08 August, 2014

COMPLEMENTARY ALTERNATIVE MEDICINES AND HOW IT COULD CONTROL EBOLA




I was travelling in Jumla, a remote district in mid-western Nepal in 1992, when I became acutely aware of how scary diahorrea can be. I was all of 19 years old. I’d flown there on a rickety plane that landed in a small runway. The plethora of tea-shops that I was assured, by the non-governmental organization that had hired me and had sent me out, were in existence and would take care of my food and lodging never materialized. Instead, there were small homes selling a few items-perhaps a biscuit packet, some cigarettes or matches. Tea was still a luxury. 

After tramping around the villages for six weeks, and living off fox tailed barley bread sprinkled with salt and chilli, and recording stories of mysterious deaths on the side (“my sister was walking back home to her husband’s house and she fell down dead on the way”, “about seventeen people have died in that village that-a-way, we don’t know why”) my fellow guide suggested we try to climb up to Rara lake. “It will take only half a day,” he said. This sounded like an adventure and I agreed. 

Halfway up the mountains, however, two things became apparent to me: first, that I had severe diahorrea. I suspected it could be giardia. And second, our water had run out, and I was quite pleased and happy to sit down on the trail, look at the mushrooms, and not move. A pleasant drowsy haze fell over me. My guide took one look at me and realized the state of affairs: I could hear him crashing down the bear-infested jungle to get to the river to get me that precious bottle of water. After the bottle, and a few sugar candies (how little do people realize how precious those sugar candies are!), I was able to get up and walk again. Obviously, we didn’t make it to Rara Lake that time. 

Here’s a description in Wikipedia about the trek, written by  travel writer Ethan Gelber. Note we tried to do it in half a day:  
Although more trampled than in the past, the road to Rara Lake is still without any of the comfortable services available along more popular trails. Logistically it is not an easy trek; it is hard to get to and from, and it is an organizational challenge, requiring informed guides and porters to tote the two weeks' worth of material that will keep you warm, dry and fed. It is also tough on the bones, involving several 11,000-foot passes. However, once you overcome the obstacles, the rewards are legion: few if any other trekkers, incomparable natural splendor, "untouched" villages, blissful quiet.…[6]

Since that day, I often think about the people who don’t get the bottle of water, and who die from simple dehydration. Nepal often gets epidemics of choleras and diahorrea even now—ebola is obviously of great concern. If ebola makes it to Nepal, legions of people will die due to an apathetic government and unevenly run government health posts and beaureaucracies. 

Because of this experience, I’ve often had great interest in medication that can stop diahorrea. Anybody who’s tried the Western medication available on the markets may have experienced what I did—the sense of being “stuffed up,” and which disrupts digestion and well being for a few days. Undoubtedly the diahorrea does stop, but the sense of unease doesn’t. 

Recently, a herbal dealer from the same district Jumla sold me an herb called “bhotay khayyar.” It resembles a betelnut, and the man assured me he would pop a small bit into his mouth while he walked, and it had no adverse effects. More to the point, he said, this herb stops diahorrea and “blood in stools.” He titled this condition “Ragatmasi.” I didn’t know anybody who got ragatmasi, but since diahorrea was a common problem, I bought a handful from him. On a recent visit to Kapilvastu, when I again got diahorrea from eating the tempting but dangerous street food from a chat-wallah, I took a bit of the bhotay khayyar. Almost like the Western medication, it stopped the diahorrea-but gave me terrible gas and a feeling of being “stuffed up.”

On the other hand, a cleaning lady who came by complaining that she had blood in her stools for the past month, and uttered the word “ragatmasi,” seemed to fare better with it. I gave her three tiny samples, and instructed her to take one morning, afternoon and night. The next morning I asked her if she was feeling better. “Oh yes,” she said. “I took a tiny bit of that jadi you gave me. The blood stopped completely. In fact, I only took one piece, the rest is still with me. I feel so fine I ate a dozen bananas and a liter of yogurt. In fact, I think the bananas and yogurt cured me, not your herb. How can that tiny little thing act so fast?” 

In New York, in one of my forays into interesting ethnic neighborhoods, I came upon a Chinese supermarket. I bought, in this order: a bag of tea titled “Slimming Tea,” a plastic bottle of Siberian Ginseng, and a small bottle of Chinese medication marked with a small label that said it was useful in diahorrea. The “Slimming Tea” apparently did not have FDA approval, because what happened to me after drinking it was quite startling and unprecedented: it felt like my intestines were being wrung out, and I was sitting in the toilet for a full hour till everything was purged. In hindsight, I think it was an extremely strong purgative. Since I didn’t want to be size zero like the fashionable Chinese ladies, I happily threw this slimming tea into the trash. Then I tried the Siberian Ginseng. I had little interest in Ginseng but a lot of interest in Siberia—obviously Siberia sounds romatic when you’re living in New York City, so I bought it and popped a tablet. What followed was again quite startling—vivid nightmares and great aches and pains in the upper arms. I imagine now that I fell into “The White Man Trap”: the bottle was clearly designed for white folks who would be as enamored as I about the notion of Siberian ginseng, and take it without realizing how it could have dangerous side effects. The people from Siberia probably take it in their alchol, or make a medicine with 20 other herbs, with the ginseng being only a small compound. But of course in NYC, it was sold full strength and in a white man’s dose. I advice people not to take it in this form. 

But all these mistakes and travails of complementary alternative medicine was worth it, because  in the third bottle I hit the treasure. I regret today that I didn’t keep this small nodescript bottle, nor noted down the chinese characters on the label. The bottle was filled with small black balls, which you were supposed to take 3 (or was it 5?) balls at one point. I seem to remember that they were small enough they could be swallowed with saliva during emergencies when water was scarce. Each time I took it, my diahorrea and stomach pains stopped almost immediately, and I felt no bloating, gas or other pains. I would be back to eating a normal diet within 1 to 3 hours.

The point of this story being: there are already thousands of complementary alternative medication that stop diarrhea that have gone through 5000 years of “clinical trails” in ancient cultures. Why don’t we tap them for stopping the ebola crisis? I’m going to assume that bottle was a common enough off-the-counter medication that one can find in a supermarket in New York City. Of course, I told you the story of the Ginseng and the slimming tea to point to the hazards of picking up the wrong complementary medication. But I think its time now to think about effective medicines that already exist in the world’s pharmacopeia—and not just imagine that the experimental drugs are the only way to solve this crisis.

04 August, 2014

MODI’S NEPAL SPEECH, DECONSTRUCTED



I’m not sure if I caught all of Indian PM Modi’s speech to the Nepal Parliament, but the portion I did was  powerfully articulated, well thought out, and persuasive.  What came across most clearly was the PM’s interest in decreasing poverty not just in Nepal but all across the 7 SAARC nations.

I’d read a great deal about Modi—from Modi’s critics. One criticism was that his much vaunted results about decreasing poverty in Gujarat was hyped up. His poverty figures, said critics, were less than what the Modistas claimed the numbers were. After listening to his speech, it was clear to me that PM Modi has a clear anti-poverty agenda—not just for his own country, but also for the SAARC region as a whole. Whether he can show results is unproven. But clearly he’s putting a remarkable amount of energy and devotion to this project, traveling thousands of miles and meeting people of all persuasions in order to inspire them with this vision. And that, I think, is achievement enough, considering his predecessors.

The sincerity in his voice was unmistakable when he talked about tourism, for example, and how bringing pilgrims to Nepal to visit Pashupatinath would help everyone from the chana-seller to the ricksaw-pullers to the tea-sellers. The mention of the tea-sellers got a bit of a laugh from the Nepali parliamentarians, but it was a friendly, we-are-with-you laugh, the sort no doubt Modi will get all over the subcontinent, because I don’t think there’s anybody in South Asia who is not a tiny bit thrilled with his I-used-to-be-a-tea-seller and now I am a Prime Minister story. It’s a story that South Asians love (engrained in us by Bollywood)—the notion that anybody can, with hard work, pull himself up by his chappal straps to the highest position in his nation. If Modi, surprisingly, got some portion of the Muslim vote, this story probably had a big hand in it.

Modi started off by exhorting the Parliamentarians to do their job—basically, write the Constitution. There was a bit of the grandfatherly touch to his lecture—writing a Constitution is a great endeavor, he said, and you sit here with this great task before you. He then went on to commend the Parliamentarians, mentioned the world’s eyes were upon Nepal, and that this Constitution would show the way to all those warring parties who chose war over peace. The country of Gautam Buddha, he said, would show the way. All of this was very persuasive, I must say, even if had a tiny ring of an elder coaxing recalcitrant children who were refusing to do their homework.

Suitably wowed, the Parliamentarians then listened to Modi talk about herbal medicine. “When Laxman fainted, this is the place where Hanumanji came to get medicine for him,” he said. (I’d always wondered about where exactly Hanuman went, because I sure would like to go there and find that herb myself.) Mr. Modi then mentioned, with that same note of sincerity in his voice, that a project that developed Nepal into a herbal processing and developing nation would help “all of humanity”. This sort of broad, humanistic vision cropped up a couple of times in his speech, enough to make you think his vision extends beyond the usual narrow nationalistic one. I liked this humanistic approach. Helping all of humanity is an ideal that can get me out of bed, no matter how tough the outer conditions of life at any given time.

Modi then got onto water and electricity. This, of course, is a touchy subject with Nepalis. “If we build Pancheswor, this will generate five times more electricity for Nepal than it has at present,” he said. “Perhaps if Bharat helps Nepal to end its darkness now, then Nepal can help Bharat to end its darkness in a few years’ time.” So far, so good.

Then he got onto HIT. Yes, HIT. Highways, I-ways, and transways. Highways, as in roads, I-ways, to connect Nepal to the rest of the world, and transways, to transmit electricity. “We’d like to build transmission lines,” he said. Obviously, transmission lines are important, since without them electricity cannot be transported from one place to another. And this is also a big obstacle for why Nepal is not able to properly use its massive hydro potential. I hoped he meant the Sanskrit “heet”, as in “benefit”, and not “HIT”, as in “we’re gonna get you with this one.”

“We don’t want the electricity for free, of course,” he said. Or rather, joked.

Then he got on to the one billion dollars recently earnmarked for Nepal. “And this money is separate from the one given before,” he said, trying to act cool. “The one before—well, that’s separate.” The Nepalese did give an extra-energetic slap to their desks to this ghosana.

“I think that money is going to be spent by one or two politicians getting health care in Singapore or America,” an elder in my house grumbled, watching this portion on TV. No criticism of the Indians here, only of the Nepali politicians misusing public funds.

On the theme of double meanings, Modi—who so far had been swinging along with his speech, then turns to… Sikkim. Now as anybody knows, mention Sikkim in a room full of daura-suruwal wearing Nepalese, and you’re going to get one reaction—fight-or-flight. Modi approached it in this manner. “And on the theme of organic farming,” he said, “I’d encourage you all to get into it. The organic produce really brings in the dollars.” Everybody was on the organic farming boat. Then: “In our own country Bharat, the state of Sikkim has totally turned organic.” Then the (confusing) clincher. Then he says, rather sneakily and cleverly: “If you want to become like Sikkim, we can help you.”

Eer, Mr. Modi. Excuse us, but we don’t really want to become like Sikkim. Not even for all the organic farming in the world, thank you.

Modi did mention that he wanted Nepal to become even closer—and this is the sort of neighborly hug the Nepalese wonder about, wondering if it’s the camel in the tent. Modi mentioned the bridge over Mahakali would bring Nepal closer to India. This felt like a genuine expression of: “why are we so distant even if we are so close”, and a bridge over Mahakali surely sounds like a good idea, although perhaps the locals of the area would have to be consulted before anybody in Kathmandu gave the go-ahead on that one.

Modi did mention that Nepal was a sovereign nation, and he had no intention in meddling with its internal affairs. He just wanted us to be the best we could be. Which, somehow, also rang true.

All in all, the Nepalese should probably take Modi’s speech for what it was: the speech of a great orator with a great interest in social transformation, reduction of poverty, and neighborly connection, without necessarily forgetting their own interests and boundaries. A strong Nepal would continue to be a strength for India, primarily because Nepal and India have always been allies and always will be. As for the sharing of natural resources, it would have to be done judiciously and with equitable agreements, including into it many clauses for ecological preservation and conservation. Water is a finite resource, and it needs to be managed as a resource that could run out, if over-used or not stewarded with respect. And electricity, while greatly needed in order to lift people out of poverty, must be done with care so that its dams don’t destroy the ecological flow and balance upstream and downstream. It’s not something that couldn’t be done, with great thought and care. I hope for the sake of both countries something along those lines can be worked out. 

Sushma Joshi has a BA in international relations from Brown University.