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Date posted: January 3, 2012

Dr Mansoor Ali

JYOTHIRGAMAYA - A Successful School Health Programme implemented by the Government of Kerala.

Joythirgamaya is a comprehensive approach aiming at uplifting the inherited intellectual, emotional, social and reproductive health of each adolescent seeking solace in the programme at Government and Aided High Schools of Kerala by the department of Homoeopathy, Govt. of Kerala. A handbook is provided to the doctors participating in this project which intends to bring the uniformity in functioning, proper guidance, awareness of the various psychological aspects, of the common complaints faced in adolescents, mode of case taking, how to select the rubrics in the mental plane, miasmatic diagnostic ideas, understanding of basic statistical facts, schedule for the working pattern and appendix which contains all tables and data for this programme.

School health program, a concept that originally materialized in the mind of Dr. S. Gopikumar, is being implemented as a government approved project through out the state. The programme is being well appreciated and remarkable achievements obtained in many districts, the acceptance of the project among the scientific field is also encouraging.

Poor School Achievers
About 10 percent of children in early school performs poorly due various reasons apart from mental sub normality. The causes are not always apparent. The following are some of the causes of poor learning.

a. Child suffer from chronic illness with interruption in studies.

b. Too frequent relocation of parents

c. Some children with undetected error of refraction or mild deafness.

d. Cultural disharmony of child with his peers in the school.

e. Lack of adequate environmental stimulation in the home for school work.

f. Incompetent and harsh teachers, even brilliant students feel uninterested in class room

g. Child may be immature and not yet ready foe the instructions

Offering Effective Treatment for 

  • Adolescence problems
  • Ego Defense Mechanism.
  • Personality disorders
  • Learning disorders
  • Separation Anxiety
  • Anxiety Disorder
  • Disruptive behavior disorders (Conduct disorder, ADHD)
  • Impulse control disorder
  • Autistic disorder
  • Grief vs Depression
  • Depression in Teens
  • Substance Abuse
  • Mental retardation
  • Stammering
  • Stereo typic movement disorders
  • Eating disorders
  • Sleep disorders
  • Early onset schizophrenia

Three Handbooks

  • 1.For Doctors
  • 2.To be filled in detail by Parents
  • 3.To be filled in detail by Teachers

Hand book includes

  • Detailed case taking format with choices & suggestions
  • Related rubrics of questionnaire of students
  • Miasmatic symptoms
  • Mental status examination
  • Statistical principles
  • General out line in conducting School Health Programme
  • Philosophy of prescription
  • Principles of counseling

Feed back received from the concerned team of each district were elusive of scientific data and uniformity. So in order to obtain a uniformity in each and every stage of the implementation of this programme a team of doctors were selected by the director of Homoeopathy. The team of medical officers worked relentlessly to bring about necessary changes, alterations, inclusions and exclusions in the questionnaire and planning of activities after consultation with psychologist and statistician. So that the project can be carried out uniformly throughout the state and obtain scientific and statistical data which can be proudly presented to the scientific world.

The project entering its 8th year. After receiving several suggestions name  ” Joythirgamaya” was unanimously approved and hence forth the school health programme of department of Homoeopathy shall be known as ” Joythirgamaya”.  A central committee ,which is to be an authority in each and every aspect of the implementation of the programme is named as “STEP” ( School health Technical Expert Personnel) is also formed. An emblem and slogan were also approved. The slogan is “COMFORT TO THE MILLIONS AND HAPPINESS TO THE MULTITUDES”

General Outline in Conducting School Health Programme
The strength and effective output of any programme is basically determined by its uniformity in conduct and analysis of the data. So the school health programme also needs standardization. The suggestions given below are not rigid to comply in every aspect but should show attainable perfection with the suggested format.

1. The convener may first create an awareness about Joythirgamaya among the headmasters during their district level meeting and distribute the brochure. 

2. Criteria for selecting schools: District medical officer and the convener must jointly select three schools in a district , out of which one of the newly selected school is considered as control group where only survey form is given to understand the magnitude of the problem. This school is monitored at a fixed interval and note the changes with the help of a survey form. This school may be selected for medical intervention in the subsequent years. The other new school is meant for implementing the programme afresh. The third may be an existing one for the continuation of the previous year programme in ninth and tenth standard and a fresh case taking in eighth standard.

The total strength of the students in the high school section should not exceed 500, because quality of service rendered is likely to be unsatisfactory if the task is a not proportional with resource at your disposal. It is to be remembered that the control school must be identical in almost all aspects with the newly selected school.

3. Every year details of the school health programme should be briefed at the parent -teacher meeting which is likely to be held on the last Friday of June. If possible, District Medical Officer may attend the PTA meeting and discuss with the school authorities, to create rapport. This awareness class is most important for the newly selected school. The changes in the programme, importance of the age related problems, scope of Homoeopathy etc. may be highlighted to the parents as well as to teachers. The consent letter from the school PTA and the Headmaster must be obtained before starting the programme in the school. Explain the working schedule chart to the Headmaster.

4. As a next step, collect the academic performance and other activities of the school for the last three years, for e.g. success rate, socio economic status of family, general educational status of the parents , infra structural situation of the school, availability of studying materials etc.

5. Collect the list of name, class and division, of all the high school students

6. Maintenance of the Registration book by the Convener: – The registration book is to be prepared and maintained which shall contain all the details of the process, about every student, who has been enrolled in the programme. Details of the book is as follows. After getting the list of the students from the school, class and division wise, it is sorted in alphabetic order and enter the name of the student, followed by his register codes, which is unique to that student and it should not be a class number.

Write the Code Number given to the to each student (as per the register) in the allotted box of all case sheets. It should be done meticulously, since the bio data page of each student will be detached from the case records and it is kept under the safe custody of Convener in order to maintain secrecy and prevent possible misuse . A transparent cello tape should be affixed over the code number box in order to prevent probable manipulation on it by the students. The registration book contains activities of each phase of the schedule. (Ref, Excel File Name: Reg Form)

Here the first 2 box indicates the code of district second two boxes indicate year, third set indicates the registration number of school, (the selected school may be coded as 01, 02, 03) fourth set stands for class, subsequent boxes indicate division of class, register number given to the student, and last box is for gender. Code number is mandatory in the following case records J G 1 ; J G 2A, J G 2B J G 2C , J G 4 JG 5. It may be noted that in few instances the class division may be designated in two letters. In such situations team is entitled to give a single letter to the division according to their own discretion.

District codes are as follows : – Trivandrum 01, Quilon 02, Pathanamthitta 03,Alapuzha 04, Ernakulam 05, Kottayam 06, Idukki 07, Thrissur 08, Palakkadu 09, Malapuram 10, Kozhikode 11, Wyanadu 12, Kannur 13, and Kasargode 14. 

7. Introduction to case sheets: J G 1A, the check list, that is to be administered to the students at the beginning of the programme and same questionnaire in fresh form is subsequently given for review also. JG 1 B for the sociogram for students, J G 2A for parents, JG 2B for parents with problem children. JG 2 C for parents’ review , JG 3 for teacher, JG 4 is the proper case recorded for students, 7 G 5 to assess the socio economic status of the student’s family.

8. Administration of the JG 1 format to the student: JG 1A, the first format is given to the students . It is the primary survey on the student’s level of problems. It must be imparted with caution, not to share each one’s idea in filling the questions with other’s, and students should not have any preconceived idea about it before filling the format. The questions are graded from one to three as indicated in the form A B and C, (D stands for the value zero). Each part of the question must be summed up separately. The values obtained from all questions has to be entered on the excel format given (File Name is ANOVA1). The JG 1 format must be administered to the control group also, at the same interval and at simultaneous  time as far as possible. Total time taken to administer the JG 1 format is 15 – 20 minutes.

9. Parent form (JG 2A) is given to the students on the same day, so as to be filled by their parents and returned in sealed covers within two days. The receipt of this form should be entered on the registration book provided. It is better to admit the students for personal interrogation, only for those who come with duly filled JG 2A form.

I0. Administration of JG 3 for teachers.- This format is given to the teachers on the same day after giving an awareness to the teachers, regarding the project. This form maybe collected before personal interrogation, but surely before selection of medicine month.

11. Administration of JG 4 format: The JG 4 format is the actual case record for the students. After filling the code numbers in boxes and name of the student by the team members, a transparent cello tape should be affixed over the box in order to prevent probable manipulation on it. Then give the questionnaire to each student to fill it. Each question must be properly explained to them and at intervals simple psychological tests without stress or strain maybe employed.

12. Next phase is the group discussion on the filled case records among the team.  This is probably one of the most important aspects of this programme. Prior to discussion Convener must distribute case records (ie .JG 1A, JG 2 and JG 4) to individual doctors after noting their name in the registration book with date of issue. The doctors receiving the cases must study, each case thoroughly and present and discuss in group. For the discussion the teacher format may also be considered. By this the team members can get an overall idea about the problem cases and strategies to be taken to tackle the problems, which includes probable rubrics, cross references, diagnostic parameters etc.

13. Next step is to prepare for the interview with the students. A registration card should be issued to every student when they come for personal interrogation, that should contain name of the student, year of issue, registration number, name of school. Each student must be interviewed after noting down the preliminary data such as height, weight. Visual acuity may be checked with the help of snellen’s chart for selected cases, that is provided with you. It is to be noted that the question no 59 of part one of the students case record (JG 4) is likely to give some clue to the essence of the case. JG 5 must also be filled by the doctor at the time of interview but may be rated later.

14. After the personal interrogation, a sociogram form (JG 1B) is given to the students. It is cross checking exercise for the team, by the students. In this assessment, the team members must win the confidence of the group before exercising this test. It is also to be remembered that there is high risk of manipulating the data if it is performed non diligently.

15. If any student is suffering from serious behavioral problems or very low academic performance, a more serious intervention has to be carried out with the help the form JG 2B and personal interrogation with the parents to delineate the core of the problem.

16. After case taking, analysis and repertorization of the case has to be done. Children with problems that hinder his creativity and academic performance must be analysed more precisely by group discussion., so as to reach a perfect similimum. The philosophical approach to be made is already given in the chapter philosophy of prescription in this booklet. It is quite possible to reach a similimum in many ways but common, working methodology has to be evolved in due course of time.

17. Potency and dose: It is based on the principles of organon of medicine. In this programme medicine is prescribed to adolescents (stronger vitality and mostly based on mental general symptoms, so the selected remedy can be given preferably in 1 M potencies in single dose. The medicine must be administered to students the morning hours under the supervision of team of doctors in order to ensure its intake. Date of issue of medicine to the student must be noted in the registration book by the convener and in the case record. It is preferred to give 2 dram blank globules to take 4 pills at night for the next 15 days.

18. Follow up of the case: It is to be done in a preplanned way. It can be classified as phase one, two, and three. Phase one starts with the introduction of the scheme in the first PTA meeting and ends with the administration of the drug to students.

Second phase starts after the administration of drug in take, to the next 45 days. The team may visit the school couple of weeks after giving the medicines. At the end of phase two, a team of doctors should visit the school again and give the form JG 1 and obtain the result on the same day itself, homoeopathic evaluation may also carried out. The team should perform the same procedure on the control group school too. This mid test is done to assess the progress of the case. The data obtained at the end of the phase two must be noted in the registration book of the convener and in the excel sheet.( Excel file Name: Reg form, and ANVOA 2). The same procedure has to be followed in the phase 3 operation which that is on or after 45 days from the last day of second phase. Excel files to be used for it includes Reg form, and ANVOA3. During the third phase JG 4 has to be restudies , assess and improvements noted.

19.Adminstiration of JG 2C.– This is the review form for parents that is to be administered on the end of phase 3. It is given through the students and obtained the filled format after two days.

20. Students with serious physical ailments who are on life supporting drugs should be excluded from this project. But in conclusion report but it is reasonable to specify their problems, and can present as a specific cases among the team members and to the members of STEP. Similarly children with other chronic ailments can be included in the programme and can present as a specific cases among the team members and to the members of STEP.

21. Diet and regimen: Diet and regimen to each case depends upon the selected drug, and nature of pathology, if any, and according to the nutritional needs.

22.Transmission of data: The activity report should reach at directorate of Homoeopathy Trivandrum according to the given below schedule. The collected data on each phase of the programme should be transmitted in soft copy with necessary remarks by the convener.

Data to be transmitted are as follows:

a. Preliminary data about schools to be send in the format given (File Name Data Sheet, Excel file) and the details of the Phase one activities in ANVOA 1 Excel file. And ANOVA Excel file within 20 days after the completion of the phase one.

b. Details of the Phase two activities in ANVOA 2 Excel file within 20days after the completion of the phase two.

c. Details of the Phase three activities in ANVOA 3 Excel file within 20days after the completion of the phase three.

d. Details of the specific cases may send after one month after the conclusion of the phase 3

e. If there are diagnosed cases of ADHD, Conduct disorders, ODD etc., it may be reported in detail to Director of Homoeopathy for developing future strategies in the coming years.

f. Provisional diagnosis in psychological basis and miasmatic diagnosis

23. Every doctor attending in this programme should follow professional ethics and dedicate themselves to make this project successful.

24. Some important points to remember:

  • Code number given to each student is final throughout the programme and it should not be changed when student is promoted or failed
  • Convener is the sole responsible person to keep all the records and the contact person with the members of school health technical expert personnel.
  • District Medical Officer will be the controlling authority in overall activity of the programme and should monitor the working schedule by visiting the school.

Out Come
The programme is being well appreciated and remarkable achievements obtained in many districts, the acceptance of the project among the scientific field is also encouraging
.

For more details :

1.Dr.Jemuna
Director of Homoeopathy
Directorate of Homoeopathy, Govt. of Kerala
East Fort, Thiruvanathapuram.695023, Kerala.
Email : directorhomoeokerala@yahoo.in
Mob : +91 9447170342
Web : www.homoeopathykerala.gov.in

2.Dr.Gopikumar  Mob.+91  9746313300   Email : gkumardr@gmail.com

3.Dr.Vijayakumar  Mob: +91 9847045032

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