Can Public Health open up to the AYUSH Systems... and give space for People's Views of Health and Disease?
Item
- Title
- Can Public Health open up to the AYUSH Systems... and give space for People's Views of Health and Disease?
- Creator
- Mira Sadgopal
- Alpana Sagar
- Date
- 2007
- Description
- Some thoughts to add to the debate in MFC at NTI, Bangalore, 28-29 December 2006
- extracted text
-
Can Public Health open up
to the AYUSH Systems... and
give space for People’s Views
of Health and Disease?
Some thoughts to add to the debate in MFC
at NTI, Bangalore, 28-29 December 2006
Mira Sadgopal’ and Alpana Sagar2
The current double issue of the Medico Friend
Circle Bulletin (December 2006 - March 2007) carries
an array of background articles and matter to support
serious debate on 'The Public Health System and
Public Health Education' at the MFC Annual Meet on
28-29 Dccombor 2006 at Bangaloro. Our effort in this
article is to point out a major lacuna that we see in the
debate so far, that is, the need to genuinely include
India's non-allopathic systems and people's local
'health and healing' cultures within the Public health
system. Blindness to the issue, if one goes by the
articles collected in the Bulletin, appears virtually total
at this point. It is not an easy issue - it is fraught with
contradictions and unaddressed questions. But we
find it untenable for us to go on with our debates
without facing it. Our expectation is that friends
gathered here will give serious attention to this and
open up to looking for how we can move towards
'mainstreaming' the non-allopathic or so-called
AYUSH systems in the public health system in our
country. In fact, whether we talk about it or not,
somehow it is a stated goal in the Indian
Government's 11,h Five Year Plan (2007-2012)1
It is our contention, while exact figures are not at
hand, that the vast majority of our billion-plus
population share cultural bases and even ethnic
resonances with the non-allopathic healing systems3.
So it should seem odd to all of us, we think, that
western medicine or 'allopathy' persists in dominating
the public health services system long past the 'British
times'. True, in recent years a proportion of qualified
non-Allopathic practitioners (with degrees like BAMS
and BHMS, etc.) have been appointed within the
primary health care system, but they operate within
the all-Allopathic framework.
Only in recent years - for both right and wrong
reasons - have the non-allopathic systems been
drawing a measure of serious official attention. In
2003 a full-fledged Department of AYUSH was set up
in the Ministry of Health and Family Welfare. The term
'AYUSH' includes 'Ayurveda, Yoga, Unani, Siddha &
’ Mira Sadgopal <miradakin@gmail.com>
2 Alpana Sagar <alpanasagar<biyahoo.com>
3 The non-allopathic systems are also known as 'Indian
Systems of Medicine (ISMs) & Homeopathy, and by the
new official acronym 'A YLISH’. Many people refer to them
as 'alternative' medical systems. In this paper 'western
medicine' and 'allopathy' are used synonymously.
Homeopathy’ - the formal or codified non-allopathic
systems. The term is now being coaxed to include the
vast and diverse local folk healing traditions of India,
as well as the codified trans-Himalayan system of
sowa-rigpa in Ladakh (akin to Tibetan or 'amchi'
■ medicine). The WHO, by the way, recognises the
significant role in public health of both 'formaE and
'folk' traditional healing systems.
In calling for 'mainstreaming of the AYUSH
systems in Government health policies and
programmes' in the 11lh Plan, the Planning
Commission sees the National Rural Health Mission
(NRHM) as the main field for operationalising this aim.
Here we enter an area of public health where little
data and scant research-based analysis exists and so
much is to be worked out... First, what is meant by
'mainstreaming' itself? Does it mean employing
AYUSH physicians in the PHC system? It is already
happening, for example, in Gujarat where we hear
that now most doctors at PHC level have AYUSH
degrees but are expected to practice allopathy, a
phenomenon that has been in existence for some
years and needs to be studied. Or by mainstreaming
is it meant that the various systems of health and
healing -- allopathic and 'alternative' - will be brought
on par? Will there be parity and equity between all the
systems? The prospect is mind-boggling. Yet in China
parity was adopted at the outset of the PRC (1949),
so that Chinese and western medicine function on par
to the present day - we need to study that 1
experience. The question is:
How could the Public Health system and
P H education evolve if it were to be adequately
informed by the ISMs and become consistent
with people's'health'cultures?
Let us first look at some background regarding
the philosophy and history of public health, and the
contrasting natures of the allopathic and nonallopathic systems.
Background...
While the origins of a 'sense of public health' can
be traced to antiquity, western-style 'public health'
today has its roots in training programs begun in
Munich in 1881, at Harvard-MIT in 1913, and by
Johns Hopkins in 1916 (Badgley). Historically public
health has been defined in terms of governmental
action, but voluntarism played a role (Porter). (While
then voluntarism represented action and funding by
people or organizations, today we call it 'community
participation'. Also, there has always been a private
sector with a hand in medical care.) The services
were generally limited to the non-personal, e.g. public
sanitation and preventive health education geared to
control problems in vulnerable populations (Frenk).
The history of western medicine gives insight into
the development of public health, where public
medical services are directed towards groups of
individuals while clinical services are directed towards
isolated individuals known as 'patients'. So while
public medical services differ from classic medicine in
this respect, public medicine has shared the outlook
Can Public Health open up to AYUSH & People's Views... ? by M Sadgopal & A Sagar. MFC, Bangalore 26-29 Dec 2006
1
and history of allopathic medical care. Hence it
partakes of the many problems of allopathy
historically epitomised in a mechanistic, reductionist,
medicalising, techno-centric and elitist approach to
health.
In India, as in the West, the formal systems of
medicine have usually been available to the wealthy
exclusively. The Greek forefathers Hippocrates and
Galen served whoever could pay their fees. While
ancient Egyptian medical texts do mention diseases
of the poor including occupational diseases, nothing
was done to protect workers (Sigerist). In India, the
mythical Ashwinis were the ones who roamed about
healing the common people, while Charak was court
physician. The surgeon Sushrut is said to have
learned his nasal plastic surgery from barbers in
Maharashtra, but unco codified it bocumo tho
privilege of kings. Often, as in Babylon and Greece,
priests were the earliest physicians. From the 16lh
century onwards physicians in Europe recruited
themselves from the middle class (Sigerist). Ironically
it was Christianity that instituted the view of everyone
deserving medical care, but it also led the witch hunts
that eliminated lakhs of women and men folk healers!
Thus the history of medical care is a story of elite
professionalisation that excluded the folk healing
systems and acquired an officially sanctioned
monopoly over the definition of health and illness.
The story in India has unfolded and is still
unfolding in similar manner. Public health in British
India was enclavist - it lacked interest in needs
beyond those of the army and the white community
(Ramasubban). While pluralism in treatment-seeking
behavior in the population existed, allopathic doctors,
British and Indian alike, never appreciated it. On the
contrary, European medical caregivers worried about
having to ‘gain ground and diminish the influence of
ignorant
hakims
and
Hindu
practitioners’.
Interestingly, though they doubted the efficacy of
indigenous medicine, even in the 1900s they were
obliged to make some room for the vaidya and the
hakim. (Arnold) However a result of this attitude since
the British period has been that allopathy has
dominated and turned a blind eye to the AYUSH
systems, stultifying their development. Arnold also
points out that,
‘In the end the future of western medicine lay not
with the colonizers but with India's emerging elite.
In the years alter 19M they were able to take up
western medicine as part of their own hegemonic
project.'
To accommodate to this domination, the AYUSH
medical colleges have modeled themselves after the
department categories of Allopathic colleges. The
pedagogical content is often couched in western
medical terms or includes facts grafted without
comment from western medical science into the
classical knowledge base. Research is conceived
within western medical frameworks and based upon
those criteria instead of referring to existing
, indigenous knowledge frameworks.
2
And what is the understanding of health and
illness that this Western system holds?
In Hippocrates' time environment, diet, activities
of daily life and so on were understood as factors in
health or illness, but this view was replaced in the 19lh
century by the theory of 'germs’ (or living micro
organisms) being the prime factor for illness. The
human body was already being regarded with the
mechanistic eye of the industrial revolution, and this
redirection of medicine towards biology gave
importance to technology for eradicating disease.
Thus it accelerated the process of medicalisation,
subsuming all the other ways to understand health
and illness, and blinding generations after that to the
crucial insight that health is politically, socially and
economically determined. Consequently, even today
tho discourse on medical and public health care tends
to get limited to the organization and distribution of
services.
Undoubtedly, these latter concerns are critical to
insure quality of care and its equitable availability to
all - as such, public health systems management is a
corner stone for health services development. But it is
equally important to be clear and equitable with
regard to the kinds of medical care to be delivered by
the health services system.
Do we approve of a public health system that fails
to take into account the intelligent perceptions of
the poorest? ...that doesn’t acknowledge their
livelihood struggles? ...that falls short of valuing
the traditional healing systems evolved from
generations of their life-times? ...that discredits all
other knowledge systems other than its own, a
system blind to its own arrogance?
Do we want a system that medicalises all aspects
of our lives and takes away our power over
decisions about our own health and gives it to
medical professionals?
Simple home remedies and local healing
traditions evolved over time have been communities'
way of resolving issues of health and illness in their
lives. Similarities found in the use of plants and herbs,
and different cultures using similar plants for
corresponding conditions indicates a people's
knowledge base evolved with experience over time,
not to be dismissed lightly. Similarly, methods of care
practiced by dais (traditional midwives) do not
deserve the discredit pronounced by allopathy
standing in judgment. Dais understand pregnancy and
childbirth and even the women themselves differently,
as a part of life and thus affected by aspects of life
like nutrition, rest and stress. This contrasts with the
doctors' view that all pregnancies are ‘at risk' and
need medical management.
It is slowly being accepted that the view held by
doctors is not necessarily correct. However, whatever
acceptance of traditional elements of care that occurs
within allopathy is piecemeal, insofar as it can be
taken into and adjusted within the allopathic world
view. In general a deeper, more genuine grasp of
non-allopathic patterns of thought is resisted. It is
Can Public Health open up to AYUSH & People's Views? by M Sadgopal & A Sagar. MFC, Bangalore 28-23 Dec 2006
good that some of the allopathic regimens, particularly
some obstetiic practices, are being recognised as
unscientific. They have persisted for years because
the male 'fathers of obstetrics’ had flawed and sexist
notions about women. For example, in childbirth the
'lithotomy position’ is now widely replaced by a semi
sitting posture in which the womb contractions- are
enhanced by the direction of gravity. Thus, the use of
traditional birthing stools or bearing down in squatting
position during labour, as taught worldwide by
traditional midwives, is at last validated. It is
remarkable that doctors could discard these methods
so easily as being the practices of 'illiterate uncouth
women', rather than acknowledging them as
techniques
evolved
through
women’s
long
experience. Incidentally, Victorian era doctors
adopted the lithotomy position (meant for urinary
stono surgery) so thoy could curtain thomsolves oil
from women’s sight while viewing and handling their
‘private parts’.
Such major errors have occurred because
modern allopathy, developed in the wake of the
industrial revolution, is a 'reductionist' system that
looks firstly at parts and how they function in the
human body as if it were a 'wonderful machine',
generally without referring to either the natural or the
social environment.
In contrast, the non-allopathic or AYUSH systems
are found to be 'holistic' in that they take reference
from the wide natural universe in which human bodies
and minds function or mal-function, and they see aL
parts and workings of the body intimately related to
each other. They are premised upon interdependent
processes and energy flows. Thus, in Ayurveda the
human body is a microcosm within the macrocosmic
universe composed of the five energetic elements, the
panch mahaabhoot. So humankind is not opposed to
nature and rather needs to keep in balance with it.
The finest physicians in these systems have
cultivated special sensitivities to mind-body states,
like the ancient physician and surgeon Sushrut who
describes subtle internal changes in pregnancy
perceivable by a woman as do-hridayni or 'being with
two heart-beats'.
Being reductionist in nature has given allopathy
(and western science in general) a particular
advantage, however, and that is the capacity to focus
practically on the minutest of physical details and
mechanisms in body function. Thus having generated
the germ theory and fueled by capitalist interests, it
could come up with precisely attributable, measurable
therapeutic interventions like antibiotics for treating
communicable diseases. Today it astonishes us by
technical feats unimaginable earlier such as coronary
artery 'by-pass' surgery that is now almost routine in
the
upper social class... and heart valve
replacements, etc. even for members of populations
depending on the public hospital system. Or stem-cell
research that promises intervention to correct even
genetic
disorders.
But
allopathy's
excessive
dependence on technology sometimes definitely
leads in the wrong direction, for example, the
unchecked worldwide trend of unnecessary cesarean
section operations.
Various observers have pointed out that a
prominent feature characterising the health culture of
Indian people is pluralism in seeking treatment and
relief of ailments. People make choices to draw from
the various healing systems and sets of practices,
including allopathy/ In a sense, this pluralism may be
even more characteristic of women than of men.
Another less commonly made observation especially
for women, is that rather than being helpless about
their own health care there is a strong element of
agency in making health choices. Women choose
despite their restricted access to health care and their
tendency to look after others first.
Generally speaking, women in India find more
resonance in the AYUSH systems and local health
traditions as compared to allopathy. This is because
of their pattern of social and cultural relationships,
their power or lack of it within each system, and the
way most Indian women relate to their bodies and to
nature. Contrary to what most analysts have argued,
it is probably not their powerlessness (economic
weakness, poor educational status) that "drives"
, women (as it is said) to a vaidya or hakim. As regards
mental and emotional health, too, there is more
resonance. In the allopathic view there is a sharp
mind/body distinction or split, hence a dichotomy of
mind and emotions. The male mind (supposedly not ■
emotional) is seen as the standard “sound mind", and
so women's mental and emotional health issues tend
to get discounted. But in the traditional views, in
general found throughout India, a person's "man"
(roughly translating as "mind" but located closer to the
heart, in the upper chest) is a combination of both
mental and emotional facets. This is not to say that
women's mental health issues are not neglected by
practitioners of Ayurveda, Unani or Homeopathy. It is
only to suggest that the AYUSH systems and local
health traditions may provide relatively more space for
women's mental health issues to be addressed.
Patriarchy or dominance by male-structured
values is very much a part of all the medical systems.
Patriarchy is present in traditional systems of care as
well and the males have more power than the women.
Women may be healers of smaller ailments but it is
usually men who are the shamans etc. At global level,
allopathy has been more exposed to criticism and
pressures from the women's movement, and today
there are many more women physicians in that
system than there were forty years ago. Much of
feminist critique concerns health issues as seen by
women, in particular women's health both including
reproductive health and beyond it. However, the
AYUSH systems on the whole have not been
exposed to this discourse. In these systems there are
a lot of unfounded unquestioned biases about
4 See Leena Abraham, 'Indian Systems of Medicine and
Public Health Care' (Chapter) in Review of Health Care
in India. Mumbai: Cehat, 2005.
Can Public Health open up to A YUSH & People’s Views... ? by M Sadgopal & A Sagar. MFC, Bangalore 28-29 Dec 2006
3
women’s bodies. Furthermore, in the local traditions
some blatant taboos still work against women even
today. While the codified texts and the practitioners of
each system carry a number of sexist ideas and
gender-based prejudices, most AYUSH practitioners
are unaware of these drawbacks. In Ayurveda caste
prejudice is another negative feature that does crop
up-
Because of allopathy’s pre-occupation with the
technical location of a pathology, it tends to ignore
many ailments that women experience, considering
them not "serious" or not amounting to “disease". For
example, common anaemia and weakness, vaginal
irritations, menstrual disorders, all kinds of pains, etc.
typically receive scant or no attention. At the same
time allopathy tends to medicalise natural aspects of
health like menstruation, pregnancy, childbirth and
menopause.
On the other hand, the AYUSH systems and
LHTs are more concerned with correcting imbalances
in health and sustaining it. Subtle signs indicate states
of humoral balance or imbalance that would be
helped by various types of correction, not merely by
medicines, such as modifying diet content, regulating
timing and amount of meals, fasting and yogic
posturing or movements.
Moreover, perhaps
surprisingly, in AYUSH systems male and female
bodies are not as opposed or dichotomised as in
allopathy and western culture. In Ayurveda
differences in individual make-up or nature (prakriti)
are more important than biologically distinct
reproductive organs and hormones.
Nutrition is another distinct area of expertise in
the AYUSH systems, particularly in the ISMs.
Although the Ayurvedic system of nutrition contrasts
starkly with the protein-carbohydrate-fat framework of
allopathy, its elaborate schema is rational no doubt.
The same would hold for Unani principles of nutrition,
which we hear have been applied with proven
success in improving child nutrition through ICBS in a
Block in Tamilnadu by a Unani Medical College 5
Questions of 'How?'
Given that 'parity and equity’ of systems is an
objective, there are fundamental questions of how
AYUSH (with or without the LHTs) is going to be
'mainstreamed' at par with allopathy in the public
health system - questions of fundamental conceptual
nature and questions of specific application. The most
basic is the difficulty of interfacing fundamentally
different knowledge systems. The non-allopathic
systems are based on entirely different conceptual
principles and assumptions that generally contrast
with the western medical world-view.
Allopathy is accustomed to interpreting the nonallopathic systems on its own terms and up to the
present time in the field of public health this lias been
5 Source: Prof. Hakim Syed Khaleefatullah, Chennai
(Member of A YUSH Steering Committee, 11th F YP).
4
allowed because allopathy is dominant. EJut what if
allopathy were 'brought onto on par1 with ayurveda
and unani, or with homeopathy? To many of us it
raises the basic question of 'What is science?' More
practically speaking, we need to know the answers to
the questions
'How is the validation of medicines or therapeutic
procedures to be done and accepted?'
'How will physicians resolve issues of interacting
therapeutics, side-effects, counter-indications?'
Will there be a change in the way of looking at
health and disease taking a wider view beyond
the germ theory' and individual-based causes?
Without a live and strong internal tradition of
critique and development, the potential of the AYUSH
systems to address women's health needs and public
health issues is restricted and unrealised.
Moreover, in these days of LPG (liberalisationprivatisation-glcbalisation) we are
seeing
the
allopathisation and commodification of AYUSH
systems on a massive scale. Already from past years
of subordination, the AYUSH colleges mimic the form
of Allopathic colleges in terms of department
categories, structuring of text-books, etc. Ayurvedic
medicines are researched by allopathic criteria. But
the scale on which Ayurveda is being globally
marketted and sold, and the price tags on its newlycelebrated therapies, is unprecedented. Not only is
there no concern for public health, it is also drawing
off the graduates of AYUSH colleges. The majority of
graduates of Unani colleges today and many from
Ayurveda colleges are going into cosmetics
manufacture and beauty parlours. And ironically
globalisation is bringing Ayurveda therapies back to
us in new expensive garbs geared lor tourist
consumption.
Even looking at management of medical services
the problems are immense. If mutually acceptable
standards for therapeutics, medicine interactions and
so on are achieved, then what will be the mechanism
for regulation? Who will carry out inspection? What
kind of criteria will be evolved for quality of care and
cure? Which kind of health problems will by attended
to by whom? What about immunisation, which certain
non-allopathic
disciplines
don't
accept,
like
homoeopathy? Will we continue to insist on
vaccination as a mainstay of public health? Where will
there be the 'choice' for users and how are they going
to decide? Who makes the decisions, healers or the
people they treat?
As of now, it is hard to imagine a lack of systems
hierarchy in actual PHO settings. And, are there
enough AYUSH doctors in India for Primary Health?
As one of our friends suggested, would it be feasible
at PHC-level to think of a kind of trained "Healers'
Group" (including various systems' physicians and
specific therapists), adept at dealing with 30-40
commonly occurring health disorders or conditions? In
Gujarat now there is experience of some special
'Ayurvedic PHCs' (also called 'healing centres'); what
Can Public Health open up toAYUSH & People's Views? by M Sadgopal S A Sagar. MFC, Bangalore 28-29 Dec 2006
good that some of the allopathic regimens, particularly
some obstetric practices, are being recognised as
unscientific. They have persisted for years because
the male 'fathers of obstetrics’ had flawed and sexist
notions about women. For example, in childbirth the
'lithotomy position' is now widely replaced by a semi
sitting posture in which the womb contractions- are
enhanced by the direction of gravity. Thus, the use of
traditional birthing stools or bearing down in squatting
position during labour, as taught worldwide by
traditional midwives, is at last validated. It is
remarkable that doctors could discard these methods
so easily as being the practices of 'illiterate uncouth
women’, rather than acknowledging them as
techniques
evolved
through
women’s
long
experience. Incidentally, Victorian era doctors
adopted the lithotomy position (meant for urinary
stone surgery) so they could curtain themselves off
from women's sight while viewing and handling their
‘private parts’.
Such major errors have occurred because
modern allopathy, developed in the wake of the
industrial revolution, is a 'reductionist' system that
looks firstly at parts and how they function in the
human body as if it were a 'wonderful machine',
generally without referring to either the natural or the
social environment.
In contrast, the non-allopathic or AYUSH systems
are found to be 'holistic' in that they take reference
from the wide natural universe in which human bodies
and minds function or mal-function, and they see all
parts and workings of the body intimately related to
each other. They are premised upon interdependent
processes and energy flows. Thus, in Ayurveda the
human body is a microcosm within the macrocosmic
universe composed of the five energetic elements, the
panch mahaabhoot. So humankind is not opposed to
nature and rather needs to keep in balance with it.
The finest physicians in these systems have
cultivated special sensitivities to mind-body states,
like the ancient physician and surgeon Sushrut who
describes subtle internal changes in pregnancy
perceivable by a woman as do-hridayni or 'being with
two heart-beats'.
Being reductionist in nature has given allopathy
(and western science in general) a particular
advantage, however, and that is the capacity to focus
practically on the minutest of physical details and
mechanisms in body function. Thus having generated
the germ theory and fueled by capitalist interests, it
could come up with precisely attributable, measurable
therapeutic interventions like antibiotics for treating
communicable diseases. Today it astonishes us by
technical feats unimaginable earlier such as coronary
artery 'by-pass' surgery that is now almost routine in
the
upper social
class...
and heart valve
replacements, etc. even for members of populations
depending on the public hospital system. Or stem-cell
research that promises intervention to correct even
genetic
disorders.
But
allopathy's
excessive
dependence on technology sometimes definitely
leads in the wrong direction, for example, the
unchecked worldwide trend of unnecessary cesarean
section operations.
Various observers have pointed out that a
prominent feature characterising the health culture of
Indian people is pluralism in seeking treatment and
relief of ailments. People make choices to draw from
the various healing systems and sets 'of practices,
including allopathy. In a sense, this pluralism may be
even more characteristic of women than of men.
Another less commonly made observation especially
for women, is that rather than being helpless about
their own health care there is a strong element of
agency in making health choices. Women choose
despite their restricted access to heal h care and their
tendency to look after others first.
Generally speaking, women in India find more
resonance in the AYUSH systems and local health
traditions as compared to allopathy. This is because
of their pattern of social and cultural relationships,
their power or lack of it within each system, and the
way most Indian women relate to their bodies and to
nature. Contrary to what most analysts have argued,
it is probably not their powerlessness (economic
weakness, poor educational status) that "drives"
women (as it is said) to a vaidya or hakim. As regards
mental and emotional health, too, there is more
resonance. In the allopathic view there is a sharp
mind/body distinction or split, hence a dichotomy of
mind and emotions. The male mind (supposedly not •
emotional) is seen as the standard "sound mind", and
so women's mental and emotional health issues tend
to get discounted. But in the traditional views, in
general found throughout India, a person's "man"
(roughly translating as "mind" but located closer to the
heart, in the upper chest) is a combination of both
mental and emotional facets. This is not to say that
■ women’s mental health issues are not neglected by
practitioners of Ayurveda, Unani or Homeopathy. It is
only to suggest that the AYUSH systems and local
health traditions may provide relatively more space for
women’s mental health issues to be addressed.
Patriarchy or dominance by male-structured
values is very much a part of all the medical systems.
Patriarchy is present in traditional systems of care as
well and the males have more power than the women.
Women may be healers of smaller ailments but it is
usually men who are the shamans etc. At global level,
allopathy has been more exposed to criticism and
pressures from the women's movement, and today
there are many more women physicians in that
system than there were forty years ago. Much of
feminist critique concerns health issues as seen by
women, in particular women's health both including
reproductive health and beyond it. However, the
AYUSH systems on the whole have not been
exposed to this discourse. In these systems there are
a lot of unfounded unquestioned biases about
4 See Leena Abraham, 'Indian Systems of Medicine and
Public Health Care' (Chapter) in Review of Health Care
in India. Mumbai: Cehat, 2005.
Can Public Health open up to A YUSH & People's Views... ? by M Sadgopal & /A Sagar. MFC, Bangalore 28-29 Dec 2006
3
women's bodies. Furthermore, in the local traditions
some blatant taboos still work against women even
today. While the codified texts and the practitioners of
each system carry a number of sexist ideas and
gender-based prejudices, most AYUSH practitioners
are unaware of these drawbacks. In Ayurveda caste
prejudice is another negative feature that does crop
up.
Because of allopathy’s pre-occupation with the
technical location of a pathology, it tends to ignore
many ailments that women experience, considering
them not “serious” or not amounting to "disease". For
example, common anaemia and weakness, vaginal
irritations, menstrual disorders, all kinds of pains, etc.
typically receive scant or no attention. At the same
time allopathy tends to medicalise natural aspects of
health like menstruation, pregnancy, childbirth and
menopause.
On the other hand, the AYUSH systems and
LHTs are more concerned with correcting imbalances
in health and sustaining it. Subtle signs indicate states
of humoral balance or imbalance that would be
helped by various types of correction, not merely by
medicines, such as modifying diet content, regulating
timing and amount ol meals, fasting and yogic
posturing or movements.
Moreover, perhaps
surprisingly, in AYUSH systems male and female
bodies are not as opposed or dichotomised as in
allopathy and western culture.
In Ayurveda
differences in individual make-up or nature (prakriti)
are more important than biologically distinct
reproductive organs and hormones.
Nutrition is another distinct area of expertise in
the AYUSH systems, particularly in the ISMs.
Although the Ayurvedic system of nutrition contrasts
starkly with the protein-carbohydrate-fat framework of
allopathy, its elaborate schema is rational no doubt.
The same would hold for Unani principles of nutrition,
which we hear have been applied with proven
success in improving child nutrition through ICDS in a
Block in Tamilnadu by a Unani Medical College.5
Questions of 'How?'
Given that ’parity and equity’ of systems is an
objective, there are fundamental questions of how
AYUSH (with or without the LHTs) is going to be
’mainstreamed’ at par with allopathy in the public
health system - questions of fundamental conceptual
nature and questions of specific application. The most
basic is the difficulty of interfacing fundamentally
different knowledge systems. The non-allopathic
systems are based on entirely different conceptual
principles and assumptions that generally contrast
with the western medical world-view.
Allopathy is accustomed to interpreting the nonallopathic systems on its own terms and up to the
' present time in the field of public health this has been
6 Source: Prof. Hakim Syed Khaleefatullah, Chennai
(Member of AYUSH Steering Committee, 11'" FYP).
4
allowed because allopathy is dominant. But what if
allopathy were ’brought onto on par’ with ayurveda
and unani, or with homeopathy? To many of us it
raises the basic question of What is science?’ More
practically speaking, we need to know the answers to
the questions
'How is the validation of medicines or therapeutic
procedures to be done and accepted?’
'How will physicians resolve issues of interacting
therapeutics, side-effects, counter-indications?'
Will there be a change in the way of looking at
health and disease taking a wider view beyond
the germ theory and individual-based causes?
Without a live and strong internal tradition of
critique and development, the potential of the AYUSH
systems to address women’s health needs and public
health issues is restricted and unrealised.
Moreover, in these days of LPG (liberalisationorivatisation-globalisation)
we
are
seeing
the
allopathisation and commodification of AYUSH
systems on a massive scale. Already from past years
of subordination, the AYUSH colleges mimic the form
of Allopathic colleges in terms of department
categories, structuring of text-books, etc. Ayurvedic
medicines are researched by allopathic criteria. But
the scale on which Ayurveda is being globally
marketted and sold, and the price tags on its newlycelebrated therapies, is unprecedented. Not only is
there no concern for public health, it is also drawing
off the graduates of AYUSH colleges. The majority of
graduates of Unani colleges today and many from
Ayurveda colleges are going into cosmetics
manufacture and beauty parlours. And ironically
globalisation is bringing Ayurveda therapies back to
us in new expensive garbs geared tor tourist
consumption.
Even looking at management of medical services
the problems are immense. If mutually acceptable
standards for therapeutics, medicine interactions and
so on are achieved, then what will be the mechanism
for regulation? Who will carry out inspection? What
kind of criteria will be evolved for quality of care and
cure? Which kind of health problems will by attended
to by whom? What about immunisation, which certain
non-allopathic
disciplines
don’t
accept,
like
homoeopathy? Will we continue to insist on
vaccination as a mainstay of public health? Where will
there be the ’choice’ for users and how are they going
to decide? Who makes the decisions, healers or the
people they treat?
As of now, it is hard to imagine a lack of systems
hierarchy in actual PHC settings. And, are there
enough AYUSH doctors in India for Primary Health?
As one of our friends suggested, would it be feasible
at PHC-level to think of a kind of trained "Healers'
Group" (including various systems' physicians and
specific therapists), adept at dealing with 30-40
commonly occurring health disorders or conditions? In
Gujarat now there is experience of some special
'Ayurvedic PHCs' (also called 'healing centres'); what
Can Public Health open up to A YUSH & People's Views? by M Sadgopal & A Sagar. MFC, Bangalore 28-2:1 Dec 2006
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