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, May 7, 2009
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.
References:
• 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 www2.jabsom.hawaii.edu/ FamilyMedicine/Conference%20Schedule/.../Principles%20of%20Community%20Medicine%5B1%5D.ppt
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.
References:
• 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 www2.jabsom.hawaii.edu/ 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.
Human Biology for Homeopathy Unergraduate Course
The following is the proposal that I had sent to the Central Council of Homeopathy, New Delhi, India in December 2002
Workshop on Human Biology in BHMS
Preamble:
The structure of homoeopathic undergraduate curriculum is profoundly influenced by the Medical Council of India’s curriculum for MBBS course. The professional and ideological priorities of homoeopathic practice are certainly not the same as an allopathic graduate. Therefore, the syllabus for pre-clinical subjects in BHMS cannot be the same as the one proposed for MBBS. Since the current syllabus draws the contents and process strongly from the MBBS syllabus, it is high time that we addressed to a need for reviewing the syllabus for the subjects like Anatomy and Physiology to begin with.
A closer look at the curriculum of Anatomy and Physiology in BHMS syllabus is a revealing experience in that there is a generous dose of these subjects at the cost of providing a homoeopathic orientation to the students right from the beginning of the course. Even as the Medical Council of India has reduced the duration of first MBBS from 18 months to 12 months and toned down on the regular dissections, we still persist with the age-old syllabus giving high priority to even the dissection of the entire brain.
A fair and unprejudiced assessment of the contents in Anatomy and Physiology of BHMS syllabus and their utilization in our clinical practice can be a topic of doctoral dissertation. On introspection, we do understand the usefulness of the minute details that we studied either in Anatomy or Physiology in our clinical practice. On the other hand, we are at times baffled by some of the simple issues pertaining to the structure / function of the human body. The main culprit for this academic disaster is the distorted priorities set in the syllabus.
Reflections:
The need of hour is to debate upon
- Should we be teaching Anatomy and Physiology at BHMS?
- If we should teach them, why we should?
- What shall be our priorities for these subjects?
- What should be the content?
- What should be the format?
- What are the material and human resources needed?
There is no denying that we should be teaching and more importantly, our students should be learning the basic medical sciences, including Anatomy, Physiology and Biochemistry. These are not only needed to provide the academic parity for BHMS with other health sciences undergraduate courses, but also to equip the learners with the fundamental information to practice medicine.
Once we are convinced that we should after all be teaching these subjects, it is time to set our priorities for these subjects. The professional responsibilities of a homoeopathic practitioner are to some extent dictated by the societal and establishmentarian discernment of homoeopathy as a health-care profession. Homoeopathic professionals are considered as experts in certain predetermined diseases like the chronic diseases, persistent diseases, etc. They are not considered by the establishment for various reasons, to be competent to pursue higher education in the branches like surgery, obstetrics, etc. Unless we aim at bringing in a paradigm shift in the popular and political perception to see homoeopathic practitioners as a mainstream group indulging in the same tasks as an allopathic professional, we have to reconsider our curricular options.
Since we as homoeopaths have a strong therapeutic range in chronic diseases, it is conventional wisdom to focus on that aspect while writing the course objectives of the basic medical subjects. In this regard, stressing on the dissection of human body by every student and prescribing a whole range of equipments to teach anatomy is nothing short of dissipating the scarce resources. Seriously thinking, there is a lot that needs to be clipped out from the syllabus of Anatomy and Physiology in BHMS and there certainly are some issues, which need to be included to make it truly purposeful for the homoeopathic students and practitioners alike.
Proposal:
It is proposed to convene a workshop of senior teachers of Anatomy, Physiology and Biochemistry in homoeopathic institutions across the country and deliberate on the ways and means of rationalizing the curriculum of these subjects, in terms of course aims, learning contents, assessment techniques, material and human resources to implement the course, etc.
The workshop may consider the following issues:
- What shall be our priorities for teaching Anatomy, Physiology and Biochemistry?
- What should be the teaching / learning content?
- What should be the teaching / learning format?
- What are the material and human resources needed to implement the suggestions?
Of late there is a trend in the health sciences related courses to integrate the teaching of Anatomy, Physiology and Biochemistry under the generic name – Human Biology. An attempt is made to present an integrated view of these basic medical sciences to appreciate the symbiotic and holistic rapport of these disciplines. This also provides a more humanistic approach to medical students – an issue, that is very close to homoeopathic philosophy.
Therefore, the proposed workshop could also consider evolving the educational objectives of Human Biology as an alternative to discipline-based teaching of Anatomy and Physiology / Biochemistry as is in vogue now.
Format of workshop:
- Send a proposal to Central Council of Homoeopathy for consideration to associate with this project
- Form a core group to liaise with the institutions and send the message across
- Identify a venue for the workshop
- Draw a tentative Income – Expenditure statement
- Request each of the recognized homoeopathic institute to depute one faculty member, preferably holding a senior position in the institute from the departments of Anatomy and Physiology / Biochemistry
- Finalise the list of participants for the workshop
- Identify the resource persons to co-ordinate the workshop
- Finalise the dates for the workshop
- Arrange or the staying and other necessities of the participants
- Organize the workshop
Expected Outcomes:
The workshop shall focus on evolving
- Educational objectives of Anatomy, Physiology / Biochemistry
- Consider introducing Human Biology as an alternative to “Anatomy, Physiology / Biochemistry”
- Reflect upon the possibility of launching “Human Biology” as the alternative on an experimental basis at least in one University
- Resolve to provide the “homoeopathic orientation” right from the first year of BHMS course and even in the basic medical disciplines.
Monday, December 29, 2008
Branding Homeopathy Education
Homeopathy is set to emerge as a major influence on the global healthcare policy in the next two decades. The only constraining factor for this could be the brand of homeopathy education. The organised homoepathy education has to measure upto the global standards in documenting evidences for the training that happens in the institutions.
I presented a paper at the recently concluded National Homeopathy Summit at Lucknow on 'improving admissions in homeopathy colleges'. There was palpable apathy even among the managers and principals of the homeopathy colleges, which is incomprehensible; these are the institutions who are on the brink of collapse unless some resuscitation is given. Still there is an aura of 'fatalism' perhaps in the manner there was reaction.
There is every possibility that the southward trend of admissions' volume in homeopathy colleges can be halted and the numbers can be improved.
Is someone listening???
I presented a paper at the recently concluded National Homeopathy Summit at Lucknow on 'improving admissions in homeopathy colleges'. There was palpable apathy even among the managers and principals of the homeopathy colleges, which is incomprehensible; these are the institutions who are on the brink of collapse unless some resuscitation is given. Still there is an aura of 'fatalism' perhaps in the manner there was reaction.
There is every possibility that the southward trend of admissions' volume in homeopathy colleges can be halted and the numbers can be improved.
Is someone listening???
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