Will you go to an Ayurveda surgeon?

IMA calls move to allow Ayurvedic doctors to perform surgeries unhealthy. Those trained in ancient science argue, 'we have been doing a good job so far'

Dr Amrut Salunkhe laughs when asked why, when he cleared his Class XII exams in 1978-89 with an 88 per cent in physics, chemistry and biology, he chose Ayurvedic medicine and not the more popular modern/allopathy practice? Dr Salunkhe, who is from Dhulia district of Maharashtra, says it was a simple matter of seats being filled up.

"Then I could study MBBS only in the Pune region and all the seats were taken. So, I took admission at a government college in Nagpur where they taught Ayurvedic medicine," says the associate professor of ENT and Ophthalmic surgery (shalakya tantra) at Worli's MA Podar Hospital.

Over 600 doctors from all over India under the banner of Indian Medical Association (IMA) organised a mahapanchyat to protest against the National Medical Commission (NMC) Bill, 2017, at the Indira Gandhi Stadium, on March 25, 2018 in Delhi. The NMC Bill seeks to allow practitioners of Ayurveda and other traditional medicine to practice modern medicine once they complete a short-term bridge course, among other wide-ranging institutional reforms. Pic/Getty Images

At the time, the original texts for Ayurveda studies were still in Sanskrit and so, over the BAMS course, he learnt Sanskrit. After completing his BAMS, he did a MD in Basic principles of Ayurveda and a second MD in Shalakya i.e ENT and ophthalmolgy, and later joined Worli's Podar hospital, where he teaches students and also conducts ENT surgeries like septoplasty, SMR, tonsillectomy, adenoidectomy and other minor surgical procedures such as cataract removal. The hospital, he says, recently acquired an upgraded machine to conduct more advanced cataract operations. "But, that had to cease operations due to COVID-19."

In a year that has seen healthcare as the top conversation across the world, comes another debate. Should Ayurvedic surgeons be allowed to conduct surgeries?

Dr Sarika Varma, Gurugram based ENT surgeon, argues that if the government spent more on healthcare, it would be able to set up a larger number of medical colleges and allow more doctors to join the system. Pic/Nishad Alam

While the move has been long in the making, on November 20 this year, the Central government issued a notification authorising post-graduate practitioners in specified streams of Ayurveda to be trained to perform surgical procedures. The gazette notification by the Central Council of Indian Medicine (CCIM), a statutory body under the AYUSH Ministry to regulate the Indian systems of medicine, listed 39 general surgery procedures and around 19 procedures involving the eye, ear, nose and throat by amending the Indian Medicine Central Council (Post Graduate Ayurveda Education) Regulations, 2016.

According to the notification, the procedures listed include removal of metallic and non-metallic foreign bodies from non-vital organs, excision of simple cyst or benign tumours (lipoma, fibroma, schwanomaetc) of non-vital organs, amputation of gangrene, traumatic wound management, foreign body removal from stomach, squint surgery, cataract surgery and functional endoscopic sinus surgery. The move has drawn protest from the Indian Medical Association (IMA), many of whose doctors have struck work to protest.

Dr Rajeshwar Reddy has been a PG guide for 20 years and has been a PhD guide for the last six years. He says that he has trained more than 30 students and "all are leading Ayurvedic surgeons their field". Pic/Ashish Raje

Earlier this year, Dr Sarika Varma, a Gurugram based ENT surgeon who consults at various hospitals and runs the chain of allergy clinics called Allergy Doc, started a petition on change.org demanding that India spend 10 per cent of its GDP on healthcare. "India spends 1.6 per cent. Compare that to the spend of UK, which is 16 to 18 per cent. India even spends lesser than Bangladesh and Sri Lanka, which spend six per cent of their GDP on healthcare. How are we to have a better healthcare system in India?" she asks. To this, she has added the request that Ayurvedic practitioners not be allowed to conduct surgeries.

"Ayurveda doctors study ayurveda, not modern medicine. What kind of anesthesia or postoperative antibiotics do they plan to use? This kind of unscientific mix of specialities will be dangerous for Indian people. These surgeons will practice in rural India, where there is no access to quality healthcare. If a minister falls sick, he or she goes to AIIMS, Vedanta or MAX [hospitals] which have the most qualified doctors in the country, who have studied modern medicine. Have you seen a single minister heading to an Ayurvedic hospital? Why then, a different set of rules for the people?"

The problem, argue both Dr Varma and Dr Avinash Bhondawe, the president of the Maharashtra chapter of the IMA, is that the last few years have exposed how India suffers from a lack of doctors. Allowing Ayurvedic doctors to perform surgeries then, is a quick way, says Dr Varma to allow more surgeons into the healthcare system, but at what cost?

Stressing that modern medicine has nothing against Ayurveda, Dr Bhondawe argues that it's the mixing of the different streams of medicine that isn't palatable. "The government of India, in the last few years has been allowing different medicine paths to mix. In Maharashtra now, there is a six-month course available in which homeopathy doctors are taught pharmacology." The problem comes, he says, in standardizing what is being taught. "An allopathy surgeon is taught anatomy, physiology, how organs work and how hormones react to different medication. Who will teach Ayurvedic surgeons about this?" On the other hand, the dilution of Ayurvedic studies, he points out, will affect the progress of Ayurveda research too. "Instead, why doesn't the government invest in researching more on this ancient practice, which has proven efficacy in its own speciality, and find better solutions?" If the government does want a crossover of medicinal streams, it should then, Dr Bhondawe says, set up a separate council that will teach students about traditional and modern medicine, right from the start, with a curriculum designed for it. "Let the degrees reflect that a particular surgeon has studied under Ayurveda or modern medicine, so patients can choose their care."

Dr K Rajeshwar Reddy, professor of surgery at Podar hospital, with a 30-year career behind him, says the problem is the lack of public awareness about surgeries being conducted by Ayurvedic hospitals. He calls the government move, a good decision, saying it will perpetuate the cause of Ayurveda which, without any push, has not evolved in the last millennia.

If they conduct hernia or cataract operations or appendicitis, how different is it from what a modern medicine surgeon will perform at any other hospital?

There's no difference really, say both Dr Reddy and Dr Salunkhe. The procedures, and pre- and post-operative care are the same and the same allopathic medicines will be provided. An additional benefit of an Ayurvedic treatment is, he says, that the surgeon will prescribe a suitable diet to ensure that the patient does not have a recurrence of the disease. "In fact, not just does modern medicine practice types of surgical procedures described in the Sushrut Samhita thousands of years ago, but some of our procedures—like the medicated seton which is used to treat ano-rectal fistulas—are more popular than modern medicine therapies," he adds.

An Ayurvedic ENT surgeon, says Dr Reddy, will study four-and-a-half years in the BAMS course, followed by a year in internship and three years of post-graduation in surgery before starting their practice. It's a path similar to an allopathy student's. And the course, Dr Salunkhe adds, is not stagnant either, having been updated twice in the last 10 years. In fact, says Dr Salunkhe, many of their students are now working in areas like Jalgaon and other parts of Maharashtra where they conduct cataract surgeries under topical anaesthesia.

It is here, feels a senior ENT specialist who didn't wish to be identified, that allopathic practitioners differ from Ayurvedic practitioners. "Most allopathy surgeons will not go to rural areas where healthcare really needs a boost. But, Ayurvedic doctors don't have that problem." As far as the quality of their surgery is concerned, this doctor has witnessed their work over the past two decades at close hand, and says that it's at the same level as any other doctor in the city. "They are very well equipped to perform basic surgeries such as tonsillitis and cataracts. And that's where the maximum number of surgeries lie. Also, when Ayurvedic doctors perform allopathic surgeries, they usually call an allopath in the operating theatre to guide them especially in more higher grade of surgeries."

But, will the quality that's available in Mumbai translate to the rest of India? Dr Sheetal Sabherwal, MD DGO and practising obstetrician, gynaecologist and surgeon, says, "It takes a lot of practice to develop skills as a surgeon. In Mumbai, a student at a government hospital will learn far more than the one at a private hospital, because the patient load is in excess and so, there are more chances to operate under seniors. How many people go to an Ayurvedic hospital for a surgery? Where and how will these students learn? Also, if a student does come for a job, there are enough MBBS students one can choose from to train."

"COVID-19," says general surgeon Dr Ashwini Wagh, "has exposed the deficiencies in our healthcare system. And the government is trying to cover this up by letting loose a whole lot of inadequately trained doctors into the stream. But, even if the Ayurvedic doctors do the bridge course, as has been proposed, how are they to prepare for what they are up against?"

58
No. of surgical procedures in notification that Central Council of Indian Medicine has cleared

1.6%
Portion of GDP India spends on healthcare compared to UK's 18% and Bangladesh's 6%

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