Going back to the roots of healing

Touch of faith: Ayurvedic gynaecologist Ami Parikh examining a patient at her clinic in Mumbai. Abhijit Bhatlekar / Mint; (below) tribal women near Karjat, Maharashtra, cultivate medicinal herbs for a living.

Ami Parikh, the doctor, is an Ayurvedic gynaecologist, a gold-medallist from Jamnagar University, one of the country’s premier colleges of Ayurveda. Parikh grows many of her own herbs, and she has treated at least 20,000 patients over the last 30 years. These are mostly women—those who cannot have babies, who are having babies, who have difficulty sustaining pregnancies, or who are diagnosed with any other troubles that lie like landmines between a girl’s first period and menopause.

Many, but not all, have found healing at Parikh’s clinic—another chance at normal life without going under a surgeon’s scalpel or undergoing hormone replacement therapies.

Such stories should make it impossible to ignore the promise that Ayurveda offers as a cheaper, effective, and more accessible alternative—and this in a nation where millions have no access to basic healthcare, where cities hold 70 million people who, according to the International Diabetes Federation, will become diabetics in the next 15 years.

Instead, it is surprising that Ayurveda has managed to survive at all. Even as the number of women outside Parikh’s clinic continues to rise, all brought there by word-of-mouth stories of successful experiences, the government has brutally mismanaged this discipline of healing.

Years of jerky policy, visionless leadership, and a Western mindset that refused to offer traditional medicine a level playing field have reduced Ayurveda from a healthcare system to a range of fast moving consumer goods (FMCG).

There are funds, but nowhere to funnel them; there are colleges, but no one to recognize them for longer than a year, there are students, but no one to teach them; there are practitioners, but no careers; there are laboratories, but no scientific rigour.

Quality control

The burden of proof is one that Ayurveda staggers under; many modern doctors feel they would need to see more proof of efficacy before putting faith in Ayurveda. “It is a system that has worked for several thousand years," says Mrudula Phadke, former vice-chanceller of Maharashtra University of Health Sciences, which oversees every medical college in the state. “We just need more trials, more evidence, more quality control."

Quality is a particular problem. In 2008, a report in the American Medical Association’s journal discovered that 21% of 193 Ayurvedic supplements, produced in India as well as the US, contained lead, mercury and arsenic. A few years earlier, 12 cases of lead poisoning, stemming from Ayurvedic products, were reported in various US states. This is bad press that Ayurveda could well do without.

But the scale of what exists on the ground is surprising. According to the department of Ayurveda, yoga and naturopathy, Unani, Siddha and homoeopathy (AYUSH), there are roughly 800,000 registered practitioners who man 21,582 dispensaries and 3,330 hospitals with 64,721 beds. These offer primary, secondary and tertiary healthcare, mostly to poorer classes.

Beyond these numbers, where formal Ayurveda ends, there thrives another tradition of folk medicine—where over a million local healers (vaidyas, vaids, vaidus and ojhas) infuse Ayurvedic precepts into the consumption of local herbs, trees, animal products and minerals. According to figures from the Bangalore-based Foundation for Revitalisation of Local Health Traditions (FRLHT), approximately 700,000 traditional birth attendants, 600,000 herbal healers, 60,000 bone-setters, 60,000 poison healers and 27,000 specialist healers use over 6,000 plants, 300 animal species and 70 mineral extracts, in conjunction with sketchily understood principles of Ayurveda.

Treating the whole

Ayurveda, Parikh says, opens up a whole new way of preventing disease and managing health. “It is about the whole person," she says. “I don’t treat parts of a body. I treat the whole. When our body is in balance with itself, with its own nature, health is a natural result."

When a patient walks in, Parikh observes closely. “What is the gait like? Is it tired or strong, arthritic or fluid? How does the face look? Is there puffiness, paleness or rosiness? What do the eyes look like? Is the patient smiling or concerned? It tells me so much," she says. “Of course, you have to rely on investigations, lab tests, reports as well, but it does not end with that alone."

The patient then sits close to Parikh’s chair, by the open window, and Parikh places her fingers on the wrist to examine the nature of the pulse. All the while she asks questions: How are you feeling? What is going on? How are you eating? What are you thinking about these days?

Three factors are used in Ayurvedic diagnosis—prakruti, or individual constitution; bala or strength of the immune system; and satamya or food and drug sensitivities. As the factors differ, so do the courses of treatment.

“Every person is different," Parikh says. “Even the same person is different at different points of time. Our bodies adapt and react to every season, every event, and every situation. I have to see what the nature of the dosh (problem) is. Then I check for saamtva-amm (undigested food or indication of subverted metabolism in the gastro-intestinal tract, known as the mahastotras; or at the level of organ systems or tissues, known as sapta dhatus) and nir-aam (absence of such subversion)."

The concept has direct bearings on how the body responds to medication. "If a patient with a vata dosh (gassy constitution), who has undigested food in his body, is given a heavy dose of medicine with vattika properties, his condition will worsen," she explains. “His body isn’t capable of handling the medicines. I would do more harm by trying to force medicines into a system that cannot absorb them."

‘Medical pluralism’

The importance of inexpensive, grassroots healthcare has grown even as global healthcare costs rose to $4.1 trillion (Rs 186.55 trillion) three years ago. Barack Obama, then running for US president, said in a speech: “We all know the saying that an ounce of prevention is better than a pound of cure, but today, we are nowhere close to that ounce. We spend less than four cents of every healthcare dollar on prevention… profits are made by treating diseases, not preventing them."

The World Health Organization (WHO) issued a policy statement the following year, highlighting a pressing need for a “paradigm shift" towards “integrated, preventive healthcare". Darshan Shankar, executive director of FRLHT, says that the “singularity of medical systems is part of the old order and societies all over the world are entering...an era of medical pluralism".

Other experts stress caution in relying on alternative healthcare. John Walton, president of World Federation of Neurology, headed a British parliamentary committee in 2001, to assess alternative health systems. While evidence-based Ayurveda seems promising, Walton concluded, “there are too many outdated practices that are being followed in Ayurveda and they concern me".

WHO estimates that, by the end of 2010, more than two-thirds of the world would have tried some form of alternative medicine. Four in five developing nations already rely on traditional systems of healthcare.

Countries such as India and China have living traditions that offer low-cost preventive healthcare and enable management of chronic diseases—sustainable options when quality healthcare is fast becoming a luxury.

“‘Living tradition’ is a loaded word," says Shankar, whose organization has been working with folk-healing communities across India for almost two decades. “It would not be living if it did not work. Ayurveda is a functional, practical system of healthcare."

Now, as rising healthcare expenditure begins to steer the conversation towards a new, pluralistic idea of medicine, India is making renewed efforts to restructure Ayurveda by drafting a new policy that will hopefully offer it a level playing field.

But problems remain. Ayurveda and its stakeholders—ageing keepers, practising physicians, its education, its industry and its researchers—languish in a vacuum created by ill-guided policies, botched execution, and lack of vision and leadership. They all want change they can believe in, but no one knows how to make it happen. Amid all the hand-wringing, the potential of traditional healthcare grinds to a halt.

priyanka.p@livemint.com

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