Medicine in Khurdistan

I arrived in Teheran in the thick of winter. It was January 1977 and the Shah of Iran was still on his throne. I was to work among the Khurds of Iran for a year. But I would first stay in Teheran for a week to get acclimatized, and also prepare for the cultural shock that awaited me at Ghorveh, a village 7500 metres above sea level, in the very heart of the Zagros ranges.

“Don’t get too comfortable with the glamour and wealth of Teheran,” said Moira the nurse who had come to escort me to the hospital, “Teheran is the Shah’s showpiece. But where you are heading there’ll be only mud huts and primitive living. The British missionary doctor, who set up the hospital fourteen years ago, has never once left the mountains. Perhaps now that you’ve come he can go on furlough.”

Early one morning, we boarded a bus to Hamadan . It was packed with women in colourful attire, and high spirited sturdy men in their shaggy coats. There were hens and chickens too, and one woman even had a goat tethered to the leg of her seat. An ‘Alladin’ something like a huge lantern, kept the interior of the bus warm. Men huddled around it, lighting their cigarettes from the open flame.

“I’m sure this bus is going to explode in flames,” I said, panic in my voice.

“Don’t get so paranoid,” Moira advised, “This is how they travel. Just sit back and hope for the best.”

The ascent into the Zagros ranges was breathtaking. The snow was six inches thick and the temperature outside -6 degrees C. White walls of ice loomed on either side, giving the illusion that we were travelling through tunnels of ice. A veil of falling snow made visibility poor. Progress was at snail’s pace. The bend in the roads became more treacherous as we climbed higher. The stench within the bus must have anaesthetized me.

Moira shook me awake when we reached Hamadan .

“The gateway to Khurdistan!” she said. Mount Alavand loomed over the city.

The bus stop was crowded with tall strapping men in baggy pantaloons and large turbans, fair in complexion but rough in speech and manner, eyes unblinking as they looked me over. Women were dressed like gypsies in colourful skirts and tunics that fell to their ankles. Heavy chains and coins dangled from their necks. Their heads were encased in elaborate turbans, and gold teeth flashed as they laughed and talked.

The final ascent to Ghorveh was in the hospital vehicle. The mountains and ravines looked more treacherous than the road we had travelled. The temperature had dropped to

-4 degrees. We were now in the heart of the ranges. A third of the entire Khurdish population lived in these parts. The rest were scattered over Iraq , Syria , Turkey and Russia . They had forsaken their nomadic existence in the Sixties, when the Shah had brought in social and economic reforms and given them land for agriculture.

Here and there in the valley were villages – small clusters of 50 – 100 huts, flat roofed windowless structures of mud and wattle, spread over the flanks of the mountains in terrace-like fashion. From a distance they looked as though they were built one on top of the other. Partly hidden by snow, this winter landscape would have delighted any artist. The mountains stood like sentinels, insulating these people from the rest of Iran , and making them less susceptible to outside influences. Though they had sworn allegiance to the then Shah since 1922, they were a law unto themselves, and lived unfettered by the laws of protocol. They were of Indo- European stock and claimed descent from the ancient Medes. To a large extent, they had preserved their racial purity, language and customs.

Stiff and frozen from the long journey, my heart sank when Moira pointed to a small blue gate in a fortress of stone. Embossed on it was a four-leaf clover representing a cross, which was a symbol used by Christian organisations.

“This looks like a prison,” I said, barely suppressing my tears.

“Homesick already?” Moira teased. “High walls are for protection. They keep out unwelcome visitors and ensure privacy. They also keep out hungry wolves and bears that prowl about at night.”

There were four expatriates on the staff – two nurses, the British doctor and his wife, and I was the fifth. The rest were locals, none of them qualified but trained by the doctor and his wife.

I was to stay in a rambling bungalow at one end of the campus. The trees around looked stark and bare like ghosts, against the white background of snow. Had I not been so dog tired, I might have refused to stay alone. I shivered even under six quilts, as the house was heated by just one kerosene-fired bohkari.

Early next morning I had a visitor. He was Rahimi the Education Officer for the region.

“I am your Farsi teacher – the only Khurd who can speak English in these parts.”

This man made all the difference to my stay in Ghorveh. What could have been a harrowing, depressing year became one of exciting discovery of a culture totally alien, where people lived so close to Nature, and adapted to the cycle of seasons.

Yet practising medicine in these parts was truly frustrating. The hospital was the only one in a radius of 100 kilometres. There were no fixed hours of work or rest. They came trudging through the mountains or donkey riding at any time of day or night. Farmers, shepherds, carpet weavers, irrespective of their status, they all had a high sense of drama. The capacity to exaggerate was unsurpassed. A mild twinge of pain became an apoplexy, a slight temperature felt like a scorching Turkish bath, a spot of bleeding was a massive haemorrhage. Xrays were considered therapeutic, and something to decorate their huts with, and the suzan ,(injection) was sheer magic! Often, the pharmacist would be manhandled if no xray or injection had been prescribed. The good old doctor solved the problem by prescribing “Ampoule Americana” (distilled water) for belligerent patients.

Though at night biting winds howled through the trees, spring was stealing into the mountains by early March. With melting mountain streams trickling down, the valleys grew lush with springtime greenery. Preparations for Now Ruz began days ahead of this only happy festival in the year. The annual Spring cleaning threw up clouds of dust in every narrow lane, as carpets and eiderdowns were dusted, and dragged down to the rivulets for their yearly wash.

The nights echoed to the beat of the dihool (drums) and zirna (flute pipes) as men and women danced and sang. The music sounded weird to a stranger’s ears.

On Char Shambeh Suri the Wednesday before Now Ruz, courtyards were aglow with small fires. Men, women and children jumped over them, symbolically consigning to the flames the cares and troubles of the past year, and deriving strength for the new. Later almonds, sultanas, pistachios and a very sweet speciality called ‘Buslogh’ were passed around.

Now Ruz was celebrated on the 21 st of March, the day of the Spring Equinox. The hospital was deserted. We were invited to the homes of staff members. The women were turned out in resplendent colours like Audobon’s birds of bright plumage. They wore voluminous silk skirts over pyjamas bunched together at the ankles. A three metre piece of material coiled into a rope was wound around the midriff. Over this was a flowing gown of deep maroon velvet slit down the sides, and a tabard decked in silver coins and weighing just as much. No ugly black chaddors for these women. They held their unveiled heads aloft encased in yards of turban, their dark eyes enhanced with mascara, their fair cheeks suffused like rosy apples.

The sturdy men folk were equally impressive in their heavy costumes and headgear, a ceremonial knife stuck in their waist bands.

Down the street skilled Haji Firuz – a pixyish figure in a red dress, and a face blackened with soot, beating his drum and singing his merry songs. The men left off their incessant fingering of their prayer beads, long enough to dive into their pockets, and throw him some coins.

“Bring us good luck Haji Firuz”

Laid out on a table in each house were seven objects called ‘Haft Sin,’ representing the planets of the solar system, and all their names beginning with the consonant ‘S.’ (vinegar, garlic, herbs, apple, hyacinth and dried fruit.) There was also a mirror for light, and a gold fish in a bowl. They believed that at the hour of Now Ruz, the gold fish would remain stationery, head pointing to Mecca . Bread, candles and boiled eggs for each member of the family were also placed on the table.

The last of the Nor Ruz festivities ended thirteen days later, when families picnicked beside flowing streams, bowls of herbs nurtured over the last months were cast into the water bearing away the sins of the last year.

Festivities over, it was time for serious work. The apricot, apple and plum trees were in bloom, their pink and white blossoms bringing colour to the hills. The men were busy with ploughs and oxen, turning up the dark earth in preparation for the sowing of barley and wheat. They worked from dawn to dusk with brief intervals for prayers and refreshment. Women brought food for their men, sitting astride donkeys. They spread out under the trees on a plastic sheet, piles of paper thin ‘nun’, cottage cheese, and curd. Tea was brewed over ancient samovars lit by kerosene stoves, and served in tiny glasses. Holding a lump of sugar in their mouths, the men tossed down several glasses of black tea after their meals.

For the shepherds too, the day began at dawn. They guided their flock high into the hills, and returned only at dusk. While the animals grazed, the shepherds gathered medicinal herbs to be used at home in an emergency. Most times they lazed around, playing their special music on flutes made out of hollow stems.

Women had an extremely hard life. Given in marriage at puberty, they begat offspring in quick succession. By their mid-twenties they aged into harried matrons, the blush in their cheeks long gone, their breasts long and pendulous through continuous breast feeding. They accepted their destiny with docility, praising Allah for the fertility of their wombs. Many young girls whose bony structure had not reached maturity had to undergo caesarean sections.

Sterility was a curse, the worst form of punishment from Allah. A barren woman was held in contempt by the entire family. This was the main reason for divorce. Men refused to believe they were at fault even if they had several ‘sterile’ wives. A mother of female children had to relinquish authority to a new wife.

Yet the bonhomie that exists between co-wives is incomprehensible to an outsider. Sharing a husband was a small price to pay for an extra pair of working hands. There was too much work for one woman alone. Apart from household chores, carpet weaving was exclusively in the woman’s domain, starting from the spinning and dyeing of wool. The looms were vertical and usually in one dark corner of the kitchen. The women would hop on to a perch in front of the loom, and work in dim light, because the patterns were all in their head. But though this was a leisure occupation, in a crunch, the carpets were mortgaged to a bank for a pretty penny.

Each season brought with it a crop of diseases. Infant mortality was very high. Measles was the prime killer, taking on a virulence that wiped out hordes of children. They believed that “Small pox makes you blind but Measles takes you to the grave.”

Mothers smeared the little bodies with a paste of mud and ash, and fed them with herbal brews. But only the fittest survived. Out of eight or ten pregnancies, only one or two would live.

With summer, swarms of flies invaded the villages like the plagues of Egypt . The villagers lived in close proximity with their cattle. They seldom took a bath. Dirt and dust were trapped in the layers of their clothing, and body lice thrived and multiplied. Water from running streams was used by man and beast alike, for washing, cooking, bathing. Flies, filth and contaminated water proved a deadly combination. Epidemics of gastroenteritis were frequent. Concoctions of honey and opium, stupes of boiled egg, flour and lard did nothing to relieve the colic. They came in droves, wizened skeletons barely alive. The wards were turned into re-hydration centres, and all of us worked round the clock.

Neither strings of blue beads entwined in their hair, nor topaz bracelets, or miniature Korans sewn into their clothes could prevent Trachoma spreading by flies. Many ended up blind. They were by no means poor. Just ignorant, unhygienic and superstitious!

When mother’s breast milk ran dry, infants were fed with sweetened black tea, which they considered nutritious. A bawling infant was given a pinch of opium.

Men had a hard time wresting a living from the earth. Crops and grass were dependent on winter rains. Irrigation was achieved through a system of aqueducts that began at the foot of the hills. They had to be periodically dredged to prevent clogging. Sometimes a farmer would stealthily divert water from another man’s field. He was dealt with on the spot with knives and staves, before being dragged off to the House of Arbitration. They came with deep cuts and stab wounds. Women would sometimes join in the fracas, and if menstruating, would pretend it was an abortion and claim damages.

Summer was also a time for weddings. Fathers haggled over the bride price, drinking multiple glasses of tea and puffing on the hookah. The “Namza’ (engagement) eventually was sealed with the chanting of the Koran and exchange of gifts. The groom was now allowed to speak to his bride in the presence of a chaperone.

Weddings were elaborate affairs spread over three days. On the first day, a group of women led the girl to the community ‘hamam’ for a ritual bath. Here she was brought up to date with the facts of life and ways to cope with the demands of marital life. A similar ceremony involved the groom, except that it was more boisterous, and the groom was the butt end of many a joke.

After the bath, the bride was brought to the hospital for a certificate of virginity which was a safety measure for the girl. Though parties were simultaneously in progress in both houses, the boy and girl met only on the final day, when the bridegroom’s party went to fetch the bride. Her face was covered with a red diaphanous veil. A relative held a mirror to her face on which she would concentrate until she reached her husband’s house. She brought along a red trunk with her trousseau, a carpet and a samovar, all bought out of the bride price. A cock’s head was severed on the threshold, before she could cross over.

Sometime during the revelry, the couple was led into the marital chamber and locked in. After a reasonable time, old hags would rush in to see if the marriage was consummated. If there were no tell tale signs of blood, all hell would break loose. The certificate of virginity now came in handy. (If the fault was with the boy, he was secretly brought to the hospital the next day.) The women would announce to the gathering, “All is well. Allah be praised.” A lavish meal would follow, and festivities would continue through the night.

In autumn, the land lay fallow and dry, and men rested from their labours. If not gossiping in the tea houses over tea and hubble-bubble pipe, they lay around nagging, quarrelling, threatening, demanding. Some women had devised their own ways of self-preservation. “Psychological Aphonia.” Inability to speak except through incomprehensible guttural noises scared even a cruel husband, and brought him to his knees. Tongues are magically loosened if the husband showed remorse for his misdeeds.

A good Khurd would never donate blood even if his wife was dying. A request for blood donations would meet with stiff resistance, even the risk of a bashing. The British doctor had received his fair share of blows for daring to make such requests. Losing or saving a wife was all in Allah’s hands. If she died, another wife would always be available.

Yet, the scene after a death was horrendous. An eerie weeping and gnashing of teeth would follow. Smiting of breasts and tugging at hair like demented devil dancers, clawing of cheeks to draw blood, were part of the mourning rituals.

“Let it not be said that we didn’t love her,” they would wail, “Her soul must rest knowing that we loved her.”

On the seventh day a lavish meal for the poor assuaged their guilt.

Women were busy even in winter, working on their carpets, while girls threaded multicoloured beads into belts and chains with intricate designs.

Old men huddled in corners, their glazed eyes staring into space, their thoughts befogged by the fumes of the opium pipe.

The Staff and villagers knew that the sentinel hills were no longer impenetrable. The country would soon be soaked in a blood bath. They pleaded with the British doctor to close the hospital and leave before it was too late.

“We are Sunnis. We dread the Ayatollah’s mullahs more than we ever feared the Shah. We will not be in a position to help you.”

As I left Ghorveh I wondered if the proud spirit of the Khurds would be quelled or would they fight for their dignity and survive? Would they flee into the mountains and organise themselves against the imminent new regime? Only Time would tell.

World Medicine 2-11-1977


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