Don’t Believe Everything You Think

Posted by Joel Gales - Comments Off

Varkala Beach and adjoining Papanasam Beach are places that inspire the faithful. Each morning while the fishing boats are still beyond the break, worshipers gather to offer puja, or worship, at the edge of the sea. Holy men set up ephemeral kiosks atop coffin-sized beds of packed sand and sit shaded by colorful umbrellas to burn offerings in memory of loved ones—for a fee, of course. Their customers include some women but mostly men clad only in dhotis who make their way to the ocean’s side with garlands of flowers or offerings wrapped in banana leaves. Here they briefly immerse themselves in waters reputed to have healing powers and scatter their prayers in the lapping waves.

Perhaps it is this atmosphere of healing and cleansing that has inspired the clustering of Ayurvedic treatment centers, resorts, and spas, which are concentrated along Varkala cliff. Visitors cannot walk more than fifty feet without encountering some business venture offering treatment, and barkers stand on the sidewalk handing out flyers promoting relief from every kind of malady: piles, insomnia, sexual dysfunction, hair loss, skin conditions, and even paralysis.

In the face of this rampant commercialism where cures for disease are aggressively peddled alongside tee shirts and statues of gods, it’s hard for me not to want to walk away from it all in disgust, including my scheduled two and a half weeks of panchakarma treatment later this month. But I don’t want to give up just yet; I came for the specific purpose of receiving this treatment, and I am too stubborn not to see it through.

Understanding that I can be stubborn, I have been questioning my beliefs about natural healing and how many of my long-held assumptions came into being. My grandmother used to ask her dinner guests to refrain from discussing sex, politics, or religion at her dinner table as these topics were likely to invite controversy and ruin digestion. To that short list I would add health beliefs, as what we eat and how we heal ourselves can be very emotional topics. There is nothing more personal than how we take care of our bodies, and in this age of diminishing religious faith, health and dietary practices seem almost to have taken the place of theism.

My fascination and sometimes blind acceptance of natural medicine can be traced to my mother and her siblings’ beliefs in alternative healing, which ran counter to the conventional beliefs held by the older generations in my family where many of the men were doctors. The relatives of mine who rejected, to a greater or lesser extent, conventional medicine, were also children of the sixties, when the counter culture embraced natural remedies over the conventional medicine of their parents. One sibling became a chiropractor, one became a psychologist (which was on par with becoming a snake handler in my family), one studied herbology and Mayan uterine massage, and my mother turned vegetarian in her teens and advocated natural foods, vitamins, and alternative healing remedies all her life. I was raised drinking goat’s milk and remember arguing with a science teacher when I was fifth grade that non-organic vegetables had been robbed of their nutrient value and thus we needed to use vitamins as supplements (both my mother and the teacher have later been vindicated; studies have shown organic vegetables to have higher nutrient values but also that vitamin supplements are not necessary unless the diet is extremely poor).

Realizing the foundation for my beliefs has made it easier for me to let go of them, or at least to evaluate them non-sentimentally. But there are lots of reasons that people have for believing in alternative healing modalities aside from growing up in a family of conservative Republican doctors. Here are a few that I have culled from a book I read recently called Trick or Treatment (Simon Singh & Edzard Ernst, M.D), which seeks to examine the scientific evidence behind many modalities of natural healing, including widely accepted therapies like acupuncture and chiropracty.

Doctors
Motivated either out of ignorance of the lack of scientific evidence, laziness in wanting to give patients “something” to hold them over until nature heals the problem, or in hopes that the placebo effect will help the patients, doctors are one reason the authors give for people believing in unproven therapies. I have had doctors recommend homeopathic remedies to me on several occasions, and I’m not just talking about some shady quack at an emergency medical clinic (a “doc in a box”), I am talking about doctors from respected healthcare networks in the San Francisco Bay Area.

Similarly, in the UK, either from the reasons cited above or for its fondness for alternative therapies encouraged by Prince Charles, roughly half of all practicing doctors had arranged for acupuncture sessions for their patients according to a 2002 British Medical Association report.

The Media
The book brought up a particularly painful example of how the media is quick to cover sensationalist alternative medical “cures” with lack of proper investigative reporting into the scientific studies underlying them. In 1993, 60 Minutes ran a program called “Sharks Don’t Get Cancer” which reported on the promising possibility of shark cartilage as a miracle cure for cancer. This program aired at the time just after my grandmother had been diagnosed with cervical cancer, and my uncle encouraged her to buy and drink the expensive supplement as part of her daily routine. She hated it, but she was dying, so someone got rich off her desperation. Luckily she did not eschew conventional cancer treatments, so she got a few more years after a grim diagnosis.

The World Health Organization
The widely respected WHO has published two studies over the years upholding the efficacy of acupuncture despite there being no definitive scientific trials: Acupuncture: the WHO view (1979); and Acupuncture: Review and analysis of reports on controlled clinical trials (2003).

For the second report, the WHO took into consideration almost every trial ever conducted, which seems like a good thing on first impression, but the quality of those trials varied widely. The organization also took into consideration many sub-par Chinese trials which were almost always positive as the validation of acupuncture in China is politically motivated and negative studies are often unpublished. Further, the WHO panel evaluating the paper did not include a single critic of acupuncture.

It is these papers and their frequent citation that have led me, as one of many, to believe in the validity of a treatment despite the fact that it has not been backed up by trustworthy clinical trials. Throw in the fact that major insurance companies cover these treatments, and it is natural to assume this modality is valid.

The argument from practitioners of natural healing is that research into conventional medicines is influenced by money from pharmaceutical companies who strive only to increase their stock price at the risk of the health of those they profess to serve. We have all seen the drug commercials with the happy narrator’s voice reading through a list of side effects which are often more serious than the disease, and then later the commercials that advertise for prior users to join class action suits after the “miracle drugs” are pulled from the market.

Similarly, there are plenty of examples from academia where egos got in the way of new theories that undermined long held beliefs. Read Sapolsky’s excellent book Behave for a short history of the struggle in neuroscience circles for acceptance that the brain can change after birth, which is now the commonly held understanding.

Even if our professional reputations are not tied to our beliefs, it’s still hard to let go of them. They make us who we are, in many ways, and it takes a healthy ego let go of what no longer makes sense. It’s also very difficult to know what exactly is the “truth” when scientific findings are either supported or undermined by new evidence on a regular basis because, well, it’s science. I just read in the New York Times that fish oils are no longer believed to help with heart conditions despite prior studies showing the reverse and millions of dollars being spent on this supplement (which still may help with depression and other ailments, but that will take further study). Sometimes it makes me want to pull out my hair in frustration, but I will have to resist the urge—I don’t think the Ayurvedic clinic down the street can help me grow it back.

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Tue
10 ^th

The Re-Set Diet

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With my blood work panel showing everything as normal, Dr. Rajah explained that there were three phases to his treatment. Phase 1 was the preparatory diet in which the digestive fire, or agni, would be stoked so that I would be able to digest the medicated ghee efficiently during phase 2. The ingestion of ghee (Sneha-paana) during phase 2 was the primary treatment, and its purpose was to lubricate the cells in the body in order to dislodge toxins, which are known to have a sticky quality in Ayurveda. It could last from 5-7 days, and having experienced choking down ghee first thing in the morning in preparation for panchakarma, I prayed for the shorter duration.

Following the ghee treatment, the final phase would be a period of recuperation during which I would follow the same diet protocol as in the first phase while gradually re-introducing prohibited foods. He promised me that my high blood pressure and other complaints would be alleviated if I followed his instructions strictly, and that I would be rejuvenated down to the level of every cell in my body. It helped to keep his words in mind to encourage me as I struggled with the diet in the days that followed.

It was a pretty simple regimen in that I had only to remove anything that takes the act of eating from the mundane to the sublime:

no oil or butter, not even for cooking
no dairy
no fruit, raw or cooked
no raw anything as it’s understood to be hard on digestion in Ayurveda
no meat
no honey or sugar in any form
no bread or bakery products
no beans because of the digestive difficulties they presented, although pulses were fine
nothing metabolized in the liver, like alcohol, nicotine, or drugs, including OTC substances like Ibuprofen. Luckily, I had let go of my last bad habit, nicotine gum, a few weeks before.

He did allow me small amounts of salt and also a little black tea or coffee, the latter of which I had also managed to give up but then started to drink in modest amounts if for no other reason than it seemed a little naughty. And my menu was in serious need of naughty.

At a loss for how to make my usual Indian vegetarian foods, like palak paneer or any subzi (veg dish) cooked in oil, I began to research no-oil recipes online. The best advice I found was to brown the vegetables in a pan while using small amounts of water to keep them from sticking. The broth with the browned veggies would form the base of the curry or soup I was making, and it would be a little more flavorful than simply boiling the vegetables in water. The most helpful websites that I could find invariably catered to people on Candida diets or to those with horrible, incurable diseases.

To complicate matters further, I was in a small village with a limited selection of vegetables, many of which were unfamiliar and sold by vendors with whom I did not share a common language. I took some chances and bought some of the stranger looking ones, like bitter gourd (Karela), which I later determined I could not make palatable without oil, but mostly I stuck to what I knew: beets, okra, tomatoes, potatoes, carrots, ginger, onions, garlic, pulses, and basmati rice.

After much experimenting, I was able to cook a decent curry, but I still missed oil. The food was good in a simple, humble way, but lacked the depth and flavor that oil imparts.

There were also restrictions on the water I drank as it had to be boiled with herbs. It was very important that I drank only boiled water, and it could not be chilled afterward. I had heard that drinking cold drinks is bad for digestion as it cools the digestive fire, but I had not heard of drinking water that had been boiled for several minutes. After some online research, I learned that Ayurveda teaches that boiling water raises its energetic qualities to a level of sharpness that helps to dissolve toxins in the body and also stimulates the agni toward better digestion.

Do you remember in school learning about “suspension of disbelief,” that strategy of the mind that allows us to watch a play without having the enjoyment of it ruined by constantly thinking about how the actors on stage were just people and that they weren’t really falling in love or stabbing each other? I am employing that technique every time I boil water for drinking. I am not sure if I buy the theory, but I want to follow the instructions strictly so that if the cleanse/reset doesn’t work, then I won’t be left wondering if the results would have been different if I would had drank the boiled water.

After about a week on this diet, I got my first normal blood pressure reading at the doctor’s office even before starting the main ghee treatment. I also lost a little weight, which I didn’t really want because I was already where I wanted to be, but I know how to fix that later. I did find the diet to be constipating at times (my vata dryness issue), but the good doctor promised that issue would be addressed as well. One thing I know is that I will appreciate the day I can eat some heavenly paneer again, but I think I will also try to make these simple oil-free dishes more of a mainstay in my diet. They might not thrill my palate, but my heart seems to like them.

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Thu
05 ^th

When the Patient is Ready, the Vaidya Will Appear

Posted by Joel Gales - Comments Off

Arya Vaida Sala might have been a bust, but I was optimistic about my plan to meet with a doctor I will call Dr. Rajah (Malalayam for “king”), a well known and highly regarded doctor of Ayurveda in northern Kerala. I had recently become acquainted with his wife, also a physician, who recommended his treatment protocol for hypertension after I turned to her for guidance when Arya Vaida Sala didn’t work out. Dr. Rajah held a PhD in Ayurvedic medicine, was on the faculty at a medical college of Ayurveda, and had just published a book on evidence-based approaches to curing diseases using modern medical practices coupled with Ayurvedic treatments.

That interweaving between modern medical science and the centuries-old science of Ayurveda composes the curriculum in Ayurvedic colleges in India, which is not something I fully understood before coming here. Unlike the schools of Ayurveda that have been established in the United States, Europe, and other countries that are catching on to (or cashing in on) the rising trend of Ayurveda worldwide, schools in India require a much more in-depth understanding of what is taught in Western medical schools.

Just to be admitted to the BAMS (Bachelor of Ayurvedic Medicine & Surgery) undergraduate program, high school students must complete standard pre-med classes such as chemistry, physics, and biology, before leaving grade 12. Once admitted to a BAMS program, the course of study spans 4-½ years and is followed by a 1-year internship. During the academic years, students study anatomy, physiology, and the history of Ayurveda, but also toxicology, pharmacology, surgery, ENT, skin, obstetrics and gynecology.

Once graduated, the doctors can use the title Vaidyar (abbreviated Vr.), the classic term for physician, before their names and are able to do many of the things we see Western doctors do, like write prescriptions for allopathic medications and even perform minor surgery. Following the BAMS degrees, doctors can go on to earn a PhD, such as Dr. Rajah held, which certified specialization in one of many subject areas such as general medicine or pharmacology. Understanding Dr. Rajah’s qualifications, I knew I was going to an expert in the field whose personal philosophy to target diseases with the minimal amount of medicine was one I respected.

In the interim before I arrived in the small (by Indian standards, at least) coastal town a couple hours northwest of Kottakal where Dr. Rajah practiced, I had tapered off all my blood pressure medication, so I was anxious to be under a doctor’s care. When I arrived at my appointment the evening of my first day, Dr. Rajah was with another patient in the modest treatment room built on the porch of his rambling Keralan home on the outskirts of town, so I sat on the porch to wait and passed the time watching birds swooping down through palm trees to catch twilight dinner in the idyllic yard surrounding the house.

After his patient left, he greeted me warmly and showed me in to his office. He took my blood pressure, which showed a diastolic in the mid 90’s, asked me some preliminary questions, and then sent me to a nearby medical lab to get some standard blood work and liver function tests performed. I was happy that he had ordered tests before even talking about treatment; it showed me that he wanted to gain a full understanding of my physical condition before throwing a bunch of herbs at me and talking about panchakarma, which I’d come to understand he recommended for only a very small number of his patients. He also never asked me about any of my eating habits, looked at my tongue, or performed any of the standard intake questions I’d come to associate with an Ayurvedic intake.

Nor did he perform any of those examinations the next morning when I went back for my follow-up appointment. I came to understand during the course of our next few appointments that my disorder was indicative of the underlying imbalance, and it didn’t matter what my dosha makeup was or its role in predisposing me to having the blood pressure issue. It was enough that I had it, and the treatment was standard regardless of what my tongue looked like or how my body was structured.

But what gave me the most confidence that I was with a true healer instead of a salesman was that when I asked what I owed him the next morning, he seemed almost puzzled for a moment, but then answered, “Oh, nothing, this is just consultation. For the main treatment, it will be the standard cost of 5000 rs.” That’s about $75, or what a couple of days in a panchakarma center would have cost me. I skipped out of his office feeling like I was on the right path, or at least one that wouldn’t cost me thousands to travel down.

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Sun
01 ^st

Arya Vaidya Sala Kottakal

Posted by Joel Gales - 1 Comment

One of the most well known and highly regarded Ayurvedic institutions in all of Kerala and throughout India, Arya Vaidya Sala Ayurvedic Hospital & Research Centre was my first choice in seeking treatment. In addition to the many online reviews and articles praising their treatments, I was referred by Ayurvedic practitioners for the quality of their medicines. The main drawback was that the center is in the middle of a busy city unlike most of the peaceful, secluded resorts, but still the positives seemed to outweigh the shortcomings. In addition to their sterling reputation, the prices I found online were much lower than the thousands of dollars charged by resorts catering to Westerners. Or so I thought.

While the website states there are additional costs for treatment and medicine, I could find no information on these tariffs, which turned out to be almost as much as the room per day. Thus, a three-week stay would cost just over $2000, which puts this place on par with some of the resorts I researched.

Their site also offers a free “online consultation,” but it’s not what I would call a real online consultation. Instead, potential patients fill out a simple form that sends an automated reply directing them to come to the hospital in Kottakal for an in-person consultation. There’s no way to book this place without going in person for evaluation, so you don’t know if you will even be admitted. I thought that made sense as a doctor would need to assess a potential patient in the flesh in order to conduct a thorough examination, and I knew from their website that they treated hypertension in addition to other disorders.

After filling out the evaluation form online, I called to speak to someone in their office because I wanted some reassurance that making the trip to otherwise undesirable Kottakal would not be in vain. She told me that I would need to be seen by a doctor, and while there were no vacancies at the time, there were frequently cancellations for bookings, so the best I could do was to show up and try to grab a spot. Undaunted, I made the long train overnight train journey from lovely Canacona station, which is about 1.5 km from Palolem Beach center, to less-than-lovely Tirur station in northern Kerala. From there I caught a rickshaw, which was incredibly cheap after Goan prices (only 250 rs for about 15 km) to make the final part of the journey to my hotel in Kottakal, where the main Arya Vaida Sala hospital is located.

My hotel was just over half a kilometer away from the in-patient panchakarma center, but I had been told when I called the week before to report to the out-patient center, which is closer to 2 km away. There are several hospital buildings, including a cancer ward, the outpatient building, a medicine manufacturing facility, and the PK center. The entire area, which I began to think of as the Ayurveda Industrial Complex, is encircled by four main roads and includes an area of about 8 km. There are also research centers, a huge and beautiful outdoor herb garden, and even a trash disposal site for the hospitals. Surrounding the hospitals are hotels (none that I would call a good value), restaurants, pharmacies, and drug compounding shops that thrive on the business the hospital brings.

The morning after my arrival, I walked to the out-patient treatment center to get in line for my free consultation. I had a photograph of my passport on my phone, which they let slide, but ideally I would have had the actual book in my hand. (Note: always carry your passport when you will need to prove your identity.) After about twenty minutes sitting in a crowded waiting room, I was shown to the doctor’s office. She asked me a few preliminary questions, but nothing as in-depth as I’d been asked by Ayurvedic doctors before. She took my blood pressure, which was 140/100, the highest it had been since Bombay, but I had also been cutting my dose of blood pressure medicine as the side effects, which included dizziness, edema, and nausea, were becoming too much to bear. I asked her if she could prescribe me a new blood pressure medication that didn’t have side effects, but she said she wanted me to go to the PK treatment center first so the doctor there could determine the course of treatment. She assured me that if the doctor at the PK center was not available, she would help me with getting new medication that afternoon, so, with her referral slip in hand, I made my way to the center close to my hotel.

Upon arriving at the center, I was given a sheet of paper with the room types listed along with prices. I had to get out my calculator when I first saw the prices to make sure that the hot walk hadn’t given me any temporary brain damage when I was doing the conversion from rupees to USD, but I my initial calculations were correct: the price including treatment and medication was much higher than I’d expected, even for the more basic rooms with A/C.

After studying the list of rooms, I told the young man behind the desk that I wanted the most basic room with A/C, and he seemed taken aback. He told me there were other options that were much more “deluxe” and included amenities like attached kitchenettes, cable television, and so on. He got on the phone and spoke to someone in what I assume was Malayalam and then hung up to tell me that my choice was not available and that the only room left was due to a cancellation, and that was the more expensive room that included what I considered a bunch of unnecessary luxuries.

He then said that I needed to choose the length of my course of treatment, which went anywhere from 7-28 days. “How do I know how long the treatment needs to be without seeing a doctor?” I asked. He seemed annoyed by the question, and assured me I would see a doctor, but then also told me that he would need full payment the next morning before I was admitted, and that was when I would see the doctor. “Ma’am, the boy will take you to see the room so you can tell us if it’s acceptable.” Okay, whatever, I wasn’t in the mood for his circular logic, and I planned to go back to the outpatient doctor to see if I could get my blood pressure medicine changed, which was at that point my primary concern, especially after the high reading from that morning.

I’d named the pushy sales guy behind the desk “Rick” because it rhymed with a word that I thought described him well. Rick then called over a man to take me to see the room, but before I had gathered my things, he was outside, and by the time I reached the courtyard outside, he had disappeared. I waited for a couple of minutes while the guards, who spoke no English, tried to fathom what I wanted when I asked them where I was supposed to go to see the room. Finally my guide stuck his head back around the courtyard gate and motioned impatiently for me to follow him.

It was a typical hot day in India, and my heart was beating a little too fast for my comfort as I walked up the inclined sidewalk behind my guide who was not slowing down or even checking to see if he’d lost me again. I was trying to focus on my breathing instead of my thoughts so that I would stay calm, but I was getting pissed by that time. We made it to the building where a couple other people were waiting, but the elevator was broken so we had to walk up three flights of stairs to the room. The young man who’d taken over as our tour guide in the lobby opened a door to show us the $35/night room, and right away I muttered, “you have got to be kidding,” as he kept asking us “room ok? Room good, yes?”

No, room not good, room kind of shitty, dirty, and dark, I thought to myself. There was a short, narrow bed with dingy sheets, and the floor didn’t seem clean. The place smelled of Ayurvedic medicines, and the attached kitchenette was nothing more than a sink with a counter. The bathroom was tiled but beyond that nothing nicer than your typical Indian bathroom with a Western toilet and a shower head coming out of the wall. There was a partial view of some greenery in the back yard, but it was nothing like the photographs I had seen of the lovely manicured gardens with pools of water reflecting the surrounding plants.

He seemed to need immediate validation that the room was acceptable, so I finally said, a little sharply, “No, the room really isn’t okay, and I need to see a doctor before I can make a decision.” He didn’t seem to understand what I was saying, so I repeated more loudly, “I want to see a DOCTOR NOW!” At last, he got the message, and he showed me out of the room and downstairs to the doctor’s office.

To the credit of the hospital, both the doctors I saw were very nice, but even this doctor didn’t seem interested in asking me any questions, looking at my tongue, feeling my pulse, or performing any of the standard intake procedures you think of when you see a vaidya, or Ayurvedic physician. She did take my blood pressure again, which was back to normal, even after I’d thrown my little hissy fit a few minutes before.

I explained to her that I needed to understand what length of time I would need the treatment before I could secure the room and pay the hefty price tag for that length of treatment time. She nodded, said she understood, and after hearing my basic complaints (hypertension, recurring insomnia, dry skin, rosacea), she told me that 21 days would be ideal but that 14 would suffice, depending on time and financial constraints on my side. I said that time was not the issue, but that the price for the room and the medicines daily was pretty high considering what I’d been shown a couple of minutes before. She conceded that the pricing was expensive, but she told me I could do the first part of the treatment as an out-patient and then complete the next two weeks in the facility. She also kindly recommended that I keep checking back every morning to see if one of the room types had had a cancellation.

I thanked her and made my way back to the administration office to see my friend, Rick.

Once back, I let him know that I’d seen the doctor and she had recommended 21 days of treatment, so that was the length of time I needed. I told him that as I didn’t need A/C (and having it during PK is not recommended by some practitioners as it cools the body too much), I would be happy to take one of the smaller, more affordable rooms without A/C. He immediately told me that there were no other rooms available, even the basic hospital rooms that had “NON-RESERVABLE” printed next to their description on the sheet of paper. I asked when the next availability was for a room, as I could come back in a month if necessary, to which he impatiently responded that “all rooms were booked one year in advance,” which I found hard to believe. I asked if I could check back daily for to see if there had been a cancellation for a cheaper A/C room, and, after thinking about it for a second, he assured me that was an option but only after I had been admitted and paid in full for the expensive room for 21 days. I would be willing to bet that, had I checked in, there would never have been a cancellation.

“Okay,” I finally said, “I will take the room, but I want to check in tomorrow morning because I already have my hotel room for the night.” Suddenly, Rick was my new best friend. Smiling, he told me that I could come at 8 a.m. for immediate check-in. “And how much is the food?” I asked, as their kitchen supplied all the detox meals during treatment. He had no idea. Really? Was it his first day or something? That seemed like a pretty basic piece of information.

Putting on a smile, I told him I’d see him first thing in the morning, and then I made my way back to my hotel, ready to move onto Plan B even thought I didn’t know what that was yet.

Once back, I messaged a doctor of Ayurveda in nearby Thalassery with whom I’d become acquainted through an Ayurveda Facebook group to see if her clinic offered PK treatment. She responded to tell me that only about 5% of patients even needed the somewhat drastic PK treatment, but that the industry was making so much money here in India (and abroad) that no one was telling the truth. When I told her about my experience that morning at the hospital, she said, “No, they will not treat you, they will cheat you.” For the first time that day, I felt like someone was being straight with me.

She said all that I probably needed was dietary modification, herbs, and a simple treatment to get my blood pressure under control, so I asked if her partner, whose specialty included hypertension treatment, could see me. While I’m agnostic on the idea of fate or divine intervention, I do believe that we see opportunities clearly at the right time, so after she confirmed an appointment for a couple of days later, I set out to buy my train ticket.

I cannot call this post a review of the esteemed hospital, and for all I know, they may have had very good treatments and medicines. However, the feeling I got while I was there was that I was being hustled and misled. Ayurveda is big business here in India and abroad, and it’s difficult if not impossible to find providers who will be honest with you or who know what they are doing. My experience with the sales and intake department at AYS in Kottakal, unfortunately, did not leave me with a good feeling about what they could offer as far as healing. Ayurveda is supposed to be a spiritual practice, but what I encountered felt like I was dealing with an insurance company in the states: they didn’t care so much about my health as they did about getting my money.

But let the journey continue.

Note: during my wanderings I carry a blood pressure cuff so that I can monitor my status a couple of times a day. I also keep my blood pressure pills in my purse, and I always make sure I am near a hospital in case I need emergency treatment.

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Tue
19 ^th

In Praise of the Indian Toilet

Posted by Joel Gales - 2 Comments

An Indian floor toilet at Bhakti Kutir resort in Palolem, Goa.

On the evening of my final night in India last year, my friends asked me what I was going to miss most about their country. “The food,” was my immediate answer. And the people, of course, especially them. “But I am going to miss the arse wash a lot, too.”

For those of you not familiar with the typical toilet scene in India, let me break it down for you:

In establishments that cater to a Western (or Westernized) clientele, there is the typical Western toilet that you see in countries like the U.S. along with a roll of toilet paper and a small spray hose (the device for washing the “arse,” or ass). When you see businesses advertising “Western-style toilets,” that’s what they are talking about. In more modest businesses serving a primarily Indian customer base or in public places, like trains, rarely will you see a Western toilet, and there will be instead an opening in the floor, typically with a treaded foothold on each side. There may or may not be toilet paper or a wash hose, but there will always be a water source along with a small spouted container, which you use to pour water over yourself until, aided by your hand, you are clean.

While I don’t really like the bucket-only scene, I still appreciate the use of water to clean down there. Not only does it cut down on the amount of toilet paper you use, but it gets your junk cleaner than paper alone, especially after passing solid waste. I have heard people decry the Indian toilet as being primitive, but once you have used water to get clean, it’s difficult and a little disgusting to go back to using only toilet paper. Westerners might be shocked at the use of water only—not to mention touching our naughties—but imagine how dirty to the Indian mind our method seems.

I know folks back in the San Francisco Bay Area who throw the toilet paper in the trash instead of flushing it; they do this not because they have old pipes, but because it is better for the environment to keep it out of the water system.

cartoon drawing of Spiderman squatting over a traditional Indian toilet — Spiderman, a natural yogi, having no issues with the Indian-style floor toilet.

But wait, you say, what about the extra water we will be using to wash our bums? Good question, but according to this article in Scientific American, the water used to produce toilet paper is so much greater than the relatively small extra amount we would use to clean ourselves that there’s no comparison.

If you just clicked that link above, you saw the article was praising bidets, which are typically the height of a Western toilet. But is the raised toilet really an improvement over the floor toilet? I know a couple other folks who use a device intended to lift up the feet when using the toilet in order to aid in bowel movements. We, as a species, are meant to squat when we move our bowels. The Western-style toilet precludes this pose as it puts us in a position halfway between squatting and standing, where, subconsciously, our bodies aren’t sure what to do. Ever tried taking a poop standing up? Me, neither, but I bet it would be damn hard because our anatomy is not designed to expel solid waste while we are standing (tigers chasing us might dispel that inhibition).

Of course, the floor toilet is not accessible to everyone, like people who are unable to squat, so this post is not directed toward the whole of our population. However, for most of us, with a little practice the position can become familiar enough to seem natural. Keep in mind the following when you are faced with using a floor toilet:

Larger end of the opening is under your spine; face forward toward the smaller opening.
Wash yourself clean with water and then, if you must, use a tiny bit of toilet paper to blot dry. Throw the paper in the trash can.
Get in the practice of using the non-dominant hand to do the cleaning lest there is no soap and you’re about to go back to your lovely thali in the off-the-beaten track restaurant you just discovered.
If you are on a train, hang on to something while you are squatting. You don’t want to go rolling across the bathroom floor if the car pitches suddenly.

Sorry for all the shit talk, but in Ayurvedic and yogic philosophy, taking a daily dump or two is of primary importance. In this case, what is good for the body is also good for our earth. As the scientists who study this shit will tell you, using a little water will save a lot, and don’t forget all the trees we won’t have to chop down to make the t.p. If you are still in doubt about the cleanliness aspect, common sense will tell you that using water to clean down there is more hygienic than using dry toilet paper; if you don’t believe me, I have only one thing to say to you: dingleberries. So before you call the floor toilet and arse wash “primitive,” think about how each is better for our bodies as well as the environment, and perhaps you will see the traditional Indian toilet in a different light.

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10 ^th

What To Do if You Get Sick

Posted by Joel Gales - Comments Off

The first time I went to India, I was lucky enough not to get sick, even though everyone told me I would. This time I was not so lucky, but lucky for you, I now have a lot of good tips for taking care of your health once you arrive.

First, you should have travel insurance. I followed the suggestion of some of my favorite travel bloggers to purchase insurance from World Nomads, which cost me about $350 USD for six months of travel coverage. I was mostly worried about medical insurance in case of catastrophe, but the policy also covers the cost of trip cancellation or even lost gear. When I needed a doctor a couple of weeks ago, I called the help line and was connected almost immediately to a friendly representative. She didn’t have any suggestions for clinics in my area, but told me I could walk into any one and just bill them later for the out-of-pocket charge.

I was looking for a clinic because I just had learned I had high blood pressure during my second visit to the R.A. Podar Ayurvedic College a few days before when I went to get herbs for insomnia. The student doctor at the College advised me to have my blood pressure checked every day, but that seemed like it would be inconvenient and expensive, so I set out to go buy a blood pressure machine.

Don’t be misled when you Google something like “blood pressure monitor Mumbai,” and you are shown a business name and exact address. In all likelihood, when you show up at the address, it will not be the store shown on the map (in this case Omron), but will be a line of stores for one or more blocks that carry the same brand name of supplies. I was completely confused when I could not find the store “Omron,” and everyone kept telling me, “yes,” whenever I asked where it was. That’s because each place I asked was a mini-Omron (and other medical brands) dealer, although there was no official store. (The same phenomenon will occur if you try to find the Asia Paint store down by Lamington Road…)

I began to record my blood pressure and, sadly, it was high every time, so I sought out a clinic for allopathic care. While I am a believer in the powers of Ayurvedic herbs, for critical situations I always seek the care of allopathic physicians. The two systems of practice are complementary, as any honest vaidya will tell you; if you are having a heart attack, go to the hospital first and then seek the care of an Ayurvedic doctor for herbs, cleansing, and dietary advice after you have recovered.

On the advice of a friend, I wound up at Healthspring in the Breach Candy/Kemp’s Corner area of South Mumbai, and I was happy with the care I received there. The doctor was concerned for my blood pressure, so he put me on medication right away and told me to come back in a week. I didn’t have an appointment either time I went in, but was seen nonetheless in under twenty minutes. The total cost of my visit was 600 rs (about $9.50 USD), and the cost of the medications only about 200 rs.

After you see a doctor, he or she will write you a prescription that you can have filled at any pharmacy (or “chemist” as they are called here). They don’t take the paper the prescription is written on, so hang onto it in case you need a refill. Last year, I was able to get refills on all my prescriptions from the U.S. simply by showing the doctor my prescription bottles, but in all likelihood he would have just written the prescription based on what I told him.

Bombay Belly

Warning: shit talk about to start. Before my follow-up visit with the blood pressure doc, I lost my damn fool mind and had a dosa from a street vendor, which probably would have been ok had I not dipped it heartily into the accompanying raw coconut chutney. This stand was right across the street from my pad in Breach Candy, and I had eaten from there with no consequences numerous times during my last visit. Not heeding the advice of my friends, I grabbed a dosa masala late one Thursday afternoon, and then felt the effects for the next 60 hours as I visited the bathroom more times than I wish to remember. Thank god for the arse hose is all I have to say. I guess that’s why it was invented here.

dosa street vendor in Breach Candy, Mumbai, India — Oh, dosa man, why hath thou foresaken me?

I knew that I had more than a case of simple traveler’s diarrhea because I had cramps and the symptoms endured long past my last dose of hot chili sauce. Luckily I was not also throwing up as the dehydration would have been more severe, but I knew enough to start drinking water with electrolytes immediately. Here that product is called Electral, and it comes pre-made in small juice boxes or you can buy the more economical sashes (aka packets) that you add to a liter of water. While there is no Pepto-Bismol (Bismuth subsalicylate) product here, there is the equivalent of Tums, which is called Digene, and there is also Imodium, but I don’t recommend stopping up the pipes unless you are so dehydrated you are in danger, in which case, get yourself to the hospital.

In the medical kit I’d packed, I also had a broad spectrum antibiotic that my doctor in the U.S. had prescribed for traveler’s diarrhea, although my doctor here told me it was not the best choice for my condition. Regardless, something worked, because things started to get markedly better within twelve hours after popping my first pill. I now have a new prescription in my kit in case something happens again, but NO MORE STREET FOOD, especially not uncooked, and especially not after monsoon when the water supply is super dirty.

It’s Always a Summer Cold in Bombay

During my last visit with my daughter before taking off, I introduced her to the joys of using a neti pot. She loved it so much that I gave it to her because I knew, just knew, I could get another one easily in India. Wrong. As a matter of fact, not one person in the four chemist stores I visited knew what one was. The closest thing I could find was a plastic salt water solution that you shoot up your nose with no indication of how it will come out. And not cheap, either —300 rs. No thanks, I can get, like, six street dosa for that!

shop attendant hand mixes herbs at Kapiva Ayurvda in Breach Candy — The shop attendant conveniently mixed the three powdered herbs for me

On my miserable walk up to the grocery store and chemist, I found a neighborhood Kapiva Ayurveda herb store open,so I popped in to see if they had any neti pots. They did not, but the young man minding the counter called the doctor to find out what herbs I could take to help me. He gathered up four: sitopaladi churna, prawal pisti, giloy satwa, and laxmi vilas ras (nardia). The first three were powders, which he gracefully mixed together to form one that I was to make into a paste with honey to ingest after each meal; the laxmi vilas ras was in tablet form, and I was to take two after eating along with the herb honey paste. However, after doing some research on the web after I got home, I learned that the laxmi vilas ras had small amounts of strychnine in it and should be used only under a doctor’s close supervision, so I opted not to take that.

I have no idea about the reputation of these herbs, but the shopkeep assured me that they were made of the finest organic ingredients, and they seemed professionally packaged. I declined the more expensive herb with gold in it—sorry, but I’m dubious of the alchemical properties of gold in herbs—which brought the price down by a third. The total for all four herbs came to about $670 rs ($10.50 USD), including the jar of organic honey I bought. Not bad considering the cost for the same in the US would have been over $50 from my usual organic herb dealer. Now let’s just see if it works.

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General Health