Full transcript
0:17Hello everyone. I welcome you to my
0:20course introduction to medical
0:21humanities and this is the seventh
0:23lecture. In my previous lecture, I spoke
0:27about global health patterns in which I
0:30emphasized the importance of many
0:33international organizations
0:36with particular reference to WH and
0:41looked into the SDH which is social
0:44determinance of health along with SDG
0:47which is sustainable development goal.
0:50Now these are key terms in understanding
0:53uh the medical humanities or global
0:55health patterns. Uh in today's lecture
0:58I'll tell you what I'm going to briefly
1:00do. In today's lecture
1:04I primarily look into the rich history
1:07of Indian health care system.
1:11We are familiar with many terms these
1:14days which talks about swastat samrit
1:17bharat yoga saya or health is wealth.
1:21Now these kind of
1:25slogans
1:27reflect what Indian health care system
1:31had always envisioned.
1:34In fact, if you look at the indigenous
1:38traditions, there was always a pattern
1:41to look into not just the physical
1:43aspect of the disease but
1:48to reflect upon it in totality
1:52and that is what I'm going to do here
1:54today. So what I do primarily is that in
1:57this particular lecture I divide the
2:00health care practices in India depending
2:03on the timeline. So I talk about
2:06indigenous practices, move on to
2:09colonial uh times, follow it up with
2:13modern health care system and if I can
2:17say uh I also take up contemporary
2:22health care facilities within the
2:25timeline of modern. So with that I begin
2:29to talk about the basic premise of why
2:33we are discussing the Indian health care
2:36system. And if you look at the system of
2:38Indian healthcare, it is one of the
2:40largest most diverse system in the world
2:43serving over 1.4 billion people. In
2:46fact, as we are counting more than that
2:49and therefore the expansion of
2:52healthcare facilities or infrastructure
2:55is not just needed but it has been
2:57happening over a period of time. The
3:00health care facility that has been
3:03generated is not uniform and like I said
3:08the infrastructure depends on several
3:10factors and therefore we too have a very
3:14multi-layered or multi-tered health care
3:17system.
3:18The expansion of health care insurance
3:22coverage has also increased and there
3:24are quite a few schemes that we can talk
3:27about in detail when I reach the modern
3:30healthare system and in fact I have also
3:32discussed it earlier uh and then look
3:35for India as a potential global hub for
3:39pharmaceutical production and medical
3:41research.
3:44Now uh in the pre-colonial era we find
3:47that even before the western medicine
3:50came health care in India was primarily
3:53based on indigenous medical systems that
3:56had developed over centuries. Now the
3:59major traditions included aayurveda
4:02yunani siddha folk and tribal healing
4:06practices. Now if you look at these
4:10practices what did ayurvea include?
4:13Ayurveda included a wide range of
4:15medical practices including herbal
4:19pharmarmacology,
4:20surgery, preventive health care, dietary
4:23regulation and physical therapies.
4:27In fact, if you remember in lecture two
4:29in one of the slides I had shown you
4:32sushut making a
4:35you know ear an artificial ear because
4:37the ear was mutilated. So you can link
4:41it with that uh as well. So
4:45another important system was Yunani
4:48system. In Yunani medicine there was a
4:50focus on four bodily humors to restore
4:53health. Siddha medicine on the other
4:56hand developed primarily within Tamil
4:59intellectual traditions in South India
5:01and was closely associated with herbal
5:04remedies, physical therapies and
5:07spiritual approaches to healing.
5:09Alongside these formal systems, many
5:12rural and tribal communities developed
5:14their own forms of healing. If you look
5:17at the folk and tribal healing
5:19practices, they included extensive
5:22knowledge of medicinal plans, midwifey
5:25practices for childbirth, bone setting
5:28techniques and ritual healing
5:30traditions. In these medical traditions,
5:33health was not seen purely as a
5:35biological condition. Instead, it was a
5:38balance between body, mind, environment,
5:41social relationships, and spiritual
5:44life. So you take so many things that
5:48were part of this tradition in the
5:50pre-colonial India. In fact it was a
5:53kind of what you can call it in today's
5:55term a very composite kind of a package.
5:57So there was not a very unidimensional
6:00emphasis on one direction of health uni
6:04is one. So there was kind of there was a
6:07practice of looking into it as a total
6:11product. So that was what was happening
6:14in healthare systems in pre-colonial
6:16India. Shushut is an important name but
6:18you can also come across several
6:21indigenous practices that we are doing
6:23now as well as part of the Ayurveda
6:26tradition, the Yunani tradition and also
6:30folk and tribal healing practices along
6:32with the Siddha tradition. If you look
6:34at the key characteristics of these
6:37particular tradition, you will find that
6:40there was an integration of theory and
6:43practice. What do you mean when I say
6:45there was integration of theory and
6:48practice? It means that the frameworks
6:50that were constituted were not just
6:54intellectual frameworks,
6:57but they had mapped these frameworks
7:01with everyday life.
7:03Similarly, there were there was a
7:07medical pluralism
7:09in which multiple systems of medicine
7:12coexisted and function alongside one
7:14another.
7:16So it was not like if Aayyurveda
7:20tradition is being you know practiced
7:23for one particular disease only that
7:25will happen. There was a combination. So
7:28pluralism means that there was a
7:29combination of ayurvea, yunani, folk and
7:32healing practices along with siddha that
7:34might happen or maybe one or two
7:37combinations were made and they were all
7:40embedded in social structures meaning
7:42that they occupied
7:44a very recognized kind of a role in
7:48society.
7:50The fourth and important point was that
7:54this was not separate from broader areas
7:57about the universe, ethics and
7:59philosophy. Concept of health were
8:02closely linked to understanding of
8:04nature, balance, spirituality and
8:08relationship between human beings and
8:10environment. So you will see that many
8:13of the verats that happen even now the
8:16fasting as you call it many of the
8:19traditions in uh in s in in cultural
8:23practices uh in I I'm from Bihar and
8:27there we do chhat puja that is also uh a
8:30kind of a gratitude puja towards uh the
8:33sun god. So you know there were many
8:35traditions that took into consideration
8:39the natural elements as well when they
8:42were navigating into health conditions.
8:45The knowledge finally I can say was
8:47experiential knowledge that relied
8:50heavily on experiential knowledge
8:52developed through centuries of
8:54observation, practice and knowledge
8:57transmission. However, the structure of
9:02this indigenous health care system in
9:05India began to change during the
9:07colonial times. This is no news to us
9:10that India was a colony for a very long
9:13time. And because of being a colonial
9:17state, a lot of traditions came from
9:21there.
9:22I am not going into
9:25what was good or what was bad or how it
9:28kind of uh shaped. Uh my only concern to
9:34look into the colonial time is to map
9:37what changes happened in the Indian
9:40healthcare during that period.
9:44So in the colonial times you will see
9:48that the health care system of India
9:51began to change and it expanded
9:55immensely
9:57by establishing the medical
9:59institutions. Medical institutions
10:02became primarily
10:04popular because they were safeguarding
10:07the health of European soldiers,
10:09administrators and traders. Over time,
10:13the colonial state began to
10:15institutionalize western medical
10:17education and practice through the
10:19establishment of hospitals, dispensaries
10:22and medical colleges. These initiatives
10:25gradually contributed to the spread of
10:27biomedical knowledge and the formation
10:30of a new class of Indian medical
10:32practitioners trained in European
10:35medical tradition, the one that we see
10:37today.
10:39At the same time, colonial healthcare
10:41interventions were also linked to
10:43broader administrative and governance
10:45objectives. Public health measures such
10:48as sanitation campaigns, vaccination
10:51programs, and epidemic control policies
10:54were introduced to manage diseases like
10:56cholera, plague, and smallpox in urban
10:59and military centers. The colonial
11:01administration introduced western biio
11:05medicine which focused mainly on
11:07anatomy, pathology, laboratory science
11:10and hospitals. Medical colleges,
11:13hospitals and public institutions were
11:15established following European models.
11:18And in this regard among many
11:20institutions established during this
11:22period one of the most significant was
11:25the Kolkata Medical College which played
11:27a key role in introducing modern medical
11:30education in India. So if you look at
11:34the history of Kolkata Medical College
11:36which we now call medical college and
11:39hospital Kolkata. This was established
11:41in 1835. It's an important date. uh if
11:45you look at it, it was during the
11:47administrative time of Lord William
11:50Benting that this came out and what they
11:52did in this particular college is that
11:55they emphasized on the western
11:57scientific medical education which was
12:01rooted in anatomy, physiology and
12:03clinical practice. The doctors as I
12:06mentioned earlier were primarily trained
12:09for uh colonial administration. But what
12:12it what it led to and what what is
12:15significant in this direction uh in
12:18terms of mapping uh the health care in
12:21India this was one of its kind
12:23institution that got established and led
12:26to many modern practices that we see
12:29today came from there. So uh that is why
12:32we see that Kolkata Medical College as
12:35an establishment was extremely important
12:38in fact foundational to the western
12:41biomedical knowledge that we come across
12:43today. Other than uh Kolkata Medical
12:46College we find that the modern health
12:48care systems in India have developed
12:51significantly over the past few decades
12:54through public initiatives. Now this all
12:57happened you know that uh after the
12:59partition India suffered immensely and
13:02must have taken quite a toll to build
13:05the kind of infrastructure that they had
13:08to. If you look at the contemporary
13:12times, we are very ahead in terms of
13:15health infrastructure and that is
13:18primarily because we have prioritized
13:21health over a lot of other things and of
13:25course like you know you say health is
13:27wealth. We have lived by that dictim. So
13:30when you look at the modern health care
13:32systems in India, you will find that
13:34health care delivery functions through a
13:37mixed system of public and private
13:40sectors. And while government se
13:43institutions provide free or subsidized
13:46care for large sections of the
13:48population, private hospitals and
13:50organizations also play an important
13:52role in service delivery both across
13:55rural and urban areas. In fact, uh,
13:59scientific research and technological in
14:02innovation have contributed to major
14:04improvements in disease treatment,
14:07preventive strategies and life
14:09expectancy. DPI and e Aziz in their
14:12study suggest that these advancements
14:15have strengthened health care outcomes
14:17and improved the management of both
14:20infectious and non-communicable
14:22diseases.
14:24Emerging technologies like 3D printing
14:26is being used in medicine to produce
14:28customized implants, prosthetics and
14:31even biological tissues for medical
14:34treatment.
14:36Ashwin Tachi at all suggests that
14:38digital health technologies also help
14:41address healthcare inequities by
14:44improving access to health care
14:46information and services particularly in
14:49low resource settings. in uh in fact if
14:52you look at doctors without borders and
14:56their program where I was talking about
14:58cultural competence they emphasize a lot
15:02on doctors working in low resource
15:06settings so you know when you have
15:08everything I'm not saying it becomes
15:10easier but that is manageable they say
15:13that different cultures cater to
15:16healthcare infrastructure in a different
15:18way and therefore even working in low
15:22resource settings is an important
15:25training that should happen. So in fact
15:28uh doctors without borders also
15:31emphasizes on these kind of initiatives.
15:35If you look at the policies of economic
15:38liberalization and globalization they
15:40have further transformed India's medical
15:44infrastructure. I mean a lot of medical
15:48tourism is happening because of the
15:51economic liberalization policies and the
15:53way India is seen as uh an important
15:58center of health contemporary times in
16:02if we are living in the age of AI and
16:05that is something that is penetrating in
16:08all walks of life whether it is language
16:11whether it is uh our day-to-day life in
16:14terms of mapping uh where we want to go.
16:17Uh I mean food delivery apps, education,
16:21everything is mapped by digital and
16:24health is no exception. In fact, health
16:28uh is one area where they are realizing
16:31there are many researchers that indicate
16:34that there is huge potential of AI
16:37penetrating into the sphere of health
16:40and uh that is what I am going to
16:43briefly touch upon. Yes. Um it's an
16:45introductory course and therefore I'm
16:47talking a little bit about it. I'll
16:48discuss more about it in perhaps the
16:50last lecture of uh my entire course
16:53where I discuss the future directions
16:55but even here I'm touching upon a little
16:57bit so that you get an idea of how uh in
17:01the modern health care system digital is
17:05an important component. So if you look
17:07at uh the recent years, digital
17:10technologies are rapidly transforming
17:12the way healthcare is delivered across
17:14India.
17:16One important development is the
17:18development of the mobile health
17:21platforms and you can see it on your
17:22screen as I point out. This allows
17:25patients and healthcare providers to
17:27communicate through digital devices.
17:30These platforms make it possible to
17:32conduct remote consultations, monitor
17:35health conditions and share medical
17:37information without requiring patients
17:39to travel distances. The government is
17:42also promoting digital health care
17:44through initiatives like Aayush Man
17:46Bharat digital mission. So this is also
17:49to build and strengthen the digital
17:53health infrastructure of India. The
17:56another point that we can take into
17:58consideration is the e Sanjivveni app
18:01which expands access to medical
18:03consultations especially for people
18:05living in rural or remote areas. Digital
18:09technologies also play a major role in
18:12public health management. They help
18:15disease surveillance, vaccination
18:17tracking and the collection of health
18:19data which helps improve the efficiency
18:23and responsiveness of health care
18:25systems. Alongside technological
18:28innovations, the publicled
18:32health programs add to these kind of uh
18:36digital and malth technologies.
18:40What are public health programs? several
18:43health programs run by the government
18:45primarily to take care of the public.
18:49The first that we can talk about in this
18:52regard is integrated child health
18:55development services which is ICDS,
18:59National Rural Health Mission, NRHM
19:02and Janice Suraka Yojna JSY. These three
19:07uh programs I particularly take mention
19:10of here. But then there are many. In
19:12fact, if you look at the nutritional
19:15interventions, they include iron and
19:18folic acid supplements, vitamin A
19:20supplements, food fortification, and
19:23take-home rations for pregnant and
19:26lactating women. Interventions aimed at
19:30maternal nutrition often include growth
19:33monitoring, anemia prevention program,
19:35breastfeeding promotion and counseling
19:37on dietary practices during pregnancy.
19:40So if you look at this entire public
19:43health programs, you will find that the
19:46national rural health mission has
19:49emphasized on improving the rural health
19:52care access. The jani suraka yojana
19:55jennani is mother. So lactating and
19:58pregnant women uh with all these
20:00programs where you know they are
20:02supplied with iron, folic acid, vitamin
20:06supplement and stuff like that. And
20:08additionally there is a lot of
20:10awareness. In fact uh for a particular
20:13research I had the chance to visit to
20:16some of the schools and I was looking at
20:18the primary education participation of
20:21uh girls in state of Bihar and that is
20:24where I went to some of the schools and
20:27I realized that the whole idea of midday
20:31scheme
20:32was very scientific. In fact, it had the
20:36meal combination also in such a way
20:39where there was a policy of maintaining
20:42the nutrition. So, you know, uh when we
20:45dis when we look at these programs from
20:48the outside, we don't realize sometimes
20:51that the kind of research that has gone
20:53into the making of those programs. But
20:55when you actually uh go there and find
20:58out, you tap into the humanities aspect
21:01of this. So you know a good nutrition
21:04leads to good health and midday meal
21:07scheme important public health
21:09initiative regarding that is something
21:11that I wanted to highlight. So again a
21:14medical humanities quotient. The second
21:16uh important initiative is Aayushman
21:19Bharat Prahan Mantri Jan Aroia Yojana
21:21and I have already explained a lot about
21:24it. It began as a policy which looked
21:28into the expansion of healthcare uh
21:31coverage in India. Not only
21:33strengthening medical research but also
21:37looking into the possibility of
21:39providing economic support and to
21:43certain extent economic security
21:46regarding medicine. So if you look at
21:49the Aayushman Bharat program, you will
21:52find that the primary objective of
21:54Aayush Man Bharat is to provide
21:56financial protection and improve access
21:59to quality health care services for
22:02economically vulnerable sections of the
22:04society. And under this scheme, eligible
22:07families receive health insurance
22:10coverage of up to five lakh per year for
22:13secondary and tertiary hospital care.
22:15This coverage helps reduce the financial
22:18burden of hospitalization and prevents
22:20many households from falling into
22:22poverty due to high medical expenses.
22:25Now if you realize there has also been
22:28an attempt to give this five lakh
22:31insurance irrespective of class. So you
22:34will find that uh this particular
22:37program which in its nomomenclature
22:39itself has jan arrog yojana uh which
22:44means uh uh I mean people living without
22:48any disease living with good health and
22:51that is the kind of program it is. It is
22:54a major step towards universal health
22:57coverage and what does this lead to?
23:00This means that a healthy life is kind
23:02of ensured or maybe I can put it this
23:05way that someone will not
23:08face health consequence in the absence
23:11of
23:13uh medical support because there is a
23:17program which ensures that medical
23:19support is guaranteed up to five lakhs.
23:22Uh the another uh uh important uh
23:26initiative that I can talk about is the
23:28ministry of Aayush. And if you look at
23:30the ministry of Aayush, it it was uh it
23:33came in 2014 and this particular system
23:38came to integrate
23:41the older pattern. And if you look at
23:45the ministry of Aayush, we are going
23:48back to our indigenous times. And that
23:50is why if you read many of the research
23:53papers, you will find that Indian
23:55medical health system was at par with
24:00many many health systems that were
24:02prevalent at that point of time. And
24:04Ministry of Aush is now doing that
24:07particular thing. What is it doing? It
24:10is going back to our indigenous
24:12traditions where
24:14Ayurveda, yoga, yunani, siddha and
24:18homeopathic healthc care traditions were
24:21prioritized. So in ministry of Aayush
24:25this kind of research and integration
24:27the pluralism of different disciplines
24:31within the domain of medical is also
24:34prioritized. So that is what ministry of
24:36Aayush is also doing.
24:39Uh finally let's come to the
24:41intervention of AI in uh Indian
24:44healthcare systems. We find that a lot
24:46of disease screening diagnostic
24:50and outbreak prediction is happening
24:53through AI. And in this uh regard a
24:57study by Shakhar Siva Subramanyam and
24:59Alpan Rahul that suggests that when
25:02supported by strong digital
25:04infrastructure appropriate policies and
25:06collaboration between government
25:09research and healthcare providers. AI
25:12based interventions have the potential
25:14to significantly improve disease
25:17prevention, treatment and healthcare
25:19accessibility in India. An equally
25:21important foundation of health care in
25:23India remains community-based healthare
25:25workers and there is where you know all
25:28these Asha workers Anganari workers come
25:30into play which is going to be my uh
25:34almost last points that I'm making in
25:37this. So if you look at uh the whole uh
25:41research it indicates how the grassroot
25:44level participation is important. So
25:47when you look at the community
25:49healthcare and the grassroot level, we
25:52uh we emphasize in the context of India
25:54specifically that it has to work within
25:58the within the domains that have
26:01remained on the margins. So people who
26:04are living in rural areas, people who
26:06are living in forests and so what you do
26:10is you train Asha workers and Anganari
26:13workers to support healthcare delivery.
26:15what they do they bridge between health
26:19systems and communities. So they go with
26:21information they go with not just the
26:24resources but also knowledge of it and
26:26hence contribute to health education,
26:29nutrition and maternal care. They also
26:32uh are very instrumental in promoting
26:35vaccination and institutional
26:37deliveries. uh you might have seen it in
26:40your neighborhood as well as your home
26:42that they often come with vaccination uh
26:45u I mean regarding polio and what all
26:49these things lead to this is a
26:50preventive care where sanitation is
26:53emphasized the hygiene awareness is
26:55taken place by uh Asha and Aanadari
26:58workers in totality what does it do when
27:02the rural health care of India improves
27:04it acknowledges and takes into
27:07consideration ation the overall health
27:10quotient of India. This is where the
27:12role of Asha workers and Anganadi
27:14workers cannot be in ignored.
27:17Finally in terms of conclusion we can
27:20say that India always had a very rich
27:22tradition.
27:24In fact if you look at the colonial time
27:27it just added to what was already there.
27:30And today when we are seeing the
27:33dominance of the western medical
27:37tradition uh we also know that we are
27:40moving in to complement it with the
27:44indigenous practices that were there.
27:46The very fact that we are now thinking
27:49of holistic health uh where body mind
27:54and environment is central to the
27:57policies. We know that we are going back
28:00to the indigenous times where there was
28:02more pluralistic tradition of health
28:05practices and all this put together
28:09along with AI and technology is going to
28:13only build the health infrastructure of
28:15India and this is where uh the vision of
28:19medical humanities lie where we
28:21integrate not only the medical factors
28:25of operation but also also socioultural,
28:29economic and other related factors into
28:32the understanding of medicine and
28:35health. Thank you. I look forward to
28:37seeing you in the next lecture.