Many genetically transmitted diseases are common in Sindhis. These include ischaernic heart disease, diabetes, hypertension, thalassaemia minor, G6PD deficiency, obesity and possibly gross osteo-arthritis.
Dr. O P Kapoor
Sindhis are unusual Indian patients. They have no state of their own. After the partition many of them have spread all over the world and are living as NRIs, e.g. In West Africa (Lagos and Siereleone), Dubai, Hongkong, Singapore, Indonesia, Japan, Phillipines, Taiwan, Spain, Las Palmas, Gibraltar, Bahamas, UK, USA, etc. All over the world they continue to remain religious, God fearing and still speak in their Sindhi language. They are possibly the hardest working people in India, though they also enjoy eating, drinking, music, sex and a very good social life. Many of them have turned to various cults like Radhoswamy, Chinmayanand, Satya Sai Baba of Bangalore, Saibaba of Shirdi, Dada Vaswani of Poona, Aasaram and many more cults. To me it appears that they have no secure feeling. They are taking the help of these cults to maintain their mental health (less commonly Osho, Brahmakumaris and ISKCON). After adopting these cults many of them stop drinking and develop sober habits but continue to eat more.
They are so ambitious that it is worth noting that our Home Minister and one of the other Central Ministers were Sindhis in our Indian Government. It is interesting to note that 2 out of 4 best private hospitals in the city of Bombay are run by Sindhis. Thus the Sindhi man works the whole day and has no time for exercise. This aggressive attitude person disposes them to certain diseases like ischaernic heart disease, hypertension, etc. Most of them will never miss their good lunch and have a hearty dinner and even on the days of fasting which many of them do once a week, the caloric content of the fruits and milk which they consume is very high. Nearly 100% Sindhis offer regular prayers every day. Unfortunately, even the “prasad” which they consume consists of greasy sweet kada (may be followed by a big papad of equally high caloric content). Thus the prasad can amount to as much as a small meal.
The Sindhi women continue to be old traditional ideal wives and mothers and most of the time are home bound, busy cooking and looking after the house. Many of them do not leave their house for days together and continue to eat a good breakfast, lunch and dinner and snacks (specially “tikkis”, fried potatoes and sweets) in between, thus leading to obesity and predisposing them to diabetes and hypertension and osteoporosis (due to sedentary life).
Many genetically transmitted diseases are common in Sindhis. These include ischaernic heart disease, diabetes, hypertension, thalassaemia minor, G6PD deficiency, obesity and possibly gross osteo-arthritis. The following are my other observations:
On general examination most of them are overweight. The commonest musculo-skeletal symptoms of “lingan mey soor” is due to a combination of overweight and lack of exercise. Many of them have got a prominent protuberant abdomen, in males often due to alcohol and excessive calories and in females often due to multiple deliveries. This leads to reduced abdominal tone and appears to me as one of the factors of chronic constipation (pet saaf kona acheyto). Most of the Sindhi women complain of swelling and oedema of the feet and slight pitting. On majority of the occasions it is due to salt retention following marked obesity and deep venous insufficiency. Many of these women have very fat thighs, buttocks and calves hidden in their very roomy dresses. Many of them mistake fat on the legs as oedema.
The gross osteo-arthritis of the knees and hip joints is possibly familial and some of the most advanced cases of such osteo-arthritis in our countries are seen in Sindhi communities.
Most of the Sindhi women do not take any hormone pills after menopause which often occurs around 45 to 48. Thus after 10-15 years, around the age of 60 to 65 they start getting repeated fractures with minimal trauma and most of the doctors do not make the diagnosis of osteoporosis which is rampant in elderly Sindhi housewives.
Many Sindhi women appear anaemic on general examination. Most of them will say that they have gone to a number of Doctors in their life time but their anaernia does not respond to treatment. This is because they have thalassaemia minor which they should be told to learn to live with and for which there is no permanent cure.
The incidence of G6PD deficiency is very high in Sindhis. Off and on I see rich Sindhi males coming with severe anaemia from Far East after having an attack of malaria for which they are given anti-malarial drugs. This is because of deficiency of G6PD which was missed by clinicians in those countries.
Premature greying of hair in both sexes is universal in this community and they keep on using hair dyes for years.
Most of the Sindhi patients especially women complain of symptoms of “monjh” which is equivalent to ghabrahat (chest apprehension) in other Indian patients. Many of these patients have absolutely no heart disease and have nothing else but panic disorder. The incidence of this symptoms is so high in Sindhi females that every alternate patient complains of the same not responding to any treatment! However, ischaernic heart disease in Sindhis specially those living abroad is extremely common (like the Asians in UK) and should be excluded before diagnosing functional complaints. Many of the females will complain of symptoms due to so-called “low blood pressure”. Most of these symptoms are due to anxiety and tension and not due to low blood pressure. The symptoms of “Saheko” which really means dyspnoea is often present along with “monjh” without any organic disease.
Diabetes and hypertension are extremely common in this population. Often they neglect the treatment of these diseases and develop ischaernic heart disease (both sexes). Fortunately, because they can “afford”, many undergo angioplasty and coronary bypass heart surgery and then agree to take drugs life time. Even the incidence of 11 strokes” due to abnormal brain circulation is more common in Sindhi population (mainly due to negligence and not taking treatment of “detected” or 11 undetected” hypertension). For the same reason kidney failure (CRF) is more common in Sindhi population.
Regarding diseases of lungs, COPD is still off and on seen in so-called poor Sindhis (from Ulhasnagar) who continue smoking bidis and cigarettes. The modem Sindhis have more or less given up smoking.
The standard complaints of most of the Sindhis specially women are “ograai” and “pet saaf konaache ‘ vto” which literary means belching and in complete evacuation. The belching is so severe that the patients often present with aerophagy syndrome. Belching is not a disease and is not only a habit (which started in this community in childhood) but is associated with over eating. In my experience Sindhis have the highest incidence of belching and aerophagy in the world. Another common complaint is the “Coated” tongue. They continue using tongue cleaners and always correlate their coated tongue (which is normal) with their abdominal complaints of distension and constipation.
Incomplete evacuation is often due to their sluggish colon and associated poor abdominal tone and flabby abdomen and possibly lack of outdoor exercises. Blood cholesterol and triglycerides are often very high in Sindhi population and are mainly related to intake of alcohol and rich diet.
As compared to many other communities, in Sindhi women the symptom of leucorrhoea is very common. In males the symptoms of sexual weakness are more or less universal often due to excess of alcohol, tension, diabetes, iatrogenic causes and more “expectations”! However, the incidence of urethral syndrome and Dhaat (male leucorrhoea) as seen in many other Indian males is more or less never seen in Sindhi males (although they often over indulge in sex). Interestingly like in Arabs, I find that the incidence of AIDS is much less in Sindhi population.
Regarding the different sub-communities in Sindhis – the picture described by me above is commonly seen in Sindhwarkis. Although, Hyderabadis and Amil Sindhis have also more or less same illnesses, belching, aerophagy and other gastrointestinal symptoms are less common in them. More often Bhaibandh and Shikarpuri Sindhis join cults like Radhoswamy and after taking “Naam” stop non-vegetarian food and often alcohol, though many of them who were smokers continue smoking. Also many of these type of Sindhi like to retire from sex life around the age of 50-55.
Finally, in poor Sindhi population of Ulhasnagar most of the above picture described by me would often be seen.
The writer was Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai.