A doctor speaks on the phone as she looks out from a window at the 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 Indian Medicine Central Council (PG Ayurveda Education) Regulations 2016. The amendment lists 58 surgical procedures that postgraduate students of Ayurvedic education in two branches – Shalya and Shalakya – are to be formally trained in and which they can practice independently afterward.
The Indian Medical Association (IMA) has opposed this move, calling it an attempt to create a new and illegitimate ‘mixopathy’, as well as calling the CCIM’s ways to be “uncivil” and “foul”. The body, which is India’s largest association of medical doctors, also said the newly constituted National Medical Commission (NMC) is responsible for asserting these two separate systems of medicine independently, and that is how it must be.
The ministry subsequently published a clarification that postgraduate scholars can only perform the basic surgical procedures listed in the amendment and that it’s a restrictive reform, not a policy shift.
But IMA has rejected this clarification, and has demanded that the amendment be withdrawn. It has also called for a public demonstration on December 8 and the suspension of non-essential medical services for 12 hours on December 11. Finally, IMA has also asked for four bodies under the NITI Aayog, which are mulling ways to integrate multiple systems of medicine, to be dissolved.
This isn’t the first time representatives of these two systems have been at odds with each other. Their previous bones of contention include questions of whether AYUSH practitioners can prescribe allopathic drugs, if allopathic nursing homes and hospitals can recruit AYUSH scholars, and Ayurveda and allopathy can indeed be integrated.
Roshan Mendhe has a bachelor’s degree in Ayurvedic medicine and is a graduate of the Tata Institute of Social Sciences, and is currently a public health consultant. According to him, Ayurveda PG scholars get similar exposure and practical training as modern medical PG scholars. Allopathic practitioners frequently recruit Ayurveda doctors as assistants, he added, and that Ayurveda practitioners regularly staff clinics in rural areas and ICUs in tertiary-care centres. So if this all is already happening, in his view, an amendment to provide formal training and legal protection is only warranted.
However, “if the AYUSH ministry wants to provide PG degrees for surgeries, it’s fine, but they must use only Ayurveda techniques and drugs,” Ujjval Rana, currently working as a state maternal health consultant with a UN organisation, said. “Both systems must be mutually exclusive.”
“Ayurveda should be mainstreamed but based on its strengths and evidence. It would have a lot to offer.”
According to Shabeer P.K., a public-health consultant, AYUSH practitioners may prefer to stay back in rural areas “if they get a chance to upgrade their portfolio”. On the other hand, he continued, doctors trained in allopathic medicine prefer to work in urban areas.
“It is sometimes critical to have these strategies to save lives where trained manpower is scarce, particularly specialised manpower,” Shabeer said. “At the same time, it is also important to have serious training and supervision to empower AYUSH [practitioners] to perform in modern medicine.”
Indeed, the shortage of trained government doctors in rural areas is a constant challenge in India. There is a severe crunch of specialist doctors, including surgeons, with 81.8% positions lying vacant at government community health centres.
At the same time, hoping trained Ayurveda specialists could fill this gap might not work. A 2016 WHO report found that each category of healthcare worker – except traditional and faith healers – prefer to practice in urban areas, where only about 35% of India’s population lives.
So even if Ayurveda practitioners and IMA doctors reach a consensus on any of the topics of debate, the problem of ~65% of India’s residents being unable to access trained doctors would still exist. This problem can be solved only if the adequate infrastructure, better working conditions and incentives are in place. And until such time, unregistered medical practitioners (UMPs) will continue to be the rural population’s preferred point of contact.
A major source of confusion that the new amendment could drive pertains to law and regulation. Only a few states in India allow Ayurveda practitioners to practice allopathy as well: Maharashtra, Tamil Nadu, Gujarat, Punjab, Uttar Pradesh, Bihar, Assam and Uttarakhand. And at present, no person can perform surgeries without allopathic drugs and diagnostics.
For example, an Ayurveda practitioner can prescribe allopathic drugs in Maharashtra – but in Kerala, doing so is illegal. So can a Shalya PG scholar operate in Kerala but without prescribing the requisite drugs? Would these details be at the state’s discretion? What if these practitioners move from one state to another?
It is important to provide career growth, but public welfare must come first. Both systems must reach a point where they can complement each other. The Ministry of AYUSH has the government’s support but lacks credibility, while the IMA has been responding aggressively. Meanwhile, on the ground, most healthcare workers are dissatisfied with one or another part of their jobs – even as there is a strong divide among doctors themselves about working in urban versus rural areas.
In this context, UMPs can’t be written off for the foreseeable future – not until we have strong and clear regulations, and robust training and infrastructure in place.
Prachi Singh is a public health professional working as an independent consultant. She has consulted with various organisations, including the National Health Mission, Punjab; the National Health Systems Resource Centre, New Delhi; and the WHO.