A female doctor talks on the phone while looking out a window at Mahendra Mohan Choudhury Hospital, Guwahati, April 2020. Photo: PTI.
On November 20, the Central Council of Indian Medicine (CCIM), a statutory body of the Ministry of AYUSH, issued an amendment to the Central Council of Indian Medicine (PG Ayurveda Education) Regulations 2016. The amendment lists 58 surgical procedures that postgraduate students of Ayurvedic Education in two branches – Shalya Y Shalakya – must receive formal training and can then practice independently.
The Indian Medical Association (IMA) has opposed this measure, calling it an attempt to create a new and illegitimate ‘myxopathy’, as well as calling the CCIM’s ways “impolite” and “unclean”. The body, which is India’s largest medical association, also said that the newly formed National Medical Commission (NMC) is responsible for enforcing these two separate systems of medicine independently, and it should be.
The ministry subsequently released a clarification that graduate scholars can only perform the basic surgical procedures listed in the amendment and that it is a restrictive reform, not a policy change.
But IMA has rejected this clarification and has demanded that the amendment be withdrawn. It has also called a public demonstration on December 8 and the suspension of non-essential medical services for 12 hours on December 11. Finally, IMA has also requested four bodies under the NITI Aayog, which are reflecting on ways to integrate multiple systems of medicine, to dissolve.
This is not the first time that the representatives of these two systems have been at odds. Their previous talking points include questions about whether AYUSH practitioners can prescribe allopathic medications, whether allopathic nursing homes and hospitals can recruit AYUSH scholars, and whether Ayurveda and allopathy can be integrated.
Roshan Mendhe has a BA in Ayurvedic Medicine and graduated from the Tata Institute of Social Sciences, and is currently a public health consultant. According to him, Ayurveda GP scholars get exposure and hands-on training similar to modern medical GP scholars. Allopathic doctors frequently hire Ayurvedic doctors as assistants, he added, and Ayurvedic doctors regularly attend clinics in rural areas and ICUs in tertiary care centers. So if all of this is already happening, in your opinion, only an amendment to provide formal training and legal protection is warranted.
However, “if the AYUSH ministry wants to provide PG degrees for surgeries, that’s fine, but they should use only Ayurvedic techniques and medicines,” said Ujjval Rana, who currently works as a state maternal health consultant with a UN organization. “Both systems must be mutually exclusive.”
Ayurveda should be integrated but build on its strengths and evidence. I would have a lot to offer ”.
According to Shabeer PK, a public health consultant, AYUSH practitioners may prefer to stay in rural areas “if they have the opportunity to improve their portfolio.” On the other hand, he continued, doctors trained in allopathic medicine prefer to work in urban areas.
“Sometimes these life-saving strategies are critical where skilled labor is scarce, particularly skilled labor,” Shabeer said. “At the same time, it is also important to have serious training and supervision to empower AYUSH [practitioners] perform in modern medicine “.
In fact, the shortage of trained government doctors in rural areas is a constant challenge in India. There is a severe shortage of medical specialists, including surgeons, with 81.8% of vacancies in government community health centers.
At the same time, hoping that trained Ayurvedic specialists can fill this void might not work. A 2016 WHO report found that every category of healthcare worker, except traditional and religious healers, prefers to practice in urban areas, where only about 35% of India’s population lives.
So even if Ayurvedic practitioners and IMA doctors came to a consensus on any of the debated topics, the problem that ~ 65% of Indian residents cannot access trained doctors would still exist. This problem can only be solved with the right infrastructure, better working conditions and incentives. And until then, Unregistered Physicians (UMP) will remain the preferred point of contact for the rural population.
A major source of confusion that the new amendment could generate concerns law and regulation. Only a few states in India allow Ayurvedic practitioners to practice allopathy as well: Maharashtra, Tamil Nadu, Gujarat, Punjab, Uttar Pradesh, Bihar, Assam, and Uttarakhand. And today, no person can perform surgery without drugs and allopathic diagnoses.
For example, an Ayurvedic practitioner may prescribe allopathic drugs in Maharashtra, but in Kerala, doing so is illegal. So a Shalya PG academic can operate in Kerala but without prescribing the necessary drugs? Would these details be at the discretion of the state? What happens if these practitioners move from one state to another?
Providing professional growth is important, but the public welfare must come first. Both systems must reach a point where they can complement each other. The AYUSH Ministry has government support but lacks credibility, while the IMA has been responding aggressively. Meanwhile, on the ground, most healthcare workers are dissatisfied with one part or another of their jobs, even when there is a strong division among the doctors themselves about working in urban versus rural areas.
In this context, UMPs cannot be canceled for the foreseeable future, not until we have strong and clear regulations, and strong training and infrastructure.
Prachi Singh is a public health professional who works as an independent consultant. He has consulted with various organizations, including the National Health Mission, Punjab; the National Resource Center for Health Systems, New Delhi; and WHO.
