Mumbai: In May, Vinit Rathod wrote Maharashtra’s state medical entrance examination. Like the 320,000 other students who attempted the exam, Rathod hoped he would get into a medical college that would give him his white coat and a shiny MBBS (Bachelor of Medicine and Bachelor of Surgery) degree. But if he failed to meet that cut-off, he planned to get a BAMS (Bachelor of Ayurvedic Medicine and Surgery) degree instead.

Future course: Ajit Patil, a first-year postgraduate student at Poddar College. Unlike Ayurvedic purists, Patil says he plans to practise both allopathy and Ayurveda. Abhijit Bhatlekar / Mint

When the exam’s results were announced in June, Rathod instantly knew that his chances of pursuing that elusive MBBS—or even a dental degree—were dim.

With a low state rank of 6,306, he had no choice but to amend his dream. It still consisted of opening a small clinic, where he could play physician to neighbourhood families. Only now, the signboard would bear the letters BAMS instead of MBBS.

But Rathod is beginning to realize that even this modified dream may elude him. During the admission process—where the government allocates medical college seats based on choices of students over three or four rounds, until all available seats are filled—Rathod was shocked to see that he had no Ayurveda colleges to choose from. “The choice of Ayurveda," Rathod explains, “was simply not there."

This has become a familiar annual cycle. Every year, the department of AYUSH (Ayurveda, Unani, Siddha and homeopathy), which manages Ayurveda education, derecognizes all government and government-aided Ayurveda colleges because they “fail to meet the exacting criteria that the government wishes them to follow", says Kuldip Raj Kolhi, the AYUSH director for Maharashtra. This year, of the 254 Ayurveda colleges across India, only 77 have been offered recognition thus far.

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So, every year, state admissions proceed, heedless that students have been denied an entire discipline of medicine. Every year, the finest, most promising students select colleges and medical streams without even being able to consider the option of Ayurveda.

Every year, even as Ayurveda loses potentially fine young doctors, deans of Ayurveda colleges travel to New Delhi to make “presentations" to the government, begging them to relax the rules a little so their colleges may be re-recognized as an approved centre of learning.

Every year, the government obliges.

Medical malady: Sharvari Amrutkar with a patient at a government hospital in Maharashtra’s Rahata village. Appointed under the National Rural Health Mission, Amrutkar says indifferent bosses and delayed salaries have made every day a struggle. Abhijit Bhatlekar / Mint

And so, every year, armed with a re-approval, but without any real change in infrastructure or teaching staff, these colleges open for admission to the last remaining students—students with the lowest ranks, who have been unable to secure a seat anywhere else, students who have no other choice.

Thus, a new cadre of Ayurveda practitioners, bound by fate rather than desire, is formed—students stuck with a discipline they did not want, colleges stuck with students they wish they did not have to teach—to people a system already manned by those who wish they weren’t in it.

When these students hobble into the classroom, they “go into shock", says Namyata Pathak, an MD (Ayu) doctor and a research associate at the Kasturba Health Society in Mumbai. “There is no effort made to orient us into this ancient system of healing. It’s like we’ve been hurled back in time, when texts were written in incomprehensible Sanskrit and physicians believed that the human body had over 300 bones. I cannot describe that deep shock a student faces in those early months when there are no maps to understand the road ahead."

Pathak offers criticisms of the structure of the curriculum as well. “They taught anatomy in the first year, but they completely ignored biochemistry," she says. “How can you ignore such a huge leap of science? And how can you then wonder at the lack of researchers in Ayurveda? Anyway, because they did not teach biochemistry in the first year, students didn’t understand pharmacology in the second year. The whole thing just snowballs, because the foundations were not thought through." To cope, she says, students need mentors who can “handhold, cajole, teach, let you watch while they practice".

Even that is difficult, says Vinita Inge, an MD (Ayu) student. By tradition, Ayurvedic doctors (or vaidyas) are protective of their skills and their formulations. In old vaidya families, Ayurveda is an art passed down only to male heirs. “Even if we want mentors, we have to go and beg at the doorsteps of famous vaidyas," Inge says. “If someone allows us to sit in their clinic, they will not tell us what medicines they are giving the patient or how they are making it. It’s all very frustrating."

Shailaja Chandra, the bureaucrat who drafted the first policy paper on Ayurveda in 1999 and is putting together a report, ahead of the next Five Year Plan, on the state of Ayurveda, believes the curriculum needs drastic revision. “There is too much of a ‘me too’ factor working in Ayurveda," she says. “There are too many people trying to compete with modern medicine. But Ayurveda has so much to offer that modern medicine does not. Let’s focus on that. Let’s focus on what the discipline is, rather than trying to make it into something else."

As with learning, so with practice. Two years ago, the government launched the National Rural Health Mission, which aims to revitalize traditional healthcare systems by, among other things, appointing Ayurvedic doctors in hospitals and public health centres across India.

Sharvari Amrutkar and Manoj Kulkarni—a newly married couple, both postgraduate Ayurvedic doctors—were among the first such appointees. Amrutkar turned down a job at Mittal Ayurvedic College in Mumbai, which offered her Rs15,000 a month, to take this post, far from home and friends. When the couple moved to Rahata—a village of 20,000 on the outskirts of Shirdi, Maharashtra—to serve as AYUSH doctors in a local government hospital, they were filled with idealism. They both hoped to provide model Ayurvedic healthcare to rural India.

Since that early enthusiasm, every day has been a struggle. “We report to allopathic doctors," says Amrutkar, watching over her eight-year-old son, admitted to the hospital with a fever. “They tell us to follow allopathic practice—give paracetamol, they say. The government grant for Ayurvedic medicines reaches the hospital at the start of the year. But our bosses do not provide Ayurvedic medicines to us. They tell us: ‘Patient badhao, phir layenge (increase the number of your patients, we’ll get medicines then).’ How will we increase patients if we have no medicines to give them?"

Getting paid is another struggle. Both doctors are entitled to a monthly salary of Rs12,000, but like their peers in similar posts across India, they don’t see the money for four, sometimes five months. “It’s not that the government hasn’t sent our salary to the hospital," Amrutkar says. “The salary, like the grant, reaches the hospital early in the year. But the system is corrupt. We often have to pay Rs500, sometimes Rs1,000 to get our salary cleared. We often feel like leaving. We probably will. And yet, we wonder, if we also leave, who will stay to do the work?"

Even this precarious life is enviable, some students say; at least the couple works within a system that wants to revitalize Ayurveda. Many students graduate as doctors who aren’t too confident, more secure in practising as the local allopath than as a trained vaidya.

Students such as Ajit Patil, a first-year postgraduate student at Poddar College, are unabashed about their decision. “We’ve been told by our professors that we are trained to practise both," he says. “I plan to go back to my home in Kolhapur and practise both— allopathy and Ayurveda. We are permitted to do it."

For the Ayurvedic purists, options are limited. The website of NASYA (National Ayurveda Students and Youth Association) optimistically lists about 45 courses that students can pursue after their undergraduate and postgraduate studies. But its list of job opportunities for Ayurveda doctors doesn’t even reach double digits.

Doctors can become pharmacists at government dispensaries, hospitals or institutes; they can retail Ayurveda medicines or (after sufficient experience at a respected firm) open a pharmacy; or they can work as sales executives in pharmaceutical companies. If none of this works, they can always teach in Ayurvedic colleges.

It is little wonder, then, that many students in their final year of study are terrified of finding their way in the world. “Beyond our own circle, we have little respect," says Mrudula Lad, a fresh postgraduate who now works as a resident medical officer in a Mumbai government hospital even as she hunts for ways to contribute to Ayurveda. “Mostly people look upon us as hacks. They don’t understand Ayurveda, and we aren’t confident enough to command the respect we deserve. Something in this system—the way of thinking, the way of teaching—is not working. It’s not working for Ayurveda, it’s not working for us."