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