A three-decade-old wrangle between the allopathic and AYUSH fraternities has been resurrected following a recent clarification on a 2016 notification. This time, the clash is not about the AYUSH practitioners’ right to treat using allopathic drugs, but their “right” to conduct surgeries.
Three important groups affected by this order have this to say: The Ayurvedic fraternity maintains postgraduates in Shalya and Shalakya (two surgical streams among 14 post-graduate courses) are taught procedures listed in the curriculum; that the oldest-known surgical specialist was, in fact, an Ayurvedic surgeon/sage Sushrut (600 BC) who wrote the Sushrut Samhita — a profound exposition on conducting human surgery which continues to receive worldwide acclaim. Surgery was practised by Ayurvedic surgeons long before the advent of western medicine.
Allopaths question the logic of this claim. Can Sushrut’s millennia-old pre-eminence bestow the right to practise modern surgery? Do these Ayurvedic surgeons know the hidden risks of every surgical procedure and how to surmount sudden mishaps?
The Ministry of AYUSH justifies its notification on the ground that not all vaidyas but only postgraduates qualifying from two surgical streams have been authorised to perform selected surgeries. And none of this is new. But the moot point is who decides whether Ayurvedic surgeons possess sufficient proficiency to conduct these surgeries safely? By what standard are their skills judged? Surgical proficiency cannot be judged by different standards in one country — particularly when less-educated patients would rather save money than question a surgeon’s qualifications.
The statutory regulatory body for AYUSH education is the Central Council of Indian Medicine (CCIM). Over the last 20 years, it has become a clone of the erstwhile Medical Council of India. For decades, stalwarts of Ayurveda have lamented that CCIM has only promoted what private college managements demand, propelled, in turn, by students’ need to earn a stable income as medical professionals. In this misplaced zeal to give better earnings to the Ayurvedic vaidyas, CCIM has sidelined many skills that Ayurveda could have included, which are relevant even today.
Even the Ayurvedic fraternity laments that the statutory body that sets standards for Ayurvedic education has subjugated the curriculum to nurture more and more replicas of doctors of modern medicine. Thereby, an ancient, time-honoured system and its wealth of empirical knowledge has been substituted by teaching students to imbibe as much allopathy as possible. This has killed the knowledge, purity and goodness of classical Ayurveda, which ironically is the Ayurveda in high demand in Europe, Russia and America.
Until now, the debate was riveted on Ayurvedic vaidyas using allopathic drugs to treat symptoms. But now it has expanded to encompass surgery. And two facts make the case for Ayurvedic surgeon-vaidyas weak. When it comes to surgery, it is not knowledge but rigorous training and continuous practice which makes for perfection. Both require clinical material and most Ayurvedic hospitals do not have a fraction of the surgical patients found in allopathic general hospitals. Allopathic students of surgery learn first by watching and then performing scores of surgeries under supervision. In over 400 Ayurvedic hospitals, it is reported that, perhaps, only 10 have attached allopathic hospitals. Surgical skills are by no means impossible to learn but they become difficult to master without continuous training and supervision. Due to the paucity of patients, limited scope for training and access to gaining hands-on practice, it is hazardous to allow all Shalya and Shalakya postgraduates to undertake surgical procedures.
Ironically, even an MS Surgery (allopathy) or a surgeon who has passed one of the world’s toughest examinations to become a fellow of the Royal College of Surgeons (FRCS) is not permitted to conduct even comparatively simple operations like tonsillitis. In the last three decades, specialisation has excluded general surgeons from performing what was once considered routine. For example, only an ENT surgeon can perform a tonsillectomy. Therefore, to notify that Ayurvedic postgraduates in surgery can perform omnibus operations runs counter to the norm in India and in other countries.
In performing surgery, the only benchmark should be the duration of hands-on training received — counted by surgeries under supervision, and being judged through external evaluation. Every surgeon’s skills and competence must be tested by applying exactly the same standards before she/he can operate. This conundrum of different standards for surgical training must be solved because patient safety is far more important than the career progression of Ayurvedic postgraduates.
This article first appeared in the print edition on December 15, 2020 under the title ‘Surgical Mis-strike’. The writer is former secretary, AYUSH Government of India, and health secretary, Delhi government
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