Can Ancient And Modern Healthcare Collaborate?

Can Ancient And Modern Healthcare Collaborate?
In my small town in Sialkot, just a few kilometres away from the motorway exit, there is a medical trust that houses both an MBBS physician and a homeopathic healer. For more than a decade, they both have been working side by side. Since the place runs on charity, no advertisement is done for either healer. Both doctors are, in fact, well known to the patients in the town and surrounding villages, and patients choose one of them for their treatment based on their personal preferences. No one forces or even influences them.

Can such a peaceful coexistence of two diverse schools of patient care be reproduced in the healthcare business throughout Pakistan? I doubt it.

To even consider this theory, we have first to assume that non-biomedical methods, including herbalists and homeopathy, are a form of naturopathy. At least, that is what a layman thinks of these methods.

What is Naturopathy? Naturopathy means using the body's natural healing powers to procure health. This healing philosophy not only credits itself for miraculous cures but also proclaims exceptional preventive potential. The basic principle of naturopathy is an interplay of stimulus and reaction: by providing a stimulus, you elicit a response in the body, which is not just a local reaction at the level of the organ (where you applied, let's say, the cold compresses) but the effect ripples throughout the body, stimulating the tissue down to the cellular level. In short, naturopathy draws on the body's hidden healing potential.

Now, what in the world do an herbalist and a homeopathic have to do with naturopathy? one may ask. And you are right. A better term for their methods would be phytotherapy—the use of medicinal plants for health and healing. But here again, you may ask what herbalist or naturalist in Pakistan uses these plants. Once again, this is true. Unfortunately, however, all non-biomedical professionals in Pakistan pretend to be naturalists, extolling their methods and medicines as coming from a natural source like herbs, and, what is more interesting, almost all patients in Pakistan believe in this baloney. That's why we have to pretend, too, that these hacks are real naturalists, to find a way to fit them into the legal healthcare system.

We can follow two models from recent history to bring about this integration in our system.

The more interesting example, closer to our own culture, is Ayurvedic medicine in India. Ayurvedic has continuously been practiced in Southeast Asia for over two thousand years. With the advent of modern medicine brought to India by Europeans, Ayurvedic methods fell out of favor, at least at the academic level. However, this ancient healing system has now been recognized by the government of India as one of the official systems to practice medicine in the country.

Since this recognition, the field has feverishly flourished. By now, there are more than 400,000 registered Ayurvedic practitioners and more than 250 tertiary institutions. In these temples of ancient wisdom, thousands of medical students receive extensive training lasting five to eight years. Graduating Ayurvedic physicians then find more than 25,00 hospitals and 15,000 clinics where they can carry out their practice. Ayurveda medicine serves hundreds of millions of people in India alone—people who prefer to be treated primarily with natural methods while using modern medicine only in case of emergencies. Who are we to object if a patient prefers one system over another?

The other brilliant example of a blend of traditional and modern medicine is China’s healthcare system which successfully incorporated Traditional Chinese Medicine into mainstream healthcare.

Since its recognition in 1982, Traditional Chinese Medicine has become part of the official practice of medicine. While India allowed the traditional methods to be practiced in separate buildings, China brought its ancient wisdom inside the modern hospitals, where they work parallel to, and often in tandem with, modern western medicine.

Many hospitals in China have a whole floor dedicated to traditional methods of treatment. To imagine this scenario, picture a post-surgical patient poked with pins for pain relief, using acupuncture to manage the pain instead of narcotics. Or a cancer patient inhaling the fumes off a medicinal bowl containing a soothing oil in boiling water to avoid nausea and vomiting.

Back to our main question, is such integration of the opposing systems possible in Pakistan? But before that, you need to know that, for all practical purposes, the supposed "traditional medicine," the natural healing method, so to say, is the to-go healthcare for most patients in Pakistan. These healers form a wide and deep network, through which only a minority ever filters out and reaches biomedical healthcare.

So to answer our main question, we will have to learn why patients prefer the non-certified system over the biomedical one, information that would also make it easier to understand how indulging with this same network we can work out a harmony with it, benefiting our patients and the healthcare system as a whole.

Poverty is perhaps the most powerful influence. The lack of purchasing power makes the option of a complete treatment for just five hundred rupees much more attractive than consulting a certified physician, where just talking to a doctor alone costs thousands of rupees, followed by a few more thousand for tests and medicines. But this approach should not be cause for concern so long as we can regulate these visits. The good news is that most patients don't need a certified physician, let alone a specialist, on the first visit. Minor illnesses, which are more common, get better on their own, using the body's natural healing mechanisms or only simple medicinal regimens.

However, the harm starts when the illness persists, eluding the limited diagnostic skills of the healer. In such cases, both an undiagnosed disease and useless medicines doubly damage the patient's health. This should not be allowed. By just bringing patients' visits to non-licensed professionals under the umbrella of law by recognising the legitimacy of these healers, we can access an extensive database that could then be used to regulate the initial healthcare visits. For this achievement, recognition alone wouldn't be enough. We would have to develop some database portals. For this purpose, a cellphone medical record app linked to the national ID card would be ample technology.

Even though poverty is the most significant social factor, it would be foolish to underestimate the problem of our priorities. Looking at people’s attitudes, one can confidently conjuncture that the most ignored part of a Pakistani’s life is his health. Whether it is about prevention or treatment, health, like the smallest kid in the household, must make room for all others, makes all the compromises. Health gets the first pinch in case of a financial crisis. Doctor visits are delayed, follow-ups postponed, and medicines stretched out to manage emergencies, such as a funeral or another family responsibility.

In the same spirit, since we take health for granted and sickness less serious, the logical first choice for a health visit is usually a local healer, cheap and approachable. The solution to this priority problem also lies in using the network of uncertified practitioners. The state can use these clinics as a whiteboard for patient education, displaying not only information about healthy lifestyles but also algorithms for the escalation of care in case of treatment failure. Just like using the app, exhibiting these charts should be a mandatory clause for registration and approval of these places.

Another factor is the patient’s lack of trust in our modern healthcare system, our most painful national fact, painful both because of the existence of this gap between a people and its healthcare as well as the pain this mistrust produces in the form of unnecessary suffering from the disease. If given a free choice, one can easily wager, most patients would choose a quack over a certified physician. We see it happening around us every day. But why do patients hesitate to go to a doctor in the first place? This reluctance prevails across the social spectrum. Rich or poor, educated or illiterate—all would avoid going to a clinic or a hospital if possible. Patients strongly believe doctors work in league with labs and pharmaceuticals, ordering unnecessary medicines and tests.

This feeling has taken such a deep root in our national psyche, and not without reason, that it seems impossible to eradicate this impression. To remove this dishonour, biomedical healthcare must take the initiative in and of itself. The system can achieve this task by simply adopting the global ethics of medical practice, transparency, and accountability. Developing this level of democracy within healthcare, hard as it may sound, can raise the biomedical healthcare system to its rightful position of leadership and trust.

It is time we brought together various schools of healing under one roof. However, regardless of the nature of the challenges, this kind of initiative would have to come from biomedical healthcare, the system that, despite its weak character, remains the most authentic authority on healthcare. Besides, only this institution has the budget and the backing of the government.

Initially, both groups would show reluctance, for they would first have to lay aside decades of differences. Yet, if they both start with their mutual goal—the patient's well-being—it might prove the first step toward what has been so far inconceivable. At first, it would be logical for biomedical healthcare to mistrust many of the natural-sounding methods of hakims, homeopathic, and others. Yet, at the same time, this can be an excellent opportunity to observe these weird-sounding treatments firsthand. While it would be unethical to let patients undergo a treatment full of risks and dangers, observing a few acceptable methods can initiate us to incorporate the two worlds of medicine—old and new—to patients' benefit. Take acupuncture, for example, used by many hospitals in China to treat post-surgical pain. Cupping is another routinely applied technique for managing stress and anxiety as well as fibromyalgia, a syndrome of non-specific body-wide pains and aches, the mechanism of which still evades all medical finesse.

Gradually, the trust would build between the two systems. And during this formation phase, patients would not only be safe from harmful practices but also get the best of both worlds. It is hard to imagine producers like cupping being done in our tertiary care hospitals or a knee replacement being recommended by a homeopathic practitioner. Both therapies have their own benefits, but none of them does any good to our patients because they are forced onto patients who are not likely to benefit from the procedure, even though either of them can be an excellent treatment if chosen carefully. This ideal situation can only be possible with the collaboration of the two systems. Over time, we may reach a point where a physician would refer a patient with fibromyalgia for cupping while a homeopathic practitioner recommends knee replacement after a few failed attempts with futile medicines.

Similarly, we would learn to treat the patient and not just the symptoms. Consider knee pain, for example. A patient with knee arthritis whose only concern is pain may be allowed to experiment with various medicinal courses as long as these drugs are not toxic. On the other hand, a patient with knee pain who wants to do full-time work may be offered a knee replacement, a cure that would afford him freedom from pain as well as a full range of mobility.

Although this level of collaboration may seem impossible, may be even as hard to imagine as the fusion of faith and reason, but great outcomes often require taking unpopular positions. At the moment, our goal should be the improvement of our patients' health, even if we have to sacrifice our egos and stereotypes in the effort.


The writer is an Internist and Nephrologist. He has won Top Internist Award in 2021 and Top Nephrologist Award in 2022 from Michigan, USA. He can be reached on Twitter @awaiszaka