EARLY SCHOOL SCREENING PROGRAMME OF THE MLD TRUST: A ROAD TO SCHOOL HEALTH THROUGH HOMOEOPATHY

Dr. Madhavi Tamboli M.D (Hom),
Co-ordinator, Urban Clinics, Dr MLD Trust

Dr. Latika Agrawal M.D. (Hom)
Medical Officer, Dr MLD Trust’s Dahisar Centre

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Introduction

Dr. M.L. Dhawale Trust has been conducting health screenings in the preschool section of Vidya Mandir (Balodyan), Dahisar for the last seven years. The objectives of this activity are to enable early diagnosis with intervention and promote preventive health care. It is a known fact that treating the illness in its initial stages provides faster relief and thus a better prognosis. What better time is it to start, than in early childhood? After all, a healthy child builds a healthy Nation! Keeping this in mind, a yearly health camp is being organized. A distinctive aspect of these annual screenings is that they have not been restricted to only physical checkups, but also encompass the screening of behavioural, emotional and academic issues.  The purpose of this article is to describe the screening as conducted in September 2018 and to draw out the lessons from the process standardized over the years so as to enable a suitable adaptation of the efforts in different places and levels.

 

Objective of screening programme:

• Early identification and accurate diagnosis of most of the treatable conditions.
• Raising awareness of teachers and parents so that appropriate remedial steps can be taken.
• Introduction of Homoeopathic intervention as a means to address the ailments of the child at all the three levels.

 

Postulated outcomes:

• Early detection and intervention of the problems at the inception itself will prevent further deterioration of the child’s condition.
• A better future of the child is ensured as it will be physically and mentally healthy.
• Promotion of Homoeopathic intervention as a holistic, cost effective science.

 Method

The screening comprises of the following 3 phases:

1. Planning
2. Camp- Screening process/Health Checkup
3. Post camp report and Parent-Teacher orientation meeting

Planning:

1. Planning for the camp started in June 2018, around 3 months prior to the screening date. The planning required finalizing:

• Dates for the camp according to the school schedule for the year and availability of doctors. This process starts at the beginning of the academic year so that teachers get enough time to evaluate the children of their respective classes. This year the screening was finalized from 24^th – 27^th
• Number of doctors required to examine the students (N = 438) within a stipulated time (2 hours per day within 4 days) needs to be determined. At least 4 doctors, along with a medical officer, are needed on each day.
• Availability of dentists for examination since preventive dentistry has now become a discipline in its own right. Two dentists were present on all the days.
• Printing of the required material: Printing material included a questionnaire for the teachers to assess the students, health check-up card for the doctors to write their assessment, and a Health report card that is given to the parents mentioning the health status of the child and the necessary guidelines. This is done by the school after taking the necessary inputs from the medical officer/supervisor.
• Date for post-screening orientation program for the parents and teachers. This year, the orientation was conducted on the 20^th  October.

 Camp: Screening Process:

• A brief assessment of the general and mental health (hyperactivity/ inattention/emotional/ scholastic issues/ recurrent absentees) was done by the respective class teachers prior to the camp.
• This was followed by a questionnaire to be filled in by the teachers, especially designed by the Department of Psychiatry, MLDMHI to assess the functioning of the child in the school at various levels (Appendix 1).
• The team comprised postgraduate students from the MLDMHI and Dahisar OPD of the Dr. M. L. Dhawale Memorial Trust. Team members were was oriented to the nature of physical and mental conditions expected in the screening, the procedure of assessment through parental enquiry, observations, and examination. The importance of correlation of the data provided by the teachers through the abovementioned questionnaire and that obtained from the parental inputs, along with observations and examination done by the team, was emphasized.
• Around 100-120 children were seen in around 2 hours by the team of 4-6 doctors.
• Each child was screened for the present or past complaints along with the measurement of height and weight. This was followed by a physical check-up of the child. A brief mental health assessment was done based on the questionnaire filled by the teachers. On an average, it took 5 to 7 minutes to screen each child and document the observations on a specially designed proforma. (Appendix 2). Children with problems took longer (10-12 minutes).
• The dental examination was done simultaneously, taking 4-5 minutes for each child.
• Parents having doubts regarding their child’s health were also spoken to and guided accordingly.

 

Post camp report:

STANDARD	TOTAL NO. OF CHILDREN	TOTAL NO. OF CHILDREN SCREENED	NO. OF CHILDREN NEEDING HOMOEOPATHY \ FURTHER EVALUATION
NURSERY	117	112	33
JUNIOR KG	181	180	55
SENIOR KG	140	134	36
TOTAL	438	426	124

Table 1: Children screened in the Camp at Vidya Mandir

Analysis of complaints:

Following were the Illnesses observed in Balodyan this year:

SR. NO.		ILLNESS/ SIGNS	NURSERY	JUNIOR KG	SENIOR KG	Total	%
1.	PHYSICAL	Underweight	6	27	25	58	14
2.		Overweight	4	3	11	18	4
3.		Dental caries	45	79	59	183	43
4.		Recurrent sneezing/cold/cough	25	44	20	89	21
5.		Ear Wax	19	35	28	82	19
6.		Skin complaints	7	7	3	17	4
7.		Anaemia	5	3	–	8	2
8.	MIND	Hyperactivity/Inattention	5	9	18	32	0.5
9.		Speech Delayed or other speech issues	4	2	1	7	1.6
10.		Others [convulsion(C)/ Squint(S), Hypothyroidism(T), Heart Disease(H), Mouth Complaint(M), Emotional issues(E), Tongue Tie(TT), Abdominal Complaint(A), Borderline IQ with Autistic traits(B)	2 (C), 1(M), 1(TT)	1(C), 1(S), 1(T), 2(M), 1(E)	1( C), 1(H), 1(E), 2(A), 1(B)	15	3.5

 

• Among the children, 14% were underweight and 2% anaemic; this could be due to several reasons, the most important being faulty dietary habits and defective assimilation. Adequate nutrition is necessary for the mental and physical development of the children. Nutritional deficiencies may give rise to concentration difficulties – in studies and other difficulties like memorizing problems, thereby affecting their performance. The chances of recurrent infections also increase with undernourishment.
• Hence, further evaluation and orientation about the diet and regimen is needed. At the same time, it is also noticed that the percentage of underweight children has decreased by 7% as compared to the previous year. The credit goes to the school management and the principal for arranging orientations for parents and staff who actively reinforce the value of balanced nutrition.
• As compared to the previous year, children with recurrent cold and cough had increased by 6%. The likely reasons were: non-treatment of the previous cases, low hygiene care, and disordered nutrition (as seen above). Colds are often transmitted from one child to the other in the school itself.
• There was an increase in dental complaints by 18% as compared to the previous year. Dental hygiene forms an important feature of good health. Dental caries produce pain due to which a child is unable to chew food resulting not only in arresting the physical growth of child but also in decreased haemoglobin levels leading to anaemia and other gastric problems. Anaemic children get tired easily, sleep in class, are less active in class, and find difficulty in memorizing.
• Approximately 19% of children had impacted wax in their ears. Ear wax has both lubricating and antibacterial properties. However, excessive accumulation can lead to hearing loss, irritation, pain in the ear, dizziness, ringing in the ears, and other problems.
• Chronic skin diseases like pityriasis, tinea, etc., along with obesity were negligible this year. Other problems like speech difficulties, convulsions, heart disease, squint, hypothyroidism, abdominal complaints, tongue tie, and emotional issues were seen in 3.5% children.
• The teachers had observed hyperactivity in many children. It has to be understood that it is a transitional phase for the child who is grappling with adjusting to a new environment and changes in daily routine. The child too wants to explore more and tends to be very active in class. Hence, at this age, it is very difficult to label a child as hyperactive or attention deficit. Having said this, there could be a few children who do display a gross inability to sit in a place, attend to the teacher’s instructions, and understand the academic curriculum. These children need to be observed and assessed carefully and the parents need to be guided accordingly.

Post-camp parental orientation meeting:

The orientation meeting was held on 20^th October 2018. It was addressed by Drs Madhavi Tamboli and Latika Agarwal from the Homoeopathic department and Drs Mannan Parmar and Saloni Parab from the Dental department. The meeting was attended by 188 parents.

Based on the above screening report, parents were oriented about:

1. Healthy nutritious diet: role of vitamins, minerals, carbohydrates, proteins, and fats in the overall growth of the child.
2. Personal and environmental hygiene for reducing frequent illnesses and maintaining a healthy body.
3. Importance of dental hygiene and preventive measures for dental hygiene.
4. Significance of a good home environment in the upbringing of a mentally healthy child.
5. Importance of quality time spent with the child in raising a secure and confident child.
6. Role of Homoeopathy in treating and preventing illnesses.

The orientation was very well received and appreciated by the parents as well as the school authorities. This was followed by a question-answer session.

The school appreciated sincere efforts taken by the MLDT in organizing and conducting the camp. The gratitude was reciprocated with appreciation for the school authorities and teachers and other staff who also organized the camp very efficiently with a promise to conduct the camp again the next year.

Implications of undertaking School Health screening

Since we have been conducting the camp for the past seven years, we have been able to identify the following emerging pattern:

• There has been a considerable decrease in undernutrition and obesity due to regular screenings and efforts taken by the Trust and the school authorities in orienting the parents. The parents have also taken the required steps. This emphasizes the need of regular and comprehensive parent orientations.
• The percentage of allergic, respiratory, and skin conditions has been the same. This could be associated with non-medical intervention and hygiene issues.
• There has been increase in the dental complaints as compared to the previous years. Although dental complaints have formed the major part of physical complaints, repeated orientations and checkups are definitely needed.
• Behavioural, emotional, and academic disorders like hyperactivity and inattention, mental retardation, slow learners, learning disability, and speech disorders have been identified, although in a smaller percentage. Early interventions have definitely helped in cases with proactive parents. Teachers, too, are now better aware and equipped to identify these conditions due to the orientation given over the years. A few cases of autism spectrum disorder were also identified. The screening and orientations have seen spontaneous referrals from the school.

Benefits of conducting the health screening camp:

For school and parents:

1. Early detection of the complaints leading to early management resulting in reduction of chronicity of the complaints.
2. School, teachers, and parents get expert advice from doctors rather than acquiring inauthentic knowledge from unwarranted sources.
3. Those seeking Homoeopathic treatment have benefited considerably; this has resulted in increased faith of parents and teachers in Homoeopathy and the Institute has strengthened over the years.

For the institute:

1. Direct contact with the society on a large scale is established.
2. Rapport is developed between society and the doctors.
3. Awareness about the Institute and the role of Homoeopathy in various illnesses is increased in the society.
4. Early diagnosis leads to better prognosis of the cases.
5. Resident doctors who are part of these camps learn to organize the camps at individual level. They get to observe and examine many children at a time, thus sharpening their clinical skills. They learn to identify mental illnesses as well. The management of time during such screening camps is also learnt.

Limitations and cautions while undertaking such programs:

1. Planning must begin at least 3 months in advance as there are many variables involved i.e. availability of the students/ doctors/ parents/ school premises.
2. Planning and printing of the required material requires time.
3. Aims and objectives of the camp must be kept in mind while planning them.
4. One must be very cautious in diagnosing cases on the basis of screening alone. Screening should be followed up by concrete clinical evaluation. It is only after the latter that we are able to orient the parent regarding the likely management steps that are needed.

Appendix 1: Questionnaire for Teachers

 

Appendix 2: Child screening card