Regular readers of these posts might be aware that over the last number of years I have been making annual trips to India in order to pursue continuing studies of homeopathy. This year was no exception. I usually travel sometime between November and January. These are the Indian winter months, which, compared to the beastly heat of the summer and the continual rains of the monsoon (they only recognize 3 seasons there), are generally considered to be the best time to alight onto the subcontinent. It is definitely the tourist season. And as such, it is the time of year when the opportunities to attend a conference or some other type of homeopathic venue are most abundant.
It has been only a week since my return, though the ice, snow, cold and power outage of the last few days make my trip already seem like a distant, dreamlike memory. At any rate, as in the past, the trip was timed for a conference convened by my long term teacher, Rajan Sankaran. I had, in addition, arranged for the week following the conference to attend the clinic of a very experienced practitioner who I had met on my previous trip and whose perspective and practice of homeopathy is quite different.
Compared to five years ago when I attended my first conference, the journey to the other side of the world has settled into familiar routine. The non-stop flight from JFK to Mumbai on Air India has taken on the feel of a commuter run with terrible movies and howling infants. The ISKCON hotel with the reasonably priced, generously sized, clean, marble floored rooms, wonderful breakfasts and the attached temple where the chanting and dancing begins at 4:30 am daily and doesn’t stop until late in the evening (ISKCON stands for “International Society of Krishna Consciousness, better known as the ‘Hare Krishnas’) is a familiar world unto itself. And the conference venue of the Sea Princess Hotel where the luxurious ambience, obsequious employs, and lavish lunches still never ceases to grate my essentially ascetic soul.
Over the years, I’ve gotten to know the neighborhood a bit, too. The shops, the shopkeepers, the managers and bellboys and elevator operators at the hotel, even many faces on the street have become familiar. I know the “For You” men’s shop, where I exchange dollars to rupees for the best (black market) rate, and the best place to make a long distance call in relative quiet. It is run by a man I call ‘the accountant’ because one is apt to find him sitting in front of his booths almost any time of the day, making calculations with his calculator.
There is my favorite local restaurant, the ‘Vaishili’. I have found that one can tell almost immediately on entering a restaurant what class (caste?) of people a it serves. The ambience, cleanliness, the number and attire of the waiters (waitresses are rare to non-existent), the prices and, most of all, the look of the patrons are all instant indicators. The Vaishili rates somewhere in the middle: neither low brow nor posh, adequately clean so as to not raise concerns about sanitary conditions, it serves the South Indian food which is my favorite cuisine – idlis, dosas, and thalis – all modestly priced and served by waiters in ill fitting pink uniforms.
Then there is Mr. Pal, the ‘fixer’, who is my go to guy for jewelry. He works out of a little hovel near the beach and what once was the Holiday Inn, next to a series of money exchanges. Without an introduction, one would never know where to find him – or even to look for him at all. His ‘shop’ is a tiny (think bathroom size) airless cubbyhole that can hold no more than 3 or 4 people.
Mr. Pal doesn’t have normal hours, either. One just shows up and if he is not around, leaves a message. Sometimes someone will place a call on their mobile and he’ll appear on his scooter in a few minutes, or sometimes he’ll drive up to you on the street when you least expect it. He is invariably cheerful, but not ingratiating and can almost always greet foreigners with a few sentences of their native tongue.
His shop has no displays, just a simple table. His goods are stored in a seemingly bottomless trunk that he begins to unload when there are customers - boxes and bags of gemstones, rings, necklaces, bracelets and sundry other objects. Most Indian jewelry sold in the shops is not very attractive, tending to be oversized, ostentatious and gaudy. Pal’s merchandise is apt to be smaller, simpler and just more tasteful. The prices are reasonable - with an operation like that there can’t be much overhead, and there is even a little room for haggling. I never leave without at least a few presents that are sure to be appreciated back home.
The conference attendees, too, are for the most part returnees from years past. We greet each other like old friends or those relatives that one sees only at that one special yearly occasion. The largest contingents are the Germans, Belgians, and Americans. There are a number of French, Brits, Irish, Israelis, Aussies, and Canadians, too – with a Japanese, Mexican and Russian thrown in to spice it up. Of course, there are the Indian homeopathic colleagues and students of Dr. Sankaran always in attendance and the same film crew of a dozen or so people (who as far as I can tell are sitting idly for nearly the entire day).
Even the smell, that fetid damp odor that permeates everything that so struck me on my first trip and has welcomed me the moment I step out of the plane each time thereafter has come to seem almost ordinary…
Of course, in the end, my visit this year turned out not to be so routine at all. On the morning of November 26th, Thanksgiving morning, I went down quite early to check my email and was surprised to find a number of alarmed messages from family and friends asking if I was ok. At that point, I had no idea that at 11 pm the previous night the terrorist attack was launched on the other end of Mumbai.
It also turned out that the attacks, although causing momentary panic and uncertainty, didn’t disrupt our activities. Mumbai is an enormous place – 22 million people, and we were hours away from the tourist landmarks that had been hit. Once the truth was separated from the rumors and the scope of the event was clarified, aside from the increased presence of security at hotels and the airport there was, in fact, little direct impact on us at all.
It is amazing and a shame that 10 intent young men can hold a huge city a hostage of havoc, suffering and panic. But that is another story…
PART II
The repository of homeopathic knowledge in India is remarkable - and deep. There are over 100,000 homeopaths there, and they are recognized as physicians, having attended medical college and in many cases done internships, residencies or apprenticeships.
It is not that homeopathy in India is without its problems. Speaking with homeopaths there - homeopathic practitioners, educators, students, as well as recent graduates, has allowed me to get something of an idea of what they are. To a great extent, it seems that the main problem centers on the educational system, which reflects educational problems throughout the country. In a phrase, it is a mile wide and an inch deep.
For instance, Indian engineers and IT experts are internationally renowned for their excellence, but that reputation is built on a very small percentage of graduates from the most prestigious schools. These are the ones one is apt to meet at Berkeley or MIT or in the private sector. But the vast majority of graduates are the products of substandard schools, and their competence reflects their education. Likewise, the elite primary and secondary schools for the wealthy classes can be of the highest caliber, but that goes down dramatically as one descends the social ladder and moves from urban to rural areas. There are areas of India where the children are lucky if there is a school or teachers at all.
So with homeopathic colleges, the level of education is quite uneven. A recent graduate of a college in Mumbai who I met this past visit complained that his education offered him absolutely no clinical experience. Logically, he feels totally inadequate to the task of opening a practice. He complained how hard it was to find a practicing homeopath to take him under his wing - though he was eventually successful in doing so.
But he needs to earn some form of a living now, so he works nights at a small private allopathic hospital specializing in cardiology, and several times a week sits in with his homeopathic mentor. It will take him many years to become adequately trained to be on his own. The fact that he even is endeavoring to become a competent homeopath is itself admiral – because, as it turns out, most graduates of homeopathic colleges never become practitioners.
A colleague of mine estimated that only some 5 to 10% of his graduating class actually became professional homeopaths. In a country like India, where per capita educational resources are so scarce, the inefficiency is a terrible waste.
At first I was somewhat incredulous, but a number of times, I have heard the same thing. To begin with, about half of the graduates from homeopathic colleges never begin practice. Many of them are women who are not career oriented, but seek some form of higher education before getting married. Some are people who have no great affinity toward homeopathy but who gained admittance to a college, and enter a different profession. Even more startling is the fact that the majority of the other half who do practice, don’t practice homeopathy. They are de facto allopaths – trained homeopaths who prescribe conventional drugs.
The aforementioned lack of adequate post-graduate training opportunities is only one of several major factors that appear to play into this situation. Another is the method by which high school graduates gain entrance to medical schools in general. On one hand it is very simple - the pool of interested high school students takes an exam, and those with the highest marks fill the available seats.
What makes it more complicated is the fact that in India there are four different recognized systems of medicine, each with its own medical schools, hospitals and clinics. Graduates from any of these schools are recognized as physicians. Yet, regardless of whether a person aspires to study allopathy (conventional medicine), ayurveda (traditional herbal medicine), homeopathy or Unani medicine (a traditional arabic medical system, there is only one pool of students all taking the same exam and competing for a place.
Placement in the schools depends on ranking in the exam. From the ‘toppers’ on down, the higher ranking candidate gets to choose the school from any system he or she wants as long as places are still available. Since allopathic medicine is dominant, garnering an overwhelming percentage of the resources the government spends on healthcare, and a career in allopathic medicine is more lucrative, conveys greater status and provides much greater opportunities in terms of post-graduate study, research and travel abroad, the allopathic schools are seen as the most desirable by the candidates and those seats are taken first.
In fact, it is the rare high school graduate who is filled with the ambition to become a homeopath, unless there is a family tradition or some other form of exposure. Thus, the homeopathic colleges are filled with students who hoped for placement at an allopathic college, but whose exams scores were not sufficient to gain admittance.
This does not mean that the students are not highly capable. In proportion to the pool of students who takes the exam, the number of places available is a very small fraction. So, the students attending any of the colleges are quite bright and usually remarkably high achievers. But, by and large they have no deep commitment to homeopathy, and once they have graduated, the majority take advantage of their status as physicians to essentially establish allopathic practices.
Compared to the challenges of successfully practicing homeopathy, writing scripts for antibiotics, prednisone and the like is much simpler and much more lucrative. The majority of young physicians, even though they may be formally trained in homeopathy, generally lack the financial resources, adequate clinical training and commitment to become homeopaths.
Fortunately, this is not universally the case. Even though it is a small percentage of graduates who actually do become homeopaths, we must remember that this is India, and the numbers are still great when compared to almost every other country in the world. And unlike almost anywhere else in the world, there are homeopathic medical facilities such as hospitals clinics and research foundations along with some of the most remarkable homeopathic traditions.
PART III
The first time I saw Dr. Dilip Dixit, he was sitting at a table with his wife in the student canteen of the M.L.Dhawale Memorial Homeopathic Hospital in Palghar, India. I didn’t know who they were, but the couple caught my attention because other hospital staff rarely ventured into the canteen – which was really just a large tented area abutting the back of the hospital building, furnished with rusting metal tables and cheap plastic chairs.
They were too old to be students, older than most of the staff even. I observed them sitting by themselves at the end of long table, slowly and silently eating a homemade meal out of a typical three tiered Indian tiffin-carrier. They felt to me then to be one of those older couples that through the passage of time had largely dispensed with the need to communicate verbally.
A little while later, I headed over to the hospital, into one of the outpatient clinics held every morning in a series of exam rooms along the main corridor of the first floor. The various clinics were organized by department: internal medicine, rheumatology, gynecology, and the like, and a schedule for which clinic I was to attend each day for the duration of my stay had been handed to me early on. This particular morning it was to be infectious diseases.
I was looking forward to this particular clinic for a number of reasons. One was that it afforded an opportunity to gain some more first hand experience in the homeopathic treatment of pathologies like AIDS and tuberculosis. Another was it gave me a chance to see patients with diseases that were unusual or even non-existent in America such as leprosy and plague.
Finally, I had been assured by a number of the post-graduate students, whose status at the hospital was akin to interns and who attended the clinics with me, that it was a particularly good clinic because the attending physician, Dr. Dixit, was a very interesting teacher with a wealth of experience. That certainly couldn’t be said for some of the clinics I had attended during my stay, so I was particularly excited about this opportunity.
For reasons that I never quite grasped, the clinic protocol seemed to call for the attending physician to arrive late – sometimes to the point of not attending at all. As per custom, as the patients arrived, registered at the reception area and took their places along wooden benches in the hospital corridor, the PGs and I crowded into the small clinic room at the appointed hour, about ten of us sitting or standing around an empty desk waiting for the attending physician to appear.
Often it was the assistant physicians assigned to the clinics, who themselves were only a year or two past their internships, that in the absence of their senior, began calling in patients and who sometimes ended up conducting the entire clinic themselves.
On this particular morning there was no assistant physician, probably because the gravity and complexity of treating these types of illnesses precluded young, inexperienced juniors from taking on the responsibility. Fortunately though we were not made to wait too long.
Unlike much of the staff, Dr. Dixit was not in full time attendance at the hospital. Instead, almost every Wednesday morning, he commuted the two or three hours to the hospital from the city of Thane, which was located just beyond the limits of the municipality of Mumbai.
It was only 15 minutes or so past the appointed time when Dr. Dixit arrived. I immediately recognized him from the canteen, and noticed how he entered the room and took his seat at the desk with the same quiet manner I had observed earlier. He didn’t greet anyone or even formally begin the clinic. Silently sitting at the desk, he simply waited for things to start up.
Dilip Dixit is a diminutive man with a somewhat rounded face defined by prominent buckteeth and a set of eyebrows permanently arched on the inner corners. It is almost an impish look, but an impish look marked with concern. Although I was not to see it on that day, he also can drop his brows and break into a wide smile, endearingly innocent and spontaneous.
On that morning, his first communication came in the form of a simple nod of his head, an indeterminate lift of his forefinger and an unintelligible murmur. It was enough of a signal for whoever was closest to the door to beginning calling in patients. Without explanation or discourse to the PGs or myself, he briefly spoke with the patient and dismissed him after writing a remark and prescription into his charts.
For the most part, at other outpatient clinics, the attending physician recognized that as a linguistically challenged foreigner, I might need a little help by way of access to patient records, translation and/or discussion regarding the case. But this was shaping up to be different.
By the third or fourth patient who passed in and out of the room, I had started to become disheartened. I couldn’t understand their symptoms were let alone what pathology they were being treated for, nor how they were being treat. I wondered whether the quiet man I had observed in the canteen was too shy to begin a conversation with a group or with a foreigner, or perhaps too timid about his English… Whatever the cause, without the language skills to understand the patient and no information forthcoming from Dr. Dixit, I began thinking to myself, “Another clinker of a clinic”, and prepared to wile away the morning reading some homeopathic literature borrowed from the hospital library.
Thankfully, a fellow student interceded by way of a question posed to Dr. Dixit in English about the homeopathic treatment of leprosy. Dixit answered in kind with great detail, juxtaposing an interesting philosophical perspective with a highly specific breakdown of the pathological forms of the disease, and particular homeopathic strategies for each form. Captivated by the obvious depth of his knowledge, I scrambled to get at least some of it down on paper.
With that done to the best of my memory, I quickly added a follow-up question not only to clarify a detail of his explanation, but also to signal Dr. Dixit of my presence in the room and my enthusiasm for what he might have to offer as a teacher.
PART IV
For eighteen years, Dilip Dixit sat with his mentor, Dr. M.L. Dhawale, mastering the homeopathic philosophy, perspective and skills that had been so assiduously developed over many decades of practice and teaching. Word has it that Dhawale was an extremely forceful personality and a demanding teacher with a commanding presence. Certainly, his writing evinces a brilliant analytical and methodically precise mind grounded in a thorough knowledge of medicine in general and homeopathy specifically.
As a second generation homeopath, Dhawale had begun his training quite early in life and inherited the rudiments of the structure he was to develop into the ICR, the Institute of Clinical Research which today involves thousands of homeopaths and students and encompasses hospitals, clinics and teaching facilities in the Indian state of Maharastra where Mumbai is located as well as a number of neighboring states.
Judging from his writings, above and beyond his work with patients and his teaching, Dhawale also devoted a good deal of his time and energy to thinking about how to teach homeopathy. Out of that grew the comprehensive educational system that produced the cadre of homeopaths who today, a quarter century after his death, work in or with the ICR affiliated institutions, the clinics and hospitals and various teaching programs.
This systematic and efficient education stands in marked contrast with much of the homeopathic education around the world that can often be either rote, partial or fragmentary. These educational programs graduate homeopaths deficient in various areas essential for effective practitioners to master - be it exposure to anatomy, physiology and pathology, clinical experience, philosophy or material medica.
On the other hand, for the most part the ICR homeopaths with whom I have come into contact appear to have a good handle on all these areas. And the most impressive of them have mastered them to such an extent that they are comfortable and effectual in a hospital ICU unit or a mobile clinic traveling to a slum or a remote rural area, handling patients with all types of the severest pathologies from malaria to acute renal failure to AIDS.
One of the secret keys to the general success of the ICR has been the attitude that Dhawale inherited from his own father and instilled in the organization as a whole. For in addition to insisting on the highest level of competence, he demanded dedication to the notion of service. To him, homeopathy was more than a medical art, more than a profession. It was a total commitment to serve people from all walks of life, regardless of their ability to compensate the practitioner.
One senior doctor related to me how as a young man he had pursued his studies with Dr. Dhawale while also continuing to work in his spare time campaigning for his father who was a politician. One day, Dhawale sat him down and demanded that he make a choice – become a homeopath or continue in the family tradition. To become a homeopath meant that there were nothing else that distracted you from your path of medicine and service.
It has been my experience that this tradition still exists within the ICR. The doctors work hard, sometimes for little remuneration in facilities that charge little or nothing. They have been equally generous in sharing their knowledge with me without expectation of financial reward. This is even more remarkable for the fact that in India, as in much of the developing world, foreigners are often expected to pay more than natives.
For instance, this past December, after one week of sitting with Dr. Dixit in his clinic in Thane, a small city just beyond the limits of Mumbai - after he had rearranged his schedule on my behalf so he would have more time to instruct me, after he had spent hours during the week talking with me, I was prepared to pay him for his efforts. We hadn’t discussed it beforehand, nor even while I was there had the topic been brought up. Actually, I was a little nervous about what the financial expectation might be. It turned out though, that on the last day of my visit he dismissed the notion altogether, refusing my offer to remunerate him even a token amount let alone significantly.
Although he certainly was carrying on the tradition of generosity propagated in the ICR, it was not that Dr. Dixit was invested in the notion of service, per se. He had told me as much. It was for others, he said, to run the mobile clinics in the villages and slums, to create the schools and run the charitable foundation. Where his interest lay was in the homeopathy itself, investigating and experimenting how to treat patients with all sorts of pathologies homeopathically.
This was his niche within the ICR, dating back decades to his time as Dr. Dhawale’s student and maintained ever since. What established it was Dixit’s desire to discover a method of treating leprosy homeopathically. Dhawale himself was of the opinion that leprosy was a disease that lay beyond the scope of homeopathy. So, it was a rather bold ambition idea for his apprentice to attempt to disprove this notion.
It seems that Dhawale encouraged his student in his pursuit to expand the boundaries of homeopathic treatment. Yet, he demanded not only clinical proof of positive results through cured cases, but also that Dixit establish a systematic approach and theoretical construct toward the treatment of the disease that could be passed on to others. While the success of a single, lone practitioner in treating leprosy would have been noteworthy, it was just as important - or maybe even more important – to be able to pass this knowledge onto others. That is to say, to count it a true success there had to be a systematic, reproducible method in Dixit efforts. This was the task put forth to him.
PART V
Like so many endeavors in India, getting to Thane, a town that lies just beyond the municipal boundaries of Mumbai, wasn’t that simple. For reasons that I don’t quite comprehend, in the greater Mumbai metropolitan area there are restrictions and limitations placed on the movement of certain forms of transportation.
For instance, it is impossible to travel via the omnipresent 3-wheeled motorized rickshaws – often affectionately called ‘tuck-tucks’ by foreigners – into the center of the city. There is a circumference around the heart of the city that demarcates the point beyond which they are illegal. Likewise, if one were to travel from Mumbai to Thane via rickshaw, there is a point beyond which one has to disembark, walk across a wide, busy road and find another rickshaw to bring you the rest of the way to the city.
The inconvenience of getting out and hauling one’s luggage across a highway is only outweighed by the annoyance of having to negotiate through a cluster of raucous ‘rickshaw-wallahs’ who are clamoring for the attention and fees of the approaching foreigner.
Somehow I ended up inside one of the vehicles and the driver put-putted away to the appointed destination, the ‘Tip-Top Restaurant’ where I had been instructed to meet my host for the upcoming week, Dr. Dilip Dixit. It was a Sunday morning and the traffic was relatively light, so we sped without much resistance toward the center of town.
Unfortunately, it turned out that the driver didn’t seem quite confident about the whereabouts of said Tip-Top restaurant. But after a few stops to query pedestrians along the way, he deposited me in front of a rather imposing building. Looking around, there was nothing that indicated to me that we had arrived at the appropriate destination. I looked quizzically at the driver – he hadn’t received his fee yet, so he wasn’t apt to just take off, and shrugged my shoulders with upturned hands in a universal display of ‘I don’t know what is going on’. He simply lifted his forefinger, pointing upwards.
Sure enough, on the sixth floor there was indeed a Tip-Top restaurant. Only it wasn’t the right one. Actually, I instinctively knew that the moment we pulled up to the front of the building – but I didn’t consciously acknowledge it… Why is it that all too too often ignore that little voice in our head?
Anyhow, after waiting well past the appointed hour and then making a call or two, I learned that this was a recently opened branch of the original Tip-Top that was placed in a burgeoning office building development on the outskirts of town.
So, I dragged my bags down to the street, commandeered another auto rickshaw whose driver knew the destination of the original restaurant in the center of Thane. As I said nothing is simple…
The chaos of Thane city center was a tumultuous mix of cars, buses, rickshaws, carts, pedestrians, noise, shops, and roadside hawkers. I stood in a plaza of sorts, across from a large multistoried building with colorful billboards painted to its side. The bus station was to the left of it, and directly behind it lay the train station with throngs of commuters pouring in and out.
Dr. Dixit emerged from the building across the street, weaved his way through the traffic and greeted me. He had a diminutive stature and a jowly face with large chipmunk like front teeth giving him a nearly elfin visage. With a brisk gate and a lick of grey streaked hair boyishly falling across his forehead, he appeared younger than the man I first met some ten months earlier at the homeopathic hospital in Palghar, but the meager eye contact and timid manner were familiar. Later, I would see that in the domain of his clinic with his patients and apprentices how the timidity disappeared.
He offered a tepid handshake and greeted me with an explanation that the Tip-Top restaurant where I had initially stopped was a recently opened branch mostly serving as a banquet facility for weddings and business groups, and that I should avoid eating there because they often served left over foods to individual dining guests, and had already garnered a reputation for being the source of a number of cases of food poisoning.
I didn’t share with him that it was already too late on that account for I had already taken my breakfast there while waiting for our rendezvous time. (Fortunately, I had survived and even enjoyed the meal.) Instead, I thanked for the advice and followed him back across the wide street as he had already grabbed one of my bags and was again wading through the traffic.
We entered the building through a small, inconspicuous opening between two shops, walked through a dark, narrow corridor and began ascending the stairs. The place was like a beehive. The dimness of the hallway gave way to brightly lit small shops and businesses. Plumbing suppliers, luggage stores and other retailers displayed their wares, IT start-ups were full of computers and earnest young employees, a training institute of some sort with students milling about, an internet café crammed with 20 computers each operated by a user and hardly enough space to sit. It was no less crowded than the street had been. It was no different than the street really – except it was inside.
On the third floor, there was a sign painted on the wall: Dr. Dilip Dixit, Homeopathic Consultant and an arrow pointing diagonally upward toward another small flight of stairs that delivered one to a roof terrace. The terrace itself was littered with construction supplies, but it gave a nice view of the plaza and was somewhat removed from the din of the street below.
Off to one side, a door with Dr. Dixit’s name. He unlocked it and we entered into his clinic. Dr. Dixit apologized for the disorderly appearance, explaining the space was in the midst of renovation.
Another narrow corridor led to a small, bare waiting room with a few benches along the walls. There was a passably clean bathroom with a barely functional toilet off to the side. Past the waiting room a few steps, Dr. Dixit unlocked yet another door. Behind it lay another small room with enough space for a desk and two or three chairs. There were two closet sized spaces toward the rear, one for storage and the other housed his homeopathic pharmacy.
For forty years, this small and nearly inaccessible place had been his clinic.