First Naturopaths in training

…Naturopathic Doctor, Naturopath and the Natural Medicine Practitioner: What is the difference?

There is so much confusion surrounding Naturopathy and Natural Medicine in Ghana. Many have heard about Natural Medicine but not Naturopathy. Naturopathy in recent times have gained popularity due to the advocacy and education of Nyarkotey College of Holistic Medicine.

Modern Naturopathic History in Ghana

Many who have heard about Naturopathic Medicine is by the work of Prof. Raphael Nyarkotey Obu. The founder of Nyarkotey college of Holistic Medicine is regarded as the father of modern Naturopathic Medicine in Ghana. In fact, the history of Naturopathic Medicine in Ghana cannot be told without his name.

Prof. Nyarkotey has promoted and advocated for modern Naturopathic Medicine using the rigors of modern science and started Ghana’s first ever recognized Naturopathic Medicine College which has gained National and International recognition. With his Doctor of Philosophy degree in Naturopathy and Healthcare Science, Master of Business Administration and Legal training (LLB) and many more; Prof. Nyarkotey has remained the most credible and most sought personality in the Naturopathic Profession in Ghana, Africa and on the international front.

Interestingly, due to his works and publications on Naturopathic Medicine in many newspapers and scientific journals in Ghana, many natural medicine practitioners are now taking solace under the umbrella of Naturopathy to refer to themselves as Naturopathic Doctors or Naturopaths.  But are they the same? If not, what is the difference?

Prof. Nyarkotey Obu (regarded as father of Modern Naturopathy in Ghana) is putting Ghana on the map of Modern Naturopathic medicine training

The B&FT sought the explanation from the renowned researcher and expert in Naturopathy, Prof. Raphael Nyarkotey Obu, the president of Nyarkotey College of Holistic Medicine.  According to him, this exposition took a center for discussion during the May, 2021, World Naturopathic Federation (WNF), Canada, global meeting when one Nigerian colleague raised the issue of Natural medicines as well as Naturopathic Medicine.  In that meeting, Prof. Nyarkotey Obu reiterate that, Naturopathy in Nigeria is under the body of the Medical and Dental Council as they regulate some aspect of alternative medicine which Naturopathy falls.

This regulation he said under the Nigeria Medical and Dental Council makes it uneasy for those without Naturopathic education to be registered and licensed to practice. Hence, they formed the Natural Medicine bloc and runs courses in Natural Medicine.  However, it still doesn’t make them Naturopathic Practitioners.

The Concerns for National deliberation

Modern Naturopathic medical students at Nyarkotey College of Holistic Medicine studies both the biomedical sciences and natural therapies

In 2016, Professor Agyeman Badu Akosa, former Director-General of the Ghana Health Service, advocated for a national health dialogue on the proliferation of health experts without identifiable sources, educating people through the mass media. He raised the alarm in Accra during an interview with the Ghana News Agency on the sidelines of the 67th New Year School and Conference on the theme: “Promoting Universal Health for Sustainable Development in Ghana: Is the Information, Communication and Technology the Game Changer.”

Prof. Akosa was concerned that some of these people speak with so much authority such that Ghanaians believe them; “these are naturopathies, naturopathic practitioners, computer doctors, people who can say they can melt fibroid,” he said.

He is concerned that these people are preying on the ill health and sensitivity of the people of Ghana. He notes: “I want us to begin to talk about the health of Ghanaians. Who should be doing these things? Which of these people are going against any standard practice? So that in the end, I say the patients who should be at the centre of the healthcare industry will benefit sincerely from knowledge that is generated in health,” he added. His other concern has to do with the rate at which People just get up and begin to prescribe diets for people.

Naturopathic and Natural Medicine definition

Touching on the definition of Naturopathy and Natural Medicine, Prof. Nyarkotey posits that, the definition of Naturopathic medicine and Natural Medicine basically are intertwined but differences exist. He states that, there are two global bodies representing Naturopathic profession and Natural Medicine.  He explained that the World Naturopathic Federation (WNF), Canada is the global body representing the profession of Naturopathic Medicine.

They define Naturopathic Medicine as: “a system of healthcare with a deep history of traditional philosophies and practices, medically trained practitioners and a breadth of natural treatment options to serve patients.”  From the definition of World Naturopathic Federation (WNF), anyone referring to himself or herself as Naturopathic Doctor or a Naturopath have had a sound Medical education as well as Natural Medicine education combined. The emphasis is “medically Trained.”

The Board of Natural Medicine Organization under the World Organization of Natural Medicine Practitioners which also represents Natural Medicine practitioners  also explained that:

“Natural Medicine is a generic term which refers to all practitioners who do not engage in diagnosis, disease prognosis, disease treatment, prescribing drugs and surgery.

The basic premise of natural medicine is that ill health is nothing more than imbalance or disequilibrium. The expression of symptoms is the body’s attempt to re-establish balance. Traditional Natural Medicine practitioners’ main emphasis is on guiding their clients to wellness. Naturopathic Medicine is one subset of the generic term ‘Natural Medicine’.

Naturopathic medical students observing first aid session

Professional Education

He further explained the difference using education. He asserts that, A licensed naturopathic physician (ND) attends a four-year, accredited, graduate-level naturopathic medical school and is educated in all of the same biomedical sciences as an Medical Doctor.  In India, Naturopathic doctors attend five- and half-year program in Naturopathy and Yogic Sciences under the Ministry of Ayush (Ayurveda, Yoga, Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy).

So in addition to medical and clinical sciences, naturopathic education incorporates natural and nontoxic treatments with a strong emphasis on disease prevention and optimizing wellness. Naturopathic medical education incorporates standard medical curriculum, and studies including clinical nutrition, physical medicine, homeopathic medicine, botanical medicine, psychology, and counseling. A naturopathic physician takes rigorous professional board exams so that they may be licensed by a state or jurisdiction as a primary care general practice physician.

As at 2014, there were only six of these schools in North America, one of which is the Canadian College of Naturopathic Medicine in Toronto, Ontario. These schools have been accredited by the Council on Naturopathic Medical Education (CNME). The CNME is a member of the Association of Specialized and Professional Accreditors and abides by ASPA’s code of good practice. The U.S. Secretary of Education recognizes the CNME as the national accrediting agency for programs leading to degrees or diplomas as a Doctor of Naturopathic Medicine.

The CNME is recognized as the accrediting body by all the approved schools as well as the professions national associations in both the U.S and Canada. This schooling involves training in the same medical sciences as medical doctors, as well as, training in natural forms of healing such as clinical nutrition, botanical medicine, Traditional Chinese Medicine and acupuncture, homeopathic medicine, naturopathic manipulation, physical medicines and lifestyle changes. Approved naturopathic colleges give students a thorough knowledge of diagnostic techniques that can only be acquired through contact with a patient. All of the approved naturopathic colleges also require 1,500 hours of supervised clinical practice with patients.

In addition, all licensed naturopathic doctors in Canada and the United States write board exams that are standardized for North America. These board exams are called the Naturopathic Physicians Licensing Exams (NPLEX) and are administered by the North American Board of Naturopathic Examiners (NABNE) which is similar in structure to the National Board of Medical Examiners.

While NPLEX creates the exams, NABNE sets policy regarding the qualifications of applicants to take NPLEX, sets policy regarding the administration of NPLEX, verifies the qualifications of applicants to sit for NPLEX and administers the NPLEX at testing sites in the U.S. and Canada. The successful completion of the NPLEX is just one part of the requirements to become a licensed Naturopathic Doctor and NPLEX does not guarantee that the examinee will be licensed. Licensure is granted by the regulatory boards in the province or state where the Naturopathic Doctor practices.

“In Ghana, with consultant from the Commission for Technical and Vocational Education and Training (CTVET) based on Education Regulatory Bodies ACT, 2020 (ACT 1023), and feedbacks from the World Naturopathic Federation(WMF), we have been able to developed the first ever National Occupational Standard for Naturopathy at the Higher National Diploma and Bachelors in Naturopathy and Holistic Health Sciences.  The curriculum for Naturopath has over 3,500 minimum hours for training of Naturopaths and over 5,000 for Naturopathic doctors. This requirement supersedes the WHO and WNF recommendations for Naturopathy training,” he said.

Major differences

Prof. Nyarkotey explained that designation boils down to three main considerations: qualifications, regulation and designation.

“In jurisdictions where Naturopathy is regulated such as North America, South Africa, India etc, qualifications, or educational standards ensure that the practitioner has been adequately trained. In a regulated country only those practitioners that have completed the appropriate training and obtain licensure are able to practice. Regulation also ensures title protection which helps identify qualified practitioners for the public.”

He is of the view that, Doctors of Natural Medicine, Herbalists and many other modalities are normally unregulated. But in some jurisdictions they are regulated.  For instance, in Ghana, Medical Herbalists are highly trained professionals from the Kwame Nkrumah University of Science and Technology (KNUST) and write professional qualifying examination and are integrated into the healthcare system. They also belong to a professional body called Ghana Association of Medical Herbalists (GAMH).

Apart from that, the large portion of the natural medicine practitioners or traditional practitioners are also regulated by the Traditional Medicine Practice Council based on ACT 575. But they do not necessarily have to present with any educational certificate to get their license to practice traditional or natural medicine. This is where the challenge is. Prof Nyarkotey cites, Section 10 of the Traditional Medicine Practice Act 2000, (Act 575) which deals with qualifications for registration. It states:

• Where the Board is satisfied that (a) an applicant has adequate proficiency in the practice of traditional medicine, and (b) the application has been endorsed by any two of the following: (i) the district chairman of the Association; (ii) the traditional ruler of the community; (iii) the District Co-ordinating Director, it shall direct the Registrar to enter the applicant’s name in the register of practitioners and issue the applicant with a certificate of registration on the payment of the prescribed fee by the applicant.

“The challenge here is the silent nature on the educational requirement to enable registration. The question is how the board also justifies the adequate proficiency. The WHO prescribes 1500 minimum hours on clinical training for two-year Naturopathy and over 2500 for four-year naturopathy training. We need a benchmark in this area. This is because certificate of registration from the Council is different from one medical training in natural medicine. There should be a minimum education for all who intends to practice before the grant of licensure.

This was the subject for contention in Sri. Gopichandra S/O Yellappa vs. The State of Karnataka, on 13 August, 2013. the petitioner was found practicing Alternative Medicine in a backward village called Kirawatti in Uttara Kannada district and claimed to registration certificate from one alternative medicine council. the court ruled that the certificate of registration does not indicate that petitioner had undergone a medical training course or a medical certificate course or a diploma course in alternate medicine. In Ghana, alternatively, those who are unable to acquire a standardized education should have expressive limitation on their scope of practice.”

Designation

Prof Nyarkotey states that, designations can be very confusing.  “For Naturopathic Medicine community, the World Naturopathic Federation(WNF) had recommended titles for all practitioners based on their level of qualifications. For instance:

1. Traditional Naturopath for those with Diploma in Naturopathy with a minimum of 1,500 hours of education;
2. Naturopath / Licensed Naturopath for those with Professional Diploma in Naturopathy with a minimum of 2,500 hours;

• Naturopath for those with 3,500+ hours, minimum of three year Naturopathic studies;

1. Naturopathic Doctors(ND) for those with 4,000+ hours, minimum of four-year Naturopathic studies”.

This means he said, “a naturopath, Traditional Naturopath or a Doctor of Natural Medicine is not a naturopathic doctor”.  Naturopathic doctors are highly regulated with a distinct scope of practice. However, in jurisdictions where there are no regulations and titles protected, anyone can arrogates to themselves the title of Naturopathic doctor when they are not.  That is the challenge here, he said.

He notes: “For instance, in Ghana, Naturopathy takes solace under the Traditional Medicine Practice Act, 2000 (Act 575).  Section 13 of the Act further deals with Titles of practitioners. It notes:  The Minister, on the recommendations of the Board given in consultation with the Association, may prescribe by Regulations the titles to be used by practitioners based on the type of service rendered and the qualifications of the practitioners. This section leaves a room for ambiguity unlike in North America and other regulated areas where the titles are clearly stated in the act for protection.  This notwithstanding, for international best practices, the World Naturopathic Federation (WNF), Canada recommendations should be adopted for the Naturopathic Profession in Ghana,” he explained

According to him, the court was very particular on this title. For example, in Kalkisinh Imanallah Duleray vs. State of Gujarat & Ors. (17 April, 2001).  The court held that mere registration, cannot possibly amount to acquiring any particular or specific qualification, as may be required under any other law for the time-being in force, and or to confer upon such a member a right to hold out, profess and declare to the world at large that he is a “Doctor”. This would be misleading the public and would be a gross abuse to the science of Naturopathy as well.

So when you looking for a practitioner in a non-regulated areas or you are dealing with a non-regulated modality, such as Doctor of Natural Medicine it doesn’t really tell you anything. There may be ideals of educational standards or ideals of practice, but when anyone can use a designation without an outside, independent regulatory body overseeing each applicant and ensuring standards it leaves room for a lot of confusion.

Scope of practice of natural medicine practitioners

Natural Medicine/Nature’s Practitioner is one who practices (teaches) a preventive healing system in which only natural substances and techniques are used, including but not limited to nutritional and dietary therapeutics; botanicals(herbal remedies), electrotherapy, natural environmental force, Manual therapy techniques, remedial exercises, mineral therapy and biochemical therapy(the use of natural minerals and cell salts) hydrotherapies, and homeo-therapeutics( a dynamic use of mineral and plant extracts).

Scope of Practice of Naturopathic Medicine

Prof Nyarkotey provided the legal scope of naturopathic practice what is taken from the US dictionary of Occupational titles. It states:

Doctor, Naturopathic 

“Diagnoses, treats, and cares for patients, using system of practice that bases treatment of physiological functions and abnormal conditions on natural laws governing human body: Utilizes physiological, psychological, and mechanical methods, such as air, water, light, heat, earth, phytotherapy, food and herb therapy, psychotherapy, electrotherapy, physiotherapy, minor and orificial surgery, mechanotherapy, naturopathic corrections and manipulation, and natural methods or modalities, together with natural medicines, natural processed foods, and herbs and nature’s remedies. Excludes major surgery, therapeutic use of x ray and radium, and use of drugs, except those assimilable substances containing elements or compounds which are components of body tissues and are physiologically compatible to body processes for maintenance of life”.

Competence of Naturopathic doctor

The Seven Areas of Competence for the Naturopathic Medical Graduate:

1. Medical Assessment and Diagnosis
2. Patient Management
3. Communication and Collaboration
4. Professionalism
5. Career Development and Practice Management
6. System Based Practice
7. Practice Based Learning, Research and Scholarship

Take Home

According to Prof Nyarkotey, Modern Naturopathic Doctors are highly trained medical Professionals with minimum of four-year naturopathic education with mandatory supervised clinical training with wider scope of practice depending on the jurisdiction. Traditional Naturopath and Naturopath have a minimum of one to three-year Naturopathic education with supervised clinical training. For Traditional Naturopath and Naturopath who received correspondence education have limited Naturopathic Medical knowledge with no clinical training.  However, the similarities are that they are all likely to use the same natural therapies in their profession.

For instance, he said, traditional natural medicine practitioner also uses eclectic modalities with the goal of enhancing optimal health. Modalities include, but are not limited to traditional healing techniques such as, herbal preparations, homeopathic preparations, harnessing the energy field , ethno- remedies (remedies of various cultures), spiritual counseling, hydrotherapy ,lifestyle management, flower essences( for relaxation and calming the mind) addictions counselling, manual techniques, nutritional and dietary techniques, non-invasive assessment techniques such as pulse, tongue assessment and physical assessments as well as nutritional and dietary imbalances, metabolic assessment, and non-invasive allergy assessment, traditional urine, saliva analysis, hair mineral (lab interpretation) and other non-invasive assessment techniques. They can decide to receive education or not. All these modalities are also used by Naturopath. However, a Naturopath can further:

“Provide services generally described as primary care, including the performance of common preventive screening examinations; Recognize and appropriately refer urgent and emergent presentations; Diagnose and treat acute and chronic diseases and conditions using accepted standards and evidence-based, peer-approved approaches including history, clinical examination, imaging and laboratory investigation; Refer to and consult with other health professionals and specialists when outside of scope and where recommended by current guidelines and accepted practices,” he said.