Gandhi & Health: Celebrating 150 Years
“Anyone who observes the rules of health will not need to knock at the doors of doctors from day to day.” Mahatma Gandhi, the non-violent political mover and shaker who took the greatest colony away from the greatest empire in history, thus playing a role, in the history of anti‐imperialism, analogous to the roles of Bolivar in South America, Ataturk in Turkey and Mao in China. He was, however, more than just a leading anti‐imperialist and the main founding father of the largest parliamentary democracy. His interest in health, hygiene, nutrition and health‐care was just as great as his interest in politics. Some of his concerns in regard to health and health‐care harmonize with expert 21st‐century medical views. He insisted that avoiding disease is a lot better than getting and curing it, and so it’s important to be clean, control your diet, get substantial daily exercise and not take more medicines than you really need which is a vital message for affluent people today.
When he was 18 years old the idea that he study in England was mooted, and his own proposal was to study medicine there. Though he chose public law as his profession and then public life claimed the bulk of his time, the passion for caring for ailing individuals remained and developed from what it once was a hobby to a sort of spiritual need. His vocation to be a medical healer was deeper than his vocation to practice law. However, Gandhi was also a sharp critique of professional medical practices. He was a firm believer of the fact that the doctors induce us to indulge, and the result is that we become deprived of self‐control and become effeminate. He even went on to say that to study European medicine is to deepen our slavery, hence, every Indian doctor should give up medicine and understand that rather than mending bodies he should mend souls, that it is better that bodies remain diseased rather than that they are cured through the instrumentality of the diabolical vivisection that is practiced in European schools of medicine and if any patients come to him, tell them the cause of their diseases, and advise them to remove the cause rather than pamper them by giving useless drugs.
Gandhi believed that medical science is the concentrated essence of black magic and quackery is infinitely preferable to what passes for high medical skill. Vivisection in his opinion was the blackest of all the dark crimes that man was committing against god and his creations. He objected not just to vivisection but also to any other avoidable cruelties to animals. He believed, for instance, that it was cruel to derive smallpox vaccine from cows. He felt that in taking this vaccine humans were guilty of a sacrilege and taking vaccine from a cow’s udder is an act of extreme cruelty to thousands of living creatures which is no credit to man’s sense of pity and it behooves him, therefore, to forego any benefit that may accrue from it. He wanted to restore the Ayurveda and Unani medical sciences to their pristine glory and he hoped that the union of these two with the Allopathy school of medicine will result in a harmonious blending and in purging each of its special defects. Gandhi incorporated education in health and hygiene in his programs aimed at achieving complete independence by truthful and non-violent means. He emphasized on vegetarianism, which is inseparable from naturopathic way of treatment. His belief in Nature Cure stemmed after reading two books written by German clinicians, Dr. Louis Kuhne and Dr. Adolf Just who propagated hydrotherapy and mud-cure clinics respectively. He himself established a Nature Cure center at Uruli Kanchan village in Maharashtra which is now known as Nisargopchar Gramsudhar Trust's Nisargopchar Ashram. Though he advocated naturopathy as a way of treatment, there were a few physicians like Dr. Thomas Allinson and Dr. Bidhan Chandra Roy to name a few, whom he held in high esteem.
Amongst all his preventive and treatment principles there are a few which hold true even in modern day medicine. For instance, Fasting, also known as Langhanam in Ayurveda texts is used to preserve good health if done at least once in a month. He associated fasting with “purification” of the body and/or the soul (according to the need of the occasion) and he would sometimes, as everyone knows, use fasting as a method of political or otherwise moral struggle. According to modern day medicine fasting is the voluntary abstinence from solid food and stimulants (like caffeine or nicotine) for a limited period of time, and it depends upon the ability to meet the body's requirements for macro‐ and micronutrients, during a limited period, without endangering health. “Generations to come will scarce believe that such a one as Gandhi ever in flesh and blood walked upon this earth” – are the famous words uttered by Einstein after the death of Gandhi. Some people might believe that there are no similarities between these two legends of the 20th century, yet both hold special places in modern day’s science and medicine and this binds them together in a single chain of thought. While Einstein helped to create a revolution in our understanding of the natural world, Gandhi helped to create a revolution in how human nature can be changed by peaceful means for the benefit of others and he did this in a way that displayed great leadership and creativity. The vagaries of human nature like, anger, jealousy, revenge can however, be overcome by following Gandhian principles in life. Enshrined in the life of Gandhi are three simple but key principles, which Gandhi in part incorporated within his religious convictions – Truth, Love and Self- Denial / Self-Sacrifice.
Another key principle that Gandhi espoused was that the end rarely justifies the means. For him, means were invariably more important than ends. In the goal-driven and competitive environment of many academic settings, it is easy to forego moral principles. At its extreme, the negation of truth and the distortion of means to justify ends can be seen in scientific fraud, which some over-zealous researchers can term as “borrowing” of ideas, especially if a high prize awaits them. The most celebrated example of this is one of the most important scientific events of the 20th century, the discovery of the structure of DNA by Watson and Crick. In this case, the key item was an X-ray crystallograph developed by Rosalind Franklin and which provided convincing evidence for the helical structure of DNA. Watson and Crick subsequently gained the Nobel Prize for their work, and Franklin did not share in the prize. It seems that Watson and Crick did not obtain Franklin’s approval for using information from the X-ray crystallograph. Did the end justify the means in this case?
The answer to this still remains controversial and in all likelihood will always be. In current times of intense competition for funds and of competitive rankings, there is perhaps more pressure to think of goals and targets, rather than the means used to attain these goals and targets, and thus a temptation to forego acceptable moral standards in the process. Having an ethical compass and key values is critical in order to survive the challenges of modern medical environment. In extreme cases, some senior physicians/researchers may develop a Hubris syndrome where power, over-confidence and arrogance appear to take hold and result in immoral behavior, deceptive misrepresentations and half-truths and can occur in situations such as those where individuals are reluctant to admit to partial or total ignorance of a topic.
Gandhian values and principles have been evident in some outstanding scientists, such as Joseph Rotblat – a nuclear physicist who played a part in developing the atomic bomb. He was subsequently a tireless campaigner for peace, and together with his colleagues he was awarded the Nobel Peace Prize in 2005. Rotblat emphasized the moral responsibilities of scientists to work for peaceful applications of science. We need more scientists like Rotblat who will carry the Gandhian torch of nonviolence, one that is illuminated with the energy and brilliance of scientific genius. It is not our patient who is dependent on us, but we who are dependent on him. By serving him, we are not obliging him; rather, by giving us the privilege to serve him, he is obliging us. This quote by Gandhi should be the guiding principle for all hospitals and doctors across the country. However, there is now a goal-driven and competitive environment in many health-care settings, where medicine is now a big business and India itself is generating money from ‘health tourism’, whereby overseas patients gain treatment in India at a fraction of the price that they would pay in the west. Where health care is a business, and where private medicine is a major player, then moral dilemmas will inevitably arise. The basic concept is - rather than counting on what others can do for you, make your life count for others.
Over the last two decades, the curative model of health care has begun a subtle shift towards a participatory model of health promotion emphasizing upon practice of healthy lifestyles and creating healthy communities. The definition of health promotion provided in the Ottawa Charter is currently the most widely accepted one: “The process of enabling people to increase control over, and to improve their health.” Health promotion encompasses five key strategies with health communication and education as its cornerstones. Currently health promotion education in India is fragmented and not uniform across institutes. It is yet to be recognized as a critical domain of public health education. There is a need for designing programs for short-term and long-term capacity building, with focus on innovative methods and approaches. Public health institutes and associations should play a proactive role in designing and imparting academic programs on health promotion. India currently is faced with triple burden of diseases i.e. the existing communicable diseases, the emerging and re-emerging communicable diseases and the ever-increasing non communicable, lifestyle related diseases. All of these are one way or the other interlinked to lifestyles and behaviors at individual or community level.
Behavioral change through effective communication has been perceived and proven as a useful and the most cost effective tool for addressing public health problems. Health promotion content in medical and allied health professional curricula is yet to gain its due coverage. During the doctorate in medicine and in community medicine, elements of health promotion are covered but not in a systematic way. Present MD (Community Medicine) curricula are yet to infuse the holistic concept and multidisciplinary approach of health promotion. Conceptual understanding of health promotion needs to be integrated into undergraduate medical and allied health professional education. On the other hand, in what could benefit over 10 crore vulnerable and underprivileged families, the Finance Minister has recently unveiled a new National Health Protection Scheme under which a health coverage of up to Rs 5 lakh per family will offered for secondary and tertiary care hospitalization. The government will also establish 1.5 lakh Health and Wellness Centres under the Ayushman Bharat program. This is touted to be the world’s largest government funded healthcare program. However, many factors such as trust vs insurance model, pricing viability, upfront investments and opportunity for insurers hold the key to success of this scheme.
Other government schemes like POSHAN Abhiyan and GOBAR Dhan Yojana are also steps towards aiming a healthy and disease free Indian society as was envisaged by Gandhi. Finally, on a lighter note, although Gandhi was opposed to being seen as a saint or having a legacy, he might have chuckled at the thought that certain cells in the brain have been named after him – mirror neurons, which act like a mirror and respond when an action is performed and also when that same action is observed, appear to underlie feelings of empathy and have been named ‘Gandhi neurons’ by an Indian-born American neuroscientist Dr. Ramachandran in 2008.
