready to recognize them in the first place. While government estimates peg the number of manual scavengers at anywhere between 14,000 and 31,000, the Safai Karmachari Andolan[27] says the figure is closer to 770,000, with nearly 1,800 sewer cleaners.

asphyxiating to death in the last decade. The government is also not ready to acknowledge them and their deaths.[28]

More than four years since it came to power, the Present government has not released a single rupee for the rehabilitation of manual scavengers.[29]
No necessary steps to eradicate manual scavenging have been taken by the government, even though mechanized sewer cleaning technologies have been in existence for long now.[30]

The Government also displays a false or illusory political will focused on short term fixes. The Swachh Bharat Mission, the esteemed flagship program, gave people toilets but it never gave them ways to dispose of the waste. According to Bezwada Wilson, most of the toilets built were single pit toilets that become full after about a year’s use. This excreta-turned-manure pit needs cleaning every few years and that work is carried out by manual scavengers, who Wilson called the anonymous ‘foot soldiers of Swachh Bharat’.31 Integrated low cost sanitation scheme (ILCS) also is a huge failure in this regard

Conclusion

Yes, Manual scavenging has to be eliminated completely. But the deplorable conditions of the Manual scavengers cannot be ignored until that has been done. The Government has hastily made a law while abdicating its responsibility without considering the manifold issues pertaining to it. One of them is their health. The deplorable conditions which they work in make them susceptible to dreadful health conditions. Thus what is required is, Firstly accurate statistics with respect to the number and details of the manual scavengers of all forms, since hiding the numbers is just going to exacerbate the problem at hand; Secondly a comprehensive health care system for the time being targeting the manual scavengers which shall consist of an occupational health delivery system with trained manpower and infrastructure including investigation facilities, environmental assessment, evaluation of occupational health status, first aid training of the workers on a regular basis, periodic awareness programmes, periodic medical examination, compulsory health insurance policies etc.; Thirdly, Laws, devoid of loopholes, which are to be formulated after deliberating with the subjects who have the epistemic privilege of their own, to constructively deal with the horrendous practice altogether which surprisingly still remains a reality in a sovereign socialist secular democratic republic like ours.

1 Paper written by Tharani Vemuganti as part of Assignment I of Research Methodology Course in NALSAR, Hyderabad.

2 Kakkoos Documentary Film- Directed by Divya Bharathi.

3 Karl Marx, The Eighteenth Brumaire of Louis Napoleon.

4 HuffingtonPost: Modi Has Failed Manual Scavengers, Says Activist Leading Safai Karmachari Andolan (07/04/2019) https://www.huffingtonpost.in/entry/manual-scavengers-who-do-indias-dirtiest-job-say-modi-has-failed-them_in_5ca9a3c2e4b047edf95b652f

5 Dr. B. R Ambedkar.

6 Indian Young Lawyers Association and Ors. vs. The State of Kerala and Ors.(2017)10 SCC 689. 7 Occupational Health and Safety Association vs. Union of India (UOI) and Ors. AIR 2014 SC 1469. 8 C.E.S.C. Limited and Ors. vs. Subhash Chandra Bose and Ors AIR 1992 SCC 573.

9 “Is it milk and honey which runs in our ditches?”

10 A. Narayanan v. The Chief Secretary, Government of Tamil Nadu (2009) 1 Mad LJ 1249.

11 Sangeeta Barooah Pisharoty : Twenty-Three Years Since Anti-Manual Scavenging Act Not Much Has Changed on Ground 11/APR/2016.

https://thewire.in/labour/twenty-three-years-since-anti-manual-scavenging-act-but-not-much-has

-changed-on-ground.

12 Dr. S. Krishnan, Manhole Workers Dodge Danger Down Under: International Journal of Emerging R esearch in Management &Technology, Volume-7, Issue-5.

13 Centers for disease control and prevention, definition of Leptospirosis. https://www.cdc.gov/leptospirosis/index.html.

14 Ambekar AN, Bharadwaj RS, Joshi SA, Kagal AS, Bal AM, Zero surveillance of leptospirosis among s ewer workers in Pune. Indian J Public Health.;48: 27-9 (2004).

15 WHO, Conditions of Hepatitis https://www.who.int/features/qa/76/en/

16 https://www.indiawaterportal.org/articles/who-gives-sht.

17 Nethercott JR. Airborne irritant contact dermatitis due to sewage sludge. J Occup Med. 1981;23:771–4.

18 Samskruti P. Murthy: Descent into hell, 9th Dec, 2018. https://www.thehindu.com/sci-tech/health/descent-into-hell/article25699783.ece. 19 Id.

20 The Employment of Manual Scavengers and Construction of Dry Latrines (Prohibition) Act, 1993.

21 The Prohibition of Employment as manual scavengers and their rehabilitation act, 2013.

22 The Prohibition of Employment as manual scavengers and their rehabilitation rules, 2013.

23 Report by Rashtriya Garima Abhiyan: “Justice Denied: Death of workers engaged in manual s cavenging while cleaning the Septic tank or Sewer” https://idsn.org/wp-content/uploads/2018/12/Report-Justice-Denied-Death-of-workers-engaged-i n-manual-scavenging-while-cleaning-the-Septic-tank-or-Sewer2.pdf

24 Leo Tolstoy.

25 Dr. B.R Ambedkar.

26 David Roberts, What is “political will,” anyway? Scholars take a whack at defining it https://www.vox.com/2016/2/17/11030876/political-will-definition

27 An organisation led by Bezwada Wilson which aims at eliminating Manual scavenging.

28 Reuters, HuffingtonPost: Modi Has Failed Manual Scavengers, Says Activist Leading Safai Karmachari A ndolan 7th April 2019

https://www.huffingtonpost.in/entry/manual-scavengers-who-do-indias-dirtiest-job-s ay-modi-has-failed-them_in_5ca9a3c2e4b047edf95b652f

29 Dheeraj Mishra, Modi Govt Has Not Released a Single Rupee for Rehabilitation of Manual Scavengers

, 31st Aug,2018. https://thewire.in/government/modi-govt-manual-scavengers-rehabilitation

30 Kabir Agarwal, T echnological Solutions, Including Robots, Aim to End Manual Scavenging, 14th Oct, 2018. https://thewire.in/labour/technological-solutions-including-robots-aim-to-end-manual-scavenging

31 Rakhi Bose, Manual Scavenging is Illegal in India. Then How are There 7 Lakh ‘Foot Soldiers of S wachh Bharat’?, 9th Oct 2018. https://www.news18.com/news/buzz/manual-scavenging-is-illegal-in-india-then-hows-there-7-la kh-foot-soldiers-of-swachh-bharat-1898891.html

Submitted by :

Tharani Vemuganti
Pursuing LLM, NALSAR University