BEYOND BORDERS
ticed in India for more than 5,000 years along with the technique of surgery referred to as Shastra Karma . The term Ayurveda ( in Sanskrit language ) translates to “ Ayur ” meaning “ life ” and “ Veda ” meaning “ science .” The most comprehensive text on Ayurveda is Charaka Samhita believed to be written between 100 B . C . E . and 200 C . E ., consisting of 120 chapters in eight volumes describing topics including anatomy , etiology of diseases , diagnosis , prognosis , therapeutics , pharmacology , hygiene and healthy living , as well as physician training . An interesting assertion in the exhaustive writeup is that there are four important pillars to medical practice 3 : the patient , the physician , the nurse and the medicines . All are essential to recovery and return to health .
On the surgical side , Susruta Samhita describes several surgical instruments and many procedures . Although Ayurveda was somewhat neglected with the advent of modern medicine , there has been reemergence in recent years with establishment of several teaching institutions ( 300 currently ) and the department of AYUSH in the central government of India to promote research and patient care using various forms of traditional medicine .
The constitution of India obligates the government to ensure the “ right to health ” for all . Each of the 28 states is required to provide free universal access to health care services ; however , the quality and quantity of health care provided by each state is highly variable . The current Indian health care system is a complex network of the private and public sectors . The public sector consists of primary , secondary and tertiary care centers mostly run by the state governments . The tertiary care refers to advanced medical facilities often part of teaching institutions ( India has 731 medical colleges as of 2024 and can boast “ We ’ re number one !” in the world - China has around 190 ). The secondary care facilities are usually large metropolitan hospitals , run by state governments , providing acute and specialized care . Primary care centers are responsible for immediate care and preventive care ( known as primary health centers or PHC ) and are located throughout the massive rural population of India ( approximately 25,000 PHC and community health centers ). The private sector consists of numerous corporate hospitals ( usually for-profit ), clinics , nursing homes and individual practitioners ’ offices .
Although India claims to have already achieved the WHO-stipulated goal of 1 physician per 1,000 people , there is still a significant shortage of primary care facilities , especially in the rural areas . Even the existing ones often lack vital resources including an adequate number of health care providers and essential medical equipment . There is a shortage of physicians wanting to serve in rural primary health centers , many of them choosing instead the urban medical practice with better facilities and infrastructure . A significant number also go abroad to countries like the U . S ., Canada or the UK .
Although there is difficulty in finding an adequate number of physicians to serve in rural India , the urban areas have an abundant supply of physicians , especially skilled surgical specialists as well as excellent medical facilities for advanced surgical procedures such as joint replacements . The cost of these procedures is much less in India compared to the U . S ., which has led to India becoming a highly popular destination for medical tourism . Sadly , despite the significant progress in the health care systems and the health delivery modules , there is still an unacceptable gap in health care access between the rural and urban population of India .
The medical needs and the cost of health care have also changed significantly over the past several decades . While communicable diseases like tuberculosis , malaria and HIV / AIDS still pose challenges , the increase in disorders like diabetes , cardiovascular disease and cancer – that need protracted care – has strained the system . Although medical care is free in government facilities , many patients seek the more advanced treatments available in the private sector leading to significant out-of-pocket health care expenses and sometimes financial ruin . Private medical insurance coverage is still limited and often affordable only to the middle class and the wealthy . A new initiative by the central government of India is a national health insurance scheme that provides coverage of up to about $ 6,000 per family per year for secondary and tertiary hospitalization . It helps economically challenged families , covering about 500 million beneficiaries , with twin goals of better access to higher-quality health care while reducing the burden of out-of-pocket payments . Other initiatives include establishment of more health and wellness centers that provide primary health care including maternal and child health . The percentage of GDP spent on health care must increase significantly in the next five years to implement all these measures . One could be cautiously optimistic that India can meet the goal of universal , high-quality health care by 2030 as stipulated by the UN , barring the occurrence of another pandemic , major political turmoil or a war .
Let me end this dialogue with a great quote attributed to Martin Luther King : “ Of all the forms of inequality , injustice in health care is the most shocking and inhuman .”
References :
1
Selvaraj S et al . India health system review . New Delhi . WHO 2022 . 11 ( 1 ) 978-992
2
Kumar A . The transformation of the Indian health care system . 2023 . Cureus . 15 ( 5 ): e39079 . DOI 10.7759 / cureus . 39079 .
3
Majumder B , Ray S . Qualities of physician in light of Charaka Samhita-A literary study . 2022 . Int Res J Ayurveda & Yoga o5 ( 11 ): 107-116
Dr . Iyer practices at the Neurodiagnostic Center of Louisville and is a retired professor of neurology at the University of Louisville School of Medicine .
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