Monday, July 27, 2009

Repurcussions of New Education Agenda

The report given by Prof. Yashpal Committee has been taken by the Ministry of HRD on war footing along with the recommendations of the National Knowledge Commission as part of the 100 day agenda of change. It would be wise to go along with the tide and see how it can be leveraged to the strategic advantage of CCH in the shifting sands of educational reforms. The proposed legislation on Special Educational Zones that is under consideration by the Ministry of Commerce and Trade also has to be watched with concern and interest to see what elements of surprise it has in store.

Overall, a situation that is unsettling for the old guard and the Status quoists and a huge vista of opportunity for those who are driving for a positive change

Sunday, July 5, 2009

Curriculum Re-engineering for BHMS Course

Roadmap for Curriculum Re-engineering
 Draft the vision statement for a basic homoeopathic doctor
 Discuss with peer group and finalise the Vision statement of a basic homoeopathic doctor
 Brainstorm for the knowledge, attitude, communication and skills that are expected of the basic homoeopathic doctor
 Arrange these educational components into ‘disciplines’.
 Evolve the weightage for each of the ‘discipline specific’ components
 State the departmental objectives of each of the departments and the interdepartmental objectives for a BHMS course
 Generate the specific instructional objectives for each of the discipline / subject and the instructional objectives for the interdepartmental areas
 Categorise each of these objectives into the four domains of medical education
 Identify the content for achieving each of the instructional objectives
 Suggest the appropriate Teaching / Learning methods and media
 Indicate the feasible evaluation methods to assess the learners for the achievement or otherwise of the intended learning objectives
 Identify a University, which has about three to four homoeopathic institutions imparting BHMS course within a radius of 25 to 30 kilometers to test run the course from the first year onwards.
 Assure academic parity for the students who enroll for the BHMS course of that University
 Impress upon the University academic bodies and the institutions to implement the new curriculum
 Train the teachers of the homoeopathic institutions of that University and the possible external examiners in the principles of educational science and technology
 Conduct the course and the examinations as per the re-engineered curriculum
 Obtain regular feedback and rectify the errors on a priority basis
 Provide transparency for all the stakeholders like students, teachers, administrators and parents in the educational process
 Evaluate the effectiveness of this program as an experiment against the control group of the existing curriculum
 Rectify the loopholes and improve upon the program
 Extend the program across the board
Vision statement of BHMS Course
The purpose of BHMS Course is to evolve a Basic Homeopathic Doctor. The education of Basic Homeopathic Doctor shall be to integrate the principles of homeopathic philosophy with the understanding of basic and applied clinical disciplines, so as to provide sufficient and relevant knowledge, skills and aptitude for the practice of homeopathy in the Community / Hospital Health Care Situations.
Qualities of a Basic Homeopathic Doctor
1. Understanding of the concept of health / disease / healing from the homeopathic view point
2. Understanding of functional aspect of human health as per the basic medical sciences
3. Understanding of disruption of human health dynamics through horizontal integration of the para-clinical disciplines like Pathology and Microbiology with the principles of homeopathy
4. Understanding of diagnostic methods by vertical and horizontal integration of homeopathic principles with clinical disciplines like Practice of Medicine, Surgery, Obstetrics & Gynaecology and their allied specialities
5. Understanding of the outcomes of Homeopathic Pathogenetic Trials’ and their clinical verifications as ‘Data Base’ for prescriptions
6. Understanding the basic pharmaceutical procedures in homeopathy - preparation of medicine, potency scales, dosage forms
7. Understanding of the multidimensional learning of Drug Action
8. Understanding of the various Strategies of Prescription and demonstration of their application in practice
9. Understanding of the legal and ethical issues involved in the medical practice
10. Understanding of the scope and limitations of homeopathy for the doctors’ own patients or community in which they work
11. Competence to practice preventive, promotive, curative and rehabilitative medicine in respect to the priority health issues
12. Understanding of the socio-psychological, cultural, economic and environmental factors affecting health and develop humane attitude towards discharging one’s professional responsibilities
Learning objectives classified into –
1. Anatomy including Embryology
2. Physiology including Biophysics and Biochemistry
3. Homeopathic Pharmaceutics
4. Homeopathic Materia Medica
5. Homeopathic Philosophy including Foundation Course
6. Homeopathic Repertory
7. Pathology including Microbiology and Parasitology
8. Forensic Medicine including Medical Jurisprudence and Toxicology
9. Community Medicine
10. Principles and Practice of Obstetrics and Gynaecology
11. Principles and Practice of Surgery including its allied specialities
12. Principles and Practice of Medicine including its allied specialities
Phases of BHMS Course
Phase I: (12 Months)
No. Subject Teaching Hours
Theory Practical
1 Anatomy including Embryology 200 100
2 Physiology including Biophysics and Biochemistry 200 100
3 Homoeopathic Pharmacology & Pharmaceutics 200 100
4 Principles of homoeopathy 200 -
5 Foundation Course consisting of - Logic, Philosophy, Psychology, Biostatistics * 200 -
* No term end examinations. Assessment in the form of Assignments, Project work, Seminars, etc.

Phase II: (18 Months)
No. Subject Teaching Hours
Theory Practical
1 Pathology including Microbiology 200 100
2 Forensic Medicine including Medical Jurisprudence and Toxicology 100 50
3 Homoeopathic Materia Medica 200 100
4 Organon and Homoeopathic Philosophy 200 100
5 Community Medicine * 100 100
6 Obstetrics and Gynaecology * 100 100
7 Principles of Surgery * 150 50
8 Practice of Medicine * 100 50
* University Examinations not to be conducted during this phase

Phase III: (12 Months)
No. Subject Teaching Hours
Theory Practical
1 Community Medicine 100 100
2 Obstetrics and Gynaecology 100 100
3 Principles of Surgery 100 100
4 Practice of Medicine * 100 50
5 Homoeopathic Materia Medica 100 100
6 Organon and Homoeopathic Philosophy 100 100
7 Homoeopathic Repertory * 50 -
* University Examinations not to be conducted during this phase

Phase IV: (12 Months)
No. Subject Teaching Hours
Theory Practical
1 Homoeopathic Materia Medica 200 100
2 Theory of Chronic Diseases and Homoeopathic Philosophy 100 100
3 Homoeopathic Repertory 100 200
4 Practice of Medicine 200 200

Phase V: (12 Months) – Internship
Apart from the hospital / clinic / community based medical service, this shall include seminars, project work, assignment, etc to develop
 Communication skills, Personality development, Managerial skills
Examination Scheme
For every 100 marks of theory paper,
 Practicals – 40 + 10 (internal assessment)
 Viva – 30 + 20 (internal assessment)
Internal assessment shall be calculated as 20% of Continuous Assessment Test score in the Practicals and 40% of the Continuous Assessment Test score in the Theory exams. There shall be at least three Continuous Assessment Tests in each Academic Phase.
Eligibility to appear for Phase 1 exam
 80% attendance in the subject(s) concerned
 Appearance in at least two-thirds of the Continuous Assessment Tests
 Minimum score of 50% in the CAT
 Successful completion of the Project / Assignment for the Foundation Course
* The candidate may not be promoted to the next higher class unless he / she has successfully completed ALL the subjects
Eligibility to appear for further exams
 80% attendance in the subject(s) concerned
 Appearance in at least two-thirds of the Continuous Assessment Tests
 Minimum score of 50% in the CAT
 The candidate may be promoted to the next higher class even if he / she has not successfully completed all the subjects till Phase 4 of the course
 The candidate shall be allowed to carry over the papers till Phase 4. This facility is made to provide continuity for the clinical postings
 However the candidate shall be permitted to appear for Phase 3 exam, only after successfully completing all the Phase 2 papers, and phase 4 exam only after successfully completing all the Phase 3 papers
Examination pattern
 Examinations shall be conducted as Theory, Practical / Clinical and Viva.
 Practical / clinical examinations for the subject Principles of Homoeopathy in Phase 1 of the examinations need not be conducted.
 Theory exam for every 100 marks shall have 2 long essays of 10 marks each, 12 short essays of 5 marks each and 10 short answers of 2 marks each.
 The practical / clinical examinations shall be patterned on Objective Structured Practical / Clinical Examination
 The Viva shall be patterned on Structured Oral Examination

Restructuring homeopathic postgraduate curriculum

Vision of MD Homeopathy Course
To generate human resources who can align with the objectives of national health programs and improve the contribution of homeopathy as clinicians, researchers and teachers.

The postgraduate in homeopathy shall –
o acquire a high degree of proficiency in theoretical and practical aspects of homeopathy
o recognise the need of physical, mental, spiritual and social health concerns of the sick
o be aware of appropriate investigation procedures to diagnose and manage the sick
o adapt scientific disposition while acquiring knowledge and skills relevant to homeopathy
o obtain adequate competency in providing comprehensive health care
o develop communication and interpersonal skills for interacting with the sick and members of health care teams
o develop ethical outlook in relation to clinical practice, research and teaching

Course Structure

MD Part I
It shall be for the duration of one academic year. It shall consist of the following subjects –
o Human Biology – comprising of horizontal integration of anatomy, physiology, biochemistry, psychology and having a homoeopathic orientation.
o Homoeopathic Concept of Disease – comprising of horizontal integration of pathology, microbiology, community medicine with homoeopathic principles and vertical integration of homoeopathic philosophy with clinical subjects like medicine, surgery, obstetrics and gynaecology.
o Research Methodology and Biostatistics – research procedure, research design, sample design, significance of biostatistics in research studies, statistical tests of significance, essence of biomedical ethics, biomedical ethics in relation to homeopathic research, etc.
o History of Medicine – events and personalities who have influenced the course of medical practice with special reference to homoeopathic practice.

Note – Resources for the integrated teaching / learning of the subjects Human Biology and Homoeopathic Concept of Disease have not been developed. Thus, there is a need to co-operatively generate such resources, so that there is objectivity both in teaching and evaluation. Central Council of Homeopathy may constitute a one-man committee to prepare a framework of curriculum for these subjects. Subsequently, subject experts in the constituent disciplines may be invited for a workshop, which can finalise content both for theory and practical teaching.

o House job with special focus on wards and clinics of the specialty subject to which admission is taken
o Lectures and practicals on Research Methodology and Biostatistics
o Lectures and practicals on Human Biology and Homoeopathic Concept of Disease
o Submission of synopsis to the university within six months of admission to the course
o Seminars, symposia, group discussions, assignments, project, journal reviews and poster presentation on the topics of MD Part I subjects.
o Teaching sessions for the undergraduate students in both classroom and wards for the specialty subject to which admission is taken

MD Part II
It shall be for the duration of two academic years. It shall consist of the speciality subject only. Examination shall be held at the end of two academic years.
o Lectures and clinical / practicals on Specialty subject
o Seminars, symposia, group discussions, assignments, project, journal reviews and poster presentation on the specialty subject.
o Teaching sessions for the undergraduate students in both classroom and wards for the specialty subject
o Planning and conducting of the research study under the supervision of Guide
o Submission of dissertation to the university six months before Part II examination

Papers for Examination
Examination for History of Medicine shall consist of
o one theory paper of 100 marks on 9th month of academic year
o one project on a topic of history relevant to homeopathy mutually decided by the student and guide for 75 marks
o one poster presentation on a topic of history relevant to homeopathy mutually decided by the student and guide for 25 marks
o one seminar on a topic of history relevant to homeopathy mutually decided by the student and guide for 50 marks

Evaluation criteria for certification
Evaluation Maximum marks Total marks Minimum marks
Theory exam 100 100 50
Project 75
Poster presentation 25
Seminar 50

MD Part I

Subject Theory Int. Assessment Viva Total
Max Min Max Min Max Min Max Min
Human Biology 100 50 50 25 50 25 200 100
Homoeopathic Concept of Disease 100 50 50 25 50 25 200 100
Research Methodology & Biostatistics 100 50 50 25 50 25 200 100

Internal Assessment shall be as follows –
Human Biology – 2 theory paper for 100 marks each on 6th and 9th month of academic year.
Homoeopathic Concept of Disease – 2 theory paper for 100 marks each on 6th and 9th month of academic year
Research Methodology and Biostatistics – 2 theory paper for 100 marks each on 6th and 9th month of academic year

MD Part II

Specialty Subject Theory Clin / Pract Viva Total
Max Min Max Min Max Min Max Min
Paper 1 100







Paper 2 100
Paper 3 100
Paper 4 100

o Shall be submitted to the university six months before Part II examination
o Two copies shall be submitted to the university along with a CD
o Dissertation shall be valued by two examiners – one internal and one external by persons who are eligible to be guide in that subject
o Approval from both the examiners is necessary for the candidate to appear for Part II exam
o In case one of the examiners does not approve the dissertation, it may be sent to another examiner – external if the external examiner has disapproved and internal if the internal has disapproved the dissertation.
o In case both the examiners have disapproved the dissertation in the first instance or if the third examiner also disapproves the dissertation, it may be returned to the candidate with the remarks of examiners, so that the candidate may resubmit it after making suitable amends within six months.
o The candidate shall be permitted to appear for Part II exam only after the dissertation is approved

Part I exam shall be conducted after completing one academic year
o To be eligible for part I exam, the candidate shall have
 at least 80% attendance
 successfully completed the log book comprising of 10 cases, 6 seminars and 6 journal reviews to the satisfaction of the Guide
 completed 20 hours of teaching undergraduate classes
 obtained at least 50% in the assessment of History of Medicine
 obtained at least 50% in the internal assessment of Human Biology, Homoeopathic Concept of Disease and Research Methodology & Biostatistics
o To be successful, the candidate shall obtain at least 50% separately in theory and viva in each of the three subjects
o Two examiners – one internal and one external – shall conduct viva, with each awarding marks out of 25. Total of these marks shall decide the result
o In case the candidate in unsuccessful in any of the subject he / she has to appear for the theory and viva of that subject only

Part II exam shall be conducted after completing two academic years
o To be eligible for Part II exam, the candidate shall have
 at least 80% attendance
 successfully completed Part I exam at least two years before Part II exam
 completed the log book comprising of 60 cases – 30 chronic and 30 acute, 12 seminars and 12 journal reviews to the satisfaction of the Guide
 completed 50 hours of teaching undergraduate classes obtained approval of the examiners for dissertation
o To be successful, the candidate shall obtain at least 50% separately in theory, clinical / practical and viva
o Four examiners – two internals and two externals – shall conduct viva. Guide of the candidate shall be one of the internals, Each examiner shall award marks out of 25. Total of these marks shall decide the result.
o Clinical examination shall consist of a chronic case and an acute case. Chronic case shall be evaluated for 70 marks and acute for 30. Evaluation shall be conducted jointly by the examiners, each of who shall award marks out of 70 for chronic and 30 for acute case. Average of these marks shall be calculated for declaring the result.
o In case of Practical examination in Homoeopathic Pharmacy, the examination shall consist of a major procedure and a minor procedure. Major procedure shall be evaluated for 70 marks and the minor for 30. The examiners shall conduct evaluation jointly, each of who shall award marks out of 70 for major and 30 for minor procedure. Average of these marks shall be calculated for declaring the result.
o In case the candidate in unsuccessful in any part of the paper, he / she has to appear for the entire paper consisting of theory, clinical / practical and viva

Part I examiner shall be selected as follows
 Human Biology from the faculty of Materia Medica, who shall co-ordinate the PG Department of Human Biology
 Homoeopathic Concept of Disease from the faculty of Homoeopathic Philosophy, who shall co-ordinate the PG Department of Homoeopathic Concept of Disease
 Research Methodology and Biostatistics, from the faculty of Repertory, who shall co-ordinate the PG Department of Research Methodology and Biostatistics
o Evaluation and PG Department of History of Medicine shall be co-ordinated by the faculty of Homoeopathic Philosophy
o The examiner so selected shall
 have MD Hom in the relevant subject, i.e., Materia Medica, Homoeopathic Philosophy or Repertory as the case may be
 hold at least the rank of Assistant Professor
 have at least ten years of teaching experience in an institution recognised by Central Council of Homeopathy
 be in the relevant PG Department

Part II examiner shall
 have MD Hom in the specialty subject
 hold at least the rank of Assistant Professor
 have at least ten years of teaching experience in the subject concerned in an institution recognised by Central Council of Homeopathy

Restrucruring homeopathic postgraduate education - an outline

Postgraduate Curriculum for Homeopathy
Course duration – 3 years
Phase I – 18 months
Phase II – 18 months
Phase I Highlights
 Postings in hospital, peripheral OP, Mobile Clinics, Health Camps
 Assignments to integrate National Health programs, Priority Health Problems and Homeopathic Philosophy
 Teaching / Learning situations – Case presentations, Group discussions, Ward rounds, Seminars, Journal club, etc
 Identification of research subject, Synopsis presentation
 Formative evaluation of the assignments, Case presentation, Group discussions, Ward rounds, Seminars, Journal club, etc
 Certifying evaluation for theory paper in Research methodology and Biostatistics for 100 marks and viva for 50 marks.
 Internal assessment of 50 marks for the assignments and case presentations
Phase II Highlights
 Postings in hospital, peripheral OP, Mobile Clinics, Health Camps
 Assignments to integrate National Health programs, Priority Health Problems and Homeopathic Philosophy
 Teaching / Learning situations – Case presentations, Group discussions, Ward rounds, Seminars, Journal club, etc
 Research program and Dissertation
 Certifying examination as follows
• Theory papers : 200 marks
• Clinical exam : 100 marks
• Viva on Dissertation : 100 marks

Need for postgraduate education in homeopathy

Every growing branch of knowledge needs both vertical and horizontal growth. Horizontal growth denotes extensive learning at every level. Vertical growth denotes an in-depth study involving subject specialisation. This vertical growth symbolises the postgraduate education. Homeopathy too as a branch of knowledge has to organise education at postgraduate level.

Postgraduate education in general aims at generating human resources who can be counted as experts in the field, advanced knowledge that could improve significance of the discipline and skills that could enhance practical use of the discipline. Thus the major need for any postgraduate study is awareness that there is a scope for improvement in that discipline. This knowledge improvement could be in the understanding the basics of the discipline or in improving the applicability of the discipline. Such an improvement is brought about by a procedure of enquiry, observation and interpretation, which are collectively called as research. Thus, research is a systematic process based on logical principles, of evolving new knowledge and skills to solve problems or improve the existing problem solving skills. Postgraduate education in homeopathy is a relatively recent phenomenon that is aimed at improving the state and status of homeopathic practice and education. As in any course, the purpose of postgraduate education in homeopathy should aim at elevating the basic and applied knowledge and skills of homeopathy.

Need for postgraduate education in homeopathy is two-fold –

î To advance knowledge and skills for professional performance, and

î To produce human resources who can support academic structure.

Need and modus operandii of research for advancement of professional knowledge and skills is explained under the heading Relevance of research in homeopathy, later in the same chapter. The need to have competent human resources to support academic homeopathic structure has to be objectively discussed to organise the postgraduate education.

Subjects for study in homeopathic undergraduate course can be conveniently classified as –

î Pre-clinical

î Para-clinical

î Clinical

> General clinical

> Applied homeopathic

î Homeopathic.

Pre-clinical subjects include Anatomy, Physiology and Biochemistry. Para-clinical subjects include Pathology, Microbiology, Community Medicine and Forensic Medicine. Clinical subjects include Medicine, Surgery, Obstetrics and Gynaecology. These clinical subjects have a purely clinical component that helps in learning the evolution, presentation, assessment and management of clinical conditions and a parallel homeopathic component for understanding evolution, assessment and management of the same conditions from homeopathic perspective. This point of view is drawn from homeopathic disciplines like its Philosophy and Materia Medica. The purely homeopathic subjects include Homeopathic Pharmacy, Homeopathic Philosophy including Organon of Medicine & theory of Chronic Diseases, Homeopathic Materia Medica and Homeopathic Repertory.

Pre-clinical subjects help the learner to know about normal parameters of health, i.e., how a human body is structured and how does it function. It is advantageous to include Psychology to know how normal human body behaves. Para-clinical subjects help the learner to understand how human body shifts to disease state, what are the possible causes for the shift, how to plan health promotion and disease prevention schedule and what are the legal and ethical implications of homeopathic practice. Such knowledge has to be gained from homeopathic perspective.

Thus, there is a need to develop human resources who can facilitate learning of human health and disease from homeopathic orientation. This is where postgraduate courses for homeopathic teachers in these subjects assume importance. The Homoeopathy Central Council (Minimum Standards of Education) Amendment 2002 makes it mandatory for all homeopathically qualified teachers to have postgraduate qualification i. e. MD (Hom), both for entry level and promotions. Postgraduate courses in homeopathic and some clinical disciplines are now available to supply this requirement. However, teachers in pre- and para-clinical subjects will suffer professionally unless remedial measures are provided for their academic and professional advancement.

One option is to allow any homeopathic postgraduate qualification like MD (Hom) either in Materia Medica, Homeopathic Philosophy, Repertory, Medicine, Paediatrics, Psychiatry or Pharmacy as an accepted qualification to gain entry and promotions for any pre- para-clinical subject. Thus we may have the bizarre instance of MD (Hom) in repertory becoming a teacher in Anatomy; that speaks for the vision of academic planners in homeopathy.

The other option is to include postgraduate programs like MSc (Anatomy), MSc (Physiology), MSc (Biochemistry), MSc (Psychology), MSc (Pathology), MSc (Medical Microbiology), Master of Public Health, etc in The Homoeopathy Central Council (Minimum Standards of Education) Amendment, so that a BHMS graduate can pursue these courses to gain academically relevant knowledge and skills and grow professionally in these departments of homeopathic institute. BHMS qualified person with postgraduate qualification in relevant pre- and para-clinical discipline would be in a better academic state to teach and train homeopathic students in those subjects.

The third option is to design a post graduation program for these subjects in a way that it takes into consideration course content from homeopathic perspective. For example, Pathology is taught not just for histopathological content, but also their pathodynamics from core concepts of homeopathy. Such a curriculum may be structured on the principles of Educational Science and Technology, so that the teachers not only gain mastery over content but also competency in a wide range of curricular components like lesson planning, applying appropriate teaching – learning methods and media, and relevant evaluation techniques to make learning not only more meaningful but also enjoyable.

Postgraduate education in clinical and homeopathic disciplines also needs a review for academic competence. There has to be a dispassionate SWOT analysis of existing courses and openness and willingness to bring about changes if necessary to improve the academic stock of homeopathy.

Thursday, May 7, 2009

A Case for Community Health Oriented Homeopathy Practitioner – re-orienting the trainers of internship program

A Case for Community Health Oriented Homeopathy Practitioner
– re-orienting the trainers of internship program

Community health is a discipline that is gaining wider attention from the stakeholders of health, than was seen earlier. The reason for this shift could be the changing horizons of health philosophy, which is veering towards an inclusive health policy on a global scale. The increasing linking of health issues with human rights have brought into the health policy loop, the crusaders of social advocacy. Medical practitioners too are gradually getting sensitised to the social, environmental and economic dimensions of health and are accepting that medical model of health is not to be taken as an exclusive and isolated entity, but has to be seen in the entire range of human and social integration.

The medical curriculum – whichever stream of medicine it may belong to – is increasingly giving greater emphasis for the inculcation values among its learners, the non-medical dimensions of health – disease axis. Thus, it can be seen that many universities are exposing their medical students to the community health issues right from the first year of their studies. Such strategic moves facilitate the internalisation of values in the human interaction that get reinforced during the ‘hardcore’ clinical learning.

There are many global movements that are striving to position community health at the heart of healthcare delivery. The People's Health Movement, which is a worldwide movement of people's organisations, non-governmental organizations, academic institutions and wide range of civil society networks and social movements is driving the World Health Organisation for the adoption of a resolution on Primary Health Care and Social Determinants of Health, so that the member countries make their health policies to ensure they are based on the principles of the fundamental right to health and the social conditions that create health, ensure that their current health care systems are modified to better respond to people's needs and the modified system has a clear process of continuously assessing people's health needs in a participatory manner and adopt public policies that are able to ensure sufficient and well-trained health care personnel and build the training of health care personnel on the principles of the right to health among other advocacy issues.

The concept of ‘Community Campus partnership for Health’ that is gaining momentum in the North Americas aims to foster partnerships between communities and medical education institutions so that they can synergise on each other's strengths for improving the health education curriculum and orienting it to the community health sensitivities. Community Campus Partnership for Health is a non-profit organisation that promotes health through partnerships between communities and higher educational institutions. It has a network of over 1,200 communities and campuses across North America which are collaborating to promote health through service-learning, community-based participatory research, broad-based coalitions and other partnership strategies.

The homeopathic undergraduate curriculum in India has laid sufficient emphasis on the community orientation of homeopathic practice. Towards achieving this goal, the Central Council of Homoeopathy has –
• Increased the duration of learning community health to three years, from the one year study that was earlier, and
• Made at least one month of internship posting at the Community Health Centre, preferably in a rural area.

These measures are intended to ensure that there are sufficient learning opportunities in the field of community health. However, since the last seven years that have passed after the new ordinance was enacted and at least three batches of students have come out under this scheme, there is a need to take stock of the impact of this new initiative. There is no organised study to assess this impact, if any was conducted, there it is not published in any of the journals nor presented in any seminar. However, the anecdotal evidence is suggestive of ‘no change’ in the attitude of the learners from the previously held beliefs.

The students under the older curriculum had the notion that ideologically homeopathy is customised medial therapy and that there can be no violation on this and the ‘new generation’ of learners who have studied under the modified curriculum continue to hold on to the same belief with the same intensity. The reason is even though the duration of studies was increased by two more years and there was compulsion to spend at least one month in the rural postings, the comparable scaffolding to facilitate this transformation was neither provided by an ideological articulation that there is compatibility of homeopathy in community health nor were there efforts to evolve robust models of community health practices on a larger scale. Whatever individual efforts were made have remained as isolated islands.

This is not to suggest that no efforts are made either at ideological dialogue or on-site experimentation of homeopathic principles in community care settings. Whatever small efforts were made are good enough to herald a new beginning. From these experiences, a scalable model can be developed and debated on a larger platform. The implementation of the consensual outcomes of such an effort can propel homeopathy into the mainstream of community health.
In this regard, the following activities are suggested to assess the impact of homeopathy in community health. This could be a pilot project at one centre or multiple centres. My plea is to reorganise the internship program for community health orientation, because –
• It would be easier to debate on the ideological issues with mature minds of internees than with the first or second year students, and
• The duration of at least one month can be gainfully utilised for experiencing the impact of homeopathy in community healthcare.

The planning for the internship program may be done to identify the objectives, activities and outcomes of the community health posting. The learning objectives of the internship program is to foster an understanding of the psychological, social, biological, and public policy factors that influence the health of people in populations.

At the outset, the internee shall be tested for the ‘entry behaviour’ to assess the existing knowledge, skills and aptitude so that he / she can be prepared to undergo the action learning from a position of strength and clarity. The assessment of entry behavior shall include the assessment for the following objectives –
• Define health, disease and recovery
• Describe what is meant by community health
• Describe the main health and social indicators used in community health
• Define epidemiology and describes its role in community health
• Define and differentiate between incidence and prevalence
• Describe how to identify and investigate epidemic
• Describe the epidemiological aspects of diseases
• Describe the epidemiological and preventive aspects of malnutrition
• Discuss the concept of family planning and family development

Objectives of the community health posting:
• Explain the influence of social-culture aspect on the individual perception of health and illness
• Discuss how community development affect changes in the lifestyles and epidemiologic transition of disease pattern
• Describe health promotion aspects for prevention of chronic disease
• Determine the social factors which may influence the prognosis of specific diseases
• Demonstrate the patient education skills as part of the management of patient’s problem.
• Demonstrate relevant, effective communication skills when talking to the patient, patient’s family and other medical staff
• Identify verbal and non-verbal behaviour when communicating with the patients, their family and the medical staff
• Demonstrate sensitivity towards religious, cultural, traditional and moral values of the community
• Demonstrate skills in scientific inquiry and critical thinking in the process of compilation, analysis and utilization of health data collected in the community for the purposes of identification and prioritization of community health problems
• Plan, implement and evaluate health promotion programs
Activities during the community health posting:

The following are some of the activities suggested for the community health segment of internship posting –
1. Conducting a survey of the population to understand the community that they will be working with, to be sensitive for the social, cultural, economic, linguistic and environmental diversities; to identify the health status of the community that they will be working in; to get the primary data with reference to morbidities and disease trends and to assess the possible existence of maintaining causes.
2. Data collection and projection
3. Providing clinical services – taking the case, analysing it with the background of the socio-environmental factors and providing the therapeutic care
4. Health education to the population on disease prevention and health promotion including nutrition and lifestyle counselling
5. Seminars, Poster presentation and Journal club on medical humanities, social and clinical research methods, etc.

Outcomes of the community health posting:
At the end of the posting, the internee would–
• have become sensitive to community health needs and identify him/herself with such healthcare delivery
• apply the principles of homeopathy for the individual and epidemic morbid expressions in the community
• develop team spirit for the promotion of community health
• make proactive efforts to actively assist community health efforts

At the end of the pilot study, it can be assessed for the effectiveness of the program by evaluating the extent and depth to which the stated objectives are realised. The second cycle will be to modify the program in the areas that have remained unattainable and project more realistic objectives or to modify the activities to support the realisation of objectives.

Thursday, March 19, 2009

Role of homeopathy in community health

Preventive and Social Medicine or Community Health is emerging as a cementing force that is binding together medical care providers, health policy planners, government machinery and also the activist groups that are focussing on health related issues. The involvement of multiple stakeholders provides an understanding of how important community-based health issues are in the future of healthcare operations. The International Conference on Primary health Care, 1978, popularly called as Alma Ata Declaration lays stress on health being a fundamental human right. In this context, it is appropriate to examine the role of homeopathy vis-à-vis community health: whether these two entities are mutually compatible or is there a dichotomy in aligning these two.
Homeopathy, based on the operational principle ‘let likes be cured by likes’ is traditionally associated with an individualistic approach for therapeutic decision making. It is also a generally held understanding that every subject receiving homeopathy medicines has to be measured as an individual, applying the parameters of homeopathic pathometrics. These parameters include diagnostic profiling and personality profiling of each subject. This has become an integral and indelible routine in the homeopathic therapeutic decision making. Therefore, the populist interpretations of Hahnemann’s writings have revolved around the opinions that reinforce that homeopathy is customising prescriptions for the individual patients.

Community health, as a discipline, strives to provide health services in the community, understand community resources, promote health and prevent disease, empower communities with information on health related issues and promote community participation in healthcare activities among other issues. For achieving this, the community health strives to take into account the socio-cultural aspects of patient care, coordinate a community’s health resources for the care of patients, identify and intervene in a community health problem and assimilate into community and participate in its organisations.

Therefore, the approach of Community Health has is focused on preventive, promotive and therapeutic modalities for larger segments of society at any given time. The focus here is more inclusive of the society, than the single subject. In its quest for wider reach, community health trusts the opinion, ‘what is good for the population is good for the individual’. Thus, the operational principles of homeopathy and community health seem to be diametrically opposed and the popular image of homeopathy seems to be unsuited for its wider application in community health context.

However, this fallacy is as superficial as it can be. Scratch the history of homeopathy a little more deep; you will find that the greatest social impact that homeopathy has made, is in the ‘mass’ situations – be it the Asiatic cholera during Hahnemann’s time or the recent epidemics of Japanese Encephalitis in parts of India. It is another matter that the homeopathic profession has not completely showcased the good work it has done in the manner that could attract the attention of health policy makers to take position on the potential of homeopathy in community health context.

The corollary of the statistical significance of ‘what is good for mass is good for individuals’ could also be ‘what is good for one individual is good for another with the other circumstances remaining the same’. The second statement is the one that drives homeopathic materia medica. Thus, by deduction, homeopathy is compatible for ‘mass’ therapy.

Therefore, to explain the role of homeopathy in community health, we need to look for indications in interdisciplinary areas like Medial Sociology, Social Epidemiology, health geography and Multilevel Modeling. We may draw further inspiration from the research that is undertaken in the areas like ‘social model of health’. Medico sociological research on healthcare organization and policy can be focused on different levels – the macro, social level; the meso level of the formal organizational structure and the micro individual level.

Charles Mc lntire defined Medical Sociology in the late nineteenth century as the professional endeavour devoted to social epidemiology, study of cultural factors and social relations in connection with illness, and the social principles in medical organisation and treatment. Initially the medical professional endeavoured to develop it as a subsidiary discipline. However, it was the efforts of sociologists that developed medical sociology as an academic and research based discipline. Medical sociology concerns itself with the sociological study of the social institution of medicine, its knowledge, practice and effects. Medical sociologists investigate the social organisation and production of health and illness. They are also interested in the frontier areas of public health, demography, etc to explore phenomena at the intersection of the social and clinical sciences.

Social epidemiology is defined as "the branch of epidemiology that studies the social distribution and social determinants of health," that is, "both specific features of, and pathways by which, societal conditions affect health". The aim of social epidemiology is to identify socio environmental exposures that may be related to physical and mental health outcomes. The principal concern of social epidemiology is the study of how society and social organization influence the health and standard of living of individuals and populations.

Health geography is the interdisciplinary approach of applying geographical information to the study of health, illness and healthcare. Though it is based on the biomedical model of health, it is grounded in the empiricist ideology that stresses on observational evidence. This socio-ecological model takes a more holistic approach to health and illness. It emphasises on the treatment of whole person and not just components of the system.

Multilevel modeling is a process that applies parameters which vary at more than one level. The concept of levels is the critical factor in this process. Multilevel modeling has gained greater popularity due to the ease ushered in by computer technology and user friendly software applications. The goal of multilevel model is to predict values of some dependent variable based on a function of predictor variables at more than one level. For example, we might want to examine how a person’s health is influenced by the characteristics of an individual and the environment in which he / she lives.

Taking example of healthcare research, in the effort to assess the impact of two different therapies, one may have to take not only the response at individual level, but also at the environmental or other collateral levels. The data may be analysed for assessment of not only the individual level response, but also the levels of group response and responses of groups from various geographical distributions. These correlations must be represented in the analysis for correct inference to be drawn from the experiment.

To quote John Dewey, ‘I should venture to assert that the most pervasive fallacy of philosophic thinking goes back to neglect of context’. In the context of infectious disease treatment, it was observed and recorded by Thomas McKeown that improvement in living conditions, especially diet and housing, public sanitation and personal hygiene were also factored as important in eliminating the potential for infectious diseases. This contextualisation is also validated in homeopathy – from pathological response to individualised response to pathogenesis to constitutional flair that may transcend diagnostic criteria. Even in the modeling of human behaviour, context can be very important. Individual action may be determined by independent variables operating at different levels, from micro to macro.

A transdisciplinary approach by integrating areas of study like medical sociology, social epidemiology, health geography and multilevel modeling, to health and illness has resulted in contextualising health and society. In any phenomenon related to society and health, it has become necessary to impress upon the importance of context. Because of the human – social interaction is an open system consisting of variables that are diverse and perhaps beyond the control of external contextual influences, the application of multilevel modeling brings in a semblance of ‘organised thinking’. The biopsychosocial model developed by George Engel in the 1970s explains the convergence of various factors in the disease / disability generation. This demonstrates that characteristics or processes occurring at one level of analysis may have their effect on characteristics or processes at another level.

There is an increased interest and activity among the health policy researchers to understand the relevance of multilevel approach that could study the impact of the biopsychosocial model. The report prepared by the Office of Behavioural and Social Sciences Research, in the National Institute of Health, titled ‘Towards Higher Levels of Analysis: Progress and Promises in Research on Social and Cultural Dimensions of Health’, suggested integrating social science research into interdisciplinary, multilevel studies of health. It recommended a development of state-of-the-art social science method so as to measure data at various levels of social institutions.

If we agree that homeopathy is compatible as a mass therapy, how do we justify this phenomenon without deviating from homeopathic ideology? The Organon of Medicine not only provides examples of how the mass situations can affect the individuals – not just in the epidemic situation – but also in individual instances. In the aphorism 36, while discussing the simultaneous occurrence of dissimilar diseases, Hahnemann makes a mention of ‘… patient suffering from a severe chronic disease will not be infected by a moderate autumnal dysentery or other epidemic disease. The plague of the Levant, according to Larry does not break out where scurvy is prevalent, and persons suffering from eczema are not infected by it. Rachitis, Jenner alleges, prevents vaccinations from taking effect…’ Further, in aphorism 77, ‘… those diseases are inappropriately named chronic which persons incur who expose themselves continually to avoidable noxious influences …. These states of ill-health, which persons bring upon themselves disappear spontaneously, provided no chronic miasm lurks in the body, under an improved mode of living, and they can not be called chronic diseases’. These expressions underline the foresight and openness that Hahnemann had regarding aetiopathogenesis for homeopathic pathometrics.

He further distinguishes the characteristics of epidemic diseases vide aphorism 100, ‘…. A careful examination will show that every prevailing disease is in many respects a phenomenon of a unique character, differing vastly from all previous epidemics, in which certain names have falsely applied – with the exception of those epidemics resulting from a contagious principle, that always remains the same, such as small pox, measles, etc.’

In the aphorism 101, he states ‘… the carefully discerning physician can, however, from the examination of even the first and second patients, often arrive so nearly at a knowledge of the true state as to have in his mind a characteristic portrait of it, and even to succeed in finding a suitable, homoeopathically adapted remedy for it.’

In the aphorism 102, he states ‘… all those affected with the disease prevailing at a given time have certainly contracted it from the one and the same source and hence are suffering from the same disease …’

The above cited excerpts from Hahnemann’s writings iterate the compatibility that homeopathy has with the concept of community health. To take the argument further, we can assert that homeopathy not just takes cognisance of the individual or of the community in isolation, but an individual within the community and a community as a whole. The interrelationship of individual and community, and the outcomes of individual – community interactions have a strong bearing on the health of the individual and health of the community. Thus, the strength of homeopathic principles is the holistic community health, of which an individual is also a part. Another reason to assert that homeopathy and community health are mutually compatible is the approach to disease and illness is the holistic understanding that homeopathy has towards disease generation and health prevention, and the social model of health that is gaining wider acceptance in community health.

In the earlier model of public health practice, the working hypothesis was that diseases are caused as a result of exposure to noxious factors in the external environment. This is like the stimulus – response equation. Though this approach produced considerable successes in primary prevention, it does not satisfactorily address to the entire range of public health issues. Therefore, the emerging model of public health based on the social model suggests that in all its manifestations, disease is a reaction of the human organism to, and /or a failure to cope with, one or more unbalancing changes in its internal environment. These are caused by one or more unfavourable exchanges with the external environment and /or failures in the structural and functional design of the organism. Therefore, human illness is attributable to the dependence of organisms on a fundamentally hostile external environment and to unfortunate evolutionary legacies. This concept suggests that primary prevention is only a part of the whole and that there are different approaches to prevention, including interfering with disease mechanisms, and remedying human organisms’ design failures. This is much in tune with homeopathic approach that includes multilevel of parameters.

Therefore, the emerging model of public health, with a transdiciplinary approach stemming from the seamless fusion of medical humanities and clinical disciplines has veered to the homeopathic approach that was modeled more than two centuries back, and which was applied by homeopathic practitioners more in the individualized care settings than the community care context. It is now a challenge for the homeopathic community to leverage the principles and legacy of homeopathy to position homeopathy as a viable mainstream model for public health.

• Annandale E: The sociology of health and medicine. Cambridge: Policy Press, 1998
• Bury M: Health and illness in a changing society. London. Routledge, 1997
• Engel GL: The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr 8; 196(4286):129-36.
• Gabe J. P, Elston M. A, Bury M: Key Concepts in Medical Sociology. Sage Publications, Canada. 2004
• Hahnemann S: Organon of Medicine (6e). B. Jain Publishers, New Delhi, 1982
• Luke DA: Multilevel Modelling (3e), Sage, 2005
• Mackenbach J: The origins of human disease: a short story on "where diseases come from", Epidemiol Community Health.2006; 60: 81-86
• McKeown T: The Role of Medicine: Dream, Mirage or Nemesis? Princeton Univ Press, 1979
• Meade M. S and Earickson R. J: Medical Geography (2e). Routledge, 2005
• Michael Bury, Jonathan Gabe: The Sociology of Health and Illness: A Reader. Routledge, 2004
• Wong V. S: Principles of Community Medicine, accessed from FamilyMedicine/Conference%20Schedule/.../Principles%20of%20Community%20Medicine%5B1%5D.ppt

Friday, January 2, 2009

Teaching "Human Biology" in Homeopathy UG Course

I have come across the syllabus of Universities of Stanford and Washington in the U S of A, where they have included Human Biology in the pre-clinical study of their medical and dental courses. It is in fact not a completely new subject. In fact the Human Biology subject has the anatomy part, physiology part and biochemistry part. The teachers who are qualified in these basic sciences undertake their respective teaching and evaluation of students.

What is different is that the learners are made to feel that these subjects are not independent of each other, but have interconnections, whose appreciation is beneficial in clinical practice. Often the very text and reference books that are prescribed for the ‘stand alone’ subjects are utilized. However, there are some books that are designed for this ‘networked’ subject.

Ayurvedic students learn anatomy as “Shareera Rachana Shastra”, which has concepts and contents unique to itself. It is not the same as the mainstream anatomy.

I have deliberated much on this concept of Human Biology and feel that it is a good idea to give it a try at least on an experimental basis. While generating the educational objectives of this subject, care can be taken to give sufficient justification for the inclusion / deletion of the contents on the basis of their relevance to clinical practice with special reference to homoeopathic situation.

Though faculty development is a major issue, the efforts needed are minimal, since the teachers who are already in the field have to re-orient and upgrade their knowledge base. This can be organized in the form of re-orientation programmes for the select teachers.

This programme need not be started as a blanket agenda covering the entire 184 colleges in one go. It can be started on an experimental basis in one of the universities that has couple of institutions and evaluated for a period of one or two years for its effectiveness and attainment of purpose, and reviewed for continuation or otherwise. An interim permission form the competent authority to the effect that such an experimentation doest not imperil the academic future of the students who are the experimental subjects needs an administrative and political determination, which I hope is not lacking in the present leadership.