Indian Medical Association (IMA) had sloganed - stop the legalization of quackery, stop mixopathy, etc., on authorizing Ayurveda postgraduates to undergo training for 58 surgical procedures by the Central Council for Indian Medicine (CCIM) - a statutory body under the Ministry of AYUSH, Government of India.
However, the former had also called for a nationwide strike on 11th December 2020 toward the CCIM’s move.
Many skilled Ayurveda practitioners can perform surgery in India. However, many Ayurveda colleges have poor quality education due to low patient numbers, which is a grave concern.
Let us try to be objective and realistic in our approach to this matter. We recall the important historical moments that allowed the integration of modern surgical practices into Ayurveda curricula.
Origin of Surgery in the History of Ayurveda
The Sushrute Samhita authored by Sushruta in 600 BC had the following points concerning surgery:
- Surgical instruments
- Different types of incisions
- Different suturing and bandaging techniques
- Fracture reductions
- Techniques of foreign body extraction
- Surgical management of obstructed labor
Nagarjuna had, however, redacted Sushruta's original texts from his writings in 400-500 CE. Banaras was the place where Sushruta used to practice surgery. The extracapsular surgery of cataract removal using a sharply-pointed instrument has been described by Henri. This is the earliest surgical technique for treating cataracts.
Sushruta pioneered reconstructive surgery, and Vaidyas still used it during colonial rule. A case report from a Vaidya that used a forehead fold to reconstruct his nose was published in the Gentleman's Magazine in 1794. It made the western world more aware of the procedure.
Surgical Practice by Ayurveda Practitioners in The Recent Past
BHU offers Ayurveda and western medicine under the same roof as the Institute of Medical Sciences. These were the founders of this unique institute, who were also graduates of an earlier Ayurveda School that granted AMS (Ayurvedacharya and Medicine and Surgery) degrees to BHU.
Prof. KN Udupa & Professor. PJ Deshpande is two such pioneer. Although they come primarily from Ayurveda, their training in surgery was received from the University of Michigan and the Vienna Academy of Medicine.
These universities welcomed them and trained them in surgery - setting an example of the institutions' values. These teachers, however, even taught MBBS students. Many Ayurvedic Vaidyas studied modern surgery under the instruction and guidance of these professors.Many of these Vaidyas had been trained and were able to spread their knowledge across India.
Hence, Ayurveda has many skilled surgeons. Based on their experience, however, these surgeons might only be able to perform certain types of procedures - anorectal procedures are the most popular. Likewise, Ayurveda has skilled ENT and ophthalmologists who can operate on many cases. Thus, the extent of their clinical exposure during training is one of the main factors that affect their practice.
The Root Cause of The Problem?
Most students see Ayurveda programs as a way to enter western medicine/surgery. These students joined these colleges after they couldn't get into MBBS programs. BAMS is often an option chosen where students are admitted after 3-4 years of unsuccessful attempts for the pre-medical entrance exams.
There are loopholes in the system that have led to the establishment of many substandard colleges. About 250 colleges are currently functional, out of the 400 existing. Many colleges have no patients or teachers. These institutions flourish because of the fake patient records and ghost-teachers presented to the inspecting CCIM Committees.
Students are not exposed to many cases in most Ayurveda colleges. Most cases they see are chronic diseases such as stroke, joint disorders, and skin diseases. The training they receive in any given branch is not the same and can vary from one institution to another.
How & Who Should Get The License And Who Shouldn't?
The current notification by the CCIM makes it crucial for Shalya/Shalakya graduates to be trained appropriately in the listed surgical procedures. Although this does not confer a license or permit to practice surgery, it is a directive that makes surgical training mandatory. The students will be able to practice these skills once they have earned their degrees.
These questions immediately follow:
- Is it true that all Shalya Shakya graduates are eligible to practice surgery under this notification?
- Does this apply retrospectively or prospectively?
Because this is a matter of modification in the curriculum, it should be applied prospectively and never retrospectively. The blanket approval of all Shalya Shakya postgraduate degree holders to practice many surgeries without first assessing their knowledge and skill in the area is clearly problematic.
After assessing their clinical work, approval may be granted to practice surgery aiming to provide justice to many highly skilled surgeons in this field.
Sushruta Samhita comprises approximately half of its surgical content. Therefore, all postgraduates with surgical specialties have to be trained and practice surgical skills. It is unreasonable to expect them not to use advanced knowledge and resources, as well as the most recent instruments and surgical techniques.
Thus, the logical next steps must be a well-researched curricular framework with facts-based implementation, improved systems of continuous medical training, including hands-on instruction after masters' degrees, and better research in lesser-explored areas.