Safety & Efficacy of Traditional Medicine

Twenty years ago, in 2006, I was involved in the organisation of a regional meeting on traditional medicine in south Asia, which was held in Bangalore in India.

Recently, I have read some discussions about research on the safety and efficacy of traditional medicine. They reminded me of a speech given my friend Dr Bala on this theme in that meeting. Therefore, I have decided to share some extracts from his speech in this post.

Background to the Regional Meeting Held in Bangalore in 2006 

I was asked to organise and coordinate a meeting on traditional medicine practices in South Asia by a group of international NGOs. Similar regional meetings were held in that period in other parts of the worlds. Final reports from those meetings were put together and provided to the department of Traditional Medicine in the World Health Organisation (WHO) in Geneva.

However, my participation in the whole process was limited to the meeting held in India, since I was busy in other research work in that period. My friends from People's Health Movement in India had played a fundamental role in organising that meeting. 

Dr K. Balasubramaniam (1926-2011) from Health Action International Asia-Pacific (HAI-AP) had given the keynote address at that conference. Dr Bala, as everyone called him, had done pioneering work in access to essential medicines and was a key and respected figure in the international People's Health Movement (PHM) in those days. That meeting was also an opportunity to meet some of my old friends including Dr H. Sudershan from Vivekananda Girijana Kalyana Kendra, Dr Mira Shiva & Dr Ravi Narayan from PHM-India.

That conference was my first real encounter with traditional medicine. It was also the first time that I had visited an Ayurvedic medical college and understood the kind of training Ayurvedic doctors receive in India.

In this post, I would like to share some extracts of the keynote address of Dr Bala focusing on "Evaluation of Safety and Efficacy of Traditional Medicine". His keynote was much wider in scope. For example, he devoted a significant part of his speech to the subject of "Preserving and safeguarding biodiversity sustainability and traditional knowledges". 

In the coming days, I want to share some more papers from that conference. If you wish to read more documents from that meeting, I invite you to check the final report of that conference, which can be freely downloaded.

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Evaluation of Safety and Efficacy of Traditional Medicine 

Dr K Balasubramaniam, Sri Lanka

I believe that this conference will focus on herbal remedies which constitute the therapeutic armamentarium of traditional systems of medicine in the region.

The World Health Organization (WHO) has defined herbal medicines as "Finished labelled medicinal products that contain ingredients from aerial or underground parts of plants parts or other plant material or combination thereof, whether in the crude state or as plant preparations. The same WHO document adds "Medicines containing plant material combined with chemically defined active substances, including chemically defined substances and isolated constituents of plants are not considered to be herbal medicines".

It will therefore, follow that chemically defined isolated constituents of plants used in modern medicine are not herbal medicines, it has been estimated that these medicines derived from plants constitute about 25 percent in modern pharmacopoeia.

The World Health Organization posed a question 2002 whether a herbal medicine can be used clinically if no harm has been found after the use of that herbal medicine for generations and there is no documentation of such an effect. For an answer to the question, reference is made to an earlier WHO document published in 20003 which states "Absence of reported or documented side effect is not an absolute assurance of safety of herbal medicine. However, a full range of toxicology tests may not be necessary. Tests which examine effects that are difficult or even impossible to detect clinically should be encouraged. Suggested tests include immuno-toxicity, geno-toxicity, carcinogenicity and reproductive toxicity", It adds the following caveat, "only when there is no documentations of long historical use of a herbal medicine or when doubts exist about its safety; should additional tests be performed.

A rigid framework that has been prepared for modern synthetic drugs will never be possible for herbal medicines. There has to be some flexibility in toxicological requirements for herbal medicines.

Accordingly, a group of experts met in Chandigarh, India, to develop a suitable framework for carrying out toxicological studies on herbal medicines. The framework developed was broadly accepted by the Indian Council of Medical Research and the WHO. The actual tests to be carried out in the Chandigarh model are given in tables 1 & 2 (click on the tables for a bigger view).

The tests recommended by the WHO are given in Table 3 below (click on the tables for a bigger view).

WHO has called on clinical researchers to conduct clinical evaluation of traditional medicines within the specific framework of rigorous clinical pharmacological principles without ignoring or trampling on the concepts of the traditional systems of medicine.

I wish to take this opportunity to present an alternate view for evaluation of traditional medicine.

Traditional systems of medicine are a summation of several thousands of years of human experience in the selection of plants for preventive and curative healthcare. Practitioners of traditional systems of medicine argue that the efficacy of herbal remedies is due to the synergistic activity among the several ingredients of herbal mixtures. Complex mixtures of plants or herbs form the basis of traditional medicines. The mixtures are usually subject to crushing, heating, boiling, etc. It is possible that this process may change the chemical structure of the active ingredients in the plants.

Clinical pharmacologists and other scientists working on medicinal plants, on the other hand, focus all their attention on isolating and identifying biologically active ingredients in medicinal plants and herbs. When a promising new biologically active chemical ingredient is isolated, it goes through all subsequent investigations identical to those for a new synthetic chemical ingredient.

Traditional healers do not accept that the efficacy is necessarily due to the active ingredients in the plant.

According to the active ingredient approach the modern clinical pharmacologists, take the knowledge from the plant but throws away the wisdom of centuries.

If there is acceptable historical evidence that traditional herbal remedies have been effective in the treatment of certain diseases, but neither their active ingredients nor the mechanisms are known, is it ethically or morally acceptable to not use that treatment? Examples of successful treatment by traditional medicines will be useful to answer these questions,

In the fate 1980s children attending the Dermatology Department, Hospital for Sick Children, Great Ormond Street, London showed marked improvements in their eczema symptoms. These improvements were due to oral treatment with aqueous decoctions of a mixture of 10 Chinese medicinal herbs. Clinical experimentation and pharmacological testing revealed that a mixture of the 10 herbs were necessary and that the efficacy could not be attributed to any single active ingredient from any one of the 10 Chinese herbs, A placebo controlled double-blind clinical trial using the 10 Chinese herbs was carried out on 47 selected children with non-exudative eczema. The conclusions of the trial were to validate the standard of current conventional clinical trials utilized in the UK that the traditional Chinese therapy was efficacious.

If these children had to wait till the clinical pharmacologists had screened the 10 Chinese plants for active ingredients and tested them for biological activity, they would never have been given the chance of getting effective treatment with a mixture of 10 Chinese herbs.

Potential cytotoxic drugs are tested for their activity against experimental or human cancer cells. Efficacy depends on the ability to kill specific cancer cell types without affecting normal body cells. Studies on the effects of certain Ayurvedic herbal preparations for possible cytotoxic activity revealed that these herbal preparations did not kill the cancer cells but transformed them into normal healthy cells. These drugs, therefore, have a different mechanism of action, Classical testing methods would have missed this important anti-cancer activity.

I wish to pose a philosophical question. Is medical science one universal and uniquely expressed (western) paradigm – a biomedical paradigm? If it is possible to conceive of alternative methodologies, theories and practices in other domains such as music, logic, linguistics, art and politics, is it not possible to consider possibilities of alternative methodologies in medical science, knowing that doctors practice medicine within a biopsychosocial paradigm?

The guiding principles by which knowledge is built up in the biomedical paradigm are those of the scientific method where hypotheses are clearly stated, then tested and accepted or rejected as truth "until further notice" or "within the stated confidence limits” using only experimental or quasi-experimental designs – a deductive approach to problem solving.

Is it possible for research scientists to examine other methodologies, for example, using experiential methods – an inductive approach, to evaluate traditional herbal remedies?

There is an enormous amount of research on medicinal plants in research institutes in developing countries and the transnational drug industry.

Based on the WHO definition of herbal remedies and the herbal remedies used by practitioners of the traditional system, I wish to pose the following questions:

The Indian Council of Medical Research has taken the plant Pterocarpus marsupium from its use in folklore and Ayurvedic medicine to Phase III clinical evaluation for the treatment of diabetes mellitus using well accepted pharmacological principles. It was handed over to the industry for pharmaceutical development and marketing. This product will be marketed to practitioners of modern medicine. Table 4 (click on the tables for a bigger view) lists examples of modern drugs derived from plants that have been used in the traditional systems of medicine by ancient people around the world.

The question I wish to pose is as follows: "Will this type of research and development to isolate therapeutically active chemical ingredients achieve the objectives of this conference which is to promote the continuous development of traditional medicinal in the region to maximize its contribution in preserving and improving public health."

Let me make it clear that R & D to isolate therapeutically active ingredients from medicinal plants is of critical importance. There is no doubt about it.

But what I wish for you'll to discuss is the need for research to evaluate the safety and efficacy of the herbal remedies used by practitioners of the traditional systems of medicine. For example table 5 gives a 5 list of Ayurvedic remedies for some common ailments (click on the tables for a bigger view).

Is there a need to develop appropriate methods for clinical evaluation of traditional herbal medicines: methods and criteria not to be limited to the methods and concepts of modern biomedical science.

Interestingly much of the scientific literature for traditional medicine uses methodologies comparable to those used to support many modern surgical procedures: individual case reports and patient series with no control or even comparison group.

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For a full version of the keynote address by Dr Bala at the South Asia Regional Conference on Traditional Medicine, held in Bangalore, India in 2006, including the list of references, I invite you to download and read the conference report, that I had prepared. Please write to me at sunil.deepak@gmail.com if you would like any of the presentations made at the meeting.

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Reforming Hindu Traditions

In 2018, I had spent a few days in Rishikesh where a chance meeting with a young Swami ji (ascetic) had led to some interesting discussions about how to bring reforms in Hinduism. (Click on the images for a bigger view)

In terms of discussions around Hinduism, it is strange how a new aggressive narrative of Hinduism is being pushed in some traditional and social media (especially in English). Hinduism (along with Buddhism and Jainism) is predominantly seen as a religion of peace which accepts people of different religions and creeds, as shown by the millennium-long Indian traditions of accepting people persecuted in their own lands including Parsi, Jews, Armenians, etc. International image of Hinduism is also associated with spirituality and Mahatma Gandhi including elements such as Yoga, meditation, non-violence and vegetarianism. However today, there are many persons in India and outside, who talk of Hinduism exclusively in terms of hate, violence and discrimination.

This post is about a discussion with a Swami ji from Rishikesh about how to reform Hinduism, it does not go into the new narratives being built around it.

Rishikesh

Rishikesh is the last mountain town where the river Ganges passes before reaching the plains in Haridwar. I had been to Rishikesh a few times as a child. My most memorable visit was in early 1968 with my maternal uncle. At that time, the Beatles had just visited the ashram of the Guru Mahesh Yogi and this had brought international spotlight on this obscure town. Last year when I went to Rishikesh, I had vague memories of those old journeys. I went to look for the old ashram of Mahesh Yogi but it was closed and covered with overgrown vegetation. This part of Rishikesh has now many new ashrams and there is a new huge white statue of Shiva built in the middle of the river.

As the river Ganges comes down, the old town of Rishikesh is located along its left bank, near the area of Triveni Ghat. All the new ashrams and yoga centres of Rishikesh are located to the north of the old town, along the opposite side of the river.

I was staying near Triveni Ghat and spent a great deal of time sitting along the river bank, with my feet in the ice-cold river waters, talking to old men and women who had come here on pilgrimage from different parts of India. Every afternoon, underneath the trees of Triveni Ghat, persons gathered in small groups and discussed. These discussions were usually very down-to-earth and mixed an earthy humour and occasional obscenity with the spirituality.

Meeting the Swami

The Swami ji was much younger to me, probably around 40 years and was clean shaven. He wore the saffron cloth of renunciation and seemed well educated. I met him near Bharat temple, which is one of the oldest and most beautiful temples in Rishikesh. He was from West Bengal and I talked to him about my experience of living in Assam. I was curious to ask him what had brought him to the path of renunciation, but felt a bit embarassed, it seemed like a very personal question to ask to an occasional acquaintance.

We started talking about Upanishads and I explained to him my fascination with Katho-Upanishad, which tells the story of Nachiketa's visit to Yama, the God of death and their discussions about the meanings of life and death. He was very knowledgable and recited different shlokas from that book, explaining his understanding of it.

Then he asked me if I had been to the Ganga-aarti? During this aarti a group of young Brahmins do a choreographed dancing prayer holding metal lamp-stands full of burning lamps, which has a great visual impact. I explained to him that for me, the teachings of Upanishads held the real meaning of Hinduism and I did not have much faith in rituals like aarti. I had found aesthetic pleasure in the choreography of the burning lamps and prayers sung by the faithful, but not any spiritual connection to it.

 

My comments about the aarti provoked a discussion during which Swami ji explained to me his understanding of Hinduism. He said, Hinduism is like Ganges, a river made of a lot of different streams. There is the Spiritual stream of Hinduism with an abstract view of God, and this stream finds a value in the sacred books of Veda and Upanishad. There are many other streams. Like the Vaishnav stream of belief which is practiced in Assam by the followers of Shrimanta Shankar Dev, which focuses on Bhagwat Puran and does not have any idols. However, according to him the biggest stream of Hinduism is that of simple persons who believe in the different Gods, in the different avatars of Vishnu and in the stories of Ramayan and Mahabharat. For them, the stories of Ram, Krishen and Shiva are the bedrock of their faith, these are felt as true in a material sense.

Swami ji felt that many of the present problems of Hinduism were caused by the disconnect between persons believing in different streams of the religion. According to him, most of the highly educated Hindus among the thinkers, writers, academics and other influential groups are like me, who appreciate the higher teachings of Gita, Veda and Upanishad but do not have the simple faith of common persons in their Gods.

"Persons like you, they dominate the society and what they say is taken up by TV and newspapers. You do not believe in Gods and Goddesses but you give your advice on what should be done about Hinduism. How to celebrate our festivals, where to make our temple, how big should be the statue, how to reform our traditions, you know everything and you want to take all the decisions for all the Hindus. The simple people for whom Ram, Sita, Krishna and Shiva are real, their opinions are considered as inferior and unimportant. This is creating problems in our society because they are the majority but they do not have a voice and people like you are a minority but you have a big influence", he said.

My point was that if a festival like Diwali creates pollution because of crackers or if we use Plaster of Paris statues covered with chemical paints at Ganesh Chaturthi and Durga Puja and after the festivals, throw them into rivers & create pollution, then something has to be done. Why can't we find another way to celebrate these festivals without feeling that others are persecuting us? Our religions need to change with the changed reality of the world.

He said that reforms in Hinduism must come from within, they can't be imposed by others. According to him we need persons like Mahatma Gandhi, or a Guru who understands the bigger picture and who shares the faith of common Hindu - only such a person can bring a change from the grassroots.

Conclusions

The words of that Swami ji have remained with me and I have reflected on them. I can see that I have a certain intellectual way of being a Hindu, I do not really believe in temple-rituals or Gods. I like visiting temples, just like I like visiting churches, museums and art exhibitions, for an aesthetic pleasure.

There is a lot about Hinduism in India, as it is lived by millions of persons, which I don't really understand - from Kanwariyas who walk for hundreds of kilometres to collect water from Ganges for their temples, to the pilgrims who spend weeks on the road for festivals like Ambubashi or Kumbha Mela - I understand all of it in an intellectual way but I can't understand the simple faith which moves these people.

The question is how can we promote a grass-root change in them? According to the Swami ji, the reformist movement has to come from them, and from their gurus and other persons in whom they have faith. These can't be forced by laws. In a way I understand this point, I had written about it in relation to the Sabarimala judgement.

But I am not convinced about the role of persons like me, who believe in Hindu spirituality but do not have the simple faith in rituals and prayers, do we have any role in promoting reforms related to that way of faith in following Hinduism? What do you think? Please do share your point of view in the comments below.

(Originally written in 2019 and updated in 2023)

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Museo - The Camera Museum of Gurgaon

Museo, the camera museum of Gurgaon in NCR (India) is a vibrant cultural space in a rapidly growing urban area, which needs many more such spaces. An initiative of the well known photographer Aditya Arya, who is passionate about photography conservation, restoration and archiving, it formally belongs to the India Photo Archive Foundation. (Image: Aditya Arya in the lobby of Museo)

During my last visit to India in late 2022, most of the time I was unwell and bed-ridden. The highlight of this stay was a visit to Museo during which I had a brief encounter with Aditya.

This visit to Museo was also an opportunity to visit and on-going art exhibition organised by Oxygen Art Guild and curated by Tarun Das. I was lucky to meet and speak to Tarun as well.

Thus, this post is about both Museo Camera Museum and the Oxygen Art Guild exhibition. I am not going to repeat the information about the backgrounds of Museo museum, Aditya Arya and Oxygen Art Guild , you can check those on their respective websites. This post is mostly about the things which had especially struck me during this visit. Before I start, I would also like to recommend you to check the different old-pics collections at the Aditya Arya Photo Archives website.

Museo Location

Museo is located off a small road in front of the Galleria market (DLF phase 3, Nathupur) in downtown Gurgaon. The nearest Delhi Metro stations are IFFCO Chowk and HUDA City Centre, from where you can take an auto or a cab to reach Museo. It has sufficient parking space but its location on a narrow and busy road can be tricky to navigate.

If you are visiting Gurgaon and are wondering about places to visit, do visit and spend some time in Museo.

Museo Activities

Museo is a vibrant cultural space with some permanent exhibitions and areas for temporary exhibitions. Photography is encouraged in all the museum spaces.

For example, it has weekend classes on photography (and other cultural activities such as dance classes) including the one year photography diploma course as well as different workshops (when I visited, there were posters of workshops about cyanotype, film and analog photography, salt print process, environmental portraits by Sundeep Bali and street photography).

There were also some on-going exhibitions, about which I have written below and there was a live music performance by Ruchika and Deepak Castelino. The ground floor of the museo building has the camera museum while upstairs are the different exhibition and workshop spaces.

Camera Installations

There were some installations made out of old cameras or in which cameras played a significant role scattered around in the building.

One striking installation was the "Hug Me" man by the well known Gurgaon artist Gopal Namjoshi made from junk metal and old analog cameras. Namjoshi is known for his monumental installations in which often junk metals play an important role.

Another installation which I liked, had a mannequin surrounded by all kinds of carrying bags for the old analog cameras. (Image below has the 2 installations - the Hug Me man and the camera-bags)

The third camera installation which particularly struck me was the inverted pyramid handing above the central gallery. There were also some big old cameras from early 20th century.

Temporary Exhibitions

Among the temporary exhibitions, I especially loved "Nirvasanama", which documented the life in exile of Dev Shumsher (1862-1914), the "liberal" Prime Minister of Nepal, who was exiled in India in early 20th century.

Colours of Convergence

In the art exhibition "Colours of Convergence" organised by Oxygen Art Guild and curated by Tarun Das I liked the works of -  watercolors by Sudhangsu Bandopadhyay, woodcut on paper by Jintu Mohan Kalita, oil painting by Aniruddha Mukherjee, acrylic on canvas by Apurba Karati and very especially the Cityscapes of cows by Jiban Biswas.

Last year, I had met Valeria Bertesina, an artist who curates the Paper Art Biennale in Schio and that had been my introduction to understanding the meaning of "curating art exhibitions". In Museo, I had an opportunity to talk to Tarun Das (in the image below), who had curated the exhibition "Colours of Convergence", which was another opportunity to reflect on the different ways in which individuals can "curate" exhibitions, imprinting it with their dialogues with the artists in selecting and deciding what gets exhibited and how.

 

Vintage Analogic World

As we go deeper into the digital world, it is not just analog cameras and photographic prints which are disappearing but the whole world is changing. This nostalgia for the disappearing world is represented in Museo by a painted ambassador car, an old lambretta scooter, a biscope and a colourful three-wheeler.

Sculptures in Museo

There are  also a few sculptures scattered in the open area surrounding the Museo, which are worth looking at. These include 2 sculptures of boys reading a book.

In the End

Except for the malls, which have a primary commercial purpose, Gurgaon has only a few cultural spaces. Another such local cultural space is the Sanskriti Museum.

I hope that the next time you are in Gurgaon and are wondering about places to visit and things to do, you can visit the Museo Camera Museum! 

Remembering Dr Usha Nayar

My dear friend Usha died last year in February 2021. I heard about it only today, when I saw a message from her daughter Priya. A very nice website has been created for remembering Usha, her life and her work, where you can find many of her writings. While I process that she is no more, through this post I want to share some of my memories of her.

I had met Usha through an Italian friend, Dr Enrico Pupulin in 1996. At that time, Enrico was the head of the Disability and Rehabilitation (DAR) team at the World Health Organisation (WHO) in Geneva. He was keen to conduct a multi-country research on implementing community-based rehabilitation (CBR) programmes in some urban slum communities. In CBR programmes, disabled persons themselves, family members, and local community persons are trained in providing support to children and adults with disabilities. Enrico wanted to see if this approach would work in the poor communities living in the slums.

Enrico had gathered some really committed persons from seven countries for this research, including Fr Alex Zanotelli from Nairobi, Kenya and Dr Eduardo Scannavino from Santarem, Brazil. Usha was also one of them. In those days days she was the professor of child and adolescent health at the Tata Institute of Social Sciences (TISS) in Mumbai, and together with her husband Chandran, she was also the founder of a voluntary organisation called Smarth, which was active in some slum areas such as Bhiwandi and Dharavi areas in Mumbai. I was asked to coordinate that research project.

Over the next 10-12 years we met many times. In 1999, we were together in Brazil. In 2001, we all converged in Mumbai, when we visited the Bhiwandi and Dharavi areas. Not long after that visit to Mumbai, Usha told me that Chandran had been diagnosed with a cancer. In spite of all their efforts, he died some time later. That was a difficult period for their family.

In the following years, we kept on meeting on and off. Usha came to Italy for a couple of workshops. Then we were both involved in the organisation of an international workshop in Helsinki, Finland. Usha also did the compiling of responses for an international survey on disability and rehabilitation for the WHO. Her warmth, humility and humane approach made her an ideal colleague, who was appreciated and loved by everyone.

Some more years later, another difficult period for Usha came when some persons from their voluntary organisation accused her of improper use of the donors' funds. Though all the financial controls showed that the funds had been used properly and no evidence of any wrong-doing was found, it took a toll on her. Even more unfortunately, it led to a decline and then closure of that organisation which she had started with Chandran.

In August 2012, as she reached 65 years, she retired from TISS as a senior professor. Few days later, in September, she left India and came to the USA, where she started a new phase of life as a professor in the New York State University. It also meant that she could be closer to her daughter.

Once we were sitting together and talking, I don't remember in which country it was, when I had told her about some personal set-back which was worrying me at that time. Usha had told me, "Have faith in God, sometimes what you see as a set-back, can become an opportunity for a new direction in life." Then she had told me about an episode from her own life. She had completed her gradutation, post-graduation and PhD from Allahabad university and she was very keen to have a job in that university. "The job that I had wanted so much, it was not given to me, it was given to someone who had family ties to some big-wigs", she had said, "I was so disappointed, I felt that my life was over and I will not achieve anything in life. Some time later, there was an opportunity in TISS, I applied and was successful. If I had not had that set-back in Allahabad, I would not have had the good fortune to work in TISS. Only afterwards I understood that God works in different ways." I still remember those words.

Over the last couple of years, Usha had also become more active with Yoga and the teachings of Upanishads, which had long been my area of interest as well. We had sometimes exchanged messages through Facebook and I had told her that I looked forward to an opportunity for talking about spirituality with her.

Instead, destiny had other plans. In February 2021, she died a couple of days after receiving a Covid vaccine, but I never heard about it. A few months later, after the second dose of a Covid vaccine, even I developed a cardiac arrhythmia, which took a few months to improve. My doctor in Italy said that it was probably a coincidence and not due to the vaccine. Ever since the pandemic started, health sertvices have worsened and there is no way to know for sure. However, no one can deny that so many of our lives have been changed by that pandemic.

Dear Usha, perhaps one day we shall meet and have our discussion about spirituality on the other side and laugh about it. Goodbye my friend, I am glad that our paths crossed.

    

The Kashmir Story

Over the last couple of weeks, I have been reading about the film “The Kashmir Files”, its box-office success, its impact and the heated discussions it has generated. Perhaps, after a few weeks, it might become available on some streaming platform and then I will be able to watch it, though I am not sure that I will – from what I have read, it has some very graphic violence and I have no stomach for watching violence.

However, reading about “The Kashmir Files” has reminded me of another film about Kashmir and the Kashmiri Pandits – the film was “I Am” (2010), and it was directed by Onir. I think that it was a good film that merited greater attention. I had translated its subtitles into Italian, when it was shown at the River-to-River film festival in Florence.

The Kashmir Story in “I Am”

“I Am” was an anthology of four short films, loosely connected with each other. Among those four stories, the Kashmir short film was the second story of the film. It had beautiful performances by Juhi Chawla as Megha, a Kashmiri Pandit, and Manisha Koirala as Rubina, as her childhood Kashmiri Muslim friend.

This part of the film started with Megha’s journey to Srinagar to sell her house. Rubina comes to the airport to pick her up and is happy to see her old friend. Megha is by turns, angry and anguished, at the memories the return has brought back. She is unwilling to give in to romantic nostalgia about the city, and maintains some distance from her friend.

During the 24 hours of Megha’s stay in Srinagar, there are only a few scattered moments of nostalgia for her childhood home. A visit to the ruins of her uncle’s home who was killed by neighbours, brings back the memories of her terror of those days when they had abandoned their home and ran away to the refugee camp.

An encounter with a group of youth on the road, brings out that the story of the exodus of Kashmiri Pandits has been changed and retold by the locals. In this new retelling, they were the cowards and villains, who had run away from the valley.

At the same time, Megha’s dispersion of her father’s ashes in the river, brings out the attachment of older generations for Kashmir and their dreams about the day when they will return to their original homes.

Those 24 hours also show Rubina’s changed life in the Kashmir valley – she is lonely, living closed at home and is unmarried, while the guy she used to love has left India. Her brother, who had become a militant, has repented and come home, but is disabled and a shell of his former self. Police comes to their home frequently to check because they are a militant family. The city is divided by barbed wires and check-points, which gets deserted as the evening falls and people rush to their homes.

Megha’s righteous anger and resentment at the fate of Kashmiri Pandits, has one final moment of push back from Rubina. A brief exchange between the two friends, brings out the tragedy of changed lives of Kashmiri Muslims, especially those of the women and youth. The awareness that in the end there were no victors among the ordinary persons on the two sides plants a little seed of mutual understanding.
Impact of “I Am”

“I Am” was a film dealing with other difficult themes along with the Kashmir story. Perhaps that is why its Kashmiri section did not receive proper attention. It had a strong impact on me because in the process of doing its Italian subtitles, I had spent a lot of time with each of its scenes.

This part of the film gave precedence to the view-point a Kashmiri Pandit. It was shot in dark and drab colours. It showed a Srinagar of barbed wires, road-blocks and sad people, and not the romantic town of lake and gardens from 1980’s Bollywood.

The whole sequence of Megha visiting the ruins of her killed uncle’s house, had a very strong impact on me. Its background score was filled with the shouts of slogans by angry people asking all kaffirs to leave Kashmir or be killed. I could identify with her refusal of Rubina’s sympathy, when she responds, “Don’t worry, I am not going to cry”.

The film also shows the impact of the events on the other side, through Rubina’s family. They have also suffered and continue to suffer due to the militants on one hand and Indian army on the other. However, I felt that it was more difficult to empathise with them, because their pain was closely linked to issues related to militancy and its violence.

For example, there was a sequence when Megha is accompanied by Rubina’s mother to a neighbourhood shop for buying saffron. The elderly shop-owner remembers that he had accompanied Megha’s pregnant mother to the hospital when she was born. However, their discussion also brings out that it was that same person’s son who had killed Megha’s uncle and later, died as a militant. Megha comes back from the shop full of indignation – “You only had that shop to take me, whose son had killed my uncle?” she asks bitterly.

While I could see the dismay, regret and frustration on the faces of the local Kashmiris, I also had a feeling at the back of my mind that “it was their sons and families who did it”! I think that is the biggest difficulty when we look at victims of Islamic terror, that we are less willing to acknowledge the pain of its Muslim victims.

The Elephant in the Room

I remember talking to Onir in Florence about the Kashmir portion of the film, expressing my appreciation and saying that it was a great pity that this episode of our recent history had been allowed to be forgotten.

To write this post, I watched again the Kashmir portion of “I Am”. I think that there is an aspect of the Kashmir situation which had remained untouched in the film – the rise of more conservative Islam which was linked with militancy. Traditionally, the Kashmiri Islam has been moderate and open, and it had a history of a peaceful co-existence with Hinduism. Over the past couple of decades, the more conservative version of Islam has become more common, but its role and significance in the Kashmiri Pandits' exodus was never mentioned in the film.

Whose sufferings need acknowledgement?

As far as I understand about the events in Kashmir, the problems worsened with the Soviet invasion of Afghanistan at the end of 1979. To counter that the Americans started supplying money and arms to Mujahideen through Pakistan, which contributed to strengthening of the more conservative ideas of Islam in the region and reached Kashmir through Pakistani militants in the 1980s. Apart from the militants, it impacted different groups of persons, such as -Militants from Pakistan along with radicalised Kashmiri youth killed many Kashmiri Pandits and provoked their mass exodus in late 1980s and early 1990s.

Militants and hardliners from Pakistan along with their companions in Kashmir started killing moderate Kashmiri Muslims and those seen as sympathetic or collaborating with India, starting from early 1990s and continuing even now. Around 7000 Kashmiri “political opponents” have been killed, though some say that the Kashmiri victims have been many times more. They specifically target the intellectuals and they can abduct or rape their families.

Since the 1990s, Indian army has been fighting the Kashmiri separatists and militants and once again, a large number of victims have been reported, not only among the militants, but also among the civilians. The army rule has also affected general life.

Each of these groups have their own stories to share. I have read of Kashmiri Pandit families weeping at the shows of The Kashmir File - they are happy that finally their sufferings have been acknowledged through cinema. Onir’s film “I Am” did not show that violence directly, it focused on its aftermath.

I think that one of the good films about the impact of army in Kashmir was Shaurya (2008), which touched upon the human right abuses.

Stories about the situation in Kashmir involve different and complex issues. The views of the Islamic hardliners and militants may not be acceptable or understandable for most of us. However, I think that our cinema needs to explore these different areas and view-points so much more. For example, little is known about the violence against moderate Muslims in Kashmir and it would also benefit from a greater exploration in literature and cinema.

The Angry Indians

There are some persons on the Social Media, whom I call the "Angry Indians". They can be broadly divided into 2 main groups. One group is of persons who claim that they are trying to safeguard Indian culture and Hinduism. Often they have furious fights amongst themselves and some of them are full of hate. They often act in ways contrary to the beliefs they claim to defend.

The other group of that of persons who define themselves as progressives or liberals. They claim that they are trying to safeguard India's plurality and diversity. However, their main aim seems to be to counter BJP-Modi, and they are not really concerned about anything else. Like the first group, often they also act in ways contrary to the beliefs they claim to defend.

I call these 2 groups, the Hindu Cultural Warriors and the Progressive Cultural warriors. They are also co-dependent on each other, creating spaces for their fights and constantly, feeding-off each-other. Here are some recent examples of issues around which they fight.

India Versus South Asia

Recently the American vice-president Kamala Harris greeted the "South Asians" on the Holi festival and the Hindu Warriors erupted in protests. Don't you know that Holi is a festival only of Hindus of India, they asked. They don't like to be grouped together with India's neighbours, especially with Pakistan. On the other hand, Prograssive Warriors love using the term South Asia, I think mostly because Western progressives like it and even more, because they know that the other group hates it.

I need to confess that I am partial to Kamala Harris, since she has my mother's name, but my defence of the term "South Asian" has nothing to do with her name. I feel that the term "South Asian" acknowledges the common cultural identity of what was once known as Indian subcontinent. It is an identity which is shaped mostly by Indian culture, by its tradition of creating and accepting, even encouraging, blurred boundaries between the religions and its basic idea of "all the different paths lead to the same God".

All countries of South Asia have some Hindu, Sikh, Jain and Buddhists - in India and Nepal as majorities and in other countries as minorities. So wishing "Happy Holi" to all the people of these countries, did not seem like a bad thing to me and I can't understand why the Hindu Warriors don't like the term South Asians.

I can understand if conservative persons of other religions in "South Asia" resent Harris' greetings, because that is happening in some parts of the world. For example, there are many persons in Europe who get offended if you wish them for festivals which do not belong to their religions (for example, some Muslims get offended by the widespread Christian symbols in public spaces around Christmas and Easter times. So they are coming out with ideas like hiding Christmas trees in private spaces and saying "Season's greetings" instead of "Happy Christmas").

However, in India, festivals of all the religions are holidays for everyone and I have grown up in an environment where we wished everyone for all the festivals. For example, we always said "Happy Eid" or "Happy Gurupurab" and not "Happy Eid to Muslims" and "Happy Gurupurab for the Sikhs". So, if Harris is treating all South Asians as "people who celebrate Holi", why should the Hindu Warriors get offended? They should be jumping with joy!

Indian Festivals

Another issue which often leaves me confused is when Hindu Warriors get offended if someone dares to say anything about an Indian festival. I can understand the irritation about the extreme positions of some Progressives, who may be motivated by virtue-signalling - for example, their calls for "water saving" at Holi or for not making bonfires on Lohri and Holi. I can also understand the irritation because Progressives seem to focus only on Hindu festivals. However, I don't see the need to feel offended if someone says that Deewali can be hazardous for environmental pollution or the Durga and Ganesh statues pollute our rivers and lakes - I think that we need to look at these seriously and search for solutions.

Compared to other religions, Hinduism is not bound by any one book or any one tradition, so it is easier for us to question our old cultural practices and start new ones. For example, over past decade, I have seen different variations about the way we celebrate Rakhi, the festival in which sisters tie a rakhi on their brothers' wrists. Now, for promoting greater inclusion, some of our family celebrates it by sisters tying rakhis on the wrists of both, their brothers and their wives; and, at Karvachauth, both husbands and wives together keep fast. If we can change our rituals and practices according to the changing times, it is good for us as a community, and is certainly better than to remain with outdated practices and ideas.

Therefore, if the fire-crackers of Deewali cause horrendous increases in pollution and problems for people with breathing difficulties, especially in the big cities, and there are calls to limit their use, why should that be seen as an attack on Hinduism? IMO, it does not matter that traffic or industry or crop-burning are more polluting. On Deewali evenings, even 30-40 years ago, when traffic and other kinds of pollution were much less than today, the doctors' clinics used to be full of people with asthma attacks and breathing difficulties. I can vouch for it because I practiced medicine in Delhi in the 1980s and saw it every year. So why can't we use this opportunity to find alternative joyful and fun ways to celebrate Deewali? BTW, even Europe has campaigns around Christmas and New Year to limit the use of fire-crackers.

If chemical-based colours used in Holi can cause skin allergies or dermatitis, they also end up in our sewage waters and rivers. Our rivers and lakes are usually in terrible shape at festival-times. Use of chemical colours painted on the Durga and Ganesh statues, are bad for our environment in the same way. The answer for Hindu Warriors should not be to shout about these as "attacks on Hinduism" but to think of how to promote a wider use of plant-based natural colours. If we can promote our local artisans and organic colours' and dyes' industries by doing that, it will be even better. It can become an economic opportunity and also in line with our scriptures, which ask for the respect of nature.

BTW, the fun of Holi and the joy of covering people's faces and clothes with colours is increasingly finding emulators in Europe. Vicenza, the provincial town near which I live, has been organising "Holi celebrations" during summers, where it is an opportunity for people to drink, dance and play with colours.

Hinduism - Hinduttva

Many of the Hindu Warriors are promoting a version of Hinduttva which seems to be inspired by the ultra-orthodox members of Christianity and Islam. Progressive Warriors are their partners in this, they also agree that Hinduttva means only that and nothing else. In fact for Progressives, the word Hinduttva belongs only to BJP, so they are fighting against it (they also think that the colour saffron belongs only to BJP and it should not be used).

I personally think that the word "Hinduttva" or the "essence of Hinduism" can not be reduced to only one meaning. Hinduism has developed along thousands of streams of ideas and practices across different parts of India, which have a lot in common and at the same time, an incredible amount of variations. Thus, if our ideas about Hinduism are infinite, the meanings of Hinduttva should also be infinite. So, why do we accept to let the idea of Hinduttva be hijacked by these 2 groups?

IMO, a wide public debate on the meaning of Hinduttva would be beneficial to India. It might help us to understand which cultural values are shared by the majority of Hindus and by majority of Indians. Though I don't think that we shall ever reach a consensus, this discussion would be useful. Probably, this commonly shared idea of Hinduttva would be closer to the results of the PEW survey in 2021 on the Religions of India. This survey report had shown that in spite of different religions, most Indians hold similar common beliefs. The "common shared cultural values of India" should be valued and safeguarded. Such an understanding of Hinduttva will be forged by the encounters of different religions of India and it will acknowledge the blurred boundaries between the religions, as one of its key characteristics.

The more conservatives among the Hindu Warriors do not accept anything except their ideas about traditions of Hinduism. At the same time, the ideas of blurred religious boundaries and common traditions shared across religious diversities are increasingly non-acceptable also to Progressives. They often talk about India's past and how it gave a home to persecuted minorities of the world, to cry about the lost Ganga-Jamuni tehzeeb and the lost traditions of accepting religious diversities in ancient India. However, for today's world they do not want to look at the norms and processes governing the acceptance of other religions in India's past. Instead, they would like to follow the ideas of secularism developed in the west, which are based on separation of religious identities.

 

In India, the Progressive Warriors seem most concerned about how to safeguard the more conservative and orthodox ideas of minority religions. I personally feel that the ideas of identity-politics developed in the west are problematic for a harmonious multi-cultural living in India because they destroy the blurred religious boundaries which has been a fundamental characteristics of Indian cultural world. For the same reason, Progressives defend maintaining separate specific laws for minority religions and fight the idea of common civil code - again, I feel that this is a completely anti-progressive attitude. You don't help the minorities by strengthening the hands of the most conservative and radical voices among them.

Insulting Religions

Some of the Hindu Warriors are always looking for people insulting Hinduism, to fight with them. If you use a Sanskrit verse from a Veda in a rock-song or if you print the picture of a Hindu God on a bag or god-forbid, a pair of shoes or underwear, they are waiting to rise up and start a campaign to destroy you. The Progressive Warriors, OTH, are willing to overlook all insults to Hinduism but are very careful in making sure that you do not insult the minority religions.

I think that the idea of "insulting God" is stupid because it does not fit in with the basic ideas of Hinduism, which include the belief that God is within each of us. "Aham Brahm asmi", "Aham Shivam asmi", "So Hum" - all mean "I am" or that "God is inside me". In Shrimad Bhagvad Geeta, Krishna shows his Virat Roopa to Arjuna to explain that he is there in every particle of this universe. These fundamental ideas should guide Hindus to the respect of nature and respect of every human being.

So, how can anyone justify killings in the name of Gods or religion if one believes in this teaching? If one believes that God is inside every being, how can anyone justify discrimination towards any person because of his caste or his religion? And, once you accept that God is there in every particle of the universe, how can anyone offend God?

Recently, I had read about people being killed in Punjab for "offending" the Sikh sacred book Guru Granth Sahib. I wondered if they had forgotten the story of Guru Nanak's travel to Mecca? The story says that some men complained that Guru Nanak was sleeping with his feet pointing towards Mecca and thus offending God. So, Guru Nanak told them, shift my feet towards another direction where there is no God. The story says that in which ever direction they shifted Guru Nanak's feet, Mecca appeared on that side. Therefore, the idea of Sikhs who get offended because someone disrespects their holy book and kill those persons, seems incomprehensible to me.

It is a pity that such messages of "offending God" are also spoken by people wearing saffron, who talk of beheadings and killings. Their saffron clothes should signify spirituality and learning. Yet, they can refuse the temple drinking water to a thirsty boy, because he belongs to another religion and say that they are defending Hinduism. How can they defend Hinduism if they do not believe in the ideas contained in the Veda and Upanishads?

IMO, Progressives have facilitated this rise in the Hindu chauvinism by closing their eyes to similar ideas and practices of conservatives of minority religions by suggesting that only the majority bigotry matters. Every time, there is violence or aggression involving persons of different religions, it seems that the Progressive speak out only if victims are from the minority religions.

In The End

The Hindu cultural warriors are convinced that if they don't save Hinduism then it is in great danger. The progressive cultural warriors believe that the problems lies only with the Hindu chauvinists and they are blameless. The thinking of both the groups is a problem.

Fortunately, in spite of everything, life goes on. I have great faith in common Indians, as shown by the findings of the PEW survey. I think that in spite of all the mutual hate expressed by the two groups, common Indians will find the right balance and a way to go forward.

Day before yesterday was 23rd March, the birthday of Doctor Saheb (Dr Ram Manohar Lohia), the iconic socialist leader, whose ideas had so much impact on me as a child. Today it is 25 March, the day on which papa had died 47 years ago at the age of 47. He was an associate of Doctor Saheb. If he was alive today, he would have been 94. Even after so many years, I miss him. I think that I would have loved to talk about the subject of this post to him and to Doctor Saheb - though I am not sure if they would have agreed with me!

The City of 47 Ronin

The tiny town of Ako in south-west Japan is known for the story of 47 Ronin. The city has a beautiful Shinto shrine with the statues of those 47 warriors who had chosen to become outlaws to avenge the death of their lord. (Click on the images for a bigger view)

I had watched the film "47 Ronin" starring Keanu Reaves, which was based on this story. A couple of years ago when I was in Okayama for a meeting organised by Sasakawa Health Foundation, I had discovered that it was not very far from Ako. Thus, I took that opportunity to go and visit this city and to become familiar with its famous legend. This post is about my visit.

Samurai and Ronin Traditions in Japan

The Samurai (Bushi) warriors became an important group in Japan in the 12th century when they worked for feudal lords. Those lords along with their samurai were the real rulers of Japan.

The samurai followed a code of conduct called Bushido. According to the Bushido, when a Samurai became master-less, for example by the death of his master, he was expected lay down his arms and to commit suicide by Seppaku (by plunging a knife in the stomach). Any samurai who did not kill himself was known as ronin, a warrior without honour.

The ronin were looked down upon by their fellow samurai and by the society. They were ridiculed and faced public humiliation.

In 1868, with the Meiji reforms, the military control of country was replaced by a centralised bureaucratic governance. This ended the role of samurai.

I feel that the idea of warriors without a lord committing suicide according to an ethical code sounds similar to the ideas in medieval India about widows letting themselves be immolated along with their husbands' bodies under the "Sati" rituals. Such ideas may seem acceptable while one is wrapped inside and isolated in those ritualistic beliefs. Perhaps some can argue that the suicide bombs by radicalised Islamists are similar rituals, though those are fundamentally different since they also involve additional killing of unsuspecting persons. However, an unwrapping of self and a contact with wider world makes such ideas of ritualised suicides seem like aberrations and a kind of mental illness (though the traditionalists won't agree with this view).

Looking at the figures of Ronin through modern eyes, I feel that seeking revenge for their lord's death was a better option for the warriors, than killing themselves through ritual suicide, though in the Ako story, they did kill themselves after taking their revenge.

The Ronin of Ako - Historical Background

"Ako vendetta", was a historical event in which a group of ronin avenged the death of their master Lord Naganori Asano.

In 1701, Lord Asano, the Daimyo of Ako, was forced to commit ritual suicide by Kira Yoshinaka, a scheming official of the imperial court. However, Asano's samurai did not commit seppaku as foreseen by the Bushido and instead became ronin. Their initial attempts to avenge the death of Lord Asano were unsuccessful. Finally, those 47 ronin managed to kill Kira at Sangakuji in Edo (now known as Tokyo).

Even though by taking up the arms after the death of their lord, they had violated the samurai code of conduct, their honourable action in avenging Lord Asano was recognized. Thus after their revenge, those 47 ronin were allowed an honourable death by committing seppuku.

During the Meijo era (1868-1912), the story of 47 ronin became very popular all over Japan through songs and traditional plays such as kabuki. It was a tale of persistence, honour and sacrifice. The Hollywood film "47 Ronin" (2013) was inspired from this story.

The City of Ako

Ako is located in the Hyogo prefecture in south-west Japan, between Osaka and Okayama. Its railway station is called Banshu-Ako. It is a small coastal town facing the inland sea. It has a population of around 50,000.

Ako is located on the banks of Chikusa river and has a good network of canals. On 14 December each year, Ako celebrates the Gishisai festival to remember the 47 ronin, with a parade of the warriors dressed in old costumes and illuminations with lanterns.

Reaching Ako

When I told my Japanese friends that I wanted to visit Ako, they were a little surprised. The city's name was not so familiar to them. I had to explain the story of 47 Ronin to them. Even at the tourist office in Okayama where I went to ask for information, they were surprised that I wanted to go to Ako. They were not sure if there was much to see in Ako. However, as you can see from the images, it is a beautiful city and is worth visiting.

To reach Banshu-Ako, I took the Ako line local train from Okayama. The journey took around an hour. Passing through small towns and villages (including Bizen and Osafune, two famous small towns in this region) along with verdant mountains, it was a beautiful journey.

The local train network also connects Banshu-Ako station to Himeji and Kobe on the east.

Places to visit in Ako

The city centre is small. The places to visit include the ruins of the castle of Ako and some shrines and temples. Among the shrines, the most important is the Shinto shrine linked with the 47 ronin located near the castle.

Among the temples, the most important is Kagaku temple. The Kagaku temple, the Ako castle and the Shinto shrine of the 47 ronin, are all at a walking distance from the railway station. The main street in front of the railway station leads to the castle. A map of the city in the square facing the railway station will show you all these landmarks. The city, including the railway station, is full of banners, posters and tiles with images of the different Ronin warriors.

In Kagaku temple, I met a group of Japanese artists, who were visiting the city and making drawings of its different buildings. They were curious about me but we had to communicate with gestures as they could not understand English.

The Kagakuji (or Sengakuji) was the family temple of the Asano family. It is a beautiful Buddhist temple with a giant bell and with different shrines. I was told that Kagaku temple has the tombs of the 47 Ronin, each marked by the number "7" to denote death by seppuku. However, I had also read that the tombs of the 47 ronin are in the cemetery of the Sengakuji temple in Tokyo, so I am not sure if the tombs in the Kagaku temple of Ako were real or not. I tried asking about them but was unable to make myself understand and thus, did not see them. In the temple, there were no sign boards indicating the tombs.

Ako Castle and Oisho Shrine of the 47 Ronin

When I reached the castle, some of the persons from the group of Japanese artists had also reached there and they smiled at me. There was no ticket to enter the castle, which does not have many things to see. Imposing walls surrounded the castle ruins. This castle was destroyed by the bombings during the second World War, and its walls have been recently rebuilt to recreate the old ambiance.

Inside the walls, most of the ruins were just empty spaces marked on the floor explaining the different building of the old castle. The castle was built by Naganao Asano Ako, the third lord of Ako domain and the grandfather of Naganori Asano. It had taken them 13 years to built this castle. I was told that the rooms of the Lord and his wife were marked on the floor, but since it was only in Japanese, I could not identify them.

On one side inside the castle, there is a short and squat tower (Tenshudai), where you can go up and have a panoramic view of the area.

A winding path passing near the Ako Museum of History and the Gardens of Ako castle took me to the shrine behind the castle. It is marked by a row of statues of the 47 ronin on both the sides of the path. This shrine is also called Oisho shrine to remember Oisho, the leader of those Ronin.

Each statue of the ronin was different - showing men of different age groups, each with his favourite weapon, some of them standing while others were sitting. Against the background of the castle ruins, the two rows of statues lining the path leading to the shrine made a powerful visual impact.

Inside the shrine gate (Torii), on the two sides were two giant wooden statues of pot-bellied old men. The one on the left was Daikoku Sama, symbolising luck and matrimonial happiness. The one on the right was Ebisu Sama, symbolising success in business and trade.

Inside the shrine, there were different memorials for persons to express their admiration for the warriors - for example, through the streamers of paper-cranes usually placed in cemeteries. The courtyard also has a statue of Oishi Kuranosuke, the leader of the Ronin.

One of the shrine buildings was Homotsu-Kan or the treasure hall, entry to which has a ticket. Inside you can see the Oishi "Glass of Rules" for the Ako samurai. The rules included the following - do not fight, do not spill drink from your mouth and do not force a non-drinker to drink.

A path from the Shinto shrine led to castle garden - a beautiful garden just outside the castle ruins. When I visited it in April 2017, it was not yet completely done and some parts were closed. Still it seemed to be landscaped beautifully with a canal, some gently bubbling fountains and a quaint bridge.

The garden ruins also include two ponds, both beautifully designed to evoke feelings of peace and harmony.

Conclusions

I could visit Ako only for a few hours. It was a rainy day. I knew that there would not be enough time to visit the historical museum or to go to the sea coast in Ako. On the other hand, I had thought that I will be able to visit Chikusa river and a couple of other shrines near the railway station. However, the visit to the castle and the Oisho shrine took most of my time and I could not do more, I had to rush back to catch the train to Okayama.

I think that Ako merits a visit. If you are visiting south-west Japan, such as Okayama or Kobe, it would be worthwhile keeping a morning to visit it.

*****

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