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.

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