By Asmita Wele
(Journal of Ayurveda and Integrative Medicine)
Current status of Ayurveda in Hungary
A former Hungarian diplomat who worked in India for a long time, established a company ‘Garuda Trade Limited’ in 1990 to market Ayurvedic products in Hungary. He organized series of lectures by Ayurvedic scholars with support from Dabur India Ltd. Later in 1996, he founded the Hungarian Ayurveda Medical Foundation and envisaged a 30 year program for promotion of Ayurveda in Hungary [1].
The Ayurveda medical system was officially recognized as part of Naturopathy in 1997 by the Hungarian Government [2], [3]. This regulation allowed trained Hungarian medical doctors to practice Ayurveda medicine. Earlier, Traditional Chinese Medicine and Homoeopathy were introduced in Hungarian universities at Szeged, Pecs, Miskolc and Debrecen, but Ayurveda was not much known. As an effort to popularize Ayurveda, many copies of Indian Materia Medica were distributed to Hungarian government officials, hospitals, medical universities and scientific centers. CAM centers of the Faculty of Public Health of different Hungarian universities at Szeged, Pecs, Miskolc, Nyiregyhaza started offering short courses on Ayurveda. Private organizations like Maharishi College from the Netherlands also started few courses and training programs. Indian government facilitated training courses on Ayurveda massage and beauty treatments for experts from Hungarian thermal spas. The Indian Embassy organized series of lectures under the theme ‘Ayurveda for All’ to promote interest amongst doctors, medical workers, vets, students and common people.
The first international conference on Ayurveda organized in 2001 at Budapest, was attended by over 500 participants from India and 14 European countries. The Governments of India and Hungary prepared an ambitious plan of co-operation in 2008 to promote Ayurveda not only in Hungary but also in the central and eastern Europe [4].
The Government of India established AYUSH center at the Indian Embassy of Budapest in January 2014 [5]. Ayurvedic consultations are offered to public at the AYUSH clinic at Embassy. AYUSH days are celebrated twice in a year. The Indian Embassy of Budapest has taken substantial efforts to promote Ayurveda by organizing various events, interviews of Ayurvedic vaidyas on Hungarian television, commissioning articles on Ayurveda, Yoga and nutrition in local newspapers. All this has helped to increase visibility of Ayurveda in Hungary.
In 2014 a conference ‘Ayurveda in the spirit of Integrative Medicine’ was organised by Traditional Indian Medicine for the Public Health in Hungary Foundation (TIMPHHF). It was founded by the former Prime Minister of Hungary, H.E. Dr. Peter Medgyessy to address health issues like alcoholism, depression and ageing in the Hungarian population by complementing Ayurveda to conventional system of European medicine. A Secretarial delegation consisting of officials and experts from Department of AYUSH, Ministry of Health and Family Welfare, Central Councils and national institutes witnessed signing of MoU for establishment of Ayurveda Chair at the University of Debrecen [4]. Renowned Ayurveda scholar Dr Madhav Singh Baghel was appointed as first Chair Professor. This initiated an exciting phase of systematic promotion of Ayurveda in Hungary.
Status of clinical practice
Hungarian conventional medical system is very well established and covered under social security system of the country. However, it faces a challenge due to the increasing burden of ageing population suffering from geriatric diseases along with non-communicable diseases (NCD). Alcoholism, depression at the beginning of early middle age, changing food habits of younger generations, late onset of parenting leading to infertility issues are some of the reasons for local medical community to search Ayurveda and other oriental medicines for answers. Long delays to access the doctors and diagnostic tests due to shortage of skilled human resource are reason for commoners to approach Ayurveda and other complementary systems.
Since the early nineties, Ayurvedic clinical practice in Hungary is associated with the Yoga schools, organizations like ISKON or Maharishi Ayurveda Foundation. It mainly consists of advice related to diet and lifestyle management. Ayurvedic consultations are offered through visiting vaidyas from various parts of India. The patients are treated for skin diseases, allergies, arthritis, cancer and many chronic complaints using locally available food supplements and products purchased on internet.
Calendula Center situated on the shores of Lake Balaton in Siófok nearly 80 km away from Budapest is one of the largest private Ayurveda clinic that offers wellness services and treatment consultations [6]. It has Kerala massage, Yoga and a kitchen to provide Ayurvedic diet to the patients. The center has its medicinal plant growing farm and manufacturing unit. The pharmacy has about 2000 plants and 400 formulations and has registered 14 Ayurveda based products for sale in Hungary.
Another prominent clinical facility is the Bio-energy Center in Budapest. It is a well-planned, well-equipped center with consulting rooms, Panchakarma therapy rooms, Yoga halls, antenatal care session room, conference hall and cafeteria. Currently, about a dozen medical doctors practice Ayurveda as per Hungarian law. They have formed an association known as Hungarian Ayurveda Scientific Association of Ayurveda. They act as an interface between local community and policy makers.
Under the present law (40/1997 Government Decree and the 11/1997 NM Order) Ayurveda can be practiced by medical doctors only; hence separate registration for Ayurveda practitioners may not be necessary. Ayurveda education to train medical doctors in line with Hungarian model is being proposed by Italian [7] and German organizations. Apart from the medical doctors, there are individuals who practice Yoga and Ayurveda under the cover of therapist with neither proper medial background nor training of Yoga and Ayurveda. They also offer short courses in Ayurveda and Panchakarma along with treatments. Such practices pose threat to scientific nature of Ayurveda.
Ayurvedic products in Hungary
Ayurvedic products entered Hungary through the company Garuda Trade limited in 1991. In accordance with the Hungarian law at that time, about 100 Ayurvedic medicinal and cosmetic products of companies like Dabur India Ltd, Baidyanath Ltd. Kolkatta were registered under the category of food supplements. At present, products of Himalaya Herbal Health ltd., Maharishi Ayurveda, U. Muniyal and Company, Emami Pharmaceuticals, Arya Vaidya Pharmacy and some others are available in the market as health and food supplements. Product availability suffered a setback due to the EU regulation regarding herbal products. In an effort to register their concerns to EU regarding the impending implementation of EU regulation of Traditional Herbal Medicinal Products Directive (THMPD, 2001/83/EC as amended), a two-day meeting of European and Indian Ayurvedic experts was organized by the Indian Embassy in association with the European Ayurveda Association (EUAA) with the support of the Indian Department AYUSH (Ministry of Health and Family Welfare, Government of India) in Budapest in 2010 [8]. The meeting was attended by EU officials from Brussels. However, the directive is in force and Hungary strictly adheres to the EU regulation.
Hungary also experienced a bad taste of affairs because the terms Ayurveda, Ashwagandha and Shilajit were found registered as trademark by a company, in Hungarian Intellectual Property Office (HIPO).
The biggest challenge is to register and market traditional multi-ingredient Ayurvedic products. Along with other European nations like Germany and Italy, Hungary is supporting Non-Conventional Medicine (NCM) or Anthroposophic medicine. To co-ordinate the activities, The Hungarian Ayurveda Medical Foundation recently came up with an initiative called Ayurveda Coordination Centre of Europe (ACCE) [1], which is an online database of Ayurvedic organizations, products, licensing authorities, legal background and customs rules with regard to Ayurvedic products in European countries. Apart from the pharmacy at Calendula Center, no pharmacies manufacture Ayurvedic or herbal products in Hungary.
Establishment of Ayurveda Chair
University of Debrecen has already taken some initiatives to offer Ayurvedic courses under the umbrella of CAM. Prof. Dr. Gyorgy Blasko had prepared a comprehensive course structure for the students of UD in 2009. A major breakthrough for officiating and integrating Ayurveda with mainstream medicine began with signing of the MoU for setting up an Ayurveda Chair in the Medical School of University of Debrecen in November 2014, as stated earlier [4].
Ayurveda Chair at University of Debrecen (UD) commenced in 2014, under the able leadership of Dr. M S Baghel to propagate authentic Ayurveda in Hungary. The Chair is expected to work to develop a structure whereby visiting faculty members would be able to come to the school for teaching. The Chair has been instrumental in signing MoU with Gujarat Ayurveda University and National Ayurveda Institute of Jaipur, for the purpose of collaboration regarding academic, research and clinical expertise support.
Dr. Asmita Wele is working as Chair professor from 2017. The Chair has recently initiated credit courses by complying with the requirements of medical education department of UD. Eligibility is set for medical, dental and pharmacy students who have completed pathology and pharmacology subjects in MD course, with a batch size of 25 students. Two batches have completed the course titled ‘Introduction to Ayurveda and Integrative Clinical Practice’. The third batch of 50 students is underway.
Like other European countries, medium of instruction of higher education is Magyar (Hungarian). At UD, the medical course is taught in both Magyar and English. Although English is the second language from school; local students face its challenge and hence lectures need to be translated by an interpreter from English to Hungarian. Similarly public lectures are also translated.
The library of the Ayurveda Chair in UD consists of 500 volumes of reference books, journals dedicated to Ayurveda, volumes of Ayurvedic Pharmacopoeia and textbooks in English language which are procured from CCRAS. Apart from this Hungarian Ayurveda Medical Foundation, Budapest has a library of over 900 books on Ayurveda and a systematic record of invited lecture series. During 2003 and 2015, a total of 13 postgraduate dissertations were concluded at various universities on Ayurvedic massage therapy, cosmetics and herbal veterinary products. More than 20 books are translated in Hungarian language, mostly on the concept of wellness or self-help. Hungarian version of the book ‘Ayurveda Unraveled’ authored by late Dr. Sharadini Dahanukar and Dr. Urmila Thatte with the title ‘Ayurveda Mindenkinek’ was published by the support of Embassy of India to Budapest. Another popular book authored by Prof. Subhash Ranade et al. titled ‘Ayurveda and Wellness - The Ayurvedic massage (Ayurveda és a Wellness – Az ayurvedikus masszázs) is also available.
Apart from UD- Medical school, one more university from Hungary -University of Miskolc (UM)- Faculty of Health has started a 2 year diploma course approved by the Hungarian Governmental Agency of Educational Affairs (Oktatási Hivatal). Ayurveda Chair at UD is instrumental in the advisory capacity to develop syllabus and evaluation patterns of this course. The course, extended to 4 semesters having 120 credits commenced on February 10, 2017 for nursing and physiotherapy students. It has successfully completed two semesters.
The Ayurveda Chair and International Center of UD have earned an Erasmus grant for teacher student exchange program, recently. The exchange of Ayurveda and modern medicine student and teacher will happen soon. It would also facilitate strengthening of existing Ayurveda Chair operations.
Initiatives regarding research
The Vice Chancellor (Rector) of UD, Prof. Zoltan Szilvassy, is a very eminent medical doctor and scientist holding the prestigious Doctor of Science, title. With over 100 research papers to his credit in PubMed, he has been studying the effects of various molecules on cardiovascular and nervous systems and diabetes. He and his team could successfully increase bioavailability of curcumin in human system and yet it could not show efficacy. To their astonishment, bioavailability of curcumin increased with administration of whole drug rather than the isolated active molecule and it showed effects in all three systems with which they are still working. A pilot clinical trial on Hungarian fenugreek has shown encouraging results. Thus, Prof. Szilvassy has keen interest in the scientific research on Ayurvedic products and concepts. Due to his initiative, a research project in the area of drug development i.e. specific therapeutic nutraceutical has taken a good shape. The areas selected for the purpose are allergies, insulin sensitisation and immunomodulation. UD is in a position to extend the fenugreek experience to nutritional food products, based on Ayurvedic concepts. Effect of snehan, swedan and virechan on allergies have been studied by another physician clinically. Professors and PhD students from department Psychology are interested and have studied a little on some aspects of Prakriti.
Apart from a major drug development project, the Chair has initiated two research projects that deal with basic concepts of Ayurveda. A project titled ‘A study of Health status and Constitution (Prakriti) of the middle age and elderly population in Nyiregyhaza’, in a township nearby Debrecen is being executed by The Faculty of Health UD. The second interdisciplinary project in collaboration with Faculty of Public Health titled ‘To assess health seeking behavior of university teachers and students’ which is in pipeline. Results of these projects will form the basis for a grantable project on concept of Rasayana formulations.
European Institute of Ayurvedic Sciences
Ayurveda and modern medicine both have their strong and weak points. Starting with integrative approach, a balanced confluence of ancient wisdom and new knowledge having vibrant technology would be charting a new path. To further advance academic, clinical and research activities; UD with a strong support of the present Hungarian government signed the MoU of establishing European Institute of Ayurvedic Sciences (EIAS), with CCRAS, Ministry of AYUSH, Government of India. To mark the occasion a symposium titled ‘Evidence Based Ayurveda: Integration in Research and Clinical Practice’; was organised jointly by the university and Ministry of AYUSH in Debrecen for Medical Doctors. Padmashri Vaidya Rajesh Kotecha, Secretary Ministry of AYUSH and Vaidya K. S. Dhiman, Director General of CCRAS, delivered speeches regarding opportunities of collaboration with AYUSH for education, research, practice and products. Eminent Ayurvedic clinician Dr. G. Geetha Krishnan from Medanta Center, New Delhi and acclaimed Scientist Prof. Bhushan Patwardhan enlightened the medical community at UD regarding models of successful clinical and research integration during the symposium.
At EIAS Hungary, three tiers of courses are proposed; introductory credit courses at graduate level to sensitise medical, dental, pharmacy and health science (nursing, physiotherapy, psychology, public health) students, master level courses for nursing, physiotherapy, nutrition branches and a postgraduate diploma for MD general physicians. The process of approval of the postgraduate diploma program of Ayurveda through Hungarian National Education Council or Ministry of Human Capacity Building is underway. To maintain the quality of education, textbooks and manuals will be prepared to suit the need of students. They will also be translated in Hungarian.
The objectives of introducing specific courses to different branches is with a vision of establishment of necessary structure required to operate the whole system of Ayurveda medicine. Additional advantages offered by these courses for graduates other than medical doctors is an opportunity to become lifestyle consultants, skilled assistants at old age homes and rehabilitation centers. They can also become independent practitioners to cater to the needs of geriatrics population and can offer their services to health tourism and wellness industry that already exists in Hungary.
Along with the courses, establishment of a clinical facility at UD in collaboration with internal medicine unit is very much a part of EIAS plan. Integrative clinical training under joint supervision of modern medical doctors of respective specialities from UD and Vaidya specialists from India will be imparted as a part of the curriculum. Clinical research on impact of therapy based Ayurveda treatments and pharmacological research is envisaged with development of a modern pharmacy unit to maintain quality production of Ayurvedic products. Collaboration with Agriculture Faculty of UD to assess possibility of growing essential Ayurvedic plants has been initiated. Joint efforts by the chair and head of Food Technology branch to develop or alter conventional foods like pasta, based on Ayurvedic concept of nutrition has cleared first step.
Initiation of a comprehensive collaborative PhD program in areas of drug development and clinical research, in near future is also a part of EIAS vision.
Challenges and way ahead
Hungary is a central European country having historical ties with India. It boasts of family oriented social systems, agriculture based economy, rich cultural and scientific heritage but maintains low profile in the European political situation. The overall culture shows more similarity with Indian culture than any other countries in Europe. Therefore, to exercise the core concept of Ayurveda ‘localization’- to make it suitable to people in the environment they live- and balancing between globalization and localization is possible. People are sensitised to Ayurveda and they wish that Ayurveda should be brought to them from authentic sources like universities [9].
Hungarian healthcare system has identified the need to incorporate health traditions into the lives of its people. They have identified Ayurveda as a potential science having both components medicine and healthy lifestyle. However, the challenge of taking it beyond religion and protecting from quackery needs attention.
Initiative by UD to integrate Ayurveda into modern medical education, beginning with short term credit courses and postgraduate diploma courses, certainly is the right direction [11]. Development of course material like textbooks, handbooks, question banks and their subsequent translation into Hungarian language to fulfil the course objectives is an immediate need [10]. Clinical practice as a Hungarian Medical doctor with additional skill set and qualification of Ayurveda is a step towards integration for health of the society. Development of OPD and IPD setup, with a stringent pattern of practice that demands meticulous documentation is a challenge due to terminological differences. Some differentiation in conventional and non-conventional therapies and medicines will have to be brought to the table. Professionals other than doctors can practice as therapist, lifestyle consultants or nutritionist with some provisions or modifications in existing system. A system of registration or licensing Indian Ayurvedic doctors (BAMS, MD) by employing some licensing exam similar to UAE or SWISS system is a necessary step.
The EU directive is binding for registration of herbal products for treatments. Treatments with available oils and single or polyherbal formulations are being administered at present but there are various limitations to prescription or dispensing pharmacy mode of practice to be at par with contemporary medicine. Efforts are being taken by local associations of citizens, medical doctors and Yoga schools to propagate benefits of Ayurvedic system to generate demands; however, this issue needs to be addressed diplomatically by both the governments at EU level.
Ayurveda is not only traditional system, but it is a system of medicine beyond cultural boundaries. It talks about eternal principles where localization is focused. In this sense, with the three tier approach ‘Hungarian Model’ will make the initiative sustainable.
(Asmita Wele currently works at the Department of Pharmacology and Pharmacotherapy, University of Debrecen. Asmita does research in International and Humanitarian Medicine, Allied Health Science and International Education. Their current project is 'Studies on Herbo-Mineral formulations for glucose hypersensitivity in different conditions'. She was the Professor and Head of the Department of Rasashastra and Bhaishajyakalpana Vigyan of College of Ayurveda (Bharati Vidyapeeth DU))
