Doctors at the Borders: Ayurveda’s Encounter with Public Health and Epidemics
From the Series: Responding to an Unfolding Pandemic: Asian Medicines and Covid-19
From the Series: Responding to an Unfolding Pandemic: Asian Medicines and Covid-19
On March 11, 2020, the Government of India advised the states and union territories to invoke the Epidemic Diseases Act, 1897 and effectively enforce its advisory in an effort to contain the Covid-19 epidemic.1 Whereas the Act has been criticized as archaic, not having a clear definition of “dangerous epidemic,” and lacking a public health focus (instead having a regulatory emphasis), it has been implemented in the country on many occasions during public health emergencies since its promulgation 123 years ago.
In an interesting account, an Orissa State High Court order in 1963 prosecuted an alternative medicine practitioner for disobedience under this law.2 According to the order, the petitioner was a homeopath from Puri who refused to inoculate against cholera. The practitioner had a “conscientious objection” against inoculation, believed that it was “dangerous to human health” and was on preventive homeopathic medication, he claimed. His petitioner also raised the contention that,
by the passing of the Orissa Homoeopathic Act, 1958, Homoeopathy has become one of the recognised system [sic] of medicine in the State of Orissa and that consequently the taking of medicine taken under the Homeo system, which are held by a competent medical practitioner to be equivalent to inoculation against cholera, must be held to be a sufficient compliance with the provisions of the said Regulations.
The plea was dismissed as there was no provision in the Act or its rules which indicates “statutory purposes” of taking homeopathic remedies for the purposes of preventing cholera, or that these would be “treated equivalent to inoculation against cholera.” The order said:
I am not concerned here with the question as to whether inoculation is injurious to health or not or else whether any other system of medicine provides a better remedy against attacks of cholera. The simple question is whether the petitioner has contravened the provisions of Regulation 7 and 8. On his own admission he has contravened them and his guilt is thus established beyond doubt.
The court indicated that if the petitioner feels the remedy is providing immunity against the epidemic on par with allopathic methods of inoculation, he can approach appropriate authorities to get a suitable exemption clause in the regulations.
In the early days of the Covid-19 epidemic in India, on January 29, 2020, the Ministry of AYUSH of the Government of India released an advisory based on the guidance of various AYUSH research councils.3 This listed a number of ayurvedic formulations, a long list of Unani formulations, and single-drug medicines, as well as a homeopathic medicine mainly for preventive care. Most importantly it mentioned, “Arsenicum album 30 could be taken as prophylactic medicine against Coronavirus infections.” Later the minister responsible made a correction that these are to be used for immunomodulatory effects, without a claim of any curative effect.
As the epidemic progressed, almost two months after the first case was reported, the Government of Kerala, the state which had the most confirmed positive cases, came out with a directive which ordered that patients at all AYUSH hospitals be discharged and that emergency patients should be referred to a nearby “medical institution.”4 The order also said that no patient with fever or respiratory infection should be treated at AYUSH centers. “After collecting details of the patients [at] reception” such patients should be referred to “Health/Medical Institution” and “follow health department instructions.” Due to public demand, subsequently, the government ordered that Ayurveda medicine outlets can remain open during the lockdown period. Other governments followed suit. East Delhi Municipal Corporation, in an office memorandum,5 listed the AYUSH department as “nonessential departments” under the lockdown.
Following a detailed interaction between the prime minister and practitioners of AYUSH across the country, on March 28, 2020, an official release by the Press Information Bureau of the Government of India called for checking “unsubstantiated claims of AYUSH” and working toward “evidence-based research.” It suggested that “AYUSH medicine producers could utilize their resources towards producing essential items like sanitizers which are in high demand these days . . . ” and called for fighting the epidemic through “constant awareness building.” The tone of this official release was one of cautious restraint on the effectiveness of “immunomodulating properties of traditional medicines” though many experts had repeatedly raised the point of clinical efficacy during the meeting. Shortly after this, an AYUSH ministry release on March 31, 2020, stated: “AYUSH Ministry urges diligence in Covid-19 claims and initiates work for scientific and evidence-based solutions to fight the coronavirus.” A channel on the ministry website was opened for giving suggestions (see also Tomar, this series), which, it was explained, would be vetted by a “scientific committee.”
These accounts of isolation and alienation of what was previously called “indigenous medicine” in the wake of epidemics and “dangerous” situations can be traced back to colonial times. The conflicts—highlighted as desire and dissent, hate and hegemony, ambition, and ambivalence in the contestation of a legitimate space (Arnold 1993)—continue even after a century. The historical pathways in which institutions, knowledge, products, and services developed during the formalization of Ayurveda have been skewed toward clinical, medicalized approaches (see also Banerjee, this series). The consequent dissonance in its public health engagements is palpable even in the advisory definitions of “health/medical institution.” At a broader level, the collective public health roles, not just in epidemics or emergency responses, but in areas such as childbirth, medico-legal domains, sanitation, biosafety, public health nutrition, etc., also remain guarded territories away from Ayurveda. The definition of pluralism outlined as a core principle of the National Health Policy 2017,6 comes with the disclaimer “when appropriate.”
Conversely, the progressively medicalized, market-based approach of Ayurveda is challenged by a language of “evidence,” which further denigrates it into a sense of inferiority in dealing with such situations. These idioms of evidence also impede the permeability of the tangible such as pharmaceuticals in the contested space of markets. The hope and desire of the Ayurveda community toward integration and mainstreaming and its constant efforts to prove itself even with regard to prophylactic interventions continues at the borders of public health regulations as well as through definitions of “essential” and “appropriate” interventions.
The overenthusiastic, indiscriminate responses emerging out of the hope for integration have been a matter of recent debates and divisions within the Ayurveda community. Some clear positions emerge from within. One group of physicians thinks there is nothing Ayurveda can do in such a pandemic; in contrast another group represents those who make overenthusiastic recommendations of prescriptions. There are also some who demand clinical interactions with Covid-19 patients to iteratively learn about Ayurveda’s possibilities based on a personalized understanding. Yet another group represents those who want to develop theoretical coherence first and then develop clinical and research protocols at a distance, until the territories are clearer. While continuing to debate whether Ayurveda should remain “pure” or “integrated” in its health system function, in the current role play, it becomes increasingly difficult for Ayurveda to propose an integrative and holistic approach. The official advisories highlight the softer aspects of AYUSH such as yoga, good nutrition, and awareness raising, while distancing themselves from “medical” engagements in an institutional response. There are stories aplenty of the Chinese integrative approaches to the current epidemic (see Sun and Hsu, this series), which continues to kindle hope and desire in the AYUSH community. Even as I write this article, the Government of Kerala has held an expert consultation with the Ayurveda vaidyas in the state. A newly formed taskforce has submitted a detailed report on actions to be taken. Another National Taskforce and related working groups have also been formed. The story is still unfolding, with a hope that the delays in implementation will not flatten the curve of enthusiasm . . .
1. This Act is applied when the government thinks the ordinary provisions are insufficient for containment of the outbreak and gives special powers for the central and state governments to announce a specific region as risk prone and announce quarantine measures, including border controls and penal provisions in case of defiance.
2. “Orissa High Court, J. Choudhury vs The State on 11 April, 1963,” AIR 1963 Ori 216, 1963 CriLJ 659. It said, “The petitioner is a practicing homeopathic [sic] doctor in Puri Town. He was prosecuted for an offence under Section 188 I.P.C. for having refused to get himself inoculated against cholera on 4-7-59 (during the Ratha Jatra Festival).”
3. AYUSH stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa Rigpa, and Homeopathy.
4. Government of Kerala, (No. B1/89/2020/AYUSH), March 23, 2020.
5. East Delhi Municipal corporation, Office memorandum, “Preventive measures to contain COVID-19” No. ADC (CED)/EDMC/2020/308, 20-03-2020.
6. The Government of India, National Health Policy 2017 states: “Pluralism: Patients who so choose and when appropriate, would have access to AYUSH care providers based on documented and validated local, home and community-based practices. These systems, inter alia, would also have Government support in research and supervision to develop and enrich their contribution to meeting the national health goals and objectives through integrative practices.”
Arnold, David. 1993. Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India. Berkley: University of California Press.