Founder

Dr. Narendra Dabholkar

Editor

Prabhakar Nanawaty

Suman Oak

Rise of Modern Medicine in India

Long years ago, we make a tryst with destiny, and now the time comes when we shall redeem our pledge, not wholly or in full measure, but very substantially. At the stroke of the midnight hour. When the world sleeps, India will awake to life and freedom. A moment comes, which comes but rarely in history, when we step out from the old to the new, when an age ends, and when the soul of a nation, long suppressed, finds utterance. It is fitting that at this solemn moment we take the pledge of dedication to the service of India and her people and to the sill larger cause of humanity.

– Jawaharlal Nehru

I see before me the bottled water kept for the dignitaries on the dais. It reminds me of three classes of Indians. One who can afford bottled water; others who manage to get some water in their taps or in a nearby tap or a pump irrespective of its quality or regularity of supply; the third set of Indians are those for whom drinking water is a daily problem and who will be ready to drink any polluted water.

– I. K. Gujral

Of all the dynasties that ever ruled India, the British rule was the shortest and yet the most pervasive. As Kosambi DD (An Introduction to the Study of Indian History, 1975) pointed out, India is a land of long survivals, where many different modes of production manage to co-exist. Until quite recently, one could see cow dung cakes, an essential fuel for cooking by the poor, drying on the outer wall of the Indian Atomic Energy Establishment in Trombay, which houses a nuclear reactor. Almost everything that ever existed in India, with the exception of the Indus valley civilization, is still there to varying degrees; but modern India and all its current institutions bear the imprint of the British Raj more that of any other historic period. Modern medicine founded by the Raj occupies a special place. It was something new. It would have come even without the British intervention, but when is uncertain.

There are three distinct features of modern medicine. First, it is entirely new to India. Two, its scope has progressively increased over the years, in particular since the end of the colonial rule. And, three, it is secular and an effective cultural challenge to Ayurveda, mired in mysticism and Hindu nationalism. However, the obvious popularity of modern medicine in modern India is because it has opened the possibility of a healthy society; first by its ability to treat diseases which were untreatable in the past, and second, by treating medicine as an integral part of the universal system of healing based on constant renovation.

India has emerged as a medical tourist centre. Anything that can be done anywhere can be done in India. Indeed if it were not for the cost, India provides the most efficient healthcare for the rich. Let me contrast it with Canada which has a free and accessible medical system. Almost everyone has a family physician. Suppose, you are diabetic and, suppose, your family physician deems it necessary to have your kidney and visual function (both of which tend to deteriorate during diabetes) tested by specialists, it might take several months before it is done. In contrast, in India, if you have money, you can go to one of the many fancy hospitals and the whole thing can be done within a few hours.

But India is a poor country. Mansion and slums co-exist side by side, as do the hungry and the over-fed. A substantial population lives in the villages and modern medicine exists in urban areas. Even for urban slum-dwellers, modern medicine is rarely accessible, while Indian dignitaries go to the US or UK for medical help, more to exhibit their wealth or political power than for getting what they could not get in India.

Modern India is home to almost 250 million middle-class, relatively prosperous citizens, more that the total population of most countries. These 250 million people generate more health problems requiring medical care than do the remaining one billion. These prosperous 250 million are taken care of by profit-making, well-equipped modern hospitals which have mushroomed and can provide as good medial care as anywhere. However, this new phenomenon of the hospital industry is no solution to healthcare; indeed it is a deterrent as elaborated by Dr. Arnold Relman quoted by Dr. Melvin Konner (The Crisis in Healthcare, 1993)

Dr. Arnold Relman, a leading physician and the former editor of The New England journal of Medicine, [one of the most, if not the most, important journals of clinical medicine has written, The growth of the medical industrial complex continues unabated. Dr. Relman is by no stretch of the imagination any sort of socialist. He believes that If most of our physicians become entrepreneurs and most of our hospitals and health-care facilities become businesses, paying patients will get more care than they need and poor patients will get less . [physicians ] will be seen as self-interested businessmen and will lose many of the privileges they now enjoy as trusted professionals.

I think situation in India is worse than in the US. Perhaps one needs a Prime Minister who could nationalize all private hospitals, as Indira Gandhi did for banks.

There are three groups of diseases. Most diseases are minor problems and the patient would recover without any treatment. The second are serious life- threatening diseases, which can never be treated by even the most advanced Ayurvedic or Unani-tibb physicians, but can and are managed by modern medicine and its associated support system. The third is a group of diseases which are currently incurable, but sufficient leads exist to suggest that modern medicine, and only modern medicine, would be ale to treat them in the future.

On the other hand, social factors give rise to new disease; and diseases uncommon in a certain group of people tend to be come more common; for example, heart disease, diabetes, testicular cancer, and so on. How environmental factors, and even the misuse of existing medication, are hindrances to a healthy society requires surveillance and research. New approaches become necessary to deal with this. This is an unending process but not beyond the reach of modern medicine.

Modern medicine eliminated smallpox, bubonic plague and polio. Cholera can be prevented and treated. This is no mean achievement. If cholera still haunts India, it symbolises a lacuna in governance and not in medicine.

India like any other country must use its resources efficiently and must take steps to deal with mass poverty and the affections it causes. It costs no less to train an Ayurvedic or Unani-tibb physician than to train a physician in modern medicine. All Ayurvedic and Unani-tibb training institutions must be transformed into schools of modern medicine, and any drug or procedure of proven benefit in indigenous medicine incorporated into the modern medical curriculum.

Modern medicine offers appropriate therapy or surgery for many common diseases of India, pulmonary tuberculosis, malaria, pneumonia, diabetes, trachoma, breech presentation and toxemia of pregnancy, AIDS, venereal diseases, cardiac diseases, etc. The efficacy of the medical system can only be evaluated when we consider its success in treating these ailments.

There is an implied sense of ethics in al professions; in medicine, it was emphasized by Sushruta, Hippocrates, Avicenna and others. Volition of medical ethics by physicians of modern medicine has been pointed our as a problem by many (see Sheikh K and George, Health Providers in India: On the Frontiers of Change, 2010). However, the question of medical ethics cannot be examined in isolation, nor can it be ensured in the absence of ethical governance. Nevertheless, private by employees of teaching and government hospitals is a serious constraint on the efficiency and universal availability of therapy at these institutions. Abortion of female foetuses must be made a criminal offence.

The two important need of the Indian society are sanitation and the removal of poverty. India need universal healthcare. If Cuba, Britain and Canada can provide it, India can too. Modern medicine, though introduced by the colonialists, is now as Indian as parliamentary democracy.

Pre-colonial India was fragmented into multiple enclaves ruled by despotic feudalists. British made India into one country. Since they left, regional political forces have beet steadily emerging, threatening the unity of India (Khilnani S, The Idea of India, 2012). Indian secularism is threatened. Indian democracy is in practice barely more than periodic elections. But whatever happens to India, science has its own power; and modern medicine, introduced by the Raj will not only survive but become more universal.

(The excerpts from the Book Medicine, Healthcare and the Raj written by Dr Dayaram Sharma posthumously published by Three Essays, Gurgaon.

The Book can be obtained from Three Essays, B-957, Palam Vihar, Gurgaon (Haryana), Phone Numbers: 91-124 236 9023, +91 98681 26587)

Medicine, Healthcare and the Raj: The Unacknowledged Legacy

Daya Ram Varma,

Three Essays, Gurgaon,

Rs 500, pp 196

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