Medical Education Governance in India

Surgery as part of Ayurveda

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Sushrut Samhita

Mains level : Read the attached story

Last month, a government notification listed out specific surgical procedures that a postgraduate medical student of Ayurveda must be “practically trained to acquaint with, as well as to independently perform”.

Q.Allowing modern surgeries to Ayurveda professionals is a mixopathy and an encroachment into the jurisdiction and competencies of modern medicine. Critically analyse.

What is the notification?

  • The notification mentions 58 surgical procedures that postgraduate students must train themselves in and acquires skills to perform independently.
  • These include procedures in general surgery, urology, surgical gastroenterology, and ophthalmology.

The issue

  • The notification has invited sharp criticism from the Indian Medical Association, which questioned the competence of Ayurveda practitioners to carry out these procedures.
  • They have called the notification as an attempt at “mixopathy”.
  • The IMA has planned nationwide protests against this notification and has threatened to withdraw all non-essential and non-Covid services.

Surgery as a part of Ayurveda

  • It is not that Ayurveda practitioners are not trained in surgeries, or do not perform them.
  • In fact, they take pride in the fact that their methods and practices trace their origins to Sushruta, an ancient Indian sage and physician.
  • The comprehensive medical treatise Sushruta Samhita has, apart from descriptions of illnesses and cures, detailed accounts of surgical procedures and instruments.
  • There are two branches of surgery in Ayurveda — Shalya Tantra, which refers to general surgery, and Shalakya Tantra which pertains to surgeries related to the eyes, ears, nose, throat and teeth.
  • All postgraduate students of Ayurveda have to study these courses, and some go on to specialize in these and become Ayurveda surgeons.

Distinctions in surgical procedures

  • For several surgeries Ayurvedic procedures almost exactly match those of modern medicine about how or where to make a cut or incision, and how to perform the operation.
  • There are significant divergences in post-operative care, however.
  • The only thing that Ayurveda does not do is super-speciality surgeries, like neurosurgery or open-heart surgeries.
  • For most other needs, there are surgical procedures in Ayurveda. It is not very different from allopathic medicine.

Ayurvedic surgeries before the notification

  • PG education in Ayurveda is guided by the Indian Medical Central Council (Post Graduate Education) Regulations framed from time to time.
  • Currently, the regulations formulated in 2016 are in force. The latest notification of last month is an amendment to the 2016 regulations.
  • The 2016 regulations allow postgraduate students to specialise in Shalya Tantra, Shalakya Tantra, and Prasuti evam Stree Roga (Obstetrics and Gynecology), the three disciplines involving major surgical interventions.
  • Students of these three disciplines are granted MS (Master in Surgery in Ayurveda) degrees.

Arguments in favour

  • Ayurveda practitioners point out that students enrolling in Ayurveda courses have to pass the same NEET (National Eligibility-cum-Entrance Test).
  • Ayurveda institutions prescribe textbooks from modern medicine, or that they carry out surgeries with the help of practitioners of modern medicine.
  • Their course, internship and practice also run parallel to the MBBS courses.
  • Postgraduate courses require another three years of study. They also have to undergo clinical postings in the outpatient and In-patient departments at hospitals apart from getting hands-on training.
  • Medico-legal issues, surgical ethics and informed consent is also part of the course apart from teaching Sushruta’s surgical principles and practices.

So, what is new?

  • Ayurveda practitioners say the latest notification just brings clarity to the skills that an Ayurveda practitioner possesses.
  • The surgeries that have been mentioned in the notification are all that are already part of the Ayurveda course. But there is little awareness about these.
  • A patient is usually not clear whether an Ayurvedic practitioner has the necessary skill to perform one of these operations.
  • Now, they know exactly what an Ayurveda doctor is capable of. The skill sets have been defined. This will remove question marks on the ability of an Ayurveda practitioner.

What are the IMA’s objections?

  • IMA doctors insist that they are not opposed to the practitioners of the ancient system of medicine.
  • But they say the new notification somehow gives the impression that the skills or training of the Ayurveda doctor in performing modern surgeries are the same as those practising modern medicine.
  • This, they say, is misleading, and an “encroachment into the jurisdiction and competencies of modern medicine”.
  • The IMA has condemned the move calling it predatory poaching on modern medicine and its surgical disciplines.
  • The IMA has demanded that the notification, as well as the NITI Aayog, move towards ‘One Nation One System’ (of AYUSH) be withdrawn.
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