In the Bonesetter's Waiting Room

by Aarathi Prasad

  The newspaper report did not give an address for the Gouds’ home, which was understandable: I had heard of frenzied stampedes in past years and of attempts to get to the family that had ended in injury, or even death. If the anticipated number of patients was to be believed, it was not difficult to imagine the potentially lethal crush of those seeking the fish medicine. I got into the taxi Nandu had called for me and gave the driver vague instructions to get us to Doodh Bowli. Once there, we were going to have to be creative.

  The drive took us very near to one of the bone setter’s clinics I had visited two months earlier, deep into the old part of the city, down narrow streets where women in full purdah walked slowly through markets, men milled round the mosques, and children, oblivious to the call to prayer, chased goats that roamed the alleyways. On a main road a funeral passed, the cadaver just visible under its shroud, carried high by men who were taking it to the cemetery opposite. We stopped several times, asking locals if they knew the whereabouts of the Gouds’ family home. Many told us that we would need to go to the Nampalli Exhibition Grounds that night, if we were after the fish medicine; others nodded in recognition of the name of their famous medical neighbours, but their vague hand signals told us to continue in various conflicting directions.

  A man directed us down an extremely narrow lane leading to a maze of tiny houses, which occasionally opened up into small squares, or ran past formerly grand buildings and arabesque gateways behind immense outer walls, faded to sepia. My driver was sceptical. A short way down the road he asked again and a young boy confirmed the route.

  ‘To the fish medicine house, you can go that way, left into that gali,’ he said.

  ‘But can we drive down there?’ My driver looked worried for his car, which was nearly as wide as the road. The boy assured him that cars did drive down the alleyway, so despite its precarious angles and the livestock and local residents who competed for a foothold along its length, we went ahead.

  Where the alley finally widened into a market square, we stopped and asked after the Gouds once more. A tiny old lady, clad in a sari and with gold rings in her nostrils and ears, agreed to leave her vegetable stall and come with us as our guide. She seemed unsure about how to get into a motor vehicle, and a little uneasy once in it, but, true to her word and for a small fee she directed us straight to their street.

  In among the predominantly Islamic homes, mosques and public architecture, the way she indicated appeared to lead to some sort of Hindu temple complex. A man urinated against its walled entrance, framed by a dramatic archway. At least sixteen feet high, it was coloured a vibrant shade of blue and displayed painted sculptures of Hindu deities, lotuses, conch shells, other iconic symbols and motifs. As soon as the car turned in, the temple came into view. With tall and ornate pointed domes, it was profusely decorated – much like its gateway – with painted sculptures depicting gods and goddesses and scenes from the Hindu scriptures, with enormous doors made of opulently carved wood. Inside, its elderly priest, dressed simply in a white lungi waist-cloth, held a burning lamp as smoke billowed from the censer he swung.

  It was clear that our car would not be able to navigate the even tinier alleyways behind these walls, so I got out and, heading down a medieval-looking street filled with khaki-uniformed policemen, I found myself directly outside the Gouds’ home, walled off from the street and with a red door that opened directly onto a family courtyard. Standing outside, answering questions and listening to the requests of patients who had arrived a day early, was an elegant man in his forties, dressed in a simple white cotton kurta and wearing a tilak of bright red powder on his forehead.

  Still a little jet-lagged, I explained to him that I had landed in Hyderabad the previous morning after an 11,000-mile journey especially to meet Dr Harinath Goud, but that the appointment we had arranged hadn’t quite worked out. The man introduced himself as Gauri Shankar, Harinath’s nephew, and invited me to come back to their home that evening, to attend the prayer ceremony that was to take place before the medicine was distributed. I could then watch as the fish treatment was dispensed. ‘Come at nine-thirty,’ he told me kindly. ‘We will talk more then.’

  At nightfall, when the day’s heat had abated to a relatively refreshing thirty-four degrees centigrade, I found Gauri Shankar talking to a group who had gathered in the streets outside his ancient home. The atmosphere seemed surprisingly calm, though from inside the doorway I could hear sounds of a crowd. Gauri Shankar whisked me past the house and through a door leading to his neighbour’s compound. The narrow passageway opened up into a courtyard, around which apartments were assembled in the manner of traditional homes in Damascus or Moorish era Granada, or like the old riads of Marrakech.

  I followed him as he skipped up a steep staircase, onto a terrace. ‘You’ll have to jump over this wall,’ he said as he adroitly leaped from his neighbour’s roof terrace onto his own. I followed suit, only realising the reason for the complicated route when I landed on a roof that was already filled with waiting patients sitting cross-legged in neat lines. When I looked down into his courtyard below, it was clear it had long since filled to capacity. The prayer ceremony was about to end and there was a celebratory mood among the crowd: I could hear throaty laughter and singing before, improbably, an enormous, cream-covered cake emerged to cheers and the refrain of ‘Happy Birthday to You’. It was then that I caught my first glimpse of the elusive head of the family, Dr Harinath Goud. Bearded, in orange robes and with long hair, Harinath looked the image of India’s traditional sadhus, respected men of God. The courtyard crowds previously seated now formed an orderly queue as Harinath and his wife, an elegant, jovial woman dressed in an orange sari, began to distribute the medicine. Many of the first to receive the blessed herbs seemed well-practised and I recalled hearing that those invited to the Gouds’ home were neighbours, family friends and previous patients.

  Giving the medicine out was not an easy process – the helpers of Harinath and his wife took an unsuspecting, finger-sized fish out of the container in which it swam, prised its mouth open to insert a small amount of soft yellow herbal paste and handed it back to the couple. The Gouds then instructed the patients to open their mouths wide in turn. Holding the wet, wriggling fish so tightly I wondered how they weren’t crushed, the fish doctors inserted their fingers deep into the throats of those waiting in line. An inevitable chorus of gagging ensued as the living fish wriggled down to their death by digestion. For many of these second- or third-time visitors the process took just a few seconds and looked deceptively effortless – barely worse than swallowing an aspirin. For others, the procedure was clearly a far less comfortable one.

  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 sev
eral 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 I
ndia, 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.