A recent proposal by the Central government to train AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) doctors to perform surgeries, with the goal of increasing qualified health personnel, has caused an uproar in some groups of allopathic doctors such as the Indian Medical Association (IMA). However, it has been treated with cautious optimism by some public health professionals.
The IMA has called for a protest against this proposal by deciding to withdraw non-COVID 19 related services on December 11.
According to recent government estimates, there are over 770,000 AYUSH doctors in India of which more than half are practitioners of Ayurveda, over a third practice homeopathy, 6% practice Unani and the rest practice other systems. Most AYUSH doctors primarily practice in urban areas and some have even been accused of using antibiotics and steroids irrationally to treat a range of ailments without the necessary allopathic training.
An AYUSH doctor in a government health centre in rural India said that she felt guilty for practising allopathy – against what she had been taught. The health centre lacked a regular supply of Ayurvedic remedies. When an infectious disease broke out in the village, she was forced to treat patients using allopathy. When things went wrong, though no fault of hers, she was blamed, and an enquiry board was instituted against her.
To make matters worse, AYUSH doctors are often given administrative tasks in health centres, and women AYUSH medics are asked to get involved with prenatal checkups without the necessary training, because of a preference for ‘lady doctors’ in rural areas by pregnant women. Recognising this, the government in 2018 issued a circular to upskill Ayurvedic, Unani and Homeopathic doctors in skilled birth attendant (SBA) training.
Khichdi medicine and mixopathy?
The IMA is right to worry about khichdi training, a mishmash that works well for food, but not for education, producing substandard doctors.
The general quality of allopathic medical education, barring government and some private medical colleges is inadequate in India. Medical college seats are highly competitive, and a very small fraction of those who take these centralised exams make it to college. Barring a few exceptions, most aspiring doctors ‘choose’ AYUSH colleges only as a second-best option that is an indirect route to allopathic practice in underserved areas. The current move seems to encourage this avenue, without addressing the quality of allopathic training possible in pre-existing medical colleges.
Research has indicated that there are serious problems with the current Ayurvedic curricula in most colleges including sub-standard levels of teaching and an understanding of human anatomy and physiology that is a virtual copy of the allopathic medical curriculum. There is virtually no engagement with the limitations of Ayurveda in treating acute infections and the need for allopathy in emergency medicine.
Further government policy permitting Ayurvedic practitioners to prescribe allopathic drugs in several states in India has naturally diminished the need to train well in Ayurveda. Therefore, efforts to harness the potential of AYUSH systems in preventing and managing non-communicable diseases (NCDs) such as diabetes and auto-immune disorders have not gained momentum.
AYUSH systems are holistic systems of treatment. If used correctly it can and does bring relief to millions of people. We, therefore, find the IMA’s high-handed approach in condemning these knowledge traditions problematic and 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 doctors with techniques in allopathic medicine is a death knell for these indigenous medical systems, in spite of a laudable intent to revive and bring to mainstream AYUSH systems.
Allopathy provides quick relief while AYUSH systems take time and is tailored to the individual. Often patients have little understanding of the benefits and limitations of these systems and all they want is quick, affordable and easily accessible treatment. The government is enabling exactly this, but without expending the resources and investment necessary to ensure quality and standards in treatment.
By forcing AYUSH doctors to practice alongside allopathic doctors, AYUSH doctors may end up being scapegoated if things go wrong. Also, they will forever 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 that AYUSH doctors can be trained in, so they can refer patients to the right places for treatment in a timely manner. Similarly, allopathic doctors could be sensitised to AYUSH systems, especially in the management of chronic diseases, nutrition, exercise, mental health and overall well-being, so they can refer patients to AYUSH practitioners.
The current COVID-19 pandemic has showed us how weak the foundations of our public health systems are. India needs to strengthen a health system that is highly unequal, inaccessible and of spotty quality.
Sreeparna Chattopadhyay is an independent researcher and V. Srinidhi is a medically trained doctor and a public health researcher at the Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India.