A parliamentary panel had been entrusted to review the new National Medical Commission Bill on healthcare in India. Finally, and thankfully it advised the government to scrap its proposal for a bridge course to allow AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homoeopathy) practitioners practice Allopathy.
However, while approving the amendments in the NMC Bill, it was left to the state governments to take necessary measures for addressing and promoting primary healthcare in rural areas. As a result, despite dropping the bridge course from the NMC Bill, the decision has been left to the states.
In fact, many states have already allowed AYUSH doctors appointed in Primary Health Centres in rural areas to practice allopathy during ‘emergencies’. Presently 13 states, including Karnataka, Maharashtra, Tamil Nadu, Gujarat, Punjab, Uttar Pradesh, Bihar, Assam, and Uttarakhand have made this legal.
Was This Move Needed?
A dispassionate look at the jaw dropping figures released by WHO in June 2016 could possibly make us see some sense behind the government’s move.
It says, in 2001 nearly one third of practitioners calling themselves allopathic doctors were probably just out of school.
Gravity seems all the more telling when one realises that the scenario is extremely distressing in rural India, where:
Recent data of Medical Council of India shows that as on September 2014 total number of doctors qualified in modern medicine was 9.32 lakh and that of AYUSH doctors stood at 6.8 lakh.
Alternative Medicine & Allopathy Work on Different Principles
It is difficult to understand how this move of the government helps the cause of the rural masses for accessing healthcare.
First and foremost, you have already derided your own indigenous systems of medicine as second rate and with one stroke you have decimated the self-esteem of AYUSH practitioners.
After all they are a sizable number and are delivering healthcare to the best of their ability not only to the rural masses but also to their urban counterparts especially in the southern states of India, in particular, Kerala.
Second, it is very important to note that the principles on which these medical disciplines are based are different from one another even among themselves and certainly from allopathy.
The treatment, for example, in allopathy is directed towards a particular disease and would be same for all suffering from the disease.
On the other hand, treatment in homeopathy is based more on symptoms and the constitution of the patient for the same disease and thus would be different in different patients. Similarly, the treatment in ayurveda is dependent on the nature of the patient further categorised according to the doshas – Vaat, Pitta and Kapha.
Hence, it tantamounts to teaching allopathy to a person afresh, even if he is a well qualified doctor in his own discipline. It is impossible to condense a course of five and a half years to six months especially in an era where ‘Super Speciality’ rules the roost.
Further, in several decisions by various courts of India, it is clearly stated that the doctor should write his speciality in which he has a complete and recognised training and not some kind of an experience.
Medico-Legal Nightmare in the Making
The argument advanced is that such trained doctors would be allowed to prescribe only from a predetermined set of allopathic medicines and practice allopathy during ‘emergencies’.
But, in fact, these are the situations where a proper diagnosis is of utmost importance before writing the medication. Making a proper diagnosis would be a tall order for such half-baked ‘allopaths’.
In emergencies or calamities, people who deserve to be treated by well-qualified doctors (of any system) the most, would be denied the same and subjected to this ‘khichri’ system created by the bridge course.
This crash course won’t help them understand when to refer the patient and that can be quote dangerous.
You cannot create several standards of care because value of life of a poor rural patient is no less than that of an urban rich. The fear is that this is exactly what would be created, which in the process would become a medico-legal nightmare.
Aren’t AYUSH Disciplines Scientific Too?
All these disciplines represented by AYUSH are scientific in their own right. In fact, a sizable number of patients even in urban India prefer going to Ayurvedic doctors over Allopaths, especially in Kerala, with gratifying results.
So what is the point of making khichdi doctors with the number of service providers, read doctors, remaining the same, defeating the very purpose on which the whole premise was based.
It will be naive to imagine that these doctors getting trained for six months with the so-called bridge course would practice only in the villages and serve the people. After being licensed to practice modern medicine, they may also like to migrate to urban areas as it is more lucrative.
And there is no way to ensure that such doctors would stick to the list of medicines as prescribed by the government.
So, if implemented, this is a disaster in the making.
What Is the Solution?
The long-term solution lies only in producing more doctors in all systems of medicine and imparting them the best of training in their respective fields. There’s also a need to increase the presence of public and private healthcare to remotest of regions by giving incentives.
(Dr Ashwini Setya is a Gastroenterologist and Programme Director in Delhi’s Max Super Speciality Hospital. His endeavor is to help people lead a healthy life without medication. He can be reached at firstname.lastname@example.org)
(The views expressed above are the author’s own. FIT neither endorses nor is responsible for the same.)
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