NOTES AND COMMENTS

WHAT ARE WE DOING WITH OUR INDIGENOUS MEDICAL TALENT

The Indigenous systems of medicine could be used successfully in the achievement of health goals, through raising the standards of education leading to certification. The expertise of these about four lakhs of registered practitioners should be utilized fully in primary health care services.

[Presidential Address by Prof. Archana Sharma, at the 74th Session of the Indian Science Congress, Bangalore, January 1987 (1)]

The irony of the above statement lies in the fact that, perhaps not even a single one of the four lakh practitioners named, above was present in the Indian National Science Congress, which is the largest single gathering of Indian Scientists! By "Scientist' we still refer only to those who have a training in modern Western Science and Technology. As a nation,' we seem to have little awareness of the fact, that there exists a large body of professionals still practicing the, Indian Tradition of Science and Technology.- No wonder then, that we have not even an outline of a plan, as to .how to utilize them, leave alone any larger vision about their potential and development.

Consider for example the "Manual for practitioners of Indian Systems of Medicine and Homoeopathy", published by the Ministry of Health and Family Welfare in November 1985(2). This has been written to spell out ways of involvement , of practitioners of Indian systems of medicine and Homeopathy in Family Welfare and Primary Health care". The following extracts from the report give us some idea about what this "involvement' could mean. For example, in the Second Chapter, (on "Mother and Child Care') we find the statement that: If any of the following signs and symptoms are present, the mother or child should be immediately referred to the health worker or to the sub-centre". Following this is a list of symptoms, such as head ache, "cough, swelling of feet, etc. in pregnant women, difficulty in passing urine, diarrhoea, fever,, etc. in new born infants, and so on. The third chapter (on "Immunization"), says that the practitioners should: Assist the health worker in arranging for immunization, by various means such as - "keep aside those who are obviously sick or who have a skin disease so that the health worker can examine them". The fourth chapter (on "Nutrition'), says that "whenever you find a. malnourished child in the community, you should refer the child to the health worker Similarly Identify the cases with signs symptomsi of anaemia in pregnant and nursing women and children refer them to rather health worker (male/female) for treatment, whenever you find pregnant or nursing women or young children who have any combination of these signs and symptoms, you should refer them to the health worker for treatment. The seventh chapter (dealing with Malaria, TB, Leprosy and blindness), says that in each case the patient should be referred to the PHC-Hospital for proper investigation and diagnosis.

In fact the entire manual does not contain a single- instance where the practitioner is required to use or draw upon his training as an indigenous medical professional in any way. The manual treats the practitioner of Indian Systems of Medicine1(ISM) as an "unskilled worker whose only" task seems to be to refer the patient to the health worker or.PHC for "proper investigation and diagnosis”.

The National Health Policy Document (1983)(3) recognized the problem when if said The Country has a large stock of health manpower comprising of private practitioners in various systems, for example Ayurveda, Unani, Slddha, Homoeopathy, Yoga, Naturopathy, etc. This resource has not so far been adequately utilized. The practitioners of these various systems enjoy high local acceptance and respect and consequently exert considerable influence on health, beliefs and practices. It is therefore, necessary to initiate organized measures to enable each of these various systems of medicine and health care to develop in accordance-with its genius (emphasis added).

Nevertheless such statements have remained mere sentiments or sporadic pronouncements and have not been reflected in any action plan. This Is hardly surprising, since the problem is deep-rooted, and hence does not admit of any solution that can be brought about By merely cosmetic changes.. It calls for a deeper examination of our entire approach to health care and an understanding of the historical forces that have governed Its development in the last, two centuries, since the advent of British rule... The problem itself is one which we share with several other non-Western societies, particularly those which have a history of European domination. However it is interesting to. .note that there are countries where serious efforts have been initiated to involve their own traditional systems of medicine in National Health Care. One such major effort is now under way in China.

In the words of a former head of the Scientific and Technological Bureau' of the Public Health Ministry, of the People's Republic of China "Traditional Chinese medicine and pharmacology have develops over thousands of years and include the medical knowledge of minorities such as the Tibetans, Mongolians, Vygurs, Yus and Dais. After the founding of the New China, the Central Communist Party affirmed the advantage of traditional Chinese medicine and formulated a policy of unity between ' traditional and Western - trained practitioners. Traditional practitioners in private practice have been organized and assigned to work at hospitals, and have enjoyed the same status as practitioners of Western Medicine. Practitioners of Western medicine have been encouraged to learn traditional techniques and vice versa. Western style hospitals have added departments of traditional medicine, and entire hospitals have been dedicated to traditional medicine. Traditional medicine and pharmacology have been systematized and studied by modern scientific methods. Young and middle-aged practitioners, whether or not they began with traditional training, have been chosen to follow in the footsteps of older practitioners who have particularly advanced their fields and to further develop these fields.

The new combination of traditional Chinese and Western medical treatment has improved the rates of both prevention and cure of common and serious diseases. Acute abdominal conditions usually requiring surgery can now be treated non-surgically. For example, at the Zunyi Medical College in Guizhou Province and the Dalian Medical College in Liaouing Province, 11,722 cases of conditions such as acute appendicitis and acute pancreatitis have been treated since 1958 with combined traditional Chinese and Western methods, with a cure rate of 92.7%. Treatment of bone fractures and bone and joint injuries this way has lead to a new type of trauma orthopaedics. The orthopaedic department of Tianjiu Hospital has developed a system of treatment for bone fracture that has proved its worth in more than 100,000 cases.

Anaesthesia by acupuncture is a Chinese creation, and a significant achievement in combining traditional Chinese and Western medicine..... Acupuncture anaesthesia has been widely used in cranial, cervical, thoracic and abdominal operations. It has also been used successfully 1n complex heart surgery!., and in the replantation of severed limbs.

Since 1977 the World Health Organization (WHO) has also supported the development of traditional Chinese Medicine by helping to popularise Chinese acupuncture in various countries .and acknowledging acupuncture therapy as "a new internationally applicable medical discipline". Today of the foreign students studying natural sciences In China, those majoring in traditional Chinese medicine make up the highest percentage (5).

The reason we have cited the Chinese experience in such detail, is not so much to plead that such integration should be reproduced here. It is rather to convey, that various non-Western societies are evolving their own ways and means for coming into their own, in a world which till recently was dominated politically and in ideas by the Western civilization. It should be clear that interacting with the West should not mean 'just absorbing everything that is broadcast in the name of modern, or being run over by modern ideas. Rather, the interaction should be on our own terms; it is based on our own grals and needs that we should decide what needs to be accepted or rejected from the West and what we accept needs to be modified suitably to be incorporated in our own scheme of things. If _ we can have such a clarity in our thought and approach, then we can certainly hope to achieve something of significance perhaps even more than China, given the fact that we still have a large body of personnel trained in Indigenous System of medicine, they still command a lot of respect "and influence "with our people and an enormous body of knowledge in this area still exists-both as texts and manuscripts as well as the knowledge and practices amongst our people.

REFERENCES:

1. Resources and human well being: Inputs from Science and Technology' by Archana Sharma (Address by the General President, 74th Session, Indian Science Congress) Pub Indian Science Congress Association (Calcutta 1987).

2. Manual for practitioners of Indian Systems of Medicine and Homeopathy. (Ministry of Health and Family Welfare 1983).

3. National Health Policy, (Ministry of Health and Family Welfare 1983) para 11.

4 Health care in China: A unique partnership between ancient and modern medicine by' Chen Haifeng and Shen Chenru, Impact of Science on Society. Issue No.143 (1986).

5. Traditional Chinese Medicine by Hon Zhaotang, Beijing Review May 19, 1986, pp.15-23.



Author:A.V. Balasubramanian