Dr. Leela: Hi Dr. Navin, welcome to the Hotseat. What a pleasant surprise. You were with me at homeopathic college! When Dr. Barvalia suggested I interview you, I thought I’d meet someone well advanced in age, grey and balding …
Dr. Navin: Hi Dr. Leela welcome to our hospital! I’ll take you for a guided tour once you’ve got what you need for the interview. Well, when Dr. Barvalia told me you would be coming in for an interview and visit to the hospital, I hardly expected you I recognized you immediately. You do look nearly the same as when I saw you in college.
Dr. Leela: Thank you! That, I must remind by husband about. Now, please tell the whole of cyber-world who you are and what you do.
Dr. Navin: Right now I’m working here at the Dr. M. L. Dhawle Memorial Trusts’ Rural Hopsital, Palghar as Assistant Director – Clinical Services and In-Charge of Emergency Services. I’m also currently completing my MD (Homeopathy) Part II at Palghar.
But the story started when I did not get a seat in MBBS, like you, I chose to study homeopathy over Dentistry or BPharm. I wanted to be a doctor for the ‘whole person’, not just one’s mouth. I graduated from CMP Homeopathic Medical College 2 years after you, in 1992. Not ready to begin a private practice, I began to work in allopathic hospitals to gain adequate clinical experience. I even worked in the ICU’s of these hospitals and all this gave me a good clinical orientation. I was a little ashamed at what I perceived to be ‘homeopathic limitations’ in medical practice. We experienced some of our professors doing excellent inpatient work at Mumbadevi Hospital. But it was restricted only to them. Beyond that we seemed unable to deal with the harsh realities of medical emergencies and disease prevalent in society today.
I was attracted to the philosophy of the Institute of Clinical Research (ICR) of Dr. M L Dhawle which is firmly based on and . Dr. Barvalia had influenced us towards their homeopathic philosophy in college, I decided to train with them for a good homeopathic foundation.
Dr. leela: I heard you completed this in 12 months, certainly a record! How did you do it?
Dr. Navin: I think I was ready to work very hard and learn everything I possibly could. I initially followed the Standardised Case record which is the basic training tool of this ICR. It integrates various steps, in order to bring out the analysis and synthesis of various homeopathic concepts including the methods, strategies and approaches to homeopathic cases. This helped me develop my analytical thinking.
I once shared my desire to learn the application of homeopathy in hospital based cases and in emergencies, with Dr. Kumar Dhawle, the director of ICR. He was visionary and decided to send me to a tribal area in Andhra Pradesh to work with a retired Army Pediatrician, Dr. P. Raju. This was for me the critical turning point of my life – clinically and spiritually.
Dr. Leela: Please tell us more about this experience.
Dr. Navin: Well, Dr. P. Raju retired from the army with a variety of surgical skills though he is a qualified Pediatrician. His wife is a Gynaecologist. He was very clear in his ideals. He wanted to serve the poor, those with no medical facilities in the rural and tribal areas of India. Amplapuram in Andhra Pradesh is where he established his 150 bedded hospital which was run only by himself and his wife! This man has amazing energy – I truly believe, supplied by a Higher Power. He is well into his 70’s right now, fit as a fiddle, doing a whole day’s work. He starts operating from 6 am every morning, and then sees over 1000 people per day in the outpatient department. He’s been at this for 40 years now, non-stop. He is a phenomenon.
He does everything, every type of surgery. His experience is so vast, it amazes me. Being in a rural area, he must be the only doctor for miles around. That entire area considers him a demi-God and he does not let them down while he remains humble in his service.
Dr. leela: The world needs more people with this type of humility and commitment.
Dr. Navin: Yes. He truly inspired my life. I learnt from him that money should NEVER be a consideration. The consideration is service of one’s fellow man – making no difference in its quality between human beings. Serve people even if they can only pay you a rupee (5 cents) for your service, or if they can pay you a fortune. Serve them sincerely and the money flows in anyway. He is today a multimillionaire – but remains a simple hearted, humble man. His focus is his service to humanity and there is never a lack of money.
Dr. leela: From my perspective, I see this as serving humanity with the love of God, and God takes care of the rest (including money)
Dr. Navin: Right. I agree. I decided from then on that money would never figure as a priority in my practice of homeopathy. This is a value my entire organization, the ICR, shares and nurtures. Our focus is to serve humanity and heal the sick with compassion and care . This ideology has remained with me till today and yes, I remain financially sound and very stable.
The other important aspect I gained from that experience was the clinical confidence and excellence that he imparted to me. While I was with him, I was forced to prescribe homeopathy in serious clinical situations. I felt myself faltering when accosted with snake bites, meningitis, endocarditis, cardiac failures, glomerular nephritis, etc. Since I was sent there to help establish an In-patient Homeopathic department, I had to suddenly manage these cases with homeopathy. I’m sorry to say I could have done a better job if I was more experienced. But Dr. Raju always remained supportive and allowed me to at least begin to formulate a clinical strategy to treat these people homeopathically. I was successful in some cases, and especially with the cases of acute glomerulo nephritis in which I was able to treat a large number of pediatric age-group of patients.
Dr. Leela: That’s very interesting! What were the remedies you used? Did you use constitutional remedies in tandem with the acutely indicated remedy?
Dr. Navin: Always we needed to start with acute simillimums as they would come to the hospital in acute distress. The remedies I used were Opium, Terebinth, Merc sol, Alumina, Lachesis, Ars Iod, to mention a few. Once the acute stage was relieved, we moved on to the constitutionally indicated remedy to complete the cure for the long term.
Dr. leela: So you wrote up this experience into a paper that you presented at the UK Homeopathic Millennium Conference in 2000?
Dr. Navin: Yes I prepared a paper with these cases “The IPD Management of Acute Glomerular Nephritis in the Pediatric age-group with Homeopathy‘. I was able to do a comparative study of the same age-group with a study that has been published at the same time in an allopathic hospital in Chennai managed with Modern Medicine. This comparison gave my paper a lot of credibility. It was very well received at the Millennium Conference
Dr. leela: That’s great! I would like to discuss the homeopathic hospital protocols and training modules you have helped develop for the ICR here in Palghar. But first please give us a background on the growth of the Palghar hospital itself.
Dr. Navin: Yes I would like to shift focus now, to the team work that has brought about the phenomenal growth at Palghar specifically and in the ICR as a whole. We have grown from a small clinic that was established in 1985, to a full-equipped 50 bed hospital and the premier postgraduate (MD) institute. The development was slow earlier, but it grew by leaps and bounds from 2000.
For the first 10 years from 1985 to 1995, we focused on tribal health service, for which we were lead by DR N.L.Tiwari. He started first rural homeopathic clinic which later expanded to six more rural homeopathic clinics in different villages. Over ten years, homeopathy was totally accepted as a therapeutic system in these villages. It was time to expand and serve the needy people from the tribal areas. In 1995 we were blessed with a Mobile Van Homeopathic dispensary which reached the hamlets of tribals even on the worst of the roads or rather where there were no roads! A dedicated work by the team of doctors, ready to work in adverse conditions almost free of cost, laid the foundation for this success. In 2000 we had a new mobile van converted into a fully equipped dispensary with an ultrasound machine, Lab, consulting rooms and dispensing room.
This was the only way to reach these people isolated completely from any health service. They readily accepted any help they could get, but they still had the idea that to get well, they had to be given an injection! Initially the patients would throw away our medicines as they found them unfamiliar. How come everyone gets the same sugar pills?
Dr. leela: I can imagine – doling out sugar when people bring in serious clinical problems – they must have wondered if you were actually doctors 🙂
Dr. Navin: Yes we had to deal with two types of blocks. One was the expectation that an injection needed to be given in order to feel better. The other was our elaborate homeopathic case taking; requiring lot of personal information which people found unnecessary.
Dr. leela: That, I completely understand!
Dr. Navin: It took a little while to show these people that the sugar pills actually worked even though it seemed like everyone was getting the same thing. What happened is that around the year 1996 there was a Malaria Epidemic in the area were covering through our mobile van dispensary. Some of my senior colleagues Dr GODA, DR MANOJ PATEL and DR BIPIN JAIN handled the cases very well even with scanty prescribing data. These farming labourers were having fever paroxysms while in the fields while working and we were able to reach them right where they were, onsite, without them needed 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. We re-studied the entire experience by conducting a symposium which helped us conceptualize our methods for tribal service and epidemics.
Dr. leela: Yes homeopathic miracle! All it takes is a few innocuous looking sugar pills. So the Symposium helped the ICR to now rework a strategy to bring quality homeopathy to this sector of people.
Dr. Navin: Right, we overcame the case taking hump by seriously modifying our strategy. We chose to take Boger-Boenninghausan’s approach to case taking and analysis. We concentrated on the chief complaint in terms of its location, sensation, modalities and concomitants. Then we included general observations of physical constitution, tongue, discharges; correlated this information pathologically and viola, we had our similimum prescription. Boger’s Synoptic key is important to help in this analysis.
Dr. leela: Yes, Dr. Barvalia expounded in the September 06 interview the importance of understanding Boger’s approach to understanding the pathogenesis of remedies and seeing the similarities in the case.
Dr. Navin: Precisely. Dr. Barvalia contributed to our Symposium as well. Dr. Boger’s brilliance and phenomenal contribution to homeopathy needs to be revisited by the homeopathic world.
By 1997/98, the need to connect the tribals to a hospital set-up was evident. A hospital would serve the needs of basic health services to a 70 km radius, as well as promote the use of homeopathy. The entire model was based on the guidelines drawn by our Guru Dr M.L. Dhawale.
But, as always with homeopathic establishments, funding remains a central problem. The good things is that as we developed our approaches and showed good clinical results, philanthropic people as well as organizations were ready to support the advanced development. Dr Manoj Patel, Dr Anoop, Dr Kapse, Dr Ujjwala , Dr Vishpala Parthasarthy formed a formidable team to raise funds for the hospital development project.
Dr. leela: But apart form this you also continued to provide satellite services in the villages.
Dr. Navin: Yes for our satellite clinics, we realized that to continue services in the rural area, we had to involve the local community totally in its development. They give us the land and help with actually building the dispensary. We provide basic facilities for diagnosis as well. This method has been replicated in Pune, Baroda and Mumbai.
Through the Palghar Hospital, we developed a model and protocol for the ICR that now runs Five Hospitals and a sixth hospital is in the pipeline! We have a simple principal for running a hospital. The cost of building the establishment is raised from donations. But the day to day running cost of the establishment is raised by the hospital it self though the services provided to the community. Quality service and good clinical results based on a clear value-system will ensure that the hospital supports itself on a no profit – no loss basis. We have found this to succeed in all other locations.
Dr. Leela: How are you able to serve both the poor and the rich?
Dr. Navin: Deserving patients are categorized into three classes by a social worker based on clearly documented information while the economically well placed pay at the market cost (100%). These three categories of people are:
* General Class who avail services at 66% of the market cost.
* Charitable Class receives services at 33% of the market cost.
* Free Services are for the poorest poor fully funded by the hospital from its poor patient funds.
To run this model, the yearly patient turn over is important. This trunover is maintained by the General and Charitable class of patients. This is solely dependent on Quality of services and clinical results. So there is always challenge to us homeopaths, to deliver the results and serve one’s patients well. For last six year we have sustained ourselves on this model and expanded our services furthur. Our work is observed by the medical social workers of the Tata Institute of Social Sciences (TISS) who post interns regularly at our peripheral dispensaries.
Dr. Leela: If you and others have read an article by Siegfried last month, on the History of German Homeopathic hospitals, one would notice that besides conflict over principles of practice, inadequate funding was a central issue that forced many places to close down.
Dr. Navin: As I mentioned earlier, the moment we begin to focus on funding, we’re in the wrong boat. We need to focus on ethical and good quality homeopathic prescribing with an aim to serve people without reservation to economic status. The money comes in when required; An Honest Intent is important. Even the land for this hospital, it was originally a dumping ground. The government gave it to us at a very low price as we were going to set up a charitable health care center for the tribal areas and those who had no access to medical care. The donations to buy this land came in almost at once.
Dr. leela: I couldn’t agree more with that philosophy. It’s the “blessing” 🙂 that follows such thinking. What is the present status of the Palghar hospital in terms of development?
Dr. Navin: The Out patient department has all the different specializations including Emergency medical services. Other departments include, Ophthalmology, Orthopaedics, Psychiatry, Dentistry, Gynaecology, Surgery, Pediatrics and Neonatology a fully equipped laboratory, Radio Imaging facility, emergency Operation theater, physiotherapy, and an OPD patient load of about 70,000 patients per year.
We aim to serve our client with standardized systems irrespective of their paying capacity. First we receive the patient in our screening department for screening in terms of his clinical illness, past illnesses, we study him as person, and screen him for his social circumstance. We attempt to establish the diagnosis, investigate where ever necessary take specialized opinions from MD colleagues in Modern Medicine, Once this is done he is referred to various specialized departments for homeopathic case taking. Decisions on his homeopathic constitutional medicine, acute medicine, miasm, susceptibility, dosage and potency is decided and follow up planning is done on a protocol that is taught to the homeopaths. We record our cases on a standardize case record.
All this standardization and record keeping has helped us apply Homeopathy to various circumstances and clinical situations, which we had never done in past. These records are available in acute cases and cases with pathological changes in almost all branches of medicine for statistical evidence. We could thus understand the scope and limitations of homeopathy in wide variety of cases.
Dr. leela: This means that you now have clear evidence and statistics of high standard to supply for government records and for research purposes.
Dr. Navin: Yes, all this developed phenomenally since the year 2000, and now we have the 3 year MD residential training programme affiliated to MUHS, Nashik. We offer PG courses in Medicine, Psychiatry, Pediatrics, Materia Medica, Organon, Repertory, with 6 seats each. That means we have a total of 36 MD seats. We are established as premier institute in post graduate studies in homeopathy. We are a preferred choice for homeopaths willing to put in 1000 days of hard work. Many merit list holders in past two years have opted for our training. I think this is due to the quality of work we are able to do here.
With this background, we are now able to offer a clinical workshop for serious homeopaths from foreign countries. We conduct this once a year in January. People with a serious interest in homeopathic prescribing for serious diseases in a hospital and out-patient setting, as well as those keen to experience first hand the running and capability of a Homeopathic hospital are welcome to attend.
Dr. Leela: Yes we will be including the announcement of this Workshop in this issue of the ezine. Tell us more about this MD training and the hospital work you have.
Dr. Navin: At the time of induction itself, when a trainee is introduced to the institute, he gets glimpses of its objectives, origin, culture, training methods, training modules, ethics and norms. Apart from the basic training in specified subjects in homeopathy we focus on sensitivity training as a person, training of the observer within the physician, and clinical training for balancing his sensitivity and sensibilities.
Then there is bed side training for them to learn to prescribe in acute and emergency cases and make accurate observations of management. We have developed a standard case record specifically for IPD management. Our aim is to develop an MD homeopath’s ability to devise strategies for handling patients at multiple levels in a hospital set up
We train the student in human care, economic care, legal care, social care, ethical values, system care and team work. The success of this training is demonstrated in the bed side manner and action.
We focus on the trainee learning to be part of the established system in the hospital for which requires an understanding and respect of the system.
Dr. leela: What are these systems you are referring to?
Dr. Navin: The Systems is a complex whole, set of connected things organized in such a way so as to work together. It demands methodical work as per plan.
- Systems of admission (OPD & Casualty)
- Systems of Clinical Care (while patient is admitted)
- Systems of Dispensing
- System of Operations & Procedure
- System of Rehabilitation/ Recovery
- System of Billing
- System of Discharging the Patient.
Hospital Systems is a module where each MD student has to learn to be a clinical administrator.
Dr. leela: So in short, an MD has to first learn to be a ward boy, a clerk, a nurse, a social worker, a pharmacist before donning the mantle of an accomplished MD. He must work his way up the ladder as it were – a good exercise in humility and respect for others, right?
Dr. Navin: (Laugh) Something of the sort. Our Organization believes it is important for a hospital working homeopath to understand how all these systems connect to each other for efficient functioning, how each role is important in the TEAM EFFORT of serving the suffering patient. Then once he’s got that grasp, he must earnestly learn the medical aspects. These include:
Ward procedures (suctioning, wound dressings, putting in IV lines, etc) ; Minor procedures (Wound Suturing, Pleural Tapping, Ascitic Taps, Lumbar Punctures, Blood collection for blood gases, and other lab work, etc) ; Life saving procedures (Inserting an Endo-tracheal tube, Putting in a CVP line, Emergency training, etc) ; Medico-legal procedures.
He must understand the indications and utility of all these procedures with the contraindications, risk, and surgical preparation required for all of them. He must know how to interpret various investigations and reports as well.
All this is additional training that is not necessarily part of the usual homeopathic training. For MD’s it is important today, to be technologically in touch and accessible. Each doctor has to be computer savvy and carries a Pen Drive. Each postgraduate is expected to use homeopathic software. Presently we use CARA, Hompath, RADAR and Organon 96, which is the indigenous software of the ICR group.
All this is in addition to serious clinical homeopathic training. This makes the job tough for the MD Trainee. They need physical strength and mental stamina to sustain this, coupled with a high degree of motivation.
Dr. leela: Dr. Navin, you’re making me feel that I was born a decade too early This is what I’ve always wanted to do. Luckily I have now have admission into an MD course, but restricted to Homeopathic subjects. I would have been thrilled to work in a residential course, but family constraints do not allow me. Still, I see all this, a tremendous hope for the development of hospital homeopathy worldwide.
Dr. Navin: Yes one of our objectives is to develop a successful protocol for the functioning of Homeopathic Hospitals that can be easily replicated. We have found over the last 6 years that we seem to have got the combination right. This begins with the correct mindset and focus, onwards towards clinical training including how to work with scientific advancement in Modern Medicine without compromising on homeopathic principles. Of course this requires collaboration with MD’s from the Allopathic side who are open to our system of medicine and also trust that our remedies really do work. That is not difficult when they are able to clearly observe the clinical improvement.
Dr. leela: We saw this at our own Mumbadevi hospital. But what I like about the Dhawle Group is that you have concentrated on maintaining homeopathy as the main and first choice therapeutic modality for every clinical case.
Dr. Navin: Yes, we have been very careful in our choice of MD’s from Modern Medicine who are part of our hospital infrastructure. As I mentioned earlier, they have to be open to another system of therapeutics working within their management responsibility. If they see results, they too are ready to allow the patient under their care the confidence that a homeopathic remedy will work. They wait for our therapeutics to be applied for a healing response within a stipulated period of time. Each case has a planned therapeutic programme and an expected outcome . The team sets goal to achieve them. Occassionally due to our own short-coming to find an appropriate simillimum, the outcome does not fulfill expectations. The team then decides whether the situation is in the interest of the patient and whether he is benefitting with the plan of treatment. When sufficent time has elapsed, if the patient does not improve then we on our part need to be open enough to accept our limitations as physicians and allow the patient to choose the next alternative. This attitude becomes more important when one is working in a team, more so in acute critical illnesses. Openness , acceptance of a result/limitation and the best interest of the patient should be our focus. Then desicion making becomes easier when following this rationale. But, we train our homeopaths so that they can meet the high clinical demands required of a competent homeopath. Our MD course is geared towards this.
Dr. Leela: I understand that. For me its a question of lifelong evolution and development as a homeopath. That is why we need to have competent senior homeopaths in charge, imparting their knowledge without reservation to sincere junior homeopaths, whilst completely confident that the Law of Similia holds true in every situation – convinced that it is only the level of compentency and methods of the chioce for remedy analysis that needs to be worked at.
I think the homeopathic System of Medicine demands a wholistic development of a homeopath – spiritually, emotionally, intellectually and professionally! Could you give us an example of how this works in action?
Dr. Navin: Quite right! One good hospital case was actually a surgical case. A 25 year old man came to the ER with:
– Sudden pain which started on left thigh
– He had developed swelling and tenderness in the hamstring about 20x15x10 cms.
– He was unable to extend his limb
– He was unable to walk
– The USG showed a deep muscular abscess that extended through the thigh with multiple septae.
We had to call in an Orthopaedic surgeon for an opinion. He suggested that it should be drained as it was very large, loculated and painful. He agreed that we could manage the case with homeopathy. He took the patient into the Operation Theatre and midway through the draining he called us in to have a look. The tissue was very friable (easily bleeding on touch) and there was a lot of pus but it was loculated in pockets and the surgeon had to literally lacerate the wound and remove the septae to allow all the pus to drain out and not leave small loculations of pus. The therapeutic objective now was to prevent a recurrence of the pyemeia. Based on our observation of the wound in the operation theatre, the choice of remedy needed to cover this stage of the healing process – the post surgical wound.
The Totality at this stage was:
Ailments From: Cut surgical
Laceration during surgery
Pus and necrosis
Remedy whose primary action: Promotes granulation, Prevents Pyemia
The remedy choice was Calendula. We continued Calendula for over a month with no other medication along side – not even a local application of it. Also, the dressings were done with sterile gause and sterile water, nothing else. The progressive healing can be seen in the . He recovered completely on only Calendula – to complete funtion and complete recovery of the range of movement in the limb.