In the Bonesetter's Waiting Room (18 page)

Feeling a little nauseous, I moved away from my vantage point to find that Gauri, who had been flitting between patients and making preparations for the queues now filling the roof space, was now back upstairs with me. I asked him about what was going on: what exactly was this medicine? What was the family's rationale for giving it and why did everyone (except, presumably, the fish) think that something apparently so extravagantly insane was a good idea?

I knew the medicine was widely supposed to be a cure for asthma, but I was having a hard time believing the thousands who turned up every year were all suffering from that one affliction. Indian herbalists and patients had often told me how a medicinal formula known to ameliorate one problem could also help with a host of others. Cardamom, for example, is popularly said to balance all three
doshas
, and is used to treat indigestion and stomach acidity, respiratory illness, high blood pressure and premature ejaculation. Or there is a species of wild pear lauded for its usefulness in treating asthma, dysentery, epilepsy, gastric disorders, menstrual complaints, lumbago and ulcers, not to mention as an abortifacient and an antidote to snake venom.

These were not easily dismissed as baseless claims: unlike many pharmaceuticals, traditional herbal medicines don't depend on one active ingredient. Instead, they use the whole leaves, bark or sap of a plant, consequently several active constituents may remain present in a single herbal preparation. It also chimes with the underlying holistic philosophy of both herbalists and Ayurvedic and Unani practitioners, of restoring balance to the body as a whole. However, few of these claims have been subjected to modern scientific scrutiny, so the evidence for whether single preparations might be effective for several maladies is largely anecdotal. There are exceptions – analysis of turmeric, long used in Ayurveda, for example, identified an active ingredient known as curcumin which was found to have a spectrum of biological activities: antioxidant, anti-inflammatory, antiviral, antimicrobial and anticancer. I asked Gauri Shankar about the medicine he was dispensing that evening.

‘The medicine is for asthma, cough and flu,' he told me. ‘Only this, nothing else. It has spread only by word of mouth […] we do not make any ads. My father used to tell [us], in his day they used to prepare a handful of medicine. This year we are preparing five hundred kilograms. We are expecting four to five
lakhs
people (40–50,000). The medicine takes eight to ten hours to prepare and we begin organising one and a half months before. It is getting more expensive, but we do it happily.'

As the forty or so people who had been waiting on the roof terrace multiplied into hundreds, with more jumping over the neighbour's wall to join the queue, Gauri Shankar told me how his family found themselves at the centre of a rapidly expanding medical tradition unique not just in India, but in the world.

‘We are the fifth generation in this house. Our family has been here since 1845. At that time this place was [in] the jungle – it was outside the walls of Hyderabad. Our great-great-grandfather was a man called Veeranna Goud. He used to sell toddy (home produced palm wine) and he was very charitable. Twenty-five paisa out of every rupee he made he would give away. At that time in Hyderabad there would be a lot of floods. He would buy food and blankets and give them to people who needed them. One sage, a holy man, had watched him doing that charity and blessed him. He blessed the water here. It is now our well – that is why the house was built here, because the well is here.' Gauri promised to show me the well later, once the crowds had abated.

‘Using this water and some herbs,' he continued, ‘the sage taught him to make the medicine we give. But the medicine has to be free. If it is charged for, it will no longer work. We still prepare this medicine using money from our own pockets. All our brothers keep twenty-five per cent of our income for this charity.'

To ensure they had enough medicine, Gauri and his brothers spent months in the forests outside Hyderabad, gathering the herbs according to the sage's secret formula, then washing and pounding them to produce the 500 kilograms of herbal paste. Apart from the practical requirements, they also make time for the spiritual – performing
pujas
(Hindu prayer ceremonies). These don't come cheap: priests need to be paid, offerings to the gods bought and guests – likely a large number – fed.

Neither Gauri nor his family had been what I had expected. The idea of asking patients to swallow live fish had set off my quackery radar from the moment I first heard their story. But I struggled to think of the Gouds as quacks: though it was unclear to either me or the wider world exactly what was in their medicine, they certainly appeared to have a genuine desire to heal.

THOUGH THE ANNUAL
fish medicine distribution is one of its kind, the drama of the proceedings is something that might be framed in the context of India's growing phenomenon of television God-men and -women, astrologers and faith healers who also engage their mass followings in theatrical spectacle. Their power is evident when you consider that several have enough influence over their followers' minds so that some of them reportedly get away with engaging in excessive behaviour (ranging from the unsavoury to the criminal); while amassing large sums of money and securing the backing of politicians and the powerful.

But what's particularly interesting in a medical context is their marketing of health-related formulations to devotees whose ears and hearts they have already captured through millions of television screens daily. Television yogi Baba Ramdev, for example, is associated with the Patanjali company (which in turn, owns 90 per cent of a television channel too). Patanjali makes a range of consumer and food products promoted by Ramdev, including cornflakes (‘cheaper than Kellog's') and instant noodles (‘cheaper than Maggi's'); as well as Ayurvedic medicines for a range of conditions: including yoga for paralysis and hepatitis; herbal formulations for diabetes, weight loss, infertility and sexual dysfunction; hair oil and face washes which claim to help with dark spots and pigmentation. In 2015, their sales were reported to amount to 2,000 Crore (over 200 Million GBP or 300 million US dollars).

You might say there are some similarities between Gauri and his brothers and people like Ramdev: they are not qualified medical practitioners; their patients have no strong evidential basis for believing in their cures; they are educated, well spoken, and have the trust of their close community; and word of mouth recommendations and sheer force of numbers are also a powerful force in the uptake of their products. The similarities, though, probably stop there.

I knew better than to ask outright what was in the paste – the family would never disclose the recipe gifted to their ancestor by the sage. As Gauri told me, ‘Only our brothers and their wives know what is in the medicine. Not even our sisters, because once they are married they go to another family.' I couldn't be certain, of course, but I did not get the impression that this secrecy was particularly a proprietorial move. With a medical practice this successful, imitators abounded and the family's website made a point of emphasising that if the medicine is not given by the Goud family and for free, it will be ineffectual. Revealing the herbal mix, I was told, would open their practice up to the market, to those who traded in healing and profited from it. And, as Gauri said, if the vow his ancestor had made to the sage that money would never change hands was broken, the formula that had been so effective would, by the holy man's posthumous volition, cease to work. But even if I wasn't going to be told what the paste was made of, I was curious to know the rationale behind their treatment, so I asked Gauri how it worked.

‘There are some types of plants from which we prepare medicines,' he began, still naming no names. ‘Every plant has natural steroids. The thing is, we need to recognise what steroids and what type of steroids. The medicine works because of these natural steroids.'

It made sense that a medication for asthma would be based on steroids: asthma sufferers worldwide receive corticosteroids via inhalers, or tablets or injections which mimic steroids naturally produced in the body to calm inflamed airways, helping to ease and prevent the typically asthmatic symptoms of coughing, wheezing and shortness of breath and also making it less likely that sufferers will react to triggers such as pollen or air pollutants. Phytosterols – plant steroids – are in the cell walls of plants and look and behave a lot like cholesterol. Practically every scientific study of plants used in traditional medicine for asthma has identified steroids as a possible active ingredient. Most plants contain at least some of the several hundred different sterols found in nature, including many that we eat – spinach, mustard, fenugreek, coriander and celery for example – and some will have more ‘potent' sterols than others. However, the amount of sterols we absorb from what we ingest is minimal, and without knowing the Gouds' herbal recipe it is impossible to say what, if any, effect it might have.

Still, in very general terms of the science, so far so good. But then Gauri continued, ‘The effectiveness of the medicine is based on the stars and on the time [at which it is given]. After the fish
prasadam
is administered, the patient has to be on a forty-five-day diet where they are only allowed to eat twenty-five items. We are not Ayurvedic doctors, but this medicine and diet is based on Ayurveda.'

I had read that the treatment cycle would officially end when the stars Arudra (Betelgeuse), Punarvasu (corresponding to Castor and Pollux) and Pusyami Karthi (stars in the constellation of Cancer) are in ascendance. In India, still today, marriages happen at times the stars dictate and to matches they recommend, babies are named according to lucky constellations ruling the time of their birth, buildings are constructed, journeys begun, space missions launched. To the Gouds, the mixture of the practical and the superstitious was also absolutely inherent to the efficacy of their prescription.

‘And why does this only happen on a certain day and time?' I asked. I expected talk of the constellations falling into place, but this time Gauri's answer was a soundly practical one. ‘This time is when the summer season changes. The months of rain start after this. It is at this time that asthma gets worse,' he said.

‘So why do you need the fish?' It was the star ingredient, the one that clearly set this asthma treatment apart from any offered in India's AYUSH medicine.

‘When there is asthma, the airbags in the lungs will be having congestion,' Gauri told me. ‘That, till now, there is no surgery to correct. No permanent cure exists – there is only an inhaler. The fish is alive, so it swims down the throat. While going through, the fish cuts through the phlegm with its tail. These fish – we only use murrel fish – they are very strong, fish flow against the current. Then they go to the digestive system, they get dissolved in minutes.'

It was interesting, I thought, that like anyone who produced medicines, from pharma companies to home remedies, it was always important to understand how these treatments were going to reach the area of the body where they were needed. For pharmaceutical companies, drug-delivery studies are complex affairs – if an ingredient is sensitive to damage by stomach acid, for example, tablets are covered in protective films or casings or are made soluble. For the Gouds, the living murrel fish was the drug-delivery system, forming a casing that protected their herbs and at the same time forcing it through any phlegmy congestion in the throat of people with asthma.

However, because of the anatomy of the passages to our stomachs and lungs, I was doubtful about the necessity of a wriggling, slippery fish. Past our throat area there are two ‘tubes': the trachea (leading to the lungs, where excess mucus in asthmatics is secreted) and the oesophagus, leading into the stomach, the final destination of the murrel fish. All food, which is what these live fish would be recognised as, travels down the passage to the stomach, because when the mouth opens to swallow something, the trachea closes off to prevent it entering the lungs and causing asphyxiation. That means that the value of a fish powering through mucus applies only to a length of about ten centimetres, after which, the fish will have a free run towards the stomach, with a helping hand from gravity. Moreover, some of the Gouds' vegetarian patients were given an alternative delivery system – an unrefined sugar paste called jaggery. The sheer drama (and, for many, trauma) of swallowing a live fish might equally have induced a placebo effect. The effort of its ingestion perhaps invoked an undeniable, visceral sense in recipients that an intervention had indeed taken place and, therefore, that there would be an effect.

Murrel fish are grilled, salted and curried across South East Asia. A murky deep brown colour with fine black striations, some species can grow up to a metre long in the wild, but mostly, as they are a farmed delicacy, they are eaten when they are rather smaller. Aside from their alleged phlegmdestroying abilities, it is this availability that makes them a good choice as a vehicle for the herbal paste: for around ten years Hyderabad's Fisheries Board, amusingly housed in a giant fish-shaped building in the city, have been providing finger-length murrels to the Goud family's patients at ten rupees apiece – this year, 50,000 of them. I asked Gauri how the government came to be involved.

‘This happened since 1996,' Gauri told me. ‘Before that, we got the fish ourselves. At the time there was Hindu–Muslim fighting going on in Hyderabad. There was a curfew. But people come innocent to this place. All religions came. So the government saw that and they got involved. We used to distribute the medicine just over there, where the temple is now. We donated that land.'

After 150 years, the fish treatment system that first began in the village home of the brothers moved to a sports complex. Seven years later, following an incident there in which a man was killed, it moved once again, this time to the Nampalli Exhibition Grounds not far from the Gouds' family home, where it still takes place today. State government sponsorship for the fish treatment was wide-ranging. This year, once again, venue hire and policing costs were being funded from the public purse. Then there was the announcement by Chief Secretary Rajiv Sharma, which directed various other state departments to make the necessary arrangements for the event to run smoothly. These included the Greater Hyderabad Municipal Corporation, Road Transport Corporation, Andhra Pradesh State Road Transport Corporation (to provide buses to ferry patients arriving at the train station), the water board and, of course, the fisheries.