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Towards holistic care

Towards holistic care

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DARSHAN SHANKAR

In the world of music today it would be considered weird, perhaps sacrilegious, for any group of professional musicians or individual musicians to insist that only one cultural genre of music was genuine and to demand therefore that all other forms of music be barred from performance.

In the world of knowledge, however, this kind of weirdness is existent and the COVID-19 pandemic is proving a prime example.

Because of the spread and magnitude of the pandemic and the fact that to date there is no evidence-based antiviral treatment specifically to tackle COVID-19, a rational policy ought to have been to seek involvement from every possible credible source of public health service. Certainly it should have included legally recognized systems of AYUSH healthcare, particularly for prevention and management of mild and moderate COVID-19 conditions.

AYUSH practitioners should have been invited and pressed to contribute from day one. But the reality is that they have been kept out on the specious grounds that they do not have the competence to undertake antiviral management of COVID-19. Today, almost 17 months since COVID-19’s first surge, large sections of the community who survived the disease are facing post-COVID-19 syndromes. 

In the wake of the second wave, which is yet to peak, alongside the inevitable post-COVID aftermath, it is perhaps necessary to review how well we have been employing the country’s  health resources. On the one hand, our mainstream health system is stretched to a breaking point and, on the other, other legal systems of healthcare available in the country are grossly under-utilized.

It is undoubtedly true that AYUSH knowledge systems cannot design antiviral therapy. But let’s take note of the facts. Long before the advent of the germ  theory and alongside its evolving advances, even today dozens of health conditions described in Ayurveda by specific names and aetiology which correspond in biomedicine to the set of ‘infectious’ diseases  like  diarrhoea, herpes zoster, urinary tract infection, mycosis of lungs, gangrenous wounds and fevers, are being treated clinically by AYUSH systems without the use of conventional antibiotics.

The diagnosis and treatments for these conditions are designed within the framework of their own humoral theories. This fact is evident from an analysis of health-seeking behaviour and real life data being generated in thousands of AYUSH clinics and hospitals throughout the country.

Dr Narendra Pendse and Dr Prasan Shankar, physicians in our university hospital, have been handling patients who voluntarily approach us with mild, moderate COVID and for post-COVID problems, mostly by teleconsultations as well as occasionally through in-person consultation. 

Typically, we have been able to deal with COVID symptoms like fever, cough, loose motions, vomiting and headaches. Clients recover without side effects in four to 14 days, depending on intensity. Similarly, in the case of clients with post-COVID symptoms like persistent cough, fatigue, anosmia, loss of appetite and impaired digestion, Ayurvedic management has been able to bring them to normalcy within two to four weeks. Patients with neurological complaints do take longer to recover.

What the clinical performance of Ayurveda management of so-called infections tells us is that while it is fully justified to treat a disease and its symptoms labelled as infectious like COVID with appropriate antivirals  in Western biomedicine, it is irrational to insist that another system of medicine also manage those diseases with antivirals.

Carrying on with the music analogy, it’s like directing accomplished musicians in different cultural traditions of music to perform similarly to a (politically) dominant mainstream. Ayurveda has its own systemic theory and clinical practices to treat  respiratory,  febrile  and metabolic symptoms. It has its own vast armoury of herbal and herbo-mineral formulations — over 400,000 of them — documented in  CSIR’s flagship database called the Traditional Knowledge Digital Library (TKDL).

Instead, Ayurveda is discredited. Data from largescale multicentric randomized clinical trials (RCTs) is demanded from AYUSH systems when it’s well known that such data is the product of public investment in clinical research and such investments in AYUSH are negligible. That’s like asking great cooks in ethnic communities to produce a Michelin award to certify their competence when their skills are evident from the millions who consume those ethnic delicacies with satisfaction on a daily basis.

Today the need to revisit our COVID national management strategy has become imperative in the wake of rising infection rates and post-COVID problems experienced by survivors, like chronic fatigue, shortness of breath, chest pain, COVID fog, loss of smell and cognitive impairment, dizziness, tinnitus, anxiety, depression, insomnia, joint pains, persistent cough, reduced appetite and secondary lung infections. These post-COVID symptoms affect thousands of citizens across all social strata and they face a huge dilemma because mainstream medicine has no solutions. Such health conditions no longer have any viral target  because they are systemic disturbances and need holistic intervention. The economically underprivileged  populations are particularly vulnerable.

While safety and effectiveness should remain a central concern in employing an integrative management strategy, this concern can be addressed. The clinical track record of AYUSH and, of course, its legal status should inspire enough confidence in policy to urgently employ  its services. The bogey of evidence from RCTs must be buried because we already know it does not exist even for biomedical management.

Instead, one should draw strength from real-life clinical practice. AYUSH is already serving millions of citizens on the ground. The feedback from the Ministry of AYUSH’s Sanjeevani app, recently launched to upload citizens’ experiences on safety and effectiveness of AYUSH interventions, indicates a very favourable public response.

In public interest and particularly in the wake of the second wave which some epidemiological models predict may give rise to further waves, it is important to recalibrate the national COVID management strategy and urgently adopt integrative healthcare for prevention, for home management of mild symptoms and, of course, for post-COVID healthcare of citizens.  

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