Allowing Ayurvedic doctors to perform surgeries: Why the clash

#IMA launches the #freedomstruggle of #Modernmedicine from the forces of #Mixopathy pic.twitter.com/O0OrD5SJQy

— Indian Medical Association (@IMAIndiaOrg) December 7, 2020

The Indian Medical Association (IMA) has released a statement opposing the notification published by the Central Council of Indian Medicine (CCIM) stating that Ayurveda doctors with Bachelor of Ayurvedic Medicine and Surgery (BAMS) will be provided training in 58 surgeries in their post-graduate courses.

The notification, issued last month through an amendment to the PG Ayurveda Education Regulations, 2016, will allow Ayurveda students to perform certain surgeries, including orthopaedics, ophthalmology, general surgery and ENT. This also includes procedures such as removal of benign tumours and cataract operations.

Students will be trained in two types of surgeries – MS (Ayurveda) in shalya tantra (general surgery) and MS (Ayurveda) in shalakya tantra (eye, ears, nose, head, throat and dentistry).

Doctors are worried that such a notification allowing PG in Ayurveda students to conduct surgeries, will be misleading to patients. Further, as per a statement released by the IMA, most of the 58 surgeries listed are performed by super-speciality surgeons. With these subjects not being taught in the BAMS level, it would be extremely risky to allow Ayurveda doctors to perform them, with half knowledge.

Following the notification, IMA doctors had staged a protest on December 8. If demands are not met, Doctors have threatened to close all non-emergency medical services on December 11 from 6 am to 6 pm.

What has prompted the move

Currently, as per 2016 regulations, Post Graduate students of Ayurveda specialise Shalya Tantra, Prasuti evam Stree Roga (Obstetrics and Gynecology) and Shalakya Tantra. Hence, Ayurveda Doctors are already trained to perform most of these surgeries. However, the notification brings more clarity on what procedures Ayurveda doctors are allowed to perform. This also gives more clarity to patients on what procedures Ayurveda doctors are trained to carry out.

There is also a huge shortage of doctors in the country. As per a statement made by the Government in Parliament, there is only one allopathic doctor for 1,445 students. This is as opposed to the WHO’s norm of 1 doctor for every 1,000 people.

Many allopathic doctors are also unwilling to serve in rural areas and far-flung interior parts of the country, hence, the need to supplement health care with alternative healthcare practitioners.

The BJP Government, under PM Narendra Modi, has been in the process of integrating indigenous and alternate streams of medicine and has formed a separate Ministry for the same – the Ministry of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy).

Under its new National Education Policy (NEP), the government also plans to integrate modern medicine with traditional systems of Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy (AYUSH).

The pandemic has seen a further thrust towards promoting ancient traditional systems of medicine, along with modern medicine.

The ancient Indian surgeon

Surgery is not new to Ayurveda. Those in support of Ayurvedic practitioners performing surgery cite the example of Sushruta, the ancient Indian sage from 500 BC who is known as the father of surgery.

The ancient text of Sushruta Samhita, one of the premier treatise on the subject from the ancient world, goes into great details to describe the instruments and procedures which are still followed in modern-day surgery. The text is also one of the first to suggest that students of surgery should first learn about the human body and its organs by practising dissection in a dead body.

Ayurvedic surgery has evolved from the times of Sushruta, using modern instruments and technology now. Ayurvedic practitioners have been performing surgeries for over 20 years, and this notification legalises these procedures.

The procedures include surgeries such as cyst removals, cataract surgeries and gynaecological procedures. There are, however, restrictions on performing complex surgeries including cardiac ones, neurological and spinal surgeries.

Khichdi medicine

So, why are allopathy doctors agitating?

The fight between Allopathy and alternate medicine streams such as Homeopathy and Ayurveda is an old one. While allopathy doctors do see promise in many Ayurvedic treatments and medicines as supplementary to modern medicine, they have been raising concerns about the practice of mixopathy – or allowing Ayurvedic practitioners to prescribe modern medicine.

Dr Rajan Sharma, President of the IMA, has even said that such an integrative system could lead to a khichdi medical system, producing doctors who are hybrid. In its statement, the IMA has said that it is “corrupting modern medicine by mixing with other systems and poaching the disciplines of modern medicine through the back door”.

While postgraduate Ayurvedic surgical training is a formal three-year course, allopathic doctors also point to concerns regarding whether Ayurvedic medical colleges and hospitals will be able to provide the same quality of training as allopathic institutions. This puts a question mark on the ability of Ayurvedic doctors to perform intricate surgeries.

There could also be a lack of clarity on the part of patients on who their doctors are, what system of medicine they belong to and how qualified/trained they are to perform such a surgery. While many patients in India are willing to try alternative medication, there are others who are wary of getting operated on by non-allopathic doctors.

Currently, there are no restrictions on where Ayurvedic doctors are allowed to serve. With allopathic doctors often unwilling to serve in rural and far-flung areas, this concern could be taken care of to a large extent by deploying Ayurveda doctors.

However, if Ayurvedic doctors are sent to rural areas and allowed to perform surgeries, there should be a guarantee that there is no difference in the quality of care that people in the rural areas and urban areas receive.