29 August, 2010

A river between us


29 Aug 2010--The Kathmandu Post
As the rivers rose this monsoon, I thought about a trip I’d taken last year in the spring. I was going from Dharan to a village in Saptari. I had been told the bus trip would take two hours. As the bus started to bump and grind through a white expanse of sand, I realised I was crossing the breach in the Koshi barrage. Here and there, there were desultory detritus of life from the past—a tree half buried in sand, a home sunk into the morass. We’d already been in the crowded bus for four hours. The last hour we crossed a desert that had appeared in the middle of Nepal’s fertile Tarai. The village was nowhere in sight.  

As the bus started to slowly grind across the pure white expanse of sand, I had one of those moments of complete disorientation and loss that I’d felt only a few times before. I’d felt that going deeper and deeper into Bombay’s red-light district with two British journalists once on an investigative journalism trip. The same sense occurred to me now, in the middle of the Koshi barrage. My cell phone stopped working. Although I was only a few hours away from working cell phone connections and modernity, a few inadvertent steps into the wrong direction, and I could be lost forever.

A water pump was installed in the middle of the riverbed—for miles around, nothing was visible except white sand. A little naked girl stood next to it, drinking water. This stark memory reminds me that people in the Koshi river area, which is flood-hit year after year, must feel the same—that although they are only a few hours away from modernity, they are lost forever.

The water pump brought up interesting questions. Shouldn’t the NGO that so helpfully set up a single water pump have concentrated instead on moving the population elsewhere? As people wiser than me have pointed out, it makes no sense to build human habitations on top of a flood plain, and then run around, year after year, trying to rescue people. The logical solution is to encourage people to move out of the river’s range. If people insist on living there, then building houses on stilts, like in different places in India and South East Asia, is a solution.

The government and NGO interventions make me wonder. Wouldn’t you want to give incentives to people to resettle on higher ground after dealing with an expected flood each year? Perhaps the answer to why people seem encouraged, by state policy, to keep rebuilding on dangerous ecological zones lies in something known as the “Flood Mafia”. Financial benefits accrue year after year, especially on the Indian side of Bihar, as government officials take their cut from the central government of India to rebuild, once again, some entirely untenable human habitations in the middle of a dangerous ecological zone.

Of course, there are problems with forced, rather than voluntary, resettlement. I remember a beautifully build ecological village with a circle of pretty houses which an INGO had set up to resettle victims somewhere in the Tarai. A journalist pointed out that people deserted this artificially constructed village, and nobody lived there now. I wonder if the architects of this exquisitely constructed habitation had forgotten one thing—human relations. Were the houses too close together? Did people feel humiliated being put in this space clearly meant for “victims”? Did they have land to farm, or jobs to do? Did they feel stifled in this artificial world? Why, in other words, did they leave?

Mile-high project reports about successful interventions line the glass covered shelves of international organisations. No doubt this “success story” of resettlement made it to some glossy project brochure about how the people of Scandinavia or the people of the European Union or the United States had successfully supported flood victims in Nepal. But why don’t we ever get to read about the resettlement programmes that didn’t work out? Like every single million dollar project in Nepal, we will be forced to hear the “success story”, but why a beautiful, artificial village became deserted may never become clear.

As INGOs are fond of reminding us, monitoring and evaluation costs too much—so therefore its better to try something and have it fail, then send an evaluator over to ask what may be fairly simple questions to fairly obvious answers.  

The rural bridges that the Swiss government built with Nepal was long the best solution for rising rivers in the monsoon. Sadly, I was told by a bridge engineer that the pace of building of rural bridges has abated with the introduction of the SWAP basket-funding model. SWAP is enthusiastically embraced by big donors. A friend who had been instrumental in adopting this model argued with me fiercely that this was the only way to ensure that donors are coordinated and are not replicating their own work. I have no thoughts either for or against SWAP basket funding—I don’t understand its modalities. All I can tell you is that for one practitioner, the pace of his important work has decreased due to this model.

This monsoon, as the rain beat down on my tin roof, entered my living room and destroyed my books, and my gas canister ran out, I thought back again to people who are left homeless, out in the rain, too close to rivers that rise every year. Imagine trying to have a cup of tea while you are homeless, a professor in college had stressed on us. When you have no clean water, no kerosene, no tea and definitely no sugar, a cup of tea becomes an impossible dream.

I read an interesting article about China’s ten day traffic jam the other day. Traffic has stalled for miles around in China’s overcrowded roads. Drivers are eating and sleeping in their cars. They are stranded by a different river, and a different flood—a flood of too many cars which cut them off from their shelters and food. They had thought they were different—urbanites who’d never face the injustices and dangers of nature. They were beyond nature. Their cars would always protect them. And yet, it appears, the two victims are not so different. Both are cut off from food and shelter. One had too much, the other had too little. But in the end, the end results are the same. Two people watch each other from opposite sides of the river, both waiting to be saved.

15 August, 2010

Guava leaf cure | Oped | :: The Kathmandu Post ::

Guava leaf cure Sushma Joshi AUG 14 - The Kathmandu Post

Last Tuesday, Kalpana Dhimal (28), hung herself after she couldn’t afford health care for her infant daughter. The baby died a day later. “Poverty-stricken mom hangs self,” was the headline of a national daily. According to the same report, the child was running a 105 degree fever. The nursing home demanded Rs.1,700 per day. Like many women, she didn’t ask her husband or family for the money. She chose to die instead.

A family of three—a father, mother and adult daughter—hung themselves on a tree after the family was unable to afford treatment for the daughter’s epilepsy a few months ago. The family was Brahmin, showing that despite popular belief, poverty crosses caste boundaries.

The nation should hang its head in shame when suicide becomes a form of protest, which it has started to be, increasingly, in New Nepal. In April, UML cadre Dikendra Rajbanshi hung himself in the premises of the party headquarters. The cause was poverty—his son couldn’t find a job, and the party couldn’t help him. Increasingly, people seem to be choosing suicide to show their protest and despair—from the 15 Nepali women who committed suicide in Lebanon last year, to the families killing themselves when unable to face spiralling health care costs, suicide seems to be overtaking bandh as the method of protest for the most vulnerable. But these folks will never be called martyrs. Their deaths are a silent form of protest against the worst injustices, but their deaths will be nothing more than teashop conversation as the nation, caught in an unending football game of politics, looks away.

Fifteen Nepali female domestic workers killed themselves in Lebanon last year. Rather than face the sexual harassment, unpaid labour, and torture at the hands of their employers, they killed themselves. I was sitting at a teashop when two men read out the news. “Why were they there?” asked one. “To make money, of course,” said the other one, a Newari farmer, in the mocking tone of one who can afford to deride people who go to make money. The conversation was over. What should have been a national crisis—15 women dead in a foreign country—was brushed over with a single comment.

Twelve Nepali men were slain in Iraq by Islamic radicals and the country went up in flames. Sixteen women kill themselves in Lebanon and the matter dies in one news item. Who cares about women, right? They had gone to the Middle East for almost exactly the same purposes—to feed their families. Protesting religious fanaticism is always so much more popular than protesting violence against women—even though the latter can be more lethal. I am not trying to incite anybody here, merely suggesting that somebody, say labour and immigration officials, should be questioned about these deaths. Has the government set up a bureau that ensures the safety of Nepali female migrant workers in the Gulf? Has the government set up adequate shelters, and repatriation programmes, for those fleeing sexual violence?

Escalating health costs is shown, in survey after survey, to be the single biggest costs of Nepali families, alongside education. People migrate for decades to the Gulf and many other countries, and the majority of their live savings may go to treat a family member in a nursing home. So the question remains—what model of health care are we moving towards?

Allopathic medicine, with its hospitals and nursing homes, could also be titled “Apathetic Medicine.” Its concern for patients is abysmal. The fragmented nature of the nursing home—X-ray, ultrasound, blood test—suck money right out of the pocket before the patient even sees the doctor. And yet, this is the only model we can relentlessly promote, all the way from the Health Ministry to donors ostensibly promoting “health care”.

There were times when a five-year-old running a fever in a Dhimal household would be given a traditional herb, and the fever would go away. All communities in Nepal, including Brahmins, have some form or other of traditional medicines. According to H. H. Risley’s The Tribes and Castes of Bengal, through, the Dhimal of the Nepal Terai were rapidly losing their “tribal identity by absorption into the large heterogeneous Rajbansi caste” as early as the 1800s. They were also losing their nature worship as they integrated towards Hinduism. Overlaid over this was the modern world—and with this loss of indigenous identity and knowledge came the singular knowledge of poverty. As people lose their indigenous identity, and with it their healing knowledge, and they come to understand as modern people that allopathic medicine is the only “real medicine”, this leaves them vulnerable to the most curable diseases. To the point where a young mother whose daughter is running a fever can only think of one solution—suicide. Indigenous systems of healing gets lost in black oblivion. Or should I say it kills itself in its slow search for modernity.

I have had conversations with learned people who show incredulity at my belief in traditional healing systems. Surely, they say, I must be joking. But these learned people don’t know certain personal histories. For instance, my family, the Joshis of Mahaboudha, know an herbal medication for jaundice that cures a patient in a week’s time—allopathic medication takes months. Just in case you think I’m peddling my family medication, let me share with you the ingredients and recipe remains secret, and I have no access to it. And the reason is this -by keeping it secret, the medication was never used for commercial profit but only for localised healing.

The “doctor” system has been deified at the expense of the age-old Ayurvedic, homeopathic, Tibetan, and other medicinal systems. A friend of mine told me recently his mother was receiving dialysis for her kidneys. She is in her early sixties. The reason? His mother had had an epileptic fit. They had taken her to the hospital, where the doctor had offered her medication, but with a catch. The medication, he had warned, could destroy her kidneys. Desperate for a cure, they had agreed. Then her kidneys, which had been perfectly healthy, started to deteriorate. It seemed inconceivable to me that a non-life threatening disease, like epilepsy, should be prescribed a medication that could potentially destroy the kidneys, and therefore life. I don’t know the Hippocratic Oath (I’m not a medical doctor, just a writer who peddles herbal remedies), but it seems to me any healer, however learned, should never give a medicine that destroys life to lessen the symptoms of a lesser disease.

I asked my mother if she knew any traditional medication for epilepsy. “Oh yes,” she said. “Remember this old aunt of yours who walks by? She used to be epileptic for 12 years. She was always covered in her own shit. And then she went to this ayurvedic centre. It was run for free, near Pashupati. She took three dosages and now she’s been free of disease for decades.” I am now reading a book which tells me guava leaf, which is available in most parts of Nepal, can treat epilepsy. I wonder, in my writerly imagination, if the family that hung themselves for lack of money to treat epilepsy had done so from a guava tree.

Why, I wonder, do we not promote our own indigenous medical systems? A similar question must have passed through the mind of a wonderful woman, Yeshe Lama. Yeshe, a programme officer at World Widelife Fund, was one of the few people in donor agencies interested in traditional healing. She compiled a directory of medicinal herbs and promoted the Amchi system of healing in the Himalayas. Unfortunately, Yes he was one of the people who died in the helicopter crash in Kanchujunga. Who will continue her work so that people in small communities don’t have to kill themselves from easily cured diseases? Will our policymakers see the wisdom in moving away from the extraordinary costs of hospitals and nursing homes towards a more local, holistic model of healing? When will we see the cure is right here in front of us?

 sansarmagazine@gmail.com Posted on: 2010-08-15 08:21

Note: A bit of good news. Two years after writing my article, I found this 2012 scientific study done on the effects of guava leaf on epilepsy. And they conclude that guava leaf does significantly reduce convulsions. It always makes me happy when my "random" eccentricities ("Guava leaf for epilepsy? What is Sushma Joshi thinking?") gets scientifically validated:

12 August, 2010

Herbs and potions


12 Sep 2010, The Kathmandu Post
Two weeks ago, I wrote an article titled “Guava Cure.” In it, I discussed the soaring costs of allopathic healthcare, and suggested traditional medicine (TM) may provide an alternative to hospital and doctor care.

That evening, I got two responses. The first one said: “You are an incurable romantic! A believer in magic! All those leaves and herbs that you believe in—I know I can’t convince you that there is a reason why science is science, and has led to the incredible advance of human knowledge. Magic can’t do that. Those stories of so-and-so being cured of this or that with special leaves, herbs, potions, etc., are just observational, which means they are not grounded on real, solid evidence. They are just anecdotes. All the leaves and herbs in the world cannot cure a person with a serious bacterial infection, like TB, for example. It’s like those religious fanatics in the US (Christian Scientists, usually, and the like), who refuse to allow their sick children to get medical treatment, because they believe that their sick kids can be cured by prayer. The kids always die, unless the government intervenes and takes over the care of the sick child. Treat a kid who has TB with Tibetan or ayurvedic medicine, and you’ll end up with a dead kid.”

I agree with my friend on one level. I was not suggesting allopathic medicine be abandoned completely. Allopathic and traditional medicine should work in tandem, with traditional medicine acting as a complement, rather than a replacement. Undoubtedly many diseases are only cured by scientifically tested medicine.

The second response was from a Nepali friend who expressed displeasure at my article. In his own personal life, ayurveda was causing havoc. He reeled off the names of 11 medicines his father was taking—all from Divya Pharmacy, Ram Dev’s pharmaceutical company. His father consulted ayurvedic practitioners and kept adding medication. One was to reduce blood pressure, one to control diabetes, one to reduce stress. The maid was made to grow wheatgrass in a flowerpot, and prepare wheatgrass juice. In addition, he was ingesting tite karela (bitter gourd), Louka juice, and aloe vera juice—simultaneously! My friend was, understandably, distraught about his father’s health.

Ayurveda (the science of longevity or life) is based on one central tenet—balance. Balance in food, medication, physical and mental equilibrium. Vata (wind), pitta (fire, bile) and kapha (water and earth, phlegm) must be in equilibrium. When these are out of balance, they bring disease. How did this message get lost for one of Ramdev’s followers? And are there many like him, putting their health in danger by extreme consumption of traditional medicines?

The question must be asked: is complementary medication dangerous to one’s health, without the proper labels, the proper laboratory testings, and the patient’s non-willingness to follow the regime? Should ayurvedic doctors also be required to go through “medical school”, and be licensed, and held liable in the same way allopathic doctors are for malpractice? Or, as my first respondent suggested, should all traditional medicine be outlawed because they have no scientific verifiability?

The World Health Organisation’s factsheet on traditional medicine says:

• In some Asian and African countries, 80 percent of the population depend on traditional medicine for primary health care.

• Herbal medicines are the most lucrative form of traditional medicine, generating billions of dollars in revenue.

• Traditional medicine can treat various infectious and chronic conditions: new antimalarial drugs were developed from the discovery and isolation of artemisinin from Artemisia annua L., a plant used in China for almost 2000 years.

• Counterfeit, poor quality, or adulterated herbal products in international markets are serious patient safety threats.

• More than 100 countries have regulations for herbal medicines. According to the same factsheet, about 70 to 80 percent of the population in the developed countries have used some form of complementary alternative medicine (CAM).

The WHO Traditional Medicine Strategy says world expenditure on TM is growing rapidly—In Malaysia alone, US $500 million was spent on TM, while only US $300 million was spent on allopathic care. Americans spent an estimated US $ 2700 million on CAM—out of pocket. Canadians spend an estimated US $2400 million, and the English are not far behind with US $2300 million.

The issue then is not that traditional medicine is only used by the poor. Clearly, its usage is rising everywhere. The issue, it appears, is a greater need for research and development on effects and contraindications of traditional medicine. National policies to regulate products must come info effect. TM practitioners must go through a period of training, and become licensed.

Traditional medicine practitioners like amchis, who serve the population in the Himalayas (ie: Dolpo and Mustang), have requested time and again to have their system of healing recognised. They also require support for academic centres where such medicine can be studied. Despite repeated requests to the government, amchis remain un-licensed. Their system of medicine is not recognised.

In countries like Indonesia and Thailand, the government has policies regarding TM. It encourages the growth and practice of such knowledge and regulates quality of medicine. In Indonesia, a widely used traditional medicine is known as jamu. Jamu makers are both licensed and unlicensed (depending upon whether they can pay the government fees.) The Thai government has started a Thai massage school in Wat Po.

It is surprising that Nepal, which prides itself on its herbal wealth, has no national policy on traditional medicine. So far, foreign companies seem to have carte blanche to come and take whatever they want from forests—no questions asked. Perhaps our great leaders should stop fighting long enough to take stock of their biological wealth, put a custom officer at Nepalgunj, inspect each truck that goes through, and charge a tax on these “leaves and herbs”. They can reinvest the tax into TM training institutions. Businesses also must give back to local communities a percentage of their billion-dollar profits.

Situated at the crossroad of India and China, two countries in which traditional and complementary medicine remain extremely advanced, Nepal could turn into a new Visit Nepal destination by tapping into the large and lucrative field of alternative healing tourism. Unfortunately, it seems our leaders are themselves in need of medication (perhaps a Himalayan herb might make their minds alert to the problems at hand, or failing that, a magic potion to instill ethical leadership skills) before they can govern the country. sansarmagazine@gmail.com