A rural doctor works at his clinic in the village of Dulki, on the Indian island of Gosaba in Sundarbans, on September 25, 2018. Credit: Manipadma Jena / Thomson Reuters Foundation
A recent proposal by the central government to train AYUSH doctors (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) to perform surgeries, with the aim of increasing the qualified health personnel, has caused a stir in some groups of allopathic doctors such as the Indian Medical Association (IMA). However, some public health professionals have treated it with cautious optimism.
The IMA has called for a protest against this proposal by deciding to withdraw non-COVID 19 services on December 11.
According to recent government estimates, there are more than 770,000 AYUSH doctors in India, of which more than half are Ayurvedic practitioners, more than a third practice homeopathy, 6% practice Unani, and the rest practice other systems. Most AYUSH physicians practice primarily in urban areas and some have even been accused of irrationally using antibiotics and steroids to treat a variety of ailments without the necessary allopathic training.
An AYUSH doctor at a government health center in rural India said she felt guilty about practicing allopathy. – against what he had been taught. The health center lacked a regular supply of Ayurvedic remedies. When an infectious disease broke out in the village, she was forced to treat patients with allopathy. When things went wrong, although it was not her fault, she was blamed and a board of inquiry was instituted against her.
To make matters worse, AYUSH physicians are often assigned administrative duties in health centers, and AYUSH physicians are asked to get involved in prenatal checkups without the necessary training, due to a preference for the ‘doctoras’ in rural areas by pregnant women. Recognizing this, the government issued a circular in 2018 to enhance the skills of Ayurvedic, Unani and Homeopathic Physicians in Qualified Midwife Training (SBA).
Ayurveda needs an intellectual reinvention
Khichdi medicine and myxopathy?
The IMA is right to be concerned khichdi training, a hodgepodge that works well for nutrition but not for education, resulting in poor doctors.
The general quality of allopathic medical education, except for government and some private medical colleges, is inadequate in India. Positions in medical schools are very competitive, and a very small fraction of those who take these centralized exams make it to college. With a few exceptions, the majority of aspiring physicians ‘choose’ AYUSH colleges only as a second best option that is an indirect route to allopathic practice in underserved areas. The current movement seems to encourage this path, without addressing the quality of allopathic training possible in pre-existing medical schools.
Research has indicated that there are serious problems with current Ayurvedic curricula at most universities, including substandard levels of teaching and an understanding of human anatomy and physiology that is a virtual copy of the Ayurvedic curriculum. allopathic medicine. There is practically no compromise with Ayurveda’s limitations in treating acute infections and the need for allopathy in emergency medicine.
A new government policy allowing Ayurvedic doctors to prescribe allopathic drugs in various states in India has naturally diminished the need for good training in Ayurveda. Therefore, efforts to harness the potential of AYUSH systems in the prevention and management of noncommunicable diseases (NCDs) such as diabetes and autoimmune disorders have not gained momentum.
AYUSH systems are holistic treatment systems. If used correctly, it can bring relief to millions of people. Therefore, we find the IMA’s overbearing approach in condemning these knowledge traditions problematic and we believe it could be because allopathic medical students are not exposed to the limitations of their knowledge system and the potential of these alternative systems.
Missed opportunities for allopathy and AYUSH
The current proposal to equip AYUSH physicians with allopathic medicine techniques is a death sentence for these indigenous medical systems, despite a laudable intention to revive and mainstream AYUSH systems.
Allopathy provides quick relief, while AYUSH systems take time and adapt to the individual. Patients often have little understanding of the benefits and limitations of these systems, and all they want is fast, affordable, and easily accessible treatment. The government is allowing exactly this, but without spending the resources and investment necessary to ensure quality and standards in treatment.
By forcing AYUSH physicians to practice alongside allopathic physicians, AYUSH physicians may end up being the scapegoat if things go wrong. Furthermore, they will always strive to gain legitimacy in an epistemologically different system that will, at best, tolerate their presence and at worst, actively work to undermine them.
There are many areas in which AYUSH physicians can be trained, so that they can refer patients to the right places for treatment in a timely manner. Similarly, allopathic physicians might be sensitized to AYUSH systems, especially in chronic disease management, nutrition, exercise, mental health, and general wellness, so that they can refer patients to AYUSH physicians.
The current COVID-19 pandemic has shown us how weak the foundations of our public health systems are. India needs to strengthen a healthcare system that is highly uneven, inaccessible and of uneven quality.
Sreeparna Chattopadhyay is an independent researcher and V. Srinidhi is a medical trained physician and public health researcher at the Ramalingaswami Center for Equity and Social Determinants of Health, Public Health Foundation of India.
