Praise the Stoic

The Human Immunodeficiency Virus (HIV) and Novel Coronavirus are entirely different creatures. One is a retrovirus hiding patiently in nooks for the right opportunity to proliferate and then slowly eat life away. It can take years or even decades before its final conquest. It never leaves once it enters. The other, Covid-19, comes and goes with speed as an unwelcome house guest with a battering ram aimed at the lungs. It is often impotent and unnoticed in the few weeks that it infects a human body. Every single HIV patient used to live a death sentence in the virus’ beginning. As a percentage risk for each individual, Covid-19 is nothing to worry over. Anyone who gets it doesn’t really have to be afraid unless he or she is very old, severely unwell or extremely unlucky, and even then the odds are in their favour. But because of the large numbers it infects, for the world at large, it is a catastrophe. Their differences notwithstanding, HIV and Covid-19 have something in common. It didn’t matter where they began or which communities or countries were brought to their knees first, eventually India ended up being their centre of attention. Just this week, India saw itself get into pole position as the country with the largest number of daily Covid cases and with every passing day, it widens the gulf with the runners-up. With HIV, India only trails a couple of African countries and has more than two million cases at present.

These are not anomalies. Through the history of disease, India has borne the brunt of epidemics and that includes both viral and bacterial ones. There have been seven global epidemics of cholera and the first was from here in 1817. A paper written in 1819 by Dr William Stuart Anderson described it: ‘The epidemic is said to have originated in Bengal. We find it raging in the camp of the Grand Army under the Marquis of Hastings, in November 1817, and it has since spread to the south and to the west, apparently unaffected by the vicissitudes of climate, and but little influenced by the nature of the country, making a gradual and pretty regular progress, and visiting camps, cities, and villages, excepting only the hill-forts; its continuance in each place being generally limited from fifteen days to six weeks; seldom returning, and then in a milder form, and with less frequent occurrence. Its progress has been remarked to be at the rate of fifteen or twenty miles a day…In many places its appearance and disappearance have been very sudden, bursting forth like an explosion of combustibles, and, as if the pabulum were all consumed, being extinguished in a similar manner.’

Towards the end of the 19th century, the third plague pandemic hit the world. It began in China but India saw the overwhelming number of fatalities. A World Health Organization document said: ‘The third pandemic began in Canton and Hong Kong in 1894 and spread rapidly throughout the world, by rats aboard the swifter steamships that replaced slow-moving sailing vessels in merchant fleets. Within 10 years (1894-1903), plague entered 77 ports on five continents. Plague became widespread in a number of countries. In India, there were over 6 million deaths from 1898 to 1908.’ In 1918, the Spanish Flu would kill 18 million Indians, the maximum of any country in the worst pandemic of history. Even right up to the moment the smallpox virus was eradicated, India would see an epidemic in 1974 that killed 15,000 over a couple of months.

All told, people here have succumbed in greater numbers than probably any other country in the world. The reasons shouldn’t be hard to deduce. One is population and, in particular, density. The plague referred above was called the Bombay Plague and the 1918 flu too entered India through Bombay, a crowded city without hygiene, and the first port of call for migrant labour. Another reason is abject poverty, which meant bodies without nutrition and weakened immune systems. Plus the absence of any meaningful healthcare infrastructure right up to the present.

Covid-19 is a good example of the only manner in which India has been able to meet epidemics—take it on the chest and hope. The total lockdown of the beginning was merely a forced pause and earlier exclamations of a successful Indian blueprint has now been torn to shreds. The country has reverted to its historical mean. Already, there are more than 60,000 cases a day and it might soon touch 100,000. Like 1918, if there is a mutation in the virus to make it lethal in a second wave, the story might play out as it did a hundred years ago despite all the economic and social advances. But if India has been able to do not much more than wait diseases out—from rabies to tuberculosis, each one seems to have the longest shelf life here—the same factors that make such a culture suffer also make it able to get through them. Eighteen million might have perished in 1918 and 1919 but it is as if there was no scarring left behind. Almost as soon as a calamity is over, India resumes its ordinary pace because inbuilt into its gene is fatalism and stoicism honed over millennia.

The oncologist-cum-writer Siddhartha Mukherjee wrote an incisive essay in The New Yorker at the beginning of Covid-19 looking at the connection between viral load, or the amount of virus exposed that led to an infection, and its subsequent severity. Titled ‘How Does Coronavirus Spread Inside a Patient’, he began by recounting a visit to Kolkata in February this year to the temple of Shitala, a goddess whose USP is to protect against smallpox. He wrote: ‘The temple was two hundred and fifty years old, the attendant informed me. That would date it to around the time when accounts first appeared of a mysterious sect of Brahmans wandering up and down the Gangetic plain to popularize the practice of tika, an early effort at inoculation. This involved taking matter from a smallpox patient’s pustule—a snake pit of live virus—and applying it to the pricked skin of an uninfected person, then covering the spot with a linen rag.’

These Brahmins became adepts at this technique that had come to them from a circuitous route that began with China and then Arabia. Mukherjee’s use of their example was only to make a point on inoculation and viral loads, and so he does not dwell at length over them. But consider this question. What difference can one imagine between the practice of the Chinese and Arabs and these Brahmins? The answer will lead to who they would be willing to cure. Three centuries ago, is it possible to imagine these Brahmins, sole experts of potential life-saving medical treatment, touch anyone considered an untouchable? Or even treat the Shudras, who are part of the four-fold caste system but relegated to menial status? The two caste groups of Dalits and Shudras would make up more than two-thirds of the population and they would all have little hope of the treatment because those who knew were bound by clear rules on who they could physically and socially engage with. Dr BR Ambedkar, the first to make a political force of Dalits, asked what progress or strength could a society hope to achieve if most of the population’s intellectual output were deliberately kept away. He laid the pitiable condition of India through its history directly at the doorstep of caste discrimination and, by extension, religion.

Extrapolate that to India’s abject state of healthcare and sanitation, and there is no surprise that diseases and epidemics find such a welcome home in India.

But even those as exploited and trampled upon as the Indian lower castes found an avenue to meet adversities. If there was no medicine, there was the potential for salvation in the afterlife. Or a munificence of gods for succour, because one of the elements of Indian civilisation, perhaps because it was so bereft of real relief, has been to offer as many gods to cater to as many sufferings there are. Mukherjee’s essay mentions the goddess Shitala in Kolkata. But she is present everywhere in north India. There is a temple for Shitala in Mahim, Mumbai, at the other end of the peninsula. Not everyone used to be allowed inside those temples, but the right to ask her for help when the disease struck was everyone’s right. South India had its own versions of such a goddess. In Kerala, when a goddess began to be beseeched for help during a smallpox outbreak, a market sprung up and it was not too long back. An article in The Hindu said: ‘This over 100-year-old market has its origin in a smallpox epidemic that flared up in the outskirts of Kochi city, towards Cherthala. In those times, when medical advances were few, the virus was unknown and virulent. The worst affected were the malnourished and underprivileged farm hands, as well as artisans from socially disadvantaged communities. With a mounting number of deaths and no cure in sight, the people took to praying to the Goddess at the Azhakiyakavu temple that’s believed to be nearly 800 years old…The families of the sick began coming in hordes to worship the goddess, camping around the temple for weeks. Slowly a small market sprung up that sold essentials as well products—terracotta ware, coir and palm leaf items—made by the commune that assembled. Today’s Pulavanibham market, a colourful bazaar of indigenous handmade items, is a result of that epidemic a century ago.’

Another disease for which a goddess was born was cholera. The Indian Express, in an article on gods and diseases, referred to a book Colonising the Body: State Medicine and Epidemic Diseases in Nineteenth Century India, in which its author David Arnold described the cholera deity. The article said: ‘Consequently, the ritualisation of Cholera is believed to have started after the pandemic of 1817. “Only in deltaic Bengal, is there known to have been worship of a specific Cholera deity, called Ola Bibi by Muslims, and Olai-Chandi by Hindus,” writes Arnold. He adds that “before 1817 the Goddess enjoyed far less popular devotion than Sitala, but she was thereafter extensively propitiated during the season when cholera was most prevalent.” Reports by European missionaries mentioned in Arnold’s book suggests that reverence for the Goddess often manifested itself in young girls dressing up as Ola Bibi/Chandi to receive her worship. Apart from Bengal, she is also worshipped in Rajasthan as the deity who saves her devotees from cholera, jaundice, diarrhea, and other stomach related diseases. Few other deities invoked by the fear of diseases include Ghentu-debata, the God of skin diseases, and Raktabati, the Goddess of blood infections.’

Even in the rest of the world, people would go to pray in a church or mosque when a disease was in the air. But you would be hard put to find new gods coming up specific to a disease anywhere else. Even now, like Corona Devi in Kollam, Kerala. A man built a shrine for her and the idol looked like the virus with spikes. It might be a gimmick but there have been reports from across the country of new rites and chants to ward off the coronavirus.

Caste, in all its reprehensibility, also, however, had a historical role in how diseases were met. In the absence of governments providing healthcare, the only rudimentary assistance was the caste group. For instance, in the 1918 flu pandemic, when the British were bogged down by the war and threw up their hands in India. The book Pale Rider about that pandemic says: ‘Though more people were dying in cities than in rural areas, therefore, it was only in cities that help was to be had. Villages and remote communities were left, for the most part, to fend for themselves. The government appealed for help, and it duly came—mostly from organisations with close links to the independence movement. Many of them were active in social reform, meaning they were well placed to mobilise dozens of local caste and community organisations. They raised funds and organised relief centres and the distribution of medicines, milk and blankets.’

Caste, by design to keep itself going, ingrains fatalism. If a life of inferiority was ordained by birth, then everything, even disease and death, was just the natural order. The only way to accept the iniquity of caste, if one were at its lower ends which is most of the population, is to believe in rebirth to set the scales right. Once that is drilled into the psyche, then disease is also a route in that direction. Prayers to disease gods might rarely be answered but it still doesn’t test faith. In a better world it shouldn’t be needed, but the stoic strength of Indians is often the only arsenal in their armoury.

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