In the Bonesetter's Waiting Room (2 page)

So many others in these pages have had the courage, foresight, or at times even the folly to challenge a system whose opacity and complexity would defeat many, their persistence rewarded with support and funding from both individuals and international organisations. The scientist in my final chapter, Professor Pawan Sinha, for one, remains philosophical about the inherent difficulties. When I asked him about the challenges of working with the visually impaired in the country with the most blind people in the world, he said, quoting Khalil Gibran, ‘When you set out to do something good, the energy of the universe aligns to assist you.'

Despite the work of these many inspirational individuals, there remains a long way to go before the ambition of that first government of modern India – state-supported healthcare for all – is realised. But if India is to achieve its full potential, it is a goal that remains vital: in one of the greatest nations on earth, the provision of world-class healthcare for all should be a major plank of government policy, not about philanthropy or ethics, or dependent on the goodwill of pioneering individuals. As an NHS colleague in London said to me – there is actually a strong economic case to be made as well. It is quite simply economic folly for a country to sacrifice its largest resource – its people – to ill health, poor nutrition and inadequate medical education.

Though I spent a good part of my childhood in India, hold an OCI (Overseas Citizen of India) card and was born to an Indian mother raised in Delhi and a Trinidadian father whose own father was taken into British indentured service from Uttar Pradesh, the stories in this book are still based on the observations of an outsider (though I think I have come to the conclusion that everyone is an outsider to some part of their own country, and even within their own cities). After completing my interviews for this book's final chapter, heavy-hearted to be leaving, I thought of something surgeon Dr Umang Mathur told me as I left the Dr Shroff Charity Eye Hospital in Delhi: ‘India is everything they say it is,' he said, ‘and nothing.'

Still, with an outsider's eyes, even in a familiar landscape, sometimes you find the most wonderful stories in unexpected places. And so, ultimately, this is a book about how people in India approach health. It places centre stage stories of Indians in the business of healing – from the forefront of cutting-edge medical science to traditional street-corner pharmacies dealing with all manner of diseases by all manner of means – all hoping to deliver a cure. In researching it, I have spent time with healers and with patients, finding out who they turn to and why. The projects I have covered and doctors I interviewed were chosen for a variety of reasons. Some were pioneers in their fields; others attracted celebrity clientele. Several have been powerful catalysts for change, or have long family histories of medical practice. Yet others are passionate folk practitioners who fuse ancient tradition with modern technology, or command vast numbers of patients who place their trust in them despite knowing little about the treatment they receive.

My aim was to allow characters and their stories to speak for themselves, vibrant snapshots of health and disease – both inside a rapidly changing nation and in the work of its diaspora, who have long comprised a disproportionately large percentage of doctors and scientists across the world.

Detailing the entire breadth and diversity of the practice of medicine in India is clearly beyond the scope of any single volume. For every individual research centre or hospital whose story I relate, there are hundreds of others whose narrative remains to be told. India has a long history of iconic, brilliant scientific and medical minds. Its interaction with the wider world, in the provision of knowledge, doctors or scientific or scholarly exchange, go back millennia. The archaeology of the sub-continent is increasingly uncovering Indian innovation, reaching far into its pre-history, and so there are an almost uncapturable number of tales to tell. I would encourage everyone to continue to explore, engage and collect the wisdom and wealth of human story this great country affords. Within the chapters that follow, my aim was to capture and curate a selection of stories that I found to reflect the experience of people from different socio-economic groups, from the educated to the illiterate, cities to forests, superstition to hard science. In India's rapidly changing landscape, any snapshot of ‘now' is destined soon to become a mere record of practices, some of which, in just a few years' time, may well be obsolete. The stories told here move between rural and urban settings, from healing traditions rooted in India's religious, royal and colonial past to its twenty-first-century innovations. From neuroscience to jungle berries, ancient formulae to e-health, royal wrestlers to pioneering heart surgery, these are tales about medicine in India – as complex, vibrant, inspiring and bewildering as the country itself.

1

Depressed in Dharavi

WHERE ‘60-FEET ROAD'
rises over the rail tracks, a short bridge loaded with abandoned heavy building materials and concrete mixers is a conduit to a part of Mumbai that its casual visitors – and many locals – would struggle to identify with. It's not that the slums of India's most glamorous city are invisible. Brought to the world's attention by the film
Slumdog Millionaire
, Mumbai's vast shanty towns envelope its international airport, so that the only way to be personally oblivious to the sea of blue tarpaulin or galvanized roofs is to land into the city by night.

ON THE GROUND
, ask to be taken to Dharavi and a unidirectional shake of taxi drivers' heads will swiftly dismiss you. The driver who finally agreed to take me – for around three times the correct fare – compensated by doubling up as a tour guide. ‘Dharavi is bigger than all slums,' he offered in Hindi, as we were held up in traffic next to a giant concrete mixer. ‘Do you mean the biggest in Mumbai?' I saw a broad smile flash in the rear-view mirror. Taking a hand off the steering wheel, finger pointed upwards in a gesture of proclamation, there was an irony in his proud pronouncement that we were entering not just the largest slum in the city, but the largest in all Asia. At 535 acres and with a population of over 700,000, Mumbai's Dharavi is second only to the Neza-Chalco-Itza mega-slum in Mexico City.

Located in the heart of a city in which rents are on a par with New York and London, the slum's real-estate value is substantial. But towards 60-Feet Road, the Subways, Tataallianced Starbucks, indie cafés and boutiques that are now familiar sights in the fashionable city disappear. There is a branch of Domino's Pizza just outside of Dharavi's borders, but they refuse to deliver there. En route from the airport you will find only one ATM, a stark contrast with their availability in other parts of Mumbai and a move by India's HDFC bank to capitalise on offering accounts to the many with little.

Along 60-Feet Road, English writing on signs and shop fronts suddenly, and almost completely, gives way to Hindi. Sometimes, on top of the makeshift roofs of the shanties lining the littered, sewage-filled waterways, you can make out large English print. To keep the monsoon at bay, a lucky few residents have acquired huge rectangles of tarpaulin that in a former life were election posters or adverts for new Mumbai luxury developments. The larger than life-sized photographs of politicians staring skyward create an inadvertent satire, as do the luxury property slogans they sport:
Have it all and save up to 72 lakh
(£70,000);
Serenity and blissful living
. Other than these, the only English in evidence over the bridge is an ALFA BOYZ gang tag sprayed onto a dirty concrete wall (possible competitors, I later learn, to the SlumGods, Dharavi's home-grown gang of breakdancing b-boys); and the words ‘Praise the Lord', writ large on the windscreen of an old ambulance parked outside my destination.

Officially ‘The Urban Health Centre in Dharavi', Chota Sion Hospital was built in 1980 as the government of Maharashtra State (of which Mumbai is the capital) began building tower blocks to rehouse Dharavi's early inhabitants and curb the slum's spread. Some of the first of these now blackened and dour blocks are directly opposite the hospital, designated
chota
(small) in deference to the main, fully equipped municipal Sion Hospital complex a few miles away. For a time, Chota Sion was set up to serve mainly the women and children of the slum, but it is now home to a strong team of social workers, an HIV/AIDS clinic, a vaccination centre and general wards. Because many husbands were reluctant to wear condoms, one of its most popular operations used to be voluntary female sterilisation, but today only minor surgery takes place here. Despite this, Chota Sion sits at the heart of Dharavi's community healthcare – both physical and mental.

Painted baby pink at some point in the distant past, the hospital's five storeys tower above the mass of shops and homes that surround it. As I stood at the main entrance, the smell of disinfectant and surgical spirit was nearly as strong as the sense of foreboding. It reminded me of a few war-torn and emptied buildings I had seen in Kabul, though this one, by contrast, was by no means abandoned. Doctors and patients went about their business, paying its state of disrepair no mind.

A guard directed me down a long corridor, past rooms where babies sat on their mothers' laps having their shots, or outpatients waited for check-ups. The busy STD clinic was decorated with a large drawing of a cartoon condom with arms, legs and a very happy face. I was surprised to see a lean white cat stride confidently along the corridor towards me, mewing loudly and looking quite at home as it passed the extensive lines of people sitting on the benches along its length, waiting to be seen. Much like the Domino's delivery team, it seemed that Mumbai's medical staff were also reluctant to serve Dharavi.

I made my way to the back of the building, which, apart from the wildlife, had an abandoned feel. On its main staircase, chipped cream paint and plaster had collected liberally along the edges of each step. A glance up the stairwell to the top of the building revealed thick red smears streaking the walls: not dried blood but the accumulation of years of betel nut-tinged spittle discharged from every floor, staining even the signs in place to forbid the practice.

To the right of the staircase I found the rear entrance to the hospital. A covered walkway cut through an open courtyard to a drive where a couple of atmospherically ancient ambulances were parked. It offered incoming patients some protection from the more vertical deluges of the multidirectional monsoon rains, as well as providing a waiting area for those who had come to approach Sabawa, the Goddess Oracle who sits for most of the day outside the hospital's courtyard shrine.

When I first saw her, Sabawa was holding court with a few devotees, her son, grandson and the men who had arrived that day with bamboo scaffolding to prepare the shrine for its annual festivity which would see the courtyard turned into a bloodbath. Her ample haunches were propped comfortably on a low wall; her retinue stood or sat on the floor around her. Their conversation paused as we
namasted
. There was something generally formidable about Sabawa, both in the powerful charisma she exuded and in her appearance – her dark, almost doll-like face adorned with a generous smile, two silver nose-rings and a too-large red circle on her forehead; her corpulent frame topped by black and grey mottled dreadlocks that tumbled nearly to her thighs. She was wrapped in a dark green sari, a colour sacred to the Goddess Kali and auspicious for married women; she'd covered her arms nearly to the elbows in green glass bangles too. Despite her girth, she looked nowhere near her seventy years.

And yet she had good reason not to look as well as she did because, thirty-two years ago, Sabawa, it was said, had inexplicably fallen ill and died.

Her son Rayvan told me this as nonchalantly as if he were giving directions. I asked him to repeat what he had said, just to make certain I had understood correctly. At first, when he told me his mother had died at the age of thirty-eight, I imagined that Sabawa had unofficially adopted him. But that was not at all what he meant.

Rayvan, with whom she had been pregnant at the time of her death, was Sabawa's youngest son, and when she was nearly to term she started experiencing strange and violent movements in her abdomen. Neighbours said that she had become possessed – that a
devi
(goddess) had entered her body. Like its gods, the goddesses of the Hindu pantheon often take on different avatars to become the spouses of their opposite-sex counterparts. This goddess – known as Kali, or Durga in her major incarnations – is the
shakti
(power) to the destroyer god Shiva, a forceful yin to his yang. Though a mother to the sons of gods and possessing the ability to be compassionate, she is no demure Mary nor bejewelled Lakshmi. Kali/Durga brings powerful, vengeful justice to the world.

The infiltration of this
devi
, or
bhoot
(ghost), into a person – usually a woman or a girl – is widely used across India to account for a range of symptoms that might otherwise be explained as depression, anxiety, epilepsy, malaise, rebelliousness or any number of psychiatric conditions. The treatments for possession can be incredibly brutal, and often extreme violence is inflicted on victims. Beatings and torture (including burning or rubbing chilli powder on the skin) are commonplace among believers. Sabawa was no exception, but the multiple hot irons that branded her stomach with circular burns did not cure her.

‘After my mother died,' Rayvan continued, ‘the community tied her hands and feet and wanted to take her body.' Sabawa's mother, distraught, prayed to an image of the goddess she kept at home and the next day announced to the community that the
devi
had spoken to her, warning that if they touched Sabawa's body they would all die. The goddess wanted this girl to care for her shrine and demanded blood. To bring Sabawa and her unborn child back from the beyond, two pregnant goats were to be slaughtered, their wombs opened and their unborn kids removed and sacrificed.

‘It started with two, but now there are one hundred and fifty goats offered every year. Hindus, Muslims, everyone comes, it doesn't matter, they all come.' Rayvan beamed. His enthusiasm was understandable, as without the goddess's intervention, neither he nor Sabawa would have been there that day to tell me the story of the events that very nearly cost them both their lives.

It was sad to imagine what the young Sabawa and her family must have gone through during those difficult days. The cause of her convulsions and collapse (or possible coma) is difficult to guess at – even today, many women across India never have a thorough medical check-up during their pregnancies. Sabawa might have had epilepsy, or eclampsia seizures – symptoms which can worsen in the later stages of pregnancy. Or less scientifically, and perhaps more sinister, accusations of possession can sometimes be a cover for simply getting rid of a person, in a vendetta, for example, or a witch-hunt. Whatever the cause, Sabawa was lucky to have recovered, an outcome the family ascribes entirely to divine intervention. In those early days in that slum, as still in many parts of India, the lack of access to appropriate medical care means that the intervention of spiritual healers can seem like the only recourse, sometimes with fatal consequences.

Since her personal triumph over disease and desperation, the faith of Sabawa and her sons in the
devi
has been intense. The
devis
whose statues filled that shrine (no more than the size of a shower cubicle) seemed even more so. Her devotees, who were often also Chota Sion patients, came every day to make offerings. They brought the green glass bangles and marigolds that laced their way around the dome of the shrine; they came to ask for healing or offer thanks for prayers granted. But more than that, they came to hear the goddess speak through Sabawa's voice, and for that they also brought goats and chickens to be sacrificed (and, rumour has it, not insubstantial offerings of gold).

‘When the goat is brought for sacrifice I ask the
devi
whether she accepts the sacrifice or not. If I see the goat trembling it is the sign of
devi
's acceptance, it is a sign to kill her for the sacrifice.'

Sabawa says she demands no sacrificial offerings or valuables, but her devotees bring them anyway. The green glass bangles she welcomes, and the flowers are useful decoration for both the goddesses and her oracle's stone, which she asks people to touch and make a wish.

‘It's just a stone,' Rayvan told me. He pointed to a rubble-strewn area across the fence, around two metres away. ‘Look there, my mother just picked it up from the other side of the courtyard. My mother could use any stone, the goddess still speaks.'

It wasn't really just any stone: placed in front of the goddesses, directly in her eye-line, was a rock about fifty centimetres in length and twenty-five wide. Its edges were slightly jagged, as was its underside, so that it wasn't entirely stable. When Sabawa sat before it and put her petitioners' questions to the goddess, the rock would become the instrument of her voice.

‘When the answer is yes, stone will move to the right; if it is a no, the stone swings left,' he explained. Rayvan bent down and pushed it to one side and then the other. ‘See, see how heavy it is … it cannot move on its own.'

As he walked off, I tried it too. It didn't even budge. ‘It is incredibly heavy,' I agreed.

‘Yes. And when the goddess gets angry, the stone moves fast, forward towards the shrine, like this!' The push of Rayvan's upturned hands indicated a violent movement and I imagined a great crash against the front wall of the shrine.

I hurried after him. ‘Does she get angry often? Why would she get angry?'

I knew that Kali and her various alter egos were no soft touch. While Lakshmi sits on a lotus and radiates loveliness and light, Kali and Durga are popularly depicted with semi-crazed eyes and hair, wearing garlands of human skulls, holding swords dripping with blood, or mounted on large predatory animals. When the goddess entranced Sabawa, she too danced wildly, energetically, with the vigour of a far younger woman. ‘Even just after she had undergone a major heart operation in her late sixties,' said Rayvan.

‘Too many questions,' he went on. I stayed silent. ‘When there are too many people at the shrine asking the goddess questions,' he clarified, ‘it's too much. The goddess gets tired. She gets angry.'

Kali, the goddess Rayvan had been referring to, was personified in a stone statue, not more than thirty centimetres in height, that was housed in the shrine. Had it not been for Kali's rage, the Chota Sion shrine would never have existed. It had not been built for the hospital, as many locals and staff believe; in fact, it appears to have been a sacred site for at least 500 years, and the hospital must therefore have been built around it.