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Thursday, August 4, 2011

Herbs bind broken bones

We heard the piercing cries long before we reached the place. We walked down a short hallway, with rooms on either side, and found a big crowd. The cries were louder, shrieks of pain. Men, women, children everywhere - on the floor, curled up, on the benches, helpless bundles being carried like babies. At its quietest, sighs and sobs in silence hung over the 1000 sq.ft. room like a fog, that even the bright sunlight could not dispel.

N. Nandakumar
Scenes from the Puttur bone setting clinic in Andhra Pradesh.

This was the Puttur Bone Setting Clinic: a household name here and in faraway Chennai and Bangalore. The clinic is at Rachapalem, about a km from Puttur town in Chittoor district, Andhra Pradesh. The single-storey block is less than a hundred yards from the level crossing on the Chennai-Tirupati line. Inside the treatment hall, the number on the LED display board flashed 159. So by 10-30 a.m. so many - from as far away as Chennai and its suburbs, from other places in Andhra Pradesh and elsewhere - with broken bones or dislocated joints had been treated. More awaited their turn for the magic touch.

A slip of a girl lay on a steel bench, her arm broken at the elbow. "She had fallen from a tree while plucking mangoes," said the men who were treating her. On another bench sat a small boy, grimacing as tears flowed down his cheeks. His fractured right forearm had been aligned, and he sat waiting for the bandage and herbal paste that would allow him to escape the tyranny of pain.

Six cousins - they call themselves bone-setters, true to the work they do - are efficient, for most of the patients who had come for a review looked well, and a few were even consoling the newcomers.

The method adopted may be unorthodox, but seemed effective. An old woman on a makeshift stretcher was brought in. One of the bone-setters pushed and pulled her fractured leg, we could see she was in terrible pain, but not a sound escaped her lips. The man attending on her applied a watery herbal paste mixed with the white of two eggs, tore out strips from a dhoti and securely bandaged the limb from hip to knee, fixed shaven bamboo splits - these served as splints - to keep the limb firm. The bone-setter then told her to return after a fortnight. The process lasted about 25 minutes. By the time she left the room, another had taken her place.

The concern on the faces of the new patients was telling. Some bit their lips, some just turned away as if to muffle their ears, others stared wide-eyed, more so the parents of children, wondering why they failed to rob the pain. In sharp contrast were the attendants of patients who were here for the second or third time. They were happy and said the wound had healed.

N. Nandakumar

A good number were from Chennai. "It is difficult travelling such a distance. But then, you are sure the limb will be alright. That is why we have been coming here," said a couple who had brought their aged relative. The old man had a badly dislocated shoulder. A senior bone-setter said, "At first we wondered if we would be able to set the ball-and-socket joint."

"But you see our troubles were not in vain," said the woman, probably the old man's daughter. "Had we sought treatment anywhere else, even in Chennai, we would have had to wait hours to see the doctor; travel up and down for days; take innumerable X-rays and do this and that test." The man added: "My uncle here, - he is past 70 - would be going around with a white plaster cast in a sling." "And, my friends would want to sign their names on my arm," the old man said, breaking into a toothless smile.

"It takes about two or three visits for some of the fractures to heal," said one of the bone-setters while bandaging an old woman who had broken her leg and had come for a review.

The treatment process is bafflingly simple. After aligning the broken bone - for which no x-ray is needed, they only touch the swelling and feel the fracture gently - they apply the paste liberally and bandage it firmly; they put paste on every layer of the bandage. Finally bamboo splints are lashed on the side "to prevent any chance movement of the limb." For some fractures, "we just apply the paste, bandage the hand or leg and tell the patient to come after a fortnight. The medicine softens the bone inside and helps it to heal," said a bone-setter.

The medicinal plant was discovered by chance by the founder of this clinic, Gopal Raju, in the late 19th century. He had shot at a rabbit and its back was broken. He carried the rabbit on some leaves and when he reached home he found that the crippled rabbit could hobble around. Curious, he applied more paste made from the leaves and within a week the rabbit was cured. Thus goes the story, but if you ask the bone-setters what leaves they use, they will only smile politely in reply.

Markandeya Raju, who sits collecting the donations, insists that the clinic offers free service. "All that a patient needs is a few eggs and some white cloth, and a token contribution of Re. one," he says. But we saw people giving him

Rs. 50 notes and getting back no change. Sometimes the senior Raju pocketed the folded notes, refunding nothing. Given that the bone-setters worked full time, and wore thick gold chains and gold watches, we wondered if the clinic really just broke even financially.

However, true to the claim, most of the patients were poor. Labourers at construction sites, maid servants, poor children. Only a few were from the middle class.

The Rajus have only one family member with an MBBS degree,

Dr. S. Rama Raju. When he is at Puttur, he studies the X-rays some patients bring. All the X-ray plates we saw showed clear breaks, some were multiple fractures. "We do not use antibiotics, no injections. Neither do we perform surgery," said a young bone-setter.

The reason why the clinic became popular should be obvious. "In 1881, when this unit was opened by Gopal Raju, one could not have dreamt of X-rays. The word that the treatment worked spread, and it became popular. After 119 years, people would at least have heard about it, if not visited the Rachapalem clinic," said some of men we talked to.

Talking of the Puttur system, Dr. Soundarapandian, former professor of orthopaedics, Madras Medical College, (he has opened the Bone and Joint Clinic in Anna Nagar, Chennai), said, "The Puttur system uses naturopathy which does not have a scientific basis. In 20 per cent of the patients, just leaving them alone would heal them. In modern medicine, we use anaesthesia which relieves the pain, calms the patient and relaxes the muscles. The work of aligning the broken bones is then easy. In some cases, surgery is inevitable. When I was in General Hospital, I used to see patients who would come back with unset fractures after treatment at the Puttur clinic for two months. There were many who would get admitted in hospital but leave voluntarily to go to Puttur, only to come back later. Even now I get many cases like that. After two months, correcting a problem becomes very difficult."

We stepped out of the clinic and found many in the courtyard - sitting on the wooden benches, squatting on the floor, on the pedestal of a statue of Gopal Raju, the founder. Some groaned in pain. Children were scared stiff by the shrieks they heard. More people were streaming in with patients. Some were carrying eggs (for the poultice), strips torn from old dhotis (for the bandages) sold outside, or with lunch boxes, for they had been on a long journey from home.

Wandering around, we saw the hills which almost faded in the background. Probably that was where the men got the herbs which they said cured. Behind the clinic, the space was littered with rags and dhoti borders. Anyway, the place was certainly not dirtier than many of our government hospitals, or corporate hospitals in the big cities. "Did we see magic? Was it proof of infinite faith, or a kind of science that science cannot explain?" we asked each other.