[Bruinrab]

Folklore and Frustration

The shabby disease remedy shop was small for its outsize promises. A dusty storefront crunched between souvenir stands, it sat near the Kapaleeswarar temple, a familiar tourist choice in Chennai. Inside spilled a teetering mass of ready relief for arthritis, heartburn, gout, piles. Beneath the scalding sun, an ox cart pounded past, scattering a swarm of people padding down the street.

The grizzled proprietor, who was asked if he had anything for diabetes, readily proffered a bottle of pea-soup-colored liquid. It cost roughly $3. Its exact contents, the man said, were as privileged as Coke’s formula. But drink a capful twice a day for three months, he assured, and the diabetes would vanish.

Though no universal cure exists for diabetes, “cures” and other mischievous medicines nonetheless abound in India. Much of the population gravitates to cryptic beliefs threaded with untruths that are hard to nullify.

People believe in bitter gourd juice and fenugreek, an Indian spice, which can temper sugar levels, but are not cures. Some years ago, the wood water cure gained considerable traction. Drink water stored overnight in a tumbler made of Pterocarpus marsupium heartwood, the promotion went, and it would wash away the diabetes.

All this exasperates Dr. Murugesan. He is among those trying to stanch the spread of the disease. Diabetes education is hard enough, without tomfoolery and witchcraft to discredit.

He had something to show on his desktop computer at the M.V. Hospital for Diabetes, a prevention program known as “Chubby Cheeks.” Animated mothers on the screen merrily admitted that they associated being chubby with health. Animated chubby students chafed that their parents refused to let them play, but forced them to study endlessly so they could become doctors and engineers. They studied, they sat, they enlarged. Dr. Murugesan takes his cautionary tale around to schools and waves it like a lantern.

Dr. Murugesan is himself an Indian diabetes story. A health educator, he devoted 20 years to erasing leprosy in southern India. Two years ago, with that scourge largely beaten back, he itched for a fresh menace. He chose diabetes. He saw its rapid ascent.

What’s more, he had diabetes.

Upon enlisting in the sugar fight, he felt it behooved him to test the blood sugar levels of his own family, and he excavated truths he had not wished for. His wife, daughter and one of his sons were all bordering on becoming diabetic. His other son, just 28 then, already had diabetes.

“I say it’s like Jesus Christ,” he said. “When you don’t look for him, he’s not there. When you look for him, he’s there. You look for diabetes, and it’s there.”

Prevention, he recognizes, is a mountainous climb in a country with a severe shortage of medical workers. What health care money exists is overwhelmingly applied to infectious perils.

The health minister, Dr. Anbumani Ramadoss, recently said he would begin a diabetes program, but the timetable and scope are unclear. Indian politicians in pursuit of votes rarely campaign on matters of health, but promise the poor cheap rice or free color televisions.

All of which perpetuates a dual continuum. Rural Indians flock to the cities, only to encounter diabetes, while Westernization sweeps its way to the villages, carrying diabetes as its passenger.

Thus Dr. Mohan, among other efforts, dispatches prevention teams to Chunampet, a cluster of villages a couple of hours south that are a feeder area for Chennai. Most of the villagers have no idea what diabetes is.

Meanwhile, Dr. Murugesan has enlistees operating in the Srinivasapuram slum, a grid of cramped thatched huts and makeshift tents that hug Chennai’s long beach.

The diabetes rates among these raggedly lives are notably below those of the middle and upper classes. But they are catching up.

When evening gushes over the slum and the mosquitoes emerge, a scattering of diabetics drift over to the tiny Vijaya Medical shop. They are poor at “self-poking,” as they explain, and have no refrigerators to chill their insulin. Some fill mud pots with water and stuff their vials in there. Others rely on the medical shop proprietor, a merry young man with legs withered by polio.

He tapes their names to the appropriate bottles and, each day, administers shots.

Misconceptions populate the conversations. Some residents say they occasionally have diabetes: a few years with it, then a few years without it. They think that diabetes pays visits.

Others are rabid apologists for the disease. Uninterested in eating less, they say that when they feel like a big meal, a luscious plate of sweets, they just swallow an extra pill or inject themselves with more insulin.

“They don’t understand,” Dr. Murugesan said. “They don’t see the darkness of this disease.”

Late in the day, back at the M.V. Hospital, he trooped upstairs to the rooftop auditorium, where 40-odd doctors had assembled to talk about prevention efforts. One thing they talked of uncomfortably: A particular profession in India, they heard, a well-paying one involving a lot of standing around, had practitioners who did not necessarily heed their own advice.

The profession was thick with diabetes. It was doctors themselves.