Therapy in Bhopal: a UK-based bodywork therapist’s experience

My name is Ian Jarvis and I am a bodywork therapist in the UK, practicing in the Warwick area and London with a system called Spineworks. I was in my mid-30s in 1984 when the gas disaster occurred and struck a chord with me. In those days we did not have 24-hour news nor internet campaigns so the news was sparse and intermittent and quickly forgotten by most.

For some reason it has remained in my mind and some months ago, when I was looking for something more ‘worthwhile’ to do there was a BMA leaflet in the New Internationalist. I contacted Sathyu in Bhopal and the BMA office in Brighton and arranged to visit as a volunteer for three months. Naturally, they were unsure about me giving Spineworks treatments in the clinic as the trustees have to be satisfied of the authenticity and efficacy of all techniques. So it was decided that if it didn’t work out, I would do whatever needed doing!

Shortly after I arrived, Biju, the Ayurveda bodywork practitioner for men introduced himself to me and invited me into his treatment room. It was nice that he did not see me as a threat but a helper. There is also a woman, Beena for the females as there is gender separation here. (Though it is not so everywhere.) I spent a lively morning with him and four patients discussing our different approaches. There are some interesting concepts and they are very inventive, having made a steamer from a pressure cooker and built two steam cupboards. A couple of weeks later a visiting American said to me that there was no temperature control for the box. I pointed to the stove and said, “Yes there is, the patient shouts and Biju turns the hob up or down – simple, fast and effective!”

A man enters with a knee problem, one of many it occurs to me. I asked Biju if knee problems are more common in Muslims than other religions. I told him we have a condition that we refer to as ‘Housemaid’s Knee’ from all the cleaning of floors they used to do while kneeling down. I have observed bruises on the ankles and knees of other men we have seen in the few days I have been here and wonder if it might be ‘Prayermat Knee’. He had not considered that but thought it could be a reason, after all they pray five times a day and the mats are not thick. Maybe we should suggest that prayer mats are made a little thicker and more accommodating to the knees. Could this become an increasing problem in the UK?

Once a doctor assigns a patient for Panchkarma treatment they attend every day for up to two weeks, this is novel to me. In the UK, people simply could not afford that even if they could find the time, so weekly sessions are the norm. I think one reason for this is that the main approach is through massage with special oil and it is a good way to be sure that the 23 herbs penetrate quickly and get to do their work. Although the therapists can choose to do extra sessions or fewer, they have no other control over what treatment to do, this is prescribed and regulated by the doctor.

The treatment table for Panchkarma is a traditional wooden construction, beautiful wood and elegant design. The idea of the wooden table is to absorb excess oil, a function it does very well. But it is also very unforgiving to the soft flesh of a person. One of my first patients, Salim, is for sciatica and I want him lying face down on the table but that just looks very uncomfortable on the wooden table. I look around but there is no sight of any padding.

The next day is Saturday and the clinic works on Saturday so as the rain pelts down I wander along to the room with a thin mattress and pillow under my arm. I dressed the table with the mattress and Salim lies down looking at least a little more comfortable than yesterday. The pain is also less than yesterday so we are moving in the right direction.

At home I always leave 30 minutes between patients, to do everything from writing up notes and preparing for the next person, tidying the room and having a pee – you never know what may arise. It also gives a buffer for not finishing on time and patients arriving early. Here they plan for 30-minute slots, which, in effect, means that each patient gets a 20-minute treatment, allowing time for getting in/out and undressing/dressing. For me that is difficult. And even then it gives no time to write up notes of the treatment. This does also suggest that the therapists can really only work on the local problem. So, if someone has a knee pain, then the knee is all that can be treated in seven to ten 30-minute sessions. There is no time to assess the pelvis and leg length to see if that is out so the likelihood of recurrence can be reduced.

When I arrived it was nearing the end of Ramadan and also the monsoon season so patient numbers were relatively light. Then they increased and if it is like this every day apart from during Ramadan, (often Biju and I are both treating and Beena has a queue still waiting at the end of almost every day), I would not be surprised to find the two Panchkarma practitioners right frazzled after so many years of this. I wonder how they keep going?

A morning in the clinic! My 8:15 didn’t arrive, a new man came at 8:25 or so and with translation help I decided to start him. 8:15 arrived at 8:50 so I started him and when 9 arrived at 9:05 he had to wait for half an hour. 9:30 didn’t come (maybe at the mosque), 10 arrived at 10:20, 11 was on time and at first I confused him with 11:30! Fortunately, I have put their registration numbers on my records so at least I can make sure who I am treating. With so many new faces in one week it is not easy to keep up. Fortunately my hands are generally more reliable than my eyes. 11:30 was on time but I overran so he had to wait 15 minutes. Lunch!

In several weeks I did about 50 treatment sessions each week of between 30 and 45 minutes in length. That is more, by far, than I would choose to do in the UK. When students, and others, ask me how many treatments they should do each week I always advise that if they can honestly say that the last session of the week has the same focus, integrity, energy, love and patient attention as did the first then it is OK. As soon as they cannot, then they are doing too many. So, can I say that? Even though the numbers are not my choice. I honestly think I can say that – for these few weeks. Could I keep that rate up for a month, a year, ten years, and working six days a week? I really don’t know but I think my energy would be depleted and even if the first and last were the same, the overall quality of my work would be going down I am sure.

This week there were several occasions when someone did not turn up or came at a different time. I was speaking about this to an Ayurveda doctor and he said that is in not infrequent that when he sees someone for a follow-up consultation they have not taken the remedies he has prescribed. Not only are the consultations and treatments free but so are the pathology tests, remedies and medicines. He said maybe people do not value sufficiently something for which they have not paid. It makes it a difficult proposition – should you give things away when people cannot afford anything and risk them not valuing it or should you charge them something at least in the hope it will make them use what you give them?

I can’t yet quite get a handle on the aim of the treatments here. I was thinking about it as I came to the ‘end’ of someone’s allotted treatments. What happens is that one of the doctors sees a patient and sends them for Panchkarma specifying a number of sessions, usually around 5 to 10. There can really be no logic to the number chosen since, from my experience it is impossible to say for anyone how many they will need. In my own practice I and the patient discuss it every few sessions so we are always agreed about the aim. It may simply be to remove pain or it may be to promote health – that is about the two ends of the spectrum. Depending on that, we both have expectations. It seems essentially different here, working with people who have been ‘sent’ – willingly of course as it is their choice to turn up. In practice, with 10 half-hour sessions I cannot expect much more than to help remove the presenting symptoms and improve the balance in their body. We, me and the patient together, can plan and hope that this will be achieved but to reach a state of positive health will take more than that.

Miracles do happen of course. One of my current patients here is Abdul, with a big scoliosis complete with kyphosis and a rotation of the spine and lots of pain. In his fourth session I focused on what I thought was the small area of greatest stress where the rotation and scoliosis seemed both to point. That was about a 2cm square of tissue. I spent about 40 minutes just working that, gently. The session ended and he was pain free, and still is, and, naturally, delighted since it has been a longterm problem. So, of course am I delighted for him. So, arguably, that is achievement. The rotation is also reduced but unless I can do more sessions to reduce (at least) the scoliosis, then I fear that over time it will revert. Not only that but he ‘should’ ideally look at his posture and usage of his body in his everyday life. Yet his allotted number of sessions has theoretically come to an end.

But, if positive health were the focus for every patient they would need a dozen Panchkarma therapists and then some. So, is the best we can do in a situation like this simply to remove pain? The problem is so vast and is not just about presenting symptoms. Look around. It is about living conditions, pollution, education, numbers of children, poverty, opportunity, work and pay, equality, gender and, at bottom, the sheer will to live and break free.

Looked at in that way it can become overwhelming – maybe here I need to come back to the Reiki mantra I learnt all those years ago ‘just for today – – -‘. We must start where we are and do just what we can and be happy, and, at the same time aim high, always looking for the miracle.

So maybe we are here just to help people remove their sickness rather than to promote their health. When you are providing a free service in a slum area where over 90 percent of the people are affected, to do the first is magnificent; to do the second is – – – ?

The plan for the next few weeks is to teach Biju and Beena some of my techniques so it will add to their skills and give them just a few more options for the nature of their treatments.

* They call them “patients” so I have used that term in this article rather than patient which I prefer.

More information on Spineworks here.

Girl with candle Bhopal

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