Healing Southasia

The history and practice of medicine in the region poses peculiar problems for Southasia. The region has a well-documented history of several canons of medicine (ayurveda, siddha, unani, as well as contemporary cosmopolitan medicine). Unfortunately, these canons, which could have provided a unified system, are divided into separate fields of knowledge, and often engage in acrimonious turf wars.

By the middle of the last millennium, the traditional Ayurvedic system had been well-established, and the skills of the surgeons and knowledge about herbs and medicine were renowned. Medicine from Southasia formed a significant part of the trade between the Subcontinent and Europe. Also well established was Unani medicine, based on the teachings of Hakim Ibn-sina and Rhazes, who were also influenced by the Indian medical teachings of Sushruta and Charaka. Across the Himalaya, knowledge of Ayurvedic medicine had been carried far by Buddhist practitioners, and was helped by the fact that much of it had been transcribed into Chinese and Tibetan (thus freeing it from the errors of oral tradition).

Until the 19th century, there was little to differentiate Southasian from European medicine. The East India Company employed large numbers of local physicians and surgeons because of their considerable medicinal skill and knowledge, and their proven effectiveness in treating wounds and infections on the battlefield. However, the delivery of this care to the populace at large was inadequate. The knowledge was confined to guilds or families, the provision of care subservient to religious and economic distinctions of rank and privilege, and thus, the masses seldom had access to healthcare.

By the time the British introduced Western medicine to Southasia, during the 19th century, technological advances (the discovery of the microscope, for example) had displaced the observational nature of Galenic medicine, and replaced it with a more experimental approach that was seen as more objective and consistent. Medicine was, thus, seen as a force that could catapult a society into modernity. When the first dissection of a human body was performed by a Brahmin student in Calcutta in 1835, the event was greeted by a ceremonial gun salute, to welcome the beginning of the end of orthodoxy, and the entry of modern science into medicine.

Over the next century, hospitals and colleges proliferated across Southasia. Although the medical services were initially developed more to address the needs of the army and the colonial rulers, it proved hugely popular with the masses. In Bangalore, for example, one clinic alone had provided as many as 40,000 consultations for a population of about 100,000. The doctors noted that it was only the poor who used these services, as the rich preferred to consult the 'traditional' healers. The advent of modern cosmopolitan medicine, available without distinctions of caste or religion, was on the whole, welcomed. All this came at a price, however. The early medical colleges encouraged traditional medicine, and also provided classical education in Sanskrit or Persian. By the end of the 19th century, this was completely done away with. Attempts by native kingdoms to start medical colleges were discouraged, and medical education was firmly regulated and controlled from London. Gradually, the native systems came to be seen as reactionary and primitive. As the practitioners of Western medicine ascended the social hierarchy, there was a peculiar role reversal. Now the poor were confined to traditional medicine, while the rich flocked to modern remedies. Meanwhile, the divisions in society prevented any actual synthesis, so the Ayurvedic and Unani schools remained as apart from each other as from Western medicine.

Civic involvement
The number of locally trained doctors in the Indian Medical Service (IMS) continued to increase, and their participation expanded as a result of the various wars in which pre-Independence India was involved. Close collaboration with scientists in the region, and across disciplines, was well in place; and by the end of World War II, improved healthcare was reasonably high on the agenda of the political rulers. With reference to India's needs in 1943, an advisor to the government pointed out, "Where better can this unity be forged than on the anvil of public health?"

Health services that had been planned for the Subcontinent had not envisioned the divisions that followed post-Independence. Large numbers of medical colleges and most of the Imperial Research Laboratories remained in what became India, while the doctors followed the political divisions. In many cases, scientific teams that had worked together were divided, as the other states built-up their own medical elites. The medical professionals of post-Independence Southasia were more at ease with Western medicine, and were wary, if not downright suspicious, of traditional medicine. This polarisation into Western (modern: good) and traditional (backward: bad) has been avoided by countries such as China, which have not made this distinction, and thus incorporated both approaches into their healthcare systems.

Apart from these divisions, Southasia also faces the dilemma of providing cost-effective healthcare to the masses. Extreme disparities show up amidst the morass of underfunded and underutilised services, and isolated islands of hi-tech care. The greatest problems that patients face are the absence of civic involvement, and the rising cost of healthcare.

Over the past few years, professionals from Southasia have begun to interact, and a number of Southasian federations have developed. A significant impetus has come from doctors in the overseas diaspora, who realise that there is something valuable to be retained in the medical traditions back home. After all, most doctors from the region, would, out of sheer necessity, be trained in English, speak two or more languages, interact with people across cultural divides, and provide effective care. It is not surprise, therefore, that there are more than 7000 psychiatrists of Southasian origin outside of the region, and less than 5000 within it. Perhaps we have unwittingly trained the real global psychiatrists – not by academic training, but simply by sharing a common ethos, which by default could just be called Southasian.

~ Sanjeev Jain teaches at NIMHANS, Bangalore. His interests include molecular genetics and the history of psychiatry.