Managing Vulnerability to COVID-19 through “Salaam–Namaste Campaign” (Our Traditional Ways of Greeting)

INTRODUCTION

Infectious diseases are one of the major global health concerns affecting innumerable individuals worldwide. Despite the availability of various antimicrobials and vaccines, infectious diseases still remain a significant cause of morbidity and mortality. In 2010, H1N1 flu, also known as swine flu, resulted in the death of around 18,500 people worldwide. Around 27,000 confirmed cases including 981 deaths were witnessed in India. The flu reemerged in 2015 with 30,000 cases across the country and 1,731 deaths. Rajasthan, Maharashtra, and Gujarat were the worst affected.¹ Malaria and tuberculosis (TB) continue to claim many lives in India. In 2018 alone, 228 million cases of malaria were reported globally, according to WHO. Most (85%) of the cases were reported in 19 countries in Sub-Saharan Africa and India. Same is the case with deaths due to malaria with 2% of the global deaths being reported in India.² Nipah pandemic emerged in 2018 in which 19 cases were reported from Kerala including 17 deaths.²

Lately, in December 2019, a novel coronavirus, now coronavirus disease-2019 (COVID-19) has emerged in Wuhan, China and spread its wing over the whole globe.³ As of June 1, 2020, COVID-19 has been confirmed in over 6.2 million individuals worldwide and has resulted in more than 373,000 deaths. More than 180 countries have reported laboratory-confirmed cases of COVID-19 on all continents except Antarctica.⁴ In India, number of COVID-19 positive cases has crossed 2.4 lakh and death toll rose to 6,642 as of June 5, 2020.⁵ Elderly, children, pregnant women, and individuals with comorbidities form the vulnerable group for COVID-19. As many as 86% of the fatalities due to COVID-19 had comorbidities, such as diabetes, hypertension, heart, and kidney disease.⁶

Infectious diseases are transmitted from person to person through direct or indirect contact. COVID-19 is being spread by coming in contact with a person having the infection.⁷ This can occur when an individual with pathogens touches, kisses, coughs, or sneezes near someone who is not infected. Handshake is used throughout the western world to greet someone wherein two people hold one of each other’s hands, generally the right ones. However, because of the phenomena of westernization and Sanskritization, majority of Indians have started practizing handshake in their personal as well as professional lives, particularly in urban India.⁸ Recent studies and reports (unpublished) have shown that from health point of view, handshake is unhygienic and a disease-spreading tradition.⁹ It may transmit more than 80% of the virus in the first contact only.

As a part of preventive and promotive efforts during the outbreak of influenza, it is always advised to avoid shaking hands or any kind of close proximity, if possible.¹⁰ The fact, that there is no vaccine and medicine available to treat and prevent the COVID-19 infection, has forced everyone to avoid physical contacts followed by an advice to stay safe at home. Worldwide, people have been advised to follow cough etiquettes, good hand hygiene practices, wearing of masks, and maintain physical distance from others. Hand washing is often promoted to reduce the transmission of bacteria and infections through handshake. But, it is not possible to practice hand washing after each hand contact, leading to possibility of transmitting infections, such as cold, flu, swine flu, and COVID-19. One way to limit the spread of germs and reduce the transmission of disease at medical facilities is to establish handshake-free zones.¹¹

The traditional Indian form of greeting, i.e., the Namaste, meaning “I bow to the Divine in you” is known from the time of Vedas and Puranas. The history (of the gesture) dates back several thousands of years. It is mentioned in the Rig Veda, the oldest of the four Vedas. According to the most ancient text, Agama,¹² the word “Namaste” means “The God in me greets the God in you. The Spirit in me meets the same Spirit in you”. In other words, it recognizes the equality of all, and pays honor to the sacredness of all. Our Hon’ble Prime Minister, Sh. Narendra Modi has always endorsed the practice of hands-free greeting. He has requested the Indian population to avoid handshakes and practice the Indian greeting with folded hands—the “Namaste”. This way of greeting gained wide acceptability in the wake of coronavirus outbreak—be it US President Donald Trump or the French President Emmanuel Macron, British Royalty Prince Charles or Israel Prime Minister Benjamin Netanyahu.¹³ “The world has developed the habit of Namaste to greet each other. We should also follow the same. It is better to avoid handshakes and greet everyone with Namaste”, PM Modi said.¹⁴ In line with him, the Indian Army Chief General launched an initiative christened “Operation Namaste” in March, 2020 to insulate the 1.3 million strong force from coronavirus infection and extend all possible assistance to the government in containing the pandemic.

In addition to Namaste, different hygienic greet alternatives are used being across different religions, such as Salaam and Adaab, is used in Muslim religion and Sat Sri Akal in Sikh religion. Pranaam is used by the males and married females in Hindu and Sikh religion whereby a person bows down and touches the feet of the older person to show gesture of respect toward him or her. Greetings around the world differ radically from culture to culture and sometimes they are shaped by religion and superstitious beliefs. In Thailand, “Thai Wai” is used to greet people. In Thai Wai, both palms are placed together on the chest and head is bowed down so that the thumbs and fingertips touch the chin and forehead, respectively. The word often spoken with the wai as a greeting or farewell is “sawat di” sometimes romanized as sawasdee. In Laos, Cambodia and Myanmar, similar greetings, known as nop, sampeah, and mingalar par, respectively, are also in use. The Japanese people use “Bow” to greet one another. The nose and forehead are pressed with another person one at the same time. The traditional Chinese greeting does not include touching at all. It involves making a fist with one hand and using your other hand to cup it, eliminating the need to touch the person you are greeting. A special greeting tradition is practiced in New Zealand, known as “Hongi” meaning touching noses.

“SALAAM–NAMASTE” CAMPAIGN

As a part of its health promotion activity, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh had started a new drive “From handshake to hands-free greetings”, christened as “SALAAM–NAMASTE” Campaign (Fig. 1) from February 5, 2019, long time before the onset of novel COVID-19 pandemic. The aim of this awareness initiative was to promote hands-free way of greetings to reduce the transmission of pathogens and infections from one another.

This campaign includes the series of activities, such as distribution of information, education, communication (IEC) materials, display of posters on major landmarks, broadcasting of information through FM radio, competitions, and slogan writing competitions. Appeal was sent to each and every department of PGIMER to propagate this traditional way of greeting. Also, a questionnaire was administered to assess the greeting practices followed by the PGI staff and students before and after the “Salaam–Namaste Campaign”.

Various methods were used to promote the campaign at the institutional level. Verbal messages were given to each and every staff member, who was observed shaking hands with others. Information, education, communication materials including posters, pamphlets, brochures, and handbooks on the related topic were developed in three languages—English, Hindi, and Punjabi. The same were distributed and displayed in the campus of Department of Community Medicine and School of Public Health and also in the important landmarks of the PGI campus, such as Tuck shop, Old Doctor’s Hostel, Library, Kairon Block, and main gate of PGI. The information about the campaign was displayed on the digital information panel and disseminated in major events and platforms organized by PGIMER, such as convocation held on February 9, 2019; workshops, continuing medical education (CME), and seminars. Brochures of the campaign were displayed on social networking sites, such as facebook, instagram, and twitter. To enhance the community participation, more people other than from the campaign area were involved using snowballing technique. Each and every staff member was motivated to promote the campaign and share with at least two persons.

CONCLUSION

Keeping in view the high incidence of COVID-19, it is the need of an hour to go back to our roots and restart greeting people with our age-old way of “Namaste”, not only in our professional lives but also with our family members and friends. Not only can “Namaste” be used for greeting but also for taking leave or to seek forgiveness. Let us greet the world in a conventional way using both hands and promote the tradition of greeting from handshake to hands-free greeting. In light of this, it would be a good idea to share some more hygienic ways of greeting someone to replace the good old-fashioned handshake. Besides this, there is a theory of positive and negative energy balanced between the right and left hand.¹⁵ Fist bump, elbow bump, hat tip greeting, and head nod could also be used to express recognition, respect, and gratitude toward a friend or family member. This practice has been recommended by many specialists worldwide calling it a “modern-day” health hazard as handshaking is responsible for transmission of around 90% of bacteria. Hands-free greetings should not be a knee jerk response rather a sustainable behavior to prevent from many illnesses.

REFERENCES

1. Mohapatra S, Dar L. Emerging and re-emerging viral infections in India. JIMSA 2010;23(1):37–40.

2. Pavithra KM, History of infectious diseases outbreak in India. Available from https://factly.in/history-of-infectious-disease-outbreaks-in-india/.

3. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan China: the mystery and the miracle. J Med Virol 2020;92(4):401–402. DOI: 10.1002/jmv.25678.

4. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report-48. World Health Organization. Available at https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200308-sitrep-48-covid-19.pdf?sfvrsn=16f7ccef_4 . March 8, 2020.Accessed: May 30, 2020.

5. NDTV Live. Corona virus live updates. Available from https://www.ndtv.com/india-news/live-coronavirus-india-updates-8400-covid-19-cases-in-india-in-last-24-hours-2-june-2020-2239067.

6. The Economic Times. Three-fourths of covid-19 patients in India are men: Health Ministry. Available from https://economictimes.indiatimes.com/news/politics-and-nation/three-fourths-of-covid-19-patients-in-india-are-men-health-ministry/articleshow/75020133.cms?from=mdr.

7. Flu season in India: How prepared are you? Available from https://www.hindustantimes.com/india-news/flu-season-in-india-how-prepared-are-you/story-scuyWrI dWgkUZ0Rs2av0aO.html.

8. Taylor K, Williams V. Etiquette and taboos around the world- A geographic encyclopedia of social and cultural customs. California: Greenwood; 2017.

9. Bloomfield SF, Exner M, Carlo Signorelli C, et al. The chain of infection transmission in the home and everyday life settings, and the role of hygiene in reducing the risk of infection. 2012. http://www.ifhhomehygiene.org/IntegratedCRD.nsf/111e68ea0824afe1802575070003f039/9df1597d9058 89868025729700617093?OpenDocument.

10. Bhattacharya S, Singh A. Namaste!! Greet the Indian way: Reduce the chance of infections in the hospitals and community. CHRISMED J Health Res 2018;6(1):77–78.

11. University of California, Los Angeles. Handshake ban to curb hospital infections. Available from https://healthmanagement.org/c/hospital/news/handshake-ban-to-curb-hospital-infections.

12. Indian Mirror. Doing Namaste. Available from https://www.indianmirror.com/culture/indian-folklore/Doing-Namaste.html.

13. Hindustan Times. Namaste: World leaders, politicians embrace Indian greeting amid coronavirus outbreak. Available from https://www.hindustantimes.com/it-s-viral/namaste-world-leaders-politicians-embrace-indian-greeting-amid-coronavirus-outbreak/story-KHjCs9zOliIFz8nHqpz4hK.html.

14. The Statesman. Avoid rumours, handshakes, greet with Namaste: PM Modi’s advice to people on Coronavirus. Available from https://www.thestatesman.com/india/avoid-rumours-handshakes-greet-namaste-pm-modi-advice-people-coronavirus-1502863652.html . March 7, 2020.Accessed on June 1, 2020.

15. Cirone MW, Balance Your Chakras, Balance Your Life. Yoga Chicago. Available from: http://www.yogachicago.com/2014/03/balance-your-chakras-balance-your-life/ .[Last accessed on 2020 June 1].