Health seeking behaviour in most societites is often marked by a multiplicity of medical or healing systems. Every healing system is a product of a specific world view of a particular group of people. Many of these world views change over time with corresponding changes in healing systems. Thus some of these healing systems either may get absorbed by the dominant healing system or probably die out . A ‘medical system’ has thus been defined as "the pattern of social institutions and cultural traditions that evolves from deliberate behaviour to enhance health." 1
Today we have two major bodies of medical knowledge : traditional or indigenous systems2 and the allopathic or cosmopolitan system of medicine (also inappropriately termed ‘modern’, ‘scientific’,’Western’). We also use the world ‘consmopolitan’ to describe a system having worldwide rather than limited or provincial scope or bearing; having wide international sophistication; composed of persons, constituents or elements from all or many parts of the world, etc. (Webster’s New Collegiate Dicionary, 1975). Therefore allopathic medicine is not Western, but intrinsically cosmopolitan.
The adjective ‘modern’ for allopathic medicine as contrasted with traditional medicine seems to connote that traditional systems are somehow unchanging vestiges of tradition and unwilling to be affected by the currents of modernity. This view does not seem to correspond with historical facts. Many traditional dais have been found to be willing and even eager, to acquire modern practices of delivery. Folk practitioners have been found to be absorbing allopathic practices and notions within their personal limitations of geographical situation and time. Ayurvedic and Unani colleges are adopting allopathic practices like double blind clinical trials in their work even as they use concepts of modern physics and chemistry in their research work. Ayurveda and Unani systems as known at present have themselves not remained static -- by the nineteenth and twentieth centuries, according to Leslie, ‘the traditional beliefs and practices of Ayurvedic physicians were radically different from the classic texts and were deeply influenced by Unani medicine." 1

----------------

1 R.L. Dunn "Traditional Asian Medicine and Cosmopolitan Medicine as Adaptive Systems" in: Lesli, C.. Ed.. Asian Medical Systems. (Berkeley : University of Caliornia Press, 1976), p. 135

2 Read Appendix 1 : ‘The Medical Heritage of India’ - this appendix describes the evolution of Ayurveda and its related developments. See Appendix 2 for a brief description of some other traditional healing systems in India.

Likewise, the adjective, ‘scientific’ for allopathic medicine alone is incorrect. Traditional systems amy not pass on all criteria of scientific and rational behaviour. They will probably not pass in terms of standardisation of treatments, replicability of regimes, or systematisation of experimental procedures. But then we should remember that even allopathic medicine is often irrational in its choice of research priorities, and in its choice of drug regimes; and much of the curative routines and doctor-patient relationship patterns are hardly conducive to a scientific understanding of disease-illness.
‘The great sin against the human spirit is closure against the diversity and variety of human experience -- a narrow dogmatism that insists on the absolute and exclusive validity of some particular language and the particular version of reality that this language articulates. And the central virtue, therefore, is openness to experience, caritas for the difference and diversities to be found within experience’.2

RATIONAL SCEPTICISM AND HEALING

Sceptics and protagonists of allopathic medicine (who believe it to be the only scientific medicine) are against the unqualified openess to experience. To them there has to be a demarcation of the absurd in medical as well as other areas of human experience and one therefore, needs to make a distinction between the open mind and the open sink. ‘In trying to demarcate the absurd, it is as important to know who says what and why, as to know what is being said and how. Absurdity is contextual -- by choosing unbelief (with respect to traditional systems), we do not rule out a subsequent change of opinion, based on new evidence, and thus nothing is lost; whereas being gullible, we lose reason from the very begining.

----------------

1 The Ambiguities of Medical Revivalism in Modern India’ by Leslie, C. Ed. (Berkeley: University of California Press, 1976) p. 356 ff.

2 W.T Jones. The Sciences and the Humanities: Conflict and Reconciliation. (Berkeley and Los Angeles: University of California press, 1965), p. 280.

The worst that can happen by following this pragmatic strategy is that the baby of truth will be thrown out with the absurd bath water.’1
Rational scepticism, which is the basis of scientific thinking, is indeed necessary in evaluating traditional, indigenous and natural therapies. It is all the more necessary in the holistic health movement where many have substituted one set of (appopathic) healing modes with another cornucopia of remedies, do’s and don’ts, rejecting the rational in favour of the intuitive. ‘Right brain’ and anything to do with right brain thinking somehow gets a sanction in perference to left brain thinking which is supposed to be the merely logical and linear and casual. (This is indeed a case of throwing the allopathic baby with the bath water of traditionalism and holism). It cannot be disputed that charlatanism and exploitative behaviour of healers -- whether allopathic or traditional -- needs to be rejected. There has to be a criteria for absurdity as well as for distinguishing the miraculous, the maraculous, the marvelous and the practical. However, this presupposes to some extent an awareness of all reasonable and rational phenomena in nature from the banal, the mundane to the mundane to the marvelous and unusual. This does not seem to be possible at our present stage of knowledge. In fact one may be closing possibilities to special forms of healing which do happen to be effective. "My own inclination as a physician", says Larry Dossey,2 "is to acknowledge it (spiritual healing) as a special form of healing, for I cannot dismiss as deranged all the persons who who have written about this phenomenon and who have claimed to experience it themselves.
I have little patience with the scientific critic who must condemn what he cannot explain, even though I respect the need to guard against the fatuous. We need to constantly remind ourselves that the best scientific minds also rejected the belief in meterorites and embraced the nation of the ether. It seems to me rank arrogance to suppose that we have exhausted nature’s inventory of how healing occurs, and we ought to expect some suprises. Moreover, I suspect the supeises are all around us -- masquerading as unexpected turns in the course of illness; the person with cancer who should have died but didn’t; or, the person who should not have died, but who did (if spiritual healing exists, spiritual sickness is to be expected.)"

----------------

1 (a) Peter Skrabanek. "Demarcation of the Absurd".. The Lancet, (April 26, 1986) : pp. 960-961.

(b) See also "Medical Controversies". Issue of the Skeptical Inquirer Vol. XII, No.1, Fall 1987

2 Larry Dossey. Beyond Illness - Discovering the Experience of Health. Boston : New Science Library, Shambhala, 1984) p.176

RENEWED INTEREST IN TRADITIONAL MEDICINES :

SOME REASONS
Over the last 15 years, there has been a renewed interest among Western educated groups in traditional medical systems, indigenous healing practices and natural therapies. There are several reasons for this revivalism -- if one may use the word.
This renewed interest is partly triggered off by a search for appropriate technology in several fields of development -- agriculture, housing, irrigation, animal husbandry, education, industrialisation and so on. Development based on modern science and technology was found to be (and still continues to be) not people centered and in fact, quite cruel to poor people’s lives. (See Chapter 3 on Enviornment). Traditional practices and traditional wisdom in these areas (i.e. agriculture, housing etc.) were often found sound and in many cases ecologically more appropriate and supportive of people’s lives. A logical extension was to therefore look into traditional and indigenous healing practices with sympathy, if not reverence. Aiding and abetting this trend was the highly professionalised, high technology oriented, doctor-centred, drug-centred approach of allopathic medical system and its practitioners, which offered little solace or time for poor patients. (The holistic health movement in the West and the community health movement in the third world started as a critique of the allopathic, hospital centred, curative system).
Over the above these cosiderations was the feeling that if a set of healing practices and beliefs could have lasted so long (some over 2000 years), there must be something worthwhile in these systems which even those of us used to other healing traditions, must look into of necessity -- especially if they could be ecologically more in keeping with people’s customs and world views as well as be of some practical efficiency.
Sudhir Kakkar, trained as a modern psychotherapist, attempted to understand Indian healers and healing systems from such and attitude.1 Describing his ambivalent feelings to this enquiry into Indian healing traditions, he feels this ambivalent he experienced has to do with..."my being an Indian, and in the study of the Indian healers and healing traditions which are so much informed by the Indian world view, and my having more than a sneaking sympathy with the healing endeavors, however bizarre thier methods and assumptions may appear to a modern psychotherapist. I could therefore identify with John Woodroffe’s remarks made more than half a century ago when, in the preface to his studies on tantra, he writes, "When I entered on a study of this Sastra, I did so in belief that India did not contain more fools than exist among other people ..... Behind the unintelligent practice, which doubtless to some extent exists amongst a multitude of every faith, I felt sure there must be a rational principal, since men on the whole do not continue throughout the ages to do that which is in itself meaningless and is therefore without result.1 This does not mean as Woodroffe also goes on to say, "that as an Indian one must accept what is without worth just because it is Indian, but that the Indianness seems to impose an obligation to understand Indian cultural phenomena as thoroughly as one can, with a critical awareness of the assumptions underlying the methods and sciences with which this understanding is sought to be reached, before evaluative judgements on what is part of one’s cultural identity can be made. " The World Health Organisation has been for long interested in traditional medicine. A study of the accompanying boxes which are extracts of the report of WHO expert group meeting is very interesting and revealing.

-------------------

1 R Sudhir Kakkar, Shamans, Mystics and Doctors (New Delhi : Oxford University Press, 1982).

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1 John Woodroffe. The Garland of Letters, (Madras: Ganesh & Co., 1955).

Concepts of Traditional Medicine and Practitioners **

Traditional medicine - Reference was made to the definition of traditional medicine already attempted by a group of experts from the African Region, convened by the WHO Regional Office for Africa, that met in Brazzaville in 1976. The definition arrived at by the group of expers was as follows :
...."the sum total of all the knowledge and practices, whether explicable or not, used in diagnosis, prevention and elimination of physical, mental or social imbalance and relying exclusively on practical experience and observation handed down from generation to generation, whether verbally or in writing.
"Traditional medicine might also be considered as a soild amalgamation of dynamic medical know-how and ancestral experience
...."Traditional African medicine might also be considered to be the sum total of practices, measures, ingredients and procedures of all kinds, whether material or not, which from time immemorial had enabled the African to guard against disease, to alleviate his sufferings and to cure himself."1
Traditional practitioners of Ayurveda define life "as the union of body, senses, mind and soul." and in this context consider "positive health as the blending of physical, mental, social, moral and spiritual welfare."2 The moral and spiritual aspects are here stressed and thus give new dimenions to man and the system of medicine by which he maintains his health.
The traditional healer - The African Regional Office expert group also adopted a definition of the traditional healer, as follows:
".... a person who is recognized by the community in which he lives as competent to provide health care by using vegetable, animal and mineral substances and certain other methods based on the social, cultural and religious background as well as on the knowledge, attitudes and beliefs that are prevalent in the community regarding physical, mental and soical well-being and the causation of disease and disability."3
** Source : The Promotion and Development of Traditional Medicine - TRS 622, WHO, Geneva, 1978

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1 & 3 AFRO Technical Report Series, No. 1, 1976 (African Traditional Medicine, Report of the Regional Expert Committee), pp 3-4.

2 From: Principles and practices of traditional systems of medicine in India. Working paper presented by M.A. Razzack to the Meeting, Quoted in WHO

Reasons for the Promotion of Traditional Medicine **

Intrinsic qualities : Since traditional medicine has been shown to have intrinsic utility, it should be promoted and its potential developed for the wider use and benefit of mankind. It needs to be evaluated, given due recognition and developed so as to improve its efficacy, safety, availability and wider application at low cost. It is already the people’s own health care system and is well accepted by them. It has cetain advantages over imported systems of medicine in any setting because, as an integral part of the people’s culture, it is particularly effective in solving certain culture health problems. It can and does freely contribute to scientific and universal medicine. Its recognition, promotion, and development would secure due respect for a people’s culture and heritage.

Approach - unique and holistic : Traditional medicine has a holistic approach - i.e. that of viewing amn his totality within a wide ecological spectrum, and of emphasizing the viewpoint that ill health or disease is brought about by an imbalance, or disequilibrium, of , man in his total ecological system and not only by the causative agent and pathogenic evolution.

Operational factor : These are some os the main reasons why traditional medicine needs to be promoted and developed. Perhaps from the operational point of view, the most cogent reason for the radical development and promotion to a traditional medicine is that it is one of the surest means to achieve total health care coverage of the world population, using acceptable, safe and economically fesible methods, by the year 2000.

** Source : WHO TRS 622.

One major reason for the medical establishment’s partial sanction, like that of WHO, of traditional medicine has been of course the Maoist reveolution in China and its attempts to integrate traditional Chinese herbal practices, pressure and yin/yang systems with modern medicine. How successful the Chinese were with these attempts at synthesis is not very clear. But it has certainly encouraged research into traditional systems like acupuncture, acupressure, moxibustion, etc.
Why is the Government of India interested in promoting traditional systems? Many of the above reasons do hold. But some observers have pointed out that the government’s support is partly for tractical and political reasons. The support of the government towards traditional medicine is seen as an attempt, to coopt the large mass of people and thereby make them demand less the services of modern medical care which in any case are accessible in any substaintial sense to urban and semi urban sections only. However, this is only a partial explanation. The increasing awareness of health care services as a duty of the state among common peoples have led to the increase in primary health centres and village health workers-- although much of this increase is in name sake only. Their actual functioning has been bedevilled by many problems: lack of state financial support to the extent required, to disinterest among PHC doctors, corruption in PHCs, etc. India is a part of an international political economy and recipient of multilateral aid. There have been pressures to be a subscriber - even if in a token sense only - of progressive health prespectives like the Alma Ata Declaration and so on. Supporting traditional systems is also good politics. One is seen as being with the people: for peoples’ traditions, etc.

WHY PEOPLE USE TRADITIONAL SYSTEMS ?

The use of traditional systems cuts across classes. The upper classes/castes would use it partly out of conviction, force of habit and pride - it must not be forgotten that practitioners of Ayurveda and Siddha were from the upper castes and tend to be still Brahminical in approach. Within traditional systems, the ones with a scholarly tradition like Ayurveda, Unani, etc. have been generally more accessible to upper castes/classes, and in the past, as in the case of Unani, access was limited mostly to males. Folk medicine on the contary was and is accessible to all classes without distinction of caste, sex, age, etc.
On the other hand, a long term study to the health behaviour of rural population of India by Banerji, et al. has revealed that "the response to the major medical problems was very much in favour of Western (allopathic) system of medicine, irrespective of social, economic occuptional and regional considerations. Accessibility of such services (modern medicine) and capacity of the patients to meet the expenses were the two major constraining factors".1

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1 D. Banerji. Health Behaviour of Rural Population in India : Imapact of Primary Health Centre. EPW. XII. (1974) pp. 2261-63.

Quite a few observers have found the health seeking behaviour of poor people highly rational. Posing the question, why do people have faith in local healers - Sathyamala etal, 1, 2 have this in answer:
"In India however, the economic and social condition of a majority of the people has not really changed. The majority still do not have control over the various events affecting their lives, including sickness. The set of beliefs, which from the basis of modern medicine are therefore not easily accepted by them. People do recognize that modern medicine has powerful remedies which provide dramatic relief but they see these remedies as some kind of ‘magic’ rather than the result of scientific understanding. Further, they do not find a suitable explanation for why disease occurs in one person and not in another from this system of medicine.
"In times of sickness, then, these people have to decide whom they will go to -- indigenous healers with a set of beliefs which are acceptable to them but with limited curative powers, or doctors trained in modern medicine with a set of beliefs which are not in keeping with their own system, but with tremendous curative powers. Faced with this choice, people tend to categorise diseases into two broad catergories: those more likely to be cured by doctors trained in modern medicine and those more likely to be respond to the practices of indigenous healers. For illnesses believed to be caused by ‘bad’ air, emotional disturbances, or ritual uncleanliness, the traditional healer is the only choice. The remedies of modern medicine do not belive or understand these illnesses. For chronic or minor illnesses, people usually go to the local healer. In case of emergencies where the local healer proves ineffective, treatment is sought from the modern system of medicine.
"These distinctions are not very rigid. The course of an illness and the outcome of previous treatment for the same illness may make a person shift from one kind of healer to another. The modern system of medicine is used mainly because of its power to dramatically relieve symptoms. It is not unusual to find people utilizing the modern system of medicine for its curative power without changing their ideas about the causes of disease. They may still go to an indigenous healer to seek relief from the ‘cause’. For people, it is ultimately not a question of using either the local healer or the doctor because of rigid tradition. It is more a question of utilising what they consider the most effective and satisfying parts of the available systems of healing."

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1 N. Sundaram Sathyamala., N. Bhanot. Taking Sides - the choices before the health worker (Madras : ANITRA, 1986) pp.15-17

2 Refer also: Alan Beals. Strategies of Resort to Curers in South India

It is interesting to compare some of the reasons listed by people coming to the Sahaj Holistic Healing Centre in Pune, India. They include : cost of allopathic care; the increase in iatrogenic (doctors-caused) diseases; the lack of care of allopathic system and the overreliance on machines, and the onesided approach to physical healing only. Some cited popular appeal and interest in the West (of traditional systems) as other reasons.
Traditional systems of medicine have a wide range of advocates and opponents. There are some who would like an integrated national system’1 assuming that such an integration is possible and feasible. Some others feel that non allopathic systems are the product of a particular social condition and a certain ‘unique genius’, and therefore they should not be disturbed - lest their ‘purity’ gets vitiated. Traditional systems will not, these advocates say, be any more traditional if they are modernised. Then there is the utilitarian-pragmatic school which basically says that whatever works in any system - let us use it , and especially so if they are simple, low cost and in keeping with people’s traditions. There are also sections of well-wishers who feel traditional systems have to be subjected to the rigorous scrutiny of modern scientific methods; what is found desirable and useful should be accepted and what is not should be discared and condemned if found harmful. This is one logical extension of the synthesis, integrated school mentioned above. (See for example, the Box on ‘Scientifically Valid Uses of Ayurvedic Therapy’.)

TRADITIONAL HEALERS SINCE INDEPENDENCE

What is happening to traditional system healers since Independence? Their growth pattern and policies of the government are the subject of Appendix 3 to this chapter. Broadly one can say that, if anything, there has been a growth of a number of indigenous schools of medicine, committees. councils and professional bodies. Roger Jaffrey writing on ‘Policies Towards Indigenous Healers in Independent India1 has this to conclude: "One of the difficulties of making clear assessments of the nature and eddect of Government policy with respect to indigenous healers is that there in no clear line being followed. On the one hand, -- indigenous medicine is essentially marginalised, with many of its practitioners part-time, dealing with a limited range of ailments, drawing heavily on the cosmpolitan pharmacopiea and perceiving cosmpolitan medicine as superior, Government policy, particularly in terms of employment and expenditure reinforces this trend. On the other hand, there is a trend towards greater respectability, with the extension of registration schemes, the recognition of indigenous contributions by the international agencies and in CHW training, and some steady expansion of employment. The failure of attempts to suppress or control unqualified practitioner, and the loopholes in registration schemes, mean that the cosmopolitan and qualified indigenous practitioners alike are threatened by ‘unfair’ competition which is outside their control, so that the formal commitment to the modernisation of medical care in India is very different from the reality."

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1 See for instance the ICCSR-IGMR report on Health for All, Institute of Education, Pune: 1981. pp.98-99

"There seem to be a few threads which can be drawn out of this, however. Firstly --- that indigenous practitioners of all kinds do provide an alternative which the Government has to come to terms with whenever its legitimacy is weakened. The greatest advances have come in the period when the new Republic was being established; when Congress was reasserting its supremacy after its losses in the late 1960s; and during the Janata regime since 1977. Secondly, ---that the alternative solution to the problem of providing a cheap extension of Government health services to rural area - the employment of para-medical personnel or community health workers - has been preferred. This has been promised on the idea that they will be more controllable, and less likely to claim the status of ‘doctor’ - when of course this is the major complaint of the cosmpolitan doctors and the major aim of many CHWs."
1Roger Jaffrey- In Social Science and Medicine 16 : 1835-1841, 1982 quoted in Socialist Health Review, Vol. 2,3, Dec. 1985

SCIENTIFICALLY VALID USES OF

AYURVEDIC THERAPY

Disease Drugs/Therapy Mechanisms

Eye Infections Argemone mexicana Antibacterial alkaloids

Barberis aristata, Antibacterial tannins

Butea frondosa

Common Cold Salt free diet Decreased HCL and

Hyperacidity chloride output

Ameobiasis Holarrhoena anti- Ameobicidal alkaloids

dysenterika; Caphaelis Connessine, emetine

ipecacuanha

Leucoderma psoralea corylifolia Ultraviolet - sensitive

Ficus glomerate psoralens

Parkinsons Mucuna pruriens Contains L-Dopa

disease Atropa belladonna Anticholinergic

Inflammation Curcuma longa Non steroidal anti-

sprains, arthritis, inflammatory

etc. curcumin

Cough, Menstrual Adhatoda vasica Antitussive alkaloid;

disorders Saraca indica Steroidal activity

Ring worm Cassia alata Antifungal agent in

leaves

Hypertension Rauwolfia serpentina Catecholamine

depletion

Source : "Modern Medicine and Ayurveda "by Ashok B. Vaidya in Health Care : Which Way to Go ? Examination of Issue and Alternative. (Abhay Bang & Ashvin J. Patel (Eds.) Medico Friends Circle, New Delhi.

"Indigenous practitioners are not dying out, they are infiltrating Government and retaining considerable popular appeal, even in uraban areas. On the other hand, their impact on cosmopolitan medicine is a great deal less than the influences the other way, and the indigenous systems remain subordinate. Yet to argue that cosmopolitan medicine alone meets the needs of the ruling class is also inadequate, since the very political support which the practitioners can generate by virtue of thier positions means that politicians woo them assiduously, even if they no longer have a coherent ideological postion which commands much supports."

Jaffrey also finds considerable continuities in policies towards indigenous healers in Independent India following the British period. There were short term training programmes sponsored by the State for traditional dais since 1902. The growth of allopathic medical colleges and the increase is allopathic doctors in the Indian Medical Service (recruited in Britain, 5 percent Indian by 1913) saw a change to greater hostility towards vaids and hakims from the allopathic doctors resulting in little offical patrinage to indigenous medical colleges.

"With the rise of medical registration for the cosmopolitan doctors after 1912, the pressures on indigenous medicine increased. Doctors who offended the imported British ethical codes and collaborated with indigenous practitioners either in their new colleges or in daily practice, were threatened with deregistration. The wedge between cosmopolitan and indigenous medicine was driven deeper by the disputes over the recognition by the General Medical Council in London of Indian medical degrees which occupied much of Indian medical politics in the inter-war period. When the Indian Medical Association was established the early leaders, also prominent in nationalist politics, called for the admission of indigenous practitioners (if they were ‘sincere’). By the mid-1930s, when these leaders were being incorporated into the New Indian Medical Council and other positions of influence, they had already drawn back from these positions because such policies might lead to a loss of their international recognition. Indigenous practitioners were first registered in Bombay in 1938, but they were on a separate register from that of the cosmopolitan, and only after a 4 year delay was qualification to become the only means of registration. The Bombay Government was well ahead of other Governments, and even here an amendment in 1949 weakened their legislation and admitted new practitioners on the basis of experience, Neverthless, the Bombay Act was held up as the model for legislation after 1974.

"The inter-war period thus showed gains and losses for indigenous practitioners. On the one hand, there was the establishment of colleges, rather than the less respectiable guru chela form of apprenticeship which had previously been the sole training method. Several of these colleges were well-funded, especially in Delhi, Madras and the Princely States of Mysore and Hyderabad, for example. The indigenous practitioners also had the support of the reports of special Government committees set up to consider policy towards them. On the other hand, their subordinate position relative to cosmopolitan medicine was reinforced by registration patterns, and previous strategies of raising status (e.g. by procuring a scientific facade through joint teaching and practice with cosmopolitan doctors) had received a severe blow. The weakness of the indigenous practitioners was partly a result of their own internal divisions. not only were there the two main groups separated by linguistic, theoretical and religious differences, but there was also the newer group o homeopathy established particularly strongly in Calcutta and Bengal. In addition, each group had a variety of career patterns. Usually locally specific, with little agreement about diagnosis or techniques. often a noted local teacher would prepare his own commentary on the traditional texts, and a school which grew up around one teacher would deride and vilify that around another. These divisions particularly affected elite practitioners, whereas the average healer might be very different - but evidence about them before the 1960s is slight and highly unreliable. Finally, there was the growing ideological split between those who wanted integrated teaching of cosmopolitan science and indigenous therapeutics, and those who considered the pure indigenous training sufficiently scientific. This divide dominates the post independence debates."1

Neverthless, some kind of integration of indigenous and allopathic systems does go on all the time in spite of statutory boundaries. This integration is more as a result of expendiency on the part of indigenous practitioners to attain quick results by way of prescription of allopathic (or modern) medicines, and to offset the perceived loss of status, of being second-rate in comparison to allopathic doctors, etc. (As an introspective comment, why do we not consider it expendiency on the part of allopathic doctors who use Liv 52 or traditional systems -- on the contrary they are considered in many circles, expect perhaps by orthdox allopaths, as progessive and open minded?).

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1 Roger Jaffrey, op.cit

STEREOTYPES, PITFALLS, AND GENDER BIAS

One should keep in mind that one of the reasons for a renewed interest in traditional systems has been the crass commercialisation of allopathic medicine and the neglect of safety and human ethics, profits and market logic dominating above all. Increasingly such crass commercialism is seen in Ayurveda, Unani, Siddha, magnetotheraphy and others looked upon as alternative and complementary systems.

Traditional medicine also suffers from the other evils of allopathic medicine: mystification, curative approach, professionalisation, high costs and a decrease (or lack of) community oriented approach. Probably this is understandable considering the fact that all healers are some kind of elites -- only the traditional healers are driven by a lack of unity, multiple world - views and a lack of cohesiveness. Unqualified support to traditional, alternative and complementary systems is at best naive and wishful.

Much harm can be done to the cause of people oriented healing by stereotyping traditional medical systems,1 or putting them in strait-jackets, like : all traditional medicine is good, harmless and/or sound; all traditional healers are poor people oriented or that all traditional healers are models of healer-healee relationships, they are truly holistic in their approach and are as much spirutual healers as physical healers. An equally deceptive practice is to generalize the features of folk medical systems and folk healers with the ones with scholarly tradition (Ayurveda, Unani, Siddha, etc.). They have no doubt some common features but often have distinct characteristics with varying access to different classes in society. (See Table 1)

The risk of ignoring or discounting the benfits of allopathic medicine while espousing traditional systems are equally harmful to the interests of people’s health problems. Often this can become an excuse of the ruling elite’s inability to extend allopathic health services or primary health care to rural poor and remote areas.

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1 See also: George Foster’s discussion of stereotyping in ‘An Introduction to Ethnomedicine’ in Traditional Medicine and Health Care Coverage. R.H Bannerman, et al (ed) WHO, 1983, Geneva: pp.22-24

The question of gender bias1 in indigenous healing systems is relatively unexplored. This area must be explored as Batliwala points out, at three levels:2

1. Is there a gender bias in the conceptualisation of women’s health and disease in other (health) systems?

2. Is there a sex-distinction in their therapeutics and in the delivery of care to women?

3. Is there discrimination against or decimation of women practitioners of indigenous systems, including folk and tribal medicine? And if so, are pressures arising from within the system, or the spread and influence of allopathy?

That there has been a bias of this kind is clear from the fact that most healers of scholarly tradition medicine (like Ayurveda, Unani) have been mostly male even as access to these healers traditionally have been to males,3 The most unfavourable development of such a bias could be perceiving female health problems from male eyes, without appreciation of the agonies involved in being a women in a tradition bound, male dominated society.

CONCLUSION

In this chapter, we have outlined some of the dilemmas and issues posed by traditional medicine systems in the contemporary world. We have tried to explore why there is a renewed interest in traditional systems even as there are some negative features of tradiotnal systems -- features probably common with allopathic medicine.

Our perspective on healing and the different modes of healing is enlarged by looking into traditional systems even as rational scepticism is desirable in trying to winnow the absurd from the possible in healing. Not all traditional medicine is holistic or has desirable aspects of holism. We explore in the next chapter this move towards holistic health and holistic medicine.

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1That is bias, due to sex -- male or female. Usually the bias is against women in patriarchal societies.

2 Srilatha Batliwala: ‘Whither other systems of Medicine’ in ‘Socialist Health Review’, Vol. 2, Number 3, December 1985.

3 See Dunn, op. cit, where he outlines this bias

Table 1

A Comparison of Some Characteristics of Three Categories of Past and Present-Day Medical Systems,

Which Emphasis on Actual Practice Rather than Theoretical Ideals

Local Medical Systems Regional Medical Systems The Cosmopolitan Medical Systems

("folk medicine") (e.g. Ayurvedic, Unani, (ie., "modern," "Western."

Chinese) or "scientific" medicine)

indigenous indigenous transplanted

popular-traditional scholarly-traditional (in most parts of the world)

Geographical usually local rural or urban regional, rural or urban global, largely urban, slowly

emphasis expanding rural emphasis

Diseases and limited range of locally broader range of regionally all of man’s diseases and

disorders of distributed + universals distributed + universals disorders

concern

Emphasis on :

Conventional little little to moderate moderate

health education

of clients)

Public health little past: strong (parallel develop- strong

ment especially urban,

and not necessarily

linked to other medical

institutions)

today: little

Preventive moderate past: moderate (strong in moderate

medicine theory)

today: declining

Curative strong past: moderate in China very strong

medicine (theory strong),

strong in India

today: strong

Access to care variable, all adults often highly variable, usually sharp past : urban elite had

have equal access (esp.in differentials, in access related greatest access

small-scale societies), to age, birth order, sex, religion, today: the ideal is

children may have less economic status, etc. equal access for all;

access (benefits of care (benefit of care sexually quite the reality is access

more or less equally unequally distributed) proportional to income

distributed in the population

Local Medical Systems Regional Medical Systems The Cosmopolitan Medical Systems

("folk medicne") (e.g. Ayurvedic, Unani, (i.e., "modern." "Western," or

Chinese) "scientific" medicine)

Practitioner male or female practitioners Usually male (some females past : male

characteristics today) today : male or female

practitioners not elitist, past : often close to or members past : secondary elite (before the

often part-time of elitist circles (sometimes elaboration of professional

social stratification and paraprofessional

related to specialization) specialities)

today: often marginal in urban today : a range from secondary

areas (sometimes middle- elite to intermediate and

in rural areas low social status

little to moderate past : considerable specialization past : little specialization

specialization today ; little specialization today : very strong specialist

fragmentation

Informal training Spirit intermediator often today usually a scholarly master- scholarly education at a school

and formal "self-trained following pupil relationship or scholarly

education of inspiration" education at a school; self-

practitioners training uncommon

herbalist and/or ritual-magic

specialist; father-son or

master-pupil education

Mode of entry self-designation as a usually informal or formal formal examinations, licensing

into "practice practitioner or by inheritance examinations, often some

form of licensing.

Source : Frederick L. Dunn "Traditional Asian Medicine and Cosmopolitan Medicine as Adaptive Systems" in Charles Leslie (Ed.)

Asian Medical Systems : A Comparative Study Berkeley - Los Angeles - London: University Press, 1977, pp.138-140.