For Hakim Mohideen’s family, many years actually meant nine generations. His father’s ancestors had come from Delhi as royal physicians in the entourage of the Mogul emperor Aurangzeb, who, in 1687, besieged and destroyed Golconda, the fort about seven miles from Hyderabad, then thought to be one of the most impregnable in south Asia. That particular siege lasted eight months in a period of Indian history in which wars were a regular occurrence, with various battles fought between the Mughals, Persian, Indian, British and other rivals over the years. Battles – on the backs of horses, elephants, or on foot – meant injuries to soldiers, injuries that needed skilled doctors, working under the patronage of their rulers.
The financial security and freedom the trusted hakims were given allowed innovations in treatment to continue in the Gulam family under the reign of the first Nizam, who took over from 1724 when Mughal rule collapsed. The family knowledge of bone manipulation and bandaging as well as plants, potions and pain relief had been passed from father to son in a continuous line. In the small clinic in which we sat, as well as from the medical supplies in the glass cabinets, there were two large bowls of lep (herbal balm) placed on the floor, which were also part of that tradition. One was white, the other yellow. I knew not to ask what was in them – they are often closely guarded family secrets, made with ingredients that vary between practitioners. Hakim Mustafa described the basics to me anyway. ‘The formulation of these leps are from generations back. The white lep is for massage; the yellow is good for pain. Its base ingredients are beeswax and oils, but for different problems, we will make different formulations.’
‘All home-made. We don’t market them so there’s no certification,’ Hakim Mohideen added. To his mind, as a BUMS-certified physician, bone setting was not an ‘alternative’ practice but one that fell under the remit of Unani, regulated by the Department of AYUSH. Hakim Mustafa described to me some of their other treatments, including 200 types of tablets, some with calcium, for example, to support bone healing; others, he said, would make the bone soft. ‘People come here with every orthopaedic problem – fractures, also rickets, osteoarthritis, cervical [neck] problems … We open between eleven in the morning and nine at night, but if any patient needs me for bone fractures or dislocations after that, we attend emergencies also.’
The small room in which we sat was where everything happened, but at three o’clock, in the lull during the hottest part of the afternoon, it was empty. I couldn’t imagine the small space bulging with the sixty to seventy patients I was told attended daily. ‘There were less people coming in my father’s days,’ Hakim Mohideen said. ‘The population is higher now. Everyone comes, now only maybe ten per cent speak Urdu [indicating an Islamic tradition]. We set the bone in seconds, but generally we spend fifteen to twenty minutes with each patient. It’s not just the treatment that takes time. When someone breaks a bone, there is an imbalance of heat. Their lifestyle needs to be adjusted, they must have dietary restrictions.’ Hakim Mustafa spoke more about the akhlat – Unani humours – applying Unani theory to conditions relating to the bone. ‘People with more bile also have more heat – they are given a different diet – but only until they get well.’ I thought back to the carrots, radishes and onions that formed the ingredients of the tablets found on the ancient Greek shipwreck. For Unani, just as for Hippocratic doctors, medicine starts with what we eat and is intimately linked with diet.
‘There are more people in Hyderabad now than in your father’s day,’ I commented, ‘but don’t more people today go to Western medical clinics now?’
‘For surgery they go to MBBS doctor. For every other fracture they come here,’ Hakim Mohideen said. ‘If they are poor people, they obviously come here. Even rich people come here if their MBBS treatment wasn’t done properly. Bone setting uses movement during therapy, while allopathic treatment means patients need to also go for physiotherapy afterwards.’ In such a system, the extra appointments required after the bone is set translated into extra expense that would have to come out of the pocket of patients – as do eighty per cent of healthcare costs in India. Add to that time spent out of paid work while immobilised in a cast and the costs of travelling to and from the hospital, and the prospect of going to an orthopaedic surgeon in the first place would simply not be a viable one for many patients.
‘And what do allopathic doctors think of your medicine?’ I asked.
‘Doctors know us, they say if it’s the Rasool family they don’t mind. There are no other families here that have as much experience as us,’ Hakim Mohideen told me. ‘Without an X-ray, just by touching we can say whether it’s a break or a fracture. But if we see that someone needs it, we will refer them to have surgery. For example, we do not treat injuries to the femur, because we simply cannot feel it well enough, because of its deep position in the leg. We will tell the patient, go to the diagnostic clinic, take an X-ray.
‘There are people who set up as bone setters who don’t know what they are doing. Sometimes we have assistants – people who hold the patient while we are locating the bone. Some assistants look at what we do and think that it looks easy – they leave here and set up their own shop. But they have no experience.’
Just then, the afternoon lull broke and the patients flooded in. Hakim Mustafa, who was looking somewhat bored and disgruntled, burst into life as people arrived. The hakims, I could see, were passionate about their work – the change in the room was palpable as the first in line hobbled in with foot pain. He sat on the floor in front of Mustafa and the hakim methodically probed the foot with his fingers and thumb before pronouncing that a tarsal had been dislocated. Without warning, Hakim Mustafa gently pushed the tarsal as the young man’s face tensed in raw agony for just a few seconds. When he relaxed again, seemingly at ease, he placed 200 rupees (about £2) on the floor in front of him as the hakim applied lep from one of the giant bowls, bandaged the foot and, with a reel of white thread, expertly sewed the edge of the fabric together.
‘Patients come afterwards once a week for about six weeks,’ the hakim said as the small room filled with people. ‘Children heal faster; for them it normally only takes ten to twenty days.’
The next patient the hakim saw had turned up for his sixth appointment – a twenty-two-year-old who had been visiting Luqman Clinic every four days over the previous month. ‘It was a total break of a metacarpal,’ the hakim told me as he placed the man’s arm on a large wooden block.
‘How did you do it?’ I asked.
‘I punched my car window.’ He smiled. ‘I was angry.’ The hakim asked if he felt better and he said that he did. He was no stranger to the clinic, despite (or perhaps because of) his youth. He worked as a personal trainer and his body-building regime had led to several minor muscular injuries over the years, but he first came to Luqman after jumping out of a window and breaking his wrist. ‘I did go to the doctor for an X-ray,’ he told me, ‘but I had been told that these hakims were good, so I came here for treatment instead.’
In a brief gap between patients, my driver, who had been watching keenly from a bench outside the clinic, surprised us by stepping forward to seek the hakim’s advice. He told us he’d been in a fight and punched a man, injuring his fist on his opponent’s teeth. ‘I did go to an allopathic doctor,’ he explained, ‘but he didn’t fix it properly.’ Hakim Mustafa duly did the requisite checks and treatments as Ramal and I looked on, hoping that his altercation and subsequent injury might have suppressed any residual road rage, at least for the rest of the day.
Even as the hakim finished treating our driver, the queue of patients was building up again and as the afternoon progressed, more and more of those in pain and those recovering sat next to us on the floor, waiting to be seen. A ten-year-old girl who had tripped down the stairs paid fifty rupees for her check-up: her pain had already diminished greatly after her initial treatment. An older man presented an ankle which was still bloody and scabby from a road accident two days previous – his regular doctor could not put a ca
st on the injury because of the state of the wound, so he sent him to the hakims instead, who applied fresh lep as well as an antibiotic powder under new gauze. Two veiled ladies came with a young girl to be treated; and then the hakim splinted and bandaged another woman, clearly in a lot of pain, whose loose chappals (sandals) had caused her to slip on a flight of stairs that morning.
I asked the hakims whether there were many women today practising Unani medicine. ‘Don’t women prefer to be seen by a woman?’ I asked. The brothers told me that although there may be a preference for women patients, female practitioners were rare, but that when their hospital opens, they intend to train ladies to work there too.
As the sounds of the five p.m. namaaz began to be broadcast from the mosques surrounding us, Ramal and I rose to leave the hakims to their ever-growing crowd. As we did so, a young wrestler with a dislocated bone hobbled in. While Mustafa treated him, I chatted to his mother, who told me that as soon as it happened they came straight to the hakim brothers. ‘If he went to the allopathic clinic,’ she said, ‘he would spend forty days in a cast and forty days having physio. I already knew he would be treated better here.’ Apart from the prohibitive cost of seeing an orthopaedic surgeon, being immobilised in a cast, of course, meant forty days of lost income – a choice that few people in the old city could afford to make. The young man, who had previous injuries of varying severity, nodded at what his mother was saying. ‘Actually if I went to the doctor, this would certainly have been an operation.’
As darkness began to fall, the buzz of the old city, like the hakims we met, continued well into the early hours, when more of their patients were freed from their jobs and family responsibilities. I chatted with Ramal about my impressions of the doctors we had met and their treatments. The sheer volume of patients who by-pass allopathic clinics and go to hakims on trusted recommendations pointed to how far Unani was built into the city’s social and historical fabric. Just as throughout its history, what I saw was that Unani, and bone setting within it, was still embracing and imbibing innovations from other systems of medicine sharing its space in India today. Hakims who blend the ancient science of Hippocrates and medieval Arab doctors with biomedical diagnostics were evidently thriving. With clinics mainly placed in tightly knit, lower-income areas of the city, these doctors were very much acting as a first port of call within their communities. For these people who chose to pay hakims rather than the private sector mainstream medics (or opt for the free but generally avoided state ‘allopathic’ offerings), value for money was clearly an important factor. But picking AYUSH over Western medicine was not simply about the amount of money changing hands.
‘That’s the thing about Unani doctors I’ve studied,’ Ramal told me, as our bandaged driver headed back towards her university at Hyderabad’s Institute of Public Health. ‘There’s a lot of trust. Many of these patients actually do not trust conventional doctors. These hakims whose families have been in practice for hundreds of years, these doctors know all about their patients – how many kids they have – they know how many kids their kids have. They really know their situations and talk to them about their homes and their lives, not just about the injuries they come into the clinic with.’
6
The Fish Doctors
TWO MONTHS AFTER I visited Hyderabad’s bone setters, I returned to its ‘twinned city’, Secunderabad, geographically separated from Hyderabad by the immense, sixteenth-century Hussain Sagar lake. I had been invited there by Dr Harinath Goud, the head of the Bathini Goud family, who for generations had been carrying out a curative ritual the details of which, when related to me by an Indian colleague a year earlier, I had found difficult to believe.
It wasn’t just, as he told me, that patients came to the Bathini Gouds to swallow live fish whole; or that they came in their tens of thousands; or that the recipe for the herbal medicine the family stuffed into the fish’s mouths had been a secret for nearly 200 years. As a unique phenomenon in India, what I found fascinating about this apparently bizarre mass medication was that over half a million Indians had received it in the last decade; moreover, the government of Hyderabad’s state was subsidising the unregistered treatment almost entirely. The reason I had waited twelve months to arrange a meeting with the fish doctors was because the ceremony took place on only one day each year.
Unlike the old Hyderabad of the Unani doctors and bone setters, Secunderabad was largely indistinguishable from any of the recently built bustling neighbourhoods of Indian suburbia. Though it was founded by the British as a military cantonment in 1806, few relics of its architectural origins remain: its iconic 1860 clock tower only narrowly escaped demolition in 2003, having nearly become a casualty of the local government’s attempts to ease the unrelenting traffic congestion. Other historic buildings were not so lucky. Just two months before my visit, a 400-metre stretch of old properties between the clock tower and the railway station were undergoing demolition to remove a traffic bottleneck and to speed up the construction of a new metro rail project.
The Kavadiguda area, where Harinath Goud lived, was an ordinary-looking place, with houses of no great age, general stores selling plastic toys and household goods and a few small shops stocked with snacks and drinks. There were no signs of great wealth here. I watched as an old vegetable-seller struggled to push his wooden cart into the street behind us. The neighbourhood bordered Bholakpur, an area which only a decade earlier had been the epicentre of a serious cholera outbreak. The root of the problem was its slum-like infrastructure: when toxic chemicals from the town’s illegal tanneries corroded its water and sewage pipes (which were laid side by side fifty years ago), drinking water become contaminated and hundreds contracted the disease. Luckily, the outbreak was contained by the local hospital, but remedying the infrastructure proved more difficult. In subsequent years the administrative meanderings of the agencies involved had resulted in the sewage pipes being replaced, but the half-century-old water conduits remained untouched. In the same way that central Mumbai slums occupied prime real estate, so that shanty houses sat close to five-star hotels, here poor dwellings built on inadequate, unhealthy infrastructure abutted the multistorey luxury homes of the well-to-do.
But the Goud family were evidently relatively new to this milieu. The house we pulled up outside formed part of a new three-storey apartment block, painted pale blue, with pretty flower designs running up its height. The entire front wall of its ground floor was decorated with dramatic gold swirls in bas-relief and, like a family crest, a fish motif – curling into itself so that its mouth and tail came together in an almost perfect circle – was embedded at its centre. Although I had undoubtedly come to the right place, the home of the ‘fish doctors’, the gates were locked, and when I tried phoning, no one was at the end of any of their three phone lines.
I sat on their thinnai – a traditional raised, shaded platform between a house and the street meant for weary passers-by – and waited. It was to be a long wait and a futile one. In the three hours I was there, other visitors to the Gouds came by, including several young men who arrived hoping for ‘passes’ to circumvent the crowds due to turn up the next day for the medicine; a woman whose father had been successfully treated by Dr Harinath’s fish and who had travelled 800 kilometres with her young family from Chhattisgarh in Maharashtra; and two of the Gouds’ family friends in Brahmanic robes and priestly paraphernalia, who arrived on a motorcycle. All had fixed appointments with Dr Harinath that afternoon and I watched the increasingly familiar pattern unfold as they arrived, waited, tried phoning and left.
Those who knew the family were unsurprised by their absence. I was told that the Gouds were, as they were every year, at a temple close to their other address – a place in what had once been their traditional family village, now enveloped by the narrow lanes of Hyderabad’s old city. The temple prayer ceremony was where their secret herbal mixture would be offered to the gods before it could be offered to their patients. Because their product was chemic
ally unknown and untested, in recent years the fish medicine had been restyled as fish prasadam – something (often edible) that had been offered to the gods. In the same manner as some popular, off-the-shelf Ayurvedic formulations; when referred to as prasadam this fish medicine took on the guise of a dietary supplement, avoiding any regulatory restrictions. This year, their gods must have taken longer than expected; either that or the family were stuck in the horrendous traffic that had been building all day in preparation for street party celebrations of the first anniversary of Hyderabad’s Telangana state. I waited a little longer, tried their phones several times again, chatted to more of their hopeful patients and then decided to return later – something I was warned against. The evening’s celebrations were predicted to clog the roads for miles around.
As I drove back, disappointed, to the university where I was staying, roads were being closed to all but pedestrians and a series of grandstands at various levels of completion were appearing along the banks of the Hussain Sagar lake. The speakers hoisted around them blasted popular music as we continued along the roads from Secunderabad and back into Hyderabad. Despite my determination to ignore the locals’ advice, I realised that they were right – a return journey would not be on the cards that night.
The next morning I got a call from my friend Dr Nandu Kanuri, an academic at Hyderabad’s Indian Institute of Public Health. Translating a section of a report published that morning in a Telegu newspaper, he told me that the Gouds’ old family village was called Doodh Bowli and it seemed that the family would be staying there until the time came to hand out the medicine, which was scheduled, according to their astrological calculations, to begin later that day at eleven forty-five p.m. The exhibition ground loaned to the Gouds by the state for the event was in Nampalli, Nandu told me. ‘That’s very close to Doodh Bowli. So I don’t think they will be going back to their new house in the next day.’ Nandu and I decided that my best bet was to try to track them down in the old city. He added a couple of points the papers had detailed: that there would be a 1,500-strong security force at the evening’s event; and that a crowd of 50,000 was expected.
In the Bonesetter's Waiting Room Page 14
