Healthcare System

Healthcare System system of medical practices to provide people with proper medical and other healthcare services. Different healthcare services differ in their philosophy and concept as to the causes of disease, their approach to healing, methods of treatment, and composition and preparation of medicinal products. As they exist in Bangladesh, they can be broadly classified into (i) Traditional and (ii) Modern systems.

Traditional system an art of healing based on traditional use of plants, animals, and other natural substances, and cultural habits, social practices, religious beliefs, and in many cases, superstitions of the present and previous generations of people (Ghani 1990). The basic concept of traditional medicine has been very comprehensively described by the World Health Organisation (WHO 1976) in the following way: 'Traditional medicine is the sum total of all knowledge and practice, whether explicable or not, used in the diagnosis, prevention and elimination of physical, mental or social imbalance, relying exclusively on practical experience and observations handed down from generation to generation, verbally or in writing. The forms of traditional medicine practiced today vary from highly organised and long established Ayurvedic and Unani systems to various folk medical practices, such as herbalism, spiritualism, and religious medical practices. Because of their origin in the remote past and the fact that most of them are practiced almost in the same way as in the past they are collectively called traditional medicine. The basic principle involved in traditional medicine is that it strives to treat the whole person rather than his isolated parts and thinks of him in relation to his emotional sphere and physical environment.

The traditional system of medicine is now being taken seriously by the World Health Organisation, Western medicine establishments, and Governments of many Third World countries. Thus traditional system of medicine is now a recognised system of medical practice in many countries of Asia and Africa. In some Asian countries, eg, Bangladesh, India and China, it has undergone tremendous modernisation over the years and is now practiced side by side with modern allopathic medicine as an alternative and supplementary system of medicine. Traditional medicinal products, particularly those of the Unani and Ayurvedic systems, are now prepared by using both indigenous and modern pharmaceutical technology and under strict quality control measures. These medicinal products are dispensed as broken pieces or coarse and fine powders, pills of different sizes, in the form of compressed tablets, as liquid preparations, as semi-solid masses, and in the form of creams and ointments neatly packed in appropriate sachets, packets, aluminum foils, plastic or metallic containers and glass bottles. The containers are fully labelled with indications/contra-indications, doses and directions for use and storage.

The traditional healthcare systems practiced in Bangladesh include the Ayurvedic, Unani, Homeopathic, and Folk medicine systems. Ayurvedic system is one of the oldest systems of medicine which has been practiced in this subcontinent for over 3,000 years. Ayurveda, meaning the science of life, is rooted to the social, cultural and philosophical principles that prevailed in India during the period 600 BC to 700 AD. Ayurveda considers the human being as a miniature universe. The properties found in the universe are believed to be present in the human body, which like the universe, consists of five gross elements: earth, water, fire, air, and the ethereal parts of the sky. These body constitutions are taken into consideration while treating a patient under this system. Curative treatment in Ayurvedic system consists of administration of medicine both internally and externally, minor surgical operations and psychosomatic treatment. The medicinal preparations employed in this system are mainly derived from plant materials and are presented in the form of powders, semi-solid preparations, decoctions, elixirs and distillates. Many of them also contain inorganic chemical substances, minerals, and animal products. Alcoholic extracts and alcoholic solutions of the ingredients, tinctures and elixirs are also frequently used in Ayurvedic medicine. The materia medica of Ayurvedic medicine contains some 8,000 published recipes. Many more are held as secret information among certain families.

Unani system originated in Greece and was named after the name of Unan province, which is regarded as the original place of development and practice of this system. Hakim Iskalibus of Greece was the first person to propagate the Unani system of medicine. However, this system flourished only when Arabian and Persian Muslim intellectuals like Al-Razi, Ibne-Sina, Al-Rashid, and others enriched it with newer scientific knowledge and discoveries in the 7th century. Because of the significant contributions of Arabian physicians to the development of this system, the Unani system is also known as the Greeko-Arab system. The famous medical book, 'Al-Kanun' (based on the Unani system) of Ibne-Sina (980-1037 AD) was the most prescribed book of medicine in Europe for several centuries. After the 13th century, although Muslim civilization declined, the Unani system of medicine was in full vigour and widely practiced as an effective system of treatment throughout the world.

According to the Unani system, the basic factors composing the human physique are four elements (fire, air, water, and earth), four types of temperament (hot and dry, hot and wet, cold and dry, and cold and wet), four humours (blood, phlegm, yellow bile and black bile) organs, vital spirit, powers and functions. Whole plants or their powders or pastes or products and their extracts, infusions, decoctions and distillates are major constituents of Unani medicine. Minerals, inorganic chemicals and animal products are also frequently used in preparing these medicines. However, tinctures or elixirs (which are alcoholic preparations) are not used in Unani medicine.

Both Ayurvedic and Unani systems of traditional healthcare have taken firm roots in Bangladesh and are widely practiced all over the country. There are about 6,000 registered and 10,000 unregistered practitioners (Kavirajes of the Ayurvedic system and Hakims of the Unani system) of these two systems of medicine in Bangladesh. A total of 15 government recognised and funded educational institutions are currently engaged in the teaching of traditional medicine in the country. Of them, 10 institutions are involved in teaching the Unani system and 5 in Ayurvedic system. Each of these institutions has an attached out-patient hospital which imparts internship training to graduates while giving medical services to out-door patients. These institutions offer a four-year diploma course and six-month internship training. Annual intake of these institutions currently stands at about 400 students. Since the 1989-90 academic session a Government Unani and Ayurvedic Degree College, affiliated to the university of dhaka, has been established in Dhaka. This college offers a five-year degree course and one-year internship training in an attached 100-bed Traditional Medical Hospital.

Homeopathic system of healthcare is not strictly an eastern medical system as it was developed in Europe by a German allopathic physician named Samuel Hahnemann (1755-1843) in the early 19th century from the allopathic system. In this system drugs are applied in very small and diluted doses. It is believed that the strength or curative power of a drug increases mathematically with the increasing degree of its dilution. There are about 1200 medicines in homeopathy, of which more than 500 are obtained from medicinal plants, a few from animals, and the rest from pure chemicals. Plant derived medicines in this system are used as mother tinctures. No excipient (preservative, colour, sweetener, flavour, etc) is used in preparing homeopathic medicine. This system of medicine is very popular in many Asian countries including Bangladesh.

Folk medical practice a simple form of traditional medical practice which offers healthcare services to the rural people with or without the use of medicinal preparations. This practice is based on traditional beliefs, social cultures and sometimes superstitions of the people, and does not involve the use of any specific medical system. The medicines of this practice mainly consist of plant and animal parts and their products, which are dispensed usually in raw forms as and when needed. Other items commonly used in this practice are 1. religious medicines, which include the use of religious verses written on papers and given as amulets; religious verses recited and blown on the face or body of the patient or on water to drink or on food to eat; sacrifices and offerings in the name of God and gods, etc and 2. spiritual medicines, which include methods like communicating with the spirits or ancestors through human media to inquire about disease and its remedy, torturous treatment of the patient along with recitation of incantations to drive away the imaginary evil spirits and many other similar methods.

Folk medical practice also includes treatments like blood-letting, bone-setting, hot and cold baths, midwifery, minor surgery, therapeutic fasting, hydrotherapy and heat therapy, including cauterisation. Practitioners of folk medicine are not normally professional people. The elderly people of the communities, religious leaders, 'bedes', or even ordinary people often prescribe folk medicine. Folk medicine is widely practiced in rural and even urban areas of Bangladesh.

Modern system the highly advanced system of health management used in Bangladesh and the rest of the world. This system does not limit itself to only curative treatment of the patient but also endeavours to extend its services to the prevention of diseases by immunization and improving the personal and environmental hygiene of the patient and the community. Well-educated and professionally trained experts practice this system of medical treatment. Technologically advanced highly sophisticated equipment and methods are used in this system to attain precise diagnosis and treatment of diseases. Highly efficacious medicinal preparations prepared from purified synthetic or natural chemical substances are used in this system. It has developed sophisticated and precise method and technology of surgical operations and performs critical operations like open-heart surgery, heart transplant, and transplantation of other vital organs of human body with high degree of precision and safety.

Organised and well-equipped hospitals and clinics have been developed to effectively and properly offer healthcare services to people under this system. However, because of inadequacy of medical equipment and shortage of manpower and infra-structural facilities, benefits of modern system of healthcare services cannot be extended to rural areas as adequately as needed. The cost involved in offering healthcare services under this system is also much higher than that of any other system of healthcare services available in Bangladesh. [Abdul Ghani]

Bibliography WHO, African Traditional Medicine. AFRO Technical Report Series, No. 1, 1976; Abdul Ghani, Traditional Medicine (Origin, Practice and State-of-the Art). In: Traditional Medicine (ed Abdul Ghani, Jahangirnagar University, Savar, Dhaka, 1990.