The influence
of culture on health and the state of a homoeopathic physician
Homeopathy Master Classes Weekly
Interview with Dr. Ajit Kulkarni,
Satara, India
Interviewee- Roman Buchimensky,
Israel
Roman - You have taught more than
20 international seminars around the world and have clinics in every
corner of the globe; you meet with people from all sorts of cultures
and backgrounds:
Ajit- Yes, only recently I returned back from Bulgaria after giving
my 22nd international seminar, thanks to Roman Buchimensky, Director,
Via Homeopatica who allowed me to blossom my potentiality.
1. Does the cultural background of the person you treat have any influence
over the way you approach them in your practice? Does it change your
practice in any way?
Definitely. When you meet people from all sorts of cultures and backgrounds,
it makes a difference at every level. As a human being you have your
own culture, your own value system and you are trained in a specific
manner. It is with this entire heritage that you start looking at the
people. I have written somewhere in my writings that life is nothing
but our own perceptual filter. We approach the life, take in the experience
and develop our own perception. It's like what we sow, so we reap. It
is we who do filtration and develop our vision.
We have to define first what is culture and what are its dimensions.
Culture is the enduring behaviors, ideas, attitudes and traditions and
it gets transmitted from one generation to the next. We see things through
a cultural lens that tints, magnifies, shrinks and otherwise shapes
our perceptions. Our culture is a mindset that we developed during childhood
socialization. What is normal in one culture may be regarded as abnormal
in other culture. The interpretation of illness is influenced by the
culture. According to the 19th century anthropologist and doctor, Rudolph
Virchow, 'disease is a disturbance of culture'. "Every culture
has its own 'idiom of distress', the pattern of behavior by which people
in that culture signify that they are ill" (Alloy, Jacobson and
Acocella).
The influence of culture over society
in general and individual in particular is a matter of serious study.
Culture profoundly influences thoughts, emotions and behavior. It operates
at primary, cognitive, perceptual and motivational levels. It acts as
a blue-print for operation within our physical and social domain. The
world is shrinking in size and new cross cultural networks are getting
formed. The period between two generations is becoming progressively
diminished and children are becoming early adults. The media influence
has encroached beyond control and people are going away from nature
in every facet of life. We have to see this in the context of cultural
background.
There are three levels of operation - as a human being, as a physician
and as a homoeopathic physician. The roles concerning each of them have
to be clearly defined. When you are working as a human being, you have
the onus to look upon the sufferers through humanitarian lens. When
you are working as a physician your role gets widened in terms of diagnosis
of the disease and overall management of the patient. But if you have
to perform the role of a homoeopath, it's altogether a different level
of consciousness. Defining the concepts of health, disease and cure
in the right appreciation and applying them on an individual instance
becomes an obligation for a homoeopath, given the holistic philosophy
of homoeopathy.
Culture does change the approach while treating with homoeopathic therapy.
One of the main reasons is that homoeopathy approaches not only the
body but also the mind and the soul. Culture is always related to all
three - body, mind and soul. The repercussions of culture have bearing
upon selection and interpretation of rubrics. Moreover, a homoeopath
must see that he doesn't suffer from cultural shock (a term coined by
Kalervo Oberg during 1954) i. e. feelings of anxiety, surprise, disorientation,
uncertainty, confusion, disgust etc. that grow out of the difficulties
in assimilating the new culture, causing difficulty in knowing what
is appropriate and what is not.
2. How is your practice outside India different from that in India (where
you practice most of the time)?
The practice in India is different in many respects from rest of the
world, esp. when you are treating the European community. Although appointment
system is followed in big cities in India, it is difficult to follow
in rural India. Indian patients are of different castes and creeds and
are not habituated to work on appointment system. Many poor and illiterate
patients don't even ring the doctor for appointment and they directly
enter in the clinic. They have already spent some money on travel and
food and to say no to them is difficult. The position of a doctor in
India is also different. A doctor has respect and honor in the society
and in rural parts of India, a doctor is still regarded as next to God.
You may think it as absurd. But see, there are many benefits of this
type of approach. First, the sense of responsibility on the part of
a doctor is increased multifold and secondly, a patient keeps full trust
on the doctor. This relationship helps a patient to recover and further
there is always a symbiotic relation between that helps to foster the
required forces.
The major difference which I have noted, when I compare Indian and outside
Indian patients, is at the level of clinical interview. There is much
more intellectualization and theorizing of the data by the foreign patients
and it takes much more energy and time in getting accurate data. I can
cite some examples. One patient while asking about any effects of food
over health, answered, "My soul doesn't accept milk". The
simple meaning of this sentence is that milk is intolerable and now
we have just to ask "What symptoms you get when you take milk"?
Clinical interview with Indian patients is easier. Indians tell their
complaints as they are and don't add to make the stuff more complex.
Their ego is less and they focus on giving the objective data. Interpersonal
problems are more deep and frequent in foreign patients and feelings
of loneliness and being abandoned are more seen.
Even in India there are different layers of patients. Most of the Indian
patients don't ask for the names of remedies and they keep their faith
on a homoeopath. The classical prescribers often give a single dose
and then most of the practice is on placebo. In foreign countries, a
remedy is usually prescribed and a patient brings the remedy from a
pharmacy. A pharmacist's role is only to give a prescribed remedy. A
homoeopath gets his consultation charges for the prescription. Some
patients apply their half knowledge of materia medica to the known remedy,
look into the net and argue with a homoeopath. In India, a homoeopath
can't charge heavy consultation fee. Although homoeopathic practice
evokes the most intellectual exercise, still it is regarded as a secondary
medical therapy. Often the situation in India is that a patient may
spend heavy charges for investigations, but for a good case-taking that
involves total life space of a patient and more than 2 hours, a patient
resents giving a homoeopath his due right.
Giving placebo helps in getting
money and effects of placebo are no doubt tremendous esp. for a homoeopath,
who has to apply the principle of minimum dose. Placebo helps in making
a patient health conscious; it helps in a regular follow-up, in a special
kind of physician-patient relation and gives time for a wise physician
to take an appropriate decision. I, hence, maintain that giving placebo
helps both patient and physician to steer towards recovery in a better
way.
Culture does play an important part in bigoted convictions and superstitions.
In undeveloped countries, we get many patients with bizarre ideas that
are stamped and carried forward. However, it doesn't mean that they
are not present in developed countries. In India, we have to define
the action keeping at the core the influence of culture. My observation
is that patients of America and Europe make use of gestures more than
Indians. There are some cultural variations in expressions and interpretations
of body language too.
3. What can you say about the sort of diseases present in particular
parts of the world in relationship to other places? Is there any difference?
Yes, there is difference and it is related to culture and consequent
life style. In Indian society, we get more cases of psoric and sycotic
miasms while outside India, esp. in Europe, cases with strong pathologies
are observed that are of tubercular and syphilitic types. In India,
family is a unit and although the concept of singular family is getting
reduced, yet the joint family concept is dominant at large. There is
much more sharing of emotions and nurturing in a family and we get fewer
patients with abandoned and isolated feeling. In contrast with this,
the personal space which the foreign patients maintain is a larger one
and often it is with thick wall and surrounded by an impenetrable fence
and people don't get adequate ventilation and they get absorbed in their
suffering. To go for a deeper interview, hence, requires special techniques.
Even it makes a difference in psychotherapy. May be I am consulted for
strong pathologies, but when I compare the Indian counterpart, I find
that cases of auto-immune disorders, malignancy, metabolic disorders
and addictions are much more in foreign societies.
The indulgence in alcoholism is higher in European countries and it
is a matter of concern. Males getting alcoholic and finally coming to
severing the relations and heading for divorce are on increase and a
conscientious homoeopath has to take into account the environment in
totality. What can you say when a 5 year old boy has craving for beer
and daily he and his father sit together to enjoy beer and the father
does it because he is not a biological father?
4. What about the social background of the patient? Does it reflect
in the kind of disease
they tend to develop? Is there a difference in the type of disease children
tend to develop in different parts of the world?
The above two questions should be studied in the context of earlier
views. I see more cases of atopic dermatitis in children in Europe and
also cases of follicular tonsillitis. I am also getting consulted for
juvenile diabetes and juvenile rheumatoid arthritis. Obesity is more
observed in foreign countries esp. European and American. I have on
my record several cases of adolescents who become very arrogant and
difficult to handle by their parents. This arrogance, I attribute to
ego-hypertrophic training which the parents in particular and the educational
system in general render in rearing up their children.
It may be an exaggeration, but it is said that every home has at least
one orphan. I have come across one more problem. In India, it is usually
the father who keeps a dominant role in the family. In western society,
it is more the mother who controls the situation. I have been consulted
for many adolescents - both boys and girls - who narrate their grievances
against their mothers in the interview.
5. Could you speak a little about the position of different governments
around the world regarding Homeopathy? Is there a palpable difference?
First note that the popularity of Homoeopathy is on the rise, today,
all over the world. Outside Europe in countries as India, Mexico, Pakistan,
South Africa homeopathy is established as a primary discrete healthcare
discipline with an in-depth undergraduate education and training and
a professional infrastructure which puts it on equal level with conventional
medicine.
In countries such as Australia and New Zealand homeopathy is developing
into a complete healthcare profession and is receiving government recognition
through positive enabling legislative change.
In India, there is a post-graduate
course of three years in homoeopathy being run by private Institutes
and Government (the undergraduate course is of five and half years).
There is a research wing, namely Central Council for Research in Homoeopathy
(CCRH), being conducted by government. Despite the fact that Homoeopathy
owes its origin to Germany, India has become the world leader in Homoeopathy,
with about 2 lakh registered practitioners, 180 teaching institutions,
including 31 post-graduate colleges, about 10,000 dispensaries in public
sector, about 250 hospitals and 650 drug manufacturing units. A survey
conducted by ICMR in 2003, reveals that Homoeopathy was preferred by
1/3rd of the surveyed households in India for minor ailments and by
about 18% in cases of serious ailments.
Homoeopathy is also recognized officially
in countries like Bangladesh, Singapore, Dubai, Malaysia etc. Homeopathy
is practiced across Europe by approximately equal number of homeopaths
and homeopathic doctors. The distribution between countries is uneven
with some countries having proportionately larger numbers of homeopathic
doctors. Four countries in Europe legally restrict the practice of homeopathy
to doctors only- Austria, France, Luxembourg and Bulgaria. However in
other countries like Denmark, Finland, Ireland, Norway, Sweden, the
number of doctors who practice homeopathy is relatively low and the
homeopaths are far more numerous. Governments in Belgium, Denmark, Ireland,
the Netherlands, Norway, Portugal and the UK have recently introduced
legislation to positively regulate the area of Alternative Medicine
including homoeopathy.
In some countries as Denmark and
UK integrated healthcare projects have been or are carried out. Some
of these projects include homeopaths who work closely together with
conventional health care personnel. The European Council for Classic
Homeopathy (ECCH) is founded in 1990 and is represented in 27 countries
in Europe, including all countries in Western Europe and an increasing
number of countries in Eastern parts of Europe. Over the past year associations
in three new countries have joined the Council. Homoeopathy has got
official recognition in Germany, Switzerland, Canada etc. In the recent
past countries like UAE, Thailand, Cuba, Argentina, Iran, and Russia
have granted official recognition to these systems, new teaching institutions
are coming up and research activities are being revitalized.
Homeopathy is widely accepted and
getting more popularity all over the world also in Abu-Dhabi, Austria,
Afghanistan, Argentina, Bahrain, Bermuda, Brunei, Brazil, Chili, Camarone,
Cyprus, Canada, Costa Rica, Caribbean Islands, Egypt, Fiji, Finland,
Greece, Germany, Guinea, Holland, Hungary, Ireland, Israel, Italy, IMO
State, Japan, Kenya, Lithuania, Mauritius, Muscat, Nigeria, Norway,
New Zealand, Neth Antilles, Panama, Philippines, Qatar, Romania, Switzerland,
Sri Lanka, Saudi Arabia, Scotland, Slovakia, Spain, Taiwan, Ukraine,
Wales etc. However, in many of these countries, there is no govt. patronage
though there is no opposition.
However, the homoeopathic fraternity
in India enjoys the support of government much more than any other country.
6. Could you share with us a few short Homeopathic cases to demonstrate
one of your points?
I once took a case of an old American lady in one of my international
seminars. The lady was very active and she independently built up her
new house at her 78 years. She was egoistic, straight-forward and excitable.
She may be rude with the others. She was doing her business with all
her energy and also looking after her grandchildren. She accepted the
request of her son and daughter-in-law to take care of her grandchildren
daily for 2 hours. But it happened that she had to give more time and
she refused to take her and quarreled a lot. Finally, she negotiated
and asked for 100 US$ per hour if the time limit of care crosses 2 hours.
In India, I took this case for discussion in my weekly discussions of
Institute and asked my students to find appropriate rubrics. One of
the students took 'cruelty' as a rubric for repertorization. Obviously
the influence of culture is evident.
Pre-marital and post-marital sex is tabooed in Indian society and whenever
such a case is confronted in practice often the students select the
rubrics like excessive sexual desire, lasciviousness, adulterous or
perverted sex. What is regarded as perverted in one culture may be regarded
as normal in other culture. I remember one more case where a boy had
many girlfriends and only on the basis on this, a student took the rubric,
'frivolous'. Actually, he was a very responsible and serious boy.
I had once an interesting experience. I treated one European lady for
many psycho-somatic complaints and the cause was disharmony between
herself and her husband. Husband wanted to divorce her and she was a
bit irresolute. She became depressed and I gave her a dose of Manganum
10M. On her next follow up, she was happy, greeted me and appreciated
me for helping her to take the decision of divorce. I was taken aback.
With my Indian culture, a lady suffers a lot from economical and social
problems and I was with my parameter.
Many such cases helped me to know the beyond known dimensions of human
behavior which is tied up to culture.
7. Usually during Homeopathic seminars an acute case appears. Could
you share with us one or two of the most memorable ones?
Oh! I have many memorable events. My first international seminar took
place at Tel Aviv and on the second day at 9-30 am I took a case of
a cook who was suffering from acute severe conjunctivitis. The eyes
were red and she had very painful sand sensation in eyes. I took the
acute totality and advised the lady to take Argentum nitricum 30 three
times per day and convey next day. In the evening on the same day, she
gave her follow-up on the platform that within hours after taking 2
doses her pains diminished and the redness of the eyes was much less.
I got applaud from Israel homoeopaths.
I recall one more case. I gave a seminar on management of acute cases
and I received a challenging case of acute bronchial asthma in the seminar.
The child was dyspneic, restless, frequently asking for few sips of
water and the chest was full with phlegm and there was loud wheezing.
The picture was apparently of Arsenic album but I selected Antim ars
200 every half an hour as the patient was warm blooded and tongue was
white coated. In the evening the child was playing nicely before the
group.
8. Do you have any experience with different cultural expressions of
the same remedy?
Once we know the culture and its influences, it becomes easier to study
materia medica and select an appropriate remedy. We must first understand
that applying our parameter of culture to the case will not do justice
to the case. We have to examine the behavior in the light of cultural
background. In a similar way, although the remedial functional action
remains the same the expressions of a remedy do change due to culture.
I can't imagine a Calc carb lady with a modern dress in rural India,
but I saw many Calcareas in Europe driving their cars nicely and consuming
cigar and alcohol. This will be too much for Indian Calc., even to call
as 'ultra-modern'. I see more anxious and family-oriented Kalis in India
and less Platinas. See, uniformity in diversity is the very base of
human beings and of our materia medica. Cultural variations will go
for a different projection of form but the very function and structure
of a remedy with its quintessence will remain the same. In other words,
once a homoeopath adapts himself with the variable cultural influence,
he will be in a position to know the real sickness of a patient and
its correspondence with materia medica. 'That there is a person beyond
culture, that his illness is very personal and that as a homoeopath,
I have to observe him as he is, objectively and dispassionately' is
to be understood also.
9. Have you seen a pattern in the kind of issues Homeopathy has been
facing in different countries in the past years? What is your advice
for overcoming those issues?
The chief problem homoeopathy is facing and likely to face in future
in more magnitude is non-acceptance and resistance to homoeopathy by
the scientific community and by the modern medicine. Once it is decided
not to accept, every measure will be used against the salubrious science
of homoeopathy and it is at this level that homoeopathic fraternity
should not lag behind in proving that homoeopathy is a scientific discipline.
Given the complex structure of homoeopathy, this is a herculean task.
The relationship between homoeopathy
and governments of different countries is a matter of concern. Homoeopaths
should take an active role to legalize the practice of homoeopathy in
their respective countries. Homoeopathy has been tested in crucibles
of TIME, has survived, and has now 'come of age;' it is no more a domestic
medicine or first aid or 'before the doctor-or-the specialist-arrives'
system. It is now bold enough to meet the challenges of most obstinate,
inveterate diseases that are impinging on humanity today. Now homoeopathy
is the second most alternative therapy in the world and given its holistic
nature and utility it needs to be disseminated largely for the sake
of human suffering.
Homoeopathic community is not united.
There are many schools and divisions. I have written elsewhere, "There
is only one school and that is of totality. You can name it as a 'School
of Totality'. Every homoeopath should be a lifelong student of this
school. Totality is the base, totality is the guide and without totality
there is no homoeopathy. It's like matter and energy that are inseparable.
Totality renders the essence and essence without totality is apparition."
There are weird ideas with which people practice homoeopathy. There
are many layers and levels of homoeopaths and there is no uniformity
in educational modules and practical avenues. Strict standardization
has to be brought at educational, practical and pharmacy levels. Classical/non-classical,
mono-pharmacy/poly-pharmacy, I am right/you are wrong - such influences
make the wonderful design of homoeopathy distorted before the public
and aspiring students who want to be homoeopathic healers.
Roman - Thank you, Ajit for your
comprehensive interview.
Ajit - Welcome.
Dr. Ajit Kulkarni
M.D.(Hom.)
www.ajitkulkarni.com
dr_ajitkulkarni@rediffmail.com
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