मेहमान: शैलेजा चंद्रा (पूर्व सचिव, स्वास्थ्य मंत्रालय) ; सुतापा अग्रवाल (पीएचएफआई) ; स्वपना चतुर्वेदी (डाइटीशियन, एम्स) और एंकर: अनुराग दीक्षित
एयर दिनांक: अक्टूबर 12, 2016 (लोकसभा टीवी)
Guests: Shailaja Chandra, Former Chief Secretary, Govt of Delhi ; P D T Achary, Former Secretary General, Lok Sabha and Constitutional Expert ; Sanjay Hegde, Sr. Advocate, Supreme Court ; Sachidananda Murthy, Resident Editor, The Week magazine.
Anchor: Girish Nikam
Air date: Aug 31, 2016
BRT was best thing for Delhi, unfortunately it failed due to bad planning a from India Today
Akhilesh Yadav, ML Khattar, Kejriwal & Jung have to work together to control monsoon mess in NCR
Proposed surrogacy law: Does it address all concerns?
Guests: Shailaja Chandra, Former Secretary, Health and Family welfare, Govt of India ; Dr. Nayana Patel, Medical Director, Akanksha Research and Medical Institute, Anand, Gujarat ; Sunita Reddy, Associate Professor, Centre for Social Medicine, JNU ; Hari. G. Ramasubramanian, Chief Consultant, Indian Surrogacy Law Centre, Chennai ; Sushmi Dey, Assistant Editor, The Times of India.
Anchor: Girish Nikam
Air date: Aug 25, 2016
India’s population stabilisation programmes require the dedicated attention of the CMs of Bihar, UP and Rajasthan.
Written by Shailaja Chandra | Published:July 15, 2016 12:03 am
Scared off by the popular backlash to family planning excesses during the Emergency, India’s political and social leadership abandoned the subject of population growth decades ago. The 10-year goals set out in the Population Policy 2000 were mostly neglected. So when Shanta Kumar, Himachal Pradesh’s former chief minister, resurrected this long forgotten issue and even sought the prime minister’s intervention, it came as a surprise. His fears are genuine but his idea of an all-party meeting is off-track. The problem does not need a political solution. It needs the dedicated attention of the chief ministers of three states — Bihar, Rajasthan and Uttar Pradesh — in whose hands lie the attainment of a goal that 24 states have already realised: Reducing fertility rates to replacement level.
With over 26 million births each year, the country’s population momentum is akin to a super-fast train which cannot be stopped. With determination, it can, however, be slowed down. Stopping the momentum is impossible: It is like telling generations of Indians, including newly-weds, to not have children or to mandate a small family norm. Fortunately, neither strategy is feasible in a democracy.
But chief ministers can certainly encourage people towards an optimum family size and provide couples with the tools to space and limit the arrival of their children — but voluntarily. Such an approach — soft and easy-going as it may sound — has, by and large, succeded.
But what is “optimum”? Demographers agree that if women in child-bearing years produce an average of 2.1 children per head — so as to replace both parents — the population gets stabilised. This number is referred to as the total fertility rate (TFR). Both low and high TFR can pose problems. With Japanese and European couples opting for fewer children, TFR in Europe and Japan has fallen below 1.5; that raises fears of societies disappearing. India’s TFR is presently at 2.3 with huge variations between states.
Kerala and Tamil Nadu achieved the ideal TFR of 2.1 in 1989 and 1992. The good news is that since then, several big states — Andhra Pradesh, Himachal Pradesh, Jammu and Kashmir, Karnataka, Maharashtra, Odisha, Punjab and West Bengal — have brought down fertility rates to replacement levels. Three other states — Gujarat, Haryana and Assam — are poised to join them in a year. The TFR in some states like Goa and West Bengal has fallen to nearly European levels.
Bihar, Rajasthan and Uttar Pradesh (30 per cent of India’s population) are, however, responsible for pulling the country back. Their neighbours, Madhya Pradesh, Chhattisgarh and Jharkhand (10 per cent of the country’s population) have also been tardy but they are moving towards the 2.1 TFR goal; for them the target looks attainable by 2020. The National Family Health Survey and the District Level Health Surveys show that most poor families if assured of two living children do not want more. But this is not the case in Bihar, Uttar Pradesh and Rajasthan where poor parents consciously want more than two children; it is also ironical that the unmet need for contraception is also the highest in these states. Higher fertility levels, early marriages, repeated pregnancies and mothers giving birth in their 40s are exacerbating the problem. Contraception is not used by 50 per cent of those who need it the most.
According highest primacy to population stabilisation in these three states is, therefore, essential. By tracking every married couple in underserved villages, a lot can be achieved. One strategy would be to give incentives to the local health volunteers who should be remunerated for every year’s delay in child birth after the age of 19 (the legal age for women to marry being 18), promoting a gap of three years between children and facilitating family planning methods.
The health minister has recently announced that his ministry will focus on high TFR districts, mostly in Bihar, Uttar Pradesh, Madhya Pradesh and Rajasthan. While this is a good strategy, the engagement of the top leadership is indispensable.
Only chief ministers carry the authority to extract work from the state health bureaucracies. As Tamil Nadu’s example shows, they can requisition the workforce of every department as well that of the private sector. At stake is not just population stabilisation but more importantly women’s liberation and a greater chance for the unborn children to live, learn and become employable. Such reasons to reduce population can swing elections, if presented intelligently.
India’s “demographic dividend” boast is sounding more and more clichéd when one sees the abysmal impact of health and education on millions of young men and women, particularly in the northern states. In the West, the term is used to signify the proportion of working people vis-a-vis the retirees. In India, the so-called dividend is actually represented by disproportionately high number of young people in six high fertility states, many of whom are unemployable. Malnutrition and illiteracy persist.
Shanta Kumar has shown initiative by raising the population issue. He should now find a way of making it worthwhile for the CMs of the lagging states to give primacy to population stabilisation. He should also distinguish between natural growth and population growth caused by unplanned in-migration from other states which is largely responsible for the polluted, slum-ridden picture that he has painted for urban India. That, however, is a matter for another story on how appeasement politics is replacing basic governance.
The writer is former executive director of the National Population Stabilisation Fund.
Indigenous Medicine in India
Country’s first Ayurvedic college started in 1889 at Thiruvananthapuram ( Ernakulum) in Kerala
Indigenous medicine denotes the use of traditional health practices by people in different cultures. While the effectiveness of such knowledge and healing skills is generally inexplicable in terms of cause and effect, traditional medicine continues to be accepted for a variety of reasons. From 2010 to 2013, I was commissioned to write two reports on the Status of Indian Medicine and Folk Healing for the Ministry of Health & Family Welfare.This gave me an opportunity to travel to all parts of the country and observe how three indigenous medical systems in particular had developed over time, besides other tribal and folk healing practices. Ranging from well-equipped National Institutions and highly sought-after hospitals and medical colleges for Ayurveda, Unani and Siddha medicine, to the healing practices of a wide variety single practitioners, traditional healers and bone-setters, my study was facilitated by the state Governments but I had the freedom to select whatever I wished to see. These two paradigms represent two entirely different approaches to indigenous medicine.
The first consists of three codified systems of medicine, firmly locked by complex concepts and elaborate treatises. So impressive is the array of this knowledge that six patent offices in the world have treated the stanzas scanned from the ancient texts to be evidence of “prior art” which had been in the public domain for centuries. India’s Traditional Knowledge Digital Library which is available to patent examiners in six UN languages enabled patent examiners to reject patent claims by referring to the textual evidence rendered into a patent compatible format. Over the last decade hundreds of patent applications have been successfully foiled because the World Intellectual Property Organisation has accepted that the description of plants and diseases given in the ancient Indian texts is clear evidence of the knowledge having been in the public domain and in use for centuries.
India is thus the fountainhead of codified indigenous medicine. Ayurveda, which accounts for some 85% of this sector is practiced throughout the Indian sub-continent and is based upon the balance of three doshas (vaata, pitta and kapha) and the certainty that it is the imbalance between the doshas which is the root cause of the disturbance which then manifests as illness. India is perhaps the only country in the world which recognises four drug-based systems under the Drugs and Cosmetics Act. A separate chapter in the Act regulates the licensing and manufacture of Ayurvedic, Unani (a system which had its origins in Yunaan or Greece) and Siddha medicine – (based on another ancient system but confined to Tamil Nadu and parts of Kerala.
The practitioners of these three systems undergo a five and a half year degree course which is governed by registration requirements exactly at par with those set out for allopathic doctors by the Medical Council of India. Homoeopathy, though a system of German origin, is also regulated by independent statutory bodies which govern education, practice and drug manufacture. Taken together with Yoga and Naturopathy (which have no texts or drugs but which greatly enhance good health,) the group of six is widely known by the acronym AYUSH.
In 1970, the Government enacted a law that created a body for regulating medical education for the AYUSH sector, making college education with a common syllabus and examinations mandatory. The Act did however permit traditional healers who had passed specified examinations prior to a cut-off date to diagnose, treat and medicate individuals who chose to consult them. Many such non-institutionally trained practitioners are no longer alive today. Their progeny, students and unfortunately a few self-styled practitioners continue to treat patients although the law does not recognise such practice. Due to poor enforcement of the law in many parts of the country, unscrupulous quacks claiming to practice indigenous medicine have often cheated unsuspecting patients, thereby bringing a bad name to the sector and its practitioners.
“India is perhaps the only country in the world which recognises four drug-based systems under the Drugs and Cosmetics Act.”
The hope that laws and institutionally qualified practitioners can stop medical malpractice does however risk losing the last vestiges of classical Ayurveda in its purest form. The Ashtavaidyas of Kerala are an institution in themselves. They are families of highly respected Brahmin scholar physicians who hail from a long lineage of vaidyas who have undergone rigorous scholarship and apprenticeship. That kind of Ayurvedic education once had three distinct parts – five years of textual study in Sanskrit, followed by five years of learning about medicinal plants in the forest, and finally five years of apprenticeship under a guru who tested a student’s perception and skills before he was allowed to come into his own. Those who understand the strength of such tutelage question the wisdom of excluding this time-honoured classical approach in the zeal to set standards and bring uniformity.
On another plane, families of Hakims who had practiced Unani medicine for generations now face the prospect of ending a family tradition. Hakim Zafar in Sambhal in Western Uttar Pradesh is an example of a traditional healer who sees more than 300 patients every morning prescribing a combination of dried herbs, which are to be boiled and drunk as a decoction. People visit him regardless of age, gender, religion and language and it appeared to me that they came only for a kind word and to collect the special herbs which created a salubrious effect. A research officer who accompanied me on this particular visit observed considerable commonality with herbs used in Ayurveda. He had however never heard of silk cocoons being a part of any potion!
At the other end of the spectrum of indigenous medicine lies a wide variety of tribal and folk healing practices which continue to be the mainstay of millions of people in remote areas. In the North-eastern states and many tribal areas in India, even when regular health facilities are available, the local people rely on local healers. I took the help of the National Institute of Folk Medicine at Pasighat in Arunachal Pradesh and had the folk healing practices in all the states studied. Although the healers are secretive about the plants they use, every state has its band of well-known practitioners who tend to everyday problems with great confidence.
At the family level, reliance on medicinal plants is a part of family tradition almost everywhere in India. “Gharelu nuske” or home remedies are routinely used for dozens of afflictions – even affecting infants, children, pregnant women and the elderly – in fact the most vulnerable members of a family because the safety and healing properties of these home remedies are well known. The use of ginger and holy basil (tulsi) in a tea-based decoction, eating fenugreek (methi) seeds in yoghurt (dahi) and drinking water in which roasted cumin has been soaked overnight are all time-honoured remedies for colds, coughs, an upset stomach, loss of appetite and general fatigue. The surprising part is that with very little variation, such home remedies are used in almost all regions of the country. Decoctions, teas,the use of grape wine (drakshasava) and an application of medicated oils, condiments and spices is commonplace. Even in nuclear families young people have begun checking the properties and dosage of medicinal plants like Ashwagandha (withania somnifera,), tulsi and ginger by combing internet sites. Indigenous medicine then, is no longer the preserve of vaidyas and hakims. A young, modern clientele, including foreigners in search of “natural products” has begun to use shatavari, triphala and brahmi to name only three products from scores that are available over the counter. Indigenous medicine’s time has come but in a guise that one could not have imagined was possible.
Recent studies are showing another trend with the use of indigenous medicine. Patients are combining modern medical treatment with indigenous medication-believing that this can alleviate symptoms, reduce drug dosage and mitigate the side effects caused by chemical drugs. This is being seen in the treatment of hypertension, diabetes, chikangunya and skin ailments and even tuberculosis and cancer. No one disputes that the drugs manufactured by reputable ASU companies and dispensed by good practitioners have positive effects on quality of life including good sleep, appetite, the most vulnerable members of a family because the improved metabolism and a sense of well-being.
However, self- medication and integration of systems is a new phenomenon largely promoted by literature on the healing properties of plants. There has been little effort to validate this approach and sometimes the positive outcomes baffle both patients and physicians.
Against this backdrop, challenges beset the sector. First,there is the issue of safety and quality. Drugs manufactured by leading companies like Himalaya, Dabur, Charak, and Baidyanath to name just a handful have earned a sound reputation and their products are manufactured, labelled and sold much as modern drugs are. Rarely if ever, are there complaints or questions about quality. The same goes for Unani products manufactured by companies like Hamdard. Family concerns like Dhoot Papeshwar in Maharashtra, Aryavaidyashala in Kottaikal and the Ayurvedic Pharmacy in Coimbatore have a time-honoured reputation built over scores of years – in some cases, the firms have been in existence for more than a century. Some of them have modernised their equipment and processes without compromising on the essentials recounted in the ancient texts. But howsoever good the quality of the products, beyond a point the indigenous systems require a physician who can recognise the signs and symptoms of affliction by diagnosing the constitution or the individual “prakriti “of the patient. That requires patience, skill, insight and experience and naturally the first challenge is to find a practitioner who combines these qualities. Considering the wide range of practitioners and an absence of bench-marking, often this boils down to an individual’s good fortune in finding a competent physician- a factor which deters many from using indigenous medicine. The canvas is much too large and the choice much too varied to find one correct answer.
Photo gallery of interviews with the healers and patients
At one end of the spectrum stand the National institutions for Ayurveda, Unani and Siddha medicine (located at Jaipur, Bengaluru and Chennai respectively) where high standards of teaching and clinical practice are pursued while following a syllabus set out by the Central Council of Indian Medicine which has been patterned on the Medical Council of India. In the process, the Guru-Shishya parampara – personalised, teaching and learning under the tutelage of a teacher has been given up entirely. Almost all Indian medicine a doctor and starting practice has overtaken the need the National Institutes have modelled themselves on allopathic medical colleges and the need to standardise and modernise has replaced the individualised approach which had been the mainstay of traditional medicine for centuries.
The Southern States like Kerala, Tamil Nadu, Andhra Pradesh and Karnataka have some fine institutions which taken together with the Gujarat Ayurvedic University at Jamnagar, the Benares Hindu University at Varanasi and the Choudhury Brahm Prakash Ayurved Charak Sansthan at Kheda Dabur Delhi, still produce practitioners who are confident of practising their system without falling back on allopathic drugs for quick results. This however, is not a uniform story when one goes to the second and third rung of colleges and hospitals across the country where the goal of becoming a doctor and starting practice has overtaken the need to master the classics and diagnostic techniques.
Finally, there is the future of integration at the tertiary level. Towards the end of 2012 when I was completing the second report, I was astounded to find that Medanta a super-speciality conglomerate in Gurgaon had an Ayurvedic doctor working collaboratively with an oncologist, a robotic surgeon and even the cardiologists. The experiences of these super-specialists have been captured in an exhaustive seminar which was organised at the India International Centre in Delhi and is available on you-tube at – https://over2shailaja.wordpress.com/2013/05/05/panel-discussion-at-india-international-centre-on-status-of-indian-medicine-folk-healing-part-ii-on-22th-april-2013/ Medanta’s difference is in catapulting integration to the tertiary level. Ironically, it is here that physicians from two different systems talk to and treat the patient according to his preferences. It is happening on a small but impressive scale but could be the harbinger of things
to come if patients remain satisfied.
During my visit to Bengaluru, I was pleasantly surprised to find an Ayurvedic doctor treating infertility cases referred by a London trained gynaecologist working in one of the city’s speciality hospitals. The gynaecologist, to whom I spoke, could not explain how the Ayurvedic doctor had succeeded in helping some 10 couples to beget a child out of 80 cases referred by her. Examples like this give the hope that barriers can be broken through traditional medicine approaches but the diversions on the way are often daunting.
Traditional & Folk Healing Practices in Manipur
Most people identify Ayurveda as being synonymous with body massage, the slow stream of oil relaxing and cooling the brain and as a process of detoxifying and rejuvenating the body. The five star hotel and spa massages embellished with soothing aromas and rose petals are a miniscule part of the panchakarma regimen which involves over 16 different procedures which are used to treat patients suffering from paralysis, mental affliction, arthritis and spinal injury. Such panchakarma treatment can be observed in every Ayurvedic hospital in the country but it is quite different from the relaxation techniques used for rejuvenation of healthy people. Both fulfil a felt need as it should be.
Although India has achieved a lot, there remains immense scope to rise as a world leader. The way indigenous medicine has adapted itself to modern times has been remarkable. It is time to build on these strengths – not for the survival of practitioners or to meet narrow sectoral interests, but to preserve a heritage which is undeniably unique, efficacious and entirely indigenous. The day that happens indigenous medicine will come into its own!
Traditional and folk Healing Practices in Mizoram
Experts talk about the successes and failures of Kejiwal’s AAP government after as it completes a year.
Guests: Shailaja Chandra (Former Secretary, Delhi Govt.) ; S. Mukherjee (Congress) ; Nalin Kohli (BJP Leader); Badshah Sen (Sr. Journalist) ;Ashish Khetan (AAP) and Anchor: Karan Thapar, Consulting Editor.