A nine-year comparative retrospective clinical audit of the UkubaNesibindi Homoeopathic Community Health Centre

Abstract

Introduction In order to facilitate higher standards of health care, as well as in teaching and learning, the Durban University of Technology (DUT) Department of Homoeopathy established its first satellite community centre called Ukuba Nesibindi Homoeopathic Community Health Centre (UNHCHC) in 2004. This clinic is in the greater Durban region at 22 Stratford Road, Warwick Junction on the third floor of the Lifeline building. This process was undertaken in active collaboration with Lifeline (Smillie 2010; Dube 2015). The main objective of this community centre was to introduce an alternative, cost effective, safe and gentle form of treatment to improve the lives of people and as well as to provide the students with the practical foundation and a clinical environment (Smillie 2010). UNHCHC provides free homoeopathic primary health care services in a primarily disadvantaged area noted for its highly impoverished people and substandard living conditions (Watson 2015). The purpose of this comparative retrospective centre audit of UNHCHC was to determine the difference, if any between patient demographics, disease prevalence profile and the major medicines prescribed, with the results of the study by Smillie (2010) at the same facility. Data was collected by performing a clinical audit on patient files from the archives at UNHCHC. All patient files from July 2008 to July 2017 were included for analysis. Aim of the study The aim of this nine year (2008 to 2017), comparative, retrospective, descriptive, explanatory, study was to determine the patient demographics, disease prevalence profile, consultation patterns and identify the major medicines prescribed at UNHCHC, and compare these results with Smillie (2010) study. Methodology The study used a comparative, retrospective, explanatory and descriptive design method by means of a clinical audit to determine a patient demographic and disease prevalence profile, as well as identify and describe the various homoeopathic treatment modalities of UNHCHC and compare these results with that of Smillie (2010). Prior to commencement of the study all gatekeeper permission was sought and granted accordingly by all relevant personnel. The data collection tool was a spreadsheet that was utilized to capture data from all files from 2008 July -2017 July. This included both new patient files and follow up patient files. The data collection form was divided into patient demographic information such as race, age and gender, employment history, year of first consultation, number of follow ups, clinical diagnosis, examination procedure (such as urine dipstick and full comprehensive physical examination), patient referral and treatment protocol. The study was conducted at the UNHCHC under the supervision of a qualified and registered homoeopath. The results were analysed by using various forms of descriptive statistics such as pie charts and bar graphs using Excel from Microsoft Office. Results An in-depth audit report of the clinical activities of UNHCHC was carried out from July 2008 to July 2017. All patient files from July 2008 to July 2017 (both new and follow up files) were included for analysis. revealed the same notion as Smillie in terms of demographics, there is a small margin of difference that can be negligible. The significant difference is the average age group that showed younger patients having more access to the facility (age group-25-39) (39.5%). The most noteworthy change was the consultation statistics that has shown an increase from 2004-2008, there were only 1044 consultations compared to, 2009-2019 where there were 5870 consultations. This shows an 82% increase from the first four years. There were not many implications that this study revealed that is worth mentioning except that the access to homoeopathic treatment has improved from 2004 to date. Access has changed amongst different ethnic groups where, 95% of Africans can now access the homoeopathic treatment that in the past they could not access. This primary health care setting has been accessed by 0.9% of White patients compared to 0% when it started in first four years. This may be due to socioeconomic shifts we are witnessing in South Africa. It is critical to note that access was not the objective of the study. Patients were mostly diagnosed with respiratory diseases, particularly upper respiratory tract infections. Smillie (2010) found that infectious diseases were the most prevalent disorders encountered at UNHCHC. The total number of prescriptions was 4 822. Other phytotherapeutic treatment medications such as herbal creams, tissue salts and herbal tinctures were prescribed in addition to primary homoeopathic treatment modalities to consulting patients during the study period. Smillie (2010) found that Natrum muriaticum (8%), Sepia officinalis (5%), Aconite napellus (5%), Staphysagria delphinium (5%), and Pulsatilla nigricans (5%) were the most prescribed remedies at UNHCHC during the period of her study. The study revealed that the recommendations made by Smillie (2010) were followed through as the centre now has, the provision of a glucometer, pregnancy testing kits and peak flow meter at UNHCHC. Two additional clinician’s assistants have been employed at UNHCHC and work on different operational days at UNHCHC, decreasing the administrative duties of the attending clinician. The clinician’s assistants also form part of the translation team when required to translate for student interns. Provision of a ground floor consulting room has been attained. A shared consultation space between Lifeline and UNHCHC serves as a consulting space. Provision of language translators has been made. In 2009 the language isiZulu was introduced into the curriculum as a module. This module does not form part of the official curriculum, but students have access to the module through the clinic director Dr Ngobese-Ngubane. In the period of 2017 UNHCHC was renovated to meet the Allied Health Professionals council criteria. The clinic now comprises of a dispensary room, three consultation rooms, one storage room, two clean toilet facilities, two signs outside of the clinic and in addition the clinic has three additional staff members, two clinic assistances and one staff member to maintain cleanliness of UNHCHC.This shows improvements on the running of the centre. Conclusion UNHCHC has continued to develop and grow over the years since its inception in 2004. Both the retrospective studies conducted at UNHCHC over its 14-year history have illustrated the growth in patient numbers as well as prevalent diseases seen at UNHCHC. The results obtained from this study demonstrates that homoeopathy as a profession, within the medical field can be included in the national primary health care system. Inclusion of homoeopathy within the public health sector could assist in reducing the overcrowding of patients experienced at the public health clinics. This statement is supported by the positive results of this study. More homoeopathic clinics should be established in impoverished communities around the country, along the lines of the UNHCHC, which has proven to be an effective community health clinic within the Warwick Junction community.