When medicines are more dangerous than the disease

Nerun YakubMedical ecologists and perceptive health scientists over the past decades have rightly come to see health and disease in the broader context of a total way of life in which social and environmental factors influence both illness and wellness. In other words, their approach is a holistic one, viewing people as 'multi-dimensional' ---- biological organisms, social persons, as well as beings who communicate and maintain their cultural systems. All these are taken into consideration in the bid to understand how health and healing work in a given society. By contrast, so-called 'modern' medicine have predominantly been treating disease as a 'clinical entity' that can be diagnosed and treated without any reference whatsoever to the individual's psycho-socialcultural environment. Today, this modern attitude has come to dominate the health sector throughout the world, even in Bangladesh. The thrust is increasingly on the commercial and profiteering interests of the industry not the actual health and well being of people. This deplorable trend is apparent in all systems of healing that exist in the country ---- allopathic, homeopathic, unani, ayurvedic or their hybrids under any other name. First comes the business, healing is optional ! According to a report in a contemporary, only 450 ---- that is, about 25 per cent ---- manufacturers of herbal or unani-ayurvedic medicines are registered with the relevant authorities, which leaves the majority doing brisk business virtually without any regulation. Of the unregistered manufacturers not all may be involved in concocting low standard, counterfeit or adulterated products. But most, reportedly, are getting away with such activities. These certainly need to be dealt with seriously. But questions do remain as to how far the regulating authority itself is capable of doing a good job. Does it have the required manpower, the competence and the ethics to guarantee that only bona fide manufacturers of standard health products are permitted to do business ? Homeopathic, ayurvedic-unani, or 'herbal medicines' as the latter are generally called, have sound knowledge- and- wisdom-based traditions behind them, which is why even the World Health Organisation recognised the value of these time-tested health care systems and recommended that they be properly revived to serve the needs of the people at large. And, specifically with this in mind, an 'Alternative Medical Care' project has been initiated by the Bangladesh government some years ago. One of the first activities under the project was to appoint 467 gardeners to grow herbs and other medicinal plants in as many gardens, in and around the zila and upazila health complexes. A Taka 50 million fund was reportedly allocated for the purpose. The details of how these gardens have been growing, or not growing, have not been furnished. But something more interesting has been reported. The gardeners under the AMC project happen to be 'fourth class employees,' drawing less in wages and allowances than the medical assistants of allopathic doctors. They are one rung higher, being 'third class employees.' So the gardeners are reportedly getting promoted to be at par with allopathic medical assistants ! This, as one critic commented, is tantamount to turning tailors into surgeons ! That may be a trifle exaggerated but the chances of the promoted gardeners functioning as dangerous quacks can hardly be dismissed, given the country's socio-economic circumstances. One finds here salesmen at pharmacies being consulted by ordinary folk for this or that ailment and the former readily obliging and prescribing potent drugs from his store ! Basic health knowledge does not necessarily have to be the preserve of formally educated medical graduates only. A fairly world class secondary school text book on human biology or health science is good enough to give primary health care education for life. Pro-people development activists have in fact been advocating that such a course be made part of compulsory education. People's health care needs could then be well served even with a handful of specialists at the top, provided enough well-trained paramedics, and barefoot doctors are developed to deliver basic health services. Indeed, if the proper policy guidelines are in place, even unlettered people might be formally or non-formally educated in primary health care to function as competent health assistants. It would be the most pragmatic thing to do for the country where the overwhelming majority are poor rural folk, suffering mostly from common communicable and deficiency diseases that hardly require specialists' attention. Unfortunately, that has not been the idea at all in the move to upgrade the gardeners to the level of medical assistants, who, we are told, are secondary school graduates but must also take a three year diploma course and a one-year internship to qualify. The move to promote the gardeners is allegedly the result of simple graft, and the offender is said to be the medical officer in charge of the project. He has been faulted with having taken a Tk 40,000 bribe per head from the would-be beneficiaries. That, naturally, has been denied. Be that as it may, the fallout from promoting the gardeners can be deadly. Without proper training in holistic health care, these upgraded fellows could very well join the ranks of 'witch' doctors who often add to the misery of innocent patients with all kinds of harmful concoctions. The market is apparently flooded with so-called guaranteed treatments, for asthma, impotence, infertility,venereal diseases, arthritis and what not. Some registered manufacturers of herbal products claimed to have tested some of these spurious medicines and found highly harmful ingredients in them, such as steroids in asthma medicine [ allopathic inhalers have them too] which may give immediate relief but long term diabetes, high blood pressure and osteoporosis ! Be it unani, ayurvedic, homeopathic or allopathic, all medicines must be subjected to the strictest regulations so that the genuine-ness of the products and practitioners is above question, and the chances of iatrogenic diseases cut down. Fraudulent managers, manufacturers and practitioners alike have to be weeded out if the valuable knowledge bases are to be protected and developed and people's faith in them kept alive. There is no doubt that the entire health sector worldwide is fraught with crises, which is why holistic health activists never tire telling people to build their own capacities in basic health care. It is a vital life skill, needed to cope with common illnesses and also to prevent diseases through home care, balanced diets and wiser lifestyles. Given the global medical crises caused by unnecessary, wrong or over -medication, this is the soundest advice that individuals and governments in countries like ours can follow. ................................................. E-mail : nyew@bol-online.com