Monday, November 16, 2015

India's Holy Cow Vigilantes

By Jason Overdorf

Newsweek (November 2015)

Outside the 150-year-old Tangra Slaughter House in Kolkata, India, a line of cows stretches down the lane alongside the arched, colonial-style building. There are no fixed prices for beef here, so the noise of a dozen shouted negotiations fills the air. But it's not all business as usual. Photography is prohibited, at least for today, and I'm allowed inside only after agreeing to keep my notebook in my pocket and not ask any questions. The beef-and-leather business is sensitive in the country where “holy cow” is not a throwaway phrase.

“People are scared,” says Syed Faiyazul Haque, a supervisor at a Kolkata tannery. “There’s an atmosphere of fear.”

That’s because at least three Muslims suspected of eating or transporting beef have been killed in recent weeks. Hindu nationalists have been campaigning for a countrywide ban on slaughtering cows, which they consider holy animals, and religious tensions are rising.

Prime Minister Narendra Modi's Hindu nationalist Bharatiya Janata Party (BJP) pushed the issue of cows to the center of its campaign for elections in the northeastern state of Bihar during October and November. The aim seems to have been to consolidate the Hindu vote by casting Muslims as the chief enemy, and thus counteract divisions among high- and low-caste Hindu voters who favored the party’s opponents. Yet Modi’s party suffered a crushing defeat. The BJP and its local allies took just 58 out of 243 assembly seats in the Bihar polls.

Muslims and many secular Hindus across India celebrated the election result, expressing hope that the prime minister who came to power preaching economic development, not Hindu triumphalism, would return to that message. But for beef and leather traders, and perhaps for India’s bid to attract more foreign investment, it may already be too late.

Traders involved in the leather and beef industry in Kolkata say vigilantes have stopped large numbers of trucks transporting cows, hides and carcasses since the anti-cow slaughter campaign accelerated last month. Many transporters are reluctant to take the risk, after a trucker accused of carrying cattle carcasses was killed in October by a Molotov cocktail in the northern state of Jammu and Kashmir. Because one carcass or hide looks much like another, not even the unrestricted buffalo trade is safe. And the charged atmosphere makes it all too easy for local police and inspectors to demand payoffs.Despite the cultural taboo on killing cows, slaughtering them for meat and hides is legal in five of 29 Indian states, including West Bengal, where Kolkata, the former capital of British India once known as Calcutta, is considered the center of the trade.

“This is a reflection of anti-Muslim propaganda in India,” Udayan Bandyopadhyay, a political scientist affiliated with the University of Calcutta, says of the recent attacks. “In order to gain mileage, the [Hindu nationalists] are making a partition in society between Hindus and Muslims.”

Even in ordinary times, the country’s meat-and-leather trade is a strange business. Last year, India, which is 80 percent Hindu, emerged as the largest beef exporter in the world. Combined with leather, the industry is worth some $10 billion. How's that possible?

It is partly because under a system drawn up by the U.S. Department of Agriculture, the meat of Indian water buffaloes, which Hindus do not consider holy, is classified as “beef.” Exporting cow meat is banned, though cowhide accounts for around a third of India’s leather exports. Yet in Kolkata, tannery workers say the mix of buffalo hide to cowhide has fallen from 50-50 to 80 percent buffalo in recent weeks. Since the first attacks on transporters in September, buffalo-processing factories have also been facing shortages.

“Our drivers are stopped while they carry buffaloes. There is fear among drivers,” says DB Sabharwal, a Hindu, who's secretary of the All India Meat & Livestock Exporters Association.

In most states, and sometimes even in Kolkata, that's technically illegal. Along with bans on cow slaughter and the consumption or possession of beef, various states have made it a crime to sell or transport cows out of their jurisdiction if they are destined for the butcher. In states where cow slaughter is legal, a “fit-for-slaughter” certificate is required to document that the animal in question is more than 12 to 14 years old or “permanently incapacitated for breeding, draft or milk due to injury, deformity or any other cause,” according to the Ministry of Agriculture. But that rule too is frequently flouted, according to people opposed to killing cows.The domestic market is more complicated. While cow slaughter is permitted in only five states, the animals are everywhere. There's no separate meat industry. But a mammoth dairy industry and the traditional use of draft animals means there are more than 190 million cattle in India, compared with about 90 million in the United States. As tractors replace bullocks in agriculture, around half of these animals are becoming a drain on the farmers' resources. And while Hindu nationalist organizations have set up nursing homes for hundreds of thousands of superannuated cows, it's no surprise that many farmers prefer to sell them rather than put them out to pasture.

The result is a tortuous path of payoffs, smuggling and don't ask, don't tell. The not-quite legal nature of the business means there are no large firms buying cows and shipping them to Kolkata—or smuggling them to Bangladesh. Animals pass through a chain of transporters before they’re sold for slaughter. Then middlemen collect meat and hides into the larger consignments needed by the leather businesses and other industries that rely on tallow and other by-products, says Shahid Akhtar, managing director of a leather goods manufacturer called Elrich International. “Those people will have problems now,” he says. “The police or vigilantes will confiscate the items, then corruption will increase. This has started to happen.”

It's not clear how devoted to the issue Modi is, or how beholden he'll be to the larger, parent organization of the BJP—a uniform-wearing cadre of activists called the Rashtriya Swayamsevak Sangh, whose second “supreme leader,” Madhav Sadashiv Golwalkar, was an admirer of Adolph Hitler.

It's not all Hindus vs. Muslims. Middle-caste Hindu merchants dominate the leather export business. Some lower caste Hindus eat beef, though many have adopted high-caste food taboos in a bid to avoid discrimination. So do many of the country's dozens of indigenous tribes. Many self-declared secularists and atheists partake too—some viewing it as a badge of tolerance or rationalism. Yet Hindu nationalists and some ordinary Hindus look on killing cows much the way devout Muslims view drawing cartoons of Muhammad—something they say Indian secularists would never countenance.

Modi's critics still blame him for the tardy police response to the 2002 riots that killed at least 790 Muslims and 254 Hindus when he was chief minister of Gujarat, his home state, though he was exonerated in court. Opponents have taken him to task for delayed and wishy-washy public statements in response to attacks on churches, belligerent statements from Hindu nationalists and the recent cow-related violence. For instance, he waited 10 days to speak out against the September 28 lynching of a man wrongfully accused of eating beef.

Arun Shourie, once one of the BJP's most respected leaders but now marginalized under Modi, believes the prime minister’s silence was deliberate—and it was interpreted as a green light by rowdier sections of the movement. After an incident of inter-religious violence occurs, other members of the BJP and affiliated organizations keep it alive by making provocative statements, Shourie said in a televised interview with a national channel. Only after weeks pass does Modi comment, and then it is to say something cryptic. “It almost comes out as if it is by design,” said Shourie.

Supporters reject such criticism. “To defame Modi, a negative campaign is coming from the so-called secularists,” says Surendra Kumar Jain, All India Secretary of the Vishwa Hindu Parishad, the Hindu nationalist group leading the push for a national ban on cow slaughter. Vigilante action has to be understood in the context of the failure of law enforcement, he says. “Suppose a woman is being raped? Will you stand by and wait for the police?”

It's not only the beef and leather industry that is at stake. India has climbed in the World Bank's ease of doing business rankings and has replaced China as the most popular destination for foreign direct investment since Modi came to power in 2014. But both the devastating loss in Bihar and the flirting with sectarian strife could further derail his plans for the economy.

The vituperative atmosphere will make it more difficult to reach a consensus with the opposition. And the election loss itself means Modi is drifting further away from a majority in Parliament, where several proposals for big bang economic reforms have already withered and died.

“Along with a possible increase in violence, the government will face stiffer opposition in the Upper House as the debate turns away from economic policy,” Moody's Analytics said in a November report. “Modi must keep his members in check or risk losing domestic and global credibility.”

Thursday, November 12, 2015

Blood, guts and glory: India's boxers hit pay dirt

They got India's first pro-boxing event off the ground. We go behind the scenes with the man who may well be the Don King of India
By Jason Overdorf
GQ India (November 2015)

An hour after the scheduled start time, Jaisingh Shekhawat, the 30-year-old chief organizer of India’s first professional boxing event, burst into the improvised pre-fight green room in a panic, his brow beaded with sweat. “What the hell’s going on?” he snapped at coach Mahavir Singh, busy supervising a last-minute briefing of the nine Indian match judges. Shekhawat caught me watching him and winced. “Mismanagement,” he said ruefully, juggling his portfolio and walkie-talkie.

All around the green room – repurposed from the drivers’ waiting area in the basement parking garage of Delhi’s Select Citywalk Mall – the fighters displayed a monastic calm. Punjabi heavyweight Gurlal Singh, to fight Haryana’s Vikas Hooda in the first of four scheduled matches, stood in the corner like a B-movie Hercules as three hangerson laced up his groin protector. Thai super bantamweight (55.3kg) Khunkhiri Wor Wisaruth was taping the hands of American super middleweight (76.2kg) Clinton Smith, while Smith’s opponent for the night, 13-time national champion Dilbag Singh, casually slipped on a glove and sunk a joke-hook into a friend’s belly to test it out, punctuating the punch with his devilish, 100-watt grin.

If anyone here had reason to sweat, it was Shekhawat, a slim, slicklooking guy with brushed-back hair and gold hoops in both ears. The delayed start put his newly formed North Indian Boxing Association (NIBA) at risk of failing to complete the programme before 10pm, when the permit for the outdoor plaza upstairs would expire. If the authorities shut them down before the end of the main event — a 12-round contest between Indian Neeraj Goyat and Filipino Nelson Gulpe, competing for the vacant World Boxing Council (WBC) Asian Welterweight Championship - the dream of bringing pro boxing to India would be confirmed a fiasco.
Already, one of the biggest news stories to emerge from the farcical pre-fight press conference the day before was a Hindustan Times article headlined “Nothing professional about pro boxing’s India debut”. And tonight, WBC Asia head Patrick Cusick was still fielding basic questions from the judges and referees about pro-level rules and scoring – which differ widely from the amateur game.

Maybe it didn’t show, but more than a year-and-a-half of work hung in the balance.

Jaisingh Shekhawat was always a boxing fan, and participated in a few state-level tournaments before getting into the marble business in his home state of Rajasthan. He had long thought there was a potential market for professional boxing in India, but it took the drive of his old trainer Mahavir Singh (best known as the coach of Olympic bronze medallist Mary Kom) and Neeraj Goyat (arguably India’s keenest pro) to get the idea off the ground. With six professional fights in China and Thailand, as well as a brief stint in India’s Mixed Martial Arts Super Fight League, 23-year-old Goyat had made connections with foreign managers and WBC officials while he was abroad. So when he emailed WBC head Cusick about a licence to hold events in India, he got a response.

Slowly, things came together. Ruling out a stadium – fearing nobody would turn up – the team decided on a free, open-air event that would draw a crowd from passersby. They convinced Cusick they weren’t just blowing smoke, and completed the paperwork to obtain the WBC licence. Handshakes were made with top boxers whose amateur careers were over and who wanted to go pro. Rahul Gokhale of Serendipity Marketing Solutions was pulled in to manage the event. Most importantly, Rakesh Naudiyal, a former international amateur boxer, convinced Kashmiri Marbles to come on board as their major sponsor, contributing around ₹10 lakh rupees – about a fifth of the event’s total budget.

Yet, when Naudiyal told me about it all, I was skeptical — not least because they were approaching me for advice.

I’ve been a hack boxer since learning the basics in a Beijing gym that doubled as a karaoke bar and brothel in 1998, picking up trainers in Boston, New York, Hong Kong and Delhi as I’ve moved around. I’d also venture I’m probably the biggest boxing fan on the Subcontinent. But that’s where my expertise ends. (Full disclosure: Naudiyal has been my friend and training partner since 2005.)

The idea wasn’t to get rich, everybody agreed. It was to give Indian boxers an opportunity to showcase their talent. Most of the team had volunteered their time, and apart from outside contractors like Gokhale, nobody expected to make a rupee off the event. Shekhawat certainly had no illusions he was going to be the next Don King — the notorious American promoter who dominated professional boxing from 1974’s “Rumble in the Jungle” between Muhammad Ali and George Foreman through the reign of Mike Tyson in the Eighties — known as much for his slimy business deals as his lightning shock of hair and hi-glint smile of pure evil.

“At the India [amateur] camp, there will be 40-some boxers in every weight class,” said trainer Mahavir Singh. “But only the top one gets the chance to compete in the Olympics. The second, third and fourth guys don’t ever get an opportunity. We want to provide a platform for them.”

My first meeting with Shekhawat, in April this year, was like a Chinese fire drill. Naudiyal was late, so Shekhawat, Mahavir and I stood around in the blazing sun outside the PVR Cinema hall in Basant Lok Community Centre. Neither was comfortable with English, so I was stuck with my “idhar se left, udharse right” taxi Hindi until Kamaljit and a few others turned up. Finally, we tramped up four flights of stairs to a stuffy office that was smaller than an aloo tikki cart. A steady string of beefy guys filled it up until Naudiyal arrived, whereupon we hit critical mass and moved downstairs again. Scouts were dispatched to find a more suitable spot, which turned out to be a McDonald’s. So I viewed the crew’s laptop PowerPoint presentation and dispensed my wisdom, such as it was, over fries and a Coke at a curvy first-floor banquet table.

“As they like to say in America, ‘styles make fights’. You don’t want two match technical boxers who’ll spend the whole night playing defence,” I told them, among other non-pearls.

With that meeting as context, my experience of the pre-event press conference was very different from that of the Hindustan Times writer. I was just gobsmacked that they had actually done anything. “With no money!” exclaimed Naudiyal’s friend Arun Kunal, owner of Add on Entertainment, who’d volunteered to handle public relations.

Patrick Cusick looked out over the audience of reporters gathered at The Lalit hotel. “We’ve been watching the development of boxing in Asia for the last 15 years,” he said. “Ten years ago, we went to China, and now they have their first world champion. We believe India can progress as quickly, if not faster.”

Ninety minutes after official fight time, after countless announcements that the first bout was going to start “in a few minutes,” the announcers were running out of material. “Hurry up and light the lamp,” said one, once they’d wrangled the obligatory-but- not-really-important VIPs onto the stage. When tapers were finally put to the aarti, Shekhawat looked like his doctor had just informed him that his biopsy was negative.

Despite the delays and the 40-degree heat, the crowd hadn’t given up. The 350 ringside chairs for invited guests were full. By the angles of their noses, seemingly every boxer in North India was in the house. Curious onlookers were lined up 20 rows deep in the plaza beyond the guest area, and another dozen rows packed the mall’s first floor balcony.

A hesitant cheer went up as the first fighter, Haryana heavyweight Vikas Hooda, was announced. A thin plume of fog sputtered from the smoke machine, then nothing, as Hooda jog-stepped through the archway and raised his fists in the air.

The thing was finally underway. Somebody must have told Hooda and Gurlal Singh that the fans wanted a knockout, because they hammered hooks to each other’s ribs with no more thought to defence than a couple guys chopping down trees. With the first big blows to the head – sweat flying like shooting stars under the lights – the crowd was hooked. After four workmanlike rounds, when Hooda, in his pro debut, was announced the winner, the emcee didn’t have to exhort the crowd to cheer.
Next up, 13-time All India amateur champion Dilbag Singh squared off against American Clinton Smith. It was the kind of mismatch typical for a top amateur’s debut in the pros – where the idea is to get your guy some easy wins and build up his reputation. Smith was listed in the programme as having 18 wins and 5 losses, but in fact he was a Muay Thai and Mixed Martial Arts fighter. A gristly, tattooed 39-year-old with a shaved head and goatee, he’d told me in the green room that he had five pro Muay Thai bouts, two MMA, but he’d “more or less never boxed before.” Once Dilbag figured that out, it was a matter of Smith being tough enough to avoid a knockout. By that measure, he acquitted himself well. Between rounds, a freshly mohawked Dilbag winked at the ring card girls and grinned at his buddies in the peanut gallery. Smith barely laid a glove on him.

By the time Delhi’s own Balbir Singh was introduced for his super bantamweight bout with Thailand’s Khunkhiri Wor Wisaruth, a veteran of 11 pro fights, the crowd had gotten into the swing of things. The loudest roar of the night rose as Balbir pranced out of the now functioning fog.

From the opening bell, it was clear Balbir didn’t think the stringy Wisaruth had the punching power to keep him off. He bullied the smaller Thai around the ring, winging wild punches and pushing Wisaruth to the ropes, until the Thai drew him into a clinch to get his bearings. When the Indian referee separated them, Balbir let go a hook that caught Wisaruth on the chin. The Thai stumbled back and dropped to the canvas, and the crowd went wild. Even by professional boxing’s more liberal rules, “hitting on the break” is illegal, and Balbir’s punch had the look of a premeditated, flagrant foul. But the Indian referee acted like nothing had happened and gave Wisaruth an eight count when he popped to his feet. For a second, disbelief passed over the Thai’s face, then the realization that he was in the stewpot for a bit of “home cooking” – a staple of professional boxing.

A minute later, Balbir floored him again, this time with a shoulder block, and again the referee pretended nothing was amiss. Wisaruth tried to stick and move after that, but Balbir put him on his back with a straight right in the second round, and seconds later, another right put Wisaruth down and out.

India’s first pro boxing card had its first KO.

Now for the main event: Neeraj Goyat vs Nelson Gulpe for the Asian welterweight championship.

A good-looking and charismatic kid with an easy smile and a mop of curly hair, Goyat was the reason the programme had come together. Unlike most Indian boxers, who quit the game as soon as they get a sports quota job, Goyat was hungry. Though he didn’t have the pedigree to match Dilbag and Balbir, at just 23 he had more years left in his prime. With six fights in China and Thailand, he was already India’s most experienced professional. And along with Dilbag, he’d inked a deal with Las Vegas-based Guilty Boxing to cover his living and training expenses. On the other hand, with two wins, two losses and two draws, he didn’t have the kind of record for people in the fight game to call him “a prospect”. And he hadn’t done anything to merit being invited to fight for the WBC’s vacant Asian welterweight title apart from being born in India. (At 8-4-0 and 3 KOs, Gulpe was a little more legit.)

“I’ve been fighting at super lightweight (63.5kg), but there was no vacant title in that weight class,” Goyat had told me a couple hours before fight time, tucked up to his chin under the blankets in his hotel room, Mujhse Dosti Karoge blaring from the TV. “That’s why I played welter weight this time.”

In the greater scheme of professional boxing, it’s a meaningless belt. The WBC Asia is to the WBC what Italian basketball is to the NBA, and even at boxing’s highest level, an alphabet soup of competing sanctioning bodies plague the sport (the World Boxing Association, the International Boxing Federation, the World Boxing Organization and on and on).

“It’s just to get India on the map,” said Kiwi referee Bruce McTavish, a veteran with more than 100 title fights on his resumé. “It’s showbiz.” But for Goyat, a win would mean an end to being treated like Smith or Wisaruth: “an opponent”, expected to lose. “After this event, people will come to me to fight,” Goyat told me. “Organizers will ask me to come to their countries. Sponsors will come to us.”

A victory might even earn Goyat a fight in Vegas. His promoter, Guilty Boxing chief executive Puneet Dureja, a non-resident Indian with 25 years experience in movie and television distribution, has purportedly signed a deal with America’s CBS Sports Network to stage a series of international fight cards featuring boxers from ten different countries over the next 12 months.

From the opening bell, Goyat took the fight to the taller Filipino, whose punches looked sluggish. Goyat pushed Gulpe back to negate his longer reach, but let Gulpe control the distance and ate a couple four-punch combinations for it. But in the end, he went back to crowding the Filipino, ducking and weaving when Gulpe tried to fire back. The strategy worked.

Compared to Balbir’s knockout, Goyat’s lopsided technical win, drawn out over 12 three-minute rounds, was an anti-climax. But in other respects, it was exactly what Shekhawat’s NIBA and the WBC needed.

When the scores were announced, Goyat’s supporters lifted him onto their shoulders in the centre of the ring and thrust a microphone into his hand.

“I’m India’s first professional boxing champion!” he shouted out in Hindi.

“If the fighters come prepared and the main event is handled in a professional manner, then it will be a success,” Cusick had told me the day before, and at that moment, a success is what it was. It was only a day or two later that the real cracks started to show. Rumours swirled that one of the main sponsors had reneged on a promise to provide ₹15 lakh and Shekhawat hadn’t been able to pay the fighters. Then Rahul Gokhale, of Serendipity Marketing, wrote me to accuse Shekhawat of stiffing him on two of the agreed ₹5 lakh fee for arranging the venue, promotional materials and managing the event.

“NIBA used my office infrastructure, manpower and consultation services for two months, and apart from that the event cost is also not paid. All commitments regarding the payment failed, and now everyone is absconding,” Gokhale wrote in an email.

Shekhawat took my call a few minutes later and assured me he was not absconding. He was very much in town, and had sent Gokhale a WhatsApp message offering to meet.

“I haven’t disappeared. I’m very near his home,” Shekhawat said.

He didn’t deny that they’d agreed on five lakhs. But he said he was withholding the final two lakhs because he wasn’t satisfied with the job Gokhale had done. Among the issues: Gokhale had promised an aluminium scaffold for the light system, but had provided an iron one; and the LED lights hadn’t been functioning for the first match. The crux of the matter, though, was the delay.

“The show was 90 minutes late. I was searching for him, where is Rahul, where is Rahul? He was nowhere to be found.”

Gokhale disagreed. “As far as I was concerned, the event was quite seamless,” he said. “Nothing went wrong.”

According to Cusick and McTavish, none of the foreign fighters complained that they had not received their money. However, it wasn’t clear if those amounts matched the sums that the team had bandied about in their discussions with me – which included match fees of as much as one lakh and post-fight bonuses ranging from₹50,000 to 5 lakh for the winner of the main event.

“As far as my purse I was given exactly what I was promised, no haggling,” Smith wrote in an email. “I am not at liberty to discuss [the] total... But I will say I hope they call me again.”

When I called Goyat, he was more cagey. The organizers had given a cheque for his match fee and the ₹5 lakh bonus for winning the title to a friend in Delhi. But he wasn’t bothered about cashing it, he claimed.

“I didn’t fight for the money. I fought to make history,” said Goyat. “This is the first professional boxing championship to be held in India. I don’t want it to be the last.”

Unpaid bills, dodgy match-ups, an incompetent-if-not-crooked referee — to the uninitiated, all that might sound a bit, well, unprofessional. But to the boxing cognoscenti, where this sort of scheming is more common than not, it may be a hint that Shekhawat and India’s newborn pro boxing industry may already be punching above their weight.

Wednesday, October 21, 2015

Meet India's child bride turned wrestling champ

By Jason Overdorf
GlobalPost (October 2015)

NEW DELHI, India — When the biggest female star in US martial arts, Ronda Rousey, announced that she was taking the fight to Hollywood this month, India’s latest wrestling heroine was most likely working in the fields or helping her two sons with their homework.
She is known only by her first name, Neetu — and she was once a child bride.
Forced into marriage with a 43-year-old, mentally challenged man by her cash-strapped parents when she was only 13,Neetu was the mother of twins before she turned 15. But she didn’t let an illegal child marriage or the repressive morals of her ultra-conservative village in the north Indian state of Haryana stop her. 
Against the wishes of her parents, Neetu left her husband less than a week after their wedding. Even though she was almost immediately remarried, she refused to give up, according to her interviews with Indian media. 
“Rowdy” Rousey would be proud.
Village elders barred Neetu from practicing at the local “akhara” — a training ground used by her town’s male wrestlers — because she was a girl. And her family didn’t want her to wrestle, either. So she used to sneak out of the house at 3 AM to go running so that she could be back at home before anyone else was awake, she told India’s NDTV. From tipping the scales at 176 pounds, she now weighs in at 105. 
Child marriage has been illegal in India since 1929, though definitions varied. In 1978 the legal age of marriage was raised from 15 to 18 for girls and from 18 to 21 for boys, where it stands today, and in 2006 the Prohibition of Child Marriage Act increased the penalties for adult men who marry underage girls or anyone who promotes, permits or solemnizes a marriage in which the bride or groom is underage.
But Neetu’s story illustrates an unfortunate failure in implementation, as tradition trumps the law. The International Center for Research on Women estimates that 47 percent of Indian girls are married before they turn 18 (though the number to wed before 15 has fallen). With its huge population, therefore, India has the most child brides of any country in the world — one third of the global total, according to UNICEF.
While the problem is most common in the states of Bihar and Rajasthan, Neetu’s home state of Haryana may be witnessingan uptick in the number of child brides. A cultural preference for male children has resulted in one of the most skewed gender ratios of any state in India, making brides a valuable commodity and raising the financial incentive for poor families to force girls into marriage. 
India has produced some of the world's top female wrestlers competing today, including Geetika Jakhar (top), also from Haryana state.
Now 21 years old, Neetu has tilled fields, worked a shop counter and sewn clothes to make ends meet, and even today she pretends to be a student to save on the fare for the hour-and-a-half bus journey from her village to the training center in the city of Rohtak.
“I became a mother at 14 and the family’s financial condition didn’t allow me to think about sport for the next two-three years,” Neetu told the Hindustan Times

Encouragement from coaches, as well as the example of Indian boxer and Olympic medalist Mary Kom, inspired her to return, she says.
“Finally, I started wrestling in 2011, and in 2014, I won my first medal in the Nationals.”
When she brought that first medal back to her village, the same village elders who’d barred her from the local training ground embraced her as their own homegrown champion. Her status as a local hero grew even further this August, when she represented India at the Junior World Championships in Brazil — even though she was eliminated in the first round.
Coach Mandeep Singh says that’s only the beginning. 
“She never wastes time,” he told NDTV. “She works very hard at her training. If she can improve her technique, the results will show.”

Thursday, October 08, 2015

India's Hindus won't eat cows, but they might just drink their pee

HARIDWAR, Uttarakhand — In a concrete-block factory a few miles from one of the holiest spots on the Ganges, workers in hairnets and beanies slap caps on bottles zipping down an assembly line. A few feet further, another group sticks on no-nonsense, pharmaceutical-looking labels that read, “Divya Godhan Ark.” 
The room reverberates with a droning, mechanical whir, and it’s redolent with a distinctive smell — like when you first open a jar of multivitamins, combined with a gas station men’s room. 
That’s because the clear liquid in the bottles is purified cow’s urine — quite possibly the fastest growing alternative medicine in India these days.
“Cow’s urine is a diuretic. It helps in detoxification of the body, and many other beneficial effects are described in the Sanskrit scriptures, such as helping to expel excess bile,” says Anil Kumar, a vaidya — practitioner of Ayurvedic medicine — employed by the company Divya Pharmacy.
Since successive Indian governments stepped up their promotion of alternative medicine a decade or so ago, unproven health products and nutritional supplements made from cow milk, cow urine and cow dung have become huge business.
Already, Patanjali Yogpeeth, which owns Divya Pharmacy, collects hundreds of thousands of gallons of cow’s urine per day to be processed and packaged as facial cream, shampoo, soap, nasal drops, hair tonic and various medicines, press reports indicate.
Patanjali Ayurved, the brand’s parent company that makes everything from herbal cosmetics to juices to cornflakes, has estimated annual revenue of around $380 million, according to investment firm Credit Lyonnais Securities Asia. Other producers such as Calves N Leaves and Vedic Cow Products report year-on-year sales growth of 10 and 30 percent respectively. And it’s not just the masses buying it: Cow dung is giving tea tree oil a run for its money at posh stalls like The Thela (“the cart”) in some of the country’s biggest malls.
Pupils at Shree Swaminarayan Gurukul Vishwavidya Pratishthanam, a Hindu school in Ahmedabad, apply a holy paste made up of cow dung, cow urine, milk, ghee and curd before a sacred ceremony on August 24, 2010.
Bovine products are just the tip of a mammoth iceberg of soaps, lotions, ointments and medicines founded in ancient Indian texts.
But medical doctors warn they can be harmful, despite being “all natural,” and critics argue that the government is promoting alternative medicines without seeking to test their efficacy and develop them into modern treatments. 
Worse still, the focus on these unproven remedies may be detracting attention from the genuine crisis in the mainstream healthcare sector — where this year the government slashed federal funding in a bid to push responsibility onto the states.
Doctors complain that patients come to them when their cancer has progressed too far for surgery or when hepatitis has already resulted in liver failure, because they’ve spent weeks or months in the care of alternative practitioners. Meanwhile, as an ongoing outbreak of dengue fever in New Delhi has illustrated, the public health system is creaking its way toward abject failure, says Dr. Sumit Ray, vice chairman of critical care at the capital’s Sir Ganga Ram Hospital.
People “are desperately looking for alternatives which are not expensive,” he said in a telephone interview. “That is understandable. The failure is on the part of the government.”
This summer, for example, Delhi’s worst-ever outbreak of dengue — a vector-borne illness spread by mosquitoes that spikes during the monsoon season — has resulted in some 7,600 infections and at least 25 deaths.
In this case, cow’s urine is not involved. But prices have spiked this monsoon season for products like goat’s milk and papaya leaves that some Ayurvedic doctors say can alleviate symptoms associated with dengue — even though medical doctors caution that they’re of little benefit.
Meanwhile facilities and personnel at government hospitals are dramatically overstretched. In some cases, hospitals have been compelled to put two or three children in one bed and set up cots on balconies to house the influx of dengue patients.
“It’s probably gotten worse [under the current government], because public health spending has actually decreased,” Ray said.
Though a program to standardize and promote traditional medicines has been in place since 1995, some see a direct connection with Prime Minister Narendra Modi’s Hindu nationalist support base.
After Modi took power in May last year, the department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy, or AYUSH, was upgraded to ministry status in November. Despite spending just $105 million of the $195 million it was allotted as a department in 2014, this year the new ministry was awarded a budget of $185 million. Meanwhile federal funding for the National AIDS Control Organization, which also failed to spend all its 2014 funds, was cut to around $215 million from $275 million last year. (India has an estimated 2.1 million people living with HIV, representing the third-largest number of cases in the world.)
While investing in alternative medicines is not a bad idea in itself — in China, for example, research into traditional remedies resulted in the discovery of the anti-malarial drug artemisinin in the 1970s — critics point out that India’s program seems more oriented toward marketing than scientific research. 
A storekeeper displays a bottle of cough syrup made from cow urine on sale at his pharmacy in Ahmedabad, February 27, 2010.
Few, if any, studies have been published in respectable, peer-reviewed journals, they say. But that hasn’t stopped practitioners — and politicians — from making grandiose claims, in part because the rules governing such “supplements” are less stringent than those for allopathic medicines. 
“If you want to save yourself from cancer, there is a need to protect cows on a priority because cow urine is effective in curing cancer completely. It can cure [100] percent. I can vouch for it. Nobody wants to hear this,” Shankarbhai N. Vegad, a member of parliament for the ruling Bharatiya Janata Party (BJP), announced to the upper house in March. 
And in January, the governor of Karnataka state, Vajubhai Rudabhai Vala, proclaimed that while allopathic medicine might control disease, only Ayurvedic medicine has the ability to cure it — permanently and without side effects. Meanwhile, high-profile practitioners have claimed that Ayurveda can treat dengue, epilepsy, AIDS and other serious conditions.
Advocates of Ayurveda do more than just talk. Last year, for instance, a bill was introduced that would have allowed AYUSH practitioners to perform abortions, if it had passed. Tuberculosis experts bemoan a decision to allow AYUSH practitioners in certain states with a shortage of medical doctors to prescribe antibiotics — saying bad prescriptions have contributed to a spike in antibiotic resistance. And AYUSH Minister Shripad Yesso Naik recently announced that five new universities of alternative medicine will be set up in the name of the prestigious All India Institute of Medical Sciences (AIIMS), despite the lack of scientific evidence for the principles they’ll be teaching. 
“India cannot be completely different from the rest of the world,” Ray said. “It’s been established that healthcare improves with increased spending on public healthcare and improved nutrition and sanitation.
“You can invest in alternative medicine, too. But more stress has to be on allopathic medicine.”
A woman piles cows dung onto a cart in the village of Luni in Gujurat state, June 5, 2013.
At Haridwar’s Divya Pharmacy, a unit of the Patanjali Ayurved group founded by a wildly popular television yoga guru known as Swami Ramdev, there’s some evidence the company is attempting a marriage of the two systems. 
In a hushed office that — apart from the portraits of the robed and bearded swami on the walls — looks as though it could belong to Merck or Pfizer, an employee fans out confidential studies on the chemical properties of cow’s urine, some conducted in house and others independently. One compares its efficacy in treating cancer with the chemotherapy drug doxorubicin.
A quick scan of some of the publicly accessible research suggests that credible proof is a long way off. 
But perhaps one day we’ll discover that quaffing cow’s urine is not as crazy as it sounds. The estrogen treatment Premarin, after all, was developed from pregnant mare’s urine by the erstwhile Philadelphia-based pharmaceutical firm Wyeth in the 1940s.

Friday, August 28, 2015

The secret to saving India's plummeting camel population: Legalize their slaughter

An Indian camel trader stands with his camels at a traditional camel fair.

By Jason Overdorf 
GlobalPost (August 2015)

NEW DELHI, India — In a shaky video clip, a camel bellows in protest as a crane lifts it into a waiting panel truck bound for an underground slaughterhouse. In others, camels thrash with their throats slit, which ensures their flesh remains halal.

It's not pretty. But the trade in camel meat has surprising advocates in the western desert state of Rajasthan—where the export and slaughter of camels was banned this March.

For centuries, the Raika, a caste of camel breeders, have worshipped the hardy animal the way most Hindus revere the cow. But with the demise of the royal camel herds kept by the state's once-plentiful rajas and maharajas, followed by the replacement of camel carts with cheap cars and trucks, the few camel breeders that remain in Rajasthan worry that outlawing camel slaughter will ensure they disappear altogether.

That's because unlike wild animals, the continued survival of domesticated livestock depends on their profitability, argues Hanwant Singh Rathore, who runs a nonprofit called Lokhit Pashu Palak Sansthan, or "Welfare Organization for Livestock Keepers," that works closely with the Raika.

“Nobody is buying camels, so nobody is keeping camels,” Rathore said.

“If you're a young camel breeder, you can't find a wife, because you don't have any income.”

The Raika aren't the most surprising advocate of legalizing camel slaughter, however. That title belongs to the co-founder of LPPS, German veterinarian-turned-anthropologist Ilse Köhler-Rollefson. A tall, athletic-looking woman with wild, curly hair, Köhler-Rollefson came to India 25 years ago when unrest in Sudan forced her to abandon a research project involving the Bedouin.

At that time, India had the world's third-largest population of wild and domesticated camels, so it seemed a natural choice. But soon after she arrived, the anthropologist learned that India's main camel herders, a desert-dwelling caste called the Raika, were unlike the Bedouin or any other camel-based society she'd ever encountered. Moreover, their cultural taboos were rapidly causing the animal from which they'd always derived their identity to disappear.

Unlike the camel breeders of Africa and the Middle East, the Raika traditionally did not believe in slaughtering camels for meat, and historically only sold them for use as riding or draft animals. They thought selling camel's milk brought with it a plague of misfortunes ranging from drought to disease—even new grazing fees issued by the forest department. They consumed camel's milk themselves, of course. But the only real income they earned from them came from selling them at the huge annual livestock fair in Pushkar, where prices had plunged due to the growing affordability of trucks and tractors that replaced camels as a means of transport.

Since her first introduction to the Raika, the anthropologist has gone native. She's bought a camel. She's founded a non-profit trust for pastoralists. She's pioneered a milk-selling cooperative. She's led teams of bards and shepherds to Germany and Africa for international conferences, and she's undertaken a 500 mile camel trek across the state known as “the land of kings” to draw attention to the rapid decline in the camel population, which plunged from more than a million to fewer than 200,000 over the past 20 years.

Gradually, she and Rathore—who started out as her driver and made himself indispensable—have succeeded in convincing many Raika to break their cultural taboos, though they still don't like to talk about camel slaughter. But their dogged advocacy backfired earlier this year when their long campaign to get the camel declared Rajasthan's state animal finally bore fruit.

Instead of releasing grazing land controlled by the state forest department or encouraging camel's milk products, the government simply named the camel a protected animal, barring export and slaughter of the animals for meat.

“We were initially very happy, because we thought there would be all kinds of support for camel breeders,” Köhler-Rollefson said. “But exactly the opposite happened.”

Pressured by a signature campaign that attracted tens of thousands of animal rights activists, the government opted to apply the same approach to protecting the camel that Rajasthan and other states have used to protect cows—a subject that draws more pressure from Hindu groups. But anecdotal evidence already suggests that has been counterproductive, because it makes raising livestock unprofitable. Half of the animals born are males, which cannot be sold for as much as the cost to raise, since there is no legal market for their meat.

“If you have 150 female camels, you only need one male camel,” said Rathore, who points out that Rajasthan’s recent law also bans castration.

“If you have 10-15 male camels, they're fighting and killing each other."

Calling any potential move to normalize camel slaughter “a cop out,” Arpan Sharma, a spokesman for the Federation of Indian Animal Protection Organisations (FIAPO), says Indian state governments should instead look for other ways to support breeders like the Raika.

“All of us have more than a full empathy with the plight of many such [people],” Sharma said. “But there is a moral and an ethical question, whether camels should pay the price.”

In principle, Köhler-Rollefson and Rathore agree. They just worry that alternatives to camel's meat aren't profitable enough.

The unlikely team, along with a group of die-hard Raika breeders, are fighting a rearguard action to save the state's camels and the Raika culture through the sale of products made with camel's wool and camel's milk. But even though a growing, if unproven, belief that nutrients in camel's milk can be beneficial to autistic children has driven Indian parents to go so far as to fly from Mumbai to Rajasthan on literal “milk runs,” Köhler-Rollefson fears there may not be any camels left by the time a viable mass market develops.

Currently, Rajasthan's milk cooperatives don't officially accept camel's milk—though they do so on the sly in times of shortage—and prices based on fat content prevent that from being a very profitable outlet.

News that the multi-billion dollar, Gujarat-based dairy cooperative Amul aims to add camel's milk to its product mix by the end of the year is more encouraging. But Köhler-Rollefson is skeptical that the initiative can succeed in Gujarat, due to its low number of camel breeders, and the issue of fat content.

That's why, to keep the herds alive, she and her Raika associates want Rajasthan to roll back the ban to allow the trade in male camels, as ugly as it may look on YouTube.

Monday, July 06, 2015

Supercharged Tuberculosis, Made in India

A patient with extensively drug-resistant TB flew from Mumbai to Chicago, and the deadly disease could become an infamous export due to problems in India's public health system
By Jason Overdorf
Scientific American (July 2015)

MUMBAI, India—On a drizzly Monday afternoon here a few weeks ago, patients crowded around a door in a hallway in P. D. Hinduja Hospital—a private, nonprofit facility that caters to around 350,000 people per year. There is a loud, steady roar of voices, and patients and nurses have to shoulder past one another to get through the door, which leads to the office of lung specialist Zarir Udwadia. The walls are clean and white, and the air carries the tangy smell of disinfectant.

Against one of those white walls a grizzled old man with a breathing tube in his nose lies moaning on a stretcher. Nearby, clutching a sheaf of prescriptions, the father of a sick college student tries to catch the attention of one of Udwadia's assisting physicians. Several families have traveled thousands of kilometers to be here. Many of these patients, like 19-year-old Nisha, an engineering student from the central state of Madhya Pradesh, have tuberculosis (TB). Nisha, who asked that her real name be withheld, has been treated for lung problems for more than a year, only to learn that inaccurate diagnoses and prescription errors have supercharged the disease rather than curing it. “My doctors kept on changing the drugs,” says Nisha. Dressed in jeans and a floral-print blouse and black Buddy Holly–style horn-rimmed glasses, she speaks in a bright, optimistic voice, although her battle with TB has left her anorexic-thin.

By exposing Nisha's TB to various drugs without wiping it out, her doctors just made it stronger, a problem that Udwadia—the doctor who first identified extreme drug resistance in the germ—and other health experts say is becoming increasingly widespread in India. Too few diagnostic laboratories, too many poorly-trained health practitioners and thousands of infected people living in crowded, unsanitary conditions has made India home to the world's largest epidemic of drug-resistant TB. More than two million Indians every year get the highly contagious disease, and a patient dies every two minutes. Around 62,000 of these people harbor TB that is immune to at least four types of drugs, according to the World Health Organization, and as many as 15,000 may have an even more dangerous type called “extensively drug-resistant” TB that fights off almost every antibiotic in the medical arsenal.

Now, difficult-to-kill TB is no longer just India's nightmare. In June U.S. health authorities confirmed that an Indian patient carried this extreme form of the infection, called XDR-TB, across the ocean to Chicago. The patient drove from there to visit relatives as far away as Tennessee and Missouri. Health officials in several states are tracking down everyone with whom the patient—who is now quarantined and being treated at the National Institutes of Health in Maryland—had prolonged contact. The disease can be cured in only 30 percent of patients and sometimes requires surgery to remove infected parts of lungs. Although TB’s slow rate of infection makes explosive epidemics unlikely, the Chicago episode shows how easy it might be for the illness to become a worldwide export.

Yet until recently Indian public health officials remained reluctant to admit there's a problem, says Nerges Mistry, director of the Mumbai-based Foundation for Medical Research. “They were always trying to deny it [existed],” she says. (Neither the head of India's Revised National Tuberculosis Control Program (RNTCP) nor Mumbai's main tuberculosis control official—both of whom are new to their posts—responded to interview requests from Scientific American.)

Resisting a cure
Tuberculosis typically attacks the lungs, but can also develop in bones, the stomach or even the genitals. Unlike the Ebola virus, which can only be transmitted by direct contact with the bodily fluids of an infected person, TB can be transmitted via coughing, in airborne droplets from an infected person, though experts say it's harder to catch than viruses like influenza or chicken pox. (However, in 2013 Scientific American reported that some TB strains may be getting more virulent.) The typical symptoms of a TB lung infection include fever, night sweats and a chronic, hacking cough.

For an ordinary infection, the WHO-mandated treatment includes lengthy treatment with a cocktail of antibiotics: a two-month course of rifampicin, isoniazid, pyrazinamide and ethambutol followed by a four-month regimen of isoniazid and rifampicin alone. If the patient fails to complete the treatment or the TB bacilli in her system is already immune to one of those antibiotics, however, then some of the germs will survive, adapt and grow stronger. Some the hardier organisms can survive to pass on drug-resistant traits to their progeny, and those traits then spread to a wider group of descendants. That means it's crucial to kill off the entire population with the first course of treatment and hunt down and kill off any resistors.

The WHO defines drug-resistant TB as a strain of bacteria immune to one of the first-line drugs used to treat the disease. Multidrug resistant TB, or MDR-TB, does not respond to the two most powerful drugs, isoniazid and rifampicin. Finally, XDR-TB is resistant to those two drugs, plus any fluoroquinolone and at least one of the three injectable second-line drugs, capreomycin, kanamycin and amikacin.

In Nisha’s case her doctors never tested her for drug resistance, so she underwent treatment for more than a year with compounds doomed to failure. As a result, she suffered side effects from the antibiotics—which included hearing loss and joint pain so severe she couldn't get out of bed—without being cured. Worse, her infection grew stronger.

What concerns TB specialists like Udwadia is that India has been creating thousands of Nishas this way. And although it has begun to respond to the problem, the reaction is too small and too slow. A slim, fastidious man with a sharp nose and a thick shock of black hair, Udwadia doesn't look like an alarmist. He wears a conformist's pinstriped dress shirt and red tie as he puts Nisha through a brief examination. But Mistry and other health experts from nongovernmental organizations say his original identification of alarmingly resistant disease strains, and his continued pressure on the medical community to do something about it, are among the biggest reasons that India's culture of denial is beginning to show some cracks.

The country’s resistance problems have arisen, paradoxically, because India has made great strides against the nonresistant form of the disease. Beginning in the 1990s India adopted a WHO-developed program called “Directly Observed Treatment, Short Course,” or DOTS. It is designed to ensure poorly educated patients in the developing world properly complete the six-month-long, first-line TB treatment. Through a huge network of volunteer “DOT providers” the RNTCP has managed to dispense the free treatment to corners of the country where the nearest hospital lies hundreds of kilometers away. It boosted the detection rate for new cases above 70 percent in 2010 and it is targeting 90 percent this year. And it has achieved a treatment success rate of 88 percent for the patients it identifies, according to RNTCP documents.

In other ways, however, India’s performance has been less than stellar. Although public health spending has risen steadily since 2000 the federal share is still less than $5 per person, a perilously low level.** As a result, the country has fewer than one doctor per 1,000 people and an even more dramatic shortage of laboratories that can test for TB resistance. DOTS cannot substitute for testing infrastructure. As recently as 2008, less than one percent of high-risk patients were tested to see if they were susceptible to various anti-TB drugs. And private sector doctors screened for TB with blood tests that were notorious for false positives.* These errors simply meant that frontline antibiotics were overused, and overuse is the classic recipe for developing resistance.Number of multidrug-resistant TB cases estimated among known TB patients, 2013. Source: WHO

In December 2011 Udwadia decided that he had seen enough. The laboratory at Hinduja—one of the few Indian labs equipped to perform drug-susceptibility testing—identified a fourth patient infected with TB that was impervious to all 12 of the first-line, second-line and last-resort drugs that the hospital had at its disposal. He dashed off a two-page note to the medical journal Clinical Infectious Diseases, declaring an outbreak of what he called “totally drug-resistant TB.”

Italian scientists had made the same claim in 2006, and the bacteria’s capacity to develop drug-resistant strains was already well known. In a country that thought it was getting its TB problems under control, however, Udwadia’s article was as important as pulling the fire alarm when you see the building in flames.

The doctor, like the antibiotics he was trying to use, encountered resistance. WHO questioned the term “totally drug-resistant,” saying absolute imperviousness had not been demonstrated. The agency also hinted that Udwadia's laboratory results might be flawed. India's health ministry added doubts about the lab, noting that Hinduja Hospital had not received accreditation from the government to conduct drug-sensitivity tests for second-line drugs.

The dispute caught the attention of the press and the public. The Times of India and other newspapers launched lengthy discussions on the extent of drug resistance. Bollywood star Amir Khan devoted an hour-long episode of his wildly popular, Oprah-style talk show to Udwadia and TB. And other Indian medical experts came out to support him, accusing the health ministry of attacking the messenger. Citations of hisClinical Infectious Diseases article by other researchers skyrocketed.

The public outcry forced the government into action. It dramatically boosted the budget for the national tuberculosis control program and increased hospital and outreach staff fourfold. Authorities stopped using older, error-prone blood tests, and began a transition to molecular testing with new GeneXpert machines that identify genetic markers of resistant strains. Though still in short supply, the machines drastically reduced false positives and allowed doctors detect resistance to first-line drugs within two hours, rather than weeks. Where they've been implemented, the machines produce a fivefold increase in detection of rifampicin resistance, for instance, according to the largest Indian study to date. Cases that the machine flags as drug-resistant are referred to the district TB officer, and a committee of specialists decides on a treatment regime. “I don't think the push would have been sustainable if not for Zarir [Udwadia]'s reports in the newspapers,” Mistry says. “It forced people to come to terms with what was really happening in the city.”

An expanding problem

But machines alone will not solve the problem. Mumbai now boasts 18 GeneXpert machines. There are only 120 nationwide, though—not enough to test all patients suspected to have MDR-TB, as recommended by WHO. And even in Mumbai, government hospitals only conduct GeneXpert tests on patients that have failed to respond to the first two months of DOTS treatment, due to the high cost of the cartridges the machine uses.

Udwadia and other physicians voice a bigger concern. The GeneXpert test can only confirm resistance to rifampicin, they note. Because India doesn't have enough laboratories to conduct further drug-susceptibility tests, any patient flagged by the machines is immediately put on the national TB program recommended regimen for MDR-TB. This one-size-fits-all treatment does have an advantage; it makes it “easier for lower category people to supervise patients and easier for the patient to take the medicines regularly,” says Rajeshree Jadhav, chief medical officer at Mumbai's government-run Pandit Madan Mohan Malviya Hospital.

Yet the off-the-shelf regimen does not account for further, stronger drug resistance that has already spread in Mumbai. According to a yet unpublished study conducted by Udwadia and his colleagues at Hinduja, it would now only cure a third of the drug-resistant patients in the city. The rest would receive three or more useless drugs and thus become even more resistant. “In Mumbai it is absolutely critical to follow up GeneXpert with full drug-susceptibility testing,” says Madhukar Pai, an epidemiologist at McGill University in Montreal and a leading TB researcher. “Otherwise, patients might get inadequate treatment.

Nor does the country have a good sense of how big the resistance problem really is. Because of the small number of diagnostic laboratories there's no way of knowing how the proportion of XDR-TB patients here compares with central Asian and eastern European countries like Lithuania—where nearly a quarter of MDR-TB patients actually have XDR-TB. But the sheer numbers of new TB infections every year, together with the tardy government response, suggest the problem may soon be larger here. A nationwide drug-resistance survey should provide more data in 2016, according to Pai. But the evidence that is available suggests XDR-TB will be “a sizeable fraction of all MDR” in cities like Mumbai—although it will remain low in rural areas.

If there are indeed many people with resistant germs, it heightens the chances of those pathogens leaving the country for the rest of the world. Nearly a million Indians traveled to the U.S. in 2014, compared with less than three million from all of central Asia. More and more middle-class Indians are being diagnosed with TB, and although the patient who carried XDR-TB to the U.S. was immediately placed in isolation, India has no provisions for quarantines or travel restrictions.

The risk of an epidemic outbreak from a single traveler is low, since TB is transmitted from person to person through prolonged, close contact. Moreover, the US has both the resources and tuberculosis control programs to react swiftly, according to Neil Schluger, chief of pulmonary medicine at Columbia University Medical Center and a specialist in TB. However, the worldwide migration of drug resistant strains does worry him a good deal. "It is like Ebola in slow motion. Potentially it is a huge public health problem,” says Schluger, but it is likely to creep along rather than explode.

A difficult future
In India, the troubling situation is not without hope Udwadia has found that some XDR-TB strains can be treated with a cocktail of drugs including the broad-spectrum antibiotic meropenem–clavulanate and the antileprosy medications linezolid and clofazamine. Johnson & Johnson's bedaquiline, the first novel TB treatment to be released in some 40 years, can also be effective. But the chances of survival using bedaquiline are less than 50–50, depending on the severity of drug-resistance and how early treatment begins. The treatment is grueling because the drug itself is highly toxic. It has not yet been approved for use in India, so Udwadia has to lodge individual requests to treat each patient on what is called “compassionate basis.”

Whereas regular DOTS patients undergo a short course of chemotherapy, MDR- and XDR-TB patients may be subjected to it for as long as two years. Radical lung surgery is sometimes also required. And other second-line medications frequently cause nausea, joint pain, hearing failure and depression so severe that suicide is not uncommon.

In Udwadia’s office a stocky, lower-middle-class woman who asked to be called Vanita (not her real name) says she was diagnosed with XDR-TB some four years after she was first treated with DOTS. For months she has been striving to eat better so that she is strong enough to withstand bedaquiline. She is too shy to express her relief when one of Udwadia's assistants tells her that she's finally met the health criteria. But her eyes shine with grateful tears above the green cloth mask covering her mouth and nose. And her doctor, who pushed the concept of total resistance, insists that particular adjective does not determine fate. “‘Total’ never means ‘totally doomed,’” Udwadia says.