Between mortality and moksh

(This article is a part of the web-exclusive series from our latest issue ‘At the cost of health’. More from the print quarterly here.)

In recent educational discourse in India, advancements in science and technology have been appropriated in an attempt to aggrandise the idea of India through its supposed achievements – few real and many imagined. The idea of ancients working with nuclear and genetic technologies is wishful thinking, but other claims seem more probable. Scholars have repeatedly lamented this re-imagination of the histories of Indian society and their progress, emerging from land that roughly falls within the borders of modern, independent India. They suggest that such fanciful endeavours gloss over actual Indian achievements, ideologies and knowledge streams.

It is through this lens that we must view ‘Tabiyat: Medicine & Healing in India’, at the Chhatrapati Shivaji Maharaj Vastu Sangrahalaya (CSMVS) – an exhibition that seeks to explore the history of medicine and wellness-seeking behaviour in India. Produced by The Wellcome Trust, a biomedical research charity based in the UK, ‘Tabiyat’ is part of their three-city event called ‘Medicine Corner’, which explores medical practices and healing within the multiple cultures that make up India. According to curator, Ratan Vaswani, ‘Tabiyat’ looks at various cultural ideas of medicine over time. The exhibits are divided into quarters that go beyond specific schools or stream of medicine. Rather, it is based on segregations that suggest a larger societal mindset when it comes to dealing with illness and misfortune. For Vaswani, these quarters represent locations within which certain transactions of healing are carried out: ‘The Home’, ‘The Shrine’, ‘The Clinic’ and ‘The Street’. But besides these broad categorisations, the exhibition lacks the curatorial initiative to contextualise each artefact within the larger narrative of medicine and healing in the Subcontinent. This lack of curatorial guidance was only partly mitigated by the exhibition walk-through lead by Vaswani, on request. Near the entrance are exhibits which suggest that Ayurveda, as Indian knowledge-system, was hugely affected by Buddhist traditions. On one side of this entrance area are the ‘Home’ and ‘Shrine’ sections, which seek to document health in the context of communities superstitions, and lifestyle improvements over the ages. While the ‘Home’ exhibits include a table of auxiliary hygiene implements, and action figures performing Yoga, the ‘Shrine’ displays items of belief including an elaborate taveez (charm to ward of the evil-eye), votive offerings for good fortune and so on. On the other side of the entry lies the more ‘scientific’ or commercially-oriented sections. The ‘Clinic’ examines scientific treatises, philosophies and methods, while the ‘Street’ section displays objects pertaining to traditional remedies and skills (ear cleaners!), which are bartered for a livelihood.

Endangered traditions
Set up in the Premchand Roychand Gallery of the CSMVS, the exhibition begins with a display of medicinal plants and herbs such as aloe vera, tulsi, curry leaves and more. While common in rural areas, these traditional articles of hygiene and health, which were once abundant in home medicine, now exist only as fashionable, edible accessories to elite urban lifestyles, sold by brands that either claim to be saviours of an ancient lifestyle or equate them with class and purity. These endangered articles of India’s healing traditions are accompanied by two sets of recent images: that of members of Meghalaya’s Garo tribe preparing plant-based medicine, and images of people living in the urban centre of Mumbai using the rural oral care champion, datun (twigs of meswak trees chewed on for cleaner teeth and gums). Next to these are video exhibits commissioned and produced by Wellcome for the Dharavi Biennale, which includes snapshots of local healers from various communities that live in the larger Dharavi settlement in Mumbai.

It is an interesting exercise to view the exhibition from the perspective of exclusion: of selves, voices, and entire sections of people as seen in contemporary times, to recognise and engage with the experience of the local. The inclusion of the Garo tribe, and of the datun, again used by tribal, rural and also migrant labour populations in cities like Mumbai, draws our attention to how these populations and their methods are largely ignored by mainstream society. They are a reminder of everyday lives of communities co-existing in a tacit contract with nature; something modern considerations of hygiene often ignore, or alternately, put an incredible premium on. This view also considers an exploration of the history of Ayurveda, which Vaswani attests is absolutely Indian in its origin but is also heavily influenced by Buddhism (in opposition to recent attempts to suggest that all Indian traditions are also necessarily Hindu traditions). Since the distant past depicted in these paintings, Buddhism in India has gone through its own long, sometimes violent and eventually, extremely political journey, where it is taken up by the marginalised. There seems to be a thread connecting the spiritual ideology of the Buddha with the physical processes of Ayurveda; where Buddhism aims to achieve moksha (a release from the cycle of rebirth), Ayurveda aims for mukti (a release from cycles of pain and suffering). Hints to these links are seen in a copy of a 1940s Li Gotami fresco from Tibet (part of the CSMVS permanent collection) or in paintings depicting the use of cannabis as pain medication.

Ascetics smoking ganja have become the mainstay of travel photography in India, and cannabis a source of frantic parental internet searches. While clearly not a call to return to the drug-fuelled seventies, these images attempt to draw the dialogue back to local, indigenous healthcare. In this respect, it is interesting to note that while India draws its anti-narcotic laws from Western notions of medicine that complicates cannabis use in traditional treatments, there is an upsurge in the Western acceptance of cannabis products as a form of relief treatment in cases of cancer and mental health. Similarly, the healers of Dharavi are practitioners of Ayurveda and other local techniques that are often excluded from the mainstream but are often the only forms of treatment for working class poor, who for a variety of reason – from economic considerations to the ineptitude in government clinics – eschew mainstream allopathic treatments.

Some of the ‘women-themed’ exhibits, while outwardly championing women’s agency in creating social change, confuses glorification with actual progress in women’s rights

One of the objects used by the ‘Healers of Dharavi’, which draws the eye, is the nearly extinct artefact called rakt-bahuli also known as rakt-chandanachibahuli (red-sandalwood doll). Loaned from Sunanda Pawar, a compounder working with an Ayurvedic doctor working in the settlement, the bahuli or doll is an object fashioned out of the heartwood of red sandalwood (rakta-chandan) trees. It is accompanied by a video of Pawar demonstrating its usage. The rakt-bahuli is rubbed against a small stone board till it bleeds a red sandal paste that is said to provide relief from pain, inflammation, diarrhoea and other illnesses (depending on who you speak to). Red sandalwood is such an undocumented product that its presence in the exhibition reminded me of the large number of undocumented, untested indigenous medicines that have been blindly replaced by antibiotics. A redress of sorts, though limited in its scope, has been undertaken by Indian Council of Medical Research, in collaboration with other government bodies, by conducting clinical trials of Ayurvedic formulations for a variety of diseases like diabetes and rheumatoid arthritis.

Strangely, the rakt-bahuli was exhibited at the confluence between ‘The Home’ and ‘The Shrine’ sections. While it may have a religious connect, it is better contextualised when seen as a healing custom, which has shifted to the street from the interiors of traditional clinics, akin to other practices like street-side naturopathy, or bone-setting, which finds its local roots in akhadas.

‘Invisible’ women
The presence of Pawar’s rakt-bahuli is also important because it is the presence of an actual woman (one of the few) in ‘Tabiyat’ outside ‘The Home’ section. The exhibition doesn’t ignore women, but only references spaces that women are ‘seen’ in. Women are represented through objects of hygiene and shringar (beauty enhancements), posters from prohibition-hungry Maharashtra that recreate mandalas as realistic images that frown upon alcohol-induced domestic violence; or the All India Institute of Medical Sciences (AIIMS) sponsored, pro-woman content popularising condom usage from the late ‘90s, which was part of the long-drawn AIDS and HIV awareness movement in India.

Some of these ‘women-themed’ exhibits, while outwardly championing women’s agency in creating social change, confuses glorification with actual progress in women’s rights. Take the AIIMS sponsored, traditionally-styled HIV awareness poster from the late nineties, which put a couple in the foreground of their home. The door is locked, and the woman holds a (fairly oversized) condom out to the man, suggesting the door will be unlocked once he accepts the use of protection. The message seems great, considering India’s HIV awareness programme has worked out exceptionally well compared to other countries, having demonstrated an overall reduction of 57 percent in estimated annual new HIV infections in the last decade. While the programme helped sex workers to create communities and community collectives to promote sex worker rights, including the compulsory use of ‘Nirodh’ condoms – manufactured and distributed by the government for free – these activities were targeted at specific populations (sex workers, truckers, children of sex workers, lower class areas which see an influx of NGOs). The rest of the country’s population has retreated behind arguments around ‘immorality’ when it comes to sexual activity and condom usage as opposed to engaging in dialogue to promote responsible, healthy sexuality.

This conversation of moral women and immoral activities often gets in the way of common sense and health advisory. Sex education, besides as a tool for responsible baby-making is seen as suggestive. Gynaecologists tend to ignore problems such as endometriosis; young women ignore gynaecologists to avoid judgement about their sexual lives and politicians offer to count condoms in university trash repositories to prove that the youth is in ruins. Ultimately, India’s gender problems mar its progress in controlling the spread of HIV or other STDs.

The exhibition provides an example of how ‘tradition’ doesn’t necessarily have to clash with modern ideas about gender equality. But in doing so it doesn’t quite reflect upon the impact (or lack thereof) of these interventions. One of the exhibits is noted Bihari folk artist Swarna Chitrakar’s pattachitra on female foeticide, on loan from the Devi Art Foundation. Pattachitras, an Oriya tradition, literally translating to ‘drawings on cloth’, was traditionally used to depict devotional/mythological stories relating to Ram, Krishna and others. This pattachitra diverges from the traditional aspect and instead focusses on the process of childbirth and subsequent problems of female foeticide. It is uncommon to see it used in this format. Chitrakar is one of very few artists using her skill at a traditional art form to promote social justice and female rights, and even her work is often snapped up by private local or international collections and museums where the people who need to see it would hardly enter. But, overall, the use of popular traditional arts to improve statistics around female foeticide is limited to these ‘experiments’ and is still not part of a comprehensive, country-wide awareness programme.

Statistics show that the gap between the number of male children and the number of female children is widening, despite efforts to ban prenatal sex selection, which studies as recent as 2013 show as having minimal impact, with only approximately 106,000 female foeticides in a decade.

The inclusion of Gauri Gill’s photograph of a daii (midwife) helping along childbirth in rural Rajasthan is an important symbol that the conversation needs to change and address issues locally. Those aware of Gill’s practice might be up-to-date with the importance of midwives in the lives of women of rural communities through her extensive photo-project, but few are aware that the Indian government frowns upon rural home-births aided by midwives. In the early 2000s, the UN required India to meet its Millennium Development Goals, one of which was a controlled maternal mortality rate.

Unlike Sri Lanka, which, in a similar situation, supported its population of poor pregnant women and midwives by offering nursing programmes and qualifications specific to midwifery, India institutionalised childbirth to an extreme degree by insisting on hospital or clinic births and making it necessary for midwives to get a nursing degree (a lot of which is outside the scope of midwifery). This effectively rendered thousands of midwives jobless, sentencing women from poor, rural or tribal populations to questionable care in government birthing clinics under various schemes such as the Janani Vikas Yojana started in 2005. Before that, in the 1990s, the state also rolled back its previous attempt of the Child Survival & Safe Motherhood Scheme (which trained midwives as opposed to rendering them useless), and thus shut down a safe and affordable alternative to birthing clinics. While the maternal mortality rate did come down in India, it is nowhere close to the acceptable requirements of the UN Millennium Development Goals. A recent (and fairly searing) investigative report by Sohini Chattopadhyay for Quartz India also suggests low quality care, equipment, unsafe procedures and abuse by doctors and nurses as routine at many government initiated birthing clinics.

The exhibition, unfortunately, fails to capture the modern female experience of medicine and wellness. Let’s face it, it’s not pretty. Given the trends we labour under, the female experience can only be spoken of as wholesome and spiritual, or not at all. Motherhood is constantly perfect, satisfying and the thing women obviously aspire to; women who speak about difficult pregnancies are often considered ungrateful mothers. Celebrities won’t speak of their pregnancies as anything but a blessing, advertisements won’t actually show women bleed while selling them sanitary napkins and Instagram won’t let poet and artist Rupi Kaur post a picture of her period-stained pajamas because, apparently, it’s ‘gross’. It’s a problem when society silences much-needed conversation about women’s health and hygiene by calling it too vulgar to discuss.

One could counter that this exhibition isn’t about female well-being but about well-being in general. But it makes no sense to not talk about the difference and the difficulties faced by almost one half of the population in a space devoted to health and medicine. What could have added to the exhibit was perhaps Kaur’s photograph, any of the numerous creative attempts at sex education by various NGOs or Arunachalam Muruganantham’s low cost sanitary pad making machine, a labour of love that is enabling women’s hygiene across India. Perhaps Muruganantham’s story would inspire the thousands of visitors that pass through the exhibition by virtue of being in the CSMVS’s fold, to spare a thought for their women who bleed every month. In a country with a history of segregating menstruating women, where even in contemporary times women in metros feel the need to hesitatingly whisper “bhaiya, Whisper ka packet dena”, perhaps a sanitary napkin making machine in the middle of an exhibition that speaks about Indian attitudes towards health and hygiene is necessary.

Fatalism and health
This increasing refusal to speak about sanitary pads and vaginal health despite growing feminist awareness is not the only interesting attitude Indians hold towards health. For a country that seems to have largely over-indulged in antibiotics and is suffering the backlash of drug-resistant diseases, we should consider the ridiculously fatalistic outlook we have towards health, and especially chronic health issues. An old (original, really) game of Snakes & Ladders is part of the display. As Vaswani apprises us, the game was originally used by parents to explain illness and physical maladies as consequence of karmic misfortune. Interestingly, modernity repackaged this game of misfortune as a game of luck, where your future doesn’t quite depend on what you do or don’t do, and instead you’re left hoping for the inanimate dice to behave. Its original purpose however is a telling statement on Indians, even today: fatalistic, superstitious, god-fearing, but ultimately carefree.

Indians are taken by the glossiness of Western medicine, but the bourgeoisie is already returning to the roots and re-embracing what they said they had forgotten

Take for instance diabetes or the rising incidence of morbid obesity. The statistics for 2015 showed that Indians are at a greater risk from both these conditions, even though these illnesses can be moderated through a change in daily schedules and lifestyles. What we see, however, is an individual and societal inability to consider both situations as serious issues, with many at-risk folks refusing to alter lifestyles with a ‘what will be, will be’ attitude. This fatalism shows up at houses of faith, asking gods to save us. Be they Hindu or Christian votive offerings, which were once limited to replicas of the body and its parts that needed fixing, but now extend to home, travel, a new car or chadars to be offered at various dargahs or a taveez that looks out for you. Our religious and superstitious fallacies are what lead to surreal moments of mass delusion – from Ganesha idols drinking milk and the mania of thinking that Mahim Creek was a source of lifesaving water (given the creek is a repository of the city’s waste), to suggesting that mentally-ill people don’t require doctors – they’re merely communicating with gods or demons.

Such fatalistic beliefs are in direct contradiction to what we  already know and have achieved, from the famed physician and surgeon Sushruta (circa 600 BCE), who is considered the first person to have described the basic principles of plastic surgery in his medical treatise, ‘Sushruta Samhita’, to various investigative attempts emerging from the region to understand and accurately depict the human anatomy, and more recently, inventions like the Jaipur Foot prosthetics and the success of high-risk surgeries in Indian hospitals including the world’s first ‘awake’ cardiac bypass in 2007. This reveals the need for Indians to rely on both dawa and dua, since there is overwhelming need among the populace to let a higher power take care of problems in some way.

The picture ‘Tabiyat’ paints is an interesting one. Indians, it seems, are all at once modern and ancient. Self-determining, yet childlike. We are taken, currently, by the glossiness of Western medicine, but our bourgeoisie is already returning to our roots and re-embracing what they said they had forgotten. Re-packaging and settling on a monetary premium is an inherent condition to embracing old wisdom. So ghee competes with olive oil and you can get your Sanjeevani herb in a box so Hanuman won’t have to lift that mountain. But on emerging from the exhibition, I did feel that we need to look at Indian health and wellness in an indigenous way, to find paths of localised healing, contextualised to the region, and to create an inclusive environment that caters to various sections of society to create positive changes in individual and social health.

~ Phalguni Desai is a freelance writer and editor, based in Mumbai.