Traditional medicine in Sri Lanka The term ‘Ayurveda’ is referred to different traditional medicines exists in the country. It refers to the Ayurveda system of medicine from North India, the Siddha system of medicine from South India and the Unani system of medicine of Arabs enriched with contributions from the traditional system of medicine called Desheeya Chikitsa is popularly known as the Indigenous system of medicine. Existing system of TRM in Sri Lanka does not exclusively represent the indigenous identity of a Sri Lankan system. It is mostly influenced by Indian system of Ayurveda and evolved through Asian roots of TRM. It was similarly exposed to all religious, trade, political missions throughout the history like any other national cultural tradition. TRM is a holistic health care system in Sri Lanka with an exclusive health belief system and positive stream of social behaviour based on the culturally honoured, ethno-centric, patient-oriented, humanistic, value-based professionalism. The national healthcare system in Sri Lanka was officially recognised after the first Allopathic hospital implanted by Portuguese. The Ayurveda Act No. 31 of 1961 institutionalised the TRM system, and it had been gradually subject to ‘Ayurvedization’ and indigenous identity was getting merged in Indian context. Once the Ayurveda education system was institutionalized it reconstituted in biomedical model. Graduate practitioners rather relied on Western medicine and began to establish a "mixed" or "hybrid" system in Ayurvedic TRM. It was not a desirable to Allopathic practitioners and highly criticized by TRM purist front which led to a double burden issue in TRM sector. It was 1980s the most significant evocation taken place with a separate Ministry for Indigenous Medicine (IM) and some of the outcomes are still sustained in the sector. Currently there is a full pledged cabinet Ministry for IM but detached from mainstream National Health System.

Participating in the conference on "Innovation and development in health: Integration of Complementary and Traditional Medicine in Public Health" the delegates from Sri Lanka got the exposure to the different systems of medicines in various countries. From the Southern Province, representing the Traditional Medical system, Dr. C. A. Wimalawathi, the Medical Superintend of District Ayurvedic Hospital in Aparakka, participated in the conference. Being a Traditional Medicine (TRM) practitioner for more than twenty years she knows how the TRM system in Sri Lanka has evolved for what it is today.

Sri Lanka itself has a long history of TRM and this is most known as the ‘Ayurveda’ system of medicine which has its origins in North India. In Sri Lanka, Public Health Care (PHC) and TRM systems functions parallel to each other. The standards achieved by the PHC in Sri Lanka are not yet met by the TRM system. From the policy level, the TRM in Sri Lanka functions as a separate health care system. However there are efforts to standardize the system by introducing different policies and mechanisms. One such effort is the ‘Medical Council Of Ayurveda’ where many local TRM practitioners are registered considering the effective treatment methods while there is the Indigenous Medical College affiliated to University of Colombo which has a six-year degree programme and another institute with a three year diploma programme, producing approximately seventy professional TRM practitioners a year. However, in this parallel set up, the professionals of the two systems try to provide a better health care service to the public. Instead of these separate efforts, combined efforts are known to be more productive in delivering better health services. In the Florence conference it was discussed how to integrate such expertise to achieve said objectives. In Sri Lanka, lack of resources, difficult in supplying the required demand for indigenous medicine and the lack of overall support given to the TRM is seen as a main hindrance for TRM to standardize its system. However there are good examples for a promising future: Having been able to win the National Productivity award for the best kept hospital, Aparakka hospital provides a better medical service as Dr. Wimalawathi sets the example to the staff. Being that inspirational character, she shared the experience of the international conference at the ‘Strategic Planning (2009) meeting for Health and Social Welfare sector of AGSL’ in 2008. In the same meeting the provincial authorities on TRM came forward with ideas to provide more medical services to the people in the rural areas of the Southern Province.

AGSL took up the ideas brought forward by the provincial authorities on TRM and is supporting the initiative on Ayurveda community health mobile clinics which brings better health services to the communities living in the inland of the Province. Currently, together with the Southern Provincial Department of Ayurveda (DoA) and other relevant local authorities, AGSL has initiated the mobile Ayurveda clinics which will provide a round of eighteen mobile Ayurvedic clinics to selected areas of Tissamaharama, Mulatiyana and Ambalangoda in the three districts of the Province.  (Ayurveda in Public Health Systems)

Proving that its holistic approach to treatments, effectiveness in the herbal treatments and the patient care have made TRM survived its times, the provincial authorities of TRM also highlighted the successful treatments on diabetics introduced by the TRM doctors in Southern Province. They requested to promote such specialized areas through the clinics to give the benefit to the people. In Uva AGSL has been informed about the specialized Ayurvedic rehabilitation treatment for stroke patient, after they get treatment in the public health system. This is a good example of cooperation between the two systems. Therefore AGSL sees the potential in giving a platform to share the knowledge of these specialized successful treatments of Ayurveda. AGSL is currently planning an inter-provincial conference on Ayurveda/TRM and the public health system in Sri Lanka. Furthermore, in the conference the integrated research carried out so far and successful areas in Ayurvedic treatment will be taken to limelight.

With expectations of supporting the initiatives on promoting TRM in Sri Lanka at the territorial level which can revive the interest in TRM in general and support to promote a stronger Primary Health care system, AGSL respond to the requests of the Provincial Department of Ayurveda in the Southern Province. AGSL supports efforts in the health sector to facilitate such improvement which will make a positive impact on the health care services. It is about ‘putting people at the centre of health care. 

Why TRM now? Interview with Dr. Danister Perera, former Registrar of Ayurvedic Medical Council ------------------------------------------------------------------------------------------   What is the importance of having different medical systems in a country’s health care system? Health care is a multidimensional and pluralistic process in which all stakeholders are having an important and definite role. As the WHO World Health Report 2008 states, health care should be rescued from "hospital-oriented system". Must be emphasized, the new trend in preventive medicine and primary health care is very much beneficial to TRM and growing attention in wellness-oriented lifestyle modification in global communities is a futuristic potential. It was in the era of bedside medicine the patient or the individual was respected in a humanistic way. Then in the hospital medicine era doctor became important and it was profession-oriented. Patient became a "case". In last decades when the laboratory medicine era began we experienced it is technology-dominated and dehumanized model introduced in which the patient became just a "bundle of reports". But we must not forget that the humanistic model and value-based practice of TRM is being remained for centuries. And, the current global trend should be able to mainstream TRM in a democratic manner. What is the current situation in TRM in Sri Lanka? Are there specialised areas where TRM treatment is more effective? Yes! There are many. Most of the non-communicable diseases are controllable and some of them are successfully curable by TRM. Like some forms of cancer, diabetes mellitus, metabolic syndrome, mental depression, chronic fatigue syndrome, muscular-skeletal disorders, cardiovascular disorders, post-menopausal syndrome, auto-immune diseases, chronic respiratory diseases, senile degenerative diseases etc. Especially TRM can be helpful as a supportive and complementary therapy with western therapeutic interventions. It can reduce side-effects and improve the healing process. Also TRM is convincingly able to enhance the Quality of Life of the patients suffering from chronic diseases. In addition to that TRM is very effective in long term care management in rehabilitative medicine. In the context of holistic approach TRM is capable of using many mental and spiritual therapies for harmonizing the disorganization and dysfunction of the human energy-system. But, let me add convincingly that "we are not properly harmonized with the national health care system." ‘Integrating TRM into Public health care system’ … how do you perceive this? Integration is a controversial and debatable issue in Sri Lanka. It has various meanings and connotations. It can be sometimes misinterpreted and misused. It is merely relative to cosmopolitan system of medicine. Is it two systems in one man or two systems under one roof? To begin we must understand the medical pluralism. First principle is acceptance of pluralistic health care systems. Then mutual respect, meaningful dialogue, sharing responsibilities in practice, reciprocal benefits and synergetic professionalism are to be installed. For this we need to establish a "co-existing culture" in health care system. It is regrettable to state in some cases we don't entertain even inclusive system model in National Health Care System (NHS). Integration is as I believe an evolutionary process. For that we need a developed socio-political system in which policy reforms can take place. Otherwise integration will be an invasion in other means to absorb TRM into biomedical stream as a supplementary division. It is basically mandatory to minimize the communication gap between Allopathic and TRM systems and lessen the "professional disagreements" within the sector.

Dr. Danister Perera has been working with Ministry of Indigenous Medicine and Department of Ayurveda for two decades and held various positions in the ministry. He was former Registrar of Ayurvedic Medical Council and attached Ministry of Indigenous Medicine. Formerly, was attached to the GEF funded Sri Lanka Conservation and Sustainable Use of Medicinal Plants Project as a Consultant Ayurvedic Specialist and later appointed as the Director of the same project. As an Ayurvedic sociologist or Indigenous Knowledge Practitioner, he is currently reading for the Doctoral thesis on health policy and mainstreaming Indigenous Medicine (IM) into National Health System. ...................................................................................................................... Therefore "integration" must be discussed with a novel approach. We have to look for a "Sri Lankan Model" in which our traditional culture is articulated. Since this existing model of integration is again biomedical system dominated and TRM is only a tail of the main body. Integration in such aspect does not mean equitable sharing or reciprocal flexibility. We need a win-win paradigm. What are the research areas of TRM in Sri Lanka? At present Bandaranaike Memorial Ayurveda Research Institute (BMARI) is conducting many research activities in different fields. The ongoing research plan is very much institute-specific and not well-focused on the priorities of the health sector. When we talk about integrated research there is no mechanism to assimilate in-sector institutes for this intervention. But there are many ongoing isolated researches carried out by various institutes which should be in line with national priorities. BMARI now started a research on chronic kidney failure prevalent in North-central Province which can be considered as a national need. Other than that diabetes mellitus, rheumatoid arthritis, vitiligo, psoriasis, gastritis, prostate enlargement, atherosclerosis are some of the ailments selected for ongoing research. My opinion is that current research plan should be revisited and dictated with sector-wide approach. Other significant limitation of ongoing research is that is not looking into indigenous knowledge at grassroots level. Since TRM is an Ethno-science we must liberate our research activities from top-down approach. A multidisciplinary research team should accommodate village level TRM practitioners as well. The outcomes of researches, as I suppose must be disseminated and substantiated for the practice. The ultimate objective of any research should be to introduce a "best practices" and transferred it to the grassroot level. What does TRM in Sri Lanka really needs today? No system is perfect. First thing to do is depoliticizing of health policies. Then evaluate the possibility of domesticate the global guidelines and international standards within Sri Lankan context is a must. Now the government policy is to encourage using all indigenous resources for development. Why not only for health care? TRM is on one hand is a people's system of medicine. Therefore granting the due place for TRM is establishing fundamental rights of the citizen to assure equal access to health care through any system. It is to be therefore protected as a national heritage by a special legislation. Government should take stewardship and encourage public-private sector partnership. It is a timely need to upgrade and update the existing legal provisions for strengthening the "equitable rights and harmonized responsibilities" in NHS. Any system is not created on its own sake. Every system must contribute only for the sake of people's health care.