At that time Internet was unknown in Kovalam and the town had been somewhat smaller. As the resort grew, a good many small hotels and guesthouses were built behind the sea front fa?ade on the former rice paddies, and with the regular daily flow of tourists to and from their lodgings to the beach, passing along his alley, business rapidly grew.
It was easy to convince people without any medical training whatsoever that the means possessed by modern Western medicine to cure disease were seriously limited, and then persuade them antibiotics were dangerous.
Barbara explained to her adepts that allopathic, or conventional medicine, was based on synthetic chemicals, which formed chemical deposits that remained in the body over a long period of time creating new health problems.
Her programmes were filled with a considerable amount of pseudo science, which pretended the understanding of the full nature of a health problem could not be derived from fragmentary knowledge, and that limited vision was the root problem, a statement that was essentially true, but she added that Western medicine was guilty of precisely that: if the root cause of a cancer was not known how could doctors cure that cancer - an idea that contained a certain undeniable logic.
She persuaded them that Ayurvedic medicine went to the root of the cause and treated it with medicinal plants containing easily absorbed natural chemicals that progressively treated the source of disease. The vast knowledge accumulated by the ancient Ayurvedacharis had enabled them to diagnose diseases and with the right medicinal plant find a cure for them.
Barbara explained to the ignorant that Western medicine employed only one medicine for a broad range of diseases: antibiotics, which many believed were all the same, whereas Ayurvedic medicine for the treatment of malaria alone offered more than twenty five different cures - surprising given the number of Indians suffering from chronic malaria. She warned her adepts against detractors, those whose ignorance of Ayurvedic medicine prevented them from understanding it, telling them that knowledge created faith and lack of knowledge created confusion.
Her adepts were convinced by her business like discourse, whereby the accredited representative of the famous guru explained how at his centre in Kovalam continuous efforts were invested in research, education, guidance and training with the help of donations via their website. The guru, like many of his compatriots, peppered his literature and publicity with the trite slogans of small town American marketeers, in the line Remember, if we are not part of the solution, it means we are the problem, however, to the unworldly housewives who attended Barbara's seminars, these words seemed professional and even inspiring.
Barbara convinced her many listeners that Ayurvedic treatment was the ultimate source of medical care, for both body and mind, and in time they would be rewarded for their trust and confidence when scientific research proved it, and the world would realise that they had been right all along.
*****
Chapter 46
Many so-called Ayurvedic practitioners have set up shop in the popular tourist resorts of Kerala, and just about any self respecting hotel or guesthouse offers some kind of Ayurvedic massages and treatment,' Francis told Ryan.
'I've seen the advertising hoardings and signs all over the place, you can't miss them. Miracle cures and rejuvenation for only twenty five pounds!'
'A lot of the so called doctor can't even speak correct English, not to mind the kind of English spoken by some tourists, meaning they can't even diagnose the real health problems of their patients.'
'I know what you mean,' he said recalling Tanya's English.
'Kerala even markets Ayurveda abroad as one of its key tourist attraction and with almost half a million foreigners expected in the state over the coming year, it's a huge business.'
'Part of our health services crisis I suppose.'
'I don't know about that, but there are around seven thousand private clinics, whatever they mean by clinic, and five hundred government clinics and hospitals in the state. You can imagine what most of them are like! The government hands out accreditation to almost anybody.'
'What about our friend Dharma?'
'He's clever, even though he's not a trained Ayurvedic doctor - that requires at least five and a half years study at a recognised Indian training institution. His only real training is that of a masseur with a few courses in traditional medicinal plants and oils.'
'So his clinic is not recognised.'
'It is, today his staff includes qualified Ayurvedic personnel, doctors, nurses and masseurs. He is the owner, though officially he is not the director. His role is that of a guru - a spiritual guide!'
'And the government?'
'They talk of introducing new regulatory legislation, but nothing is done. Their policy is to develop traditional medicine as part of the tourist industry, and also medical tourism for more conventional health care, you know anything from hip surgery to dental and eye care.'
*****
Chapter 47
Good morning, I'm Dr Swami,' he said with a broad smile. 'How can I help you?'
The assistant stepped aside and with a quick backward movement bowed out, the relief on his face was evident.
'About my friend Stephen Parkly.'
'Ah, Mr Parkly?yes, how can I explain? Please sit down.'
Ryan took a seat.
'I have just returned from the pathology department at Thriuvanthapuram General Hospital. I thought it best to make some tests as your friend was not responding to treatment.'
'What kind of tests.'
Swami hesitated, then very softly replied, 'Widal tests.'
There was a long pause.
Ryan as a specialist in internal medicine knew that the Widal test was a fairly crude assay method designed to detect Salmonella typhi antibodies in patients. It was not particularly reliable, since results from different laboratories could vary considerably.
'I see.'
There was another long silence as Ryan absorbed the significance of what he had just heard.
'So you understand the reason for our caution.'
'Yes, typhoid.'
'I am waiting for them to telephone me the results of ELISA and fluorescent antibody tests, that's why I hurried back to take the precautions necessary in the clinic.'
'Of course.'
ELISA was an enzyme-linked immunosorbent assay, that is to say a blood test that looked for antigens specific to the typhoid bacteria. Antigens were substances, such as viruses, bacterium, toxins or foreign proteins, which triggered a response from the body's immune system. The fluorescent test checked for the presence of antibodies to Salmonella typhi.
'This information is naturally confidential between us, a case of typhoid at the Maharaja Palace would be bad for Kovalam at the height of the tourist season.'
Ryan recalled that Typhoid fever was a food borne infection caused by Salmonella typhi. The infecting organisms invaded the bloodstream of the host via areas in the intestine called Peyer's patches, causing an acute systemic disease, characterized by high and spiking body temperatures. Clinically, it was sometimes difficult to differentiate typhoid fever from other fevers such as malaria and typhus. He also knew that additional laboratory tests were necessary to diagnosis the disease.
'So what are your intentions?'
'First let us see the patient.'
Dr Swami stood up and led the way. Parkly was in a private room, all the rooms in the clinic were private. He was sleeping and his breathing heavy, his face red and swollen. Ryan was not sure whether it was the fever or sunburn.
'What's his temperature?'
Swami handed him the chart.
'I see. 39.6?C. What other kind of symptoms has he shown?' he asked politely.
'He complained of usual headache in this kind of case, abdominal pains and of course diarrhoea,' hesitated Swami.
'A typical tourist gastrointestinal complaint.'
'Yes, Escherichia coli and the likes, so we gave him the usual antibiotic treatment with ciprofloxacin.'<
br />
'Good.'
'The problem is of course complications, the risk of intestinal bleeding or perforation with sepsis, I don't want to go into the others.'
Ryan was a little puzzled at the speed of the infection as typhoid normally developed relatively slowly with symptoms often appearing one to three weeks after contact with the disease.
'When do you expect the result of the tests?'
'This afternoon.'
'I see, so there's not much we can do until then.'
'Quite so. Do you have a mobile phone?'
'Yes.'
'Good, so here's my number, you can call me about three. By the way, as I just mentioned this information is confidential, if you would be kind enough to reassure his wife without mentioning our suspicions.'
They returned to the Maharaja Palace after Ryan had reassured Emma that Parkly was sleeping and it was best not to disturb him, promising he would accompany her back to the clinic later that afternoon.
Back in his room as Ryan zapped the TV to the Indian CNN news channel he could not rid himself of a nagging suspicion as to Parkly's complaint and was impatient to know the results of the tests. However, another unpleasant surprise awaited him, the Mumbai Stock Exchange had plunged seventeen percent and trading had been suspended. Over the last couple of days he had not checked the international or financial news, but he was suddenly concerned to know exactly what was happening after having convinced his mother, just before Christmas, to confide her investments, as well as the proceeds of the sale of her house, to a broker friend of his in the City.
After an uneasy late lunch with Emma and Sarah he called the clinic and was told that Dr Swami had left for Thriuvanthapuram and would not be back until six or seven.
Ryan was preoccupied by the information, not to speak of the financial news, informing neither his mother nor Emma Parkly. On the financial side CNN was reporting that margin calls had triggered the stock market rout. As share prices had risen, a great number of investors had jumped into market, many of whom with heavily leveraged positions, that is paying only a percentage of their total investments, called margin, whilst banks or brokerage houses came up with the rest.
The shares bought on borrowed money were kept as collateral with the lender. It was plain sailing as long as the markets continued to rise, but with the sudden drop in the market the value of investments dropped sharply, and mechanically the value of collateral also dropped.
Thus if an investor wanted to hold his positions, he would have to come up with more cash to maintain the value of his collateral. The result was that those investors who did not have the liquidity necessary simply cut their losses and offloaded their investments. The selling pressure produced a snowball effect with markets plunging even further as investors sold their positions to reduce their losses.
Ryan tried calling his broker friend, Tony Solomon, in London, only to get his voice mail. He figured with the time difference it was perhaps too early. Then recalculating with a difference of five and a half hours it was already 9.30am in London, Tony should have already been in his office. He then dialled the office number, but again there was only his voice mail reply.
After a frustrating couple of hours Kovalam was suddenly looking sour, he had the feeling he was in the wrong place at the wrong time. It was too hot to go out and he lay on his bed zapping the TV and listening to the financial news. Finally he dozed off. When he awoke it was already dark, he looked at his watch, it was just after six.
He took a shower then called the clinic. This time he got Swami who asked him to come over as quickly as possible - alone. He sounded worried.
*****
Chapter 48
Speaking about links to Western institutions,' said Francis, talking of another of the recurring scandals that had hit the national headlines in India, 'some of these have recently expressed deep concern about their name being used by foreign organisations they don't really control, especially when scandals like illegal kidney transplants start hitting international headlines.'
'Of course it doesn't look good when American dialysis patients are being held here on suspicion of being linked to the transplants,' Ryan agreed.
'It says in the paper they're in hospital in Kochi and their passports have been confiscated.'
'It seems like transplants were carried out on five foreign tourists and on top of that they've found a waiting list of about forty foreigners from different countries."
'Apparently it's been going on for years and the authorities have done nothing about it.'
'Yes, it looks bad, especially since the donors were promised jobs and then tricked into selling their kidneys for about a thousand dollars.'
'And resold for many more times that I'm sure.'
'At least ten times more!'
'It's incredibly gory, the neighbours said they had seen blood in the gutters outside of the house where the clinic was installed and blood stained bandages were discovered with bits of flesh on a piece of nearby wasteland.
'What's worse is that the police suspect at least fifty officials.'
'Apparently the racket was also active in Mumbai and Delhi.'
'A country wide business.'
'Hospitals and doctors involved too.'
It was an old story, for years, India had been known as a 'warehouse for kidneys' or the 'great organ bazaar' and had become one of the largest centres for kidney transplants in the world, offering low costs and almost immediate availability.
In a country where one person out of every three lives in poverty, a huge transplant industry had come into being after drugs were developed to counter the rejection of transplanted organs. The success rates of operations linked with a lack of legislation and loose medical ethics contributed to growth of kidney transplants. On the one hand there were growing numbers of desperately sick people dependent on dialysis machines and on the other any number of desperately poor potential donors willing to sacrifice a kidney for easy cash.
Since donors could continue to live normally with one kidney, an illegal kidney black market had developed, benefiting not only rich Indians but also foreigners, both at home and overseas where donors travelled to sell the their kidneys.
The number of scandals has continued to grow in spite of legislation outlawing the trade. In Bangalore a racket was discovered where almost one thousand kidneys were removed from poor donors, lured by the offer of jobs and their kidneys removed under the pretext of giving blood. Such cases were common in all large Indian cities and involved police, doctors, other medical personnel, international kidney brokers and agents, and even diplomatic staff.
The law passed by Congress, Act 42, prohibited all commercial trading of human organs except those donated by relatives and brain dead donors. Selling an organ was punishable by up to seven years in prison and a fine of ten thousand rupees or one hundred pounds.
However, since Indian states were responsible for their own health affairs, local assemblies were required to adopt and apply the legislation, which many were very slow to do.
There were nonetheless many different ways of circumventing the law, such as kidney marriages since spouses were permitted to donate an organ. The question of dead donors was practically impossible in India due to a lack of infrastructure: no intensive care units, no means of preserving brain-dead cadavers, and a lack of suitable transportation in a region where the hot climate did not facilitate conservation.
Each year more than two thousand people sold their kidneys for cash, including a number of HIV seropositive carriers.
In a country where hundreds of millions suffered from abject poverty, the lure of easy money was irresistible with the destitute ready to sell a kidney in their desperate struggle to survive, and where the distinction between ethics and survival became blurred.
In India, where poverty was rampant and the general standard of living extremely low, the savings for a Briton seeking medical care could be enormous, and some Indian centres ev
en had agreements with health insurers, such as BUPA, entitling those covered to use their hospital's facilities and services.
Though gurus and Ayurveds boasted of their thousand year old system of medicine, conventional Indian doctors, often trained in the Europe or the USA, seemed to forget that Western medicine had commenced in Greece, almost three thousand years ago, and those same Indian doctors had sworn the Hippocratic Oath. The father of modern medicine, Hippocrates, born on the Island of Cos in Greece in 460BC, rejected superstition and believed in the natural healing process based on rest, a healthy diet, fresh air and hygiene.
The Indian government not only approved medical tourism, but planned to invest billions in the sector given its success and the prospect of huge growth.
The country's medical centres boasted specialists in all fields of major surgery, including orthopaedics, cosmetics, dentistry, oncology, dermatology, holistic and Ayurvedic care for the sick.
These centres also provided facilities for post-operative convalescence so as to accelerate the return of their patients to normal physical and mental health after their operations.
Satisfied medical tourists praised the system, which quickly arranged hospital appointments, visas and flights. On arrival patients were met by highly trained and experienced personnel who had at their disposal facilities equipped with the most modern equipment. One satisfied clients boasted to the press that his trip including airfares, hip replacement and dental treatment had cost him less that the dental treatment alone in the UK.
*****
Chapter 49
Without informing Emma Parkly, Ryan jumped in a taxi for the clinic. On arrival he found a police car parked in the forecourt and inside two police officers stood at the reception desk. This time the receptionist, without formality, ushered him into Swami's office, who was waiting for Ryan with what appeared to be a senior police officer.
'Nice of you to come over so quickly Dr Kavanagh, let me introduce you to Deputy Superintendent Vijayakumar, head officer of the Kovalam Police Department,' said Swami, inviting him to take a seat.
Ryan shook hands with the Deputy Superintendent, a little confused and concerned by the presence of a police officer.
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