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.
While we were talking, the treatment of the patients on the rooftop continued; it wouldn’t be long now before the brothers would drive to Nampalli to distribute their medicine to the tens of thousands gathered there. I spotted a lady in a rose-pink salwar kameez who had been waiting for some time. This was not her first visit, and I asked her what it was like to swallow a fish alive. ‘It must be hard for vegetarians,’ I said.
She laughed. ‘I am a Jain. It is not nice, but I think you get used to it. I’d say I am eighty per cent better than I was before my first treatment.’
Jains are well known for their vegetarianism and, in the pure practice of their religion, avoid killing even the tiniest of insects as they go about their daily lives, so she was pleased when I told her that this year the family were offering jaggery to coat the herbs. Next to her sat a slight, sickly-looking young man in thick spectacles. Like the Jain, who had come from Mumbai, he had also travelled a long distance from his home in Gujarat – a twelve-hour journey by train. The friend who had accompanied him told me that he suffered from severe asthma, but that after his second fish treatment last year, he was forty per cent better. ‘For a permanent cure they say we have to come three years in a row. He has had these treatments, and for the last two years he has not had to use a nebuliser,’ his friend told me.
Sitting cross-legged on the floor next to him was a young woman in her twenties wearing jeans, a T-shirt and loafers. She introduced herself as Shreya, an educational psychologist who had come from Delhi; this year she’d flown, but last time she’d travelled over two days by train, crossing the vast distance from her home in the north to Hyderabad, the gateway to India’s deep south. Then, she had waited three hours with the crowds at the Nampalli Exhibition Grounds but this time she’d called ahead, asking if she might avoid the crush. ‘The herbal medicine is free,’ she said, ‘the fish cost very little, but the trip and accommodation cost me a lot: the travel, somewhere to stay. My brother came with me as well. So it’s not cheap for us in the end.’
Shreya thought her problem had begun four years earlier, when she bought a carpet for her room and started noticing allergies and sinus problems. ‘I saw you talking to him [Gauri],’ she continued. ‘So how does the medicine work, did he tell you? Is it Naturopathy? Ayurveda?’
I told her Gauri hadn’t revealed what was in the preparation, but that it was plant-based and, as such, could certainly contain active ingredients of some description. Without analysis, it would be hard to determine exactly what was in there and what it did. The bright yellow colour might indicate turmeric, which is known to have antiseptic properties.
‘That’s true,’ she said. ‘They put their whole hand into your mouth to make sure it goes down so you don’t taste it much, but there’s also a bit of a wheat-like taste. And when the fish moves down my throat I also notice a mentholated feeling. I felt something went inside and already gave me relief; it felt like mint candy.’ That made me wonder if there was perhaps camphor in the preparation as well. Because of their anti-inflammatory, antiviral and antibacterial properties, camphor plant extracts are used widely in Ayurveda and as a popular folk remedy for colds, flu and bronchitis.
‘After two hours you can take water,’ she continued. ‘If you can control it they tell you to avoid using an inhaler for two to three days. And he gives a paper on what to eat for forty days – that diet is quite limited – tea, one fruit, rice, garlic and ginger, only palak (spinach).’
‘That’s interesting,’ I told her. ‘These are all considered “hot” or “warming” foods in Ayurveda and Unani. And fish, because it is an animal, is considered hot as well.’
The association of phlegm with coldness is also an idea propagated in Hippocratic medicine. Perhaps some of the logic of these ancient medical systems remain present in the way we connect cause and effect when we become ill today. For example, all of us will have had the experience of blowing our noses or coughing up an increased amount of mucus when we have a cold (so called due to its perceived relation to seasonal changes and the coming of colder temperatures, a perception reinforced by the hot home remedies used to treat it: steaming honey and lemon tea; a shot of ginger wine in a hot toddy). The Gouds’ recommendation to take warming foods, then, fitted well into this system of thought and with the theories of India’s ancient systems of medicine.
‘Medical doctors would say that all this is a stupidity,’ Shreya said. ‘My doctor friend in Delhi says it is bullshit, and if I think it works it is psychological. So I’m keeping my inhaler in my pocket and coming here for the fish. It gives me options – last year, before I ever took the fish medicine I had to use my inhaler two or three times a week. Now it’s four or five times in a month.’
‘What about your family, do they know you have come here? What do they think?’
‘This is India,’ she said, and laughed. ‘The family knows everything. My chachaji (uncle) has asthma too; he said he’s too tired to come here but he’s getting relief from yoga. They all know I just want to do something about this
condition. Since coming here last year I am breathing in a good manner, sometimes I used to feel suffocated in my chest. I’d say it’s thirty to forty per cent better now. Hopefully after this time it will improve even more.’
Almost everyone who had been lucky enough to be invited to the Gouds’ home to take the fish medicine had tried the treatment before. They returned because they believed they had experienced some level of improvement. I found it interesting that everyone I spoke to tried to capture this as a percentage – however small or large they estimated that to be.
The crowds started pressing into us as the people I talked to joined the treatment queues. In an attempt to stay out of the way, I tucked myself in near the low wall of the roof terrace which overlooked the courtyard. I quickly realised this was not a wise move, narrowly avoiding being pitched over the wall by the unrelenting scrum. I began to understand how religious pilgrimages could end in tragedy and made a mental note to ask Shreya her thoughts on mob psychology, if I survived.
The queues became amorphous and less well behaved. ‘How can you push in?’ Gauri screamed at one man. ‘You are a man, stay back! Let the children come first!’ He called forward first the most sickly, then the elderly and children. ‘Bismillah ir-Rahman ir-Rahim,’ Gauri recited as he dropped a fish into the mouth of the first in line, an elderly Muslim with a long white beard in a pristine white salwar kameez.
I watched a young man in his late teens retch as Gauri’s folded hand entered his mouth. The slippery fish wriggled out of his throat and onto the terrace floor. He was made to try again. It was no easier the second and third times and finally Gauri held his mouth shut until there was no longer any danger of the fish re-emerging. Another man, older this time, also struggled as the fish got caught in his left cheek: Gauri closed his mouth and slapped his face, forcing the fish down the patient’s oesophagus. A small girl, perhaps eight or nine years old and wearing a black hijab, cried desperately as Gauri gently tried to coax her into a second attempt, even after she had almost vomited during the first. Through her tears, she tried again, still sobbing, but calmed once the thing was done.
For what seemed like hours members of the wider family and their voluntary helpers administered the cure. It was work that required great manual dexterity and unflinching focus. The more fish that were regurgitated, the fewer people could benefit.
Under the blinding floodlights and in the heat and hope of the waiting crowds, the whole evening held an air of religious fervour akin to an American Evangelical healing service. But no gods were worshipped here; the crowds simply had faith in the Bathini Gouds and their deeply held belief that it was their duty to give their medicine to every last person who asked for it.
Over the years, Harinath Goud, the family’s head, had publicly and repeatedly guaranteed a complete cure for any asthmatic patient, no matter how bad their condition, if the whole of their prescription was followed. But as the popularity of the treatment grew, so did criticism from the mainstream, sceptical at the lack of hard data and irked by the complicity of the state in such a bizarre practice. Threats were made that, should Harinath not reveal his herbal preparation for scientific analysis, legal action would be taken to force the state to withdraw its backing.
Neither event came to pass. Here, after all, was one ready-made way of plugging at least a small part of India’s great healthcare gap, and this year the first government of Telangana had again taken the decision to support the event, despite fresh objections from the Telangana branch of Lok Ayukta (literally ‘appointed by the people’ – an anti-corruption authority that operates in several Indian states) that the herbal substance’s efficacy was unproven. (No studies of benefit or harm have been conducted to date: of the herbs, the fish, the water they are kept in, nor any effects of swallowing them live.)
Three hours after I had arrived, and with around fifty people still waiting to be treated, Gauri announced that their supply of fish had run out. I could see a mixture of confusion, panic and resignation in the remaining patients’ faces. ‘You can wait here three or four hours,’ he shouted, ‘or you can go to Nampalli Exhibition Grounds, there are more fish there.’ A man in the crowd advised me to move quickly if I wanted to stand any chance of getting the medicine. As he sprinted away, I noticed Shreya still in a huddle of people standing at the back. She had avoided the most unruly queues, but her wait that evening would now be an even longer one. After the chaos of her experience last year, she was not likely to go to the larger venue, and after seeing the crush created by a mere couple of hundred people – not to mention my own brush with danger – I couldn’t blame her for not wanting to take her chances among thousands.
Once the rush had abated, Gauri was back to his old self – perfectly calm, as if there had never been any shouting, shoving or vomiting. His sweating brow was the only sign of exertion, although with the temperature still standing at around thirty degrees it might just have easily been caused by humidity. He caught my eye and beckoned me to follow him, and we headed single file down the steep, narrow stairs to the courtyard. Under the staircase, opposite rows of photographs and paintings of the Bathini Goud family lineage, was the sacred well he’d promised to show me several hours before.
‘You know how hot it has been – see the water? This well has never dried. Never in nearly two hundred years. This well was blessed by the sage and we use its water to prepare our medicine,’ he reminded me. He’d been right about the weather: the rains were late again and my visit had coincided with an unusual late-June heatwave that had led to a spate of deaths among the vulnerable.
I thanked Gauri for his hospitality. He smiled graciously and told me he had to run. I believed him. For him, as for Shreya, the hundreds at his house would be as nothing compared to the tens of thousands waiting for the sacred moment at the main venue.
‘I have to WhatsApp some people first,’ he shouted to me as he rushed through the courtyard doors out into the ancient streets.
‘Patients?’ I shouted back.
‘Yes, to tell them if they haven’t got here, to go to Nampalli as soon as they can.’
As Gauri disappeared into the night, I headed back into my waiting taxi, still parked in the shadow of the Gouds’ temple, past the Jain lady in pink, who was now in a very relaxed and happy mood. A toddler in his father’s arms next to her seemed also to have forgotten the trauma of the fish, his tears long dried.
‘Did you try the medicine?’ she asked as I made to leave.
I told her I hadn’t, but that there was nothing wrong with my respiratory system. ‘My lungs are fine,’ I said.
‘Touch wood,’ she replied.
‘Home?’ my driver asked.
‘Nampalli,’ I told him.
He did his best to discourage me – ‘It will be chaos, madam’ – but I asked him to go anyway.
Hyderabad became a different city after midnight – no crowds on the streets, markets emptied of their wares. The traffic had vanished and its pre-independence wood-carved verandas and parades of shops with their crumbling, once-white plaster facades looked more beautiful in the cool calm of night.
At the tented, decorated entrance to the exhibition grounds rows of patients still waited behind metal barricades; police guards lined the street and attempted to maintain order. I asked my driver to slow down. This time he spun round to look at me. ‘You’re not actually going in, are you? There are thousands and thousands of people.’ His tone was almost pleading. I looked in as the car crawled past, at the lines of people who had camped there for days and the hopeful new arrivals, looked back at him and told him to drive on.
In India, a country that had recently launched a Mars mission (albeit, on a day thought to be auspicious to the red planet), a medical treatment with no known evidence-base showed no signs of being relegated to the past. On the contrary, there was a mediaeval fervour here. It had originated with a holy man and involved a spiritual blessing. I was sure that next June, the crowds would multiply even further. For any pat
ient to really be able to make an informed decision about the health choices on offer, you could argue that it is important to understand whether, and, if so, how such medicines actually worked. Treatment should also be given in line with a diagnosis, whereas in this case, patients turn up to take medication for a disease they say they have. There are no checks in place to ascertain whether what they believe to be true actually is. If it isn’t true, then what unknown conditions are going undiagnosed under the cover of asthma-like symptoms? What really is the origin of their coughs? Still, here was a treatment that resonated with the psyche of a deep-seated tradition in which, in the pursuit of wellbeing, there can be no real separation of body and mind. It incorporated diet and lifestyle. It was said to have no side-effects. It was offered with no expectation of payment, or gain from the medical staff. It engendered trust. It struck me that in developing healthcare for India, and indeed any nation, it would be wise not to overlook any of these factors.
THE FOLLOWING MORNING, newspapers covering the Nampalli event reported unprecedented crowds. Head counts put the numbers of visitors at around twenty-thousand more than had come the previous year. The influx of the seventy-thousand patients had also meant that the fisheries department miscalculated the quantity of young fish of ingestible size, and so thousands of people would have been turned away, their journeys wasted. But at least they left alive. A sixty-five year old asthmatic man who travelled nearly six hundred kilometres from his home in Belagum, Karnataka, had not been so lucky. At around one o’clock that afternoon, while my disgruntled driver was helping me track down the Gouds’ traditional family home, Basavaraju stood in the long queue outside the exhibition grounds, waiting for the venue to open. He had travelled there alone, so when his asthma attack began, the only people who were there to take him to hospital were the police guards, who rushed him to Hyderabad’s historic Osmania hospital. He was declared dead on arrival, and the next day, after a postmortem, they handed his body over to his son.
In the Bonesetter's Waiting Room Page 16