In the Bonesetter's Waiting Room (16 page)

We drove on, past the rush of auto-rickshaws and vendors carrying imitation gold jewellery, sunglasses and plastic watches, sparkling sandals, pearls and brocaded bags. As we made pit stops to enjoy Hyderabad's famous street foods and its sights and sounds, I noticed that in this predominantly Islamic area of the city there were a few Unani pharmacies dotted around but no Ayurvedic shops. Though healthcare choices do not necessarily follow religious or philosophical lines, it was a phenomenon I had noticed in other parts of India too – the physical and spiritual are not easily separated.

Less than two kilometres from Char Minar and still in the old sector of the city, our car finally stopped outside an unremarkable row of shops. There, on a wall next to a furniture seller whose sofas spilled out onto the pavements, was the hand-drawn work of a traditional sign maker. Next to a drawing of a giant bottle of
lep
(herbal pain balm), there sported a cartoon image of a leg, fully bandaged from the knee down, and an arm, similarly bound from the elbow and encompassing all five digits. The sign outside the lock-up next door read
Hakim Gulam Rasool's R. Bone Setting and Neuro Clinic
in English, Telugu and Urdu, and below that, the names of the three practitioners there, ‘Dr Hakeem Gulam Mohideen BUMS.
ortho – neuro and general Unani physician
; Hakeem Gulam Rasool (Babu Bhai) –
world renowned bone specialist
; and Hakeem Gulam Mustafa DPT (
Bone specialist
):
Spl. in: fracture and dislocation, spondylitis, slip disc, rheumatism, arthritis, bone growth, frozen shoulders, etc.
'

We salaamed, and before we entered left our footwear on the pavement outside – Ramal's sturdy sneakers previously covered by the hem of her abaya and the flimsy sandals I was wearing because it was forty-one degrees centigrade that day. The room, around four metres by two, with one side entirely open to the street, was lined with glass cabinets containing creams, splints made of wood and cardboard and stacks of soft, white cotton bandages. Hakim Gulam Mustafa sat cross-legged in front of us, looking a little bored. The clinic was empty but for his teenage sons, until the elder hakim, his brother Gulam Mohideen, came in to join us. He sat in one corner, beneath a wall covered in framed photographs of former patients and notable visitors to their practice. I found myself staring at two photographs in particular – both of young boys, perhaps around ten, with fractures so severe that their limbs had bent entirely out of place.

‘That boy came in immediately after he got hurt,' Mohideen said, following my eyeline. ‘The public know to come here immediately.' I looked at the ‘after' photo of the boy's arm: well healed and back where it should have been.

Gulam Mohideen was the bone setter listed on the signboard with the letters BUMS (Bachelor in Unani Medicine and Surgery) after his name and was junior only to his father, Hakim Gulam Rasool. Aged forty-five and having worked in the family clinic since he was a young teen, Mohideen now ran a series of bone-setting practices around Hyderabad. Called Luqman Clinics after an Ethiopian former slave said in the Koran to have been given a gift of healing wisdom by God, the room we sat in was the oldest treatment centre. The newest (and largest) was to be a hospital on the other side of town, a modern, custom-built structure with an outpatient department as well as beds to accommodate inpatients. The other clinics had better provision for using modern anaesthetics, in which Mohideen had taken a postgraduate course. ‘I am the only bone setter with a Unani and a higher medical qualification in Hyderabad,' he told me. ‘I wanted to integrate anaesthetic injections to reduce severe pain.' Mohideen told me how in his father's heyday, until the 1970s, bone setters had the opportunity to apply to become Registered Medical Practitioners, or RMPs. In the days before AYUSH existed as an official denomination, this meant that doctors unqualified in Western medicine could receive legal sanction to practise within their systems, although they were not university-educated. ‘But many people didn't know how or didn't bother, because, like my father, they had already been practising independently and developing bone-setting techniques for many years,' he said.

For Hakim Mohideen's family, many years actually meant nine generations. His father's ancestors had come from Delhi as royal physicians in the entourage of the Mogul emperor Aurangzeb, who, in 1687, besieged and destroyed Golconda, the fort about seven miles from Hyderabad, then thought to be one of the most impregnable in south Asia. That particular siege lasted eight months in a period of Indian history in which wars were a regular occurrence, with various battles fought between the Mughals, Persian, Indian, British and other rivals over the years. Battles – on the backs of horses, elephants, or on foot – meant injuries to soldiers, injuries that needed skilled doctors, working under the patronage of their rulers.

The financial security and freedom the trusted hakims were given allowed innovations in treatment to continue in the Gulam family under the reign of the first Nizam, who took over from 1724 when Mughal rule collapsed. The family knowledge of bone manipulation and bandaging as well as plants, potions and pain relief had been passed from father to son in a continuous line. In the small clinic in which we sat, as well as from the medical supplies in the glass cabinets, there were two large bowls of
lep
(herbal balm) placed on the floor, which were also part of that tradition. One was white, the other yellow. I knew not to ask what was in them – they are often closely guarded family secrets, made with ingredients that vary between practitioners. Hakim Mustafa described the basics to me anyway. ‘The formulation of these
leps
are from generations back. The white
lep
is for massage; the yellow is good for pain. Its base ingredients are beeswax and oils, but for different problems, we will make different formulations.'

‘All home-made. We don't market them so there's no certification,' Hakim Mohideen added. To his mind, as a BUMS-certified physician, bone setting was not an ‘alternative' practice but one that fell under the remit of Unani, regulated by the Department of AYUSH. Hakim Mustafa described to me some of their other treatments, including 200 types of tablets, some with calcium, for example, to support bone healing; others, he said, would make the bone soft. ‘People come here with every orthopaedic problem – fractures, also rickets, osteoarthritis, cervical [neck] problems … We open between eleven in the morning and nine at night, but if any patient needs me for bone fractures or dislocations after that, we attend emergencies also.'

The small room in which we sat was where everything happened, but at three o'clock, in the lull during the hottest part of the afternoon, it was empty. I couldn't imagine the small space bulging with the sixty to seventy patients I was told attended daily. ‘There were less people coming in my father's days,' Hakim Mohideen said. ‘The population is higher now. Everyone comes, now only maybe ten per cent speak Urdu [indicating an Islamic tradition]. We set the bone in seconds, but generally we spend fifteen to twenty minutes with each patient. It's not just the treatment that takes time. When someone breaks a bone, there is an imbalance of heat. Their lifestyle needs to be adjusted, they must have dietary restrictions.' Hakim Mustafa spoke more about the
akhlat
– Unani humours – applying Unani theory to conditions relating to the bone. ‘People with more bile also have more heat – they are given a different diet – but only until they get well.' I thought back to the carrots, radishes and onions that formed the ingredients of the tablets found on the ancient Greek shipwreck. For Unani, just as for Hippocratic doctors, medicine starts with what we eat and is intimately linked with diet.

‘There are more people in Hyderabad now than in your father's day,' I commented, ‘but don't more people today go to Western medical clinics now?'

‘For surgery they go to MBBS doctor. For every other fracture they come here,' Hakim Mohideen said. ‘If they are poor people, they obviously come here. Even rich people come here if their MBBS treatment wasn't done properly. Bone setting uses movement during therapy, while allopathic treatment means patients need to also go for physiotherapy afterwards.' In such a system, the extra appointments required after the bone is set translated into extra expense that would have to come out of the pocket of patients – as do eighty per cent of healthcare costs in India. Add to that time spent out of paid work while immobilised in a cast and the costs of travelling to and from the hospital, and the prospect of going to an orthopaedic surgeon in the first place would simply not be a viable one for many patients.

‘And what do allopathic doctors think of your medicine?' I asked.

‘Doctors know us, they say if it's the Rasool family they don't mind. There are no other families here that have as much experience as us,' Hakim Mohideen told me. ‘Without an X-ray, just by touching we can say whether it's a break or a fracture. But if we see that someone needs it, we will refer them to have surgery. For example, we do not treat injuries to the femur, because we simply cannot feel it well enough, because of its deep position in the leg. We will tell the patient, go to the diagnostic clinic, take an X-ray.

‘There are people who set up as bone setters who don't know what they are doing. Sometimes we have assistants – people who hold the patient while we are locating the bone. Some assistants look at what we do and think that it looks easy – they leave here and set up their own shop. But they have no experience.'

Just then, the afternoon lull broke and the patients flooded in. Hakim Mustafa, who was looking somewhat bored and disgruntled, burst into life as people arrived. The hakims, I could see, were passionate about their work – the change in the room was palpable as the first in line hobbled in with foot pain. He sat on the floor in front of Mustafa and the hakim methodically probed the foot with his fingers and thumb before pronouncing that a tarsal had been dislocated. Without warning, Hakim Mustafa gently pushed the tarsal as the young man's face tensed in raw agony for just a few seconds. When he relaxed again, seemingly at ease, he placed 200 rupees (about £2) on the floor in front of him as the hakim applied
lep
from one of the giant bowls, bandaged the foot and, with a reel of white thread, expertly sewed the edge of the fabric together.

‘Patients come afterwards once a week for about six weeks,' the hakim said as the small room filled with people. ‘Children heal faster; for them it normally only takes ten to twenty days.'

The next patient the hakim saw had turned up for his sixth appointment – a twenty-two-year-old who had been visiting Luqman Clinic every four days over the previous month. ‘It was a total break of a metacarpal,' the hakim told me as he placed the man's arm on a large wooden block.

‘How did you do it?' I asked.

‘I punched my car window.' He smiled. ‘I was angry.' The hakim asked if he felt better and he said that he did. He was no stranger to the clinic, despite (or perhaps because of) his youth. He worked as a personal trainer and his body-building regime had led to several minor muscular injuries over the years, but he first came to Luqman after jumping out of a window and breaking his wrist. ‘I did go to the doctor for an X-ray,' he told me, ‘but I had been told that these hakims were good, so I came here for treatment instead.'

In a brief gap between patients, my driver, who had been watching keenly from a bench outside the clinic, surprised us by stepping forward to seek the hakim's advice. He told us he'd been in a fight and punched a man, injuring his fist on his opponent's teeth. ‘I did go to an allopathic doctor,' he explained, ‘but he didn't fix it properly.' Hakim Mustafa duly did the requisite checks and treatments as Ramal and I looked on, hoping that his altercation and subsequent injury might have suppressed any residual road rage, at least for the rest of the day.

Even as the hakim finished treating our driver, the queue of patients was building up again and as the afternoon progressed, more and more of those in pain and those recovering sat next to us on the floor, waiting to be seen. A ten-year-old girl who had tripped down the stairs paid fifty rupees for her check-up: her pain had already diminished greatly after her initial treatment. An older man presented an ankle which was still bloody and scabby from a road accident two days previous – his regular doctor could not put a cast on the injury because of the state of the wound, so he sent him to the hakims instead, who applied fresh
lep
as well as an antibiotic powder under new gauze. Two veiled ladies came with a young girl to be treated; and then the hakim splinted and bandaged another woman, clearly in a lot of pain, whose loose chappals (sandals) had caused her to slip on a flight of stairs that morning.

I asked the hakims whether there were many women today practising Unani medicine. ‘Don't women prefer to be seen by a woman?' I asked. The brothers told me that although there may be a preference for women patients, female practitioners were rare, but that when their hospital opens, they intend to train ladies to work there too.

As the sounds of the five p.m. namaaz began to be broadcast from the mosques surrounding us, Ramal and I rose to leave the hakims to their ever-growing crowd. As we did so, a young wrestler with a dislocated bone hobbled in. While Mustafa treated him, I chatted to his mother, who told me that as soon as it happened they came straight to the hakim brothers. ‘If he went to the allopathic clinic,' she said, ‘he would spend forty days in a cast and forty days having physio. I already knew he would be treated better here.' Apart from the prohibitive cost of seeing an orthopaedic surgeon, being immobilised in a cast, of course, meant forty days of lost income – a choice that few people in the old city could afford to make. The young man, who had previous injuries of varying severity, nodded at what his mother was saying. ‘Actually if I went to the doctor, this would certainly have been an operation.'