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Ayurveda is of Vedic origin and believed to have originated in the
second millennium BC, probably in the land between present-day Pakistan
and Iran (Kumarasingha, 1981). The traditions and teachings of
Ayurveda entered Sri Lanka with the arrival of Aryans and developed
steadily through continuous contact between India and Sri
Lanka.
Since its establishment in Sri Lanka, Ayurveda and traditional
medicine were practised together probably with the same patronage, but
seeking the higher level of Ayurveda when needed. In the civilisation
of early Anuradhapura period the physician was considered as an important
professional. During this period a notable feature of civilisation was
the importance attached to the establishment and maintenance of hospitals
for the treatment of sick. Among kings of ancient Sri Lanka King
Buddhadasa (circa 337-365 B.C) was reputed to be a skilful physician and
have appointed a physician for every ten villages. (Paranavitana, 1959).
This tradition continued throughout the ancient and modern history and by
the time of arrival of Western medicine there was a well established
health care delivery system in Sri Lanka (Ramanayake, 1985).
Antibiotics are not mentioned in the Ayurvedic medical literature, but
some of the mixtures used in the are definitely antibiotic in nature
(Silva, 1991).
Indigenous medicine was considered weaker by the Western educated
and urban populace with the introduction of Western medicine in Sri
Lanka, but British rulers knew of the value of herbs and kept the
traditional medicine under observation and control. However the
dedication of few highly qualified specialists, managed to save the core
of the traditional and Ayurvedic medicine (Gnanawimala, 1950). The
continuing struggle of the organised group of activists was successful in
the establishment of the Department of Indigenous Medicine even before
independence (Ramanayaka, 1985). Establishment of Ministry of Indigenous
Medicine, Institute of Teaching and Research in Indigenous Medicine and
registration of indigenous medical practitioners have enhanced the value
of traditional and Ayurvedic medicine among the local populace and
foreigners. Today it is estimated that more than 40 percent of the total
out patients registered daily, use indigenous medicine related services
and among poor the percentage may be as high as 60 percent (Kannangara,
1962).
Inability of the Western system to provide a proper health care
service, and fear of side-effects from many types of Western drugs have
driven even many Western educated and people of Western origin away from
Western medicine in the past decade. As noted in the survey Siddhalepa,
which is a traditional medicinal preparation, used as a painkiller and
pain reliever has more sales than the combined sales of similar
medications of Western origin. Therefore, today the traditional medicine
and its impact are higher than in any other time in the modern history of
Sri Lanka.
Indigenous medicine has been and will be the most important
health service system at first referral level for most of the poor until
their economic status is elevated and for the rest of the richer classes
it is to be used in the times of special need. Recent modernisation of
herbal preparations have actually led to an increase in popularity of
indigenous medicine and associated treatment systems (Ekanayake et al,
1989).
The main objective of this study is to carry out a comparative
study of the importance of indigenous health service system in a new
frontier farm settlement (Mahaweli System 'C' - established in 1981-1987)
and their respective old established home villages. It is clear that
indigenous health service system plays a vital role in the health status
of respondents as they depend heavily on it for most of the ordinary
cases of ill health. The evolution of indigenous health system in the
study areas and its impact on the health status is studied under the sub
topics of preventive and curative health care. The home villages are
located in Badulla, Teldeniya, Ratnapura, Mawanella, Yatiyantota,
Mirigama and Nikeweratiya, which belong to the traditionally developed
wet zone of Sri Lanka. The villages of the new settlement (Nuwaragala,
Paludeniya, Mudungama, Ridee ela, Rathmalkandura, Sandamadulla and
Belaganwewa) is located in the dry zone which was opened to development
between 1981 and 1987, under the Mahaweli Development programme.
INDIGENOUS health services are located and developed in
association with the growth of a settlement by its operators and very
rarely they are established by the government under a programme of health
care delivery. This is basically a result of choice of people and
preference of authorities to keep Western medical services as the major
form of outpatient treatment, because inability of the indigenous medical
services to provide a universal health care and universal acceptance of
the Western health care as the modern scientific system of health care
(Table 1).
| Type of
Practitioner | Mahaweli System C | Home villages |
| Local Ayurvedic physician |
56 | 21 |
| Local Ayurvedic
Dispensary | 13 | 14 |
| Renown specialist | 00 | 06 |
| Ayurvedic Hospital | 00 | 01 |
| Traditional Physician | 13 |
45 |
| 'Edura' * | 18 | 13 |
*'Faith healer'
Source: Field Data
Resource inequality is consistently found within developing
countries, especially in terms of health service facilities. In Sri Lanka
urban areas have more health resources than rural areas as in any other
developing country (Navarro, 1994). This is basically a result of the
existing distribution of goods and services, which are often controlled
by the age of settlement. Old established settlements of home villages
have a well-established health service resource system than new
settlements of Mahaweli System 'C'. The Chi square value of 71.4 with
five degrees of freedom confirms well the existing difference between the
two areas, which is significant at 99.9 percent level.
THE DISTRIBUTION of traditional health services available to
Mahaweli System C settlers is shown in Table 2. 'Edura' and traditional
medical practitioner in Mahaweli System C area are farmers by occupation
but practise their medical service as a part time occupation. Ayurvedic
physicians have come from outside the resettlement area and have
established their clinics in town centres at Girandurukotte, Lihiniyagama
and Siripura. Government dispensaries of the Ministry of Indigenous
Medicine are located at Girandurukotte and Lihiniyagama, which are
patronised by a few. These services are skeletal and seasonal in nature
as some of the 'eduras' and traditional practitioners travel to home
villages during the dry season periods and no specialities are available
other than for simple fractures. For all the other requirements in the
traditional health services, the respondents travel to Mahiyangana, Kandy
or their hometowns. Therefore service status is still in its infancy as
common to any newly settled area in Sri Lanka.
Traditional health services are at an advanced level of operation
in home villages with all types of facilities available to the user. On
the basis of number of contacts made by respondents there are nine times
more facilities at home villages than in Mahaweli System C (Table 3).
Ratnapura, Mirigama and Mawanella recorded the highest percentage of
units, which could be explained by the existence of highly developed
local traditions in these areas. Rest has low density of practitioners
and service units, mainly due to distant location from well known
traditions in indigenous medicine.
| Mahaweli System C village | Government
Dispensary | Edura | Traditional practitioner | Ayurveda
Physician |
| Belaganwewa | 1 (Lihiniyagama) | 2 | 1 | 1
(Lihiniyagama) |
| Sandamadulla | 1 (Girandurukotte) | 1 | 2 | 1
(Girandurukotte) |
| Redeeela | 0 | 0 | 0 | 0 |
| Rathmalkandura | 0 | 1 | 0 | 0 |
| Mudungama | 0 | 1 | 1 | 1 (Siripura) |
| Paludeniya | 0 | 1 | 0 | 1 (Siripura) |
| Nuwaragala | 0 | 1 | 1 | 1 (Siripura) |
Source: Field Data
| Home Village | Ayurvedic Physician | Government Ayurvedic
dispensary | Renowned specialist | Ayurvedic
hospital | Traditional practitioner | Edura |
| Badulla | 5 | 2 | 1 | 0 | 3 | 2 |
| Teldeniya | 3 | 0 | 0 | 0 | 5 | 3 |
| Ratnapura | 8 | 5 | 2 | 1 | 10 | 5 |
| Mawanella | 9 | 3 | 2 | 0 | 16 | 2 |
| Yatiyantota | 4 | 0 | 0 | 0 | 4 | 3 |
| Mirigama | 11 | 3 | 3 | 1 | 33 | 10 |
| Nikaweratiya | 2 | 0 | 0 | 0 | 6 | 3 |
Source: Field Data
Kinship connections inherited practices and the level of modernity
of the people always affect location of indigenous health
services. Normally, indigenous medical practitioners tended to
concentrate in the older, higher density residential areas and also in
the urban areas, where Western health care system cannot cope with the
demand fully. Further, the specialist traditions, government policies and
political influences can lead to the concentration of facilities in
certain selected areas than in the rest. Mirigama, Ratnapura and
Mawanella have large number of indigenous health service units due to
their association with one or many of the above mentioned
factors.
The pattern emerging from the data given in Table 2, show the
availability of more facilities in old units such as Belaganwewa and
Sandamadulla compared to the rest, which were settled later. These
patterns were identified by Navarro, (1974) and Ramesh and Hyma,
(1981) in Latin America and India respectively.
THE AYURVEDA system is a very important element in health care
delivery system of Sri Lanka, but its spatial distribution may vary from
one area to the other as it operates mainly through private clinics and
dispensaries. In addition the existence of some notable Ayurvedic
doctor family traditions have influenced the distribution pattern of
these services. Most clinics and dispensaries are located in the house of
the practitioner with a branch at the town centre. Graduates of College
of Indigenous Medicine and Ayurveda specialists of Gampaha, Keraminiya
and Sabaragamuwa traditions are the major operators identified in the
study areas. Most of the practitioners used a mixture of both ayurveda
and Western as it is practised in Sri Lanka today, but the use of Western
drugs is limited to use of antibiotics at emergencies and some general
pain killers.
INDIGENOUS medicine is based on herbal mixtures and different
types of 'power' sources. Comprised mainly of the local physician and the
spiritual healer, the traditional treatment system is a mixture of many
ancient systems of treatment, which is taught to the apprentice only on
the basis of inheritance or friendship. Sometimes a document or a
narration will give the basic elements of the treatment and today the
materials required for treatment are partially obtained from gathering
and mostly from a drug manufacturer (Wanninayaka, 1982). The two variants
of the treatment system, the preventive and curative care are identified
here for a detailed investigation.
HOME REMEDIES are mandatory in preventive care in both
traditional and Ayurvedic medicine. They appear in many forms and are
used concurrently with all types of medicine as an aid or activator for
the main course of treatment. Knowledge of the home remedies is normally
transferred by hearsay from one generation to the other and is preserved
in the minds of family elders who become the major agents of preventive
medicine in the indigenous medical care system. In recent times the
commercial scale production of home remedies has led to a much wider use
of them by all the respondents in all of the study areas (Table 4). Today
ingredients for most of the home remedies are either bought from the shop
or obtained from the Ayurvedic practitioners as the technique of growing
of medicinal plants and herbs has been destroyed or pollution has
restricted the growth of them to few areas of the country. Modernisation
and commercialisation of traditional and Ayurvedic medicine in the recent
past have produced packed instant drinks and mixtures which are used
freely as home remedies by almost everybody. Samahan, Peyawa, Kasaya Pack
and Siddhalepa are the trade names available in any part of the country
at any time and heavily used as remedies for all types of ailments and
sicknesses.
Regular use of home remedies is an integral part of life among
rural poor, especially for minor ailments, cold, running nose, sprains,
arthalgia and arthritis. Some home remedies are even taken as food in the
form of porridge, vegetable and food-drink. It is the belief of the
respondent that taken at the precise time and adhered to advice most
sicknesses can be controlled successfully if not totally by the use of
home remedies. Therefore most of the respondents have used home remedies
when needed than on a regular basis.
| Commercially available home remedy | Mahaweli System C | Home
villages |
| Samahan | 100 | 100 |
| Peyawa | 85 | 100 |
| Siddhalepa | 65 | 82 |
| Oils | 36 | 49 |
| Arishta | 20 | 35 |
| Pastes | 13 | 22 |
| Kasaya packets | 84 | 94 |
Source: Field Data
MAHAWELI System 'C' respondents have used indigenous
medicine for 13 different types of diseases and sicknesses including
fractures and general weakness. 94 percent of the time this treatment was
carried out by the specialist at home villages and locally available
practitioners or specialists at Mahiyangana, Polonnaruwa or Kandy
attended to the rest. At home villages 40 percent of the respondents went
for treatment at the indigenous medical practitioner for six major
sicknesses and diseases. Fractures, general weakness, disability,
paralysis, arthritis and skin rash were treated by these practitioners
successfully and in all other cases they were used as first referral
level or helpers (Table 5). The ability to treat fractures by the
indigenous medical services has been noted even by Western biomedical
treatment system. Four patients with fractures were advised by their
Western doctors to obtain services of the indigenous medical practitioner
for a better and faster care. Therefore all minor cases of fracture and
sprains were treated directly by the indigenous medical practitioner and
hospital treatment was sought only at times of requirement of surgery or
medical certificate. In here patient returned to the indigenous medical
practitioner after the surgery or receiving the medical certificate. In
terms of general weakness, aged preferred the indigenous medical services
to Western biomedical treatment. Fear of the side effects of pain killers
were noted by the aged as a reason for taking indigenous medical
treatment for most of the common illnesses and sicknesses. In all the
other cases it was the failure of Western biomedical system, which guided
the patients to return to indigenous medical practitioners and be
cured. The reasons for the failure of Western biomedical system are not
clear, but according to most of the respondents wrong diagnosis was the
major factor for the failure.
Generally, respondents are satisfied with the services of
indigenous medical practitioners, other than for a few who have operated
without proper qualifications and caused hardship to them. Two and six
respondents at Mahaweli System C and at Home villages respectively, had
serious complaints against indigenous medical practitioners but they have
not regarded it as a reason for rejection of the total system of
indigenous treatment service. Therefore 75 percent at Mahaweli System C
and 86 percent at Home villages used the indigenous medical services when
needed. It is clear that there is a marked difference between the two
study areas as the Chi square value obtained was significant at 99.9
percent level.
| Ailment, sickness or disease | Mahaweli System C | Home
Villages |
| Respiratory problems | 14 | 23 |
| Urine infection | 00 | 20 |
| Paralysis | 00 | 23 |
| Arthritis | 29 | 50 |
| Disability | 23 | 43 |
| General weakness | 42 | 50 |
| High blood pressure | 17 | 61 |
| Diabetes | 00 | 33 |
| Goiter | 00 | 33 |
| Cancer | 00 | 25 |
| Ear, Nose and Throat | 06 | 25 |
| Skin rash | 20 | 40 |
| Fracture | 88 | 85 |
Source: Field Data
As shown in the data a higher percentage of patients have sought
help from indigenous health services, for many degenerative diseases like
high blood pressure, diabetes, goitre, cancer, arthritis and
paralysis. This is a result of availability of renowned specialists who
have had more success in controlling the severity of these diseases than
curing them as none of the patients with above mentioned diseases have
been completely cured up to today.
INDIGENOUS medicine has sustained a healthy nation other than at
times of epidemics of infectious diseases throughout the history of Sri
Lanka. Communicable and infectious diseases have always posed a serious
threat to the credibility of indigenous medicine but it has managed to
stay on as a major supplier of health services throughout history. Today
with the loss of many documents, traditions and beliefs associated with
the treatment system, the indigenous medical service system is faced with
a problem of survival against the challenge of Western
medicine.
There is a marked difference between the two study areas in terms
of availability and utilisation of indigenous medical services, which is
a result of age of settlement as shown by the Chi square analysis of data
(Appendix A). As expected there is no significant difference between the
areas in the use of home remedies, but the percent used indigenous health
facilities were definitely higher in home villages than in Mahaweli
System C.
Various treatments of the indigenous medicine are heavily used at
various levels of preventive and curative care. The pattern or system of
utilisation is not direct, but common as it is used, at all referral
levels, without any clear order and purely based on need and advise given
by the elders. Most of the minor ailments and sicknesses were treated
first by indigenous medicine and if symptoms persist a Western medical
practitioner was visited either at the hospital or private practice. In
case of serious sickness and disease, almost all the respondents have
consulted the Western medical practitioner as their first referral level
and if the treatment was not successful, they return to the specialist
indigenous practitioner for re-treatment. The cases of cancer, goiter and
paralysis have shown this type of changed treatment and have had some
success with the change of treatment, but at the time of survey none of
them have been cured by traditional medicine.
Pluralism in medical services of Sri Lanka was clearly shown in
the data of the study areas. Indigenous medical service at its present
level of operation is definitely weaker than its Western counterpart in
many areas of action notably in the area of infectious and modern
communicable diseases. However the indispensable role of indigenous
medical services in preventive and curative care in the study areas can
never be ignored.
Appendix A
| Variables | Chi Square | Level of Significance |
| Types of practitioners | 89 | 99.9 % |
| Use of home remedies | 20 | not significant at 99.9%
level |
| Treatment by indigenous medicare | 213 | 99.9% |
Appendix B
A. Accessibility Equation
A = d · h/t
A = Accessibility
d = mean distance to hospital
h = number of hospitals available
t = time taken to travel at under normal conditions or cost of travel
under emergency situations.
B. Priority Group Identification
| High Priority | Medium Priority | Low Priority |
| Malaria | Respiratory | Jaundice |
| Viral hepatitis | | Dysentery |
| Diarrhoea | | Urinary tract infections |
| Chickenpox, Measles, Mumps | | |
Appendix C
| Factor of Comparison | Chi-square | Degrees of
freedom | Significance level |
| Income level | 8.5 | 2 | Not significant |
| Mean risk level of the living
environment | 116.6 | 4 | Significant at 99.99% |
| Occupational structure of
respondents | 100.8 | 7 | Significant at 99.99% |
| Disease panorama-outpatient
treatment | 408.3 | 8 | Significant at 99.99% |
| Disease panorama-inpatient
treatment | 67.4 | 8 | Significant at 99.99% |
| Priority grouped diseases at
outpatient | 106.0 | 2 | Significant at 99.99% |
| Priority grouped diseases at
inpatient | 55.8 | 2 | Significant at 99.99% |
| Morbidity by age group | 144.8 | 2 | Significant at
99.99% |
| Morbidity by sex - male | 73.4 | 2 | Significant at
99.99% |
| Morbidity by sex - female | 106.1 | 2 | Significant at
99.99% |
| Alcohol consumption | 3.1 | 2 | Not significant |
| Types and sources of treatment | 132 | 9 | Significant at
99.99 % |
| Sources of information on health | 56.1 | 6 | Significant
at 99.99% |
| Adherence to advice | 8.7 | 3 | Not significant |
| Types of indigenous medical
practitioners | 41.8 | 3 | Significant at 99.99% |
| Accessibility | 31.9 | 3 | Significant at 99.99% |
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