On Tuesday 09 Jun 2009 7:54:11 pm . wrote:
> the indian obsession with the right hand
Just for you: In 1999 I wrote an article for my alumni newsletter that I
reproduce here:
Toilet thoughts
When one is young, one takes for granted the experiences that one is
subjected to, and accepts rules that are taught without questioning their
meaning. At least, this was certainly true for me until I entered an NHS
toilet in England in the early 1980s in partial fulfillment of an urgent
physiological requirement.
I found, to my amusement, that the toilet paper had, printed on it, the
words "Now wash your hands please". I wondered if people had to be told to
perform this task which I and everyone I knew performed routinely without
talking about it and announcing it aloud.
Suddenly, something fell into place in my mind and I started thinking of all
that had been drilled into my resisting mind as a boy at home, and compared
it with the wisdom imparted to me by my teachers and textbooks in medical
college. I remembered being taught the word "fomite" and how a fomite might
spread bugs (of the non-carrot-eating kind). It seemed strange that the act
of washing one's hands after using them for unspeakable tasks had been
conceived of and taught to me by people who had no knowledge of fomites or
fo-midges. How had they known?
There were a number of other tips on hygiene that had similarly been passed
on to me. I was born and brought up in a Brahmin family, and there exists a
concept called "madi" in Kannada. Madi is pronounced "muddy", but is quite
the opposite in its intent. "Madi" is typically used by a Brahmin prior to
performing his work - whatever it might be - which traditionally was that of
a teacher or a priest, or even perhaps a physician. In essence it involved
having a bath and wearing fresh clothes, after which the person could not be
touched by a "non-madi" person. Even a single touch was
considered "contamination" (a state called "ma'ilgay"), necessitating a
repeat bath and a change. The concept was a joke for me, and I remember
deriving great pleasure from ruining the "madi" state of my grandmother by
touching her. A decade later, I realized that the practice of operating
theatre technique has close parallels to this "madi" state. A mere touch is
considered contamination, and is treated as such.
People still remove their footwear before entering a house in India.
Certainly this used to make much sense when cooking, eating, and everything
was at floor level in India. Removing footwear is the usual first step before
entering most operating theatres and intensive care units anywhere in the
world. Overshoes serve much the same purpose - that is, of preventing gross
contamination adherent to one's footwear from being carried in and spread
around in an area where one is trying to keep contamination down. In Indian
homes the advent of dining tables and kitchen platforms for cooking have
diluted, but have not fully taken away the significance of the simple act of
removing one's footwear.
At a recent meeting in Bangalore on nosocomial infections, one prominent
surgeon from St. John's said that in this day and age it is ridiculous and
unnecessary to take off one's shoes before entering an ICU because bugs
cannot walk up beds and tables. I was surprised at this statement from a
person who I otherwise view in a very favourable light. Floor contamination
has an insidious way of getting on raised platforms. Dust can be stirred up
by gusts caused by people walking. Pens and papers are accidentally dropped
and then picked up and replaced on tables or on beds. I still think removal
of footwear is a useful adjunct in keeping bug counts down.
As a boy, I was always instructed to wash my hands and feet if entering the
house from outside, or after visiting the toilet. The necessity for washing
hands is obvious, but why the feet? A single experience of relieving oneself
in the traditional Indian way gives new meaning to the word "splashing", and
it is easy to convince oneself that washing of feet is an essential part of
maintaining a degree of hygiene. But what about hospitals? Certainly, we all
wear shoes, and most wear socks as well, and our feet are generally kept free
from gross amounts of muck, so removing footwear is probably adequate - for
us. But things always work differently in India. I once noticed that the
canteen boy who brought in coffee and snacks to the operating theatre side
rooms was barefoot, seemingly indicating that he had removed his footwear.
But when I followed him out, I saw that he had no footwear at all. In effect,
that hospital had a system in which those who had footwear maintained OT
hygiene by removing their footwear outside, but the dozens of people who
never wore footwear at all were walking in and out of the clean area of the
OT with impunity. Maybe washing one's feet should be a requirement before
entering Indian operating theatres.
Another concept, drilled into most Indians is the idea of something
being "jootha" (hindi), or "yenjilu" (literally saliva in Kannada). If I eat
from a plate, that plate is jootha or contaminated, and no one else eats from
it until it is washed. The degree of jootha-ness that one tolerates is
dependent on one's cultural background. The concept has some scientific
basis, with the idea being to avoid any chance of an inadvertent exchange of
body fluid from one person to another. I don't know how this concept was
first introduced in India, but I have a reasonably good idea of how it came
about in modern science.
And finally, that seemingly silly habit of using the left hand for
unmentionables, and the right hand for clean stuff. Surprisingly, this has
parallels too. Every time I do a wound dressing, the nurse hands me something
sterile using a pair of tongs ("Cheatle's forceps"). The handle of this
instrument is considered contaminated, while its jaws are considered
non-infective by virtue of their being stored in an alleged antiseptic
liquid. Not too different from right hand and left hand is it?
shiv
