ESTABLISHING COMMUNITY-BASED HOMOEOPATHIC PRACTICE IN RURAL AREAS THROUGH ACTION-LEARNING PRINCIPLES
Ravindra B. Shinde, MD (Hom)1*
Translated from Marathi by: Nishigandha D. Mahajan, BHMS2
1Consulting Homoeopathic Physician, Shinde Homoeopathic Hospital, Malewadi. Akluj, Taluka Malshiras, District Solapur, Maharashtra
2 PG Student, Department of Organon of Medicine, Dr M. L. Dhawale Memorial Homoeopathic Institute (MLDMHI)
*Address for correspondence: Dr Ravindra Shinde
How to cite this article:
Shinde RB, Mahajan ND (Translator). Establishing community-based homoeopathic practice in rural areas through action-learning principles. Journal of Integrated Standardized Homoeopathy (JISH) 2019; 02(01)
Received on: December 03, 2018
Accepted for Publication: March 29, 2019
After completing post-graduation from Dr M. L. Dhawale Memorial Homoeopathic Institute (MLDMHI), Palghar, in 2008, I was a Medical Officer for 2 years at Bhopoli, working for the AYUSH-funded Mother and Child Project. This gave me good experience in the field and the hospital, as I managed the mobile clinic and a full hospital at the same time. I started my practice in 2010 at my village, Akluj, in Solapur District and inaugurated my clinic with a 10-bedded day-care centre on 18th September 2010.
The training I received in the Institute has played a crucial and substantial role in shaping me as a Homoeopath and person. The teachings of teachers like Dr Kumar Dhawale, Dr N. L. Tiwari, Dr Anand Kapse, Dr Chandrasekhar Goda, Dr Navin Pawaskar, always act as a beacon during any downfalls. Kumar sir’s messages are my energy boosters. The learning process at MLDMHI makes a huge difference in one’s life. Knowing your own sensitivities and handling them with sensibility is the basic need of a good human being for sound functioning in society – an important lesson I learnt during my training at the MLDMHI.
Bhopoli Experience: My Foundation
My clinical posting at the Bhopoli Tribal Cottage Hospital during my MD years oriented me towards the tribal community. I realized their fundamental needs and deprivation, making me think deeper and resolve to work for the community for the rest of my life. We have seen that the most troublesome issue of the community is malnutrition, caused by many factors including diarrhoea, which in turn causes high child morbidity and mortality. I distinctly remember the case of a 1-year-old child with diarrhoea described by the parents as ‘fedur’ stools, a new word for us. The community health worker (CHW) pointed to the green scum in the neighbouring pond. Stool – watery – green – scum, with complaints in a nursing child without proper weaning. Magnesium Carb was the remedy, leading us to see not only the power of the similimum but also the need to understand the people’s language. The results of our intervention inspired us to continue. Our Bhopoli team of CHWs – Nareshbhau, Tulashibhau, Gopalbhau, Bhauram – have worked at the grassroots from conducting awareness camps and orienting the community on topics like maternal health during and after pregnancy, importance of lactation, and dealing with malnourishment. Therefore, we got a good response and patient flow and compliance improved. While working as an MO in the AYUSH Mother and Child project, I could not only manage the 10-bedded Cottage Hospital, but also interact with the barely literate pada workers and lecture them in Marathi.
When we do not take fees and do not keep expectations, the phenomenon of ‘Unprejudiced Mind’ occurs naturally and easily. The junior MOs became friends and the posting became a celebration of delivering results. Receiving a cucumber from these patients in return was a striking reward of our efforts.
The ultimate effect of all this was that imparting Homoeopathic training to my wife was easy. Today, she not only does exemplary case-taking but also actively participates in organizing community camps. It is like transplanting Bhopoli back home and the family involvement increases the joy two-fold.
Struggles in initial years of practice:
On returning home, I had no place to start practice, so I started practice at home. But patients were absent, probably because it was the very initial period of my practice. Also, perhaps people in the rural area were not aware of the effectiveness of Homoeopathy and even doubted whether they are medicines.
I started with retired elderly people, the temple priest, and some daily visitors. One day, the footwear minder (a Nepali) came to me for spastic Achilles tendon, being unable to place the heel on the ground. I gave him Lathyrus Sativus (gait – heels, do not touch ground when walking – Phatak Repertory; confirmed from Boericke’s Materia Medica). Over 6 months, he could walk normally. Extremely happy with the results, and a ‘walking demonstration’, he became a firm believer and started regularly referring patients from among the devotees visiting the temple.
The temple thus became my workplace and a 2nd home. I found my life partner there; we got married in the same temple. By God’s grace, my better half is also a good human being who has helped me throughout my journey and is a constant moral support. She is a good observer and asks questions like an MD student. She always wants to learn more, so nothing is hidden between us.
The tide turned gradually and some fees could be charged. Now, there was a queue for medicines and the comments reduced. The community noticed the continuity of services and entire families started to come to the temple for medical help. All the devotees now help in serving patients. The patients wait for even an hour as there is a homely atmosphere. We do not sit on a table but on the floor with them, so they feel we are one of them. Now, the village comes to the temple for ‘darshan’ and Homoeopathy! Such has been the transformation.
Acceptance and entry into the community:
A few of my cases, especially related to maternal health, were similar to the cases at the Bhopoli Hospital. The human situation and the surrounding region at my place are similar to that in Bhopoli. People don’t know the importance of sound maternal health during pregnancy, the foetal movements are perceived to be weird and abnormal, and morning sickness is not even noticed and may even turn to hyperemesis. Socio-cultural beliefs and superstitions hold sway at both places. I decided to conduct awareness camps about Homoeopathy, maternal health, ante-natal and post-natal care, and the importance of breast-feeding. These were well received by the community.
Some Clinical Experiences:
A young woman in the third trimester developed pain in the hips on walking, with no relief with the standard injections / saline. The symptom of ‘sore, bruised feeling during walking, could not walk erect on account of a bruised sort of feeling in pelvic region’ was the keynote from Allen. Within a week, she started walking normally and showed this on the temple floor. The live experience convinced the community it was possible to be treated here for conditions with no known treatment.
A young woman in her first trimester complained of excessive morning sickness with continuous nausea. Her husband told us “Ti gharache daar khidaki band kara sangate” (She asks us to close all the windows and doors of the house). My PG training in the Repertory Dept. helped me to spot the characteristic symptom – the desire for a closed room. Phatak’s Repertory lists only 4 remedies (Colchicum, Arsenic alb, Cocculus, Ipecac). Allen’s keynotes is even more specific, explaining the need for a closed room (aversion to food; loathing even the sight or still more the smell of it). When morning sickness was also considered, Colchicum Autumnale came up, the patient improving after a couple of doses of Colchicum 200 C. My training has taught me one more very useful aspect – converting the local dialect into a symptom and then into a rubric.
An ANC patient came with pain in the abdomen and continuous nausea. She was repeatedly saying “potaat baal tirake aahe, tyachya mule daab padato potavar ani malmal hote”, meaning the baby is sideways, because of the pressure, I am getting nausea. Phatak’s Repertory gives the rubric foetus lying crosswise as if, which has a single remedy listed – Arnica Montana. We usually use Arnica as an injury remedy, but here it covered the characteristic PQRS symptoms. Only a few doses of Arnica 200 C helped. Phatak’s Repertory has been very useful in practice, as it has many aspects of modalities and cravings and aversions of foods native to India.
The case of a lactating mother with cracked and extremely painful nipples < slight touch was cured with a few doses of Castor Equi 200 C. Phatak’s Repertory: nipples – cracked:
nipples – sore, tender – touch of clothing agg.
A pregnant patient with severe sneezing causing pressure on the abdomen came at 6 months, < smell of garlic and frying masala. She prohibited cooking with them in the kitchen, which was practically impossible for the family members to follow. The rubric – food and drinks, agg and amel – garlic, odour of agg from Phatak’s Repertory indicated Sabadilla. Infrequent repetition of 30 C relieved the lady. She could peacefully eat normal food with the family.
A young pregnant woman came with morning sickness and reduced appetite, not cured with multiple medications. Again, PQRS in the local language ‘payachya nasa fugatat’ meaning varicose veins. Murphy’s Repertory – varicose veins, general, pregnancy during, heartburn with, we find Zincum Met. She recovered quickly.
In the various camps I conducted at the temple, I saw diverse cases. My training at MLDMHI helped me to cater to the large numbers in a short time. I have found the Repertory to be an extremely useful tool in giving quick prescriptions, particularly Phatak’s Repertory.
A decade later – growing with the community:
My training at MLDMHI has given me an altogether different perspective towards the Community, Homoeopathy, and ultimately my own life. Dr Chandrashekhar Goda taught me the value of establishing a connection with self and community, how to work in co-ordination with CHWs, ASHA workers, Arogyadoot, and other public agencies for better implementing Community health in the rural population. I have tried to follow Goda sir’s teaching in my practice, which has helped me set up and establish my practice in a rural area. I have also learnt from him that it is possible to do good work without getting involved in politics. If we work in co-ordination with all political parties, all come to help us. I have implemented this learning and have got very good support from all.
Some heart-warming experiences in the community:
1. We tried to treat the malnourished children. Unfortunately, the parents gave a pathetic response, being caught up with daily needs and their addictions, not even collecting medicines for their child. The daily experience of the Aanganwadi sevikas was: only 2 out of 10 parents will take care.
In 2 years, we treated 150-200 children with malnutrition through the aanganwadi sevikas, but only 10-30 parents participated. We obtained good results and video evidence of the improvements. Incidentally, Kreosote (teeth begin to decay as soon as they appear) helped in reducing the dental caries enabling the children to chew better and eat healthily. Pica significantly reduced.
I learnt the technique of taking ground-level feedback from Dr Prabhudas, Naresh bhau, Tulashibhau, and Gopalbhau. When free medicines are administered, the public feels that they are being experimented upon or we are getting government help. We have to handle these doubts.
2. Dr Prabhudas introduced to me the concept of ‘hause, gause, and navse’ – The Fairs or Jatras that take place in the villages are thronged by these three types of persons. The ‘hause’ come for fun and frolic; the ‘gavse’ come to acquire something through any means, fair or foul; only the ‘navse’ seriously visit to get their heart’s desire. These are only 3% in the community and, like the MLD Trust, we have to address their urge for health care.
Prabhudas sir also enjoined me to listen to the messages arising from within the self. One such message told me “go to the source of malnourishment and treat the adolescent girls and pregnant women, so that an aware mother will look after her child well!” But, the community feared the effect of the medicines during pregnancy. Hence, though many patients attended the camps, barely 3%, the ‘navse’, actually took medicines! Yet, the treatment results (captured on video) are really scintillating and magical! We got a very poor response from adolescent girls due to their shyness. But, our 3% mothers turned out to be powerful women who influenced 7% to change. Seeing the positive results, the ASHA and aanganwadi sevikas became more cooperative.
3. While seeing patients on Saturdays at the Narsinghapur temple, an opportunity arose to treat a mentally retarded girl. Hyosyamus 200 C in infrequent doses brought about a significant improvement in her behaviour and speech, which gratified the parents to no end. We shared this experience with the Solapur District CEO, Dr Rajendra Bharud. This allowed us to cater to a large group of children with MR, autistic traits, and ADHD, with great results.
I recalled the skill of our Bhopoli grassroots workers in understanding the local language and handling sensitive community issues. Our team comprising my wife and ASHA and aanganwadi sevikas could understand the menstrual difficulties and the personal issues of women who were attending camps. Their working together helped immensely in case-taking. Recalling my MD days with Dr Anand Kapse, we would start the case discussion: what is the core of this patient? what is the characteristic? Can the core be found in the Repertory?
I also remembered Dr Navin Pawaskar who warned: do not become another Baji Prabhu Deshpande and fight alone! Decide which patient can be treated at home and who needs to be sent to the emergency ward of a higher centre. Hence, I have had very few conflicts of a serious nature; the few that occurred were easily manageable. Dr Pawaskar’s training was invaluable in the management of my day-care centre.
4. Our Bhopoli and Palghar teams taught me to connect with important people in the community to get work done. I could tap the energies of the enthusiastic sarpanch, temple priest, hospital nurses, retired teachers, senior citizens – all these service-oriented persons have helped immensely.
The medical officer in the government dispensary and the nurses, including the long-serving employees, offer help without expecting anything in return. The taluka medical officer, Dr Mohite, helps to organize camps by offering the dispensary hall and lab facilities for testing blood and urine. He also alerts the Gram Panchayat sarpanch, ensuring government authority support. All camps have been successful without any untoward event, and without publicity through newspapers. The joy of the work is more than the publicity that comes through such efforts. Thanks to my father’s advice, I have kept away from the limelight and that has helped these 8 years to pass without any incident.
The training imparted to me at MLDMHI helped me to understand:
- A Homoeopathic physician needs to understand the community and its needs before he / she ventures into community health.
- Patience and perseverance are the keys to become a good community medicine practitioner.
- Team work is the only way forward for a Homoeopathic Physician to liaison with a team of health workers, government agencies, and members of political parties and community leaders to have a far reaching impact on community health.
- If Homoeopathy has to really become mainstream, it has to go to the grassroots, the people in the remotest villages of our country.
- On the professional front, understanding the patient’s language is of paramount importance.
- Also important are a keen ability to convert the symptoms of a patient into rubrics and mastery over the tools of repertorial analysis so we can determine the similimum and treat patients successfully.