Walking across Bengaluru’s epidemics

Kṣema’s heritage walk takes you through Bengaluru’s past pestilences and future plagues.

On a cloudy December evening, the seemingly derelict Epidemic Diseases Hospital on Old Madras Road was bustling with visitors. However, these were not patients roaming the grounds. A guided heritage walk allowed participants to roam the halls, wards, kitchens, and rooms that once housed victims of various infectious plagues and epidemics. Two identical wings—designed to hold European and Indian patients—are separated by an administrative building with architecture that shares a deep similarity with Bengaluru’s iconic Russell Market.

By the early 1920s, Bengaluru had weathered the effects of the Bubonic plague, smallpox, and the Spanish flu, among other outbreaks. Considering the poor state of facilities on Magadi Road and Langford Town, the Plague and Isolation Hospital was commissioned for construction in 1927 and was in use within a decade of completion. The change of name to the Epidemic Diseases Hospital came in 2016. The dome-like structures, spacious hallways, and intricate construction are a testament to the city’s history, even serving as a quarantine facility during the COVID-19 pandemic.

A look at the now defunct wing that held numerous patients with communicable infectious diseases, through the years.

The Epidemic Diseases Hospital presently houses the Ramalingaswami Centre on Equity and Social Determinants of Health (RCESDH), a part of the Public Health Foundation of India (PHFI). On the occasion of their tenth anniversary, Kṣema: A Health Equity Collaborative was held on 16th December. Through the guided heritage walk and interactive activities, the goal was to open dialogue on health equity and the various social determinants of health.

“Our goal as a center, right from the beginning, has been to bring the public into public health,” said Abha Rao, a research scientist and associate professor at the RCESDH-PHFI. She emphasised the need for people to be aware of the non-medical aspects of health. “These are all still sort of works in progress, and we want to develop these games and activities a little further to make them teaching tools, training tools, maybe to do research.”

One of these activities, ‘Arogya Ayke’, was a public policy-themed game, where players are provided real-life scenarios and required to choose between policy options to tackle issues with limited resources. One of the scenarios was antimicrobial resistance, with choices aiming to curb its rampant spread by either limiting organic contaminants in lakes and rivers or regulating the purchase of prescription antibiotics more strictly. Another activity was ‘Sankrama’, a choice-based game that emulated the health choices of individuals from marginalised groups. The game followed the life of one sanitation worker with a recurrent UTI, resistant to common antibiotics.

The recurrence of Antimicrobial Resistance (AMR) as a theme for discussion at the collaborative indicates the urgent need for deliberations on its implications. The urgent predicament is that the medications we rely on are losing their effectiveness. This is a quiet escalation where microbes gain the upper hand and make infections notoriously difficult to treat. Left unchecked, the grim reality is one of prolonged sickness, uncontrolled disease spread, and magnified risk of mortality.

Taking in the iconic architecture of the Epidemic Diseases Hospital with Abha Rao on the guided walk.

Considering the socioeconomic landscape of India, where the population has widely varying levels of access to reliable healthcare, AMR presents itself as a significant governance challenge. Social determinants like gender, caste, and occupation further exacerbate the impact that AMR can have. Alluding to a character from the ‘Sankrama’ game, Keerthana Anilkumar, a consultant at RCESDH-PHFI, was able to demonstrate the impact of said determinants. The female sanitation worker had to face pressure from work and the threat of pay cuts that prompted her to halt her recovery to support her family. “An individual from a marginalised community might be unable to access quality healthcare due to social exclusion or economic inequality. Unstable income sources and dependents can mean negligence in self-care. A drug-resistant infection necessitates rest and medical attention, coupled with tests and strong dosages of drugs that are seldom available in government institutions,” she said.

Speaking to Dr Gayatri Menon, a consultant and adjunct professor at RCESDH-PHFI, on the inclusion of AMR at Kṣema, noted that for people living in extraordinarily precarious circumstances—cramped and poor living conditions, combined with a lack of awareness, can act as a Petri dish for infections. “One drug-resistant infection is enough to push a community into chronic poverty,” she added.

As visitors left the historic campus on Old Madras Road, the conversations initiated by Kṣema served as a reminder that the movement for equitable public health is arduous and challenging. However, the guided walk and interactive activities prove that it all starts with awareness, dialogue, and a public willing to engage.

All images by Prathik Jayaprakash.