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“Mal-der’ or Herpes zoster and people in Kashmir

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Umair Shafiq
Bashir Kak is not well, because he had acute pain on the right side of his chest and back since the last 5 days now. He has already received injections from ‘Riyaz Saeb’ –the local pharmacist who doubles as the local ‘doctor saeb’ for the locality.
There has been no relief in the pain and Bashir kak has developed redness and fluid filled skin lesions on the right side of his chest and back.
On the way back from his Asr prayer, Bashir Kak had talked to his close friend about it. And on hearing about signs and symptoms he immediately replied, ‘This is Mal-der Bashir Kak. Don’t go to any doctor for this. Their medicines don’t help it. You should immediately go for ‘Maetrawun’. If you want I will accompany you to Khazir Kak, the famous Maetrawan wol of the town.’
Now, Bashir Kak is in confusion. Should he go to a doctor or to a maetrawan wol!
He is really suffering from the pain and he wants quick relief. No pain killers are helping him and he has not been able to sleep since the last 5 days now. Ultimately he decides against the advice of his close friend and visits the dermatologist.
Here is what conversation between Bashir Kak and the dermatologist.
‘Asalam u alaikum, doctor soob’
‘Walaikum Assalam.
What is the problem’ the doctor looks at Bashir Kak .
‘Doctor soob, I have severe pain on the right side of my chest and back from last 5 days. And I have not slept even for a min over these days. Please have a look at my chest and back. My friend said that this is ‘Mal-der’.
The doctor, after examining Bashir Kak properly says to him, ‘Yes, it is ‘Mal-der’ or Herpes zoster as we call it in our language. So, you had pain for 5 days but when did the rash start?
‘Doctor, it started yesterday only but I had severe pain prior to that as well and the same is still continuing’
‘Ok, it is good that you have come to us within a short time only after the onset of rashes. We can treat it better at this stage. If you had come much later, maybe after 2-3 days, then some of the drugs won’t help.
Bashir Kak to doctor: But doctor, some people told me not to go to a doctor for this. They advised me to go to a ‘maetrawan wol’. So should I go to him or not?’
‘The doctor smiles and says, ‘Let me answer this question in detail. I know that you can understand it very well.
See, Herpes zoster (mal-der in our local language)or ‘Shingles’ in English language is basically caused by a virus known as ‘Varicella zoster’ virus. This virus usually infects humans and causes what is known as ‘Chickenpox’ or ‘waawpet’ in our Kashmiri language. The virus, after gaining entry into our body, remains inside the body life-long in a dormant state. And it favours a typical site for this—it remains or rests in our nerve roots.
Once our immunity, against infections in the body, goes down because of any reason, the virus gets a chance to become active again. It then replicates and travels along the nerve sheath from its original resting place and infects the skin that is supplied by the same nerve trunk. That is why we have the skin lesions along a segment on one side of the body in this disease.’
‘OK, so that is why my right side only is involved and it is restricted to a particular area only on the chest. But why is it so painful? And why is the pain not going away with analgesics?’ Bashir Kak asks.
‘I will tell you the reason. See, once the virus gets activated, it travels along the nerve trunk . While travelling along the nerve it causes an inflammation of this nerve which is known as ‘Neuritis’ in medical language. This neuritis is the cause of severe pain in Herpes zoster.
And as it is the nerve that is inflamed, it does not respond well to traditional analgesics but only to specific drugs that have an effect on the nerves specifically.’
‘But what about ‘maetrawun’—does it have a role to play?’
We Kashmiris are really health conscious people but there are a few myths and wrong practices that we are still continuing even in today’s age.
About ‘maetrawun’ first—let me tell you that medical science does not dismiss the role of this particular treatment in human disease.’
We, in allopathy, call this mode of treatment as ‘Hypnotherapy’. And hypnotherapy is a treatment option that has been used in a number of human diseases in clinical studies.
You may be surprised to know that hypnotherapy has been used in diseases like atopic eczema, warts and many other human diseases including Herpes zoster.
However, what is the most important thing is to use medical treatment first and keep hypnotherapy as a reserve if the condition does not respond to medical therapies alone. And the role of hypnotherapy comes late in the disease if the person has intractable neuralgic pain that does not respond to drugs alone. Hypnotherapy does not have a role in the acute stage of the disease.
I will tell you about a relative of ours whom we saw in our home recently. This person, a male of about 37 years, had lost his eye-sight just because he had not treated his Mal-Der on time and went for hypnotherapy alone as treatment.
‘Oh Allah, is it true? Can this disease lead to such complications as well?
Yes, that is true and that is why I want to put this message across. At some sites like the forehead/eyes, ears and perianal or genital areas the treatment of Herpes zoster has to be immediate. Otherwise the person is going to land into serious complications. If Herpes zoster involved the forehead or area around the eyes, it can lead to a permanent blindness in the affected eye. That is an unfortunate event and that should not have happened in today’s age when we have access to many effective drugs against this virus.
(The author is pursuing Nursing in Udaipur)

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