By Dr. George Jacob

Kochi: I am distraught at what the Indian government plans to do to our healthcare system.

A bill recently tabled in the Lok Sabha allows doctors pursuing Indian medical systems, including Ayurveda and homeopathy, to practice Allopathy after clearing a ‘bridge course.’ Post-graduate Ayurveda physicians can now perform General Surgical, ENT and Dental procedures after Ayurveda postgraduates receive ‘formal training in such procedures.’

At the outset, the idea of a ‘bridge’ to cross over into specialized disciplines of modern medicine, and attempts to enhance the interface between Ayurveda, Unani, Siddha and Homeopathy(AYUSH) and Indian medical systems was nothing but a bypass to national disaster.

I say this as a person who has toiled hard to find my place in this vast terrain of ‘the art of healing.’ Let me elaborate.

My journey in healthcare service began at Medical College, Kottayam, in the southern Indian state of Kerala. I left the medical college in 1989 with an MBBS degree and the heart of a classmate, who later became my life-partner. Soon nagging questions from ‘well-wishers’ about pursing post-graduation overwhelmed me as I was trying to come to terms with challenges of practicing medicine in the hospital where I got a job as a junior Medical Officer in Urology and General Surgery.

The ground reality of ‘practicing medicine’ was a far cry from what I had studied in medical college. It was miles away from what I read in those voluminous medical textbooks. A senior urologist who retired as professor of Urology from my Alma Mater and a senior general surgeon had me hold the scalpel and the forceps with reasonable ability. Seniors under whom I trained taught me basic tricks of ‘surgical trade.’

For example, it soon dawned on me that decision ‘when not to operate’ a patient was more important than ‘when to, what how to’! Surgery, I realized was a craft perfected not from textbooks or lecture halls but through experience. I mastered the job not only at the operating table, but at the bedside of operated patients. Guided by more experienced.

I soon decided to pursue post-graduation in Surgery-my second love! My wife found anesthesia as her calling.

We returned to their Alma Mater and secured post-graduation of their choice. The surgeon who had just qualified was attracted to the super specialty of Surgical Gastroenterology. In 1996 I secured employment as junior specialist in a hospital in my hometown, which housed arguably one of nation’s best Digestive Diseases Centre.

I found the surgical gastroenterology Unit of that center an ideal launch pad to set his ‘Surgical Gastroenterology dreams’ soaring high. The unit was headed by a never-say-die taskmaster who guided me in Surgical Gastroenterology.

It has been about 25 years of intense training under the expert. And the surgeon in me is still learning. Honing my skills at decision making and providing post-operative care to get operated patients home. This took spending hours at the operating table, and much more at the patients’ bed side in the ICU. Anticipating and treating postoperative complications — An exercise as important and challenging as the craft of operating patients.

I narrated my story neither to flaunt the reasonable ability I managed to acquire as a surgical gastroenterologist down the years, nor to claim ‘I’m the greatest.’ I’m no Cassius Clay!

Now back to the bill. We all know that the Indian healthcare itself is infirmed, thanks to over-corporatization, commercialization of medical education, botched patient-doctor relationship and mutual trust. Added to his are the-fallouts of exorbitant healthcare costs, and inaccessibility of common man to quality healthcare, besides others.

Making a concoction of various medical systems, and creating a ‘mixopathy’ is an outlandish exercise. Various medical systems operating on entirely different principles are simply immiscible. Just as oil and water are!

After all, the government was trying to make short work of hard work of generations of healthcare providers to play ‘medical pluralism’ to the gallery-clearly an area which is absolutely out-of-bounds for a government specializing in dramatics, loud- mouthing and hyperbole.

The government’s move maybe well-intentioned to augur AYUSH medical systems, the proposed methodology is self-defeating. The Indian sage and physician, Sushrutha from 500 BC known as ‘father of surgery’ in his treatise ‘Sushrutha Samhitha’ had referred to numerous surgical instruments and techniques being used even today. This is the platform on which Ayurveds base their argument to practice surgery practiced by Allopaths. But, nuances of surgery in terms of technique and complexity and demands of surgical diseases per se strip ‘mixopathy’ of scientific temper because:
• Surgery is not mastered from textbooks or in lecture halls. It takes years of apprenticeship under vastly experienced experts both in operating theatres and surgical wards.
• The dangerous and hotchpotch mixopathy is likely to be cheaper, and therefore might become a favorite ‘healthcare mall’ exclusively of the poor and those who cannot afford its richer cousin- modern medical Surgery practiced by allopaths. An unfair and dangerous trend modern healthcare can ill-afford.
• Quality Surgery and its fruitfulness revolve around other complementary and vastly developed specialties like Anesthesia and critical care.
• Surgery in Modern Medicine is not a one-stop supermarket for diseases. Cancers for example calls for multi-disciplinary approach involving surgery, radiation and medical oncology and radiology.
• Surgery cannot put on a one-man-show. Surgical Complications call for other highly specialized disciplines like interventional radiology (often to control hemorrhage), nephrology, cardiology, neurology, gastroenterology and endocrinology for their inputs in management of complications and co-morbidities pertaining to their organs systems post-operatively and often intra-operatively.
• Attempts to create an immiscible concoction of various medical systems eventually deny them individuality, sanctity and distinction.

(Doctor George Jacob is a Consultant Surgical Gastroenterologist at Lakeshore Hospital in Kochi, Kerala)