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Table of Contents
REVIEW ARTICLE
Year : 2018  |  Volume : 1  |  Issue : 2  |  Page : 51-55

Adoption of traditional chinese medicine in a central mediterranean island community


Centre for Traditional Chinese Medicine, University of Malta, Malta

Date of Web Publication9-Oct-2018

Correspondence Address:
Prof. Charles Savona-Ventura
Centre for Traditional Chinese Medicine, University of Malta
Malta
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CMAC.CMAC_18_18

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  Abstract 


The Maltese Islands in the central Mediterranean was one of the earliest European countries to initiate political relationships with the People's Republic of China. The political interaction translated eventually to a better appreciation of the cultural diversity of the respective countries. This appreciation led to an early adoption of traditional Chinese medicine (TCM) services and their incorporation within the mainline western-based contemporary medicine generally practiced on the Islands. TCM clinical services were formally introduced in the public government-managed hospital in 1994 after a bilateral agreement was signed between the health ministries of the two respective countries. This service has now extended into the private health sector. The adoption of TCM clinical services, in the light of a greater acceptance of TCM by the patients, necessitated specific legislation to regulate the practice of TCM within the legal framework of the Maltese Healthcare Professions Act. In more recent years, since 2015, the University of Malta in collaboration with Shanghai University of TCM, have provided a postgraduate master program in TCM aimed at graduates holding a primary degree in a western-oriented health-care science.

Keywords: Education, legislation, Maltese Islands, registration


How to cite this article:
Savona-Ventura C. Adoption of traditional chinese medicine in a central mediterranean island community. Chin Med Cult 2018;1:51-5

How to cite this URL:
Savona-Ventura C. Adoption of traditional chinese medicine in a central mediterranean island community. Chin Med Cult [serial online] 2018 [cited 2018 Dec 15];1:51-5. Available from: http://www.cmaconweb.org/text.asp?2018/1/2/51/242573




  Introduction Top


The Maltese archipelago is made up of a group of islands located in the Central Mediterranean. It has been an independent state since 1964 after it obtained its independence from the United Kingdom and was declared a Republic in 1974. Its central Mediterranean position had throughout the centuries exposed the population to a wide range of cultures – an influence that becomes evident in its medical folklore beliefs that exhibit elements of European and North African folklore practices.[1],[2]

The current medical practice is primarily a westernized one strongly influenced by the British School of Medical thought since many of the medical professionals go to expand their specialist training in hospitals throughout the United Kingdom. The health-care provision on the Islands is based on a free-at-source government medical service that ranges from primary health care within health-care facilities scattered around the islands to tertiary specialized care within the government hospital and specialized centers. There is also a generally affordable private-care sector covering primary health care and hospital health-care services. Medical education is managed by the University of Malta (UM) under the auspices of three faculties as follows: Faculty of Medicine and Surgery, Faculty of Dentistry, and Faculty of Health Care Sciences. Equitable standards of care in the various health-care professional fields are maintained through the various councils set up through the health-care professions Act that requires formal registration of all health-care providers in respective registries before being able to practice their profession.[3]

Despite the absolute reliance of the Maltese community to westernized medical care, the Maltese Government was an early proponent for introducing services to provide traditional Chinese medicine (TCM) within the government medical service. Diplomatic and political relations between Malta and China were formally set up on January 31, 1972. These relations served primarily as a means of boosting the Maltese economy at a time when Malta was attempting to develop a stand-alone economic base without relying on the islands being used as a military base for the British or NATO Services. The interrelationship also served to promote Chinese culture among the Maltese population through the opening of the Chinese Cultural Institute and the setting up of the Malta-China Friendship Society in 1973 with membership to the Chinese People's Association for Friendship with Foreign Countries.[4] An aspect of this Chinese cultural exposure was TCM.

Introduction of traditional Chinese medicine services

TCM has its own unique concepts regarding disease diagnosis, classification, and management. It relies on various modalities of treatment including dietary-lifestyle interventions, physical intervention methods such as acupuncture-moxibustion-cupping, message such as Tui Na and Gua Sha, and Chinese herbal medicine [Figure 1].
Figure 1: Modalities of Traditional Chinese Medicine management

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TCM in Malta started being made available in the Malta Government Health Service in 1994 when a Memorandum of Understanding was signed between the two respective Ministries of Health.[4] This MoU provided for service facilities provided by the Maltese Medical and Health Department within the government hospital – originally St Luke's Hospital but transferred to new premises in Mater Dei Hospital in 2007. The Chinese Ministry of Health provided the services of teams of Chinese professionals from the Nanjing University of TCM. These services involve a daily clinic providing TCM services in the hospital in Malta and a weekly service in the hospital on the sister island of Gozo. All service costs are covered by the Maltese National Health Service. These service facilities today deal with about 400 consultations per week. In addition, it provided for the development of resource facilities to establish a Mediterranean Regional Centre for TCM (MRCTCM) at Corradino in Malta. This provides TCM services by Chinese professionals against a consultation fee. On June 28, 2011, a further MoU between representatives of the Ministry of Health of the People's Republic of China and the Ministry of Health, the Elderly and Community Care of the Republic of Malta provided to upgrade the resource facilities at the MRCTCM.[5] In addition, there are also registered acupuncturists providing acupuncture services in the private sector – some managing dedicated clinics.

Further TCM clinical provision services were established by the UM in 2016 after a Memorandum of Understanding was signed between the UM and Shanghai University for TCM (SHUTCM) and its affiliate hospital Longhua Hospital. The MoU provided for the setting up of a center for TCM by the UM to provide professional clinical services against a consultation fee. The clinical services, which aimed at supporting an academic program, were managed by Chinese professionals seconded to the Centre from Longhua Hospital.[6] On May 31, 2018, the TCM services were incorporated as an integral part of the health and wellness center established by the university to provide psychological and mental health support, health educational in regard to sexual health, drug abuse and nutrition, and of course TCM services.[7],[8] The integration of TCM services within the wellbeing support services emphasizes the belief that eastern and western medical systems can be integrated to support one another to the benefit of those who need help in maintaining their overall wellbeing.

Introduction of traditional Chinese medicine education

In 2012, the Memorandum of Understanding between the two respective governments was revised to include provisions for making available training courses for doctors, nurses, and paramedical professionals with 2–3-year postgraduate experience. Certification of attendance to these courses was to be issued jointly by the MRCTCM and Nanjing University of TCM. The MoU also provided for the MRCTCM to run short-term and familiarization courses aimed at previously trained acupuncturists wishing to improve their clinical experience. Certification of attendance to these was to be issued by the MRCTCM.[9] Further than providing short-term courses, no provision was made by the MRCTCM to provide a formal program of studies.

In 2010, the contact was established between the Malta-China Friendship Association and the Shanghai branch of the Chinese People's Association for Friendship with Foreign Countries to seek potential collaboration in the educational field of TCM. This led to a bridge being built between the UM, the Shanghai Directorate of Health, and the SHUTCM leading to a Memorandum of Understanding being signed in 2016 between the two institutions.[10] This MoU provided for the setting up of a 1-year full-time taught Level 7 Masters in TCM by the UM with the teaching program being covered by professionals from the UM and SHUTCM. The course targets postgraduate students who have a primary professional degree in a western-based health-care science (i.e., doctors, physiotherapists, nurses, midwives, and dentists) thus ensuring that TCM techniques will be incorporated as an integral part of standard mainline medical practice. The masters in TCM is designed to conform with the European Credit Transfer System (ECTS) widely used throughout higher education institutions in Europe and is composed of 8 study units with a total ECTS value of 90 [Figure 2].[11]
Figure 2: Inauguration of the University Centre for Traditional Chinese Medicine on 17th November 2015[15]

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In the development of this course of studies, attention was taken to ensure that the course confirmed with the educational targets identified by the World Health Organisation (WHO) for the training of qualified physicians from schools of modern Western medicine who wish to include acupuncture as a technique in their clinical work; and also provide training of other health personnel of modern Western medicine working in the primary health-care system of their country.[12],[13] To date, the course has been run twice during academic years 2015/2016 and 2016/2017 with eleven students graduating. The student profiles have included nurses (x4 students), midwives (x2 students), physiotherapists (x2 students), and medical doctors (x3 students). The small student groups facilitate reliance on a more interactive type of teaching rather than simply resorting to a didactic educational process. Some of the graduates have also availed themselves of the opportunity to have partly sponsored elective visits to SHUTCM to further their clinical experience in the field. After following the Master in TCM course, the graduates can continue studies with SHUTCM to obtain a doctorate in TCM awarded by that university [Figure 3].[14],[15]
Figure 3: Teaching sessions at the University of Malta Centre

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The need for dissemination of evidence-based information relating to TCM among the medical profession is evident in a pilot internet-based survey commissioned by the UM Centre for TCM. This pilot survey showed that whereas 40% of respondents were interested in adopting TCM practice as part of their western-based medical practice, 83% of respondents felt that they need to gain additional knowledge about TCM to properly counsel their patients. Only 3.3% of respondents stated that TCM methods were addressed during their undergraduate medical education; none reported TCM being addressed during their post-qualification hospital-based clinical training. A large proportion of respondents (43.3%) felt that TCM training should be a component of undergraduate studies or offered as an elective component of the curriculum; 33.3% felt that TCM should be formally taught as a dedicated postgraduate specialty.[16] Since in the survey, only 6.7% reported having adequate TCM reference facilities, the UM has, with the help of the Shanghai Education Commission, augmented its Health Care Library with a significant number of books on facets of TCM in the English language [Figure 4].[17]
Figure 4: Traditional Chinese Medicine books donated by the Shanghai Education Commission to the University of Malta Library presented by the Ambassador of the Peopleæs Republic of China in the Republic of Malta[17]

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The UM-SHUTCM partnership has during the academic year 2017/2018 also provided for a 4 ECTS certificate course of studies forming part of the Bachelorate in Liberal Arts run by the UM. The course of studies centered on Herbal Medicine in Western and Chinese Culture.[18] This certificate evening course was very well received with 19 students subscribing to it. The UM-SHUTCM partnership has also embarked on an outreach program to promote TCM among the health-care professions and the public in Malta. The UM Centre for TCM has thus organized day workshops for members of the health-care professions that have included nurses, nursing students, physiotherapists, and family doctors. The center has also provided a series of lectures aimed at introducing the overall principles of TCM to the professionals and the general public. These dealt with topics such as Kung Fu for Health (five lectures) and TCM Art of Health Living (six lectures). In collaboration with the Department of Obstetrics and Gynaecology of the UM, the center for TCM also hosted an invited guest professional to address the specialist staff about the value of TCM in assisting infertility management.

The UM Centre for TCM and the MRCTCM have further collaborated with the Chinese Cultural Institute promoting TCM aimed at the general public through lectures delivered by the respective professional staff and through participation in fairs organized by the institute [Figure 5].
Figure 5: Exhibition stand during Temple Fair organized by the Chinese Cultural Centre

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Introduction of traditional Chinese medicine registration of professionals

The Maltese Health Care Professions Act requires the formal registration of all health-care professions with specific dedicated councils before being allowed to practice their profession.[19] The 2009 WHO Resolution WHA62.13 encouraged the Member States to consider the inclusion of traditional medicine within the respective national health-care systems, and to establish systems of qualification, accreditation or licensing of practitioners of traditional medicine on established benchmarks.[12]

Long before the WHO Resolution, the Maltese legal system had incorporated TCM within the overall framework of Maltese health-care system. Registration in respect to TCM is currently restricted to registering as an ACUPUNCTURIST with the Council for Professions Complimentary to Medicine (CPCM) being responsible for the register. In 1997, the CPCM prepared a Document paper defining the guidelines for criteria for the examination of the prospective registrant based on 1990 Forum on Non-Conventional Medicines and the Acupuncture European Workshop cosponsored by the Council of Europe and the WHO. This document identified three levels of TCM practitioners are as follows:

  • Medical doctors trained in TCM
  • Allied health professions trained in TCM; and
  • Non-professionals individuals trained in TCM.


The CPCM document proposed that registration as an ACUPUNCTURIST should be limited to health-care professionals (i.e., medical doctors, physiotherapists, nurses, or other health professional) who have completed a minimum of the 3-year full-time educational program in western-based medicine supplemented by a postgraduate certification in TCM. The CPCM requirement for a level 1 registration as Acupuncturist included a certification attesting to a minimum of 250–500 h of theory and clinical training concluded by an examination. A syllabus of the essential study was also outlined.[20] This has been subsequently modified to 660 h of theory and 140 h of clinical training in acupuncture. The theory component should ideally cover Chinese medicine-basic concepts (140 h), acupuncture (240 h), and a Tuina and TCM course (280 h).[21]

The current Acupuncturist CPCM Register as on the July 1, 2017 includes a total of five Maltese individuals, seven individuals from the remaining countries of the European Union, three individuals listed as Commonwealth or foreign, and 19 Chinese individuals the majority of whom include the staff working in the UM Centre for TCM and the MRCTCM [Figure 6].[22]
Figure 6: Council for Professions Complimentary to Medicine Acupuncturist Registrations

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The Health Care Professions Act was revised in 2002. The revision gives a full list the professions complementary to medicine. The list includes the profession of ACUPUNCTURIST at a level 1 registration only. After 2004, when Malta formally joined the European Union, the CPCM is legally obliged to maintain a register of recognized practitioners who have recognized qualifications obtained from the UM, or a training institution in Malta recognized by the CPCM; obtained from a recognized institution in any European Union member state; or obtained from any other institution outside the EU if recognized by CPCM.

A Code of Practice for Acupuncturists was published by the CPCM in 2006.[23] The Health Care Professions Act is presently being reviewed. It is hoped that the review will establish different levels of registration differentiating the Acupuncturist Practitioner namely a health-care professional with dedicated basic training in the physical methods of TCM; the Acupuncturist Physician namely a Doctor of Medicine with postgraduate dedicated basic training in the physical methods of TCM; and Doctor in TCM formally trained in the full breath of TCM practice. Representations have been made by the relevant players in the field to the Malta Competition and Consumer Affairs Authority to establish a working group aiming to bring standardization in the educational standards in TCM within the context of the European Higher Education Area criteria.[24]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Savona-Ventura C. Malta (Republic of). In: Erickson d'Avanzo C, editor. Pocket Guide to Cultural Health Assessment. 4th ed. USA: Mosby; 2008. p. 465-9.  Back to cited text no. 1
    
2.
Savona-Ventura C. Traditional Maltese Medicine. Chinese Medical Culture Summer; 2016. p. 50-7.  Back to cited text no. 2
    
3.
Government of the Republic of Malta. Health Care Professions Act. To Regulate the Practice of Health Care Professions in Malta. Act XII of 21st November 2003 and Supplemented by Subsequent Legal Notices. Ch. 464. Government of the Republic of Malta; 2003.  Back to cited text no. 3
    
4.
Embassy of the People's Republic of China in the Republic of Malta. Brief on Sino-Maltese Relations (2004/06/12). People's Republic of China, Malta; 2018. Available from: http://www.mt.china-embassy.org/eng/zmgx/t132190.htm [Last accessed on 2018 Aug 22].  Back to cited text no. 4
    
5.
People's Republic of China – Republic of Malta. Memorandum of Understanding on cooperation between the Ministry of Health of the People's Republic of China and the Ministry for Health, the Elderly and Community Care of the Republic of Malta dated 28th June 2011. People's Republic of China – Republic of Malta. Malta; 28 June, 2011.  Back to cited text no. 5
    
6.
SHUTCM – UM. Collaborative Agreement between the College for International Education, Shanghai University of Traditional Chinese Medicine and the University of Malta dated 2016. Shanghai University of Traditional Chinese Medicine. Malta: University of Malta; 2016.  Back to cited text no. 6
    
7.
University of Malta. University of Malta Opens New Health and Wellness Centre. News Point; 31 May, 2018. Available from: https://www.um.edu.mt/newspoint/news/features/2018/05/umopensnewhealthandwellnesscentre [Last accessed on 2018 Aug 22].  Back to cited text no. 7
    
8.
University of Malta. Centre for Traditional Chinese Medicine. Malta: University of Malta; 2018. Available from: https://www.um.edu.mt/tcm/tcmclinic [Last accessed on 2018 Aug 22].  Back to cited text no. 8
    
9.
People's Republic of China – Republic of Malta. Protocol between the Ministry for Health, the Elderly and Community Care of Malta and the Ministry of Health of the People's Republic of China on Cooperation in the field of Traditional Chinese Medicine dated 25th September 2012. People's Republic of China – Republic of Malta; 25 September, 2012.  Back to cited text no. 9
    
10.
TVM News. Centre for Traditional Chinese Medicine inaugurated at University. TVM News – Malta; 17 November, 2015. Available from: https://www.tvm.com.mt/en/news/centre-for-traditional-chinese-medicine-inaugurated-at-university/ [Last accessed on 2018 Aug 22].  Back to cited text no. 10
    
11.
University of Malta. Master in Traditional Chinese Medicine and Culture [M.TCM (Melit.)] – Course Code PMTCMFTT5. Malta: University of Malta; 2018. Available from: https://www.um.edu.mt/courses/overview/PMTCMFTT5-2018-9-O [Last accessed on 2018 Aug 22].  Back to cited text no. 11
    
12.
World Health Organization. Guidelines on Basic Training and Safety in Acupuncture. Geneva; World Health Organization; 1999.  Back to cited text no. 12
    
13.
World Health Organization. Benchmarks for Training in Traditional Chinese Medicine. Geneva: World Health Organization; 2010.  Back to cited text no. 13
    
14.
Savona-Ventura C. Centre for TCM – Annual Report Academic Year 2015/16. Malta: University of Malta Centre for TCM; 2016.  Back to cited text no. 14
    
15.
Savona-Ventura C. Centre for TCM – Annual Report Academic Year 2016/17. Malta: University of Malta Centre for TCM; 2017.  Back to cited text no. 15
    
16.
Savona-Ventura C. Survey: Attitudes about Traditional Chinese Medicine among Maltese Medical professionals. Survey Monkey Questionnaire Survey dated November 2017. Malta: University of Malta Centre for TCM; 2018.  Back to cited text no. 16
    
17.
UM. Collection of Traditional Chinese Medicine Books Donated to University of Malta. UM News Point; 16 February, 2017. Available from: https://www.um.edu.mt/newspoint/news/features/2017/02/collectionoftraditionalchinesemedicinebooksdonatedtouniversity ofmalta?utm_source=update&utm_campaign=update&utm_medium=email&utm_content=top [Last accessed on 2018 Aug 22].  Back to cited text no. 17
    
18.
University of Malta. LAS1058: Herbal Medicine in Western and Chinese Culture – Centre for the Liberal Arts and Sciences. Malta: University of Malta; 2018. Available from: https://www.um.edu.mt/courses/studyunit/las1058 [Last accessed on 2018 Aug 22].  Back to cited text no. 18
    
19.
Government of the Republic of Malta. Health Care Professions Act. To regulate the Practice of Health Care Professions in Malta. Act XII of 21st November 2003 and Supplemented by Subsequent Legal Notice 3i4 of 2006 – Subsidiary Legislation 464. 10 Council for Professions Complementary to Medicine (Standing Orders). Ch. 464. Regulations dated 12th December 2006 and Legal Notice L.N. 277 of 2008: Professions Complementary to Medicine (Licence to Practise) Regulations, 2008. Government of the Republic of Malta; 2003-2008.  Back to cited text no. 19
    
20.
Attard Previ R, Cali Corleo S. Acupuncture-Moxibustion: A Profession or a specialisation. Issued by the CPCM subcommittee on Acupuncture. Council for the Professions Complementary to Medicine – Malta; 16 June, 1997.  Back to cited text no. 20
    
21.
Council for the Professions Complementary to Medicine. Criteria for Registration as Acupuncturist. Malta: Council for the Professions Complementary to Medicine; 2015.  Back to cited text no. 21
    
22.
Council for the Professions Complementary to Medicine. Council for the Professions Complementary to Medicine – Malta Acupuncturist Register. Malta: Council for the Professions Complementary to Medicine; 1 July, 2017. Available from: https://www.deputyprimeminister.gov.mt/en/regcounc/cpcm/Documents/Acupuncture%20Register.pdf [Last accessed on 2018 Aug 22].  Back to cited text no. 22
    
23.
Council for the Professions Complementary to Medicine. Code of Practice – Acupuncture. Malta: Council for the Professions Complementary to Medicine; April, 2006. Available from: https://www.deputyprimeminister.gov.mt/en/regcounc/cpcm/Documents/copacupuncture.pdf [Last accessed on 2018 Aug 22].  Back to cited text no. 23
    
24.
European Community. ECTS User Guide. Luxembourg: Office for Official Publications of the European Communities; 2009.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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