Kashmir in Sickness and in Health

CONTENTS

Acknowledgements

Chapter 1

Prologue

Chapter 2

Nineteenth Century Kashmir

Chapter 3

The Experts

Chapter 4

Healing With Preaching

Chapter 5

The Neves

Chapter 6

The Farhangi Raj

Chapter 7

From Medieval To Modern

Chapter 8

State Funded Health Service

Chapter 9

The Transition

Chapter 10

Progress Amidst Turbulence

Chapter 11

Changing Of The Guard

Chapter 12

Birth Of Medical School

Chapter 13

The Flames Of War

Chapter 14

Return Of The King

Chapter 15

A Tale Of Tears

Chapter 16

Epilogue

Bibliography

To my wife and soul mate Razia for the wonderful times we have spent together—cried together, laughed together, and all the times in between. Hundreds of hours of time spent on researching and writing this book actually belonged to her.

To the memory of Moji (my grandma), who taught me the meaning of love. She gave me everything I asked, without asking for anything in return.

To all Kashmiri youngsters on whose shoulders rests

the future destiny of this land.

"Our Lives begin to end the day we become

silent about things that matter"

(Martin Luther King)

ACKNOWLEDGEMENTS

I would like to express my gratitude to the many people who saw me through this book; to all those who provided support, talked things over, and assisted in the editing and proof-reading.

The idea began with my publication of a couple of articles in the Kashmiri English Daily—Greater Kashmir, a few years ago. Following that, Dr Muhammad Farooq Ahmad Kaloo, Ex-Director Animal Husbandry, Jammu and Kashmir and Mr Arshad Hussain Kaloo, Senior Editor Greater Kashmir, encouraged me to compile the project in a book form, for which I am grateful to both of them.

I would like to thank Kashmiri historians, Mr Fida Hassnain and Late Dr Mohammad Ishaq Khan for their guidance during the preparation of the manuscript, and to Kashmiri writer, philosopher and judge, Mr Ghulam Nabi Gauhar for his pat on the back.

Thanks are due to the staff at the Directorate of Archives at Srinagar for helping me with the search of old records—the Jammu and Kashmir Government Gazette and Annual Administration Reports (AAR), and to Mr Mufti Bashir Ahmed for painstakingly photocopying each of these and forwarding to me. I am also thankful to Prof Girja Dhar for allowing me access to her research material and to Prof Pirzada Abdul Rasheed for sharing his memories with me.

I wish to acknowledge Sister Elizabeth Kurien, Administrator, St Joseph Hospital Baramulla for providing the details about the history of the hospital, Mr Muhammad Amin ex-Administrative Officer, Sher-i-Kashmir Institute of Medical Sciences for procuring the papers regarding the historical background of the Institute, and Dr Mohammed Ashraf Khan, ex-Medical Superintendent for providing a copy of his write up about Jawahar Lal Nehru Memorial Hospital Rainawari, Srinagar. I am grateful to Mrs Jean Din for filling in the gaps in my knowledge about the life of Dr G M Din, and to Syed Altaf-ur-Rehman who supplied Dr Din’s 1930s photograph.

I am obliged to Mr Ken Osborne from the Knowledge & Archives Management, Christian Mission Society, Crowther Centre, Oxford, United Kingdom for supplying the photographs of Doctors Elmslie, Arthur Neve and Ernest Neve, to Mr Habib Naqash for permission to use one of the photographs from his collection, and to Cartographic Section, Department of Field Support, United Nations for allowing to include UN Map No. 3953.

My sons and advisors Arjmand and Iqbal have been the greatest source of encouragement with this project. Their unwavering love and faith in me has been the driving force of my life.

Finally, my heart felt thanks to my loving parents, Abbajan and Tataji, who taught me to stand upright in good times and bad times and to believe that anything was possible in life, and to my family without whose love and support nothing would have been possible in my life.

Jammu & Kashmir State Administration: 1846-2013

Map of Jammu & Kashmir—With kind permission of Cartographic Section, Department of Field Transport, United Nations, New York.

CHAPTER 1

Prologue

Love for my octogenarian mother who is well and lives in Srinagar—the capital of Indian administered Kashmir—and my affection for the mother of mothers Moaj Kash é r (Mother Kashmir) who is also alive but very unwell, and has been so for a very long time, takes me to the Kashmir Valley a couple of times every year. The start of my visit is filled with expectation, as one thinks of meeting the family—distant and near—catching up with friends and associates, and breathing the sweet scented air of the Valley. It brings back pleasant memories of more than 25 years of my early life—childhood leading to adolescence and adulthood. This is the place where I inhaled my first breath on earth, where I learned to stand upright and walk, where I acquired the faculty to cogitate, where I trained to become a doctor, and where I made the first cut on human skin and tied an eternal knot with the world of Surgery. But the excitement wears off quickly after a few days’ stay and is superseded by a feeling of suffocation, as this son of the soil surveys the oppressive subjugation of masses of humans by garrisons of armed men in uniform.

The lowest point of my visit was during the mid-nineteen nineties, when I witnessed a humiliating scene in Srinagar in broad daylight. Four heavily armed men belonging to the Border Security Force (BSF)—the paramilitary wing of Indian Armed Forces—stopped a bus overloaded with Kashmiri men and women. All passengers were ordered to line up; men were separated from women, and the leader of the four men looked into the faces of each passenger one by one, a scene reminiscent of the Bollywood blockbuster curry-western—Sholay. So far so bad, but worse was to follow. The guy picked a man in his late fifties, who had a karákurí (cap made from the skin of a lamb reared in the mountains of Karakoram,—the mountain range straddling the borders between Pakistan, Afghanistan and China) on his head, and had a grey but neatly trimmed beard. The guy slapped him hard, yelled and swore at him. The shaky victim passed out and fell. Whilst he lay on the floor with no one paying attention, the group of four body-searched the rest of the men with outbursts of intermittent verbal abuse. Each woman was looked at closely. Finally the driver of the bus got a verbal thrashing from two of the armed men. Meanwhile, unnoticeably, the floored man was back on his feet, as the passengers were allowed to embark, and the bus left.

I was in the back seat of a chauffeur driven Suzuki car (known locally as Maruti) next to the bus and was getting ready in my mind to face the worst, but for some reason my driver and I were spared—perhaps it was my lucky day, or may be because I was well attired with a suit and a tie. During the rest of the 20-minute journey I was quiet—in a state of shock, my heart having skipped a few beats during the ordeal. My chauffeur broke the silence and tried to cheer me up. Laughingly he said: "Don’t worry sir. We were lucky. All bus passengers and the driver were lucky; at least they will be able to reach home in one piece. The bearded man must have answered back. I have learnt that the best way is to keep quiet and take the abuse—lekh schá-haz thok laerith gachhi (abuse is not a spit that will leave a stain); aki kane bozun, běi kane tráwun (in one ear, out of the other)."

He looked at me through the rear view mirror. Notwithstanding my lack of response, hesitantly he continued, Sir, when I leave home in the morning, I say good-byes to my family, because I am not sure if I will be able to return in the evening.

I was lost in my own thoughts and chose not to reply, and that stopped his nervous banter. For me the scene was appalling but I guess for him it wasn’t. Like a genz (Kashmiri word for a leather dealer) of genz-khod (locality of animal skin dealers in downtown, Srinagar) accustomed to the awful stink of raw animal hide, which used to be the distinctive trademark of that locality during my childhood days, for my chauffeur, curfews, checks, crackdowns, and abuse were a routine part of everyday life.

On the same day in the afternoon I visited Sri Maharaja Hari Singh (SMHS) Hospital—the main State funded Hospital in Srinagar affiliated to the Medical School—in connection with my research into the evolution and development of modern health care in Kashmir Valley. I did not expect it to be like the British Hospital where I worked, but the appalling scenes of insult to human dignity, displayed in an amalgam of dirt, despair and overcrowding, also overwhelmed me. Again I thought of the genz living in genz-khod—the local healthcare administrators and the government of the day being the genz and the hospital the genz-khod. Kashmiris call it genz-nus (a leather dealer’s nose) that cannot smell the stench.

The idea

The two incidents described above—the hospital scene and the terror-stricken street episode—were different but had the same net effect: insult, pain and injury to human self-respect. In both instances the recipient was a human being and a Kashmiri. Furthermore, both episodes were symptoms of present day Kashmir’s ailing political and physical wellbeing. Sadly, there are many pockets in the world that like Kashmir are sick on both these counts; but when it involves one’s birthplace it raises the core temperature of one’s conscience.

As I probed into my primary research interest, that is the history of evolution of modern health care in the Valley, I was saddened to discover that brutal subjugation by outside rulers, their agents or local cronies, or hired mercenaries, was not a new phenomenon for Kashmir. An ordinary Kashmiri has had no say in the control of his/her destiny for many centuries. But within that broad context there were some periods when better governance structures and systems were installed, which translated into improvements in physical, mental and social wellbeing of Kashmiri society. Rivalry between regional and world powers also influenced events in Kashmir—for better or for worse. For instance the political tensions between the British and Russian Empires got the British interested in Kashmir, which had a positive impact on Kashmir’s social development.

As I delved into the subject further and deeper I also realised that writing about health and sickness in a society without exploring the concurrent political health would be like looking at the earth without examining the sky. The cause of wet earth is the cloud in the sky. The two facets of this thought process were synthesised—and emerge now in this book, which is essentially about the evolution of modern healthcare in the Valley from the middle of the nineteenth century when the Christian missionaries started arriving, up to the present time. In parallel it also explores the ups and downs in Kashmir’s political health during that period, and like two faces of a coin, links together the twin aspects of Kashmir Valley’s historical journey over the last 150 years.

_________________________________________________________

CHAPTER 2

Nineteenth century Kashmir

Kashmir—famous Persian poet Sheikh Saidi’s firdous (paradise), described by British civil servant Sir Walter Lawrence as an emerald set in pearls, (1) is the country of sufis, pirs, rishis, fakirs and sadhus, shining pinnacles and minarets of Muslim shrines and Hindu temples—appropriately named by locals as the pir-e-waer (backyard of holy men). It is the land of lakes and springs, rivulets and canals, fragrant blossoms and juicy orchards, colourful rose shrubs and eye catching pomegranate blooms, expanses of inherently fertile fields, panoramic rice plantations and serene saffron fields, imposing and grandiose chinars, columns of formative poplars and gracefully drooping and warmly welcoming willows, pine bearing hills decorated with green deodars and comprehensively carpeted murgs (meadows on top of hills). The vale of Kashmir is shaped like an oval bowl approximately 90 miles long and 20 miles wide surrounded by towering, snow-laden Himalayan mountain peaks that used to insulate it from the plains of the Indian subcontinent, and which have truly been the guardians of the Valley in the past.

The body of this picturesque spot on earth is bisected by the graceful curves of a wide-bosomed river—Hydaspes to the ancient Greeks, Vitasta to the old, or Veth to senior locals—the Jehlum River, that springs to life as a rivulet from the spring of Ver (Ver-nág meaning the willow-fountain) in the southeast of the Valley, at the foot of the Banihal Mountain. That is the place where the romantic Mughal Emperor Noor-ud-din Jehangir landscaped a beautiful garden and desired to be carried to when dying. Like a child going through precocious puberty the river starts friskily at source. The boisterous origin of the river is beautifully encapsulated in the Kashmiri proverb, vethe kati chhakh grazán?—Ágray. Oh Vitasta, at what place do you roar?—At the very source.

Reaching a rapid adulthood, it matures into a quiet but majestic river as it traverses sluggishly through the Valley to the northwest, and runs through the city of Srinagar on its way to join the Wular Lake near the town of Sopore, springing to life again as it leaves the lake and the Valley.

The capital city of Kashmir is Srinagar, the City of the Sun, or more correctly the city of Lakshmi—the Goddess of Wealth (Shri: Lakshmi, Nagara: city) that bears semblance to Napoleon’s drawing room of Europe—the romantic city of Venice; and is therefore appropriately named the Venice of the East—the Jehlum and its tributaries being the broad-shouldered version of the famous Venetian Grand Canal.

Doom and gloom

Our story begins some time in the middle of the nineteenth century; the insulated Valley is inhabited by handsome and olive-skinned men with prominent hooked noses—artistic and skilful may be, but with few hopes and aspirations—and pretty, ruddy cheeked women with attractive features; the Valley is yet again under foreign rule. This time the Sikhs handed this piece of land over to the British in lieu of indemnity, who in turn sold—yes, sold—Kashmir and its inhabitants for the sum of Rs 7.5 million and the promise of an annual payment in kind, to Raja Gulab Singh of Jammu and the male heirs of his body. The sale was ratified in the form of an infamous treaty by the signatories—Raja Gulab Singh and British representatives—on March 16 1846 at Amritsar in Punjab. Despite the resistance of local ruler Sheikh Imam-ud-din, the Raja and the British prevailed and like any loser in history Sheikh was binned into oblivion. The victorious Gulab Singh—the ultimate ruler of the destiny of these people—the Maharaja (Maha: great, Raja: monarch) made a grand entrance into the Kashmir Valley via the suburban town of Shupiyan on November 9.

But Jehlum had seen it all! The founding of the Shrinagari in 250BC by Ashoka, the massive troop formations of Alexander the Great along its banks and the defeat of Raja Porous, ruler of Parvarasen in the sixth century AD, the infatuated, unorthodox and unconventional reign of Queen Dida in the tenth century, the gradual decline and death of Buddhism with the rise of Brahmanism and Shaktism, the dawn of Islam facilitated by the arrival of Syed Abdul Rehman Sharif-ud-din Suhrawardi, commonly known as Syed Bulbul Shah or Bulbul Sahib, followed nearly 70 years later by the arrival of a group of Syeds led by the charismatic Mir Syed Ali from Hamadan, Iran, also called Baní-Mussalmani dhar Kashmir (founder of Islam in Kashmir), but known to Kashmiris as Shah-i-Hamadan (King of Hamadan) or Amir-i-Kabeer (The Greatest Leader). Then it witnessed 250 years of the domineering Sultanate rule including half a century of architectural, commercial and strategic genius of King Zain-ul-Aabidin commonly known as the Budshah (The Great King). Then came the civil war before the take-over by the Moghuls in the latter part of the sixteenth century, which saw the building of the kaláye (long stone wall) around the Hari Parbat Hill, ostentatiously ceremonial visits by Emperor Akbar the Great and landscaping of the Shalimar and Nishat Gardens under Moghul rule, amidst ruthless oppression by the Moghul governors. Then ensued the harsh and tyrannical reign of the Afghans, followed by brutal subjugation during Sikh rule.

No wonder the serene and placid Jehlum becomes boisterous and assertive, muddy and brown after its exit from the Valley, as it meets its blue eyed soul mate River Kishenganga at Domail—perhaps expressing annoyance and disgust at what it witnesses during its journey through the scenic Valley.

With the arrival of a new ruler Gulab Singh from the outside, a new era of subjugation and enslavement of Kashmiris began. It is no surprise that the Valley shook with an earthquake on the day of Gulab Singh’s death in 1857. Even though the British were busy counting the cost of the Indian Mutiny at that time, it was through their intervention that prevented the immolation of Gulab Singh’s five wives as suttees (2). After Gulab Singh’s death, his third son Ranbir Singh—a fanatically devout Hindu—occupied the gadhi (throne), but was he in any way better than his father? Commenting on Ranbir Singh’s era the Christian missionary doctor William Elmslie wrote:

"And why should I stop and hesitate to mention and to repeat that which come up first into my mind—the disgraceful oppression of the people. Yes, disgraceful for us English, for we sold, literally sold, the country into the hands of its present possessors; and selling it, sold with it the flesh and blood of thousands of our fellow creatures—sold them into perpetual slavery . . . that the ruler should be a tributary of ours, and yet be allowed to tyrannise."(3)

Death and disease

But it was not only the oppressive rulers that a poor Kashmiri had to endure, but also natural calamities—ferocious floods, funereal famines, fearsome fires, excavating earthquakes and dreadful diseases. Indeed, if it were not for the repeated episodes of death and destruction which the epidemics of diseases or natural calamities like earthquakes and floods brought to towns and villages and the city of Srinagar, the demographic structure of the Valley would have been different.

Cholera has been the major killer of people of the Valley for centuries. Lawrence’s research suggests that the disease was first mentioned in 1598.(4) The first recorded epidemic was in 1857. Every few years there would be a visitation to the Valley; in the nineteenth century alone there were ten epidemics of the killer disease, each one bringing with it deaths and despair. The fatal years were 1888, 1892, 1900, 1902, 1907 and 1910. Ten thousand lives were lost in 1888. The 1892 epidemic resulted in 5,781 deaths in Srinagar alone. During the day Hindus burnt and Muslims buried the dead, but during the night they simply threw them into the river. Eyewitness accounts of the epidemics make horrific reading. Commenting on the epidemic of 1892, Dr Arthur Neve, surgeon to Kashmir Mission Hospital, called Srinagar the City of Dreadful Death.(5) He described the scene as follows:

We are looking from the bows of our mat-roofed boat for the first sight of Srinagar, the so called Venice of the East. The turbid and lazy stream sweeps against the prow, masses of dirty foam, floating straw, dead bodies of dogs, and all the other garbage of a great city. How can one admire the great sweep of snow mountains, the deep azure of the sky, and broad rippling sheet of cloud and sky reflecting water, when every sense is assailed by things that disgust. Upon one bank stands a neat row of wooden huts. This is cholera hospital. Upon the other bank the blue smoke curling up from the blazing pile gives atmosphere and distance to the rugged mountains. It is a funeral pyre. As our boat passes into the city, now and again we meet other boats, each with their burden of death. All traffic seems to be suspended. Shops are closed. Now and again from some neighbouring barge we hear the wail of mourners, the shrieks of women as in a torture den, echoed away among the houses on the bank(6)

Commenting on the epidemic of 1892, the architect of land settlement in Kashmir Sir Walter Lawrence recorded:

"All business was stopped and the only shops which remained open were those of sellers of white cloth for winding sheets . . . The long lines of coffins borne to the graveyards resembled an endless regiment on the march, while on the river a sad procession of boats floated down to the burning ghats, and living passengers in other boats passed by with averted faces. Men telling me how they had lost all members of their family would break into hysterical laughter, and I have never seen such utter despair and helplessness as I saw in 1892."(7)

Mr Tyndale-Biscoe, Head Master Christian Missionary Society (CMS) High School Srinagar wrote about the cholera epidemic of 1902:

"The epidemic of 1902 was my first experience of this terrible visitation. The people were terribly scared; offices and schools were closed, and the people sat in their houses, as they said, waiting to die . . . Ten thousand deaths were reported in the city, there must have been hundreds more unreported."(8)

The disease continued to devastate the populace during the earlier part of the twentieth century. The epidemic of 1902 claimed 10,000 lives and there must have been hundreds more unreported. In 1906-7, in Srinagar and suburbs the number of reported cases was 18,439, of which 10,999 died. In 1910 the recorded number of cases was 18,448 and 9,218 deaths were reported. Regular visitation by Vibrio Cholerae continued in 1914, 1919, 1923, 1925, 1929 and 1936. The 1919 epidemic was the worst of these; it started in the township of Kulgam in the southeast of the Valley and killed 11,516 people.

Kashmiris call it wobah, the word itself conveying a sense of a rapidly spreading affliction. I remember my own maternal grandmother describing the demise of her husband (my grandfather), possibly in 1923, which made her a widow in her twenties with two baby daughters to care for, in the following words: "There was hawá-i-radhí (foul air) in the city, he was vomiting and had fever and a few loose motions. The hakím gave up and slowly he became lifeless."

The mode of transmission of cholera was thought to be through air, like Justin von Liebig’s theory of bad air as the cause for infections. It is interesting that before 1854 the medical establishment in Victorian Britain also believed that cholera was spread by air rather than by infected water. It was only after the brilliant epidemiologist and anaesthetist Dr John Snow (1813-58) removed the handle of a drinking pump infected by leakage from a sewer in Soho, London, that the outbreak of cholera that had killed almost 700 people in two weeks within a small area finally stopped. He also demonstrated that the best way to combat cholera was to separate drinking water from sewage and to boil water before use.

It was not air but filthy food and water from lack of sanitation, which provided refuge to the bacterium Vibrio Cholerae in the Valley, particularly in Srinagar. Surgeon-Colonel Harvey who visited Srinagar during the cholera epidemic of 1892 remarked:

It is not too much to say that the inhabitants eat filth, drink filth, breathe filth, sleep on it, and are steeped in it and surrounded by it on every side.(9)

Whilst one can identify the above as the typical phraseology used by an upper class Englishman, the fact is that Srinagar in 1892 was no different from London of 40 years before. The London scene in the early and middle nineteenth century is described in Time Traveler’s Guide to Victorian Britain (London) in the following words:

"The most life-threatening hazard facing city-dwelling Victorians is cholera, closely followed by typhoid fever and typhus. Four epidemics of cholera—in 1831/32, 1848/49, 1853/54 and 1866—kill about 140,000 people, with more than 60,000 perishing in the second epidemic alone. The main problem is ignorance . . . In London, there are still open cesspools, and the sewers run straight into the Thames. The metropolis stinks. In 1858, when and try (sic) to take a pleasure cruise on the Thames, they have to turn back after a few minutes because of the river’s stench. Parliament has to stop sitting because the smell from the river is unendurable. In general, the only way to cut disease is by promoting cleanliness: building new drains, protecting the water supply, setting up public washhouses and baths. In Belgravia, where the upper classes wash their hands, deaths from cholera are fewer than 30 per 1,000; in the slums, they are almost seven times that. But gradually the greater availability of soap and clean running water also makes working-class houses cleaner."(10)

At the end of the nineteenth century the majority of inhabitants of Srinagar used public streets, alleyways, lanes or courtyards as latrines. Dr A Mitra Rai Bahadur, Chief Medical Officer of Kashmir records the lack of sanitary arrangements during this period as follows:

"Barustal Gus (filth at the door) is proverbially admitted to be a mark of affluence . . . drains carrying slush, filth and sewage empty into the river, in which the washer men wash unclean clothes, dyers wash their dyes and butchers entrails of animals."(11)

I grew up in the heart of downtown Srinagar during the fifties and early sixties of the twentieth century, and remember too well that a number of our neighbours had no latrine or bathroom. How many times have I walked through the lane leading to our house and found men, women and children defecating on the pavement of the open drain? On seeing me the individual would hide his/her face inside the pheran (the long loose wrapper) until I passed along. And if one walked in the dark through the lane, one had to be careful not to tread on human excrement.

There were other communicable diseases too. Until the introduction of vaccination, practically the whole population contracted smallpox in childhood and many died of the disease. A census of students from the CMS High School Srinagar in the mid-nineteen-thirties showed that only one percent had escaped the disease. Smallpox accounted for serious loss of life; in Kashmir Valley 8,754 deaths occurred in the years 1915, 1916, 1919 and 1920. A significant proportion of the population were pitted and many became blind.

An abuse uttered by Kashmiris now used rather infrequently is: pěyá táwan (let you be inflicted by plague, táwan meaning plague). This must mean that they knew about the disease and its dangers. However, there is no official record of any plague epidemics before 1903. Whilst the south (Jammu and Punjab) bore the brunt of plague at the start of the twentieth century, Kashmir was free from the disease, until a death was reported on November 19 1903. The deceased, by the name of Ghulam Mohammed, had entered the Valley on a tonga (horse driven carriage) from Uri on November 13. His body was buried in a grave ten feet deep with two feet of carbonate of lime surrounding it. Despite that, 1,498 people died of the disease in the Valley. The epidemic is described by the younger of the two missionary doctor brothers Ernest Neve in the following words:

". . . it assumed the pneumonic form. And curiously enough there was no associated rat mortality. The authorities took vigorous measures, at first burning down all plague-infected houses . . . The disease gradually died out, after lingering with singular persistence in some isolated villages near the Wullar Lake. The mortality, all through, was terrible—over 95 percent . . ."(12)

The three Ts—typhus, typhoid and tuberculosis (the last one was known as consumption in those days), also took toll of the population. Eye, skin and bone infections were common. Goitre was common too—520 cases were recorded in 1891-1892.