Return of Indian medicinal systems necessitates quality assurance

Colonial literature branded the Indian subcontinent as a ‘white man’s grave’. It was the common practice since the inception of the East India Company in 1600 to have British doctors on board their ships to the Orient.

Captain Alexander Hamilton, who visited Calcutta in 1708, writes, “One year I was there, and there were reckoned in August about 1,200 English, some military, some servants of the Company, some private merchants residing in the town and some seamen belonging to the shipping lying at the town, and before the beginning of January, there were 460 burials registered in the clerk’s book of morality.”

There is a ‘racist’ contouring to plague, malaria, smallpox, cholera, influenza, syphilis and tuberculosis being dumped on Indian climate or native genes. With successful sanitary reforms and nutrition, these ‘tropical’ diseases had apparently disappeared from the ‘temperate’ West.

Coloniality also held poverty and poor hygiene responsible for concurrent endemics and epidemics in India. 

Colonially mediated modernity revolutionised the disease concept with Louis Pasture’s germ theory. Indian medicinal traditions were caste-based, authoritative text-based Ayurveda, Unani and Siddha schools, grounded in ‘guru-shishya parampara’.

Folk medicinal practices were clouded with superstitions, rumours, rituals, hearsays and spells of ‘divine chastisement’, ‘wrath of god’ and ‘divine intervention’ narratives. Maternity and childbirth were dependent on midwives causing stillbirths and delivery deaths.

The Indian ‘comprador bourgeoisie’ welcomed the allopathic way of medicine and medical training. The snowballing of colonial public health policy addressed diseases like cholera, kala-azar, smallpox, malaria and plague.

Though public sanitation and healthcare catered to white towns, colonial penal colonies, ports, entrepots and military barracks, the British administration’s municipal strategies of proper drainage, sewage, hygienic garbage removal, modern sanitation and safe drinking water trickled down to the us.

Public hospitals, sanatoriums and clinics were set up. Crowd management
in the fairs, processions and pilgrimage was devised.

The first maternity hospital was established in Calcutta in 1814 under the joint efforts of Count Loudon’s and Lord Moira’s spouses. By 1833, there were a few municipal health clinics and maternity centres in Calcutta, Madras and Bombay.

In 1835, a medical college and a medical school began in Calcutta and Madras, respectively. In 1845, the Medical College of Bombay was established. In 1848, Lord Dalhousie laid down a 100-bed maternity ward for natives in a massive complex near College Street, Calcutta.

After the power transfer from the Company to the Crown, the Magna Carta of 1858 promised a more responsible government. In 1860, a medical college was established in Lahore. Government reports from 1897 to 1902 list 11 government medical schools being opened in Madras, Poona, Ahmedabad, Hyderabad, Calcutta, Patna, Dacca, Cuttack, Agra, Lahore and Dibrugarh. In 1911, the Indian Research Fund Association was established. The School of Tropical Medicine was established in 1920.

The Local Self-Government Act was passed in 1920, allowing budgetary allocation for sanitary remedies during cholera, smallpox epidemics, or malaria endemics. Following this Act, from 1921 onwards, district boards and union boards took over rural health’s responsibility and bulk funding.

Simultaneously, eco-friendly Indian medicinal traditions were discouraged and discontinued systematically from public health. Allopathy was more expensive than the ones prescribed by the ‘hakims’, ‘vaidyas’ and ‘kabirajs’, but proved to be fast-functioning and more effective. ‘Quarantine’ and ‘isolation’ were the mantra of prognosis, intervention and diagnosis.

Poor and rural Indians were treated with contempt for having filthy habits and unhygienic lifestyles. Homes were intruded, and D.D.T sprayed on mere suspicion of vectors of infections. In contrast, traditional medical care was dependent on community healing and personalised family atmosphere. Further rural alienation happened. Poor patients resorted to ‘Sitala’, ‘Olabibi’, ‘Maramma’, ‘Plegammaand’ quacks.

What has changed since independence? Official recognition has been extended to the traditional medicinal practices. A series of governmental initiatives, research institutes, curriculum and ministries are
at work to revive Ayurveda, Siddha and Unani traditions as part of the national healthcare network.

However, drugs are still marketed in both classical forms like leaf, powder, decoction, medicated oil, medicated ghee, fermented products and packaged forms like tablets, capsules, lotions, syrups, ointments, liniments, creams, and granules.

There are no regulated animal trials, global standardisation and benchmarking, whereas western drugs were standardised since the 1880s, certified and allowed to be mass-produced. In contrast, AYUSH remained sporadic and dispersed to enable any standardisation, global benchmarking and quality control, emphasising only epistemological strengths!

Globally, Indian traditional medicines are considered food supplements and medicinal practices pseudoscience. During the last pandemic, uncertified concoctions in the form of capsules, pills, syrups and various other forms flooded the peri-urban and rural Indian hinterland, raising questions on the credibility of AYUSH as part of the Indian public health programme.

At the same time, the vaccine apartheid opened a new horizon for biological and medical neo-imperialism. Easily procurable, cheap indigenous Ayurvedic, Siddha and Unani medicines were increasingly replaced by Western drugs, devices of patenting and monopoly.

French philosopher Michel Foucault’s ‘knowledge is power’ accentuates the mechanism of ‘knowing’ without strategic patronage. India has reshaped its colonial apparatuses, viz. the legal system, armed forces, the economy, education, local self-government, judiciary and public health policy, at its disposal. There is not much dismantling of the colonial hangover yet.

The Union government, state governments, the national and regional leadership and ordinary people often need to agree on measures enacted to check the medical paradigm for achieving holistic transformation, particularly for public health.

The commoner’s fear of the hospital, rumour, hoarding of medicine, black-marketing, creation of artificial shortage of medicine and medical instruments and other commodities, price hikes, trauma, loss of employment, and house-births are all parts of our contemporary experience.

The paradigm of Indian public health needs to be reformulated as per scientific temper, quality assurance and global benchmarking, juxtaposing the welfare state’s relation with its citizen body and national labour forces.

(The writer is asst. professor, Dept. of Political Science and History, Christ (Deemed to be University), Bengaluru)