Case 75: Reaching out to the Unreachable- Part 1

Dr RAMDAS
Primary Physician
Clinical Coordinator: IASH / MLDMHI, Bangalore.
He is a founder trustee of IASH and has been involved with our community activities since inception.
Ph- 9844234718, ramdasacaharya@gmail.com

Dr MANJULA KUMAR
Observer
He is a recent member of the CHS team and an active participant in all activities of IASH since 2006.
Ph- 9980151675, manjulark@cosmictechnologies.biz

Dr Savitha S Wani - Community Health Services Coordinator- IASH / MLDMHI- Bengaluru.
Ph- 9901460878, drsavitha@hotmail.com

There is an enormous difference in Homoeopathic Practice in urban area and rural areas. The experiences shared here will demonstrate the differences.

THE BACK GROUND: Institute for Advanced Studies in Homoeopathy (IASH), Bengaluru has collaborated with the Dr M L Dhawale Memorial Homoeopathic Institute (MLDMHI) Mumbai to "Reach out to the Unreachable" in rural Bengaluru. The first charitable unit under this collaboration - "Dr M L Dhawale Memorial Institute’s Standardized Homoeopathic Clinic managed by IASH started functioning at Ravagudulu village, Somanahalli panchayat, Kankapura taluka in the year 2006. Ravagudlu village is situated about 32kms from Bengaluru on Kanakapura road. This Panchayat has 12 villages. The second clinic on similar lines networked with another NGO - FIRFLIES Ashram is the "Mary McBride health centre" situated in the serene atmosphere of the ashram in Dinnepalya village. The geographical area served through this unit is the population of Kagalipura, and Thalagatpura, They are Talukas situated about 30 kms from Bangalore city on Kankapura road. Kagalipura Panchayat has 24 villages; Thalgatpura Panchayat has 13 villages. These villages with a consolidated population of 35000- 40000, though are distance wise close to the capital of the state lacks in basic medical facilities! They do not have a primary health care centre and has no other medical facilities. A large population of aged, women and children are in need of basic medical care. The only district hospital is 15 kms away. Hence our objective of reaching out to the unreachable seemed appropriate when we started operating from these clinics. In these villages dwell socially and economically challenged people, 80% dependent on agriculture, 70% illiterate, and completely ignorant of health and hygiene.

Reaching out to these needy people was not easy!! Starting off was not any issue. The challenge was to make homeopathy as a main health care medium and sustain it. The Clinics function as primary health care providers on an OPD basis, which was not enough. We had to adopt a multi faceted mode of approach - like Camps, Adopting schools, Community health worker programme. Camps are specifically designed and planned like Cardiac camp in association with Narayana Hrudayalaya, Diabetes detection camp, Anemia detection camp, 0pthalmology camp in association with Nethra dhama hospital. The patients seen at these camps are followed up at the regular clinics. One such camp was the diabetes detection camp held at both Ravagudlu and Fire flies units simultaneously on September 28^th 2008. The following is the numbers/statistic of both clinics put together.

The below case shared here is a fall out of this camp.

Mr A, Aged-36yrs, Education: 10th Std. Married since1995, Hindu, Vegetarian. Occupation: Works at the Ashram. Father: Dead at a age of 63 yrs. Mother: Alive and lives with sister. Wife: 30 yrs, House wife. Children: 2 sons 12 and 10.

PRESENTING COMPLAINTS

·         Chest pain: Pricking type, on and off.

·         Wt loss: 12 kgs since 6 months.

·         Detected DM since 2 yrs while on Homoeopathic treatment, Irregular on treatment. (Had to travel 30kms so stopped)

·         General condition varies

PAST HISTORY: Chicken pox age of 6 yrs.

FAMILY HISTORY: PGF- DM.

PATIENT AS A PERSON
Cr: Salty², sweets², spicy;
THERMALS: Ambithermal .

THESE ARE THE HIGHLIGHTS OF HIS LIFE SPACE
Born and brought up in village. Pt was very sympathetic and soft by nature. He has been some one who would become sad when scolded. Would keep to himself. Though had friends was kind of reserved. Says he has not faced any strains in the childhood.

Did not pursue education as he was not interested- stopped after 10th std. Post school he decided that he likes the work that the Ashram is doing and joins them in helping the orphan children. His sympathy and helpful nature makes him support a teen age Girl who is abandoned by her parents. Pt takes her to the ashram and helps her get shelter there. Over some years, a mutual attraction builds between them.

The ashram follows an unwritten policy once the inmate is old enough to support themselves- they are allowed to go out and fend for themselves/ support the other younger/ aged ashramites by taking on responsibilities.
When this girl is old enough and has to support herself, she has no where to go. Pt marries her.
Our compounder informs that they were "one of the best couple in the whole village".
(In most of the cases we have experienced that the compounder aids tremendously in case receiving. Our compounders lives in the village, hence knows the ongoing in every house hold.
In a village set up with about 60% illiteracy the compounder are the "oral history forms". With minimal training they are attuned to Homoeopathic case taking that at times the information they give can help us arrive at Problem Resolution / similimum).

Now back to patient: "Life was good everything was sweet". Pt says my needs / expectation were very less hence did not face any problems. Wife also had adjusted, though she wanted to shift to Bangalore. She was educated and ambitious. Wanted to work as a teacher and make a better living.
There used to be arguments about this between pt and wife. Pt who was more than content in the village did not want to shift out of the village. He was happy with his two children and his wife though these arguments were on. Pt is very attached to his 2 sons. Does his work and takes care of the family with the little income. Children study at the local Government school.

In the year 2006, wife reconnects with her paternal family. The idea of her wanting to shift to Bangalore was further fueled by her parents.
One fine day she decides to leave the village, house, husband and her 2 sons!! Goes away. This separation was too much for the patient who was strongly attached to his wife and family. Went into grief and brooding and this is the time he came down with his complaints. "She must have her reasons" is what patient says. Pt is unable to handle this. He experiences sadness³ and grief. He comes down with weakness³, increased urine frequency, loss of appetite and sleeplessness. There is also loss of weight. Though the pt was hurt, sad and grieved the loss, there was no anger towards the wife.
When blood sugars show high levels of 302 he contacts the PP. He is put on Phos-acid 200 as similimum. Pt recovers. His generals as well as the specifics are brought to control. Later he is followed up with Natrum-mur as constitutional.

Natrum-mur as constitution was based on the following- 

o    Tendency to sadness

o    Reserved behavior

o    Intense sympathy and helpfulness ¬

o    Cr: Salty²

o    Thermals: Ambithermal

Pt then discontinued medicines for almost a year. During this period pt and wife reconciled. She came back to live with him.

In 0ctober 08 during the camp he presents with - Chest pain- pricking type, weakness2, and PPBS of 304 mg/dl. O/E: BP- 130/82 mm of hg.

He was apparently well all this while between 2007 and now and his sugar levels were in normal limits. As compared to the 2006 episode, all his generals are normal. Appetite was good, sleep is normal. Urine frequency was 5-6/D- 1-2/N.

Knowing the back ground PP decided to explore and gets to know that the wife has abandoned pt again to go and stay with her parents since 1 week. This time she had taken the children too. Pt went to bring her back and she refused. Father in law insulted. Pt was hurt. He was saying "I am tired of this mentally and physically".

Phosphoric-acid still holds good based on the grief reaction which expresses every time at level of pancreas- Diabetes and exhausted mental state.

On the psycho dynamic level there was a clear picture emerging: Distanced Wife/ children = Loss of LOVE/ Sweetness = Inability to assimilate the loss of love / Sweetness in life.

Phosphoric-acid 30 stepped up to 200 helped the chest pains, the general weakness was better, Mental state was better. And the regular check ups done for sugar showed stabilization of sugar levels. Not reached normal. PPBS range between 180- 200 mg/dl.

The maintaining factor persists. Wife is still not back, pt misses his children. During follow ups, tears brim in his eyes when he talks of his children.

The efficacy of Homoeopathic medicines was clearly evident. During the 2006 episode, pts generals were also disturbed. The medication of the phase remedy followed by constitutional had prevented his generals from getting effected now. The comparison becomes essential for management as also the A/F is much graver this time around, with wife taking children also with her.