Hind Swaraj with Special Reference to Medical Care

- By Anand Gokani*

The literal meaning of Hind Swaraj is Indian Self-Rule or Home-Rule. The connotations of self-rule can have both superficial and deep implications. In the superficial sense, home-rule applies to political home-rule, meaning governance by the people, of the people, for the people; but in the deep sense of the word, swaraj or home-rule is a kind of spiritual independence applicable at the individual level. In this paper, we will confine ourselves to the discussion of home-rule at a societal level where a collective group of people is governed by laws and customs which are for their common good. The smallest collection of people in this sense would be a village, and many villages together would constitute a state, and many states constitute a country. Large towns and cities would not necessarily fall into the purview of this concept as the cultural norms, customs and needs of these groups are significantly different from a village.

To begin with, let me try and define a village. A village is a collection of people with a common identity who live together in a spirit of co-operation, mutual trust, and a spirit of brotherhood. There may be a hierarchy that governs the village social structure but each would be for the progress of the state and each would be important in his/her place. The laws and customs would likewise be for the welfare of the people and for the ultimate prosperity of all. Under these circumstances, the unit of a village would prosper and be happy. The distance between the rich and the poor would be small and the basic needs of the entire community would be more than adequately served. Extending this definition to a state and then to a country would only vary in magnitude keeping the general principles the same.

The nation is an entity which is culturally, socially and geographically typical. The constituents of the nation have aims, objectives, needs and problems unique to themselves and hence only they can be responsible for fulfilling or solving them.

Keeping this in mind, every law in the country, every business and every activity should be to:

• Cater to the needs of the community at large,
• Fulfil the needs of the community,
• Be beneficial to all without harming any constituents,
• Should be easily available to the common man.

Towards this end, self-rule or home-rule would probably be far superior to any other form of governance.

Nobody can understand the problems and needs of the community better than its constituents themselves.

Home/self-rule cannot be made uniform throughout the world. It’s not a ‘one-size-fits-all’ system. Every community has specialized individual needs and can vary immensely from the needs of another community. For instance, a person in the tropics, near the equator, in a semi-developed country, may differ in the constitution and needs from another who lives in the Arctic Circle, in a developed nation. They cannot both be governed by the same systems. Hence every country needs home-rule for itself. This is the only common law all over the world, that every community needs its own Home Rule.

When societies were arranged in communities, and they all fended for themselves, there was a general sense of well-being amongst the people. But wars, greed, avarice, transmigrations, conquests and explorations lead to a massive intermingling and, in so doing, there was a domination of the physically or economically strong society over the lessor endowed society.

The ‘rule’ or ‘control’ thereafter was for ‘Profit’ and not ‘Welfare’. When the final aim of all rulers was profit for a few but with no attention to the welfare of the majority, the societies began to crumble, the social structure disintegrated, the ‘one-man-help-the-other’ ceased to happen, and each was to his own.

The ‘profit motive’ of ‘rule’ or ‘control’ became the trend the world over and, whenever it happened, there was exploitation, disharmony, conflict and suffering. One such victim of a changing, profit–based scenario is the medical profession.

Ayurveda, naturopathy, homeopathy, unani and other alternatives, indigenous means of therapy were rooted in this country, and with their use, the users were all benefited. The cost of medications was minimal, indigenously grown herbs and medicines prevailed and the cost of medical care was reasonably within the reach of the large majority. This was home-rule in the field of medicine. Home-rule related to the practice of medicine was aimed for the common good of society. The people looked up to the medical practitioner who endeavored to take his knowledge to the masses and would work both in prevention and cure. The society/community, in turn, looked after the medical practitioner/physician and his family. Medical care in that scenario was affordable, reasonable and accessible to all. Society had a more wholistic attitude to health.

Winds of change swept the world and with the frequency of international travel, burgeoning economies, technological advances and dedicated work in the field of science – a new form of medicine was evolving – allopathic medicine. This science was precise, based on clinical signs and symptoms, supported by laboratory investigations, and thereafter, treatable by sophisticated medicines and machines. This genre of medicine proliferated on the one hand and on the other hand society became globalized.

Globalization broke all barriers in the fields of business and travel and soon the world was one, big, motley, inhomogeneous, global village.

Back-tracking to Hind Swaraj as Gandhiji professed it. He promoted Indian home-rule because of the same principles enunciated above; the ‘common good’ being the theme of all action in any field. Likewise, his opposition to machinery, chemicals, expensive means to mediocre ends, all stemmed from the fact that they were all for profit and not for the general usefulness of the community. India being a country that had a large population - one of the largest in the world - and a significant section of the population being illiterate, made it mandatory to help save them from economic exploitation.

Globalization has made material goods available all over the world and the main objective of making anything universally available is to magnify the profits by reaching more people. This principle was then applied to every field of endeavor – food, clothing, machines, cars, electronic goods etc. In medicine too – this principle is employed.

It was quoted by Fritjof Capra in the Turning Point that the world’s greatest maladies have arisen largely from the petrochemicals and pharmaceutical industries. Whilst both these industries have revolutionized the lives of Mankind all over the world they have also eaten into the fabric of our being. From global warming, wars, death, destruction and ecological damage to widespread suffering from exotic and chronic diseases, all have been linked veritably to these two industries.

Based on these observations, if the concepts of Hind Swaraj was to be extrapolated to fit the modern medical scenario, one would have to restructure the entire medical system in our country. From the laying of undue emphasis on the study of allopathic medicine along with the extreme sophistication of machines and medications to the building of huge hospitals at great national expense to treat exotic and degenerative disease, everything would have to be re-evaluated.

The medicine our country needs is a mix of both modern and traditional. Our medical practitioners need education in the concepts of Ayurveda, Homeopathy, Nature Cure and other sciences as much as they have to know allopathic medicine. As much emphasis should be placed on prevention of disease as is placed on a cure. Medical care should be available to every constituent of the community at a reasonable price and not just to the privileged few who can afford the exorbitant costs.

Hind Swaraj, vis-à-vis medicine in India, means taking science to the masses and benefiting one and all.

Current medicine is concentrated in the cities with rural areas totally bereft of basic care. Whilst in rural areas people are dying of starvation and malnutrition the rich in the cities spend lakhs in treating diseases of over nutrition. This is because there is no control and hence there is a free-for-all exploitation of the people by the medical industry. A large, illiterate population with limited money to spend, and few who have grown richer in monetary wealth, characterize the Indian population and hence it becomes a fertile ground to promote any business, from the sale of junk food to the promotion of the use of sophisticated and largely toxic and expensive drugs to treat even more exotic diseases.

Home-rule would mitigate this trend and would have a more holistic approach to medicine. A more organized and ‘from- each-according-to-their-ability-to each- according-to-their-need’ kind of approach would take the place of the current ill-balanced medical care distribution. The arrangement of medical care in the form of a holistically-driven, prevention-based, primary care center followed by a secondary care center for more sophisticated therapy, finally leading to the tertiary care centre for the delivery of state-of-the-art medicine.

This step-ladder-system of delivering medical care would help everyone receive basic care and at an affordable cost. There would be a co-operation between the various health sciences in order to give the patient the best possible care. Those needing more advanced therapy would avail of the same in the secondary and tertiary centers. In this way the medical care system would not be over-burdened and neither would the patient be denied treatment appropriate to the disease.

Medical education need not then be structured according to an international pattern. It could be effectively layered such that medical doctors could be trained for the different levels of medical care. This layered system would ensure that each one had access to basic medical care which was inexpensive and approachable and when it exceeded the ability of that level of medical care then the patient could be referred to a higher center for more expert care. This would shift the focus from disease- centric medical practice to patient-centric medical practice and most of the country’s health problems would be dealt with efficiently and with a minimal expenditure.

Furthermore, if the focus and emphasis is on prevention, then diseases due to poor hygiene, malnutrition, illiteracy, ignorance, apathy, overcrowding and abuse of substances like alcohol and tobacco could all be prevented thereby saving millions of rupees in manhours lost in sickness-absenteeism and ill-health, and reducing needless expenditure in the use of medications for complicated diseases.

India, being a country yet trying to find its roots and bearings can least afford to have its population spending large chunks of their savings in health care to no useful avail. In India, there is a crying need for the implementation of preventive measures for a large number of diseases in order to save people the need to spend both time and money in regaining lost health.

If the recommendations of home–rule are implemented, the medical care in our country would be structured to suit our people and not the employment of a standard Western model of health care. Western patterns are good for countries where the population is educated, pro-active, discerning and yet the payment of health care is by a ‘third party’. In India the Western model seems grossly irrelevant, unsuitable and horribly expensive for the large majority of healthcare consumers who have to pay their own medical bills. India, therefore, needs a different model of health care which caters to the needs of its population at large.

Home rule would score in yet another area of medical care, viz. the influence of the pharmaceutical industry on the consumer through the auspices of the physician. Diseases, where new drugs are effective, are being publicised and patients’ fears and anxieties are exploited for monetary gains by the corporate medical world. Research is funded by the same organizations that would benefit from positive findings in the research. Primary interests and ulterior motives influence strongly the outcome of research projects which mislead the less discerning and less initiated physician resulting in the unwitting promotion of needless poly-pharmacy. Never before have the sale of drugs, investigations and equipments been as lucrative as it is now and has been the cause of the commercialisation of medical care.

If home rule were to prevail as envisioned by Mahatma Gandhi, but modified slightly to adapt to the needs of the current population, the health care of the nation would be ‘welfare’ based and would actually benefit its population and not be the cause of anguish, agony and loss for anybody.

Home rule, as related to the medical care scene could be exemplified picturesquely by Henry David Thoreau’s oft-repeated exhortation – Simplify, simplify, simplify!

A simplification of our existing system with the view of benefiting the large majority and being focused on ‘welfare’ rather than ‘profit’ would usher in a utopian era in medical care in India. This truly would be the realization of Mahatma Gandhi’s dream concept of Hind Swaraj.

Courtesy: This article has been adapted from the book, ‘Reflections on Hind Swaraj’, written by Siby K. Joseph and Bharat Mahodaya.

* Anand Gokani (MD), is a well-known diabetologist attached to Bombay Hospital and Research Centre, Mumbai. Email: anand_gokani@hotmail.com.