Analysis of Homeopathc Clinical Practice from Community Clinics in Kwale County, Kenya

Originally published in the American Homeopath – Courtesy Richard Pitt

Overview

The following research was based on the analysis of clinical outcomes in a number of homeopathic medical clinics run by the Kenya School of Integrated Medicine in Kwale County between 2015-2019. This research was part of a European Union supported project: Supporting the Kwale County Government through the Provision of Integrated Medicine.

This 5-year project involved a partnership between the Kenya Trust and the main benefactor, the Ministry of Health, Kwale County. The project supported the national Community Health Strategy in Kenya, with a focus in Kwale County. Part of the project involved offering homeopathic health care in rural settings in the County.

Documentation of clinical outcomes in the clinics were established to provide evidence of the efficacy and possible relevance of Homeopathic Medicine as part of a developing healthcare system in Kenya. Supportive evidence was to show how homeopathy can be applied successfully for a wide variety of acute and chronic conditions.

Research was carried out by the 4kenya homeopathic team under the supervision of Richard Pitt. The Access Data Base used was provided by the Swaziland Homeopathy Project.

Introduction

The Kenya School for Integrated Medicine had been offering homeopathic clinics in rural parts of the county for many years. The European Union project offered the opportunity to expand these clinical programmes to more communities. Over the last four years, 18 different clinics, including 4 fixed permanent clinics were established in the county offering homeopathic and nutritional support.

These clinics were mostly held in villages, working with the Community Health Volunteers and village elders. Sometimes, buildings were used, while at others, patients were seen sitting under trees. Community Health Units are part of a national Community Health Strategy in Kenya.

The establishment of these units required the training of 10 Community volunteers for each unit and these volunteers performed public health activities on behalf of the Ministry of Health in Kwale County.

Part of the goals of the project was to improve health seeking behaviour and explore obstacles to healthcare. This included the challenges of accessing healthcare in rural communities and encouraging a broad approach to healthcare, including increasing choices and opportunities.

In so doing, it was hoped that outcomes from the clinical work would show evidence that an integrated approach to healthcare would improve health outcomes. Also, it was hoped it would show evidence of the efficacy of homeopathic treatment for a wide range of conditions seen in the community. The Community Health Units allowed us to access these communities and provide healthcare services.

Therefore, the goals of this research were to show the following:

1. The overall efficacy of homeopathy when treating the people of Kwale County
2. The types of conditions seen and remedies given for certain conditions
3. An analysis of the quality of comparative improvement for a wide range of conditions
4. The specific effect of homeopathic treatment in 4 distinct regions of the county
5. The outcomes of homeopathic treatment in each clinic seen.

Analytical tools used

During the project, 3999 patients were put into an Access Data Base and analysed according to the following score system: A Visual Analogue Score (VAS) that analysed changes in specific conditions/symptoms and a Karnofsky score (a common measure that evaluated overall wellbeing and capacity for supporting a functional lifestyle) on a ratio of 0-5.

The Karnofsky score had two elements to it, a patient-based evaluation and a practitioner evaluation. The ratio is between 0 (death) and 100 (health), most people measuring between 50-80 on average. The Karnofsky measures the degree of functionality and self-reliance.

The one challenge we faced is that it was not always easy to get an accurate patient-based Karnofsky evaluation given language and cultural challenges. Assessing improvement was not always easy for people to evaluate.

Therefore, practitioner and patient Karnofsky scores tended to be the same. Many more patients were seen but could not be effectively analyzed as patients tend not to return for follow ups. Also, working in rural clinics which also functioned as student clinical internships created other practical challenges in data collection and management. However, enough cases were collected for us to be able to measure clinical outcomes.

This method of evaluation has been used effectively in the Swaziland Homeopathy Project, where over 10,000 patients have been evaluated over time to analyse the clinical efficacy of homeopathic treatment. Also, it was felt that this method of clinical outcome analysis is a useful and comparatively simple way to evaluate clinical outcomes.

This analytical measurement is also easier than using the popular Measure Yourself Medical Outcome Profile (MYMOP) which requires are more subjective analysis which is hard to do in the clinical circumstances we were working in.

Geographical area covered

Kwale County is one of the smaller counties in Kenya, situated on the Indian Ocean, and bordering Tanzania in the south. To the north it borders Mombasa County and the City of Mombasa, Kenya’s second largest city.

It is predominantly a Muslim community, consistent with the coastal region of Kenya but with a significant Christian population as well. A number of tribes are based there, the most common being the Digo and Camber. However, given the tourist area of the county, around Diani Beach, it draws a more diverse population from all over the county.

The project was established in 3 sub counties of Kwale County – Matuga, Msambweni and Kinango. 24 Community Units were established in the 3 sub-counties. Most of the clinics were established in connection with a community unit, except the fixed clinics.

Some clinics were larger than others, needing more than one homeopath to be present. Some clinics only required one person. Some clinics were rotated in order to give opportunities to visit other areas or if the numbers visiting the clinic declined.

All groups, tribes, religions in the coastal area were reached and clinics were situated in very different terrains, from the arid and more remote parts of Kinango sub-county to the more lush coastal areas in Msambweni sub-county.

Results

The following results were found as a result of this research, the research being broken down into various component parts, including geographical location, conditions seen, homeopathic treatment used and overall improvement scores etc.

Total patients: 3999
Female: 2449
Male: 1550

One of the challenges seen in the clinics being offered was being able to monitor the outcomes, which required being able to follow up on the patients. Most clinics were visited on a monthly basis and patients were encouraged to return to the clinics for follow ups in order to analyse the outcome.

However, it is common in these situations for patients only to come when feeling sick or no better. If they feel better, they simply don’t come. Often this is for very basic practical and economic reasons. They see no need to return if they are better.

For our purposes of analysis, this can make it challenging to see the real benefits of the treatment given. Therefore, of the approximately 4000 put into the database, follow ups were seen on in approximately ¼ of these cases. The out come analysis therefore was reflected in the numbers of follow ups but the other data collected concerning the types of cases seen and other demographic data related to the total number of cases seen.

Categorization of conditions

In order to facilitate analysis, 36 broad conditions were defined. Each case was allocated one of these conditions in order to create a broad classification of what types of conditions were seen. Then in each case, more specific symptoms were identified, including more specific pathologies seen so each case could be broken down further for more detailed clinical analysis.

The following 36 main conditions were classified according to a broad spectrum of similar conditions:

1	Abdomen/Rectum conditions (pain, inflammation, intestines, spleen, hernia, constipation, worms)
2	Accidents/Trauma/Surgery (injuries)
3	Anger/Irritability
4	Anxiety/Fears (dark, ghosts, alone, dogs, snakes, animals)
5	Back conditions/neck (acute and chronic pains)
6	Bladder and Kidney conditions (inflammation, stones, urinary issues)
7	Blood conditions/BP (anaemia, haemorrhages, hypertension)
8	Bone conditions (pains, inflammation, caries)
9	Cancer/tumors
10	Chest conditions (bronchitis, coughs, pneumonia, asthma, respiration, allergies)
11	Development issues children (autism, cerebral palsy, walking, talking late, teething)
12	Diarrhea/stool (acute and chronic) (types of stool – fatty, lienteric, mucus)
13	Diabetes
14	Ear conditions (pain/inflammation, hearing -loss, acute)
15	Eye conditions (pain, inflammation, vision)
16	Fevers/Flu (Malaria, Typhoid, Chikungunya, Dengue, Shistosomiasis, Filiariasis, childhood diseases)
17	Genitalia Female/Breasts (cysts, tumors, discharge/leucorrhea, eruptions, inflammation)
18	Genitalia Male/Prostate (eruptions, hernia, inflammation, swelling)
19	Head conditions (acute and chronic pains, vertigo)
20	Heart conditions (pains, palpitations)
21	Joints/Muscles/Arthritis (osteo, rheumatoid, gout, rheumatism, swelling, stiffness, cramps, contractions, burning)
22	Liver conditions (Hepatitis A,B,C, Cirrhosis, gallbladder)
23	Menstrual/hormonal issues (painful, late, profuse,) (Menopause, Miscarriage, pregnancy)
24	Mental conditions (insanity, mental weakness, shock, memory)
25	Mouth/Teeth/Jaw conditions (tongue, lips, gums, glands – pain, burning, salivation)
26	Neurological conditions (convulsions, epilepsy, paralysis (hemiplagia, paraplegia), numbness, trembling, incoordination, stumbling, MS, Parkinsons)
27	Nose/Sinus/Colds/allergies
28	Sadness/grief/shock/bad news
29	Skin conditions/nails (rashes, eruptions, eczema, warts, shingles, psoriasis, perspiration, scars, keloids, allergies, wounds, swelling )
30	Sleep issues (insomnia, sleepiness, dreams)
31	Sterility/Infertility/sexual issues (impotence, pain during coition, weak erections)
32	Stomach/digestion/alimentary system conditions (pain, ulcers, nausea, vomiting, indigestion, heartburn, mouth issues, Thirst)
33	Stroke
34	Throat/larynx/trachea conditions/voice (tonsils, cough)
35	Thyroid conditions/glands (goitre, hyper/hypo, lymphatic glands)
36	Weakness/Tiredness (general or of part)

Based on the Karnofsky score analysis of both practitioner and patient and based on all cases and follow ups seen, the following analysis was made:

68% of all cases showed some improvement.

 

 

Conclusions and Summary:
Overall, when looking at the main conditions seen, we saw an average of 68% improvement in the conditions. Of the 5% where an aggravation was found, it was not documented what percentage of those subsequently improved.

In homeopathy as we know, most attention is given to the characteristic symptoms for each person, but giving a broad categorization of conditions allows for a more objective analysis and measurement within a more diagnostic framework. A breakdown of the following conditions gives some more perspective on the types of conditions seen.

1. Back conditions: This includes act and chronic back problems, usually pain and stiffness. Diagnostically it can include osteo arthritis, lumbago, sciatica and muscular tension in the back, often as a result of working habits. Often people (mostly women) working in the fields, carrying heavy objects and through getting older, back pain becomes a common condition. The benefits seen in this condition were in the range of 58%.
2. Chest conditions: This relates mostly to asthma and chronic bronchitis. (Pneumonia is not treated much as is more acute mostly and requires immediate medical intervention). Chronic chest conditions, including asthma are very common in Kenya and much of Africa. Conventional treatment for asthma is available but tends to be taken only on an as needed basis. Also, it is not curative. Homeopathy can be a very effective intervention for asthma as it can for acute and chronic bronchitic conditions. Asthma in children is also potentially a fatal disease. Benefits seen here were in the range of 73%
3. Developmental issues: This is a broad condition that relates to the challenges of childhood development. In particular it relates to children who are late learning to walk or talk, or have mental challenges or congenital problems which can lead to conditions like cerebral palsy. In this case it also includes convulsions in children which can seriously affect children’s development. Given the seriousness of these conditions and the fact that any treatment can only improve some cases to some extent, an improvement of 48% was seen here.
4. Diabetes: This is a common and growing issue in much of Africa, including Kenya. Most people come with a diagnosis already and mostly are mostly taking tablet medication for their condition. However, the medicines are often taken sporadically. Some people present with symptoms while others have no apparent symptoms, but have been diagnosed with conventional testing. The challenge at times can be in evaluating what has changed as testing was generally not done in our mobile clinics. However, our figures showed that 82% experienced some improvement in their overall wellbeing after taking the remedies.
5. Female Genitalia: This relates to all issues except for menstrual concerns which are classified separately. The types of conditions can be broad, from discharge to cysts and tumors to inflammation. Overall, improvement was seen in 72% of cases.
6. Head conditions: This relates predominantly to chronic headaches without any other pathology attached e.g., Hypertension. Conventional treatment involves mostly analgesics and therefore homeopathy is sought after in such conditions and shows a good record of improvement. 74% experienced some improvement.
7. Hypertension: This is a serious and growing condition. Sometimes there are no symptoms, the only evidence being from blood pressure tests. In other cases, symptoms can appear, often in the form of congestive headaches, throbbing in the blood vessels and heart and respiratory distress. Conventional treatment is effective yet many only take them sporadically. In the cases seen, around 74% experienced relief in their condition, which was also verified through blood pressure measurements.
8. Joints/muscles/arthritis: This is a very common condition with many people, especially when in middle and old age. It can be osteo arthritis of single joints or more broad rheumatoid arthritis and also more general weariness and aching of the body. Use of analgesics only gives temporary relief and other treatments are generally not given. In these cases, improvement was seen in around 65% of cases seen.
9. Neurological: this relates predominantly to convulsions seen in children in one school, that supported children with serious physical and mental challenges. Some of their conditions could not be changed e.g. consequences of cerebral palsy, but in many cases, convulsions significantly improved from treatment, to the level of 67%.
10. Skin conditions: these are very common, especially in children with eczema but also in adults. Homeopathy has had a positive effect in many skin conditions, and here improvement was seen in 71% of cases.
11. Stomach/digestion: many people suffer from chronic indigestion and even stomach ulcers. H Pylori tests are commonly taken, although it is questionable if they are the primary cause in some cases. Dietary habits that involve eating only in the morning and then a large meal in the evening, usually including eating ugali (maize) can irritate the stomach and lead to indigestion, heartburn, and eventually to stomach ulcers. Conventional treatment is given for stomach ulcers and also ant acids for heartburn but homeopathy can be a very effective option here. In our situation, there was an improvement in 64% of cases.

Visual Analogue Score Analysis (VAS)

The following analysis is based on the Visual Analogue Score (VAS) for symptoms and conditions chosen. Symptoms may be very similar to the conditions chosen but also can be more subjective expressions of disease.

One can see that the percentage improvement here is higher than for the Karnofsky score alone. The VAS score shows individual improvement of certain symptoms, which are measured accordingly. It’s possible when doing the scoring that an individual symptom is improved whereas the overall sense of wellbeing (Karnofsky score) is not measured as improved.

Total symptoms follow up

1322 follow ups

The following list is the main conditions/symptoms seen and the percentage of improvement along with the number of follow ups seen:

Condition/Symptom	Percentage improvement	Number of follow ups seen
Abdomen/Rectum	82%	108
Back pain	83%	88
Bladder/Kidney	83%	42
Chest conditions	89%	213
Eye conditions	84%	32
Fevers/flu	91%	33
Genitalia female	89%	64
Head conditions	87%	116
Joints/muscles/arthritis	86%	113
Neurological	78%	37
Skin conditions/nails	78%	27
Stomach/digestion	85%	135
Weakness/tiredness	85%	33

Conclusions:

The improvement in individual symptoms/conditions is generally high. This is a very positive finding and reflects that over quite a number of cases, people experienced improvement. It doesn’t clarify the overall quality of the improvement or the duration of improvement. However, it was designed to simply measure the fact that enough people with similar symptoms experienced an improvement in their situation.

In many clinics we saw many similar conditions. Many people’s lives are similar, especially when their occupations are predominantly physical. This is especially the case for women, who often may be working the farm, carrying water and washing clothes etc.

The physical demands take their toll, leading to a tendency to acute and chronic back problems, general joint issues, including arthritis etc. As mentioned, diabetes and hypertension are common amongst all peoples and genders. It is part of a world-wide epidemic in non-communicable diseases and we saw many people experiencing these conditions.

Many may be on medications for these conditions, but not all can afford them consistently, and therefore there are many cases in which conventional medication is taken sporadically or not at all, depending on the severity of symptoms.

Comparison by Region: The following list gives the top symptoms reported for each of the four regions where clinics were situated

Most frequently reported symptoms (top 10)

Msambweni 1 Symptom		No. of times reported		Msambweni 2 Symptom	No. of times reported
Headache (acute and chronic. Migraine)		379		Cough (not bronchitis or pneumonia)	407
Cough (not bronchitis or pneumonia)		316		Headache (acute and chronic. Migraine)	318
Fever		261		Back pain acute	281
Hypertension		252		Joint pain	257
Abdomen pains		176		delayed development	257
Back pain acute		167		Fever	227
chest pains		141		Abdomen pains	217
Asthma		127		Hypertension	186
Stomach ulcer		119		Numbness limbs	175
stomach pain		118		chest pains	153

Kinango Symptom	No. of times reported		Matuga Symptom			No. of times reported
Headache (acute and chronic. Migraine)	369		Headache (acute and chronic. Migraine)			386
Back pain acute	297		Back pain acute			279
Hypertension	210		Cough (not bronchitis or pneumonia)			231
Cough (not bronchitis or pneumonia)	188		Hypertension			226
chest pains	163		Joint pain			220
Abdomen pains	159		stomach pain			184
Joint pain	130		Abdomen pains			164
Stomach ulcer	126		Chest pains (not heart. See bronchitis, pneumonia)			143
constipation	107		Stomach ulcer			141
vision blurred	103		legs painful			134

Analysis shows that headaches, back pain, both acute and chronic, joint pains, cough/chest conditions, stomach and abdominal pains are some of the most common conditions and symptoms seen.

 Most frequently prescribed remedies

Msambweni 1 Remedy	No. of times prescribed	Msambweni 2 Remedy	No. of times prescribed
Natrum muriaticum	299	Natrum muriaticum	237
Arsenicum album	260	Lycopodium	224
Lycopodium	174	Rhust-t	204
Sulphur	121	Arsenicum album	147
Rhust-t	114	Sepia	140
Phosphorus	71	Bar-carbonica	106
Sepia	68	Phosphorus	96
Natrum sulph	62	Calcarea carbonica	89
Belladonna	59	Sulphur	85
Calcarea carbonica	50	Bryonia	83

Kinango Remedy	No. of times prescribed	Matuga Remedy	No. of times prescribed
Natrum  muriaticum	299	Natrum  muriaticum	220
Arsenicum album	260	Rhust-t	210
Lycopodium	174	Lycopodium	181
Sulphur	121	Arsenicum album	153
Rhust-t	114	Sulphur	133
Phosphorus	71	Sepia	99
Sepia	68	Belladonna	95
Natrum sulph	62	Pulsatilla	79
Belladonna	59	Bryonia	64
Calcarea carbonica	50	Arnica	63

The list above gives the numbers of the most frequent remedies used in all 4 areas and accurately reflects the most important remedies used in practice. In all 4 regions, Natrum muriaticum is the most common remedy used.

This may reflect its relevance for certain conditions used often in homeopathy e.g. headaches, chronic digestive problems, as well as it being a well-known remedy throughout the world. Arsenicum album is another important remedy in homeopathy and is indicated in a variety of conditions e.g. chest conditions, especially asthma, acute and chronic stomach conditions e.g., ulcers, certain skin conditions etc.

Lycopodium is indicated in chronic digestive problems, including liver conditions, bladder and kidney conditions and chest conditions. Sulphur is one of the most important remedies in skin conditions, as well as for many chronic conditions, especially inflammatory states.

Rhus tox is used in both acute and chronic joint conditions including arthritis and also is an important skin remedy. Sepia is used for many female conditions, including menstrual and hormonal states and Baryta carb was seen in the Msambweni 2 area as it’s used a lot for developmental challenges in young children, for example, when they are late learning to walk and talk and for mental and physical issues like cerebral palsy.

It is also a convulsion remedy. One of our clinics was in a day care centre for children with serious physical and mental development issues. Natrum sulph was seen in the Kinango region and is commonly used for simple hypertension when there are no other indicated symptoms.

Calcarea carbonica is another important remedy for developmental issues in children and also for chronic joint conditions. Belladonna is used more in acute conditions associated with fever and general inflammations eg. ear infections, tonsil infection, fevers of all sorts, etc.

Phosphorus is an important remedy for chest conditions such as asthma, acute and chronic coughs, pneumonia, joint and bone conditions and liver conditions. Pulsatilla is a very important remedy for children with infections and colds.

Conclusions:

Overall, the evidence supports that homeopathy can be an effective intervention in a wide range of conditions seen in Kwale County communities. Given that most people are relatively poor and are living subsistence lives, often farming and doing other physical labour for a living, the types of conditions seen tend to be somewhat similar, often related to issue of physical labour, basic nutrition and fairly common consequences of ageing e.g. osteo arthritis.

The rapid increase in non- communicable diseases found in most communities in Africa and large parts of the world are also prevalent here in these communities. Diabetes and hypertension are very common and the use of conventional drugs to treat these conditions tends to be sporadic.

It was found that homeopathy was able to help stabilize these conditions. We are not concluding that it can cure them, as both diabetes and hypertension are often chronic and inveterate conditions and are likely to be predicated to some extent on dietary and other behavioural habits as well as perhaps some genetic predisposition.

This can lead to chronic relapsing of these and other conditions. However, if homeopathic remedies can be applied over a longer period of time, then the evidence so far shows that it can relieve the symptoms of these conditions.

Our clinic situations had some intrinsic challenges. Sometimes, there were so many patients to see that there was not enough time to take a full constitutional case. One of the distinctions that needed to be quickly made was the type of case it was and how deeply one had to go into the case taking and analysis process.

While individualizing each case is essential, within that, it can be possible to prescribe quickly based on a few symptoms. The expectation of many people is to simply to be given “medicine.” They are not coming to us because it is homeopathy but because we are there and it seems our medicine works.

Mostly people do not come with psychological issues and even find it strange if questions are asked about fears, anxieties, dreams etc. However, that does not deter from making some analyses on a constitutional basis, looking at basic body type, considering generalities and a few characteristic symptoms.

Also, certain conditions can be very difficult to find important “individualizing” symptoms that help to find a remedy. This can be particular when practicing in rural parts of Africa when there may be language challenges and also many people are not used to spending time describing their symptoms.

They simply want a medicine. This can be the case when looking at treating diabetes and hypertension and given their prominent position in the diseases commonly seen, we experimented by giving nearly all people with these conditions the same homeopathic medicine if no characteristic symptoms were seen, treating it like it was an epidemic, even though it is a chronic disease.

Given the physiological process of both hypertension and diabetes it was concluded that sodium salts may be useful to use. The homeopathic remedy Natrum muriaticum is an excellent remedy for Hypertension, both due to physical and psychological causes.

Natrum sulphuricum tends to be good for some diabetes. Therefore, if no other indications were there for another remedy, these remedies were used routinely in these conditions. Preliminary evidence supports that these remedies may have a specific use in these conditions.

Therefore, when analysing the overall results and looking at specific conditions, one can conclude that homeopathic remedies have been shown to be clinically effective and the goal now is to expand the database and perhaps cooperate with other organizations working in Africa that either are using this method of analysis already or can integrate their data in a similar way so that the numbers of cases seen in many different situations can provide further evidence of the relevance and efficacy of homeopathic medicine in an African context.

Kenya School for Integrated Medicine, PO Box 147 80403 Kwale, Kenya

Email: [email protected] www.kenyaschoolforintegratedmedicine.org: tel: 0724 567 981