by Ralf Jeutter[slideshow id=5]When I went to Ghana for the first time two years ago to be part of the Ghana Homeopathy project, I went purely as a generalist homeopath, treating patients with a wide range of conditions, as are typically seen in countries like Ghana. Equally, the teaching had a general scope, ranging from acute conditions to philosophy. This time my contribution to the project had a specific focus due to the fact that I am now a fully qualified and registered podiatrist, and also because Claire Duguid, podiatrist and lecturer at the University of East London, accompanied me on the trip.
We agreed beforehand to focus on wound care and diabetes, both in teaching and practice. Diabetes has become an endemic problem in the whole of sub-Saharan Africa, and it is projected to get much worse over the next generation. Wound care is a much neglected area in the official healthcare arena as well as in more traditional fields of medicine. There is both an educational gap when it comes to diabetes and wound care and a virtually complete lack of knowledge of how to deal with wounds practically and safely.
Claire and I saw this first visit very much as a reconnoitre mission to understand what the situation is on the ground, in this case in Julius Berdie’s city clinic of Accra and the countryside clinic in Mafi Seva. The first thing we needed to fully appreciate is the fact that there is no medical referral structure to speak of in Ghana. Ideas about a multi-disciplinary team approach with specialist interventions are not meeting with any reality. If patients have been to hospitals or medical clinics first, the result is often disappointing and expensive. The responsibility of care can therefore easily fall on homeopaths or other traditional medical professionals who are frequently first point contacts in Ghana. It is therefore of the greatest importance that those practitioners get as good a training as possible, theoretically and practically. And this is what we aim to achieve over the coming years with the help of homeopathic as well as conventional healthcare professionals, together with the Ministry of Health.
However, the starting point of this project is our own clinics in Accra and Mafi Seva. Both Emperor and Julius saw the opportunity of making the clinics known, over time, as centres which can deal effectively with diabetes and its consequences such as ulcerations. In order to make a good start on this the teaching schedule was organised accordingly. Claire delivered lectures from a purely orthodox medical point of view, covering subjects such as diabetes (pathophysiology, signs and symptoms, associated pharmacology), principles of wound care (different types of wounds, ulcers, treatment modalities, warning signs of infection, conventional pharmacological interventions).
On the first day of her teaching the Registrar of the Council for Alternative Medicine was present and was so impressed with Claire’s presentation that he promised to support this endeavour (and the school) wholeheartedly. He stressed the fact that this is exactly what is needed among alternative practitioners, namely the awareness of standard knowledge and procedures in orthodox medicine. He also underlined the importance of being able to speak the language of the profession, sentiments I completely agree with. More importantly, the students enjoyed the lectures thoroughly and felt that they learnt essential information which they can’t be without.
The second aspect of Claire’s teaching was practical demonstrations of wound care. By the time this topic appeared on the curriculum two lucky things had happened: one we got the wound care packs through customs which were very kindly donated by Disposable Medical Instruments (on the initiative of Claire) from England and secondly word seems to have spread about our project sufficiently to see the first patients with wounds. The importance of this part of the teaching cannot be underestimated, because it is here, in the treatment of wounds, where it will be decided whether the outcome is beneficial or potentially disastrous (loss of limb, septicaemia, etc.). Having received one referral from a ‘homeopathic’ practitioner of a patient with very deep lower leg ulceration (due to an accident) and suspicion of osteomyelitis, and having seen how the practitioner had dealt with this situation in his own clinic, it became clear to everyone how important the appropriate management is, and how wide the gap currently is to achieve that. However, that the referral took place is encouraging, and it is obvious that limitations of practice can only be addressed if there are alternatives to one’s own practice.
Students felt at times overwhelmed with the amount of information they received. It was important to point out that the information would be repeated but it was also important for them to review their lecture notes to aid their learning. Of course, they were now all too keen to find out what homeopathy’s place is in diabetes and wound care, which was the focus of my lectures. One dealt with the principles of treating diabetes with homeopathy (different approaches, discussion of totality of symptoms, sources where to find information, repertory work and materia medica), while the lecture on wound care homed in on the most important remedies addressing this. One of my repeated mantras was that the students need to be fully aware how important their role is in this, especially if they are first point contacts; how essential it is for them to recognise warning signs, e.g. of osteomyelitis and what is then needed (intravenous antibiotics). In the absence of those, we simply need to do our best and must know the remedies related to situations like that very well. I stressed that homeopathy does not operate in a vacuum, and that the remedy is not everything: education, practical interventions, referrals etc. are all part of their job.
On Friday, the 20th of July, the project took on another dimension (with potentially long term positive consequences) when Julius managed to arrange a meeting with the Deputy Minister of Health, who gave us the opportunity to present our work to him, and thanked us for our contribution. He is keen to make us part of a network of practitioners (alternative and conventional) we can build relations with. He was true to his word immediately by giving us a personal recommendation to an eminent professor in diabetology. This all bodes well for the future of this project.
The next phase of the project is secured when Jane Greenwood (homeopath and podiatrist), together with a podiatry colleague, will continue the teaching and practical demonstrations of wound care.
The challenge now is to continue to support practitioners to develop their skills in wound care and diabetes of wound dressings so that the work can be continued on a local level.
Special thanks go to Helios Pharmacy and The College of Naturopathic Medicine for generous donations they have made to the project.