Western Ayurveda Is Driven by Money and Economic Factors vs Educational Priorities
The third point is that Ayurveda in the West is driven by money and economic factors vs educational priorities. Almost all education facilities are privately owned and run, with very few exceptions, such as the Bachelor of Arts diploma in the U.K. This means that the courses being taught on Ayurveda vary radically from school to school, as there is no government standardization of the syllabus. The first question is not about money. It is about having private institutions determine the level and quality of Ayurveda that is being taught in the West. By their very nature private institutions must give priority to economic factors, instead of educational quality and content.
Typical commercial schools of Ayurveda need to push a high volume of low'-quality programs on students in order to make money from teaching. In most cases private education is not a lucrative business. There are two main exceptions: 1) Elite schools that cater to the rich, and 2) volume. This is why the large schools in Europe and U.S.A. tend to flood the market with programs every weekend, often diverging into other Indian subjects such as Vastu Sastra (a part of ancient Indian architecture) in order to make money.
When education is concerned with ayurvedic medicine, volume is not ideal for the students. Having a steady comprehensive syllabus is best for learning medical sciences. One of the problems with focusing on the volume of courses to make money is that of having qualified teachers. For many years in the early 2000s the largest school in Germany would offer a weekend course and then ask a student of that course to teach the same course the following month because they did not have enough teachers. Hence, when economic factors dictate the syllabus and structure of a school, the first thing to suffer is the quality of the teaching, which further adds to the vulgarization of ayurvedic medicine.
Another aspect of volume is typically observed in the largest school in the U.S.A. where many well-known teachers are brought in to teach various aspects of Ayurveda. However, there is no core teacher to bring the different subjects and teachings together in a coherent manner. The result of this approach is a number of big-name teachers who are interesting teachers in their own right, nevertheless, leaving the students with an incoherent understanding of Ayurveda. A typical scenario with all teachers (especially Indian) is that they start their course with the basics, as they do not know how much the student has been taught. Obviously after the tenth teacher giving the same basic information the students get frustrated. The fact is that the experts teaching in these schools are not coordinated to form a coherent syllabus. That is mainly due to the focus on income, and not on training students to actually practice ayurvedic medicine.
This leads us to a primary issue. Is the goal of an institution to train students to actually practice ayurvedic medicine? Or is the goal to teach students everything about Ayurveda? Examples of this are various B.A. and M.A. programs in Europe and the U.S.A. which are not science-based. A Bachelor of Arts or a Masters of Arts in Ayurveda are not focused on training practitioners or doctors. They are training people to know many things “about” Ayurveda as study in literature or the arts. Students are usually disappointed after completing three years of full-time study in Ayurveda, receiving a B.A. and realizing that they do not have a clue about how to diagnose and treat a patient in clinical practice. In spite of this obvious difference in a science diploma vs a diploma in the Arts, many students are led by these schools to believe they will be able to actually practice ayurvedic medicine. The reality is that many schools in the West do not want to train practitioners, due to the legal aspects of practicing Ayurveda in their countries. Many countries are highly litigious, like the
U.K. and the U.S.A. Training practitioners of ayurvedic medicine opens legal issues for the schools. For example, are the teaching staff certified doctors? One school in the U.S.A. even goes so far as to have students sign a paper on graduation that they will not practice Ayurveda in the same state as the school.
The next issue is standardization of the Ayurveda syllabus. Schools which focus on volume will avoid entering into difficult and profound aspects of Ayurveda, such as diagnosis, as they are not economically feasible. A smaller, non-volume-orientated school may focus on difficult subjects because they understand that the student will need this knowledge when working with patients. One of the main subjects to suffer in ayurvedic medicine is that of pathology. Very few schools enter into this subject in depth, and yet students who do not have this training are unable to practice effectively. The author’s personal observation on the lack of training is in ayurvedic anatomy and physiology. Many students join our advanced courses in pharmacology and are unable to follow normal treatment protocols due to their lack of knowledge of anatomy and physiology according to Ayurveda. If this information is not memorized, then diagnosing pathology of Dosa is impossible. This is due to the lack of standardization of the ayurvedic syllabus in the West.
The other aspect of private schools is that the larger volume-orientated institutions push their own agendas - for economic reasons - with A.Y.U.S.H. and local governments. There is no Ayurveda professor or team of professors working on a standardized ayurvedic curriculum in the West. It is being done by a few political people whose goal is making money. This leads to a total degradation of Ayurveda medicine as a whole, because the priority is not Ayurveda - it is having an economically successful school with laws that support this. As we know in modern science, there is a problem when the people paying for studies are the same ones benefitting from the results of the studies. A conflict of interest is a major problem in “Western Ayurveda”. The Indian government, ministries and A.Y.U.S.H. are very impressed with a European school which began to gross over a million Euros a year in income over several years - the same school which used students from one weekend to teach the next weekend. Because of this situation these kinds of volume educational institutional schools are deciding the future of Ayurveda in the West.
Of course, the same problem exists in India. The state of Kerala virtually controls the Indian government’s stance on Ayurveda at this time. This is purely due to the growth of ayurvedic tourism which is a billion-dollar industry in Kerala alone.
Many institutions in the West are trying to use the Benchmarks for Training in Ayurveda, document and guidelines from the W.H.O. (Anonymous 2010). No doubt this is a step in the right direction for a standardized Ayurveda syllabus in the West. On a closer look at this document, one comes up with a number of educational contradictions. For example, the students are supposed to have one hundred hours of Sanskrit study in conjunction with Ayurveda studies in order to allow study of the classical texts. All well and good, until we read the “expectations” of this W.H.O. document which states “students should be able to read and translate Sanskrit siitras after one hundred hours of study”.
If we examine any European language, for example, French, we find that students have roughly 2400 hours of French after 12 years of school. After that they go to university and can specialize in French language and receive a B.A. in French requiring another several thousand hours of study. Now, at this point, a student is able to study to become a translator. Having any kind of expectation that 100 hours of study in any language allows a student to be able to translate is absurd. Sanskrit is a complicated language and even experts in Sanskrit can make horrible translations of Ayurveda texts. An example of this is seen in the translation of the Caraka Samhita into French by Jean Papin, a French Sanskrit scholar (Papin 2013). His translation manages to reverse the meaning of virtually every critical sUtra a veritable disaster. He translates verse 57 from chapter one in the SQtrasthana section as “the Dosas Vata, Pitta and Kapha are the cause of health in the body”, when the siitrd clearly states that “Vata, Pitta and Kapha are the cause of pathology in the body”. Therefore, if a reputed Sanskrit scholar cannot correctly translate verses after thousands of hours of study, how can the W.H.O. Benchmarks, on page 9, expect 100 hours of study to:
translate from Sanskrit to English, and vice versa. Upon completion of this subject, students are
expected to be able to read, write and understand the slokas in the various texts of Ayurveda (Caraka
Samhita, etc.), translate them as required, understand, apply and interpret them scientifically.
The document Benchmarks for Training in Ayurveda (Anonymous 2010) has several other problems. It has too many inconsistencies and unrealistic goals. For example, on page 8 the Level 1 practitioner, under the category of “Technical Skills”, is expected to:
These points are certainly admirable goals for the development of Ayurveda outside of India. The whole issue of developing a benchmark, or guidelines, for education in Ayurveda is first standardization, followed by staff who are able to teach the agreed-upon syllabus. In the guidelines on page 8, the newly trained practitioner is expected to “acquire technical knowledge about diseases not necessarily covered by the program”. This is absurd, as the reality is that there are not enough qualified teachers to teach the basic program. Where will a student find the expert to give additional technical knowledge?
The author’s impression of reading the above points as a practicing Vaidya (traditional doctor) is that the average ayurvedic practitioner would have enormous difficulties in finding the time to create a database of all their clinical cases. In the 32 years that the author has been practicing Ayurveda he has never been able to create a database of his patients. The author has extensive written records dating back to twenty-five years, correlating to his move to Europe from India in 1994. However, he lacks the time and skill to create a database of clinical records. How could the W.H.O. expect new practitioners, who are developing their skills and struggling financially, to be able to find the time to create, enter and maintain databases?
The author has been training ayurvedic practitioners in Europe since 1998. He wonders how a newly trained practitioner would be able to “analyze the merits and demerits of contemporary health-care systems”. This would require many years of study in various “health-care systems” in order to effectively be able to have an objective view of such system. This is an analysis that would be best done by a team of professional educators, and not newly trained practitioners.
Lastly, how many practicing M.D. general practitioners are fulfilling the above requirements? Is this a double standard: That newly trained practitioners of traditional medicine are required to carry out tasks that are highly time-consuming, when most medical doctors are not able to comment on other healthcare systems themselves?
Then under the category of “Communication skills” on page 8 the practitioner is expected to:
Again, these are admirable goals for the development of Ayurveda outside of India. However, in order to disseminate clinical findings, there would need to be the establishment of specialized publications or groups, who could coordinate and disseminate such information. The actual reality is that there is nothing like this in the West at this time. There have been a few attempts to create “Ayurvedic journals”, notably in the U.S.A., Germany and the U.K. Unfortunately, these kinds of publications are filled with dubious or incorrect information. One such publication in 2006 published monographs on medicinal plants written by students of various schools in the U.S.A. The persons listed on editorial board (all famous people) never checked the content being published. I was asked to review one such monograph and found it poorly referenced, wrongly classified and incorrect in a number of statements, such as “this is a famous plant used extensively in Ayurveda”. Noting that the medicinal plant in question was mainly used in folklore medicine rather than in Ayurveda, brought the ire of the editor, as she then had to change the layout of the magazine, not to mention the author who was shocked that someone actually corrected his technical writing.
The second point on referrals to “related specialists” would tend to indicate purification treatments or Pancakarma (five methods of purification). For example, in Europe, there is not one Ayurveda clinic that follows the guidelines of Pancakarma as per the Caraka Samhita. Using Sodhana (reducing) therapies is a clinical procedure that requires special knowledge and training and is often a cornerstone of specialized clinical treatments in India. Hence, at the moment of writing, European practitioners of Ayurveda need to refer patients to Indian clinics for “related specialists” in Pancakarma, as none exist in Europe itself, noting that there are many “Pancakarma clinics” in Europe, notably Germany and Austria, who do palliative (Santana) therapies rather than reducing (Sodhana) therapies.
One of the main reasons why Pancakarma therapies are not used as per Caraka Samhita in Europe is that they are labor-intensive. This fact makes the cost of offering these therapies to the European public far beyond the average person’s budget. Additionally, the health insurance of most countries does not cover these kinds of procedures. Pancakarma also requires a large quantity of botanicals to be therapeutically effective. According to Dr Sunil V. Joshi, director of the Vinayak Pancakarma Chikitsalaya in Nagpur, India they use roughly 10 kilos of medicinal plants per patient, per week in Pancakarma. This includes the fabrication of medicinal oils, pastes, enemas (Basti) as well as other preparations that are used in both preparation (Purvakarma) and administration of the primary therapies (Pradhanakarma). Dr Joshi is the author of the acclaimed book Ayurveda and Panchakarma (Joshi 1997). Between the cost of raw' materials, the labor needed to fabricate the medicines and the labor needed to apply the therapies to the patient, the cost is too high to follow classical Pancakarma guidelines.
To further explain this problem, the author can share his experience of trying to set up a Pancakarma clinic in Europe in 2011. In collaboration w'ith Dr Sunil V. Joshi, an attempt was made at costing of all required materials and of two Western therapists to carry out the procedures. In order pay the rent of the clinic, the two Western therapists (trained by Dr Joshi), the material, the medicinal plants, the oils, room and board for the patient and, finally, pay of the doctor, the cost would need to be around €5000 ($5535) per week. As Pancakarma therapies as per Caraka Samhita require a minimum of three to four weeks, this would mean a cost of €15,000 to €20,000 ($22,140) per patient. Needless to say, the project never went beyond the business plan, as this would only cater to an elite five-star clientele.
Another main reason w'hy Pancakarma is not performed in the West is due to legal issues which are developed in point number 4 below'. Basically, any therapy that is invasive (e.g., entering the body) can only be done by an allopathic M.D. Unfortunately, medical doctors in the West must follow' the protocols of their health department, effectively preventing them from carrying out these kinds of ayurvedic procedures.
Thus, clinics in Europe, South America and North America offer a misrepresentation of “pancakarma” in a reduced form which is closer to KiralTya methods of Purvakarma (preparatory procedures). Prof. R.H. Singh details the differences in these methods very clearly in his book Рапса Karma Therapy (Singh 1992). Therapeutically this means the patients receive Samaria (palliative) treatments instead of Sodhana (reducing or purifying) therapies. Naturally when people in the West use the w'rong terms to describe the therapies being offered, this further reduces the credibility of ayurvedic medicine in the West.
Furthermore, the document Benchmarks for Training in Ayurveda states under the category of “Research and information-management skills” on page 8, the Level 1 practitioner is expected to:
Without a professional network of practicing ayurvedic doctors/practitioners in the West it is difficult to both:
Again, these are admirable goals, ones that ayurvedic practitioners and schools should strive to attain. I w'onder how many M.D. general practitioners w'ould be able to carry out these goals without peer-reviewed publications, alumni networks, and government/educational support systems. Asking newly trained ayurvedic practitioners, or newly formed private schools, to create these structures is unfair and unrealistic. With the standardization and implementation of an ayurvedic educational syllabus, Western governments also need to organize and support the creation of peer-review'ed research journals and research grants. Without this support, the ability of the individual practitioner is limited.
From an educational point of view a standardized Ayurveda syllabus for the West that is not based on the B.A.M.S. Indian diploma is critical for the proper growth of ayurvedic medicine. This syllabus should be developed by people in education, not those people running private schools. A panel of ayurvedic professors with Western educators would need to make a syllabus that is a compromise between Indian medicine and what is legally allowed in Western countries. At this time, most governments in the West are using a combination of the W.H.O. Benchmarks for Training in Ayurveda and the B.A.M.S. syllabus. Both have many shortcomings and are not adapted to the legal systems in these countries. As stated earlier, ayurvedic medicine is not a legal medical system in the West. Hence, using the current Indian medical syllabus is illogical, even if it were not out of date. This leads us to the next issue of each country having its own laws concerning traditional medicine.