A statutory body set up under the AYUSH Ministry to regulate Indian systems of medicine, The Central Council of Indian Medicine issued a gazette notification on 20th November notification allowing postgraduate (PG) Ayurvedic practitioners to receive formal training for 58 types of surgeries, listed 39 general surgery procedures and 19 other procedures including ENT, ophthalmology and dental procedures. This decision to allow postgraduates students of Ayurveda to practice general surgery follows the amendment to the Indian Medical Central Council (Post Graduate Ayurveda Education) Regulations, 2016[1].
However, this notification brought a stir in medical community. This notification is being criticized by the Indian Medical Association (IMA) and they questioned the competency of the Ayurvedic doctors to carry out these medical procedures. IMA calling this notification an attempt at “mixopathy” (integration of all system of medicine such as AYUSH and modern medicine)[2].
On the other hand Ayurveda practitioners have welcomed this notification with all hearts. According to many Ayurveda practitioners, surgery is not alien to them and that performing surgery is an integral part of Ayurveda since the time of Sushruta (father of surgery). They claimed that they are well-trained in performing surgeries and they even perform surgeries in rural areas, though not major surgeries like neurosurgery etc.
There are two branches of Ayurveda which is already dealing with surgery namely ‘Shalya’ (dealing with general surgery) and ‘Shalakya’ (dealing with ear, nose, throat, eye, neck, head, oro-dentistry). The AYUSH ministry also clarifies in its notification that the post-graduate students of ‘Shalya’ and ‘Shalakya’ were already learning these procedures of surgery in their surgical department in Ayurvedic medical college, according to their training curriculum, and the amendments brought forth only added clarity and definition to the regulations of 2016 that were concerned about the post-graduate Ayurveda education.
The main question that arises here is that whether allowing Ayurveda practitioners to perform surgery is legally and medically tenable? The answer to this question is the passing of the National Medical Commission Act in 2019 that was allowed for the formalization of proposals to admit community health providers, mid-level care providers in a primary healthcare centre in India. Who would give their service to the health and wellness centres across India and focus on the provision of primary healthcare with the medicine allowed to them in limited range to use for the treatment of the patients. And there is nothing wrong with it. We can see many countries using mid-level care providers like nurse practitioners, to enhance access to healthcare for common people, though with strict regulations and safeguards around standards, training, and certifications. Hence, from the medico’s point of view, there is nothing illegal in Ayurvedic practitioners performing surgery. While the notification of 2016 stipulated that the students shall undergo training of investigative procedures, techniques and surgical performance of procedures and management in the respective specialty, the details of these techniques, procedures and surgical performance were laid down in the syllabus of respective PG courses issued by CCIM, and not the regulation per se,” the clarification stated[3].
The ministry also said, “All scientific advances including standardized terminologies are inheritances of the entire mankind. No individual or group has a monopoly over these terminologies.”
Again there is a question that why this move? And the answer is the unwillingness and shortage of allopathic practitioners including surgeons to practice in a rural area or backward area forced the Central Council of Indian Medicine to take this step. The government has introduced various mechanisms such as rural bonds, a quota for those practitioners who have provided service in a rural area in their post-graduates seat along with these governments have also introduced a plan on increasing the number of medical colleges and seats in post-graduation. But even after applying all these incentives, we would most probably lack the well trained and specialist doctors in the rural area to serve the needy and unprivileged people. To fill this gap we need to explore more creative ways such as supported by efficient and quality referral mechanisms, task-sharing, etc. the arrival of mid-level healthcare providers like we can see in many states the community healthcare providers, is also a lucky chance to move some elements of healthcare such as promotive, preventive and limited curative to these healthcare providers while insuring securing clarity of role along with career progression.
In a statement, the government said that this move of the Central Council of Indian Medicine will relieve the chronic shortage of well-trained health workers in India. The World Health Organization recommendation is one doctor for every 1,000 people, but India has one doctor for every 1,450 people which is less than the recommendation of the World Health Organisation. According to a survey many people prefer to receive treatment from the AYUSH providers exclusively, they have full faith in it, while some people seek this form of treatment as a complementary treatment with the ongoing allopathic treatment they are already receiving. Also, our country is suffering from significant gaps in healthcare infrastructure. According to research earlier last year by Brookings Institute, a US-based policy organization, the country has only 0.55 beds per 1,000 people. Most of the allopathic practitioners do not want to provide service in rural areas of our country because of less facility available there.All these factors led the Central Council of Indian Medicine to take this step which is though not a new mandatory one to improve the healthcare facility in India.
Hence, the Central Council of Indian Medicine allowed the practitioners of Ayurveda medicine to perform surgery which will be helpful for us. As many Ayurveda practitioners have claimed that they are already performing medicine in various fields and that they are also getting three years training in their post-graduation, which is also confirmed by the AYUSH ministry itself. Since these notifications mentioned that all the post-graduates are not allowed to perform surgery but only those are allowed who are specialized in ‘Shalya’ (dealing with surgical treatment) and ‘Shalakya’ (dealing with ear, nose, throat, eye, neck, head, oro-dentistry). The notification also says the postgraduate students of Ayurveda medicine must be trained practically to acquaint with and to perform surgery independently. If all the guidelines of the notification come into effect accordingly, then there is nothing wrong with allowing the postgraduate students of Ayurveda medicine to perform surgery as it will be helpful to every citizen of the nation especially for the needy and unprivileged people and also it will enhance the healthcare system of our nation.
References:
1. www.thehindu.com
2. lifestyle.livemint.com
3. theprint.in
About the author –
This Blog is authored by Shalini Bhatt , B.A.LL.B. (Hons.) Course, 2nd Year student, 4th Semester, Chanakya National Law University, Patna.
