Dr Ravi M Nair
Ex. Advisor, Govt. of India
Along the Allopathic system of Medicine, the Indian Systems of Medicine and Homoeopathy have been included in the National Health Scheme. Necessary Statutory Councils have also been constituted under the acts passed in the Parliament to control and regulate the education and practice in each system.
Each Council has conceived to shape a basic medical practitioner in the concerned system leading to the conferring of titles MBBS, BAMS and BHMS. The characteristic features touching, the above courses such as the eligibility qualification for admission, duration, curriculum and syllabus, mode of examinations, and training etc. are more or less one and the same, when viewed against the object of producing a Basic Doctor in the concerned system.
The term ‘ Basic Doctor’ has been defined as follows:
“A Basic Doctor is one who is well conversant with the day-to-day health problems of the rural and urban communities and who is able to play an effective role in the curative and preventive aspects of the regional and the national health problems. Besides being fully well-up in clinical methods, i.e. history taking, physical examination, diagnosis and treatment of common conditions, he should have the competence to judge which cases require to be referred to a hospital or a specialist. He should be able to give immediate life-saving aid in all acute emergencies, he should be capable of constant advancement in his knowledge by learning things for himself by having imbibed the proper spirit and having learned the proper techniques for this purpose during his medical course”.(Para 32, Medical Education Committee Report 1969)
Here the committee is emphatic on the point that the theoretical and practical knowledge to equip the doctor with all life saving aid in all acute emergencies. There is no doubt that these life saving aid will not merely be medicines but also first aid and emergency surgical interference to the extent of minor surgery and of life saving measures in acute surgical emergencies.
Despite the difference in the preparation, application of Medicine and its philosophy. Homoeopathic teaching shares all the aspects and concepts of Allopathic education in so far as basic medical sciences viz. Anatomy, Physiology, Biochemistry, Pathology, etc., para medical sciences like Community Medicine, Forensic Medicine etc. and the clinical subjects, relating to the treating of diseases viz. Practice of Medicine, Obstetrics, Gynecology and Surgery are, concerned. There is even very close analogy with the books prescribed, media of instruction followed, mode of study designed and examination conducted between the MBBS and BHMS courses.
It is more relevant and pertinent to trace back to the valuable findings of Dr.Samuel Hahnemann, the founder of Homoeopathy with regard to this particular issue. He has clearly classified the Diseases as ‘Indisposition’ , ‘Surgical’ and ‘Dynamic’. The term surgical used by Dr. Hahnemann itself shows that surgery is not alien nor impracticable in Homoeopathy. In the aphorism No. 186 of his book ‘Organon of Medicine’ he has precisely defined the truly surgical conditions.
The management of such conditions has also been guidelined in that book. All this shows that surgery and its knowledge are an imperative necessity in Homoeopathy. If this is attained, a Homoeopath can assess and ascertain the necessity or otherwise of surgical intervention in an apparent surgical case. There are very effective medicines in Homoeopathy to avoid unnecessary surgical intervention to a very great extent. A Homoeopath with genuine knowledge in surgical disease can make miracles in this field. It may thus be made clear that the knowledge of surgical diseases is an inevitable attribute to a Homoeopath to shape him to the standard required for a Basic Doctor.
How far surgical training is necessary
As a general practitioner, a Homoeopath should have the basic knowledge to diagnose truly surgical diseases/conditions, to do minor surgery, to adopt life saving measures in acute surgical emergencies and to manage, if possible, with Homoeopathic medicines. Training to impart basic knowledge in Opthalmology, Otto-rhino-laringeology, Orthopaedics, Dentistry, asepsis and anaesthetics etc. should also be given to deal with such cases as expected of a general practitioner.
This will give him the necessary knowledge required for referring the cases which require the attention of specialists in surgery.
Advanced surgical and operative techniques need not be imparted to a Homoeopath as is outlined in the case of an MBBS holder as envisaged in the Medical Education Committee Report 1969 vide para 48. It is in the above perspective that the Central Council of Homoeopathy (CCH) has framed the syllabus in surgery to BHMS course.
It was after taking the above auspects into consideration that the Homoeopathic Enquiry Committee 1949 (consisted of then leading Allopathic Doctors, Scientists and Homoeopaths) has unanimously recommended the imparting of surgical training to a Basic Homoeopath. Following this recommendation, the particular syllabus was introduced even in the interim course – Diploma (4 years) in Homoeopathy all over India. This course was started in Kerala by 1958. Since then this syllabus has been included in its curriculum.
Where to teach surgery and why?
The most ideal place to teach surgery is the institutions where all other teachings are done, ie. in the Homoeopathic Medical Colleges and Hospitals themselves. It is in tune with this that the C.C.H. has prescribed the minimum requirements and other facilities in a Homoeopathic Medical College and Hospital. This regulation has come into force with effect from 1983 with directions to fulfill the requirements at the latest by 1990 as a mandatory one. Pending fulfillments of above requirements as a makeshift arrangement, the students were being sent to the nearby Allopathic Hospitals to get their clinical teaching in surgery.
If the above facilities are not provided in the Homoeo Hospitals, the students will never get an opportunity to apply Homoeopathic medicines in both pre operative, and post operative conditions. Again the students will not get any chance to study the extent up to which Homoeo medicines can go in avoiding surgical interventions. If at all Homoeopathic medicines have to be developed, such an arrangement is inevitable. In the event of this being done, the unhealthy tendency on the part of the students to use Allopathic medicines will also cease.
Who to teach surgery in homoeopathic colleges
As already pointed out earlier, because of the more or less sameness of the subjects and books prescribed for the courses of both MBBS and BHMS, Homoeopathy has to depend on teachers from the Allopathic side when the Homoeopathic course started in India. This position still continues. Thanks to the services rendered by the Allopathic teachers, it has become possible to develop a few teachers in Homoeopathy to impart teaching in the Basic and Paramedical subjects. It would have been possible to find sufficient number of Homoeopathic teachers conversant in the above subjects if there had been specialized advanced courses in the concerned subjects in Homoeopathy.
Even now it is the DHMS and BHMS holders who have just qualified themselves to be the Basic Doctors are imparting such teaching in the Homoeopathic Colleges with the aid of the highly qualified hands from the Allopathic Medical Colleges. But in the Clinical Subjects like Surgery, Obstetrics, Gynaecology and Medicine even such development still remains to be a distant dream.
It is because of the non availability of clinical facilities attached to the Homoeopathic colleges and the unhealthy practice of sending the students to Allopathic Hospitals to get training in these subjects. This being the position, the services of the specialised teachers in Allopathy are still required in the Homoeopathic colleges to impart skilled training to the students in surgery & in its all allied subjects, Obstetrics and Gynaecology and Medicine, as long as sufficient number of teachers being able to deliver the goods are developed from Homoeopathy. Their services are required only in respect of doing diagnosis with modem clinical techniques, using of sophisticated instruments and effecting general management. As far as medicines are concerned, Homoeopathy need not depend on them.
This traditional and conventional practice of borrowing of drafting personnel’s and technology from developed areas, or countries or fields to undeveloped or developing field or science is adopted all over the world until the desired result is achieved. What is required in Homoeopathy at this stage is none other than this. It is also a legitimate right of Homoeopaths to be blessed with all the benefits of contemporary developments in the scientific field in line with their concepts and perception. So far such developments have been confined to the Allopathic field by virtue of the availability of the facilities at their disposal. So in the interest of humanity it is upto the Nation to see that such facilities and experienced personnel’s are procured and provided to Homoeopathy also from the resourceful Allopathic field,
In the circumstances the experienced teachers from Allopathy may be drafted to Homoeopathic colleges until Homoeopathy gets, itself ready with sufficient number of experienced teachers competent to handle the subjects independently. (It is after considering these factors that CCH has prescribed MD, MS and P.G. Degree of the Allopathic system as qualifications for teaching such subjects in the Homoeopathic Colleges). In the meanwhile steps may also be taken to impart advance training in such subjects to Homoeopathic teachers. The National Government may also initiate urgent steps to organise orientation courses to keep the Homoeopathic teachers abreast with the most modern information in this field.
How to teach Surgery to Homoeopathic students?
The surgical interventions intended to be done by a Homoeopath do confine themselves to minor ones as has already been pointed out earlier. It is not the intention of a Homoeopath to deal with cases requiring major surgical interventions. What is expected of him is that of a general practitioner only. Several Homoeopathic Medicines have already been developed to do away with surgical interventions and to manage pre operative and post operative conditions, if surgery is necessary.
But even these medicines could not be used so far in a satisfactory way in the absence of facilities attached to the Homoeopathic Hospitals, They still remain to be used in an experimental basis. As the position still continues to be tested empirically, any move directed towards this end should be made in utmost caution under the direct personal supervision and surveillance of skilled Allopathic surgeons in the Homoeopathic collegiate Hospitals in a research spirit, (Such arrangements do exist and work satisfactorily now at least in some of the Homoeopathic Medical Colleges at Bombay, Delhi, Calcutta, Hyderabad etc.). This is because only Allopathic system has been able to develop surgery by virtue of the facilities at their disposal.
So their service is necessary to deal with such cases as they involve human patients. If there arises any difficulty or emergency precipitating out of the suspected inadequacy or inefficacy of Homoeopathic Medicines, the Allopathic medicines and their services have to be rushed into to ameliorate the situation. If such an arrangement is continued for a definite period, a time will come in the not too long distance when the Homoeopaths will be in a position to do minor surgical interventions as expected of a Basic Doctor independently and efficaciously. As a Basic Doctor irrespective of the system to which he belongs, a practitioner is bound to know such things in the better interest of our patient community. It is also in the fineness of Homeopathic ethics, since Homoeopathy is also one of the accepted and recognized system of treatment.
To sum up the following points may be highlighted.
1.It Is to produce a Basic Doctor that B.H.M.S., like M.B.B.S. has been conceived, designed and introduced in Homoeopathy, This being the case a B.H.M.S. holder should be as equipped as the MBBS holder to deal with minor surgical cases, to give life saving aid in all acute emergencies and in making diagnosis as well as referring cases to a specialist or to a Hospital.
2.The teaching facilities should be arranged and provided in the Hospitals attached to the Homoeopathic Colleges as prescribed by the C.C.H.
3.Homoeopathy has yet to produce competent persons as teachers in the basic and allied Medical Science subjects, steps directed, towards achieving this aim have to be taken. For this the service of the competent teachers from Allopathic system have to be made available profusely until sufficient Homoeopathic teachers are produced.
4.Pending satisfaction of the above things, an arrangement with a spirit of research mind to instill in the Homoeopathic practitioner all the qualifications and qualities required of a Basic Doctor with the willing co-operation from the Allopathic teachers in the interest of Humanity at large.