The Pragmatic Association of Southeast Asian Nations Approach of Traditional Chinese Medicine Education in Indonesia: A Case Review

Abstract

Traditional Chinese Medicine (TCM) practice has been thriving for centuries throughout the world, but its educational system has not been standardized in many countries outside of China. The aim of this article is To share experiences in planning and executing TCM education adapted to Indonesian culture and conditions. TCM practice has thrived since centuries ago in Indonesia due to TCM's empirically proven effectiveness for maintaining health and wellness. However, formal bachelor's-degree education in TCM has just begun about a decade ago. The learning outcomes of TCM bachelor's-degree education in Indonesia and the Association of Southeast Asian Nations (ASEAN) at large differs from those of China mainly because of the nearly total integration of Western medicine modalities in China. The learning strategy of TCM education in Indonesia with a pragmatic acculturation approach has been effective for improving TCM acceptance, and has been beneficial in upgrading the social and academic status of Indonesian traditional health care based on ASEAN TCM standards.

INTRODUCTION

In recent years, the World Education Services has witnessed an almost 100% increase in applications from students seeking evaluations of credentials in Traditional Chinese Medicine (TCM) earned in China. And the number of applications keeps growing.¹ It is hard to pinpoint the reasons behind this trend. For Indonesia, it is at least due to the long-term acquaintanceship the people have with TCM and its empirically proven effectiveness for addressing the many complicated and refractory diseases of the people in Indonesia and other Southeast Asian countries for centuries.

Since almost half a century ago, TCM education has developed in Southeast Asia, especially in the Association of Southeast Asian Nations (ASEAN) countries. TCM education is becoming unified and standardized. One main reason is that the ASEAN countries' TCM organizations have started having regular congresses on the topic, with participants coming mainly from ASEAN countries and China as invited guest speakers. The venues of the ASEAN TCM congress are being placed among the 5 original ASEANs—Singapore, Malaysia, Indonesia, Thailand, and the Philippines.² When 1 member state had difficulties in hosting a congress, another state would take over the responsibility. Indonesia has become the host for the seventh and the eighth ASEAN TCM congresses in Jakarta and Surabaya, respectively. This article shares the unique pragmatism in TCM education in Indonesia.

TCM education in Indonesia started as informal courses conducted by Indonesia's TCM practitioners organization (the PKNI; the Indonesian Naturopaths Association).^3,4 The problems encountered in the United Kingdom⁵ have been also encountered in Indonesia—due to political reasons and sensitivities, the only leading TCM professional organization in Indonesia does not use the term TCM practitioner (locally sinse), preferring to use the more-vague term naturopath in its official documents.

Consequently, it was very difficult to establish a bachelor's degree in TCM formal education, as there was no regulation under the Ministry of Higher Education to establish a program for this. However, a breakthrough occurred in 2013, as the first bachelor's degree TCM education began formally in the Nalanda Buddhist College in Jakarta Timur, Indonesia.⁶ It became possible because of a regulation of Ministry of Religious Affairs that permits bachelor's degree in Buddhist medicine. This degree is, in reality, identical to the degree needed for TCM.⁶ The initiative was supported by the Ministry of Health's director of traditional health care and by the professional organization of TCM practitioners—the PKNI. The lecturers of the TCM faculty are Indonesian citizens who have achieved master's or doctoral degrees from TCM universities abroad (mainly from China).

DISCUSSION

Pragmatic approach

There are some unique characteristics that might make TCM education attractive to potential TCM students—such as teaching in all Indonesian, affordable tuition fees, inclusiveness of students from all backgrounds, pragmatic and practical learning stages, and acculturation into the local traditional health care practices, among other benefits.

The teaching language is most crucial, as most students are not quite good in English or Chinese. Thus, the teaching materials are all in Indonesian, overcoming any language barriers. In the curriculum, there are courses in the English and Chinese languages designed to upgrade students' skill in the languages related to TCM. The tuition fee is equal to learning in other faculties, and only about a quarter of tuition fee of biomedical schools.

The Nalanda Buddhist College TCM program is open to students of all ages and all backgrounds. Most of these potential students are already involved in traditional health care, such as traditional acupuncturists, local herbalists (jamu),⁷ cupping practitioners, and other traditional healers; a few are biomedical doctors and nurses. Thus, most of these students are in mid- or late-adulthood. The other attractive characteristic of this curriculum is that practical skills, such as pestle needling, are taught in the first year, thus, after learning these skills, students can apply for certification in those areas, for example, as a pestle-needle practitioner. In the third year, students could apply for certification as TCM herbalists. Graduates could apply for certification as ASEAN-standard TCM practitioners, including acupuncture and herbal therapists.

ASEAN-standard TCM practice is a consensus reached by TCM practitioners' associations of the ASEAN, who organize 3 yearly congresses on TCM developments starting from 1983; the 12th congress successfully accomplished this in Bangkok in 2019.² The main difference between the ASEAN-standard and the Chinese-standard is the more authentically traditional nature of the former, free from the complicated and sophisticated medical instruments and interventions of the latter. In ASEAN countries, traditional medicine practitioners are not allowed to do intravenous puncturing, intramuscular injections, or even using stethoscopes for diagnosis. The diagnosis must be based primarily on the 4 basic methods of clinical diagnosis in TCM leading to Syndrome or Pattern Differentiation, which is used as a basis for treatments such as acupressure, acupuncture, herbs (including local jamu and food), Qigong meditation, etc. Thus, the bachelor's degree in TCM in the ASEAN region is sufficient with 144 credits distributed in 8 semesters during 4 years of coursework as the rule in Indonesia. This coursework may be supplemented with another year of a professional clinical internship.

The TCM curriculum is rationally tuned to be acculturated to the local health care practices, using local food and jamu (locally cultivated herbs) together with the body of TCM knowledge. With such an approach, this system educates a TCM dietitian or nutritionist who can give advice on food not based on calories or carbohydrate, protein, or fat contents, but based on Yin and Yang, the Five Elements, and meridian affinities, based on diagnoses made by TCM syndrome differentiation.⁸ Such acculturation has gained warm acceptance by the jamu practitioners and entrepreneurs' organizations.

The complete learning outcome of the TCM bachelor's-degree program in Indonesia is shown in Box 1.

The TCM curriculum also incorporated previously informal courses such as pestle-needle therapy⁹ into its first-year coursework. Thus, students are able to practice pestle acupuncture after learning that skill. This is possible because the education system in Indonesia is based on multientry, multiexit, and multisignificance principles, as stated in this country's Education Act¹⁰ and elaborated upon by the Government Regulation on Indonesian Qualification Framework, the KKNI (Kerangka Kualifikasi Nasional Indonesia).¹¹ In short, the Indonesian education system allows students to learn by all means any skills and competencies in continuity and, in an integrated way, to improve their qualifications, characters, personalities, and empowerments.¹⁰ Based on this system, students can also practice as certified TCM herbalists and Chinese Medicine nutritionists before graduation by passing relevant examinations conducted by the TCM-competence certification board formed by the PKNI and recognized by the Indonesian Ministry of Education. After graduation from the TCM bachelor's-degree program, students can apply for master's-degree programs in Indonesia or abroad, or attend continuing medical education programs conducted on the campus. Such a pragmatic arrangement in TCM higher education in Indonesia has been quite warmly accepted so far by the stakeholders.

CONCLUSIONS

TCM education in Indonesia is in its “toddler” phase, with bright prospects. The external driving force is the global enthusiastic attitude toward TCM worldwide. The pragmatic rational strategy in positioning TCM within the prevalent culture of the Indonesian people, especially in empowering and upgrading the local traditional health care toward ASEAN standards has become the key step in successful acculturation of TCM formal education in Indonesia.

AUTHORs' CONTRIBUTIONS

Dr. Japaries and W. Agussalim wrote the article, and Dr. Hardi, reviewed it. Dr. M. Thio, did the final editing and approval.

AUTHOR DISCLOSURE STATEMENT

No financial conflicts of interest exist.

FUNDING INFORMATION

No funding was received for this study.

SKILL MASTERY

(1) General Description

Graduate profile:

Capable of doing and developing works as a Buddhist medicine/TCM therapist independently, including assessing health conditions of clients/patients; planning and implementing health care, mental and physical preventive medicine; and promoting recovery treatments based on Dharma or TCM modalities and relevant biomedical sciences.

(2) Specific Skills

• (a) To examine and analyze patients' health conditions with the Buddhist medicine/TCM approach

• (b) To plan and implement treatment with meditation therapy for patients with stress-related illnesses

• (c) To plan and implement natural therapy based on Buddhist medicine (TCM), using manipulation (acupressure, acupuncture) or herbs (jamu), to maintain, promote, or recover patients' health and wellness

• (d) To prescribe therapeutic foods and balanced lifestyle according to patients' needs

• (e) To refer patients to more-competent health care facilities according to patients' needs

KNOWLEDGE MASTERY

Mastery In

• (a) Essence, significance, and development of the theory of Buddhist medicine (TCM)

• (b) Basic theory of balancing energy of Yin/Yang, Five Elements, internal organs, Qi–energy, Xue–Blood, bodily fluids, and the meridians

• (c) Concepts of causation and progression of diseases

• (d) Physical and mental therapeutic principles according to syndrome assessment based on the four methods of patient examination in Buddhist medicine/TCM

• (e) Anatomy, physiology, and pathobiology; basic knowledge of nutrition, biochemistry, pharmacology, and generally encountered diseases

• (f) Basic knowledge of child development from birth, through toddler age, youth, to adult and old age; and the need to modify therapy for young and old patients as well as pregnant/lactating women

• (g) Theory and practice of meditation, as well as understanding its benefit for physical and mental health and wellness

• (h) Basic concepts and procedures of applying therapeutic manipulations and prescribing natural herbs (especially local jamu) according to patients' needs

• (i)General knowledge of first aid for accidents/emergencies, such as fainting, aspiration, diarrhea, fever, etc.

• (j) Concept and theory of referring patients to more-competent facilities according to patients' needs

ATTITUDES AND VALUE SYSTEMS

(1) General Points

• (a) Devoted to The One Almighty God and having a religious attitude

• (b) Upholding human values in task implementation based on religion, morals, and ethics

• (c) Contributing in improving the quality of life of society, nation, state, and civilization progress based on Pancasila (Pancasila or The Five Principles is the State Phylosophy of Republic of Indonesia)

• (d) Becoming a patriotic citizen with nationalism and responsibility toward the country and its people

• (e) Appreciating pluralism in culture, viewpoints, religions, and beliefs, as well as the original opinions or findings of others

• (f) Being cooperative and possessing social sensitivity and awareness toward the society and the environment

• (g) Abiding in laws and discipline in social and statehood life

• (h) Internalizing academic values, norms, and ethics

• (i)Showing an attitude of responsibility for works in his/her expertise autonomously

• (j) Internalizing the spirit of autonomy, struggle, and entrepreneurship

(2) Specific Points

• (a) To work with mindfulness, responsibility, and obedience to relevant ethical codes, rules, and regulations

• (b) To manage practice individually or in groups in accordance to the prevailing regulations

• (c) Full responsibility for supervising subordinate health care workers and having substitute colleagues when unavailable

• (d) To work together with others and do therapeutic communications effectively within the work sphere

• (e) To develop and do scientific studies on the existing traditional and complementary therapeutic methods