|Year : 2021 | Volume
| Issue : 3 | Page : 175-178
Indian health care from the Ramayana era to the modern times: Looking backwards, moving forwards
Manjul Tripathi1, Awdhesh K Tripathi1, Harsh Deora2, Nishant S Yagnick3
1 Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
3 Department of Neurosurgery, Paras Hospital, Gurugram, Haryana, India
|Date of Web Publication||02-Nov-2021|
Dr. Manjul Tripathi
Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tripathi M, Tripathi AK, Deora H, Yagnick NS. Indian health care from the Ramayana era to the modern times: Looking backwards, moving forwards. Int J Neurooncol 2021;4, Suppl S1:175-8
Inspiration can be derived from uplifting stories that are set in a background of disaster. The stories may range from the mundane to the imaginative, representing real-life incidents to mythological ones. Inspiring stories emanate as fragments of our experiences, interactions, activities or knowledge, and thus are never truly “original.” Yet they serve to motivate us. Motivation in turn encourages creativity and innovation.
The real sculptor that utilizes the “chisel of imagination” on the “boulder of rock of real-time events” to construct larger-than-life mythological stories is the “passage of time.” Within a credible time duration, inspiring real-life events become legends, legends becomes fables, and fables transform into myths. Ultimately, mythology inspires belief, practices and rituals, and these practices become irrevocably engrained in one's cultural beliefs and habits. Thus, mythological stories may be used to derive life-lessons, which in turn may help in shaping the future [Figure 1]. Devdutt Pattanaik, the famous author, once said, “From mythology comes belief and from belief comes behavior.” This author has been medical doctor by training and is now pursuing the profession of being a leadership consultant. He is, however, a passionate and an ardent mythologist. He has written and lectured extensively on the nature of ancient stories, symbols, and rituals, and their relevance in the modern times. His books are immensely successful mainly because the life-lessons they provide from mythology are immediately identifiable by our society. Some of the most successful brands and companies today derive their eponymous names from mythological characters, and the company's ethos from the exploits of these characters. Nike is the name of the Greek goddess of strength, speed, and victory. Apollo, Amazon, Delphi, Mars, Odyssey, and Olympus are a few brands that are named after popular mythological characters. These ultra-modern companies, whose immensely popular products are based on contemporary scientific research, still derive their working philosophy from ancient Gods, from whom they derive their names.
|Figure 1: Mythological teachings are deeply rooted in our society. They are inextricably interwoven with important facets of our life and also profoundly influence health-care. By emphasizing on the mutual respect that is symbiotic in any patient-doctor relationship, and which has been brought out in our ancient texts through times immemorial, it is possible to bring about a sea-change in the health care delivery systems. Photo courtesy: Dr. Soumyata Tripathi|
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Hindu mythology is rife with examples of medical practice that intuitively resonate with the currently prevalent medical scenario. Reading these stories convinces us that health-care systems have been facing challenges since times immemorial, and each time, we have been successful in mobilizing our inner strength to overcome these issues.
In the popular Hindu mythological epic “Ramacharitmanas,” the epic poem in Avadhi language composed by the 16th century Bhakti poet Tulsidas, these medical adversities have been depicted in subtle ways while describing the war between Rama, the virtuous king of Ayodhya, and Raavana, the highly intellectual yet vain king of Lanka. An interesting derivative of this episode is that human emotions, characters and reactions to situations remain essentially identical, irrespective of the time lapsed, the people involved, and the geographical setting in which the event took place.
In this battle, Laxman (the brother of Lord Rama and the prince of Ayodhya) gets several injured in his battle with Meghnaad (the son of Raavana). He fainted and was cordoned off from the war zone. There were several capable physicians in the army of Lord Rama. Rama, however, asked Vibhishan (the brother of the enemy king, Raavana, who ultimately betrayed the latter) to consult a skilled, learned, and specialist physician for Laxman's treatment. Vibhishan, in turn, consulted Sushen, the official physician of Raavana's army. This story is a testimony of the trust that was exhibited in the physician's role and the health-care systems of those times. Rama unquestioningly adopted the management suggested by the physician of the enemy army and followed his advice to the letter in his brother Laxman's treatment. Such an event was only possible because of the strong and unshakable belief that both the opposing armies had in the strength of character of the physician. It was apparent that the integrity, ability, knowledge, and dedication that Sushen brought to his occupation as a healer was unquestioned by both the parties. An important fact that emerges from this episode is that in order for the healer and the patient to work in unison toward the common goal of successfully fighting the ailment, it is necessary to have an unquestioned faith in the ability and intentions of the treating physician. The adversarial king Raavana's physician, Sushen, was, therefore, respectfully brought to Rama's camp from Lanka without there being any doubts or fear that any impropriety would be committed by him during the discharge of his role in healing Lakshman. This also signifies a deep understanding of the specialty of medical practice. The poisonous arrow that had injured Laxman was a creation of Lanka's army. Rama understood that a physician from Lanka would be definitely more well-versed in dealing with the poisons prevalent in that region. Hence, the role of a specialist focusing on a particular field based upon his clinical experience and training is highlighted.
After Laxman's clinical evaluation, Sushen asked for the Sanjeevani herb, which was only available on the Sumeru mountain in the Himalayas. His prescription remained uncontested. On his advice, Hanuman (the monkey god) was asked to bring the herb from the Himalayas to Lanka. He was the chosen one for this onerous task as he possessed special abilities and superhuman speed. On his way, Hanuman was interrupted by another demon named “Kalnaim,” who was a soldier in Raavana's army. He tried to misguide Hanuman by deviating him from his path. This situation is completely identifiable in the modern-day clinical practice. Relatives and associates of the patient do not refrain in giving their unsolicitous advice regarding the treatment being administered without having an iota of knowledge of the disease as well as the medications. This not only jeopardizes medical management but also endangers lives. Tulsidas considered people possessing personalities akin to that of Kalnaim, to be having a demonic character as they try to hamper the discharge of an effective treatment to the patient. His advice in the sacred text of Ramcharitmanas is to stay clear of them.
On reaching the Sumeru mountain, Hanuman was not able to identify the herb. On asking the local people of the mountain for their help, he had the feeling that they were misguiding him. Rather than wasting any more time, Hanuman preferred to lift up the whole mountain and bring it back to his army camp in Lanka so that the choice of the medicinal plant could be made by Sushen, the physician. The Sumeru mountain with all its medicinal herbs is analogous to the plethora of medicines available in a pharmacy, from which the right preparation may be chosen by an appropriate person of sufficient caliber and competence. Sushen identified the correct herb from the mountain and successfully treated Laxman. Thus, the knowledgeable doctors well-versed in their fields should be the one choosing the appropriate medicines. Off-the-counter distribution of medicines by laymen and other unauthorized personnel should be denounced in the strongest possible terms.
Bharat (another brother of Ram, the third in line of succession to the throne of Ayodhya, who was ruling on behalf of Rama) confronted Hanuman when he saw him flying in the sky with the Sumeru mountain. Bharat confused Hanuman with a demon because of his ability to fly and to single-handedly transport a mountain through the sky route. Hanuman was only allowed by Bharat to continue transporting the mountain after he was convinced of the well-meaning intentions of the former by the explanations provided. Similarly, family members and well-wishers of the patient may hinder a patient's management plan simply because they are demanding satisfactory explanations from the doctor treating their kin. An immediate and effective clarification by the latter goes a long way in alleviating their apprehensions. Once they are convinced regarding the clarity of the plan of treatment, the management of the patient is allowed to be conducted without any hitch. Despite numerous impediments, Hanuman was, thus, successful in fetching the “Sanjeevani” herb in the nick of time on the advice of Sushen, and Laxman could be saved.
Later on, an obliged Rama sent the physician, Sushen, back to his home in Lanka with full dignity and respect. Raavana was informed of the whole incident but did not question/punish the physician despite having all the powers to do so. This episode of “Ramacharatimanas” is an exemplary tale highlighting the respect and trust that a physician of those times commanded. Sushen, in turn, did full honors to the faith reposed in his abilities and character by diligently and ethically carrying out his duties as a physician in saving a human being, not for a moment taking cognizance of the fact that he was an enemy soldier.
In those days, a physician was safe even in the kingdom of an autocratic ruler, such as Raavana. The same situation can often not hold true in the present times. Currently, health-care delivery in India is facing a most difficult time despite the improvements brought about in mobilizing resources and their dissemination, as well as the strict implementation of safety standards. The biggest impediment in the health-care delivery emanates from the dwindling trust between the healers and the patients. From the highest and most respected echelons of the Indian community that a physician occupied a few decades ago, his/her position has been relegated to receiving the brunt of the patient-relatives' anguish when things do not proceed as anticipated. The doctors today are at the receiving end of what is probably the collective and accumulated anguish of the society, whose members have erroneously perceived that it is the doctors who are actually responsible for the poor infrastructure, the skewed physician-patient ratio, and the uneven distribution of services existing in the present times. The negative publicity by the media and the political indifference in developing health infrastructure and protocols further compound the problems. This mistrust against the physician has often lead to a gradually increasing incidence of physical assaults on doctors and the manhandling of hospital staff. Doctors are squarely blamed for the deficiencies of infrastructure, which, few people realize, is the responsibility of the administrative wing of the government. The result is a large exodus of doctors to other nations where they are given a better work-environment, with potentially no risk of getting assaulted. It is important to note that most of these doctors emigrate after having completed their primary training and directly experiencing the worsening situation of the patient–doctor relationship and the political indifference. This leads to a shortage of doctors for primary care. Most of those doctors who remain in the country want to stay in tertiary care organizations in better-developed areas. The latter organizations, unfortunately, are few and not easy to get appointed to. In most public hospitals, the lack of basic amenities like an adequate number of beds to accommodate all the patients seeking treatment, the presence of an adequate nursing staff for the care, and the basic diagnostic and operative equipment are lacking. Private health-care, therefore, continues to be the lucrative option for medical personnel. It is time that the people in governance take a leaf out of the teachings of the Indian mythology and restore the respect that doctors commanded in that era.
With the episodes described in Ramacharitmanas, Tulsidas had tried to construct a just and respectful environment for the physicians in the society so that the health personnel could execute their duties without any fear or prejudice. For a doctor, a “patient remains a patient” first, irrespective of the latter's gender, caste, creed, ethnicity, religion, as well as social and political status. In another anecdote from Ramcharitmanas, Tulsidas warned physicians to remain true to their duties,
”If a physician, minister, and teacher, cringe out of greed, fear or displeasure in place of the right then gradually health, kingdom, and society get ruined. Hence, these three pillars of the society should remain neutral, just, and perform their duties without any pressure from the ruling governments.”
The teachings of Ramcharitmanas have become firmly entrenched in the ethos of our society and have influenced successive generations. Every societal interaction is based on reciprocity. Combining these two statements, it is evident that inculcating respect for health-care workers based on the teachings of this epic text will not only incite a reciprocal positive response for the patients but also influence behavioral norms in our society for generations to come.
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