With the technical advances happening at a brisk pace, it is more than likely for a grass root surgeon, especially in the developing world to get confused and flabbergasted. For some very obvious and justifiable reasons most basic research is happening in the developed world, while the major mass of humanity is concentrated in the remaining globe. It was therefore only natural for this highly burdened but technically skilled basic surgeon, who was jack of all trades, although not by choice but by circumstances, to rely (sometimes adoringly and often blindly) on the western trials for his “local problems”. But that was like putting the solutions of apples to oranges in most situations. Not much however can be taken away from the science that developed in the west in the last few centuries for the development in the science and art of surgery for the entire universe.
The history of surgery in India is amazing yet sad, as it lacked documentation and emphasis on “evidence based” medicine. It was more of an “eminence based” practice of surgery, where the science and art was learnt at the feet of the master. Susuruta has been acclaimed as the greatest surgeon of medieval times, although I would wish to remember and pay tribute to him as arguably the greatest surgeon of all times. His feats were unmatched for centuries and he performed his surgeries (with scientific basis and artistic precision) at a time when supposedly the rest of the world was living in the so called dark ages [1, 2, 3].
Though the discovery of circulation is attributed to William Harvey; it is interesting to note that Sushruta had the knowledge of a structure like heart and its role in circulation of “vital fluids” through the ‘channels’. Sushruta has described the entity of “Hritshoola” in his famous treatise “Sushruta Samihta”. His vivid account ofangina (“hritshoola “ meaning heart pain)embodies all the essential components of present day definition, i.e. site, nature, aggravating and relieving factors and referral. According to him angina is chest pain which is precordial, temporary, exertional, emotional, burning like and relieved by rest. He also linked this kind of pain to obesity (medoroga). It is remarkable that Sushruta described these conditions some 150 years before Greek physician Hippocrates [1,2,3].
India is indeed a land of paradoxes with some world class health facility at one end of the spectrum and lack of primary health care at the other. Some of the corporate hospitals can match and outdo the best in the world and with the improving facilities and skills; these centres are indeed becoming international centres of excellence. The medical tourism to India has been increasing at an alarming rate of around 10% annually and one can be easily be proud of this fact. However the lack of sanitation and basic health care facilities at affordable prices for the poorest of the poor makes it look lopsided and discriminatory. While the classes are getting world class care, masses have been ignored. There is a desperate need to channelize the thought process and resources towards optimum care for the poor masses. This bankruptcy of thoughts has also not helped the clinical and basic research and most of the research is essentially a duplication of what has already been done in the west.
There is a desperate need to conduct Indian trials with honesty and with all evidence based parameters taken in to consideration. There is also a need to conduct workshop on the issue of documentation and publication in order to overcome the mental block to publish. This icon of a surgeon (in the rural setting) who is performing his procedures against all odds in the back waters needs to be brought to the fore front of documented research. The research in India would help the whole world and the world is indeed looking towards India for the future in the field of surgery also. We are infact duty bound to find Indian solutions to Indian problems for the sake of the entire universe.
References:
1. Eisenberg I. A history of rhinoplasty. South Afr Med J 1982;82: 286-92.
2. Kansupada KB, Sassani JW. Sushruta, the father of Indiansurgery and ophthalmology. Doc Ophthalmol 1997; 93: 159-67.
3. Tewari M, Shukla HS. Sushruta: The father of Indian surgery.Indian J Surg 2005; 67: 229-30.