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| Hpathy Ezine - July, 2009 | |||||||||||||
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Dr. Navin Pawaskar, Dr. NL Tiwari, Dr. Manoj Patel, Dr. Anand Kapse, Dr. Bipin Jain and Dr. Anoop Nigwekar....talk about the extradordinary work of the Institute of Clinical Research (ICR) and the Dr. M.L. Dhawale (MLD) Trust.<-- with Dr. Leela D'Souza |
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Dr. Navin: Good morning Leela. Yes I’m happy that July was decided as the month for Dr. Dhawale’s Institute of Clinical Research (ICR), as we celebrate July 14th as Founder’s Day – a special day for our institute. Dr. Leela: I interviewed you in October 2006 and we concentrated on hospital systems for homeopathy that you set up here. I understand that is just one facet that the Dhawale group has been working at developing. Dr. Navin: Yes, it is. Dr. Anand Kapse and myself have been concentrating our energies on hospital development for the last decade. We were working out a system, documenting and maintaining records, having periodic evaluations in order to develop a model that could be replicated at other homeopathic hospitals of our organization. You can read about this experience in this article. Our model is ready for export to other homeopathic hospitals around the country that are looking for hospital expertise. In addition, we offer other institutions organizational expertise and hospital administration expertise.
Dhawale Memorial Rural Homeopathic Hospital, Palghar
Dr.Leela: Thanks also for your wonderful article giving us a taste of your experience of Emergencies in Homeopathy. I understand you have a well laid out plan for me today – Am I to interview the core group of the ICR this morning! Dr. Navin: Yes, I thought it best that each of them told you their area of expertise and development, because each of them has worked hard and motivated their teams towards the goals set and success they have achieved. I thought the interview too should reflect this team work. Dr. Leela: I’m getting excited about what we’re going to hear. I almost feel like I’ve bitten off more than I expected to chew! Dr. Navin: We have grown by leaps and bounds. We have moved “out of the homeopathic box” thinking, as it was vital for our growth and survival. First meet our most respected senior, Dr. NL Tiwari who started as a student with Dr. ML Dhawale, 20 years ago. Dr Leela: Good Morning, Dr. Tiwari, I’m pleased to meet you! Dr. Tiwari: Good morning, Dr. Leela. My assigned task is to give you an overview of our historical development. Have a sip of the coffee while it is still hot, and don’t mind me carrying on. (Smile). Well, you may know that the father of our founder was Dr. L.D. Dhawale, a consultant MD from KEM hospital in the 1930’s. He took an interest in homeopathy, as his father, a school teacher used to treat the family and also others with homeopathic medicines. He used homeopathy successfully in a cholera epidemic. Dr. L.D. Dhawale, treated patients in the prestigious KEM hospital wards with homeopathy, especially those who were not responding to conventional medicine. These cures converted many conventional MD’s to homeopathy. He soon had a circle of friends from other departments of medical specialty interested in homeopathy, and he developed a postgraduate course for them. Of interest is that he was in touch with Dr. C.M. Boger through regular correspondence. Dr. Leela: That is interesting! Dr. Tiwari: Dr. ML Dhawle, his son and our founder, did his MD as well, but desired to practice homeopathy. Even when he married, he told his wife that his first love was homeopathy and she accepted this! He worked as apprentice to his father for five years after his MD to gain insights into homeopathic treatment. In difficult cases, he was guided by his father to read various sourcebooks and those by masters to solve clinical problems. With this background, he found the need to write a book for the early learner in homeopathy, bringing fundamental concepts in homeopathy together. Thus the book, “Principles and Practice of Homeopathy” was written through 1956-1966. He presented a scientific paper at an international homeopathic conference in 1967 which impressed Dr. Sarabhai Kapadia. Dr. Kapadia realized that Dr. ML Dhawale would develop a scientific basis for homeopathy and invited him to be principal at Bombay Homeopathic College, from 1967 to 1970. Dr. Leela: How did he envision this scientific basis? Dr. Tiwari: In 1970, Dr. ML Dhawale decided that a discipline was needed in case recording for scientific clinical research and he developed the Standardized Case Record. From 1970-1975 he trained a group of students who were ready to follow these basic concepts. They met regularly for lectures. But he found that they still had difficulties in clinical management. He realized a lecture series had limitations and training methods needed to be changed. So he opened up his practice to allow these students to be clinical assistants. He realized that students needed to be observers of cases, and gain experience from observing practice and analyzing clinical results. These students brought these clinical experiences to the classroom where the presentation of the cases involved discussion and analysis that guided other homeopaths. The presenter required training as a guide while the consultant was the evaluator of this presentation. The later guided the process and offered solutions to the guide/presenter to improve his presentations and clinical observations. The consultant also needed training as evaluator and as supervisor. All this took place in a group discussion which formed the backbone for individual development. DR. ML Dhawale developed what he called the “X-Circumstance- Method” of self development for each trained homeopath, between 1976-1986, where ‘X’ represented the prejudices and unresolved emotional conflicts within each homeopath and ‘Circumstance’ was various clinical situations that brought these up. These aim at achieving the quality of an “unprejudiced observer”. My dissertation was based on this topic. Dr. Leela: Yes your article on this subject gives us a deeper idea. To me these are basic concepts of supervision, a slowly developing theory to support medical practice and psychotherapy. Dr. Tiwari: My guru, Dr. ML Dhawale was a quarter of a century ahead of his time in these perceptions, as you see in my article. All these are contained in three main books: the Dhawale ICR Symposium Volumes written between 1966 and 1976 that underwent 3 editions, the last being in 2003. These contain the basic concepts of homeopathy aimed at standardization and scientific development. The second: “Perceiving 1” written in 1983 further elucidates these perceptions and his futuristic vision. Dr. Leela: He wrote another book of homeopathic poetry as well? Dr. Tiwari: Yes, he observed that people with all their material desires fulfilled were still not at peace with themselves. He used the confrontation technique in some instances to make them realize that improvement in health of mind and body required a change in lifestyle. Similarly homeopaths who were observers of cases experienced emotional instability or conflicts which were discussed in a group to overcome their prejudices and experience empathy and understanding. This was a form of group therapy. He elucidated this in the third book, “Life and Living” also known as ‘Magic Mirror”. Another important aspect of his vision was community service. Dr. Manoj Patel will give you a detailed idea of that. Why don’t you eat your sandwich? It’s past lunch time; we’ve already had our lunch! Dr. leela: Thank you Dr. Tiwari, I will. Good afternoon Dr. Manoj Patel! Dr. Manoj Patel: Good afternoon, Dr. Leela, I have to hurry through this … there is always work pending and I have a meeting to catch up! Dr. Leela: Please go ahead! Dr. Patel: The second important fundamental thrust of the organization is to ‘give back to society’, i.e. community service. Dr. ML Dhawale believed that the homeopathic system consisted of three basic components – the patient care, education (of the homeopath), and the institution where team work was the essential component. These form the base of a pyramid where the developing individual/self is the apex. Without individual evolution, community service cannot happen. See this diagrammatic representation below.
So, the spiritual evolution of the self should spill into community service. He was influenced by the missionary service to community that he experienced while he helped establish the homeopathic college at Fr. Mueller’s College and Hospital, Mangalore, from 1984-1987. He adapted their outreach models. You will see it in his book, “Perceiving 1”. Dr. Leela: Interesting that you mention the social outreach models at Fr. Muller’s Homeopathic Hospital, I found your conceptualization of community service similar to my encounters with missionaries. Dr. Patel: Yes, with this conceptual background and two decades of homeopathic rural work behind us, a cohesive team was slowly being formed with committed homeopaths. The basic aim was developing a standardization of each concept of patient care, education of homeopaths and thrust for institutional work. We experimentally applied these standardized concepts with patients and student homeopaths at community centers and dispensaries in various rural locations. Based on the success of this experience, we were ready to take on the larger responsibility of formal training of students and community service.
Examining a Patient at his Tribal Village At remote and rural locations, community centers involved the local people and encouraging the participation of the larger community to partner in the development of the community hospital. As this gained prominence, the larger society recognized the services. This took them to the next step: involving Government departments like AYUSH in the management of primary health centers at the taluka level of two rural districts of India. Dr. Leela: So you mean that homeopaths have begun to officially manage primary health centers for the government at these talukas?
Homeopath at the Primary Health Care Centre Dr. Patel: Yes, at these primary health centers, the main work is government sponsored Mother-Child Care where homeopathy is the first choice alternative treatment. This work requires a huge coordination of government machinery along with grass root community health workers and other NGO’s working in this field. The homeopath running the primary health care centre provides holistic care in coordination with other groups and NGO’s and is trained to offer various perspectives to patients. These include: educational programmes, yoga, food, hygiene, counseling, etc.
Dr. Patel: My article will give a deeper idea of our multi-centric approach in rural areas. We believe that our service from a committed team in the right path of service attracts the support of altruistic philanthropists. The positive statistical results achieved at the Palghar Rural Homeopathic Hospital and its peripheral dispensaries have been appreciated by the government who easily granted required permissions to continue community service. One philanthropic family of Mr. Sanghvi, impressed by the community work done in Palghar, donated land of 12 acres close to a Jain temple in rural Baroda. The team developed and offered him a proposal for various hospital departments and facilities. While we began regular medical services in the temple rooms, he built for us an entire hospital followed by another building for undergraduate and postgraduate studies! Dr. Leela: Our readers can view a short film of this amazing project here. Dr. Patel: The humble Dr. ML Dhawale Memorial Clinic at Palghar, that was started and single handedly managed by Dr. V. Gandhi in 1989, developed into the Dr. ML Dhawale Memorial Hospital through the hard work of Dr. Navin Pawaskar and Dr. Anand Kapse and their teams. It has been granted the Centre of Excellence by AYUSH which for the first time has opened up funding from the Central Government for a non-government homeopathic hospital. The funding has been approved for a few departments like Respiratory Medicine, Psychiatry and Clinical Research and hopefully will involve other departments in the future. Dr. Leela: I am impressed, truly. This is reward for dedicated work in classical homeopathy! Dr. Patel: I’ll take your leave now and rush off. Dr. Kapse will fill you in on the PG education and hospital coordination that he looks after. Dr. Anand Kapse: Hello again Dr. Leela! What more can I tell you about the Post Graduate education that I coordinate here? The PG training through all ICR centers is Case Centered. As you are aware, Dr. ML Dhawale believed that clinical activity precedes educational activity, that medical training should be patient-centered rather than simply academic. So prior to medical training, a patient base should be generated to enable the homeopath to have clinical experience from the first day with the ICR. Dr. Leela: Yes Dr. Tiwari gave us an idea of this. I wanted to recap your work and the post graduate teaching for the MD with an excerpt from our last interview in October ’06 with Dr. Navin Pawaskar. Dr. Navin: At the time of induction itself, when a PG 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 bedside 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 bedside 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, a 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….. He must understand the indications and utility of all these (auxiliary supportive) 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.
In-Patient Care, Palghar Homeopathic Hospital Dr. Navin: I have written a detailed paper on the blueprint required for In-patient Care. So those interested can get a deeper and more detailed idea. Dr. Leela: Thank you Dr. Navin. I also loved your article on Emergency and Homeopathy which we will publish as well. Thank you for your guidance with my MD Dissertation on Emergencies and Homeopathy. What could you add to this input on PG education, Dr. Kapse? Dr. Kapse: Well, every student is exposed to a variety of patients and social circumstances during their training. - Urban at Mumbai - Rural at Palghar - Tribal at Bhopoli - Mobile Clinics to peripheral areas. Each PG student is developed in three ways: Knowledge: medical and homeopathic Attitude: Capacity for team work, commitment to duties, an understanding of medico-legal and social concerns, an ability to stretch personal resources, developing and modifying various sensitivities to achieve a maximum degree of unprejudiced observation through supervision Skills: Develop IPD skills, Clinical skills in working with patients and staff Dr. Leela: I think this is excellence in action. I wish this was happening when I had passed my BHMS! How do you evaluate them in these different aspects? Dr. Kapse: Internal tests are regularly carried out to assess each PG students’ development in these areas through their 3 years of instruction. Yet, student action is equally important in development, where they are encouraged to work at projects and presentations and self learning processes, and avoid passive learning. Since the undergraduate education is not uniform throughout India or Maharashtra, we coordinate a two month orientation course so that every student is brought on par with the basic clinical skills and homeopathic skills required to begin PG postings. Dr. Leela: Problem Based Learning – is in active debate the world over - whether it is reliable for medical instruction or not. Personally I thought that it could leave major gaps of learning if introduced too early in medical education. A thorough knowledge of the basic medical subjects is necessary. Dr. Kapse: That’s right, and here is where Dr. Bipin Jain comes in to explain how we have successfully established and coordinated a model of ‘Problem Based Learning’ at the early levels of undergraduate medical study. D. Bipin Jain: Hello Dr. Leela! You were the 4th batch of BHMS from the CMP (Bombay) Homeopathic Medical College, I was from the first – so we already know each other. Dr. Leela: Hi Dr. Bipin! Of course I remember you, Zenobia’s batch… Dr. Bipin: Yes, that’s right! Presently most of my energies have concentrated on co-coordinating the undergraduate degree course in, Sumeru, Baroda which we were able to start last year when Mr Sanghvi built us our hospital and college building. I am the academic director responsible for implantation of the training and instruction here. It is a pilot project of “Integrated Medical Education” at the undergraduate level. Dr. Leela: So after coordinating the post-graduate integrated medical education, you have been working to establish the undergraduate course for the same? Dr. Bipin: Yes, Dr. ML Dhawale derived and wrote “Integrated Medical Training” for UG level, as early as 1985. This was based on the concept of Problem Based Learning, with the aim of imparting holistic rather than fragmented education to medical undergraduates. What happens in medical education is that the human body is taught in separate systems or components. This division and fragmented approach continues further into post graduation and specialization. Whereas homeopathy is a wholistic medicine and medical study has to integrate the parts into a whole also incorporating the study of homeopathic materia medica and philosophy. I’ll send you an article on Integrated Medical Training giving more details. Relying on problem based learning or what we call here, case-centered or patient-centered learning, the syllabus is integrated right from the first year of medical education that builds confidence in these students to face clinical practice from the outset.
Patient-centered Learning Year One syllabus includes the study of anatomy and physiology – normal functioning and parts of the human body. From the clinic, these students see a live case and begin to study the anatomy and physiological expression in the patient enough to recognize what is normal and abnormal in the patient. They stop short of studying the actual pathology – this they will do in year two. Dr. Leela: That is interesting – knowing where to stop (medical) instruction for a first year student! And you integrate homeopathic study of Materia Medica at the same time? Dr. Bipin: The study of Materia Medica is highlighted through live cases – where the spiritual, emotional and physical dimensions of man are understood and perceived, along with identifying cause of disease in any of these three spheres and the peripheral effect in physical signs and symptoms. Thus man in the form of a patient is studied in terms of interaction with the environment resulting in expressions of signs and symptoms of disease. Every polychrest remedy is understood in this manner. Applicable and related concepts in the Organon, Repertory and Pharmacy are also studied at the same time. Every first year student develops a sense of what is normal and abnormal in the OPD. Dr. Leela: As I was telling Dr. Kapse, there could be large gaps in the exposure to the variety of cases seen in the OPD and what is necessary for undergraduate basic instruction as per the traditional method. Dr. Bipin: That’s right. We have to be sure that we cover all the necessary topics in the syllabus and every system of the human body. Hence I have to oversee all teaching and take care that the student is exposed to the most common clinical situations. They are expected on their part to develop power point presentations that are case based, researching the topics they have studied, integrating all aspects they have been taught to perceive. Aphorism 5 of the Organon, elaborated on pg. 294 of the ICR Operational Manual is the basis of teaching clinical analysis to both undergraduates and postgraduates. In addition they are inculcated with the values of community based service which is one of the core values of our organization. They also begin on a process of self understanding with the X-Circumstance Method. Dr. Leela: Yes Dr. Tiwari mentioned about this earlier in the interview, and Dr. Manoj Patel has written a detailed article on community service. Dr. Bipin: To make all this possible, we recruit teachers who are willing to fit in and work in harmony and team work. These teachers are expected to teach anatomy and physiology at the OPD level during clinics, and hence have to accept our concept of clinical teaching, a method that was developed by Dr. M.L Dhawale himself. Twenty 20 years after his death, we are implementing his blue print at our own college of undergraduate homeopathic study and we are very happy with the results. Students are delighted with the education and insights they have received in the first year of medical study. They have developed a clear understanding of what integrated medicine is. We hope to have a new generation of emotionally balanced, socially conscious homeopathic doctors, well versed in the core values of the Dhawale Organization. Dr. Leela: Thanks Dr. Bipin. I am amazed and I feel enlightened! Dr. Navin: So, Dr. Leela, you need to meet one more person, Dr. Kumar Dhawale, to get an idea about what development of an organization has entailed. Dr. Kumar Dhawale: (on the phone) Hello, Dr. Leela, I’m sorry I will be away at an important meeting on Wednesday morning, but I’d like you to meet Dr. Anoop Nigwekar instead, at Dahisar, He will fill you in with all that you need. Dr. Leela: Thank you Sir, I will go meet him. (Wednesday Morning) Good morning Dr. Anoop, I’m sorry I have arrived half an hour early for the interview! Dr. Anoop Nagwekar: Early is always better! I have kept all the material you need ready – books, periodicals, articles, references, CD’s, whatever you’d like to have. Dr. Leela: Thank you! You’re too kind. Dr. Anoop: So let’s start: The development of an institution does not take place through a few thoughts and a group of people. It requires intensive efforts in the right direction. The ICR Trust was started just after the death of Dr. ML Dhawale in 1987 with three trustees – Dr. Kumar Dhawle, his son; Dr. NL Tiwari, his student; and Stan Rebello, his patient. It remained the group of dispensaries and training facilities for homeopathic medical graduates, functioning as he has established, till about 1990. In 1990 we were offered a maternity nursing home in Malad, run by the MD father of one of our homeopaths, to take over and run if we were able to. To manage this, I was deputed for 1 year to Fr. Muller’s Homeopathic Hospital, Mangalore to learn the art of - Practical bedside management - Hospital management - Value of nursing care - Developing a relationship with conventional doctors We felt better equipped to run the Malad Nursing Home and we took on the challenge. Dr. leela: I seem to recall, in my college days (1986-90), the Malad Hospital being mentioned! Dr. Anoop: In time, the Board of Trustees grew into a governing council of trustworthy homeopaths, each of whom took up one major responsibility in the Administration. With the Malad experience behind us, we ventured towards establishing a hospital at Palghar, and development of that model for an appropriately functioning OPD, IPD and hospital systems. The next project was Bhopoli, in a tribal area, with the experiment to confirm that our model was replicable successfully. Now that its success has been clearly established, we have ventured into developing an expertise for hospital administration. These include developing expertise in building design, recruiting manpower, financial availability, involving the local community, etc. Similarly we have to have an expertise in homeopathic education which is supported by clinical training, as Dr. Bipin spoke to you about. Organization development requires a large amount of money. But when sincere work is observed by the society, there are philanthropic individuals who are willing to offer financial support. This has been our story of development from just Rs. 500 in trust fund, we now have Rs. 20 Crore (200 million). But this increased amount of money comes with added responsibility for its appropriate utilization. Dr. Leela; Wow! And how do you manage its utilization? Dr. Anoop: We have a very rigid system in place to preserve the institutional ethos and values of honesty, humility and hard work for the benefit of the poor. Those who are part of the governing council of the MLD trust are tested at all levels right from individual personality, to clinical work. They have to undergo repeated exams and clear the MICR clinical exam to qualify as a member. With a hierarchy in place, the governing council has grown from 12 to 25 members. Each of these members has executive powers for running the institution. They have all proved themselves worthy of managing the treasury and are hence given the keys. Homeopaths are unfortunately not professionals in management and so we have brought in management consultants from known associates, mainly long term patients. They provide expert guidance at no cost – we have 5 or 6 such members. With this help we designed norms for HRD, finding individuals who think in a particular way in order that we grow as an institution with new developments. Dr. Leela: I can understand the need for external input of other professionals. Dr. Anoop: We moved towards a concept of branding ourselves for fund raising from the community. People look at the quality of those running the institutions. The confidence level of a donor is enhanced when there is transparency in our work. So we are rigid about working styles. Each member is transparent in their dealings and requires approvals for any decision. We thus can offer various tax exemptions to donors. We have regular audits which we take very seriously. This attracted the attention of the government of India. They sent Dr. Eswara Das to observe our work and he made recommendations to the Health Secretary of the Central government – this was in 2001-2002. From then on, our interaction with government sponsored health fairs, NGO’s and other projects has been steadily increasing. We are now ready to create wherever there is growth potential. Dr. Leela: That is an interesting statement! What do you mean? Dr. Anoop: Well, we first ventured into community based health care systems. We were not well versed in understanding direct community needs and priorities. Health is NOT the first in individual priorities among most rural people! We joined hands with Tata Institute of Social Services (TISS). Our students lived in villages and studied their needs in order to deliver to them. For example, our homeopaths learned the wholistic thrust of organic farming and taught the local people how to do this. This is experiential growth where students were learning a wider perspective of ‘susceptibility’ of the soil! Economic independence is a very important need for the local community. The ability to create/earn and use money is almost non-existent in these remote areas. So we ventured to set up local self-help womens’ groups and started a micro-financing network. The Multi-centric Approach that Dr. Patel spoke about in his article is a representation of all this work. We realized that most importantly, we had to focus on documentation of all this work, and a group head was made responsible for documentation – the lack of which is one of the downfalls for the advancement of homeopathy today. Dr. Leela: I fully agree. So how has this been realized in concrete steps? Dr. Anoop: For one, research projects are now documented and archived with AYUSH, the Health Ministry of India. Secondly, we have started the Asian Journal of Homeopathy that is solely dedicated to documentation. I am on the editorial board to ensure the quality of articles sent in for documentation. We have also begun seminars on research methodology and are working on developing a course for homeopaths on Research Methodology. A core committee on research has been formed with each of us working on one specialized area of homeopathic research. Dr. Tamboli’s article will give you a deeper idea of what has been going on since that time. Dr Leela: This is MUCH needed, Dr. Anoop. I’m getting a little overwhelmed with all that the MLD Trust has ventured to do over the last 5 years. What commitment and teamwork can achieve! Dr. Anoop: (Smile). Without wanting to overwhelm you too much, one more new area we have ventured into is helping and collaborating with the National Institute of Homeopathy in Calcutta, a Government of India Institute, to develop and establish their systems in Hospital Management and Community Health Care. We have become professional management consultants for the Government of India (and anyone who seeks this service) and we are paid appropriately. Here we are training staff and homeopaths to replicate our successful models in these areas and help the institution to execute their homeopathic medical service as reliable professionals. All our experience wasn’t without periods of pain and soul-searching. My article “Spread of light - ..” will give you an idea of this in more detail. Dr. Leela: I’m speechless, overwhelmed with amazement, and excited. Dr. Navin, could you help me here, this was your plan! I never realized … I’ll need photographs, of all of you. It may get too hard to believe… Thank goodness for the documentary film you’ve given me, Dr. Anoop. People can view it to make sure this isn’t a homeopathic fairy tale but the truth inspired by service!
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