Are ICUs Increasingly Being Manned by Ayush Practitioners? An Explainer

Claim: 95% of ICUs are manned by Ayush doctors - Chairman of Central Council of Indian Medicine

In a government gazette dated November 19, the Central Council of Indian Medicine (CCIM), the regulatory body for Ayurveda in the country, allowed postgraduate Ayurveda practitioners to be trained to perform certain surgeries like general, orthopaedic, ENT, dental, ophthalmological, etc. This has been strongly condemned by doctors of modern medicine but CCIM maintains that these surgeries were already being performed by Ayurveda physicians and the notification merely establishes its legality.

In an interview with an English daily, CCIM Chairman Jayant Deopujari called the Indian Medical Association's (IMA) opposition to the move "hypocritical" considering Ayurveda physicians are being recruited to work in allopathic hospitals and "95% of ICUs are manned by Ayush practitioners". When Factchecker reached out to Deopujari, he said this isn't an exact figure but insisted that there are ample Ayush graduates working across hospitals in Mumbai, Pune and other places in Maharashtra.

"Recently the NABH (National Accreditation Board for Hospitals & Healthcare Providers) raided 10-15 hospitals in Mumbai and found that they were being manned by Ayush physicians. They even came out with regulation against it." Ayush doctors are easy to train, can sometimes work for less money and are hired when hospitals don't get MBBS-trained doctors. "They are equally trained with comparable course materials and a basic understanding of the fundamentals," Deopujari insists.

There is no record of exactly how many Aush doctors are currently being employed by regular hospitals. Some of this is above board, like when hospitals offer patients the option of being treated by Ayurveda, Sidda or Homeopathy doctors in their own tradition, in a "cafeteria-style approach", according to Dr KR Anthony, an independent monitor with the National Health Mission (NHM) and a former Director, State Health Resource Centre, Chhattisgarh. Many are also involved in periphery primary healthcare services dealing with basic health, administrative responsibilities and coordination of field activities. Recruiting them as community health officers for health and wellness centres with training to manage diabetes, hypertension, etc is also permissible, he says.

But allowing them to perform surgery is "too much". It's unscientific and unethical, he says. However, it's happening. "It's one of those things that is known to everyone but is not said openly," Dr Anthony says. In smaller hospitals and nursing homes, and even in some corporate hospitals, BAMS-qualified physicians, "camouflaged" as MBBS doctors, pick up the slack during night shifts or when regular doctors are unavailable. "From Uttar Pradesh to Nagaland, this is happening everywhere, widely misused by the private sector."

Dr Sylvia Karpagam, a public health expert, says they often learn certain procedures from regular doctors by assisting them during the surgeries until they know enough to do them on their own. This, in combination with telemedicine, is being used to create a multi-tier medical system to provide some version of healthcare rural areas. "But if there is an emergency, they wouldn't know what to do," she says. As is, the whole practice is riled with negligence. Procedures go wrong and mistakes happen so often, she says, adding that the overall the health system needs to be more accountable and regulated.

The problem has become especially acute since the start of the pandemic. For example, in July, Bengaluru's municipal body, BBMP recruited nearly 300 doctors to work at BIEC Covid Care Centre and only 13 of them were actually MBBS-trained doctors, Dr Anthony wrote in August. Speaking to Factchecker, he strongly objected to the involvement of Ayush doctors in ICU management, where life and death hang in the balance, calling it the "height of quackery". "People from small towns come all the way to Bengaluru believing they are being treated by specialists but they are instead being cheated using government money."

A senior doctor working in a government medical college in Chennai said that the pandemic is an exception and that can't become the norm. "In the shortage of qualified nurses, even we used final year nursing students. Because it's extraordinary circumstances. But allowing Ayush doctors to practise allopathy is different." Even when Tamil Nadu was facing a COVID crisis in the initial days, only MBBS qualified doctors were manning the Covid Care Centres. "Some mild cases were referred to Siddha doctors who treated them with Siddha medicines. That's perfectly fine and allowed. But anything else is cheating."

Referring to the CCIM Chairman's statement, they said it can neither be completely negated nor accepted. "In a government setup, it's impossible for Ayush doctors to get in as duty doctors but it might be happening to some extent in non-accredited private hospitals that too only in the five years or so. I would say in Tamil Nadu it's happening but it's rare."

Dr RV Asokan, General Secretary, IMA can't quantify to what extent this practice is prevalent but says it has "crossed the limit". But just because it's pervasive, doesn't make it legal. "The CCIM notification is the last straw," he says. "They should develop their own surgeries and post-operative care in their vernacular terms and not take over modern medicine," he says. "For instance, Ayurveda doesn't believe in microbial infection so how will they administer anti-biotics?" he asks. This is bad for both modern medicine and these indigenous systems as well which need to be practised in their pure and true form so that patients have real options.

The latest move, he says, can't be seen in isolation. From the National Medical Council's provision for mixing curriculums to the 'medical pluralism' promoted by the National Education Policy and NITI Aayog's integrated medicine heralding One Nation, One System, this is part of an overall design of the government with a political objective to promote traditional medicine at the cost of modern medicine which is seen as a western concept. But Dr Asokan reminds us that modern medicine is as Indian as any traditional ones. "Some of the earliest medical colleges were built in India, the first malarial vaccinations happened on Indian soil and India is at the forefront of modern medicine." That's why it's important to resist, he says. The law of the land says you can't practise modern medicine without the right training but the rules of the game are being changed. "There is a lot of anger and frustration among the medical community and students," he says.