Associate Writer | Holistic health services

Holism is an approach based on the understanding that elements of phenomena, problem or situation constantly interact to produce the whole; they cannot be understood or addressed independent of each other or of the whole.

An emergent property is one that results from the interaction of a system as a whole rather than from one or two of its parts in isolation. Holism rejects the belief that one can improve the whole by maximising its constituent elements in isolation; that analysis can be complete by looking at issues in isolation. Effective improvement is one that maintains a synergistic balance of the whole. In medicine, holism refers to treatment of the whole, taking into account mental and social factors, other than just the symptoms of a disease.

THE ISSUE

Experience shows that despite improved understanding of causes of poor health and new ways of addressing them, health services have remained largely orthodox and reductionist, addressing diseases in isolation. Consumers of health services have also remained largely conservative in the demands they make. Standard definitions of health systems focus only on the supply side i.e. health institutions and their services and do not integrate the demand side, i.e. patient context and needs. Comprehensive health services require that providers and consumers not just have a stake but be connected and involved

The World Health Organisation has defined health as “a state of complete physical, mental and social wellbeing and not merely the absence of diseases and infirmity”.

Current practices in the design, delivery, and demand of health services are however not consistent with this definition. In an era of enlightenment, when it is known that there are so many causes of poor health; communicable and non-communicable diseases, social and economic pressures, lifestyles etc.; health services should aspire for more robust health services, around individuals, communities and institutions, treating not just diseases and infirmities but various stresses, habits and general wellbeing factors; directly or through referrals.

CASE STUDY

Friends of Hope (FOH) is an upcoming clinic that was established to respond to the rising epidemics of both communicable and non-communicable diseases, particularly among the urban poor in Malawi. After three years of practice it observed that there were increased incidences of mental illnesses associated with mainstream diseases. Consequently, it established that the standard patient diagnosis methods and approaches were not adequate in providing effective diagnosis and treatment of patients.

FOH spent the subsequent years in developing comprehensive diagnosis approaches and methodologies. Patient diagnosis became a collective effort of medical practitioners, health professionals, patients, family members and carers at different stages of the diagnostic cycle. Professional advocacy services were involved to ensure that patient rights and inputs were observed. Diagnostic inputs were no longer medical problems only but patients’ stories, lifestyles and worldviews. These were supplemented by home visits. The outcomes were a whole range of products collectively determined on the basis of what is feasible, desirable and affordable and included comprehensive clinical, psychosocial treatments, special diets, substance abuse treatments, targeted referrals and anti-stigma programs.

CONCLUSION

A person’s health is not divided into compartments it is systemic and holistic. The implications to the design of health services are many. Make the clinic a market place for services that promote physical, mental and social wellbeing. Not only a place people go for treatment of diseases but all kinds of social and health consultations. Demystify health services, domesticate language and health concepts to allow for effective patient participation in the diagnosis and treatment process. Allow scientific rationality to be enriched with practical rationality to make health services customer friendly. Diagnosis should integrate quantitative, qualitative and interpretive aspects. Make patient care a critical input to health services and a key skill requirement of health workers.

Health is a complex phenomenon encompassing many interlinked factors. It is better addressed through the provision of holistic health services that are only realised through systemic interventions. Reductionist approaches based on targeting isolated elements can only result in some issues falling through the gaps. Seamless service is not without boundaries but such boundaries have to be interpretively determined in a holistic manner other than exclusively in a reductionist and positivist manner.