As our people are so are our homoeopathy institutions

As our people are so are our homoeopathy institutions – 2014 edition

A thought provoking and timely article on the current scenario of homoeopathy education in India with an in-depth analysis and creative suggestions

Dr Eswara Das   

The greatest threat to Homoeopathic education has been the extraordinary growth of sub-standard medical colleges with a vast majority being in the private sector

PROLOGUE
In 1981, I was working with Central Government Health Scheme, Delhi as Medical Officer. At that time an article was written on Homoeopathic Education in India for the souvenir, proposed to be published, on the eve of Dr. Hahnemann’s birthday celebrations.  I was a novice to literary jargon and the article was out of context. The Editor of the souvenir advised to   publish that article in a journal with academic objectives. I sent that with a title, “ As our People are so are our Institutions”  to Dr K.P.Muzumdar, who was editing Hahnemannian Gleanings, published by Hahnemann Publishing Company (HAPCO), Kolkata. The title was  based on a famous quote on Leaders in Homoeopathic Therapeutics, by Dr E B Nash.

Dr Muzumdar readily accepted that article and published it in Vol XLIX No 7, July 1982 issue of Hahnemannian Gleanings.  That was the beginning of my first literary pursuit. As it happens with any one, I was thrilled to see my article printed, especially in a journal like Gleanings.  There was not much journalistic presence in Homoeopathy at that time. Dr Muzumdar was kind enough to bless me with good words of encouragement. I still preserve a copy of this journal in my inestimable collections of Homeopathic literature.

Much water has flown in Ganges after that. During this saga, I acquired better skill in literary writings, talent in presentation, handiness in articulating subjects, agility in thoughts etc. Since then, several articles have been  published on Homeopathy including Homoeopathic education; got opportunity to be part of the of the Homoeopathic education revamping system and also  occupied the coveted post of Director of the National Institute of Homeopathy.  Transition from clinician to academician was incidental; Academician to Administrator was a passion. Support came from all quarters. When I left the steps of NIH in 2010, success of transforming the Institute that was gapping for guidance had become an enigma.   Experience, expertise, excitement and enthusiasm were all part of the long journey in search of pedagogic excellence. Now, in 2014, when Mr. Aunj Arora asked me  for a write up on Homoeopathic education for their Education special of Homoeopathy for All, flash  of thought went   hunting  for essentials  as to what had  happened to Homoeopathic education  ever since 1981 and  where do we stand in 2014.  A cursory inference is that we are still at the cross road looking for direction. Without any thought accepted the request of Mr. Anuj and collated the points as  a new edition of As our People are so are our Institutionswith little more analytical thoughts that the experience had given. There is no effort of either of self denigration or to hurt anybody’s position. Unless we know where we stand it is difficult to get direction.

Introduction
Homoeopathy is a distinct medical specialty being practiced across the world. It is a recognized medical system in India and a household name in many parts of the country due to safety and gentleness of its medicines. Homoeopathy is blended well into the ethos and traditions of the health culture of this country, that it has been recognised as one of the national systems of medicine. Homeopathy plays an important role in providing health care to a large number of people. Its strength lies in its evident effectiveness in certain clinical conditions for which there is very less or no treatment options in other systems. Homoeopathy takes a holistic approach towards the sick through promotion of inner balance at mental, emotional, spiritual and physical levels. All these facts are as sweet as  the pellets of Homoeopathy to the academia. 

During the last sixty years, efforts were going on to successfully institutionalize Homoeopathy in India and integrate the same in the National Health care delivery system. A reasonable infrastructure in the form of 186 teaching institutions including a National Institute of Homoeopathy at Kolkata, around 2,50,000 registered medical practitioners, 323 drug manufacturing units, an autonomous research council with 32 peripheral units,  a regulatory Council for setting standard for education at University level, drug safety regulations, Pharmacopeia Laboratory, Pharmacopeia Committee, network of 7585 primary health  care facilities under public sector, 201 hospitals for secondary health care  are with about 7381 beds etc  available in Homoeopathy in the country.  During 11^th Plan it was envisaged to establish a North Eastern institute of Ayurveda and Homoeopathy at Shillong and during 12^th Plan   proposal for establishment of an All India Institute of Homoeopathy and a Homoeopathic Pharmaceutical Corporation is also approved. This reasonable infrastructure proves that we are not much behind many other National medical systems.

Development & Status of Homoeopathy Education In India
The four segments that are fundamental for development of any medical system are  Medical education, Research, Drug Development and Health care delivery system. Homoeopathy is not different. As this article in indented on education, I focus on the education sector only and prefer to highlight the present position and scope for improvement. Possibly this is the most important sector. Unless we have a credible education system and the products (new generation Homoeopaths coming out of the education institutions) are capable to shoulder the challenges, Homeopathy   itself may not get the status that it demands.

Homoeopathic medical education and practice is regulated through the Homoeopathy Central Council Act, 1973 and under the provisions of this Act, the Central Council of Homoeopathy is constituted.

Out of the 186 Homoeopathy medical colleges in the country, 38 colleges have upgraded departments for postgraduate training. There are two exclusive PG colleges also.  The admission capacity at undergraduate level is approximately 12785 seats/ year while the admission capacity at Postgraduate level is about 1040/ yr.

Conflict of Interest in education.
The Central Council is a body corporate constituted by the Govt.  to regulate the education and practice.  The Council has enforced various   educational regulations; the most important one is the Homoeopathy Minimum Standards of Education Regulation, notified by the Council in 1983. As we marched ahead with modernization of the education system, conflict of interest gradually took the  center stage and the  requirements got pruned down to suit the pockets of the facilitators of education. One example is the calamity fell on teachers.  This regulation prescribed the requirements of teachers, facilities like hospital beds, clinical labs, library, hostel, etc.  When the Council notified it in 1983, most of the colleges were conducting the Diploma course of 4 yrs duration and the requirement of full time teachers was 62. The Council insisted for this for over 2 decades and the colleges were provided these teachers to get the status of recognized institution.  Demand for degree and postgraduate courses came to be equal among other medical disciplines.

Gradually the diploma colleges were converted to degree and PG colleges. The assumption was that the erstwhile diploma colleges fulfilled the MSE requirement for up gradation for higher courses. As the water flows in Ganges, inspections, visitations, seminars, ROTP, CME courses, evaluations  of the facilities  continued   un interrupted and  regulators certified that the  Homoeopathic education is in right track and were all  improving the quality of standards. There were efforts to show case that the Indian model  of education is the best  to be imitated by other countries. Self proclamation of  status  satisfied many.   This rosy picture paved the way for introduction of PG courses in 1989 and phasing out of Diploma course in 1999.

In 2002, the Homoeopathy (Minimum Standards of Education) Regulation was amended with a diluted version to suit the   pocket of the Managements of the colleges rather than academic necessasity. The number of the teachers was reduced to 42.   In 2006, the HCC Act was amended by the Central Govt.  making it mandatory to seek the permission of the Central Govt. to open a new College, increase the seats or introduction of a new course. Some efforts were made by the Department to make the Minimum standards   compulsory.  When an  effort was made to  understand the  standards,  the Council  and the Govt. realized that  there exist not even single college in the country  fulfilling all the requirement stated in the MINIMUM  requirements. The calamity again fell on all the basic requirements including the number of teachers. Now the name of the regulation is changed as Homoeopathy (Minimum Standards Requirement) Regulation and number of teachers has been  reduced to 25 !.

One of the justifications is that the curriculum did not demand that much teachers. The curriculum prescribed by the experts of the Council and the Education Committee of the Regulatory council had become the villain for higher standards in the MSE regulation implemented by the Council over 4 decades. The poor Hahnemann and Homeopathy became mute spectator and the management who were forced to recruit higher number of teachers  became the beneficiaries  and the surplus teachers after the new requirement  have become the victims!

Homoeopathic education has progressed from diploma to degree and Post graduation. The number of colleges has grown from 76 to 186.  The admission and demand for seats have increased.  The bed requirement has come down from 1:1 (student: Bed ratio) to mere 5/6 (30 % bed occupancy of 25 beds). X-ray and USG requirement of a teaching medical college has become optional.  Microscope, glassware’s, equipment, machinery all become calamity. The rule makers have become the evaluators.  Students who took admission aspiring to be doctors, after a stage of skepticism, compromised with their fate and started with the wind without worry on assured assumption of crossing the fence of examination!

The major transition was   that many of the Members of the Council has either opened their own Homoeopathy colleges or  got associated with a college. Therefore, it is only the conflict of interest that paved way of dilution of the standard and not the need of the system to bring quality assurances.   The blame game of the Council and the Government goes on and the victims are the poor students who opted Homeopathy as their career.  Scrupulously the makers of the regulations put the blame on Homoeopathy that with stood the onslaught from outside on its inability to withstand the modern advances in Allopathy. They started a campaign to   teach Allopathy to the Homoeopathy.  The fence started eating the fodder!

As an insider, who started learning to look from outside, sometimes feel pity on our leaders justifying their deeds before huge audience of Homoeopaths. Sometimes,  the assault  would be on the system, sometimes on the Central Govt., sometimes on the  financial aspects, sometimes on State Govt., University etc;  BUT NEVER ON THEMSELEVES.   There are Members who are a part of the education system for over 30 yrs, who even  has not thought of what is required and what is being  practiced.

Poor Leadership, low priorities, lack of vision
We have a host of professional bodies at National level such as Homoeopathic Medical Association of India (HMAI), Indian Institute of Homoeopathic Physicians (IIHP), Homoeopathic Medical Association of India (HMAI), Asian Homoeopathic Medical League (AHML) and now, the Indian Chapter of Liga  Homeopathica Medicora Internationalis (LMHI).   All these professional bodies organize local and national conferences, seminars, annual meet etc.  Education is always a topic of debate in most of their functions. This is happening more because of the necessasity to fill the  hall with  students and teachers rather than   facilitating an atmosphere of  health debate. The speaker is the same, the theme is the same and resolutions are the same.  After the inauguration and felicitation of the VIPs, the hall becomes lusterless!.  Someone in the audience once quippedon  the absence of stalwarts like Dr. K.G Saxena or Dr Mahendra Lal Sarkar with guts to tell the spade as spade.

Government progarmmes on Homoeopathy education.
In recognition of the fact that the quality of Homoeopathy education had to be upgraded, the Government of India is implementing a Centrally Sponsored Scheme “Development of Institutions” under which financial assistance is provided for the expansion and renovation of buildings; purchase of library books, equipment and scientific instruments; the strengthening of teaching hospitals; the development of computer laboratories and internet facilities; the development of postgraduate studies; for conducting re-orientation training programmes for Teachers; and, for the development of model colleges.  However, during the last 2 plan periods, the Government has completely stopped  financial support to  the private Institutions on the argument that the private institutions have to look after themselves. The  fact is that the admissions to these colleges are regulated   by the respective State Govt. the fee structure is decided by the State Govt. and the seats are allotted by the State Govt. irrespective of the fact whether one is a Govt. college or private college.

Many time the seats are not filled due to  late approvals or seat allocations, thereby leaving the private colleges to survive with the meager fees to meet the ever increasing cost of education.  The  hospital attached to the colleges are providing  public service to the community. This add up to the expenditure.  Keeping all these in  consideration, the denial of  grant in scheme  of the Central Govt. that was partially meeting the requirement of infrastructure  has put the private colleges at a great disadvantage.   On the other hand, there were problems like lack  resources to absorb the funds of the Central Govt. inadequate coordination   in different department of the Govt.  in utilizing the grants provided by the Central Govt etc  and there by neither the  infrastructure in the Govt. College  improved nor the private college could get the required funds. In almost all the financial year during the 10^th and 11thy Plan the funds allocated for improving the  Homeopathic education got lapsed there by a colossal impropriety has been done to this sector. The efforts of the Govt. to improve the quality of Homoeopathic education almost remained paralyzed.   There are good private colleges and poor Govt. colleges. It is the prerogative of the college to support any college based on its inherent strength. Closing the door to all the private college is myopic and counterproductive to bring quality assurance in education.

THE PROBLEMS
The greatest threat to Homoeopathic education has been the extraordinary growth of sub-standard medical colleges with a vast majority being in the private sector. These colleges in general have little or no infrastructure in terms of the minimum requirements prescribed; staffing levels are generally inadequate; and the quality of instruction is poor.

There is a general consensus that curriculum and course content of the Homeopathic degree and postgraduate courses require significant improvement. The existing curriculum is imitative of the Allopathic curriculum to the extent that the very character of the system gets compromised. In Homoeopathy out of 12 subjects in undergraduate course five subjects are of exclusively Homoeopathic and the rest are  allied which are common in Allopathy.

The load on undergraduate students in terms of subjects and papers at Degree level appears to be excessive and unnecessary when compared to the load for MBBS students. The curriculum is also lacking the information on the Basic Sciences, which is essential for study of Homoeopathic subjects, their understanding and proper applicability. The Allied component at degree level appears to be disproportionate with lack of actually required contents, which really help the practitioner to practice the system well. The examination system is compromised by the fact that not enough suitably qualified and committed examiners are available. The very core concept of individualization in Homoeopathy, that could be mastered  only through bedside training  and observational techniques is totally  lacking  in most of the colleges. The internship training , now made ritualistic should be made  rigorous  with  day today  evaluation of performance of the intern under the direct supervision of   his mentor.

THE SOLUTIONS
Homoeopathy advocates the care of the patient through Individualisation, which is the method of understanding the peculiar characteristics of the person and which distinguish him from the other persons with an identical/same clinical condition. For this, an in-depth understanding of the physical, emotional, intellectual and spiritual attributes of the person is required. Therefore, Homoeopathic consultation is considered time consuming.  This also requires special qualities and higher level of intellectual pursuits on the part of a Homoeopath.  Education and training in Homoeopathy should be directed in enhancing the ability of a student to master this art as well as the science medicine as conceived in its philosophical concepts to derive its merit.

Hospital services provided in a teaching hospital are mainly to enhance the clinical training of the students and interns.  This involves physical and laboratory investigations, diagnostic care, observational care, prognosis, line of treatment, auxiliary measures, life support system, etc. In Homoeopathy, observational care is an important factor to individualize the patient. This necessarily enhances the clinical training of a medical student.

CONCLUSION
If we go to the status of Homeopathic education around the world, we can’t see a better model neither in Germany, France (the two countries  that gave Homeopathy its origin). Ours is a model good enough to preserve the purity of the system, but it needs a revamp.

In spite of the tremendous expansion in education facilities in recent years the general quality of Homoeopathy medical education remains unsatisfactory. It was recognised that Homoeopathy education is just producing practitioners who are barely able to practice in the best traditions of the system. More importantly, this lack of quality in the Homoeopathy practitioners is responsible for the decline in the quality of Homoeopathic health care delivery and is preventing Homoeopathy system from playing an active role in the national health programmes. Over a period of time the Homoeopathic education has become directionless and so become cult based, rather than scientific.

FINALE
As  I look  in to the present state on a panoramic view,  the  findings in 1982, when I started  my notions in  As our people are so are our Institutions, still continue to be  the same. The only difference is that the actors different, but the script and audience same.  During this long journey from 1982 to 2014, I also enjoyed all the better fruits out of this sludge along with all its mentors. Preaching  was found to be easy.  I also enjoyed to be the  teacher, Gust faculty, examiner, visitor/ Inspector of the colleges. How long we remain contented by our self proclamation that we are the world leaders in Homoeopathy without looking onto our own shoulders. Can we continue to close our eyes to the calamity happed in USA and Canada through the famous Alexander Flexner Report, in UK through the Report of the Science and Technology Commission, in many countries of Europe, Australia,    Russia etc, where Homoeopathy enjoyed a dignity and status at one point of time and now written it obituary or kept in ventilator due to sentimental compulsion.

Now, we have a Govt. demanding action and results. Can we come out of our nascent slumber and ask for a Homoeopathic Education Commission that can go into the need based assessment of the no of institutions, their geographical distribution, the course, curriculum, the regulations, the key players etc.   Another action required may be that the Department of AYUSH may undertake an evaluation through an external agency and  grade the colleges  based on their strengths in to ABCD. The A category colleges should be assisted to become centers of Excellence, the B category colleges to be developed as model colleges and the C to further develop its objectives. The D colleges should be allowed to close down.

There is adage: One can befool somebody for some time, but not everybody all the time.  We have a responsibility to our posterity. Before they through us out, let us make amendments ourselves or give the way to those who can show the direction.

Dr. ESWARA DAS  MD(Hom), MBA( Health Care)
Former Director, National Institute of Homoeopathy
E mail: daseswar@yahoo.com