By Zeena Johar, President – ICTPH
The last two days have been indeed fascinating, as we have been trekking around to better understand the requirements of our Bridge Training Program that we intend to develop along with the School of Nursing, University of Pennsylvania. It all started earlier this week, when Prof. Marjorie Muecke arrived in Thanjavur along with five of her nursing students. The students are here as a part of her single credit class which she conducts each year in India. After having spent a week in CMC Vellore, the students got busy with our working model and understand the details of our functioning on the ground.
That gave Marjorie and me a lot more time to plan our endeavour. It all started with two physician interviews, both of whom are employed at SughaVazhvu. In our definition of primary healthcare, and our focus on technology we have identified visible competency gaps, which then govern their training before they set-out to manage a RMHC all by themselves.
Dr. Sabrinathan in Andipatti was our very first physician. A Siddha graduate by training, he took a big chunk of his afternoon to acquaint us to his stream of medicine. Educated in a private college in Tambaram, Sabri studied medicine for 5.5 years, like any other stream of medicine. The first 4.5 years were didactic training coupled with practicals, wherein labs in the first year followed out-patient department posting in the following years. The last one year of internship was very similar to any other medical curriculum, and they also worked closely with MBBS Medical colleges for observations posting in many departments.
Sabri spoke about the Central Council of Indian Medicine (CCIM) as the accrediting entity for institutions relating to Indian Medicine. Interestingly, as we spoke about different fields, it emerged that Siddha which evolved in Tamil Nadu has most of its text and learnings in Tamil and students are expected to learn this language as multiple subjects are taught in Tamil itself. Similarly, Unani saw a strong Islamic preference, because of its emergence in the Middle East, and hence, competency in Arabic is considered essential. Ayurveda saw its influence of Sanskrit, though Homeopathy didn’t necessarily see those German links.
From all our interviews it was clear that the Indian steam of medicine had a well evolved place for itself in management of chronic conditions, ones that we heard all the time were paraplegia, quadriplegia, hemiplegia – primarily paralysis of limbs in different forms wherein Siddha intervention, both pharmacological as well as therapies such as massage and varma have been effective. A lot of these patients suffering from variants of paralysis also account for the in-patient treatment. Other problems such as uterine prolapse, bronchial asthma, psoriasis, eczema are also frequent out-patient visitors to these hospitals. Surgical interventions such as bone setting, was also a skill that was acquired through their training.
It was interesting, that as we started probing further in their curriculum, basics of human body, such as anatomy, physiology were almost a replica of what is taught in our standard MBBS curriculum. Though, through our other interview, with Dr. Neela in our Ponnapur RMHC, who studied at the Government Siddha Hospital we saw a lot more rigour, and a lot more collaboration with the Government Medical College (MBBS). It was interesting as Neela narrated her experience of learning Siddha, wherein she spend a lot of her time in multiple wards in the MBBS Government College observing patients through her clinical rotations. She also cited examples, wherein the MBBS and the Siddha colleges shared faculty members, which allowed them to receive the same level of training as their counterparts within the MBBS course, the only difference being that in Siddha they stopped at diagnosis, and then followed their own specified pharmacological pathway.
It was interesting to learn, that Siddha medicine is primarily based on 8 parameters used for assessment and confirmatory diagnosis – eye, tongue, skin (colour), pulse, urine, stool, voice (speech), and touch. Though they followed a similar protocol of physical exam, which Marjorie probed multiple times and compared the narration of our physicians on physical exam for a few given scenarios to what they would practice in their setting.
A detailed diagnostic assessment of the urine, wherein the shape of a drop of oil dropped on urine as a tool for assessment for various conditions of physiological and pathological origin, was indeed fascinating. In Centres of Excellence, like the National Institute of Siddha (NIS) we may still find the same in use, but most providers have now moved to the main-stream gold standards for these biological parameter assessments.
Interacting with Dr. Neela was of great value, as she is a post graduate from the National Institute of Siddha, and hence, underwent additional three years of training. She introduced us to the concept of Varma, which is stimulating nerve-endings that holds therapeutic effect in many conditions. Trust me it works, got a firsthand experience, as she stimulated my trigeminal nerve ending close to the lymph nodes behind my ears, which sent tingling sensation in my arms!
Neela because of her PG training experienced a lot more patients. NIS in Tambaram, sees almost 400 out-patients cases each day, hence, rendering her familiarity with a lot more complex chronic conditions.
It was reassuring, that our Bridge Training Program holds a strong foundation. These providers are well competent with theoretical knowledge, which is very comparable to studying a main-stream MBBS Course. Of course, an evident gap, was lack of training in emergency management, as basic as giving an injection. Hence, all our providers have always been sceptical of suturing, intra-venous and intra-muscular injections, intravenous therapies such as IV lines etc., pharmacology of modern drugs goes without saying.
Yesterday, along with Marjorie and Arun we decided to drive down to Salem to firsthand experience the private college called Sivaraj Siddha Medical College that now offers Siddha, Homeopathy and Naturopathy as courses to students. Arun’s batch mate from his Homeopathy College in Salem has been working as a Lecturer in this college after obtaining his MSc in Anatomy. Not only was the place visually appealing and therapeutic, they had taken good attention to minimize both noise and air pollution. There was no sign of air-conditioning; cleverly designed cross-ventilation kept the temperatures well regulated and good use of sunlight ensured sterility in and around their in-patient facility.
In our conversation with the Principal of that College, he informed us that their students have multiple options as they approach their final year. He took great pride in sharing that multiple TPA’s love hiring students from his college.
I liked the way they managed their OP as well, a team at the front-end plays an interesting role of triage on patient arrival. Upon first level assessment of patient condition, the patient is directed towards one of the three streams of medicine offered in that facility.
It was interesting, as we visited their anatomy lab, as Marjorie closely observed their scribbled notes on the blackboard to get a sense of depth of knowledge that is imparted, and for the first time I saw a cadaver – the formalin was a little too overpowering, so just got a glimpse of the lean dark young body with curly hair. It was pure curiosity for me, but reassuring for Marjorie to see the level of skills imparted in this facility to their students.
We left the tranquil place around 16:30, which is when the college closes, and given they don’t have high in-patient traffic there is minimal staff that continues to stay on for night duty. The drive back to Thanjavur was interesting, observing all the poultry farms, as we passed through Namakal which apparently is the poultry capital of India. I know for sure that the Bridge Training Program will bring Marjorie back to India multiple times, as will her excursion to these smooth surfaced rocky terrains with a geologist.
As we plan for our Board Meeting next week, I stand excited at the prospect that our Bridge Training Program has to offer, not only to us but to the entire Nation. I can also now say that with confidence that Marjorie and the School of Nursing are as excited towards this venture of ours!