In the Bonesetter's Waiting Room (10 page)

I asked Dr Venkateshwarlu why it was important to the government that this kind of research should happen. ‘In India, Ayurveda, has become alternative. The government is taking steps to mainstream this as a primary system; to move it from a traditional science to a medical science,' he began. ‘The other Indian medical systems vary by place and traditions, but there are government Ayurvedic doctors throughout the country. Ayurveda can work really well with non-communicable diseases. In the West also, where communicable diseases are no problem, the issue more and more is non-communicable.'

‘You mean things like obesity and diabetes?'

‘Yes, and for malnutrition – eating the wrong foods – sometimes it's a matter of education. In India there are many people who don't eat vegetables,' Dr Venkateshwarlu continued.

‘They don't eat vegetables?' I was taken slightly by surprise. ‘In India?'

‘Well, they cook vegetables, then they might dip chapatti in the sauce, but result is they will eat things that make them feel full rather than balanced meals – high starch, fibre, but no nutrients. In pregnancy also, for example, to keep the baby small so labour will be less painful, women will restrict protein intake. We run health camps that regularly go out to rural areas to educate people about good nutrition.

‘The origin of the [Indian] diet is medicinal. You know Vasco da Gama came, the Britishers came – they all came to take the spice, which was for taste, but also medicinal. Across India, people have adapted regimes … traditional practices, regional, therapeutic diets. But dietetics is a neglected area in Ayurveda. The thing about recipes described in the scriptures is that it is not mentioned how much to take, only what to eat. Food generally, there is no dose, just satisfaction. There is no scientific validation for Ayurvedic diets [dietetics], so the government set up this research with the Central Food Research Institute and Institute for Nutrition.'

Dr Venkateshwarlu also described how they might tackle the problem of malnutrition, or other conditions such as gastric problems. He told me that after an extensive study of the active components of an Ayurvedic formulation for a disease, the idea was to come up with a dietary supplement. They might take wheat flour and enrich it with Ayurvedic ingredients. They were also using recipes described in the scriptures, supplementing staples like rice with them and dehydrating the results for use as a powder that would keep its shelf life and potency. ‘We've already developed an antibiotic food formulation and a gastric formulation,' he said.

Unlike some of the commercially available formulations that Anusha had been concerned about, the sources of the National Ayurveda Dietetics Research Institute's plants – in their medical formulations as well as in their medicobotanical gardens – were evident. Opposite the noticeboard listing the 26,943 specimens from the institute's surveys over the years, the wall to the right of Dr Venkateshwarlu's desk served as a gallery for photographs of all manner of leaves, fruits, herbs and trees, labelled with their names in Latin and English transliterations from the Sanskrit.

‘They come from different forest regions,' he explained as I surveyed them. ‘Our researchers make trips into the forests four times a year. The teams are made up of botanists as well as Ayurvedic plant specialists. They stay for fifteen days, collecting plants needed for Ayurvedic formulations, doing surveys of the forest peoples – recording their folklore with respect to the plants. In this way we sometimes come across plants not used in Ayurveda, some not even known to us, medicinally. There was one we came across, for example, a Zamina – this is a South American plant …'

‘And it was growing in a Karnataka forest?' I asked.

‘It must have been brought in colonial times – yes, it had grown there and thrived and we discovered that the local forest people harvested the fruit – for nutrition, but they also say that it is a cure for infertility. So we record plants and information like this.'

‘And what do you do with the specimens when they are brought back?' I was curious to know whether they would be analysed chemically to look for active ingredients that could be tested as a treatment for infertility. Thinking back to how people who habitually use plants as medicine used to venerate them, I also wondered whether Dr Venkateshwarlu had a sense of what the forest people thought about sharing the secrets of their herbs.

‘The tribes and locals do worry that knowledge will be misused. But they are sharing their knowledge, you have to give them financial compensation and we acknowledge them in our publications. The knowledge will also be sent to the Forest Department. When the team return they do chemical analysis of the specimens here in our labs.'

A few days after meeting Dr Venkateshwarlu I was invited to visit the Foundation for the Revitalisation of Health Traditions. I had been told that this research centre housed a very large database of plant-based products used in Ayurveda, Siddha and Unani medicines. But, more significantly from my point of view, it was also affiliated with a recently built hospital, in which patients had access to facilities that integrated both traditional and Western medicines. It was a little way out of Bangalore's city centre, part of the still rural but rapidly expanding developments towards the new airport and close to my home. As I set out with Amreesh, a twenty-two-year-old taxi-driver from my village, we talked about hospitals and healthcare I asked if he'd ever gone to an AYUSH doctor when he was ill. ‘No,' he said, sounding a little confused. ‘I go to the clinic. Everyone goes to the clinics. There are about twenty in the town.'

‘Twenty? In such a small town? Do you mean private clinics, or government?' I asked.

‘Private. There are different clinics for different problems and they charge different prices, so we go where we can afford. My wife had our baby at the government hospital, though. She went there because some family recommended a doctor working there. She had to have a caesarean and he was very good.'

I asked him why she needed a caesarean. ‘The baby was big. Three kilos.' That was under seven pounds. I told him that three kilos was not a particularly big baby – or at least it wouldn't be considered so in the West. ‘Well, it's not that big, but my wife was very small,' Amreesh explained. ‘She was only sixteen. After the delivery, though, the hospital was terrible. She had to stay for a week – the sheets were dirty, the ward was dirty. Every time she needed the staff to do something they asked for money, tips. We don't want to go back there again.'

What Amreesh told me reflected many conversations I'd had in and around Indian cities – with everyone from manual labourers in tattered saris to auto-rickshaw drivers to security guards to people eking out a living in slums. When they got ill, it was the pharmacies, hospitals or clinics of the mainstream that would be the first port of call. Though the state hospital system was woefully underfunded, there were schemes to help people living below the poverty line, so that they could at least access ‘Western' healthcare, however poor its quality. For those with a slightly higher income, there was a plethora of private clinics to suit different pockets.

I began to get the impression that the World Health Organisation's assertion that seventy per cent of the population accessed traditional treatments as primary care might really be reflecting usage by India's majority rural population. Put off by remoteness, poor salaries and lack of access to the modern facilities that middle-class medical students would be accustomed to, rural communities tend not to easily attract or keep MBBS (Bachelor of Medicine, Bachelor of Surgery) qualified doctors, instead being often better served by AYUSH practitioners. AYUSH institutions across the country have approximately 62,000 hospital beds and more than 785,000 health workers. One conventionally qualified doctor might serve up to 10,000 people in rural areas, so it comes as no surprise that the majority are thought to use AYUSH or medicinal plants to help meet their general healthcare needs.

Traditional medicine is, on the other hand, seen as a desirable add-on to Western medicine among the growing numbers of India's wealthy. The popularity of Eastern medicine in the West may also have led to ‘reorientalism' – a resurgence of indigenous practices in their country of origin. The use of Ayurveda-based beauty products in expensive Western spas and retreats was being echoed among the well-off on Ayurveda's home turf, who are increasingly buying into a new glamour of India's ancient prescriptions. As one doctor I talked to put it, ‘We do see more interest in Ayurveda when there's interest from the West.'

But at the other end of the spectrum, the reverse was true: I had heard from health workers that poorer Indians preferred to visit Western healthcare clinics. In a rapidly technologising nation that had recently launched its own mission to Mars, there appeared to be a move by those with little to leave the old behind. And, even though, as Dr Venkateshwarlu had told me, Ayurveda and its practitioners can be found all over India, I had heard from Ayurvedic doctors in Bangalore that it was not so easy to make a living from it, unless you were already a well-established vaidya to whom patients came by recommendation.

As Amreesh drove through Bangalore, I wondered what this meant for the thousands of students graduating annually from India's AYUSH colleges. Throughout the city, along wide main roads or in warrens of homes and shops of the old towns, the footprint of both the modern and the traditional was evident. There were makeshift signs on roadside walls displaying public health messages:
Touch spreads love, not disease
;
Donate your eyes
. I saw vans parked on the side of the city's traffic-clogged arteries, disguised as tents under reams of exotic fabric and offering Ayurvedic treatments for sexual dysfunction and all manner of illnesses. Medical advertisements were everywhere – from large private hospital chain and IVF clinic billboards to tiny haemorrhoid and fistula clinics to alternative signs hand-painted directly onto walls, like the one that read
German dispensary homoeopath for old inherited diseases
.

Fairly soon after we passed that sign, we found our turn-off and headed down a bougainvillaea-lined track that opened out into lush green fields, either side of which were the buildings of the Foundation for the Revitalisation of Health Traditions and the 100-bed research hospital belonging to the Institute of Ayurveda and Integrative Medicine.

The foundation had been established as a non-profit public trust in 1991 by Sam Pitroda, an electronics entrepreneur and technology advisor to former prime ministers Rajiv Gandhi and Manmohan Singh; and Darshan Shankar, an educational theoretician engaged with traditional knowledge systems. The scale of their achievement is impressive, and between them, hold both the Padma Bhushan and the Padma Shri, two of India's most esteemed civilian awards for distinguished service to their country.

Over the years, their campaign to revitalise the practice of Indian health traditions has become widely respected for its standards of clinical practice and for its work in community health, as well as its significant contributions to medicinal plant conservation, the study of medicines derived from natural sources and products developed from them. The research hospital next door was started with the aim of reinvigorating India's medical heritage in practice, as a route to introducing a new type of healthcare that embraces India's main medical traditions – both ancient and modern.

Because Amreesh had been late picking me up that morning, by the time I arrived I was at least an hour late for my meeting with Dr Darshan Shankar. His building had been constructed in the traditional style of the Bangalore region, which would have been a common sight before air-conditioned condominiums and concrete-block housing began their ubiquitous spread. The environmentally friendly unrendered brick facade under high, pitched ceilings gave way to a cool, semi-open courtyard, filled with medicinal herbs and trees, from which a staircase led to the director's first-floor office. I knocked, and after apologising for my timekeeping, rapidly became absorbed in a discussion around the foundation's database, a mammoth collection of information on
materia medica
across India's systems: Ayurveda, folk, Unani, Siddha and the Tibetan Swa Rigpa. Darshan described how their database covered usage of plant-based medicines across an astounding 2,400 years from 1500
BCE
.

‘From my perspective,' Darshan said, ‘we can see from the database that folk, Unani, Siddha, Swa Rigpa – they are all “expressions” of Ayurveda. Their theoretical forms are similar – and the materials even more so. If you query the database, for example, for plants used in Unani, you will find four hundred to five hundred indigenous Indian species – meaning that Unani probably absorbed India's
materia medica
, rather than bringing with it a whole other set of medicinal plants. When you look at the ingredients in some of its formulations, you see it's the same as an Ayurvedic treatment of another name. There has been a great amount of assimilation [into Ayurveda] – Buddhist, Jain, Islamic and colonial influences.'

Darshan pointed out that many of the oldest medical systems incorporate a strong practical element, but what sets Ayurveda apart is that it had a pre-existing, robust body of theory as well, cementing its status in India. ‘Ayurveda is
so
important in India, other systems will find a way of talking through its language and materials.'

‘What about the “other” using the language of biomedicine: modern science?' I asked. I was curious about how much integration – scientific, theoretical and clinical – had already occurred and what Darshan's vision was for the future.

‘You know, I had a cardiac condition six months ago. My family decided I should be opened up. So I went to an allopathic [conventional] doctor. He said to me, “I know what job you do – don't mix up all these types of medicines. Leave it to us.” He said Ayurveda can do nothing. But now, post-surgery I am using a combination of allopathy and Ayurveda. OK, allopathic drugs can control cholesterol levels. But why do I have high cholesterol? We need also to look at the causes of that. Allopathy – biomedicine – is interested in maintaining problems within their limits, but the best of Ayurveda is telling me cardiovascular disease is a metabolic disorder. The mind is also a very important thing – I am also doing yoga for other reasons. Sooner or later, I
will
drop the allopathy.'