Abstract
The concept of medical marginality operates as a framework to differentiate between medical practice that is sanctioned and regulated by the state (Allopathic medicine or the Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy—(AYUSH) and that which is not regulated by the state. In Indian context, medical systems under the acronym of AYUSH have been given legitimate position and included in the health service sector. By using Hardiman and Mukharji’s concept of ‘medical marginality’ in a different way, the article attempts to study how one system of medicine is marginalised even within the institutionalised framework. It aims to understand the situation of Unani system of medicine with respect to other alternative medicines as enshrined in the concept of AYUSH along with the Allopathic system. In the process of doing so, the present research, through an ethnographic study, takes Unani hospital as a case in point to analyse the position of Unani system of medicine within the larger realm of healthcare.
Introduction
In today’s world, patients have multiple choices in terms of adopting any health system for being healthy. Medical systems are generally divided into two major categories: allopathy or biomedicine and alternative medicines. The alternative systems of medicine like Ayurveda, Unani, 1 Siddha, Homeopathy and other systems claim that they provide an option to the patients that are efficient even without the use of chemicals and strong dose of medicines. Leslie (1998) highlighted the existence of different types of medicine alongside Allopathic medicine and termed it as medical pluralism. He argued that although Allopathic system exists in every country, most people continue to depend on the traditional practitioners as well. Leslie and Young (1992) challenge the modernist dichotomy between tradition and modernity that people once exposed to modern medicine would not depend on ‘traditional’ medicine. Medical pluralism according to Sujatha and Abraham (2009) had become a ‘way of life’ by which people frequently chose multiple medical treatments.
By using Hardiman and Mukharji’s (2012) concept of medical marginality, this article attempts to explore the idea of medical pluralism and the shift towards marginality. The article tries to analyse marginality and power relations among different medical knowledge systems. It aims to understand the situation of Unani system of medicine with respect to other alternative medicines as enshrined in the concept of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) 2 along with Allopathic medicine. In the process of doing so, the present research takes Unani hospital as a case in point to analyse the position of Unani system of medicine within the larger realm of healthcare.
The Politics of Knowledge Systems and Medical Pluralism
The knowledge systems of India have been dominated by colonial modernity or, as Amin (2012) calls it, Eurocentrism. According to Amin, the European narrative considered Europe and the West to be the centre of all the knowledge systems and the growth of modern civilisation, which was dominantly characterised by science and universal reason. The rest of non-European world was construed to be the periphery, which was considered to be traditional with no means to become scientific and modern. The entire debate on the West and the non-West/tradition–modern origin of science got embedded within the different medical systems. Allopathic medicine or biomedicine is considered to be the creation of the West and hence modern, scientific, logical and, thus, efficient. Ayurveda or Unani and the other alternative systems of medicine are considered to be traditional, unscientific and inefficient. In the developmental discourse, Gusfield (1967), Escobar (1995) and others have questioned the tradition–modernity dichotomy as enshrined in the modernist discourses on society. Gusfield (1967) refutes the assumptions that traditional societies have been static, and that modernising processes weaken the traditional structure. India is seen as being illustrated by a complex procedure of cultural hybridisation encompassing both traditions and modernities. In such a situation, the boundaries between tradition and modern, rural and urban fade and lose their significance (Escobar, 1995). Instead of being eradicated by modernity and development, many traditional cultures survive through their, what Escobar (1995) refers as, ‘transformative engagement with modernity’. Eisenstadt (2000) also points that the actual development and progress in modernising societies has disproved the homogenising and hegemonic supposition of Western modernity. Western model of modernity is not the only prototype of modernity; however, they have a historical superiority and continue being the reference point for others, reinforcing Eurocentric viewpoint. This is applicable to the field of medicine wherein the traditional medical systems, in order to be a prominent healthcare system, are adapting to the new technological and scientific instruments used by the allopathic medicine, without changing its own dominant features.
The debates within the medical sociology highlight three broad trends that explain the asymmetrical relation between biomedicine and Allopathic medicine and that of alternative medicine. First, those that depict biomedicine or Allopathic medicine as scientific medicine with a superior status and gains its social and epistemological legitimacy on scienticism. Second, the arguments that are casted in frames of tradition and modernity that point the alternative systems of medicine like Unani, Ayurveda, Tibetan medicine and other medical systems evolved historically in different parts of the world and had certain textual base and theory, which are outdated and unscientific. These arguments presuppose that as traditional society would modernise, and with the further development of the Allopathic medicines in its efficacy and reach, the alternative medical systems will perish. Third, that exoticises ‘other’ medical systems as the folk medicines 3 that are eclectic, unsystematised and is not considered as a medical knowledge but as superstitious and spurious practices that will do more harm to the seeker of health than providing any positive outcomes. All the above arguments are framed in terms of scienticism, universal conception of rationality and Eurocentric approach—where knowledge systems are not just categorised according to binaries with power relation, but it also constitutes a standard model by which the ‘other’ evaluated themselves.
In the recent years, there have been debates surrounding the limitations of Allopathic medicines in providing complete healthcare facilities. This viewpoint is linked with the growing awareness and expectation towards other medical systems and their efficacies in supplementing modern Allopathic medicines. In this context, it is important to understand the epistemological dimensions that frame the questions related to the varied relationship between various systems of medicines and how sociocultural and political factors influence this relationship.
The 1960s and 1970s witnessed the growth of strong grassroots health movement. It was especially popular with people who saw in alternative medicine tools for ‘ways to avoid degenerative diseases of the age and a response to the increasing environmental deterioration, particularly in relation to impure and unnatural foods and the sterility that characterized much of modern life’ (Fulder, 1996, p. 16). The coming of alternative medical systems in popular imagination has made healthcare treatment through other medical systems popular and workable. However, this popularity has raised several questions such as:
the efficiency and competence of alternative systems of medicine; how choices are made among the different systems of medicine available; and the relationship between various systems of medicine among each other.
It is in this context that the term medical pluralism gained popularity and was used to refer to a situation where multiple medical systems are available to provide treatment for healthcare (Sujatha & Abraham, 2009).
The term medical pluralism was introduced by Leslie in 1976 to signify the Asian model that was in contrast to a model of health based on ‘single, standardized hieratic system’ 4 controlled by Allopathic practitioners in countries like the USA (Sujatha & Abraham, 2012). Leslie highlighted the existence of different types of medicine 5 alongside Asian medicine as well as the varied, culturally specific medical traditions that coexist or compete with Western medicine (Ernst, 2002). Similarly, Dunn (1998) classifies medical systems by reference to their geographical and cultural settings. These are local medical systems that accommodate primitive or folk medicine, regional medical systems such as Ayurveda and Unani and the cosmopolitan medical system, that is, modern or Western medicine.
Dimensions of Medical Pluralism
Medical pluralism does not merely mean coexistence of different medical systems. It has other dimensions attached to it as well. The first dimension of medical pluralism is its multiple roots and influences towards the growth of a particular medical system. Allopathy, Ayurveda and Unani system of medicines are not homogenous in nature but always in a state of progression and development. With respect to Allopathy, allied branches of sciences like physics and chemistry had been influential in the development of medicine.
Let us take an example of interactions of two different medical systems—Ayurveda and Unani. In Ayurveda, there was no existence of quinine. However, the Ayurvedic practitioners recognised the importance and efficacy of quinine while treating Burdwan fever, the epidemic malaria during the 1860s that was creating panic in Bengal. Ayurveda had borrowed extensively from Unani medicine in the 1890s. These newly found medicines were not native to India but imported from the Middle East, Eat Africa, Central and Southeast Asia (Arnold, 2000). There have been instances of different medical traditions being incorporated into the Unani medicine. For example, Ibn Sina’s exposition on pulse and use of mercury showed Chinese influence, use of calcined metals and minerals had its origin in therapeutic–alchemical siddha traditions (Attewell, 2007). Thus, we find that these medical systems constantly interacted and exchanged their knowledge, in order to offer with better health therapeutics.
Second, the dimension of medical pluralism is how it operationalises. Minocha (1980) argues that different medical institutions and different doctors practising various systems of medicine also constitute medical pluralism. She argues that medical pluralism has multiple connotations. First, it refers to the coexistence of various medical systems. Second, it refers to the pluralistic settings within a given medical system, that is, the location of the medical practice—house, clinic or hospital. Third, Minocha refers to the plurality of medical personnel practising a medical system such as the general practitioners, specialists and other paramedical staff. Finally, Minocha uses the term to understand the patients and practitioners’ conception of illness and disease.
In terms of practice of medicine, different medical systems administered by a single practitioner constitute medical pluralism. For example, an Ayurvedic or Unani doctor prescribing Allopathic medicines along with the practitioner’s alternative medical system. A single location of medical practice can provide treatment in different practices. For example, an Unani hospital in Hyderabad provides Allopathic treatment. Another such example is that of multispecialty hospital in California that allows shamans to work with patients in its medical facility (Vance, 2016). This reflects synthesis or coexistence of multiple medical systems in administering treatment.
The third dimension is from the patient’s perspective. A patient adopting various medical therapies can also constitute medical pluralism. Scholars 6 have discussed the various motivational factors for the patients to choose different medical systems, leading to medical pluralism. The dependence of the patients towards alternative medicines is reflected through the efficacy and availability of the treatment. The family traditions, social class, religious background of the patients and the awareness among the patients about the difference between Allopathic and Unani or Ayurvedic medicines, often are latent in the decision-making process to choose different systems of medicine for treatment. When a patient has the option to choose from different medical systems, this may be seen as a radical choice for his/her treatment and cure.
The fourth dimension is of research and production. Alternative medical systems have incorporated within themselves features of Allopathic system. The flow of information, culture and globalisation played an important role. The principal changes that led to the transformation during this period were the market-driven pharmaceutical industry, especially commercialisation and standardisation. The process of standardisation implied standardising every stage of procurement of raw materials, which were mainly medicinal plants, the process of manufacturing and quality control of the products. The process of standardisation also controls the kind of equipment used, the process of diagnostics along with the publications of manuals for doctors. The pressure of strong competition from Allopathy led Ayurveda and Unani system of medicines to accommodate such processes within its own systems. All these involve a change and shift in Ayurvedic and Unani medicines to suit the requirements of the market.
The fifth dimension of medical pluralism involves its positionality with respect to modern state and governance—how does the state acknowledge different medical systems and allow practice for different medical systems to coexist. 7 Whether it is coexistence or domination of one medical system over the other is a question that needs to be asked.
Power, Hierarchy and Medical Marginality
Coexistence of multiple medical systems does not entail equity among different systems of medicine. The ‘way-of-life’ perspective given by Sujatha and Abraham (2009) provides an uncritical view of medical pluralism that manifests equality of choices for all classes and communities neglecting the power dynamic. The appearance and growth of both Allopathic medicine and alternative medical systems in the recent years has made health sphere a complex one where the issues of power, domination and hegemony come into play. In case of power distribution among the various medical systems, it is the modern Allopathic medicine that has prominence over other medical systems because they control the notion of rationality, reason and scientific knowledge, by virtue of which it ignores the ‘other’ medical systems as unscientific, irrational and unjust. Banerjee (2009) points out that modern medicine lays down what is or is not legitimate in the realm of health. The modern medicine is in the dominative, powerful position within the medical domain, and it tries to maintain established order and ensure that power and privilege remain within them, sidelining the other systems of medicine. This implies hierarchisation of knowledge systems that leads to power dynamics.
Plural medical systems become ‘dominative’ as one medical system generally enjoys a pre-eminent status over the other medical system. 8 According to Attewell, Hardiman, Lambert, and Mukherjee (2012), while the term medical pluralism is used to incorporate all forms of medical systems and therapeutics that is found in a given setting, policymakers use the term to refer to the presence of certain categories of non-Allopathic medicine within the formal healthcare sector. These medical systems under the acronym of AYUSH have been given legitimate position and have been included in the health service sector, through conformity to valid regulations and accreditations and institutional norms imposed by the government at all levels. However, according to Attewell et al. (2012), the term medical pluralism is problematic. It eradicates the hidden stratifications and asymmetries in the kinds of treatment across and within the medical systems. From the issue of unequal power and unequal recognition comes the concept of medical marginality.
Medical marginalisation as a concept has been used by Hardiman and Mukharji (2012), in order to understand the hierarchy that exists among the medical forms. Ayurvedic system of medicine and Unani system of medicine are considered as the classical systems that were practised in India before the period of British rule. The Allopathic system, which was introduced during the colonial period, however, provided healthcare for only a small minority of the citizens during the colonial rule. Even after the end of the colonial rule and till the present day, Allopathic medical treatment is still inaccessible to a large number of people, either due to the expensive nature of the treatment or due to the lack of facilities. Similarly, Attewell et al. (2012) considers that Ayurvedic and Unani systems are also inaccessible for the people. At this point of time, it is the unqualified or so-called quack healers, local bonesetters and midwives who play an important role in providing cure to the people.
Hardiman and Mukharji (2012) thus use the concept of medical marginality with respect to those subaltern therapeutics, which are non-institutionalised and are not recognised by the state but still exist even today serving the needs of the people.
Hardiman and Mukharji (2012) proposed a different approach that focuses on the issue of power among the various medical systems and the healthcare sector. The authors differentiate between medical practice that is sanctioned and regulated by the state, whether it is allopathic medicine or the AYUSH and that which is not regulated by the state. The authors define the latter as the realm of subaltern therapeutics. The term medical marginality according to the scholars makes a distinction between Allopathic, Ayurveda and Unani systems of medicines as one group and folk medicines and other spiritual medical practices in another group. The other group is considered as ‘subaltern’ or downtrodden medical system—those medical systems which neither have state support nor have any kind of institutionalised background.
The present study intends to interrogate the concept of medical marginality in a more meaningful way that explains the contemporary dilemmas and predictions. Hardiman and Mukharji (2012) have taken the state-sponsored and institutionalised medical systems to be homogenous, neglecting the fact that even within the institutionalised medical systems, there is a strong power dynamic that comes into play. Keeping Allopathic medical system aside, even between Ayurveda and Unani, there is a latent competitive characteristic that reflects their interaction. Among the multiple medical systems, there is hierarchy at different levels. For example, in South Asian context, Ayurveda is considered to be ‘Hindu’ medicine, and Unani is considered to be ‘Muslim’ medicine. Both Ayurveda and Unani systems of medicine are considered to be ‘regional’ medicine as it is found in India, and Allopathic medicine is considered to be a ‘cosmopolitan’ medicine as it is found across the world (Dunn, 1998). Such hierarchies and stereotypes devalue the medical systems and its epistemologies. The concept of medical marginality in this article does not focus on the power relationship and dominance that exist between institutionalised and non-institutionalised medical systems. It analyses the position of the Unani system, which is an institutionalised medical system that occupies respect on par with Allopathic system at one level. However, at another level, despite the Unani system being legitimate and institutionalised within the rubric of AYUSH, it is still considered to be a laggard within the medical discourse.
AYUSH as an institution is considered to be both a plural and singular entity (Lambart, 2012). Each medical system is considered to constitute ‘internally unified and historically discrete knowledge traditions’ (Lambart, 2012, p. 1030), while, collectively, the medical systems represent the state-recognised alternative medicines. AYUSH has rapidly become the single-term referent for all forms of non-Allopathic or alternative medical healthcare among healthcare professionals and policymakers. The AYUSH with its legitimatised power along with Allopathic medicine tends to disregard the efficiencies of non-institutionalised, non-regulated sector of health therapeutics. Although these forms of medicine have not been incorporated into the central healthcare domain, their marginalisation varies from one context to the other. For example, folk medicines, which are marginalised in urban societies, are not marginalised in other societies (Pandya, 2012). Similarly, Allopathic medicines which are considered to be the best in certain societies might not even be used in the remote societies like tribal communities. This article thus deconstructs the plural entity of the AYUSH and analyses how Unani being part of this plural entity is marginalised within institutional frame of AYUSH. This layered marginality and the power dynamics within the institution of AYUSH create a hierarchy of medical knowledge and practices, and it needs to be analysed.
Medical Marginalisation: Unani Hospital as a Case
The fieldwork was done in the Government Nizamia General Hospital in the Charminar area of Hyderabad situated in Telangana state of India. The hospital was built in the year 1938 by the last Nizam of Hyderabad state—Mir Osman Ali Khan. It is one of the oldest Unani hospitals in India. Along with Unani medical system, the hospital also provides treatment according to the Allopathic medical system.
A modern scientific institution like a hospital is a stratified space marked by unequal power, status, knowledge systems and practices. The struggle for a better position among the alternative practitioners of medicine does not end only within a hospital or a clinic. It goes beyond the medical institutions in the realm of social recognition, financial aid and infrastructural growth. Medical marginalisation of Unani comes to play in three different forms.
This also affected the patronage and support of the state and policymakers towards the other medical systems. Though these alternative medicines were rational and holistic and had been providing efficient healthcare service for years, they were still considered to be secondary and marginalised when compared to Allopathic medicine. The major blow to Unani and Ayurvedic systems came with the attempt of the British and Indian Allopathic practitioners to secure the Bombay medical Registration Act of 1912 so that no physician of indigenous medicine would be legally recognised (Metcalf, 1985). On the other hand, there were efforts to professionalise and modernise Ayurveda and Unani systems along the lines of the Allopathic model of medicine. National Planning Committee in 1938, headed by Nehru, had similar views of propagating modern scientific methods and the Allopathic medical system. According to the committee, Ayurvedic and Unani systems could not be considered as science and were less than the Allopathic medicine in competence. In order to receive grants by the Ayurvedic and Unani systems, they must pursue medicine along the lines of the Allopathic system. The views of the National Planning Committee, 1938, were a reflection of the colonial legacy of discrimination (Khan, 2012). This eventually led to the marginalisation of the Unani and Ayurvedic systems and the hegemony of the Allopathic system of medicine.
In post-Independence India, there has been progressive co-optation of the social and medical space available for alternative medicine by legitimated medical system, that is, Allopathy. Three major health committees and their recommendations played a major role towards the development of health services. The Bhore Committee of 1946 outlined a plan towards healthcare delivery mainly favouring the Allopathic system. The Chopra Committee on the Indigenous Systems of Medicine, 1946, recommended mutual learning between Allopathy and the other indigenous medical systems, which included Ayurveda, Unani and Siddha. The third committee was that of the Sokhey Committee of 1948. It recommended that the health service structure should be developed from below upwards. Thus, health services grew from the scientific base of Allopathy but granted some space to the alternative medical systems, paving the way for pluralistic spaces. However, whether this pluralistic space provided democratic stimulus to all medical systems or not is the question.
The communal polarisation during the nationalist struggle for Independence resulted in polarisation between Ayurvedic and Unani systems. The Ayurvedic system was propagated as the nationalist, representing the spirit of India, while the Unani system became the outsider linked with Muslims (Quaiser, 2013). With India’s various spheres becoming communalised, medicine was not left untouched, and Ayurveda and Unani systems were projected as Hindu and Muslim systems of medicine, respectively. In the Hyderabad state, medical care under the Asaf Jahi 9 rulers (1724–1948), commonly referred as the Nizams, was harmonious, pluralistic and diverse with various medical practices providing healthcare and treatment. Though in the Nizam period all the medical systems got equal patronage, the situation later was not so clear. This is evident from the latent competition between Nizamia General Hospital and Government Ayurveda Hospital in Charminar. Both the hospitals were established during the reign of Asaf Jah VII. However, trouble started among the Unani and Ayurvedic practitioners when the government decided to shift the Ayurvedic hospital to another area in Hyderabad. The entire issue was given a communal colour. Though Unani had been associated with Muslims, it never projected itself as solely Islamic. But with the changing sociopolitical context and the shift from Unani versus Allopathic to Unani versus Ayurveda reflects Unani system to be construed as Islamic and for the Muslims. Moreover, the language and the script of Urdu as a representation of Unani further led to this divide.
With the rise in nationalism and Independence struggle, the dynamics changed among the different medical systems. Though independent India established many types of council, committees, hospitals and medical institutions for the alternative forms of medicines, the state approach towards other alternative medical systems has been ambivalent and insufficient. While the state provided legitimacy to alternative medicines, there has been neglect from the economic and infrastructural support. With the colonial conquest and the support towards Allopathic medicine, the practitioners of the Allopathic medicine felt assured and confident about their position and their knowledge system. Though there was an opposition against the Allopathic practitioners, the government always supported them. The alternative practitioners defended their knowledge system against the claims of being unscientific and irrational. It undoubtedly showed the relationship to be as between the centre and the periphery and the power–elite paradigm (Jeffery, 1988) according to which the health sector is manipulated by the dominant interest groups. The centre which is considered to be powerful had a strong hold over the periphery, which was the marginalised.
The policies and reports of the 5-year plans show that as globalisation was taking root, AYUSH was given a separate identity, and this identity was more due to the commercial benefits gained by the market trades through pharmaceutical companies rather than its healthcare services. The standardisation and commercialisation that it followed was on the lines of the capitalistic mode. The interest of capital formed a central position in the formulation and implementation of the health policies. The Allopathic medical system was at the centre of the healthcare system. It influenced the structure of the other medical systems that were positioned in the periphery.
In December 2014, the National Democratic Alliance (NDA) government had permitted setting up of eighteen new Ayurveda colleges in an effort to endorse alternative forms of treatment and integrate them into the existing healthcare system. The previous government led by the Congress Party had given permission to only one college in 2013 against thirty applications seeking to establish new Ayurveda colleges. Incidentally, there was no permission for new colleges in the year 2011 and 2012. At present, there are 281 Ayurveda colleges in the country offering 15,057 graduate and 3,081 postgraduate seats. In September 2014, the government had notified National AYUSH Mission (NAM) to suggest a detailed road map to develop AYUSH infrastructure and regulate the alternative medical industry. 10 The present government has elevated AYUSH to a full-fledged ministry with an annual budget of ₹12 billion.
In India, according to 2010 data, there were around 4,78,650 Ayurvedic registered practitioners and a mere 51,067 Unani registered practitioners. There are 269 Unani hospitals in India as on 2010 as per the AYUSH data. With respect to hospitals and beds, though homeopathy has 245 hospitals and Unani has 269 hospitals, the number of beds in homeopathy hospitals is 9,631, whereas it is merely 2,546 in Unani hospitals. Ayurveda is way ahead with 2,458 hospitals and 44,820 beds across the country. The numbers of beds in Unani hospitals are quite low compared to the Ayurveda and Homeopathy hospitals. This is also true in the context of dispensaries, registered practitioners and medical colleges. Unani comes after Ayurveda and Homeopathy.
A point of entry to understand if there is any marginality from the views of doctors and paramedical staff is to analyse the Unani medical system with regard to the preferences of medical systems for their own medical treatment and also whether they wanted their family members to take up Unani as a profession. It was quite surprising to know that the doctors, personnel and even the house surgeons to some extent preferred Allopathic medicines even when their Unani equivalent was available. This was mainly because Unani treatment takes time and is slow in effect compared to that of Allopathy. Although they appreciate the efficiency of the Unani medicine, they believe that Allopathic medicine gives a faster relief from pain and illness. Also talking about preferences, out of twenty-two respondents (house surgeons), five of them were pregnant. However, none of the five house surgeons were getting their medical treatment done in an Unani hospital. They preferred other private Allopathic hospitals and nursing homes as the infrastructure and medical facility of this hospital was poor. In terms of Unani as a medical profession for the families of the current Unani doctors or even the paramedical and administrative staff, it was observed that the children of the hospital staff were mostly studying Allopathic medicine. This shows that Unani according to the Unani professionals themselves was not a lucrative profession.
From the patient’s perspective, those who mostly came from the lower income group and working class did not make a distinction between Ayurveda or Unani. They considered them to be similar and termed them as jari-bootiya ki dawai, that is, herbal medicine in English. These nomenclatures suggest that for the patients, there was no difference between Ayurveda and Unani medicines and, they regarded it to be herbal medicines. On the other hand, Allopathy as angrezi dawai suggests English medicines. With respect to the patient’s view, it can be said that most patients refer for Unani treatment as they have been disenchanted with Allopathic treatment. There has been a sense of desperation among the patients to end their sufferings in any possible way. For the patients who come from the working class, it is a compulsion to opt for Unani when the Allopathic medicines have failed, and no other alternatives are available. Thus, the patient’s preference or patient’s choice is based on the individual experiences and negotiations grounded by the external contingencies. However, the general understanding of Unani among most of the patients reinstates the fact that Unani continues to be in the marginal sphere when compared to Allopathy. The patient’s inability to differentiate between Unani and Ayurveda and seeing them as one type also diffuses Unani’s own uniqueness.
Legitimacy grounded on scienticism and scientific paradigm is one important factor for the rise and power of the Allopathic system. Allopathic medicine considers the other form of medical systems like Ayurvedic and Unani systems to be unscientific. Sarukkai (2012) argues that science gets associated with rationality, truth and logic, and these turn out to be the decisive factors for differentiating science from non-science. This is because after Enlightenment, it was a part of the larger movement in Western civilisation to appropriate reason and rationality as the defining character of their civilisation. Medicine being a part of science got embedded with the notions of logic, reason and rationality. The Allopathic practitioners judge their system to be scientific and other systems of medicine as unscientific, illogical and irrational.
With respect to India, it was considered by the West that Indian tradition of philosophy and also medicine were more about religion and spirituality. India and other non-Western cultures were removed from the possibility of science. According to Sarukkai, evidences of rational traditions of Indian philosophy along with scientific and technological cultures in India were present since long. Also, Indian medicines along with other branches of science have critical formulations of theory of knowledge (Sarukkai, 2012). The question then arises as to why did Ayurvedic and Unani systems of medicine fall behind Allopathic systems? Two streams of perspectives can be reasoned out. The first is the Eurocentric view of science provided by Bala (2006), and the second is the capitalistic perspective provided by Verma (2013).
According to Bala (2006), there is a Eurocentric view of science: that Greeks contributed to modern science, and other cultures have no contributions towards science. Bala criticises the Eurocentric notion and argues that there is an association between Arabic and Chinese cultures in Europe that ultimately led to scientific development of Europe. The Europeans linked themselves to the Greek thought and did not acknowledge the Arabic scholars who actually conserved the Greek works along with their own contributions. Bala (2006) thus provided a multicultural perspective of the origin of science and also the reason for why science is considered to have originated in the West. According to Verma (2013), the rapid development of the West was mainly because of the birth of capitalism and Industrial Revolution. Europe witnessed the Industrial Revolution that brought with itself the scientific and technological development. The rise of scientific advancement provided for the progression of medical field in the West. The capitalist mode of production of Europe acted as a catalyst for science and innovation. On the other hand, India did not change the modes of production from feudalism to capitalist and hence did not advance in scientific achievements beyond what they had already achieved. This was one of the reasons why Ayurvedic and Unani systems did not evolve into a modern scientific medicine like the Allopathic system.
Another important parameter of science and allopathic system marginalising the Unani system of medicine is the science laboratory. Alternative medicines like Ayurvedic and Unani systems engage in holistic treatment, involving changes in lifestyle. Laboratory methods may not provide relief to the patients.
The rules for verifying, legitimising knowledge in Ayurveda and Unani differ from that of Allopathic medical system. The humoral paradigm of Unani medicine does not stand on similar lines as that of scientific paradigm that guides the production of knowledge of Allopathic medicines. There are efforts to attach the alternative or complementary knowledge to the conventional scientific paradigm. There has been constant effort by the Central Council for Research in Unani Medicine (CCRUM) to authenticate the various Unani medical concepts scientifically. During 2007–2010 period, the Central Research Institute of Unani Medicine (CRIUM), Hyderabad, on a memorandum along with the Government Nizamia Tibbi College, decided to offer practical and teaching facilities on clinical research, methodology, biochemistry, genetics, pharmacognosy, standardisation of Unani drugs and biostatics to their postgraduate students of different specialties (CCRUM, 2012). During 2013–2014, there has been an effort to build up research collaborations with other reputed institutions, including National Institute of Pharmaceutical Education and Research (NIPER), Sultan ul Uloom College of Pharmacy, Indian Institute of Chemical Technology (IICT), Centre for Cellular and Molecular Biology, Nizam’s Institute of Medical Sciences (NIMS) and Birla Institute of Technology and Science (BITS), Pilani, Hyderabad campus.
Thus, we observe a continuous attempt on the part of Unani practitioners and researchers to progress by association and collaboration with the modern scientific paradigm. Apart from the inclusion of biomedical structure into the medical curriculum 11 of the alternative medicine, scientific paradigms have also been accepted in the use of scientific procedure and methods. With respect to the pharmacy, the pharmacy of the hospital still uses traditional equipment to make medicines for the inpatients. All the equipment are manually handled. No electronic equipment is used. There is even an absence of an electronic weighing machine, and most of the time, medicines are given approximately. This scenario is completely opposite to that of Hamdard and even the government pharmacy at Katedan in Hyderabad that provides wholesale medicines to all the pharmacies in the state. The machines are ultramodern and fully automated. Electrical engineers along with Unani pharmacologists supervise the production unit.
Since Hamdard is an international market band, the government needs to invest significantly in technology and qualified manpower to achieve a production level that will earn itself revenues. The Government Nizamia General Hospital or even the government pharmacy in Katedan loses out to Hamdard as they function at the state level. The Nizamia hospital pharmacy never used the medicines as a commodity to earn revenues. On the other hand, the hospital provided the medicines free of cost to patients for both the outpatient department and inpatient department. The pharmacy in the hospital makes medicine in much smaller proportion and for a much smaller group of patients which is why the government is not providing the equipment.
Medical marginalisation goes beyond the power equation among the medical systems. The power notion translates into everyday functioning of a medical system. Thus, we see how Unani is marginalised with respect to Allopathy through the views and perspectives of the medical professionals, patients and research and government policies. The doctors and paramedical staff preference towards Unani tends to be secondary with respect to the Allopathic treatment. With respect to the patients view, it can be said that most patients prefer Unani as they have been disenchanted with Allopathic treatment. The lay understanding of Unani among most of the patients reinstates the fact that Unani continues to be in the marginal sphere when compared to Allopathy. The patient’s inability to differentiate between Unani and Ayurveda and seeing them as one type also diffuses Unani’s own uniqueness. Modern laboratories and research institutes of Unani medical system structured by the tenets of scientificity have become the main sites for the production of knowledge. The quality of a medical system is measured in terms of the status of physical infrastructure. The greater technological use, the number of research institutes and the pharmaceutical companies and commercialisation process mark the efficiency of the medical system and the services provided by them. The paradigm of global economy had a strong influence on the design of the policies and the variety of services arising from it. In this capitalist struggle of making Unani products scientific and global, it is neglecting and marginalising the other not so grand producers of Unani medicines and service provider—the hospital.
Conclusion
The criterion for marginalisation of one system by the other system of medicine is determined by the supremacy of knowledge and scientificity. In order to overcome this marginalisation, it is observed that the Unani system of medicine had to comply with and incorporate within itself different scientific parameters defined by dominant biomedical₹ knowledge systems. The revival is seen to be in terms of the Allopathic model and the scientific forms of knowing. But how much such development has helped the Unani system to progress is still a question. In the process of these integration of scientific paradigm within the Unani system, it has resulted in the acceptance of the supremacy of the Allopathic system and the loss of Unani system’s unique knowledge base. Practitioners of the Unani system of medicine, policymakers and researchers are concerned with the development and shaping the present and the future of the Unani system of medicine. However, it is the labelling of the system as traditional and unscientific that obstructs them on the way of development.
Marginalisation of the Unani system of medicine can be negotiated only when there is meaningful dialogue, respect and understanding among the practitioners of different systems of medicine. The conscientiousness for the mutual respect and space within the healthcare scenario actually falls on the government and the practitioners of the Allopathic system to respect the differences among the various systems of therapeutics so that no one system of medicine feels marginalised, peripheralised or neglected.
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The author received no financial support for the research, authorship and/or publication of this article.