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Insights into Editorial: A clear reading of the Ayurveda surgery move

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Context:

Recently, a Gazette of India notification by the Central Council of Indian Medicine a statutory body under the Indian Medicine Central Council Act, and “which regulates the Indian Medical systems of Ayurveda, Siddha, Sowa-Rigpa and Unani Medicine” identifying surgical procedures that can be performed by post-graduate Ayurvedic doctors in Shalya (surgery).

Response to notification:

  1. Many of the reactions are on predictable lines. The Indian Medical Association (IMA) has written a curious self-flagellating letter to the Prime Minister.
  2. Allopathic surgeon colleagues are outraged. Social media and WhatsApp groups are abuzz with alarmist responses.
  3. Some have portrayed doomsday scenarios, ‘where our children will be operated’ by half-baked ‘Ayurvedic doctors’ in the future.
  4. We know about Sushruta and his surgical dexterity at a time when the world had not yet woken up to the art and the science of surgery.
  5. There are detailed descriptions in the Sushruta Samhita, the ancient Sanskrit text on medicine and surgery, of procedures such as rhinoplasty where the nose is reconstructed with tissue from the cheek.
  6. It was thousands of years later that modern plastic surgeons described this procedure.

After 1947, what the state did?

  1. It is useful to go back a bit into history to understand the imbroglio better. After Independence, the Indian state was faced with the difficult task of accommodating both the ascendant modern medicine brought in by the British and India’s traditional systems of medicine, notably Ayurveda.
  2. It was suggested that Ayurveda be integrated with modern medicine. It was argued that a united system would be more perfect than the Ayurveda as an individual science.
  3. Though there were islands of excellence in the old Ayurveda institutions in Kolkata, Benares, Haridwar, Indore, Pune, Mumbai,

There were two options.

  1. One was to take the best from all systems and integrate them into one cohesive science. This was possible but not easy as the systems have certain incompatible differences of approach.
  2. Faced with this vexing question, the state attempted everything. It patronised and encouraged formal medical education in modern medicine as well as in other traditional systems.
  3. For a brief period there actually existed ‘integrated’ courses, wherein both Ayurveda and Modern medicine were taught to students.
  4. But these withered away partly due to opposition from purists in Ayurveda who were outraged by the ‘dilution’ of their science.
  5. Thus, the degree in Ayurvedic medicine became largely an Ayurveda course. However, it was necessary out of a practical career compulsion to teach the basics of modern medicine to these graduates.
  6. They had to survive in the medical market, which by that time was the dominant form of health care in India.

Ayurvedic doctors’ choses areas of nursing homes:

  1. Most Ayurvedic graduates entered general practice. More importantly, several of them went on to work in rural and under-served areas. Some set up nursing homes.
  2. In rural Maharashtra, several nursing homes were run by integrated graduates. In Chiplun in the Konkan, for instance, the only nursing homes offering emergency obstetric and surgical services were run by non-allopathic graduates.
  3. In Mumbai, there is an instance of a homoeopathic graduate manning and training others on the extracorporeal membrane oxygenation, or ECMO, a complex heart lung machine in the largest unit used for critically-ill COVID-19 patients.
  4. In Maharashtra, the ‘108’ emergency response ambulance service is manned by non-MBBS doctors. During COVID-19, a large number of the quarantine centres were manned by these doctors.
  5. Incidentally, they work for less pay which allows hospitals to control costs and even make profits. All this is not a rationalisation but an explanation which we ought to know.
  6. In health care, availability is often more important than quality, specialisation and such extravagant ideas.

Integrate AYUSH with Modern Medicine for Holistic Health:

  1. Unlike modern medicine, alternative systems follow a more holistic approach, with the objective of promoting overall well-being instead of focussing on curing illness alone.
  2. Such an approach assumes greater significance in the case of non-communicable diseases which are difficult to treat once they have developed into chronic conditions.
  3. Internationally, greater scientific evidence is becoming available regarding the health impact of alternative systems of medicine, especially Yoga.
  4. Apart from a rich heritage in traditional medicine, India has nearly eight lakh registered Ayurveda, Yoga, Unani, Siddha and Homoeopathy (AYUSH) practitioners whose services can be better utilised for delivering healthcare to the population.
  5. AYUSH has to be combined with modern medicine for holistic health and to treat non-communicable diseases effectively.
  6. The ‘Strategy for New India @ 75’ released by NITI Aayog sets out the explicit target of co-locating AYUSH services in at least 50 per cent of primary health centres, 70 per cent of community health centres and 100 per cent of district hospitals by 2022-23.

A silver lining with Ayurveda graduates:

Ayurveda graduates including surgeons are a large workforce in search of an identity. India needs them.

If they are creatively and properly trained, they can play important roles in our health-care system. In fact, as we have seen in certain situations, they already do.

On site or ambulance care of trauma victims is in a shambles in India. It is effectively delivered by trained paramedics in many countries.

Given the right training, pay and identity, Ayurvedic surgeons can be trained to strengthen this service and save hundreds of lives.

Conclusion:

AYUSH, or Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy, is a priority area for the present government.

The revival of Indian medicine fits well into a certain narrative. Be that as it may, the IMA in its opposition to such moves needs to be precise and constructive. Currently, its response is like faux chest thumping of a guild of insecure professionals.

It is a pointer to an urgently needed and serious discussion about utilising India’s large workforce of non-MBBS doctors to improve access to decent health care for our ordinary citizens, then it is well worth our time.