By Manish Joshi, M.D., FCCP and Thaddeus Bartter, M.D., FCCP
Before I (MJ) moved to the United States from India almost two decades ago, my usual way to greet people was namaste — a Sanskrit word referring to a gesture widely used throughout the Indian subcontinent as a respectful form of greeting, acknowledging, and welcoming a relative, a guest, or stranger. Handshaking was not part of my culture and only occasionally performed on special occasions — receiving a college degree on a podium, getting a sports trophy or a medal, or perhaps reconciling after a fight with a friend. Yet I distinctly remember shaking hands as a child with foreign tourists, mainly Europeans, in my visits to “the pink city,” Jaipur, where I grew up. In my 28 years of living in India, I don’t remember getting a hug other than from my own very close family members — and even that wasn’t in public. There was no culture of hugging in public except in rare instances such as to console a sad/crying person on the death of their loved one.
Life changes. When I moved to the United States, the handshake became an integral facet of social interaction. I shook hands many times a day as I greeted colleagues and patients at social meetings. I also observed that hugging was a common form of greeting. The transition to handshaking felt reasonably natural for me, but it was not easy for me to assimilate into hugging; I always was (and am) uncomfortable and always feel that I am encroaching on somebody’s personal space and vice versa. Does this mean that I don’t hug my wonderful wife or two beautiful children? Absolutely not. But those are my immediate family members with whom I share personal space on an intimate and daily basis.
Life has changed again. With the COVID-19 pandemic, “social distancing” has become a household concept. As per the US Centers for Disease Control and Prevention, social distancing, also called “physical distancing,” means keeping space between yourself and other people outside of your home. (1) Handshaking and hugging appear to have faded underneath the scourge of this pandemic. Dr. Anthony S. Fauci, who has led the United States through this pandemic, is now in the national forefront advising against handshakes during this COVID-19 pandemic and even during influenza season in order to prevent transmission of these respiratory viruses. (2) As I have listened to him, the normal customs of interaction in India and many other Asian and African countries have come to mind. Does namaste, a non-contact greeting, represent a greeting style which has evolved to decrease transmission of communicable diseases? Very likely. India has one of the highest population densities in the world; physical distancing can be difficult, and the community health implications of a disease that can spread by human-human contact are prodigious. Perhaps over millennia, the Indian subcontinent, one of the oldest civilizations in the world, adopted “physical distancing” without compromising “social interacting” as a means of protecting against communicable diseases that holds true in the 21stCentury.
Does the present scenario with social distancing mean that we should negate or eliminate the very humble gesture of acknowledging other human beings? I believe that genuine social greeting (with physical distancing) is more important now, as the entire world grapples with this apocalyptic crisis, than at any other point in modern history. I am a critical care physician, and have watched the teamwork demanded by this pandemic – between ICU nurses, respiratory therapists, physicians, housekeeping personnel, and many others working behind the scenes. I have watched commitment, a “can do” attitude, and collegiality prevail despite feelings of anxiety and frustration as this disease causes disruption of routine, changing guidelines almost daily, and risky shortages. Ironically, in this time of “social distancing” we depend on each other and need to work together more than ever. Namaste came back to me naturally with the loss of handshaking – it’s an art that greets, respects, and acknowledges that we are part of something larger than ourselves. I do feel a genuine expression of gratitude for all my colleagues when I say “Namaste” to them. And I get the same genuine feeling back from them.
I (TB) was born and raised in the United States, although I could be called first generation. My mother was from a “distinguished” family with deep American roots, but my father had come to the U.S. alone as a teenager from the Philippines, where his British father was a missionary. My upbringing could best be described as Victorian. The handshake, accompanied by a look straight in the eyes, was the standard greeting. Caring was expressed sparingly, most often between a mother and her children. Expressions of intimacy between a man and his children were less common, and least common was any warm physical greeting between male friends. As I grew older and left my “cultural niche,” I watched the French hug and the Italians kiss friends (gender irrelevant) on the cheek. I preferred these expressions of warmth and companionship to the reserved constraint of my childhood. I felt that expressions of appreciation, caring, and even need for others represented a more open, honest, vulnerable, and rewarding approach to my relationships with those around me. I incorporated hugging for friendship (and occasionally consolation) into my lifestyle.
As we enter the world according to Covid, things change. The need to protect ourselves with physical distance does not negate our needs for community, for collaboration, for recognition. And now my friend greets me with namaste, a word — and sometimes a gesture — with ancient roots embodying the elements of a handshake or a hug without physical contact, a word meaning acknowledgement, appreciation, and belonging.
Physical distancing, a practice we all must follow, is vital to fight this pandemic which knows no cultural boundaries. As we transition to Covid, we also should transition not to “social isolation” but to human bonding and greetings such as namaste.
1. Social Distancing. Centers for Disease Control and Prevention.
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html. (Accessed 5/8/2020)
2. Fauci: ‘In a perfect world’ Americans would stop shaking hands. ABC News. https://abcnews.go.com/Politics/fauci-perfect-world-americans-stop-shaking-hands/story?id=70062797 (Accessed 5/8/2020)
Manish Joshi, M.D., FCCP is a Professor of Medicine in the Pulmonary and Critical Care Division of the Department of Internal Medicine at UAMS and the Central Arkansas Veteran’s Healthcare System.
Thaddeus Bartter, M.D., FCCP, is a Professor of Medicine in the Pulmonary and Critical Care Division of the Department of Internal Medicine at UAMS and the Central Arkansas Veteran’s Healthcare System.