PART I
After a hiatus of two years, I returned to India this past month. The occasion of this trip was to attend the Homeopathic International Clinical Training Course in Mumbai, something I have had the privilege to do three times in the last four years. Taught by Dr. Rajan Sankaran, one of the world’s preeminent homeopaths, the conference is a unique opportunity to deepen one’s knowledge and enhance clinical skills while witnessing an enormously creative and brilliant practitioner working with patients.
It also brings together about 80 experienced homeopaths from around the world, most of who are also homeopathic educators and all of whom are thoroughly versed in the philosophy and methodology of Dr. Sankaran’s groundbreaking work. (For an insight into some of the specifics of this system, you may want to read the following article at http://www.centerforhomeopathy.com/articles.php?showarticle=1&article=91).
If memory serves me correctly, this year there were participants from Australia, Belgium, Canada, England, France, Germany, Holland, Ireland, Israel, Japan, Korea, Russia, South Africa, United States, aside from a number of Dr. Sankaran’s closest Indian colleagues and students. We even had a visitor from Iran attend briefly.
It is very heartening to see how homeopathy in general, and the Sankaran ‘Sensation System’* in particular, has become such an international language of healing. It seems that there are very few countries where it has not reached. One particular day during the conference, I happened to see a stack of copies of a book placed on a chair by one of the Indian homeopaths. From the format and names on the cover I knew that it was one of Dr. Sankaran’s books, but it was written in a totally unfamiliar language. On asking about it, he said that he had just returned from Romania where he had taught a seminar and these were Romanian translations hot off the press being readied for shipping.
However exciting it was to participate in the Training Course to observe first hand how the Sensation System has evolved and matured over the last 2 years (it only really has formally been in existence for 5 or 6 years), what made this year’s trip even more special was an opportunity to visit a homeopathic hospital outside the city.
In a sense, these two experiences were a perfect counterbalance to each other. On the one hand, I was learning about a system that is at cutting edge of developments in the philosophy and practice of homeopathy at a fancy hotel in one of Mumbai’s most prosperous districts. On the other, I was going to witness how a much more traditional homeopathic approach was effectively taught and employed in a much less affluent, much more remote setting.
Now, rural India is a world apart from our image of a country with ever increasing technological prowess and a highly educated workforce, hurriedly taking its place amongst the most modern of nations. While computers and cell phones seem to have found their way into the countryside, they haven’t affected its entrenched poverty and lack of opportunity.
While urban centers like Mumbai with its metropolitan population of some 20 million appears to be changing at a rapid pace, adding glitzy shopping centers, American fast food chains and more cars than the roads can handle, most rural areas remain remote, underserved and largely unchanged.
Palghar is a township 130 kilometers north of Mumbai and 10 kilometers inland from the Arabian. Its population of 50,000 either commutes 2 1/2 hours by train to work in Mumbai, is employed in local small textile and chemical factories or else farms. Farmers grow grass that is sold to dairies in Mumbai as well coconuts, chickoo fruit and rice.
With a train station on a heavily used line between Mumbai and the city of Ahmedabad, population 7 million - the largest city in the neighboring state of Gujarat, Palghar does not feel so remote. It is by no means affluent, but there is a small commercial center as well as a number of schools and hospitals that serve the area.
But a short drive into the surrounding district reveals a distinctly different picture where the amenities of modern life are scarce. It is an agricultural area where little hamlets of mostly thatched huts dot a landscape of fields and hills. The roads are plied by commercial lorries, large three wheeled ‘auto-rickshaws’ overloaded with passengers that serve as taxis, ox carts and pedestrians. Services such as health care facilities are few and far between. This is not a romantic pastoral setting; the landscape is neither picturesque nor idyllic. There is a sense of desolation that accompanies the vastness and a feeling that life is harsh. It is the India of some 700 million rural people.
The Dhawale Memorial Homoeopathic Hospital in Palghar is a 50 bed facility that opened its doors in 2000. It was created as a resource to serve the underclass of 200,000 workers, farmers, landless laborers and 50,000 tribal peoples in the area. (India has a huge population of indigenous tribal peoples living in a number of states in the country. According to fifteen year old census figures, they number approximately 70 million and make up 8 percent of the total population.)
While quite new, the hospital itself has roots dating back to the 1930’s. It is the product of a vision for the place that homeopathy can play in the Indian healthcare system created and developed by two renowned homeopaths, Dr. L. D. Dhawale and his son, M.L. Dhawale.
* The ‘Sensation System’ is a term that was suggested, discussed and generally agreed upon at the conference as an appropriate replacement to the previous informal moniker ‘Bombay Method’. In fact, the great majority of the thousands of homeopaths practicing in this city don’t use this system.
PART II
The little girl lay in a coma on her back with a feeding tube up her nose. There was no gown, no blanket. Just a 3 year old in a simple shift, legs askew in what looked more like a crib than a hospital bed.
Her parents had brought her in when the fever had gotten out of control. They were too poor and too far away from any facilities to spare the time and money for medical attention when she first became sick. But when the child began to convulse and lapse into unconsciousness, they belatedly sought out help.
Now, she was in a ward at the Dr. M. L. Dhawale Memorial Homeopathic Institute, a 50 bed hospital in the rural township of Palghar, two hours north of Mumbai. That morning I was following Dr. Navin Pawaskar, the Assistant Director of the Clinical Services and Supervisor of Emergency Services at the hospital, on his rounds. We came up to the bed as the head of the pediatric unit, a woman in her 30’s, was attending to the girl.
It was a classic case of meningitis (an inflammation of the meninges, which are membranes enclosing the brain and spinal cord). What starts as a bacterial or viral infection gives rise to a fever and headache that, when untreated, escalates to convulsions, delirium, coma and possible death.
As a patient here, the child was benefiting from the best of two worlds: brain imagining and other modern diagnostic procedures coupled with around the clock homeopathic care. Her treatment was not the antibiotics or steroids that would be used at a conventional facility, but instead consisted of doses of a single homeopathic medicine.
Homeopathically prepared Opium has been a commonly used remedy for over two centuries, its curative properties first investigated by Samuel Hahnemann, the founder of homeopathy. In contrast to the crude substance, it has a wide range of action and is effective for any number of disease conditions.
Often, the key to correctly prescribing Opium is to recognize a state of stupefaction and general insensibility of the nervous system. This could be the result of inflammation or strong emotions, especially a severe fright. It is a frequently used remedy in cerebral meningitis where the patient has had convulsions and lapsed into a stuporous state with a tremendous heaviness in back of the head that draws it backward, accompanied by noisy labored breathing, half open fixed eyes, delirium, and a red bloated face.
The pediatrician explained that originally a scan had revealed swelling in the skull that had pushed the girl’s brain off to one side. But she was responding well to her remedy. Now, the fever had been controlled and the prognosis was hopeful that the child would recover. By the next day when I had an opportunity to do rounds one more time, the girl had improved further. She was beginning to respond to touch and other stimulation. What remained in question was how much damage the brain had incurred and how fully she would regain her mental capacities.
The hospital at Palghar was created to serve just this kinds of patients, low income rural people with little access to medical services. Although it was only built in 2000 - on government donated land that, of all places, is next to a municipal dump, its origins stretch back to the 1930’s when a small homeopathic study group was formed by a physician named L.D. Dhawale.
Dr. Dhawale went on to become a renowned homeopath and in the 1950’s becoming the first superintendent of the government homoeopathic hospital in Bombay. His son, Dr. M.L. Dhawale followed a similar path, joining his father’s practice and later organizing advanced educational activities for practicing homeopaths.
After the father died in 1960, the son became a highly regarded author of homeopathic textbooks and the principal of the Bombay Homoeopathic Medical College. He formed the Institute of Clinical Research (ICR) to promote clinical research in the field, as well as standardization of homeopathic education and methodology. Toward the end of his career he became affiliated with the National Institute of Homoeopathy.
Upon his death in 1987, his students and patients established the Dr. M.L. Dhawale Memorial Trust to further the work of the ICR. The vision of Drs. Dhawale and those who continue their work through the ICR and Trust is based on the integration of several convictions:
Those affiliated with the Trust and ICR are imbued with the ideal of service to those in need. This is codified in its motto: “Where no doctor reaches, we will reach. Where patients cannot afford costly services, we will try to provide at minimum costs”. Through medical facilities in both urban and rural areas, as well as mobile clinics travel in slums and to the remotest villages, they are dedicated to offering an extremely effective yet inexpensive form of healthcare to disadvantaged people.
They also recognize the importance of integrating certain necessary aspects of conventional modern medicine. Chief amongst them are the powerful diagnostic tools such as blood tests, ultrasound, and X-ray machines that are invaluable in understanding the pathological condition of patients. Along with this, certain interventions such as surgery to repair broken bones, emergency C-sections or the removal of tumors that do not respond to homeopathic treatment are also performed. At their facilities, conventional physicians are employed to conduct these procedures.
Another important aspect of their activities focuses on furthering the education of graduates from homeopathic colleges. Through intensive residencies as well as other programs, these young doctors are trained to become competent in a hospital setting, adept with performing and interpreting conventional medical diagnostic procedures and to deal with the wide variety of disease conditions that present in both rural and urban populations.
There is also the recognition that medical treatment and healthcare in general cannot be divorced from social and economic wellbeing. Efforts are made to improve the conditions of underprivileged people through various programs promoting micro-financing, small insurance and craft cooperatives as well as education.
Finally, and perhaps most fundamental to homeopathy itself is the conviction that each individual has the internal resources to attain or regain his own health. This resource, what homeopaths refer to as the Vital Force, is a dynamic energy that can be invigorated by the stimulation of the appropriate homeopathic remedy. In contrast to most allopathic treatment which is focused on alleviating symptoms, the aim is to attain the highest state of health possible.
PART III
One afternoon, Dr. Navin Pawaskar, the Assistant Director of the Clinical Services and Supervisor of Emergency Services at the homeopathic hospital in the Palghar District north of Mumbai, invited me to accompany him on a trip to another affiliated medical center about 30 kilometers away. As I rode shotgun to Dr. Pawaskar in a SUV-like vehicle with another physician riding in the back, we drove deep into the Indian countryside.
Like all Indian drivers, Dr. Pawaskar leaned heavily on his horn. (Unlike the United States where blowing the horning is conceived of as a warning – ‘watch out!’, ‘pay attention!’ or ‘move along!’, in India it not only signifies all of that, but more commonly is just a non-stop reminder to whoever may be nearby that you are there or to get out of the way. While here we might save our horn for a critical moment, the Indian driver is reflexively and continually chatting up his environment with it.) But fortunately, compared to the aggressive drivers of Mumbai, he was quite patient negotiating the twists and turns, the ox-carts, overloaded 3-wheeler taxis and pedestrians of a two lane rural road.
The main purpose of our excursion was to bring the physician riding in the back, a gynecologist, to a ‘Cottage Hospital’. This 10-bed facility had special programs for maternal and pediatric care, and he was scheduled to spend the afternoon providing pre- and postnatal care. En route, Dr. Pawaskar began to share with me a bit of the history of homeopathic healthcare in the district.
Today, the main hospital in Palghar is a pretty impressive institution: a 50-bed multi-specialty facility serving socially and economically underprivileged industrial workers, small farmers or landless laborers and tribal peoples. Only six years old, there are homeopathic outpatient and inpatient services, that include special departments in pediatrics, neonatal care, psychiatry, rheumatology, HIV & AIDS, diabetes, respiratory illness, and dermatology. In addition, it has surgical departments for gynecology and obstetrics, orthopedics, ophthalmology and dentistry as well as diagnostic facilities with a pathology lab, X-ray machines, ultrasound and ECG units.
The hospital provides 24 hour trauma care for accidents, services with trauma care. There is also a department of physiotherapy. Plans are in the works to add a department of urology and to develop the capacity to perform laproscopic and plastic surgery. In addition, there is a rigorous 3 year residency program that provides advanced training for 36 graduates of homeopathic medical college.
The establishment of the hospital was not easy task by any stretch of the imagination. Since homeopathy in India has an infinitely higher status and visibility compared to this country – it is an officially sanctioned and supported medical system there on both the national and state levels where graduates of government funded homeopathic medical colleges are recognized as medical doctors, work in public homeopathic clinics and hospitals, and have privileges to prescribe conventional drugs, it would be natural to assume, as I had, that the hospital had been created through the largess of the government.
In fact, compared to conventional medicine, homeopathy is very much a weak sister, commanding only a small percentage of the national healthcare budget. Neither is it viewed as an equal by the conventional medical community. In fact, though the land, adjacent to the municipal dump, was donated by the government, the Palghar hospital was constructed with private funds in the face of opposition from the local conventional medical establishment.
Twenty years ago, though, it was just a small clinic run on a shoestring budget providing low cost medical care for tribal peoples. Dr. Pawaskar recalled how early in his career, while finishing his formal studies in Mumbai, he would get up before dawn to begin the 4 hour journey by train and hitch-hiking (there was no money for vehicles or taxis) to get to the clinic, volunteer him services all day, and return home late that night.
Dr. Pawaskar, like the other homeopaths involved with that first clinic, had little financial ambition, being imbued instead with the spirit of service characterized by their motto: “Where no doctor reaches, we will reach. Where patients cannot afford costly services, we will try to provide at minimum costs”.
Initially, one of the greatest obstacles they had to overcome was a total ignorance about homeopathy amongst the general population. It fueled a widespread skepticism toward their efforts. Despite the fact that they were desperate for medical attention and were being offered treatment at little to no cost, people had little trust in these doctors who asked so many seemingly irrelevant questions and dispensed apparently the same tiny white pellets to everyone. They expected bottles of pills and injections. Dr. Pawaskar described how some patients would leave their consultations and promptly throw their prescribed packets of medicines away by the side of the road.
Slowly, though, through perseverance, education and especially by the positive results of the treatments, people began to be won over. As the appreciation of homeopathy grew, so did the need for more services. After some years, the one clinic was expanded to six, all located in various remote villages of the District. Eventually, the donation of a mobile van – a homeopathic dispensary on wheels, made it possible to foray even deeper into the countryside. Not only could more people be reached, but also the expense of traveling long distances while missing valuable work time was alleviated.
A big break came when an epidemic of malaria hit the area. Dr. Pawaskar explained, “These farming laborers were having fever paroxysms while in the fields while working and we were able to reach them right where they were, onsite, without them needing to get to a hospital and spend money that they did not have for transport and medicines! We prescribed to entire villages for this Malaria epidemic and we had very successful results. The news of this spread all over and people began to regard our sugar pills with tremendous respect.”1
My all too brief visit to Palghar has really been eye opening. The sincerity and dedication of the physicians, students and staff at Dr. M. L. Dahwale Memorial Homeopathic Institute has inspired a vision of the true possibilities of homeopathic practice.
1. http://www.hpathy.com/interviews/navin-pavaskar.asp