British Hornoeopathic Journal October 1992, Vol. 81, pp. 183-188

International perspectives in education

BARRY ROSE

Abstract The Executive Dean of the Faculty of Homoeopathy describes recent developments in the Faculty's international relationships. There are plans to establish the MFHom examination in India. The Special Committee for Education of the LMHI has organized discussions aimed at harmonizing standards of education for hom0eopathic doctors throughout Europe. The present situation of homceopathy in a number of European countries is summarized and the future plans and role of the Faculty of Homceopathy are presented

KEY WOADS: International; Education; Examination; India; EEC: Austria; Belgium; France; Germany; Italy; Netherlands; Spain; Switzerland; Portugal; Greece; Denmark.

Mr President, Ladies and Gentlemen, Over the last few years many aspects of the Fac- ulty's work have involved enlarging our bound- aries and having dialogue with medical hom0eopaths in other countries. It was thought that a review of what has been happening would be of interest to members. It is especially appro- priate that 1992 should be of such significance for our international forays as this is the year of complete integration into many aspects of the EEC by this country. The title of my paper is International Perspectives; I will be mainly look- ing at these from an educational point of view.

Having attended many meetings with inter- national colleagues over the past three years, it is especially pleasing to report that the Faculty of Hom~eopathy of Great Britain is still regarded as one of the major centres of medical homceo- pathy in the world and enjoys the good-will of medical hom0eopaths in a great number of other countries. This should give us no sense of com- placency but rather provide a strong base on which to build; to improve our teaching, to bet- ter the standard of our Membership examin- ation, to conduct meaningful research, and above all to play a major role in International hom0eopathy. It is too easy to become parochial and self-deprecating and imagine that as a small Faculty we have too much to do to keep our own

Based on a lecture delivered at the Sessional Meeting of the Faculty of Homceopathy on 13 February 1992

house in order, and little to offer to others. I would submit that this is a wrong approach; we have a golden opportunity to play a major role in expanding hom0eopathic influence throughout most of the world and if it means that we have to work harder and take more responsibility, then so be it; we must grasp the nettle.

India In January 1992 Major Bill Foxton and I went to Hyderabad, India, following correspondence with Dr Krishnamurty who is in practice there, and with Professor Kakarla Subbarao, a Con- sultant Radiologist and Chairman of the Med- win Hospital, Hyderabad. This is a new 250-bed hospital with state of the art diagnostic equip- ment and the scope to offer treatment for most medical and surgical conditions. We were told that a Department of Homceopathic Medicine was planned and that 20 beds and out-patient facilities would become available, the pharmacy would stock homoeopathic medicines and a library would be set up within the department.

Hom~eopathic medicine is practised by a large number of conventional medical practitioners in India but additionally by an even larger number of homoeopathic doctors who are trained by the government in the practice of homeeopathy but no other type of therapy. Their training is thought to be below MBBS standard. Over the years the question of the Faculty conducting its

183

184 British Hornoeopathic Journal

Membership examination in India has been raised on several occasions.

Dr Krishnamurty was deputed for nego- tiations about this with the Faculty in London and following a meeting between him, the Presi- dent and myself a list of the Faculty's require- ments was presented after approval by the Faculty Executive which also authorized these preparatory talks being taken a stage further by a visit to India.

These conditions were, in outline:

1 The examination would be for medical gradu- ates holding an MBBS (or equivalent) of a recognized medical school only.

2 The examination would be conducted totally in English.

3The Faculty would advise the curriculum which would contain elements relevant to ill- nesses encountered in India.

4 The Faculty would have total discretion as to who sits the examination after the submission of CVs from all intending candidates.

5 The Faculty would provide at least one, but ideally two external examiners for each sitting. Their total expenses would be the responsi- bility of the Indian group.

6 Candidates must be paid up Associates of the Faculty and the Faculty would be responsible for collecting individual candidate's fees.

Following our visit to Hyderabad to look into the available facilities for conducting both the papers and clinical at the Medwin Hospital, we are satisfied that these are adequate and suit- able. It was explained to the Authorities there that considerable preparation was vital before the first such examination and that a strong turn- out of well prepared candidates for this would be advisable to counter any misgivings by some British colleagues about the examination being conducted in India. It was stressed that the British Faculty is a body recognized by Act of Parliament to oversee teaching and research in homceopathy and as such we have a duty to our medical colleagues and also to the public to maintain a high ethical standard at all times and to ensure that our medical standards are equally high. Consequently, I explained that it is no easy matter to pass the Membership examination, as this is an accreditation to work in hom0eopathy. By awarding it we are in fact stating publicly both to the profession and to our patients that we are satisfied that the doctor concerned is com- petent to practise homceopathy and treat ill people by the use of this form of therapeutics.

It is hoped that the first Indian examination will take place early in 1993.

Europe Now let me turn to events nearer to home. In February 1991 with Dr David Ratsey I attended a meeting arranged under the auspices of the International Homoeopathic League which was to bring together educationalists from the EEC countries plus others from non-EEC countries within Europe. The committee was to become known as 'The Special Committee for Edu- cation' and it had a remit from the Liga to try to put together a common European programme of basic teaching standards in hom~eopathy. At the first meeting of the committee there were repre- sentatives from Italy, Spain, Austria, Germany, Belgium, The Netherlands, Switzerland and of course the United Kingdom. We started off by reviewing the present situation in each country with special note being made of their current teaching programme and the number of hours of instruction considered necessary to lcad to a sat- isfactory standard of clinical homoeopathy. The existence or otherwise of a 'qualifying' examin- ation and the body offering recognition of this, and/or approval of the teaching courses, was also looked at country by country. Any governmen- tal or legal bars to homoeopathic practice were similarly discussed. I think it will be of interest to cast an eye over these particular aspects and compare them to the current situation in the UK. There are differences, but overall there is a lot of common ground.

Austria Homceopathy is only practised by medically qualified doctors. The university of Vienna has a lecture on homceopathic medicine in the under- graduate curriculum but homo~opathy is not considered to be part of the official medical programme.

Almost all homoeopathic teaching is at post- graduate level; the course is taken over three years and involves approximately 150 hours theory and 150 hours practical clinical teaching. Although there is no formal qualifying examin- ation, each student has to undergo a viva at the end of their training. At present the medical authorities are considering the education pro- gramme with a view to approving a diploma for homoeopathic physicians. Until May last year there was only one medical homoeopathic society in Austria, now there are two.

Although at present homceopathic treatment

Volume 81, Number 4, October 1992 185

is not paid for by the State it is felt that current discussions indicate that this will change once a recognized homoeopathic examination and dip- loma is accepted.

Belgium Belgium has three main teaching outlets. The Unio Homoeopathica Belgica through the Hom0eopathic Medical Faculty of Belgium runs courses in 4 main cities--Brussels, Ghent, Luik and Namur. Their programme takes 3 years to complete and apart from theory it includes the teaching of the materia medica of 100 medicines. The course entails a minimum of 200 teaching hours.

Homoeopathica Europea, run by Dr Jacques Imbereehts, a Fellow of the British Faculty of Hom0eopathy, takes a minimum of 4 years to complete. It has high standards and involves attending 24 seminars on theory, materia medica and repertory. Students have to produce 10 cases with a minimum of 2 years' follow-up for their qualifying examination and answer questions on all aspects of homceopathy as well as taking a case supervised by examiners. After qualifi- cation they are expected to present a dissertation.

The third Belgian school is at the Clinical Training Centre for Classical Homoeopathy and is run by Dr Alfons Geukans at Hechtel. This involves 3 years of training, during which the stu- dent has to attend weekly case presentations as well as classes on theory and materia medica.

France In France the practice of homoeopathy is illegal unless by a qualified doctor. Medical doctors are free to prescribe whatever treatment is appro- priate for their patient. Homceopathic medicines are used by one in six of the population and are easily obtained from almost all pharmacies. Complex homceopathy is widely used and many of the training courses are sponsored by the homoeopathic pharmaceutical companies and the teaching on these courses tends to focus on the use of combinations of drugs for specific con- ditions. Although there was not a representative from France at the initial meetings of the Euro- pean Committee for Education, I believe that some homoeopathic medicine is taught at some of the medical schools.

Germany Homceopathy can be practised by qualified doc- tors (MDs) and naturopaths (Heilpraktiker). The main organization for homoeopathic doctors

is the DZVHA (Deutscher Zentralverein Hom6opathischer Arzte). Its goals are the pro- motion of scientific studies in hommopathy, organization of education, and representation of hom0eopathic interests at official government level. A few years ago another organization, the Hahnemann Gesellschaft, was founded particu- larly to promote classical (orthodox) homceopathy.

Officially a doctor is recognized as a homceo- path by obtaining 'an additional nomination' or Zusatzbezeichnung. The requirements for this include attending teaching over a period of 18 months and then and additionally a 3-week course. There is no qualifying examination at present. Discussions are being held to produce new educational requirements to improve the programme of hom0eopathic education and teaching. This has already been done in Berlin and Freiburg where a 3 year course with a final qualifying examination is held.

One of the major problems is the lack of quali- fied hom0eopaths willing to guide students in their practices, partially because of what they call 'negative financial consequences'.

The official three-week course takes place in 8 main cities. An important development which we could well emulate is the return of homceo- pathy to the universities. Officially run courses--authorized by the universities, are given in Hanover, Mainz and Freiburg. New courses for East German doctors are now again being held in Berlin and Leipzig after the almost total extermination of homoeopathy by the former political authorities.

There are many variations in the actual courses being run in Germany. They are mostly of 2 or 3 years' duration with considerable emphasis on case taking and analysis. The Berlin school which teaches classical hom0eopathy runs a 3-year course of 3-hour lectures every two weeks and examinations at the end of each year. Their programme includes: in the first year theory based on the Organon and Kent, case- taking and repertorization and the materia medica of 75 medicines. In the second year the theory is based on chronic diseases, there is the materia medica of another 100 medicines and case presentations. The third year includes a further 100 medicines as well as recapping on previous subjects. The final examination includes the presentation of 3 cases and giving a discourse.

Italy Homoeopathy is very popular in Italy, some 10% of the population is thought to prefer homoeo-

186 British Homceopathic Journal

pathic treatment. Up to 1989 any qualified doc- tor was free to practise hommopathy. In the spring of 1989 the number of medicines and dilu- tions was restricted. All preparations related to narcotic drugs, all nosodes and all medicines coming from the animal kingdom were banned by the Ministry of Health. Not unnaturally there was a great deal of protest at this and a Commis- sion was set up to look at the question and eventually the rule was suspended. Now homoeopathy is regarded as a therapeutic strat- egy, not a medical speciality and according to Italian law every graduated doctor can practise homoeopathy.

Homoeopathic education in Italy seems dis- organized. There are 26 or more schools of hom~eopathy, in some large towns there are 2 or 3 of them, each often at odds with the others. The courses last from 1 to 3 years and the aver- age number of hours of training varies from 150 to 300. Most of the courses are sponsored and directed by pharmaceutical firms. In June 1991 the leaders of some of the more balanced schools met in Milan and proposed to work together, without the support of any pharmaceutical company, to create a 4-year course of some 120 hours tuition based on classical homoeopathy. They have adopted the initials USIOH, Unione delle Scuole Italiane di Orneopatia Hahneman- niana. However there are still other schools which claim to be representative; one of these in Verona has classes one weekend a month for 9 months with a full week's teaching during the summer.

The British Faculty has been approached by several Italian colleagues about the possibility of us running our Membership examination in Italy. This poses many questions, not least the problem of how to decide if one school or group is more representative of Italian homeeopathy than others. In other words, who do we deal with? Language is another problem and various schemes are currently being considered to over- come this barrier. The general view of the Fac- ulty Council is that the MFHom is a British examination and should therefore be taken in English. However, it is very pleasing that our qualification is regarded so highly by European hom~eopaths.

Recently a senior Spanish hom0eopathic doc- tor, Dr Manuel Mateu-Ratera, attended the clinical part of the Membership examination, as an observer. The Spanish wish to set up their own qualifying examination based on our Mem- bership but additionally want to consider the

possibility of our examination for the MFHom being held in Spain. Over the past few years sev- eral Spanish doctors have attended Intermediate Courses in the UK and some have already taken the membership examination.

The Netherlands + There are around 450 physicians practising hom~eopathy (around 1% of all doctors). Almost all of them graduated from SHO, The Homceopathic Training Foundation (Stichting Homoeopathische Opleidingen) the only homceopathic training college for physicians in the Netherlands. The SHO runs a 3-year, 200- hour programme which consists of 5 modules per year, each with 2 days of teaching. Additionally a good deal of home study is expected. Their programme has been set up in collaboration with the Educational Research and Development Department at the State University of Utrecht. There are about 80 or 90 new applicants for the Basic course each year.

There is also an Advanced Course which is a 2-year course taken over 20 days and is meant for physicians with previous practical experience in homceopathy. In September 1990 an examin- ation was set up for the first time and centred on doctors who had completed the full 5-year train- ing courses.

Almost all the homceopathic physicians in the Netherlands belong to VHAN, a professional organization started in 1898. The current mem- bership is around 600 and the Association is making great strides in reorganizing itself to a greater degree of professionalism with a per- manent secretariat. Its objectives are the upgrading of homoeopathic education and set- ting rules of conduct and professional standards. To become a VHAN member a physician must ha're completed the 3-year basic homeeopathy course of the SHO. VHAN also has a Commit- tee on Scientific Research, a Public Relations Committee and a Quality Committee to deter- mine what is meant by homoeopathy and what quality requirements a homoeopathic physician must meet. In association with the main hom0eo- pathic patients group, the KVHN (Royal Dutch Hom0eopathic Association), which has around 1300 members, they are also exploring avenues of communication between hom~eopathic phys- icians and their patients.

Spain Homceopathy was not favoured during Franco's regime but is now rising from the ashes and

Volume 81, Number 4, October 1992 187

becoming well accepted and well organized. In February 1991, by a resolution of the Spanish government, 12 hom~eopathic medical groups were incorporated as the Spanish Federation of Homoeopathic Physicians whose main aim is to stimulate and foment teaching, research and the development of Hahnemannian hom~eopathy. There are approximately 280 medical hom0eo- paths in Spain, the teaching programme takes 3 years to complete and comprises 150 hours clini- cal teaching and 450 hours theory.

Switzerland The Swiss Association for hom0eopathic Phys- icians, the SVHA (Schweizerischer Verein HomOopathischer Jirzte), was founded in 1856 and the vast majority of Swiss medical homeeo- paths belong to it. Currently there are 161 mem- bers: doctors, dentists, veterinarians and pharmacists who have completed a 2-year pro- gramme of basic education in classical homeeo- pathy. A diploma is awarded at the completion of 2 years' basic education plus a further 2 years' practical experience, to include a minimum of 100 hours postgraduate training and 2 years con- ventional medical experience. There are several schools of homoeopathy in Switzerland linked with SVHA, and these all undertake teaching programmes, the main ones being in Zurich, Geneva and Bern.

At present the status of homceopathy is not clearly defined and anyone can practise it although in fact this is illegal, and apart from 4 Cantons, hom0eopathy should be practised only by medical doctors. Although there is no legal recognition, some insurance companies will reimburse patients. Homoeopathy is taught at the Medical Faculty of Zurich University by Dr P. Schneider. A course entitled 'Homceopathic training for Medical Doctors' takes place once a week during term time, each session being of two and a half hours.

In the other member states of the EEC:

Portugal There is little or no training given other than at a personal level and very few qualified medical homoeopaths practise in Portugal. Contact has been established with Dr Alda Pereira da Silva in Lisbon.

Greece Hom~eopathy can only be practised legally by medical doctors and there are several schools at which doctors can learn homoeopathy. The best

known one probably being the Athenian School of Homceopathic Medicine run by George Vith- oulkas. We do have 1 or 2 Faculty Members in Greece and some contact is kept up with them by correspondence.

Denmark The Government is basically against hom~eo- pathy but there are no restrictions on its prac- tice, although few doctors use it.

Harmonization This bricf look at homeopathic education in other European countries brings me to consider the work of the Special European Committee for Education. It is, 1 think, admirable that after only three meetings, 2 in Cologne and 1 in Brus- sels, this body, representing medical hom~o- paths in 10 countries, came to agreement on the wording of a document entitled 'A Programme of Basic Teaching Standards in Homeopathy' . I would formally like to pay tribute to the magnifi- cent chairmanship of Dr Jacques Imberechts who led the committee so diplomatically and skilfully through its immense task. This docu- ment has now been sent to the representative bodies and various schools in each country for consideration and hopefully, ratification. If it is accepted with minimal changes, and I think it likely that it will be, the Committee's next task will be to look at the qualifying homeopathic examinations in each country with a view to pro- ducing a common homeopathic qualification for doctors throughout Europe. The committee has agreed to consider the British Membership examination and its format, with our guide-lines to both examiners and candidates, and our list of suggested drugs as templates for the time being.

The introduction states: The Special Committee on Education regard the

development of the programme as an important step in the progress of homeeopathy and homceo- pathic training. Their task has not ended with the production of this report, indeed it has only just begun. A continuation of the consultative efforts and goodwill from the various countries should lead to the eventual adoption of a Common European Examination in Homceopathic Medicine.

The aims of the committee can only be achieved by gradual change of the education systems in the different schools culminating in uniform basic train- ing standards. Any such move must be based on common agreement and cooperation, and it is the task of the committee to provide guide-lines to all schools wishing to participate in this process.

Conclusion This has been a very brief and somewhat super- ficial look at a little of international hom~o-

188

pathy from an educationalist's point of view. I would finish by stressing the importance of the Faculty of Homoeopathy and The Royal London Homoeopathic Hospital in the eyes of our col- leagues in many other countries. We must not overlook, minimize or even denigrate this and I suggest that we must accept, as the British

British Hornwopathic Journal

always have, our role as senior partners in inter- national affairs. We have a golden opportunity to play a major role in expanding hom~eopathic influence throughout most of the world as well as shaping hom(eopathy for its inevitably increas- ing role in patient care. Let us accept this respon- sibly and actively.

Address for correspondence: Executive Dean Faculty of Homceopathy Royal London Homceopathic Hospital Great Ormond Street London WC1N 3HR