At Bagerhat district healthcare complex, patients began to arrive for doctor's appointments, staff were ready with their entry books and so were doctors at their wooden desks to see patients, just like any other day.
But there was something different about a day in March this year. Among the approximately 250-300 patients, 50-60 of them wanted to meet Dr Monalisa Mushtereen, the ayurvedic medical officer of the healthcare complex.
"There is a saying that the doctor's words and empathy can cure a patient more effectively than medicines. In ayurveda and unani medicine practices, we emphasise on touch and sensory organs besides medicine, food habits and lifestyle.
"The way I talk to my patients, console them – maybe that's the reason the patients want to meet me," Monalisa said.
Monalisa was in Bagerhat for one month and in that month she "had a number of regular patients." She is now practising at the government ayurvedic and unani medical college hospital (GAUMCH) at Mirpur in the capital Dhaka.
Like Dr Monalisa Mushtareen, there are more than 400 alternative medicine practitioners (ayurveda, unani, homoeopathy) working in government hospitals and health clinics under the alternative medical care system of Bangladesh government.
And according to Bangladesh Board of Unani and Ayurvedic Systems of Medicine, currently there are more than 12,000 ayurvedic and unani doctors in the country.
A pandemic effect
The pandemic seemed to have triggered a surge in popularity of natural medicine among people. In a nutshell, naturopathy or alternative and traditional medicine is gaining popularity in Bangladesh. But why is that, especially when the pharmaceutical industry is doing really well?
According to the Bangladesh Export Promotion Bureau, in the 2018-19 fiscal year, Bangladesh exported medicines to a total of 147 countries, including Myanmar, Sri Lanka, Philippines, Vietnam, Afghanistan, Kenya and Slovenia. And the industry can meet 98 percent of its domestic needs.
When asked this question, Professor Dr Shwapan Kumar Dutta, the principal of the government unani and ayurvedic medical college, said, "In 2013, the World Health Organisation (WHO) had announced 'traditional medicine strategy 2014-2023' and the organisation has been working to implement the strategy among its member states.
"The Bangladesh government is also really supportive towards this practice. In 2015, the government had announced alternative medical care where ayurvedic and unani medical practitioners are appointed in public hospitals and health clinics."
Dr Monalisa mentioned the 2014 election manifesto of Bangladesh Awami League, where it was stated that infrastructural, institutional and technological facilities shall be increased to improve the standard of education on indigenous medicines including unani, ayurveda and homoeopathy.
"And the popularity grew even more during the Covid-19 pandemic," Dr Dutta said. When no conventional medicines were working, people were dying and the ones alive had to develop immunity through healthy habits rather than depending on supplements or medicine, naturopathy got popular.
Dr Hashi, ayurvedic doctor at the Bera Upazilla health complex of Pabna shared her experience. She said, "At the beginning people here didn't know about me. The conventional doctors also neglected me as if I was some kind of quack.
"The patients were sent to my chamber just like any other doctor would get a batch of patients. But with time, they came to know me better. Now the patients want to make appointments with me."
Although the board of unani and ayurvedic systems of medicine claims that currently 25 percent of the patients in the government hospital are taking alternative medicine service, there is not enough data to support this statistic. But still, it is evident that people are more open to this.
But does that mean naturopathy is a substitute to the conventional western medical treatments? Are we supposed to rely on natural medicine if being diagnosed with cancer?
Alternative or traditional medicine is not a substitute for modern medicine or allopathy
Dr Monalisa explained how in the naturopathy or traditional medical care, treatment is given to patients with chronic diseases like digestive problems, pain management, cardiac health, reproductive health, beauty and skin solutions, obesity management, and to some extent, psychological ailment. Treatment may include multiple medical systems such as ayurvedic, yoga, unani, homoeopathy, acupuncture, etc.
She said, "We never suggest any critical patient to take natural medicines and even if these patients come to us, we immediately refer them to conventional western medicine and doctors."
According to John Hopkins medicines, ayurveda treatment starts with an internal purification process, followed by a special diet, herbal remedies, massage therapy, yoga, and meditation.
Agreeing with the fact, Dr Monalisa said, "That's why it's a lengthy process and more of a lifestyle. For better health and life, you may depend on natural remedies rather than taking medicines for every trivial discomfort – headache, stomach pain or fever. But when you have a serious disease, you must meet specialists and doctors."
Natural medicines are not supposed to have artificial or synthetic chemicals in the formula
The day I met Dr Monalisa at the hospital, she was instructing a mother of a one-year-old on what kind of food to feed the baby and how. Coincidentally, the previous day, I had just finished reading 'Ichamati', a classic novel by Bibhutibhushan Bandopadhyay, where Ramkanai, the village Kobiraj or physician, stirred me the most.
I was amazed how he made traditional ayurvedic medicine using Indian laburnum or golden shower tree, ghee, honey and other components.
As I entered the medical college that day, I was expecting someone would be extracting flowers or seeds from the herbal and medicinal plant's garden in front of the college, preparing herbal and natural medicine.
"It doesn't work like that," Monalisa suppressed a smile and said. "Alternative or complementary medicine is standardised now. We have modern classrooms with proper diagrams and medical equipment, we study biochemistry and pharmacology and work in labs. You won't find mythological sages here."
And not just traditional ayurvedic, unani or homoeopathy, the ethnic communities in the hill tracts areas of the country have their own local medicinal plants and treatment. According to Bangladesh national herbarium's plant database, there are more than 700 medicinal plants that are used in these areas.
"It is true that natural medicine uses ingredients found in nature. We study their chemical components in the lab and prepare medicine with it. But we don't use synthetic chemicals in the medicines because that is illegal." Dr Dutta said.
But many fraudulent, unregistered brands are continuing this malpractice. Dr Dutta suggests the patients to check every medicine before taking. Bangladesh Association of Pharmaceutical Industries (BAPI) website has a list of companies and medicines. According to that list currently 204 ayurvedic, 285 unani medicine companies are making more than 7,000 medicines.
"You can easily check if the medicine is registered or not. Don't just fall for any advertisement, but consult a professional practitioner".
The patients are mainely converts, from modern to traditional medicine
For the last four days, Shwapna Akhter has been on bed no-4 on the first floor of the Government Unani and Ayurvedic Medical College Hospital. This young mother of a six-month-old came to Dhaka from Khulna last week.
She has been suffering from a problem in one of her joints and also vaginal discharge. "For the last six months, I have consulted a number of 'allopathy doctors' and had an enormous number of medicines. But nothing seems to work on me. And then someone in my village suggested I try natural medicine and treatment. That's why I am here."
Although she complained, "The doctors and nurses are irregular and you will not find a doctor when you need one. Most of the time the nurses are outside busy with their phones or gossiping and if you ask for something they misbehave." But still the treatment here is cheap and she thinks the medicines are working on her.
Professor Dr Masuda Begum, the dean of medicine department of BSMMU said, "It was in nature where humans have found these remedies. So we cannot neglect these medicinal studies. But that being said we also have to understand that we, the modern people, have much more complex diseases now. So we cannot rely on traditional medicine only."
She suggests consulting doctors before taking any medicine whether it is traditional or modern.
Agreeing with her, Dr Dutta also said, "Some of the products used in ayurvedic medicine contain herbs, metals, minerals, or other materials that may be harmful if used improperly or without the direction of a trained practitioner."
While Ayurveda can have positive effects when used as a complementary therapy in combination with standard, conventional medical care, it should not replace standard, conventional medical care, especially when treating serious conditions.