vijayawada - Urban SHADE

Living with diabetes during extreme heat

Living with diabetes during extreme heat Hemanth Chandu By 11:00 AM in the morning, 32-year-old Sandhya sits outside her home with her female neighbours sitting under the tree shade. The women chat and laugh, relieved to escape the March summer heat inside the house. Within hours of sunrise, their two-room flats in the government constructed apartment in New Rajarajeshwari Peta in Vijayawada feels like a pot on a stove. “Ee vadagaalpula valla intlo baaga aaviri vachesthundi. During this hot summer, the heat builds up in the house like steam. I find it difficult to breathe sometimes,” she says. But Sandhya, it’s more than just physical discomfort. She has diabetes and feels her condition worsen during the summer. About 57 percent of Indian districts, home to 76 percent of the country’s population, are at high to very high heat risk, a 2025 study by Council on Energy, Environment and Water (CEEW) showed. Andhra Pradesh is one of the top most heat-prone states. Vijayawada and Guntur, where the Urban SHADE project works, are at very high risk of heat risk. Extreme heat is known to exacerbate health risks of diabetics. 77 million adults live with type-II diabetes in India. Studies done from some countries have shown that higher temperatures are linked to diabetes related complications related to cardiovascular or renal ailments among others, increased hospital visits and mortality risk, as the body struggles to regulate itself under heat stress. For Sandhya and other residents of informal settlements, who are already more vulnerable to the effects of climate change, the additional burden of having diabetes poses further risk. Mounting health problems A couple years ago, Sandhya used to run a food cart cooking and selling breakfast items such as dosa and idli, when she met with an accident. Hot oil spilt on her leg, and refused to heal for a long time. She finally had to go to a private hospital in the city where the doctors had to remove one of her toes. The surgery cost her Rs 1.2 lakhs which was borrowed from an informal lender for 10 percent interest. She continues to have a persistent wound. “Everyday I put on the glove and do the dressing of this wound myself,” she said. She was first detected with diabetes when she was pregnant with her second child more than a decade ago. She goes to the Primary Health Centre near her house every month, where her blood sugar levels are checked and she gets her medicines. The PHC staff with whom around 200 diabetics are registered informed us that the blood sugar levels among the diabetics rises above their usual levels during summer. Diabetes tends to place individuals at greater risk for heat-related illness during heat waves and physical activity due to an impaired capacity to dissipate heat, which can have an impact on cardiovascular health and blood sugar control. Those who already have poor glycemic control and are affected by diabetes related complications are particularly vulnerable. “I follow everything the doctor says. I take the medicine and follow the diet. But my sugar levels are never/often not in control,” she says. Because of her uncontrolled diabetes and the persistent wound on her leg, Sandhya had to give up working outside home. No relief at home Staying home provides little comfort. Though it is sometimes perceived that homes can provide protection, in informal settlements such as RR Peta, the indoor temperature is often higher than outdoors, a 2022 study showed. The qualitative study, which had RR Peta as one of its study sites, was led by architects trying to understand how the community copes with heat, and its coping mechanism to deal with heat stress. For roughly 17.4% of urban population living in informal settlements, this heat stress is far more acute. Houses in informal settlements are rarely built with thermal comfort in mind, leaving residents with limited access to cooling, clean water and heat alerts. Government affordable housing schemes continue to overlook basic passive cooling measures such as cross ventilation and insulated roofing and adequate shading making indoor temperatures as dangerous as outdoors during a heatwave.The minimum standards for constructing government affordable housing such as RR Peta is extremely low in the Indian context. In the tiny apartment, Sandhya lives with her husband and five children. The eldest who is a construction worker has moved out and lives with relatives. Two of her other older children work as delivery gig workers, while the youngest two still go to school. Even basic household work is difficult for her now. “Even if I am sweeping the house, I need to rest for 15 minutes,”she says. During summer, her legs swell, and she often gets headaches and back pain. She says,“This house barely has any ventilation and I end up sweating continuously while working. I have to do all the household work in this heat and through pain. It is so frustrating.” During the 2024 floods in Vijayawada when RR Peta was affected, their washing machine, fridge, and air cooler got destroyed. During these floods, homes were submerged, families displaced to relief camps, and livelihoods disrupted. The machines are now sitting in the house like fossils for want of repair, as the family cannot afford to repair them. Meanwhile Sandhya has to wash the six people’s clothes and cook fresh meals everyday while trying to cope with the heat. Financial precarity Since Sandhya gave up working outside, her family finances have become precarious. The household depends largely on her husband Srinivas’s income. He is an autodriver and earns around Rs 10,000 per month. Srinavas too feels the heat acutely while working, but brushes it off saying, “It’s common for us.” He has seen his own customers, mostly elderly people faint in his auto. He has pain in his right hand, but has not been able to tend to it, because of the family finances. The doctor had recommended a surgery (costing Rs one lakh) and rest for two months. This was not

Events

Consulting with the communities

Consulting with the communities “What did you have for tiffin (breakfast)?” This question brings a smile to the faces of the people sitting in for community meetings of the Urban SHADE project. In these meetings that started in February 2026 are conducted in the community, the Vijayawada-Guntur team and the Shimla team discuss the findings and the proposed intervention of the Urban SHADE project. The meetings have been set up in people’s houses within the community which they have generously opened for the Urban SHADE team, despite houses being small and cramped. In Guntur and Vijayawada, the hosts removed the cot from the house to make space for the duration of the meeting. In Shimla too, a friendly person’s house, public spaces such as grounds, or Anganwadi centres or even the lobby of a residential building were used for these meetings. We are grateful to everyone who helped us organise these meetings. The meetings were conducted with different groups from different sites of the settlement- women, old persons, persons with disabilities, outdoor workers and those with chronic illnesses. In Shimla, meetings were also determined by the location- such as upper part of settlement, and the lower parts, and some occupational groups such as municipal sanitation workers. In Vijayawada and Guntur, the team hung relevant photos and distributed some photos among the participants that helped spark discussion among them. There were photos of cracked walls of houses, hospitals, garbage on the road, newspaper headlines of floods, flood warning messages or illustrations depicting heart illness among others. This technique helped a great deal in communicating the findings of the qualitative research including focus group discussions and in-depth interviews, especially since many of the participants were illiterate or semi-literate. Persons who participated in these meetings discussed the garbage in their areas, what happened during the floods, or their experiences in public hospitals or private clinics. Many people who attended the meetings said that they saw the messages sent by the government on flood warnings for the first time. They spoke about how they barely got food or water during the heavy floods in 2024. The community members also suggested their ideas for possible interventions. In Shimla, the team presented an illustrated flow chart with the findings, gaps and the planned intervention activities. The team explained that the qualitative study presented cardiovascular diseases, musculoskeletal problems, skin disease, alcohol and drug addiction as problems facing the community. There are also increased out-of-pocket expenditures due to lack of ambulances and unavailability of medicines in government hospitals. The distance of the hospitals deters people from going there, especially older persons who are unable to walk up to main road, often leading to them missing out on follow-ups. Both informal settlements in Shimla do not have functional Primary health centres. Pregnant women and children have to go to hospitals further away to get basic check-up or immunisation. People reflected on how they are unable to sleep when during heavy rains. While they do get flood messages, they have no idea what action should be taken. The team also presented a general lack of awareness about the diseases caused due to extreme rainfall, and suggested interventions. These meetings helped validate the findings and also get buy-in from the community for the intervention activities still being planned. In Andhra Pradesh the team includes researchers Pavani Pendyala and Hemanth Chandu, field coordinator Satyanarayanamma Methukulla and community co-researchers Dasari Madhavi and Maddela Siva Parvathi. In Shimla, the team includes researchers Inayat Singh Kakar, Dr Yetika Dolker, and field coordinator, Sahil Kumar.

Events, India

Enumerators workshop India

September 2025 Household Survey Enumerators workshop, India The Urban SHADE project in India conducted a training of enumerators for conducting the Household Survey: Social and Health Vulnerability Assessment in September. The workshops were held first in Vijayawada and then Shimla in five-day spans between September 8, 2025, to September 22, 2025. In both the workshops, the research team conducted a focus group discussion with the enumerators to get a pulse on their understanding and knowledge about the different informal settlements we are studying, impact of extreme weather events in such settlements among others. Many of the enumerators who had prior experience conducting surveys participated wholeheartedly on their understanding of extreme weather events, and the various challenges in conducting surveys in the field. The research team including Hemanth Chandu, Malini Aisola, Inayat Kakar and Yetika Dolker explained to the enumerators about the Urban SHADE project and broadened their understanding of extreme weather events and how it affects people with different vulnerabilities especially the poor who live in informal settlements, disabled, or those with precarious jobs, or with chronic illnesses differently. Each section of the survey, and their questions were explained to the enumerators. The sessions covered Ethics related to data collection in great detail. It was emphasised that the data collection must be implemented consistent with the principles of the Human Rights Based-Approach to Data. The research team spoke about maintaining confidentiality and privacy of the people who will be asked questions from the questionnaire. The enumerators were made aware of the gender and cultural norms that could come to play while conducting the survey. The research team also highlighted that data collection should not lead to further discrimination among the already marginalised communities that the Urban SHADE project works with. The interviewers were given detailed instructions on preparing for the survey, introducing themselves, obtaining consent, and taking a survey. The participants were given mock practice sessions where one of them played the respondent and other played the enumerator. The situations included dealing with a busy mother who had no time, or a person concerned about the survey leaking information to the government. The situations which were designed to be tough helped the enumerators practice their skills in seeking consent and trying to convince people for a survey by being transparent and respectful. The role-playing activity broke the monotony of the typical workshop with presentations. Balaji Rao Nemala gave hands-on training on how to map settlements where the survey is to be conducted. Nemala (photo below) who is the Project Manager with The George Institute, has handled trials all over India in both urban and rural settlements. Mapping literally means drawing a map of the settlement on paper. Nemala guided the enumerators in the field on how to map the structures in a way that they do not miss a single house. This exercise gets complicated in informal settlements, which barely have any straight paths. In Shimla this was compounded by the fact that the settlements are on hilltops which required a lot of physical labour of climbing up and down the hilltops. The enumerators covered the length and breadth of the settlements marking structures in each of the narrow lanes of the settlements. The people in the settlements who were curious about the exercise asked them about it, giving the enumerators a chance to explain the survey to them. Bijini Bahuleyan, Data Manager withThe George Institute made the data base for the survey which is to be conducted in Telegu and Hindi. She also helped participants log on RedCap software which will be used for data collection in the survey, and trained them on how to use the software for data collection. The survey is expected to begin in October. In Vijayawada and Guntur informal settlements (Vambay Colony, RR Peta and Sarada Colony), the survey will be conducted in Telegu. In the Shimla informal settlements (Krishna Nagar and Eidgah colony), the survey will be conducted in Hindi.