Subedi Bamdev
Medical Anthropologist, Kathmandu, Nepal. Doctorate from the Center of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India.
J Ayurveda Integr Med. 2024 Nov-Dec;15(6):100988. doi: 10.1016/j.jaim.2024.100988. Epub 2024 Nov 24.
Medical pluralism is a global norm rather than an exception. However, the kind of medical pluralism that exists in many settings is exclusionary and undemocratic. In many nations, medical pluralism has official acceptance, allowing both biomedicine and traditional systems of medicine a legitimate space into the formal healthcare system. However, traditional systems of medicine fall far behind biomedicine in terms of structural superiority and institutional strengths. Moreover, various forms of traditional medicine, particularly of popular variants, remain excluded from formal healthcare system, and a variety of traditional healers lack official legitimacy. Though conceptually medical pluralism sounds more or less equal standing of co-existing systems of medicine, the reality is that biomedicine enjoys a dominant status over heterodox medical systems. Upon examining the amount of budgetary allocation, number of health facilities, size of health human resources, educational institutions and research output, this paper reveals an overemphasis on biomedicine, overshadowing both scholarly and popular traditional medicine. This arrangement underscores the undemocratic and exclusionary nature of medical pluralism in the country. In light of the published data sources this paper examines the structure of medical pluralism and proposes measures that can contribute to advancing inclusive and democratic medical pluralism in Nepal.
医学多元主义是一种全球常态而非例外。然而，许多情况下存在的那种医学多元主义具有排他性和非民主性。在许多国家，医学多元主义得到官方认可，使生物医学和传统医学体系在正规医疗保健系统中都有合法空间。然而，传统医学体系在结构优势和机构实力方面远远落后于生物医学。此外，各种形式的传统医学，尤其是流行变体，仍被排除在正规医疗保健系统之外，而且各类传统治疗师缺乏官方合法性。尽管从概念上讲医学多元主义听起来或多或少是并存医学体系的平等地位，但现实是生物医学在非正统医学体系中占据主导地位。通过审视预算分配数额、卫生设施数量、卫生人力资源规模、教育机构和研究产出，本文揭示了对生物医学的过度强调，使学术性和大众性传统医学都黯然失色。这种安排凸显了该国医学多元主义的非民主和排他性质。鉴于本文所考察的已公布数据源，本文审视了医学多元主义的结构，并提出了有助于在尼泊尔推进包容性和民主性医学多元主义的措施。
