Health-care and indigenous medicine

The state of healthcare in Sri Lanka has been pretty precarious of recent years. While the indicators relating to health, such as infant mortality and life expectancy, have been improving steadily, obtaining care when one is sick seems much more difficult than formerly.

The private sector was expected to ease the problem, but today there is congestion in the non-government health-care system as well.

Part of the difficulty is the change in attitudes and lifestyle. It has become almost de-rigueur to channel a specialist in case of illness. The obvious first step - which is generally quite adequate - of going through the local general practitioner is often ignored.

The change in lifestyle - not just amongst the affluent, but also amidst the not so well-to-do has affected the way in which people get ill.

Eat healthily

The general rise in the standard of living has lessened the prevalence of malnutrition and its related diseases. Beri Beri (one of the few Sinhalese terms to enter the Oxford English Dictionary) and other vitamin deficiency diseases, such as pellagra, rickets or scurvy are rarely heard of.

Ayurvedic system popular among Westerners. File photo

Instead, there has been a great increase in what used to be diseases of the rich - cancer, heart disease, haemorrhoids and obesity. These have a lot to do with lifestyle and what we ingest.

In times past, people would do a lot of manual work and eat healthily. Dolapihilla records an old story about how King Sri Wickrama Rajasingha grew kurakkan (millet) with his own hands and had his wives prepare it for consumption by his aristocrats.

People ate a balanced diet, and they went to their religion to find an internal balance. The idea of ‘balance’ or ‘harmony’ was one which underpinned thinking on health in Sri Lanka.

One was considered healthy in body when the three ‘doshas’ or afflictions, bile (pitta), phlegm (sema or kapha) and vapour (vata) were in equilibrium.

Western medicine

This belief was actually quite universal at one time. The ancient Egyptians and Greeks thought that there were four ‘humours’ which needed to be balanced: Phlegm, Blood, Yellow Bile and Black Bile.

Unani or traditional Islamic medicine - which derives from the teachings of Avicenna, Averroes, Maimonides and other Persian, Arab and Jewish physicians - preserves these ideas.

The English adjectives, ‘bilious’, ‘phlegmatic’, ‘melancholy’ (for black bile), and ‘sanguine’ (for blood) are reminders that such concepts existed in Western medicine until the 19th Century.

However, as understanding grew about how the internal organs work, methods of treatment changed. The emphasis shifted from holistic to the particular, from harmonising the body to combating disease, from indirect to invasive.

The change in concept is summarised in the joke that ‘surgery succeeded, but the patient died’.

From the 1960s onwards, there grew in the West a greater understanding of the harmony of nature and of the balance within the human body - a tendency commonly called ‘New Age’ from a line in William Blake’s ‘Milton’.

Along with such quackery as crystals and tarot cards, interest was also kindled in aromatherapy, homeopathy, osteopathy and other, native forms of healing such as Chinese acupuncture, North Indian ayurveda and unani.

Healthcare system

As a result, today there is substantial tourism to Sri Lanka in search of healing. The local industry has responded by building ‘ayurvedic spas’ - some of which only offer the most basic of treatments, massages and the like.

In Sri Lanka, we have four distinct (although related) systems of ‘indigenous’ medicine: ayurveda, siddha (from South India), unani and ‘Sinhala vedakam’ (‘Sinhalese native medicine’, which the authorities, in their wisdom, call ‘desheeya chikithsa’).

These have the capacity greatly to reduce the strain on the healthcare system. For example, they are probably more efficacious than Western methods in treating ills as diverse as haemorrhoids, arthritis, repetitive strain injury and De Quervain’s tenosynovitis.

Indigenous medicine

There were recent reports of indigenous medicine being used to cure breast cancer.

Recognition of the importance of indigenous medicine came with the foundation in 1929 of the Ayurveda Teaching Hospital, now located at Rajagiriya. This was followed in 1962 by the opening (by Jawaharlal Nehru) of the Bandaranaike Memorial Ayurveda Research Institute at Navinna.

In the 60s and 70s ayurvedic institutions were established at Anuradhapura, Beliatta, Diyatalawa, Kurunegala, Lunawa, Pallekele and Ratnapura, as well as the Siddha Ayurveda hospital at Kaithady and the Ayurvedic Drugs Corporation.

The last three decades have seen a proliferation of ayurvedic institutions, both hospitals and clinics, the latest being a new hospital at Dickwella.

In the West there has been a growing trend movement to Integrate ‘complementary and traditional medicine’ in public health. In Sri Lanka too, there has been a movement towards allowing patients a choice of therapies (and not mutually exclusively).

For example, at the Cancer Hospital in Maharagama nearly 70 percent of patients are given both Western and non-Western treatments.

Traditional doctors

In the 1970s Dr Senaka Bibile wanted to offer greater choice of drugs to patients and it was his wish to establish an ayurvedic pharmacopeia. Unfortunately, it was found that many practitioners refused to reveal their formulas.

This secrecy on the part of native practitioners, particularly those who have inherited their knowledge through the generations, is the worst obstacle in the path of indigenous medicinal research and the education of new doctors.

It is necessary to devise a programme which will provide sufficient benefit to traditional doctors to cause them to divulge the information they have hitherto withheld. It is only then that indigenous medicine will be brought to some standard of parity with modern Western medicine.