The five and half years’ course in Bachelor of Ayurvedic Medicine and Surgery (BAMS) was announced in a scholarship scheme in 2011 by the Ministry of Education. 15 slots were created in various fields such as Ayurveda, Sanskrit, Pali, Astrology, Fine Arts and Music, Naturopathy and Yogic Science in India.
Tshering Wangchuk, Karma Galey and two other batch mates are the first group to graduate with BAMS degree in June 2018. But much to their surprise, the course is not recognized and registered with Bhutan Medical Health Council (BMHC).
There are currently an additional 27 students who are pursuing similar courses which fall under alternative and complementary medical profession in country. Thirteen of the students are studying BAMS and are currently undergoing internship in India since it’s not applicable in Bhutan.
The students meanwhile approached all the responsible and relevant authorities for recognition and registration of the course since 2015. However, the proposal for the recognition of alternative and complementary medicine is still pending to be resolved.
The issue is that the alternative and complementary medicine does not fall under provision of medical categories as per the Constitution and BMHC Act.
“After investing five and half years in studying, it’s a frustration that our qualification is not applicable or recognized in the country,” said Tshering Wangchuk. He said the scholarship was offered by the government, and therefore, he’d hoped to practice his knowledge under the health ministry.
The graduates say that while the course is not applicable within the medical system in a country, however, the contents can contribute to a great need and improvement to the medical system. “60 percent of our content can be tallied with the content of MBBS,” the graduates said, adding, even if the facility and employment can’t be foreseen promptly, enabling a private practice for the graduates could be an interim solution.
BMHC stated the reason for the course not being able to register with BHMC is clearly due to lack of policy provision.
Registrar Sonam Dorji said that any medical and health professional practicing in the country has to, by law, be registered with the council. However, he said the Constitution mandates that the state shall provide basic modern and traditional medicine which doesn’t include alternative and complementary medicine.
As per the Chapter XI, Schedule I and II of Medical and Health Council Act, 2002 of Constitution empowers BMHC to recognize only three categories of medicine; that are Dentistry, Modern and Traditional Medicine.
“The other act of BMHC is that we don’t have alternative and complementary medicine clause where they could be registered.” He added the council cannot register or recognize the course unless there is an executive order from the Cabinet to put it in the schedule.
“One of our clause in our Act gives the power to the government, to add alternative and complementary medicine in the schedule,” Sonam Dorji said.
He said as per the act, the government can add or delete the clauses based on which the council requested for an executive order in order to formalize the profession. “We as a regulatory authority, our hands are tied, so we interpret the act word by word.”
System of Accountability
Department of Adult and Higher Education (DAHE)’s chief program officer of Scholarship and Student Support Division (SSSD) said the education ministry instituted the special scholarship at the approval of the Cabinet. “Accordingly the Department of Adult and Higher Education, as the focal agency for the implementation of undergraduate scholarships, had sent students.”
While questions on consultation with stakeholders and study of profession feasibility was kept silent by DAHE, BMHC Registrar Sonam Dorji said that initially the letter from and cabinet secretary has clearly written to DAHE being the department responsible to discuss with all the concerned ministries on the requirements and categories of professional needs and submit for approval to the cabinet secretary. “So we found that there was no mention of Ayurvedic medicine by the cabinet approval”.
“When these graduates came out, they reported to us following which we wrote to the ministry of education and health,” he added the health ministry has not been consulted.
On the accountability for the inefficiency, Sonam Dorji said, “As far as the council is concerned we feel that MoE is accountable. Health ministry should have been consulted since provision of health is responsibility of the health ministry,” further adding, “So at the end when the student came, this issue of passing, the bug emerged.”
“It should be clear that BMHC is not a policy, BMHC Act is the law of the country passed by the National Assembly”.
DAHE’s chief SSSD said that following the implementation of the scholarships, the department had made several requests to the MoH and BMHC for the recognition of alternative medicines and their practices in 2015 and 2017. “When the request made at the department level was not heeded, the matter was then taken up through the Secretary of Education with the Secretary of Health and then by the Minister of Education with the Minister of Health,” said the SSSD chief.
After coming to know about the issue, BMHC said it has revised the act to be presented in the form of a bill. “So the draft is prepared but then the government has to change the approach or policy and once the bill becomes an act they will be recognized as a doctor but the question is; will they be employed?”
Even if the policy sees a change, the Registrar said the big question remains, if the government will employ or let the graduates to take up private practice. “The only sector that they can be employed, by virtue that is being related to health and medicine, is MoH.” He added that currently, the health ministry policy doesn’t allow for private practice.
He said during the previous government’s time, BMHC wrote to the cabinet along with ministry of health to which MoH highlighted that the percentage of GDP that is being allotted to the health is not even enough to cover the modern allopathic or traditional medicine, for which the ministry won’t be able to absorb any alternative or complimentary medicine in the formal system.
He said another issue is that the medicine act allows for registration of only allopathic medicine and a modern herbal medicine in case of herbal. “So almost all the legislative tools doesn’t allow.”
DAHE said that having exhausted all means at the department and the ministry levels in trying to negotiate with the ministry of health and BMHC for the recognition of alternative medicines from 2015 onwards.
“Though the MoH had submitted the proposal for approval to the cabinet, no directives were given then as it was towards the end of the then government’s term”.
He said soon after the new government was formed, the proposal for the recognition of alternative and complimentary medicines was once again re-submitted to the Cabinet.
Following this, the Cabinet on 25 January 2019 had directed the MoH to deliberate with BMHC on the possibility of registering the professionals of alternative and complementary medicines for recognition after enabling the graduates to compete in Bhutan Civil Service Examination along with three choices that are MBBS, Bhutanese traditional medicine or general graduates for employment.
“They will be allowed to sit for RCSC, but they won’t be allowed to practice their profession as a doctor, but placed in the health sector in program division”. “For that we have nothing to say but will the RCSC allow it ?” Registrar Sonam Dorji pointed out.
To sit for the RCSC exam, the graduates will have to submit the statement of marks and the authenticity of certificate.
While BMHC can’t register the course, Sonam Dorji questioned that without BMHC giving the registration, the graduates will be allowed to sit for the MBBS exam but will not be working as an Ayurvedic doctor.
“And another thing is even to sit for RCSC, they have to register with BMHC, so which one should we do early is now a big question. And for that we need to seek directives from the government.”