per
was prompted by two editorials which appeared in the Hindu sometime in
September-October last year. The articles said that Chikungunya is
essentially not an infective disease and that it does not kill, and
there is no vaccine and there is no cure, and therefore the only thing
that we can offer for Chikungunya is supportive therapy. The editorials
then went on to say that they were outraged that the state
governments of
South India have said that Indian systems have the drugs to cure this
disease. The editorial even had the gumption to say that when the
allopathic system has said that there is no cure, why the state
governments were endorsing these "unproven" drugs. They are not only
endorsing it but actively distributing it through the public health
programme.This is interesting and in fact rather strange. So far we have spoken of the State as being against alternatives, and at best in some kind of collaboration with civil society on these alternatives. This is the opposite, where the state is actually endorsing alternative therapies. Interestingly enough this is not being done by the Departments of ISM (Indigenous Systems of Medicines), but by the Department of Public health, primarily staffed by medical doctors. They were the ones who distributed these drugs.
Why would the State do this? One easy and perhaps partly possible reason may be that the state should be seen to be doing something and these may prove to be cheaper alternatives. But the paper too has some answers to this which I am not going to repeat here. But it is not only about what the state is doing. It is also part of a larger perception of alternative medicine that we need to address.
We seek Ayurveda or Siddha or Unani for chronic diseases, and diseases which have no cure in Allopathy. But for diseases (especially acute ones) which have a clear etiology, we go for Allopathy, and behave as if is not in the domain of ISM. That we take recourse to ISM in epidemics is however a new phenomena though there are historical precedents to it that I deal with in my paper.
There are however a few instances, where the state has taken recourse to alternatives. In Tamil Nadu, the government trained 8000 women village health nurses and gave them a kit of 50 basic ISM drugs, in a bid to completely reactivate the Primary Health Care programme in Tamil Nadu. Today 12000 women are being trained to do the same thing.
In another instance, the Director of Public Health has banned episiotomies in department run hospitals. Also the women are now given an option, to choose if they want their child birthing experience by following Ayurveda and Siddha or by Allopathy.
Episiotomy is a little vaginal incision which is apparently done to ensure quicker and easier delivery. In a study, the department found that while in teaching hospitals with a post graduate course instances of episiotomy was 96 percent for first pregnancies (they were 100 percent in private hospitals) it fell to about 7% in primary health centres and to 0% at the sub centres. The conclusion they came to was that episiotomies were done for ‘earning and learning’: they added to the bill in the private hospitals and they were done primarily, if not solely, for teaching medical students in teaching hospitals.
When the director circulated these findings, the medical community was horrified by this and claimed that it could not be true. The director published this little booklet and issued the ban order.
So these are three instances: One in which village health workers are being trained in Ayurveda and Siddha and the entire primary health care is partly sought to be re-articulated through the Ayurveda and Siddha kit. You have the new programme for pregnancy and child birth, and you have the new trend where epidemic diseases are sought to be addressed by using ISM drugs.
What do we make of this? Is this a rosy picture or should we be wary of this. The answer is ambiguous. I am partly wary of this.
I will give you one particular instance: let’s take this fifty drug kit programme. I interviewed two among a panel of ISM doctors who were part of the advisory committee.
They both were what I call “modern doctors of traditional medicine”. But they had opposing points of view on what may be called the “epistemic” basis of their systems. Hence one of them placed objections to two drugs, saying that a particular active ingredient, had such and such side effect, or that another actually had a banned drug. But the other doctor pointed out that the problem with this is that the logic used by her fraternal colleague was extraneous to the principles of Siddha. She said he had not produced a single argument based on Siddha theory or Ayurvedic theory to say that this drug should not be included. Instead he used the allopathic theory of “active ingredients”.
The allopathic fraternity has been using this kind of logic to discredit many of the Ayurvedic preparations, and there is a complex politics and science involved in this act, which is based on different ways of constituting the world, which in turn produce different ways of constituting evidence. But the question is: Why do we speak this kind of language, which tends to undercut indigenous medicine? (The Hindu Editorials too are symptomatic of it).
For the last hundred years or so, the history and the pedagogy involving indigenous medicine has been filtered through logic of the Allopathic system. Thus the doctors themselves have lost faith in the principles of their own medicine. They are trained through a kind of pedagogy which is really a combination of Allopathy and Ayurveda. They fall between two stools, and because they fall between two stools, in terms of their conceptual articulation, you have instances where, like in the choice of fifty drugs, you reach a compromise, where you have to address disease categories that are not Ayurvedic but Allopathic. And further, your choice of drugs and the combination may be determined through the language of active ingredients and banned substances ( I address this at length in another paper).This is one part, the epistemic part of the story.
There is also the story of the political economy. Now the important question we need to pose is: Will this Ayurvedic kit act as an empowering process for the users or whether it will get them to be dependent on these medicines, the way biomedicine has made them dependent. Is it really going to re-articulate their lifestyle? Is it also going to be ecologically and environmentally sustainable? So this (among many other things) is what I am wary about. These are large and important questions, and questions that arise because a particular form of therapy/medicine is now sought to be partly expropriated and used as an appendage and addendum to the delivery of modern public health programmes and on terms and categories determined by it. This has enormous epistemic and political implications!
On the other hand, we have the rosy picture, which is that the State has actually endorsed some of the alternatives we are talking about. What it actually does given what I have said above is something that needs careful scrutiny. But at the same time we need to welcome the fact that the monopoly of allopathy is being breached; and when it is breached we don’t dismiss it for the wrong reasons.