Doctor's Review: Medicine on the Move

January 20, 2022

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No nails are used to make these boats, only woven coconut fibres which hold together hardwood planks.

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Afloat in India

More water than land, Kerala is best seen from one of its unique houseboats

It isn’t going to be easy to write this, I — oh look, a pretty bird… Sorry, where was I? Oh yes, this isn’t going to be easy. I am on a houseboat in the backwaters of Kerala. It is late in the afternoon. A breeze blows away the last of the day’s burning heat. From my cushioned hardwood armchair on the covered deck, I can see a lattice of lazy streams and small rivers framing green and glinting rice fields.

The boat is cruising slowly, and we are passing clumps of water plants, speckled with purple flowers. I can hear the birds chattering, but can only see them briefly blur by as they dash off for a meal or a tryst. That last one was pretty — it had iridescent patches on its wings. Every now and then we pass another houseboat. They are things of wonder — unique to this corner of the world.

This part of Kerala, on the southwest tip of India, is more water than land. For centuries, if not millennia, locals have built beautiful boats, known as kettuvallam (or boats with knots), with regional materials. Traditionally, no nails were used. Coir rope was used to tie together hardwood planks, which were then coated with a cashew shell resin. Bamboo poles propelled them along.

These boats were originally used as barges to transport rice and spices down to the port of Cochin. Today’s boats are more luxurious. Mine, rented from, is 26.5 metres long and has two en-suite air-conditioned bedrooms. But many of the construction materials are the same as they ever were. The walls and ceiling of this boat are intricately woven and braided coconut fibres, shaped into daring and lovely curves and swoops. It's as if Frank Gehry made the boat out of macramé.

There are hundreds of houseboats operating out of the small pretty town of Alappuzha (, about an hour's drive from Kochi, the second largest city in Kerala. Kerala’s coastal cities have been visited by many travellers over the centuries. The city of Kochi has some of fascinating examples of those who came through, and some who settled. One of the most remarkable is the Paradesi Synagogue. Built in 1568, it is the oldest in the Commonwealth. While the Jewish community is now dwindling, the longstanding building itself is a testament to the safe harbour the Jewish settlers found here on the Malabar Coast.

People from this part of Kerala still use the rivers as part of their working lives. Earlier today a fisherman pulled alongside to sell us fresh prawns. We passed women on the banks scrubbing clothes, and mothers scrubbing children. And just over there is a bus boat — part of the public transportation system.

The bus boat passengers get off here and there, and disappear beyond the shoreline on their way home, or to little office buildings, or island temples. Many work in the rice fields. They are below the level of the river, separated off by a steep bank. Once the rice harvest is done, the fields are flooded and used as fish farms. The fish eat the remnants of the rice and in the process nourish the fields.

Once the fish are big enough, they are taken out and the rice goes back in. From here I can see the tops of the heads of the people in the fields preparing for the next stage in the cycle. In the West, this sort of symbiotic aquaculture is considered cutting edge. Here is it just the way things are done.

Floating through all this life, sitting on the deck of this houseboat is at once peaceful and bubbling with detached activity — like watching a stream tumbling over pebbles. Here on the houseboat, the most strenuous activity is moving from the armchair to the dinning table, where the on-board cook presents his creations at regular intervals. Many of the dishes include local ingredients, like fresh fish, rice and grated coconut. I’ve been putting on weight.

The cook is one of a staff of three, the other two being a butler and a pilot. They are all masterfully unobtrusive — there if you want a glass of fresh coconut juice or to know the name of a particularly exotic bird, and invisible when all you want to do is doze. Which is why writing this hasn’t been easy. It is too nice to want to look at a computer screen. There is too much dozing to do, and too little time.

And, when not dozing, there is too much else to see. Did I mention that pretty bird? If you’ll excuse me, I think I’ll ask for a glass of fresh sweet lime juice and wander off to the deck to see if I can spot it again. It may not be there, but I’m sure something else enchanting will come along soon.

And, if not, there is always the on-board DVD player with the stack of Bollywood films. In Kerala, they know how to live.

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