Ispec A Blessed Experience in Botswana

ISPEC IN BOTSWANA: A BLESSED EXPERIENCE
[An experience following ISPEC Interprofessional Spiritual Care Education

Curriculum “Train-the Trainer” Course Syllabus” training at The George
Washington University, Washington DC 2018.]
@ KB MEDICAL CLINIC GABORONE BOTSWANA

2018-2019
Dr Bindeshwar Prasad Yadav
MBBS, MSc, Ph.D.
ISPEC IN BOTSWANA: A BLESSED EXPERIENCE
[An experience following ISPEC Interprofessional Spiritual Care Education

Curriculum “Train-the Trainer” Course Syllabus” training at The George
Washington University, Washington DC on July 10-12, 2018.]
Author: Dr Bindeshwar Prasad Yadav
Copyrights ©: Dr Bindeshwar Prasad Yadav
Published by: Self, electronically

Date of Publication: 05 August 2021
Place of Publication: Gaborone, Botswana
ISBN no. 978-99968-61-79-6
Author’s contact details:

Cell: ++ 267 75236246
Email: bpyadav66@yahoo.com
P.O. BOX: 504883 Rail Park,
Gaborone Station, Botswana
Acknowledgment
Over all, the project was a great pleasure. We learnt a lot. We thank the ISPEC project team
in Washington DC.
I wish to express my sincere gratitude to Dr Christina Puchalski and team members for their
continued support, motivation and inspiration through emails and calls.
I also wish to express my sincere gratitude to Dr Harold G Koenig, M.D, Duke University, USA
for his encouragement, knowledge sharing and guidance for spiritual research during
research training course at Durham in 2018 August.
K B Medical Clinic
Gaborone, Botswana
Dedication
This piece of work is dedicated to health care professionals who knows significant role of spiritual
dimension of life in disease management, and have experience by practicing on patients. The dedication
also goes to anyone who believes noteworthy importance of spiritual practices for disease prevention
and health promotion and has transformed this faith into practice.
PREFACE
Spiritual dimension of health is well known well recognised subject by health professionals.
Significant role of spiritual practices, such as prayer and worships in different faiths by
different methods have been practicing since time immemorial to get from disease and to
possess good health and prosperity. These practices have been carried out in every part of
the world by every race of people in their own way. There is a well-established link between
spirituality and health. However, growth and development of medical science has been
undermined role of spirituality in treatment and care of sick patients. But in recent years
evidence based knowledge has established strong link between health and spirituality. It has
opened a new gateway for promotion of spiritual practices to manage sick patients with full
care of spiritual component of health. With emergence of life style diseases, such as, heart
diseases, diabetes, cancers human life has become more painful, worrying and traumatic.
Rise in depression and suicide has become a big challenge for human race. In midst of such
sorrow modern science has become speechless. Solution lies in recognition and care of
human spirit soul. We see trunk, leaves, flowers and fruits of a plant, but we cannot see
plant’s root. We have seen every year leaves have dried up, flowers and fruits have gone
away; but in following year all grow new , because of root is present and able to grow gain
as a normal healthy plant. If water is poured to branches and leaves, it goes in vain, but if
water is poured to root makes plant green and flowering.. It proofs unseen part of plant is
most important. Seen is because of strong unseen. Similar phenomenon is valid for human
life. Human body and mind grow and develop because of support from unseen spirit/soul. It
is time to nourish our spirit/soul to achieve a healthy energetic body and happy peaceful
mind in way to achieve optimum health and wellness. Further, the most important point to
note is “Spiritual health is the most neglected dimension of health in practice”. It is urgent
need to combine spiritual health care in health care system.
Contents: Page
• Introduction 01
• Sensitization of K B Medical clinic health workers 02
• Goal 1. Health care education session for health care providers 03
• Goal 2. Spiritual health care education for hypertensive patients 07
• Goal 3. Spiritual health care education session for youth – students to prevent HIV 11
Additional Accomplishments:
• Experience of using FICA Spiritual history tool at primary health care clinic in Gaborone
Botswana 14
• Prayer as a spiritual intervention in primary health care as a pilot project 34
• Case reports 57
• Presentation: “Illness Health & Spiritual health education” to health workers in Gaborone
Botswana (letter) 60
• Distribution of Spiritual Health education pamphlets to community (Photo) 61
• Spiritual health education about drug alcohol abuse prevention (photo) 61
By Products of the Project
• Development of leadership quality in “Spiritual wellbeing in health care” 62

• Experiences of Working with professionals of different fields 63
• Future plan for using the curriculum 63
INTRODUCTION
Interprofessional Spiritual Care Education Curriculum “Train-the Trainer” Course Syllabus”

training was conducted at The George Washington University, Washington DC on July 10-12,
2018. Following the training, KB Medical Clinic Gaborone selected 3 goals to accomplish
with support of the Dr Christina Puchalski and the team. Although the course syllabus and
training was more focus on severely sick patients, however, the course contents are also
useful to improve quality care of the patients who need primary health care. It is also very
useful for health promotion and wellness.
As per need of the training course KBMC Team had selected 3 goals. These were followings:
Goal 1. To conduct once in 3 months spiritual health care education session for health care
providers and measure the satisfaction level of the session
Goal 2. To conduct once in 3 months spiritual health care education session to develop
spiritual well being of hypertensive patients and measure the level of satisfaction
Goal 3. To conduct once in 3 months spiritual health care education session for youth –
students to prevent HIV & STI and measure the level of satisfaction
Further, getting inspired and motivated from the ISPEC 2018 book, emails, monitoring and
conference call from Dr Puchalaki and the team we conducted additional activities such as
• Use of FICA (Faith and Meaning, Importance, Community and Address in Care) and
• Prayer as spiritual intervention.
It was a blissful experience, as most participants were having religious / spiritual

background. We also got opportunity to distribute spiritual health education material for
health and wellness and chronic illness and prevention of HIV transmission and drug abuse.
We think findings of FICA use and prayer intervention are very useful and beneficial for
health care. We wish to share these experience with mass population and professionals.
I feel grateful to Dr C Puchalaki and the team for their continued support and inspiration
through emails and call. Their support was great source of inspiration and motivation.
Sensitization of K B Medical Clinic health workers
Spirituality is important for both patients as well as health service providers. To consider
importance of great role of spirituality in health care, raised spirituality of health care
workers becomes first. Keeping the fact in mind we decided to sensitize the clinic health
workers for the up coming project.
Step 1: The book ISPEC (Interprofessional Spiritual Care Education Curriculum)COURSE

SYLLABUS was introduced to the staffs. On July 23, 2018 ISPEC book was given to the staffs
just to become familiar with our coming project.
Instruction / suggestion were given to them:
• Firstly be friend with the book

• Just turn over pages,
• Read high lighted bold headings of the slides,
• You read details of the slides which you want to
• Latter on among ourselves on we discuss contents of the book
• Further, we practice “How can we serve our patients best with information,
knowledge and skills mentioned in the book.
Step 2: With objectives to prepare health workers in KB Medical clinic to recognize the role
of health workers own spirituality to serve their patients need better a summary paper
sheet of 8 research findings was prepared which contains health related benefits of spiritual
/ religious practices. Other objective was to develop health workers’ confidence and
spirituality to take their participation in the project. The summary paper sheet was named
“AN URGENT CALL FOR HEALTH WORKRS /PROFESSIONALS FOR PATIENTS CARE” Table 1.
Table 1.
AN URGENT CALL FOR HEALTH WORKRS /PROFESSIONALS FOR PATIENTS CARE

Medical science researches show beneficial effects of Spiritual / Religious practices on
peoples physical and mental health
1 Improved health related quality of life
2 Improved coping strength during serious illness
3 Decreased depression / anxiety
4 Increased adherence to treatment
5 Improved social functioning and maintaining social relationships
6 Yoga are helpful in lowering Anxiety level, burn out and stress related health problems
Mindfulness Meditation has positive impact on burnout, anxiety, depression, sense of
7 well-being, and empathy
8 Prayer / reading a sacred text can have salutary effects on physical and mental health
FROM BOOK: “ISPEC Interprofessional Spiritual Care Education Curriculum COURSE
SYLLABUS 2018
The messages became very helpful to gain confidence of the staffs to run the project.
GOAL 1
To conduct once in 3 months spiritual health care education session for health care
providers and measure the satisfaction level of the session
Objectives:
• To self-recognise the role of health care providers own spirituality to serve the
patients need better.
• To enhance knowledge and skills of health care providers in field of spiritual care and
health.
Activities:
• The book ISPEC (Interprofessional Spiritual Care Education Curriculum)COURSE

SYLLABUS was introduced to the staffs.
• With objectives to sensitize health workers at the clinic, a summary paper sheet of 8
research findings (from ISPEC) was prepared which contains health related benefits
of spiritual / religious practices. It was named “AN URGENT CALL FOR HEALTH
WORKRS /PROFESSIONALS FOR PATIENTS CARE”. (Table : 1).
• According to need of Primary health care &Well being of patients, slides were
selected from ISPEC, and were discuss during training sessions.
• Within 12 months period 4 sessions have been conducted.
• SELECTED slides from each modules (1-6), what we thought useful for the clinic
setting, were discussed. (Table .2).
• Three staffs : one nurse, and two multipurpose health workers were benefitted with
the education sessions
Success:
• These sessions helped health care providers to realize their responsibility to care for
spiritual well being of patients for early recovery from illness and enjoy good health.
• Health care providers agreed to promote prayer among patients in form of a

catalytic agent in disease management especially in case of life style diseases, anxiety and
depression, fear of cancer , separation from loved one.
• Health care providers agreed to use FICA from ISPEC book to know spiritual history
of patients attending out door in primary health care setting.
Challenges:
• Lack of time to practice promotion of prayers and taking spiritual history while
patients are in queue, and don’t want to wait longer.
Table 2.
SELECTED SLIDES FROM ISPEC 2018 FOR HEALTH WORKERS EDUCATION AUGUST 2018
(N=142)
M1-6 U DEFINITION OF HEALTH

M1-6L DOMAINS OF WHOLE HEALTH
M 1-11 HOPE FAITH LOVE PEACE AND BELIEVE
M1-12 U+L ASSOCIATED STUDIES
M 1-13 HEALTH CARE OUTCOMES
M 1-23 RECOMMENDED STANDARDS FOR SPIRITUAL CARE
M1-23 (U+L) RECOMMENDED STANDARDS FOR SPIRITUAL CARES
M 1-25 SUGGESTED GUIDELINES FOR INTEGRATING SPIRITUALITY INTO PAEDIATRICS
M 1-26 PROFESSIONAL GUIDELINES
M1-27 STANDARDS OF PRACTICE FOR PROFESSIONAL CHAPLAINS
M 1-28 U GENERALISTS SPECIALISTS MODEL
M 1-28 THE ROLE OF THE CLINICIANS IN GENERALISTS SPIRITUAL CARE
M 1-43 AUSTRALIAN NATIONAL GUIDELINES FOR SPIRITUAL CARE IN AGED CARE
M 1-59 SPIRITUALITY DEFINITION
M 1-60 VIDEO:CALL TO THE WORLD/ LOVE AND FORGIVENESS IN HEALTH SERVICES- GLOBAL GATHERING
M 2-4 U CLINICAL TRIGGERS FOR RAISING SPIRITUAL ISSUES
M2-4L SPIRITUAL DISTRESS
M 2-7 U EARLY YEAR AND CHILDHOOD
M 2-7 L TODDLERS AND CHILDREN
M2-8 U TODDLERS AND CHILDHOOD
M 2-8 L ADOLESCENE
M2-9 U LATE ADOLESCENCE
M2-9 L ADULTHOOD
M2-10 U ADULTHOOD
M2-10 L LATER LIFE
M 2-11 U GEROTRANSCENDENCE
M2-11 L GEROTRANSCENDENCE SUBSCALE
M2-13 U SPIRITUALITY IN GRIEF / BEREAVEMENT
M 2-13 L HOW CAN ADRESSING SPIRITUALITY IN THE CLINICAL SETTING HELP THE PATIENT HEAL
M2-15 U FINDING MEANING IN THE MIDST OF SUFFERING
M2-16 L SPIRITUAL DISTRESS
M2-18 U SPIRITUAL DISTRESS DIAGNOSIS
M2-18 L SPIRITUAL DISTRESS
M2-19 U SPIRITUAL DISTRESS
M2-19 L CRITERIA FOR SPIRITUAL DISTRESS DIAGNOSIS
M 2-26 U ATTRIBUTES OF PSYCHOLOGICAL DISTRESS
M2-26 L SOCIAL DISTRESS
M 2-34 PATIENT DIGNITY INVENTORY
M2-49 FIG.1. SPIRITUAL DIAGNOSIS DECISION PATHWAY
M2-50 FIG.2. SPIRITUAL CONCERNS OR DIAGNOSIS
M 2-53 SPIRITUAL HEALTH ASSESSMENT
M 3-3 L CARE OF THE PERSON:BASED ON HONORING DIGNITY- MOTHER TERESA
M3-7 L ETHICS: ATTENDING TO SUFFERING
M 3-8 MEDICINE AS SERVICE
M 3-9 U COMPASSIONATE CARE:CLINICAL DANCE OF SCIENCE AND SPIRITUALITY
M3-9 L CONSENSUS CONFERENCE: SPIRITUAL CARE MODELS
M3-12 U COMPASSIONATE PRESENCE
M 3-19 L HOW CAN WE GET TO COMPASSIONATE PRESENCE
M 3-20 U COMPASSION : SPIRITUALITY IN ACTION
M3-20 L BEING PRESENT TO ONESELF: ESSENTIAL PART OF SELF- CARE AND PROFESSIONAL DEVELOPMENT
M 3-30 U REFLECTION ON PRESENCE
M 3-34 U RECOMMENDATION COMPASSIONATE PRESENCE IN CLINICAL CARE
M3-38 SPIRITUAL CARE QUESTIONS FROM NURSE TO PATIENTS
M 4-1 MASSAGE FROM DR.PUCHALSKI AND REV. DR.TRACE HAYTHORN
M 4-14 U FICA (SPIRITUAL HISTORY ADAPTED FOR KB MEDICAL CLINIC HISTORY TAKING)
M 4-17 L SPIRITUAL ASSESSMENT MODELS
M 4-19 U SPIRITUAL DISTRESS ASSESSMENT TOOL (SDAT)
M 4-21 L HOPELESSNESS
M 4-22 U L SPIRITUALITY OF NATURE
M 4-23 U ETHICAL STANDARDS FOR ADRESSING SPIRITUALITY WITH PATIENTS
M 4-24 RECOMMENDATIONS ………………………TO USE
M 4-36 QUESTIONS TO ASSESS EFFECTS OF CULTURE ON HEALTH CARE ….. TO USE
M 4-38 CASH ASSESSMENT TOOL
M 4-39 FACIT-SP-12 (VERSION)
M 4-40 THE HOPE QUESTIONS
M 4-41 EXAMPLES OF QUESTIONS FOR THE HOPE APPROACH TO SPIRITUAL ASSESSMENT
M 4-42 THE SPIRITUAL HISTORY
M 4-43 CASE STUDY #1
M4-44 CASE STUDY #2
M 4-50 FICA SPIRITUAL HISTORY TOOL
M 4-51 SPIRITUAL ASSESSMENT
M 5-10 U REFLECTIVE LISTENING
M5-10 L CONNECT PATIENTS TO COMMUNITY RESOURCES
M5-11 U CHART DOCUMENTATION
M 5-33 NARRATIVE: BELIEF IN MIRACLES
M5-14 U CHAPLAIN INTERVENTION IN CLINICAL CARE
M5-14 L CHAPLAINCY INTERVENTIONS
M5-18 L NARRATIVE MEDICINE
M5-19 U SPIRITUAL CARE INTERVENTIONS: LIFE REVIEW INTERVENTION
M5-19 L SPIRITUAL CARE INTERVENTIONS: LIFE REVIEW INTERVENTION (AN EXAMPLE)
M5-20 U SPIRITUAL CARE INTERVENTIONS: MBSR
M5-20 L SPIRITUAL CARE INTERVENTIONS: FORGIVENESS THERAPY
M5-23 L SPIRITUAL CARE INTERVENTIONS: INTEGRATED SPIRITUAL THERAPY INTERVENTION
M5-25 U Y VONNE
M5-25 L SPIRITUAL HISTORY
M5-26 U REVIEW OF SYSTEMS
M5-29 L NARRATIVE: NEW PATIENT WELLNESS VISIT
M5-30 U SPIRITUAL HIISTORY VISIT 1
M5- 30 L SPIRITUAL HIISTORY VISIT 2
M5-31 L INTERVENTION BY THE TEAM
M 5-37 U BIOPSYCHOSOCIAL-SPIRITUAL MODEL ASSESSMENT AND PLAN
M 5-38 U RECCOMENDATIONS
M 5-46 &64 FICA AS VALIDATED TOOL FOR SPIRITUAL HISTORY TAKING
M 6-3 U ETHICAL CHALLENGES IN SPIRITUALITY AND HEALTH
M6-3L RELATIONSHIP BETWEEN CLINICIAN AND PATIENT
M 6-4 U ETHICAL CHALLENGES IN SPIRITUALITY AND HEALTH
M6-4L ETHICAL PRINCIPLES OF PROVIDING SPIRITUAL CARE
M 6-5 U CULTURAL COMPETENCE
M 6-6 U SPIRITUAL COUNTERTRANSFERENCE
M6-6L SPIRITUAL COUNTERTRANSFERENCE SCENARIO 1
M 6-7 U SPIRITUAL COUNTERTRANSFERENCE
M 6-7 L REFLECTION
M6-8 U BETTER RESPONSE
M 6-12 PRAYER AT THE BEDSIDE
M 6-13 U PRAYER:SCENARIO 1
M6-13 L REFLECTION
M 6-14 U PRAYER:SCENARIO 2
M6-14 L REFLECTION
M 6-15 U PRAYING WITH PATIENTS
M6-15 L ETHICS AND PRAYING WITH PATIENTS FOR PHYSICIANS
M 6-20 SPIRITUAL DEVELOPMENT AS A PART OF PROFESSIONAL DEVELOPMENT
M6-21 U CONCEPTS OF CALL AND VOCATION
M6- 21 L PRESENCE IS CONTEMPLATIVE PRACTICE
M6-22U CONSENSUS CONFERENCE : SPIRITUAL MODELS:
M6-22L MODEL OF SPIRITUALITY AND COMPASSIONATE
M 6-27 U REDUCING BURNOUT:THE ROLE OF SPIRITUALITY
M6-27 L SPIRITUAL EXPERIENCES
M 6-29 CULTIVATING A SPIRITUAL PERSPECTIVE
M6- 28 U SPIRITUALITY IN CARING OF THE PATIENTS
M6-28 L SPIRITUALITY IN HEALTH
M6-29 CULTIVATING A SPIRITUAL PERSPECTIVE
M6-30 U SPIRITUAL PRACTICE HELPS CULTIVATE AWARENESS OF THE SPIRITUALITY IN LIVES
M6-30 L STOP LOOK AND GO
M 6-31 U HAVING A REFLECTIVE OR SPIRITUAL PRACTISE
M6-31 L SPIRITUAL PRACTISE
M 6-32 U MINDFULNESS MEDITATION PRACTICE
M6-32 L LECTIO DIVINA
M 6-33 U MURAQABAH SUFIS CONTEMPLATION AND MEDITATION
M6-33 L CONTEMPLATIVE JEWISH PRACTICE
M 6-34 U CONTEMPLATIVE BUDDIST MEDITATION
M6-34 L CONTEMPLATIVE ARTS, JOURNALING, MUSIC
M 6-35 U DIALOGUE, DEEP LISTENING, REFLECTION, STORYTELLING
M6-35 L CONTEMPLATIVE BODY MOVEMENTS
M 6-36 U CARE OF THE CAREGIVERS: RESTORATION AND RECREATION
M6-37 U FICA : A SPIRITUAL SELF- ASSESSMENT TOOL
M6-37 L SPIRITUALITY FOR REFLECTION FOR PHYSICIANS
Goal 2. To conduct once in 3 months spiritual health care education session to develop
spiritual well being of hypertensive patients and measure the level of satisfaction
Activities
• Within 12 months period 4 sessions have been conducted.
Success:
• 1000 copies of each of 2 types of pamphlets title “Spiritual Practices & Physical
Mental Health and Wellbeing” (Contents of the pamphlet is in Table 3); and “Spiritual Health
Education for Life Style Diseases and Chronic Illness” (Contents of the pamphlet is in Table
4)were printed and distributed to patients, patients care takers, and community members.
• Besides the KB Medical Clinic Spiritual health education session was conducted in the
Charitable Sai Baba Clinic Gaborone and in a Church in Gaborone.
• People expressed their satisfaction towards spiritual message addition with

medication
Challenges:
• People have different views of prayers
• Some seniors people afraid of misinterpretation of spiritual messages with

medicines, which might cause problem. Therefore, we need to careful while providing
spiritual messages.
c
Dr Yadav iproviding health education session with
refence to spiritual well being and Non communicable disease and over all health @ Sathya
Sai Baba free Medical Clinic , Gaborone, Botswana
Two participants (one in each photo) read the Spiritual Health education pamphlets:
In K B Medical Clinic the young lady is reading the spiritual health

education messages on “Spiritual Religious Practices & Physical Mental Health and Well
being
Messages on first pamphlet:
SPIRITUAL RELIGIOUS PRACTISES &
PHYSICAL MENTAL HEALTH AND WELL BEING
Our health care system is currently experiencing pressure. Care for HIV positive population,
elderly people, under five children, growing burden of lifestyle diseases, accident will multiply
pressure on health care system in coming years globally. It has become an urgent call to move
from disease treatment culture to disease prevention and health promotion culture. There is
urgent call to know evidence based best life practices which enhance quality of life with no
extra cost, provide better physical and mental health, increase coping strength during serious
illness, strengthen body immunity, helps to adherence to medical treatment ,make better and
stable social and professional relationship. Answer of our search is our spiritual religious
practices. There is abundance of medical research findings to make our life better with no cost,
simply by increasing spiritual practices
Medical sciences researches show beneficial effects of

Spiritual / religious practices on peoples Physical and Mental health and Wellbeing
• Prayer or reading a sacred text can have salutary effects on physical and mental health
(Puchalski, et.al –ISPEC)
Spiritual practices provide:
• Improved health related quality of life,
• Better physical well being
• Decreased depression or anxiety
• Improved coping strength during serious illness
• Increase adherence to treatment,
• Improved social functioning and maintaining social relationships
(Balboni, et al . 217;Holt,et al. 2009;Barlow,et al. ,2013; Jafari, et al.2013; Salsman, et al.
,2015) (ISPEC 2018)
• People who provide religious support and encouragement to others- through prayers,
scripture reading, etc experience greater quality life and less depression when physical
ill.
• People who attend church and pray or read religious scripture regularly are less likely to
abuse alcohol or smoking cigarettes
• People who are actively involved in religious community may have stronger immune
systems that are more able to fend off infection and protect other disease
• People who regularly attend church, pray, and read religious scriptures have lower
blood pressures and are less likely to have the disease hypertension.
( From book “The Healing Connection; Harold G.Koening, with Gregg Levis 2004)
Spiritual religious practices include:
• Regular daily prayer, Meditation, Spiritual services, Sacred text reading and more
Gratitude practices and more
(Puchalski et al &Mcskimming, 2006)
Suggestion for Health Care Institutions:
• Health care systems and settings focus on health and wellness and not just on disease
• Spiritual care is integral to compassionate, person centered health care and is a
standard for all health settings
(Puchalski, et: al- 2014;2012 (ISPEC 2018)
For further details on scientific research findings, please contact DR B.P YADAV , KB MEDICAL
CLINIC, KB MALL; CELL +267 75236246 TELL: +267 3913823
Messages on second pamphlet:
SPIRITUAL HEALTH EDUCATION FOR LIFE STYLE DISEASES AND CHRONIC ILLNESS
(HYPERTENSION, DIABETES, ARTHRITIS, CANCER AND OTHER DISEASES)
“I went to clinic in the morning; was examined late afternoon, and came back home without
medicines. The clinic has no medicine; and I have no money to buy” Nowadays many mothers,
elders, brothers and sisters tell their similar painful experiences; although service providers are
doing their best to help sick people. It presents a clear picture that nowadays people are
becoming more sick and remain like that for longer period. Number of hypertension diabetic
patients is increasing day by day. They have become life-time medicines and clinic dependant. It
shows the urgent need to shift from a culture of sick treatment to a culture of enjoying good
health and happiness. All we wish to have is minimum suffering days from sickness, small cost of
medicine and overall health care services. Challenges come, how to achieve that. Key to achieve
that is available. Abundance of evidence based medical research has shown that an individual’s
spiritual wellbeing or spiritual practice is a secret of a happy and health life. It is also a secret
early recover from illness with minimum expenses for health services, which leads to a
transformative lifestyle to overcome lifestyle diseases, such as hypertension, diabetes, heart
diseases and cancers.
Getting inspired from “ {(i) health care systems and settings focus on health and wellness and
not just disease; and (ii) spiritual care is an integral to compassion, person centered health care
and standard for all health settings; Puchalski et al 2014; (iii) physical, mental health benefits of
spiritual practices (ISPEC 2018; The Healing Connection by Harold G.Koenig, 2000)}”.
We have adopted Spiritual wellbeing intervention in primary health care services to prevent
Spiritual crisis, to accelerate early from lifestyle associated diseases, such as Hypertension,
Heart Diseases, Diabetes and Cancers and others. Spiritual observations, such as prayer,
Meditation, reading sacred books and others culturally and traditionally preferred spiritual
practices have been recommended as spiritual intervention. Now, we know evidence based,
research supported importance of spiritual practices in relation to relief from disease
discomfort, healing from physical and mental illness, and enjoy better quality of life. It is time
now, to decrease disease burden, to prevent or reduce stress, depression, and faster recovery
from diseases, to reduce disability and other life style diseases associated consequences, to
spend less money and less time to manage our sickness, we need to adopt culturally preferred
spiritual practices on regular basis. Following are suggestion:
• Go in silence for a moment, and pray for a minute while you take your daily medicine
dose.
• Have trust, prayer will go catalytic effect and will enhance efficacy of medicines.
• Have faith in healing power of God; as with God medicine will work better and faster.
• Feel happy, try to display your joyfulness, irrespective of diseases driven physical
discomfort.
• Read everyday inspiring motivating lines from your spiritual scriptures.
• Be grateful. Show your gratitude for the life we have, for the progress towards a better
health and happy life.
• Spiritual practices encourage and support us to have health friendly foods, drinks and
entertainments; and discourage unhealthy things.
• Care givers are also advised to practice spiritual activities to remain emotionally
unaffected from the patients ill health related conditions.
For further details on scientific research findings, please contact DR B.P YADAV , KB MEDICAL
CLINIC, KB MALL; CELL +267 75236246 TELL: +267 3913823
Goal 3. To conduct once in 3 months spiritual health care education session for youth –
students to prevent HIV & STI and measure the level of satisfaction
Activities
• Within 12 months period 4 sessions have been conducted in a small group of

students.
Success
AND DRUGS MISUSE” pamphlets were printed and distributed among students and
community members.
Challenges
• Students / youths seems less inclined towards spiritual practices
• They less visit church for prayer.
Spiritual Health Education to Students on HIV prevention and Drug Misuse

Messages on third pamphlet:
SPIRITUAL HEALTH EDUCATION TO PREVENT
HIV TRANSMISSION AND DRUGS MISUSE
Generally we hear from parents that school going young and youth have become victim of
alcohol, and illicit drugs. Many of them also have reported drug dependant life. Parents also
express the fear of teenage pregnancies, multi partner bodily relationship and HIV infection to
youths. In present time it has become public health problem, which needs urgent address from
all levels of society as well as from concerned public institutions. The problem invites us to look
at the way we support our youths. It seems as youth supporting style behavioural health
phenomenon. Lack of parental involvement with young in day to day life, lack of sufficient
physical exercise by youth, and lack of skills for generation of natural happiness by activating
individual body, mind, and inner energy are unrecognised important factors for unhealthy youth
behaviours, such as HIV infection risk behaviour and misuse of drugs to feel happy.
Happiness is the main matrix of human life. Whatever we do, we do to seek happiness,
pleasure. If e youth doesn’t know how to derive happiness from his /her own body, mind and
inner energy as natural process of life, he/ she turns towards drugs, and multi partners bodily
relation friendship.
Getting inspired from “ {(i) Health care systems and settings focus on health and wellness and
not just on disease; and (ii) Spiritual care is integral to compassionate , person centered health
care and is standard for all health settings; Puchalski et al 2014; (iii) Physical, mental health
benefits of Spiritual practices (ISPEC 2018; The Healing Connection by Harold G. Koenig , 2000)}”.
At puberty, new hormone plays significant role in body of both boys and girls, which masks the
intelligence of person; and they become irritable and start looking for mental peace and
happiness in opposite sex friends and drugs.
To enjoy an energetic body, peaceful mind, and vibrant inner energy for youths (school going, as
well as out of schools)we have spirituality amalgamated health education messages. It also
helps to deal with life pressure and peer’s pressure, and to enhance having good physical and
mental health while acknowledging hormonal changes in the body.
Be aware of hormonal changes in your body, which is responsible of emotional changes

in you now. It is age dependant. It will go after some age. Therefore, handle mental
emotion peacefully with full awareness.
• Be firm that it is a biological issue. Evolving as a body need with growing age. Handle
with ease. Never allow it to be a mental issue.
• Develop skills to generate happiness within your own body through practice of hatha
yoga, pranayam and meditation.
• Make a practice of daily prayer at your own place. If possible, once a week participate in
community prayer at worship place.
• 10-20 minutes time devotes to read spiritual literature.
• Develop a relationship with nature. Loving, caring relationship with plants at your
nearby.
• Be grateful. Show your gratitude for the life we have. Make it always better.
• Go for healthy food, fruits and vegetables and healthy entertainments. Give up
unhealthy food, drinks and entertainment.
For further details on scientific research findings, please contact DR B.P YADAV ,
KB MEDICAL CLINIC, KB MALL; CELL +267 75236246 TELL: +267 3913823
ADDITIONAL
ACCOMPLISHMENT
1. Experience of Using FICA Spiritual History Tool
at Primary Health Care Clinic in Gaborone Botswana
Abstract
Context: Increased evidence of significant contribution of spiritual well being in quality care
is well proved. For spiritual intervention in health care, spiritual history becomes a very
important component. Faith or Believe, Importance, Community, and Address in Care
(FICA) is one among very few standardized spiritual history tool.
Objectives: The purpose to document experience using FICA Spiritual tool at K B Medical
Clinic Gaborone Botswana was (i) to know patients acceptability of use of FICA spiritual tool
in primary health care, and (ii) to know usefulness of FICA spiritual tool in disease
management in primary health care.
Methods: The pilot project was conducted at KB Medical clinic, which is a primary health
care clinic in Gaborone, Botswana. The frame work of FICA tool includes: Faith and Belief;
Importance and Influences; Community and Address /Action in Care. Convenience sampling
method was adopted. It was a self-administered questionnaire.
Results: Out of 117 participants 112 belong to spiritual/ religious category, and eighty
percent (94/117) population is below 40 years of age. Majority are Christian faith followers
are 85.5% (100/117), and less than five percent (5/117) consider themselves neither
spiritual nor religious. Seventy seven percent (90/117) are associated with Christian church,
while only 15% (18/117) are not associated with religious community. More than one third
participants believe that faith provides courage or protection or hope or strength in tough
time in life. Twelve percent has recognized that faith inspires or motivate for better life.
Similarly, another 12% participants have recognized faith as very important or important
factor in life. Forty point two percent (47 /117) believe in healing power of prayer (25/117)
and God (22/117). Some have acknowledged the role of faith in prevention of bad practice,
such as alcohol or adultery; and promotion of good health friendly practice. For
management of illness 15.4% (18 /117) wished that the physician should pray for or with
them (of course, this wish is additional than regular prescription). Fourteen point five
(17/117) have expressed their full trust in doctor, as they fully depend on doctor’s way of
management, while 13.7% (16/117) want the doctor should concentrate on medical
prescription only.
Conclusion: It seems that FICA spiritual history tool is a user friendly, simple and
informative tool for assessment of spirituality in primary health care setting. Addressing
spiritual needs and concerns of patients is very important in enhancing quality of life in term
of health and happiness. Evaluation of FICA in different clinical settings is suggested.
Key words: FICA spiritual assessment tool, Spiritual care, primary health care
Introduction
The World Health Organization (WHO) current definition of health includes three dimensions,
namely physical, social and mental well being(1). Considering the growing importance of spiritual
well being, many health professionals have suggested to include spiritual well being as fourth
dimension of health (2,3).
Observations have documented the role of spiritual well being in improving health and reduction of
mental disorder significantly (4-6).
Dr Puchalski et al has recommended that health care systems and settings should focus on health
and wellness and not just on disease. The team has also said that Spiritual care is integral to
compassionate, person centered health care and is a standard for all health(7).
Pandav and Kumar recommend that spiritual well being should be promoted at primary care level in
routine health promotion activities by grass-root level workers, and the assessment of spiritual
needs must be incorporated in routine curative care, especially among those with chronic
diseases(8).
Several studies have shown that patients feel safe in discussing spiritual issues with health care
providers (9-13). Study by Phelps et al reports that more that three quarters of study population
(78.8%) relied on their religion to support them to cope with advanced cancer stage (13).
Previous studies have shown that 41% -94% of patients and family care givers want their heath care
providers to address their spiritual concerns(14-17). Ehman et al, in a study with self –administered
survey reported that 66% of the participants responded that they would like their physician to ask
whether they have spiritual or religious beliefs that would influence their medical treatment
decisions if they become seriously ill (18).
A study at family practice residency site by McCord et al.(19) has reported, eighty-three percent
wanted their physicians to ask about spiritual beliefs in some situations, 67% reported that
information about their spiritual beliefs would affect the physician’s ability to provide realistic hope,
66% thought it will influence doctor’s medical advice, and 62% change medical treatment.
Borneman et al have reported that FICA spiritual assessment tool is a feasible tool for clinical
assessment of spirituality . They also recommend that additional use and evaluation by clinicians of
FICA tool in usual practice settings are needed(20).
The goal of FICA spiritual tool use was to improve person –centered care by introducing spiritual
intervention to needy patients for better health outcomes.
Followings were objectives :
(i) To know feasibility of use of FICA spiritual tool in primary health care
(ii) To know usefulness of FICA spiritual tool in primary health care
Botswana demography
The population of Botswana was estimated at 2,024,904 in 2011 (21). An estimated 70 per cent of
the country's citizens identify themselves as Christians. Government meetings begin with a Christian
prayer. Religious education is part of the curriculum in public schools; it emphasizes Christianity.
Only Christian holy days are recognized as public holidays (22).
Adoption of the FICA spiritual history tool
A spiritual history tool is a set of questions designed to find out patients spiritual / religious
preferences, beliefs and practice regarding disease management, and expectations from health care
providers to address their spiritual needs. Presently there are several available spiritual history tools,
however, we have adopted FICA history tool developed by Dr Christina Puchalski and team Figure1.
The FICA tool has four domains of spiritual assessments: (i) Faith, belief, or meaning; (ii)
Importance; (iii) Community; and (iv) Address in care. All together has made an acronym FICA.
Faith, belief, or meaning provides opportunity to patients to share their religious / spiritual practices,
its importance in day to day life, as well as in difficult situations of life; and Its overall meaning in
individual’s life. Importance discuss about importance of religion / spirituality in individual’s life,
influence on health care, as well as influence on treatment during illness. Community provides
prospect to share practicing spiritual/religion community, and its role in case of illness. Address
invites individual’s opinion on intervention for spiritual need. The tool comprises of both some
closed end questions and some open ended questions.
Materials and Methods
This study is a part of ISPEC 2018-2019 project, which is a descriptive qualitative in nature. It aims
to explore feasibility and usefulness of FICA tool to make more effective patient centered care in
primary health care.
FICA acronym stands for: F – Faith and Belief; I - Importance and Influences; C- Community;
and A- Address / Action in Care.
Faith and belief section allows asking questions to identify patient’s religious / spiritual belief and
practice, patients’ view on role of religious / spiritual belief in time of difficulty. It also allows
knowing life meaning. Importance and influence allow asking patients about importance of religious
belief in personal life, the way it influences care during illness, and role of spirituality to regain
health. Support section allows identifying their religious spiritual groups where they are associated
with, as well as the support system in case of need. Address in care section allows them to express
their desire with relation with care.
It was a self-administered questionnaire. The objective of the survey was introduced to the
participants. Verbal consents of participation were obtained. Health benefits were described to
patients; and 2 health education pamphlets titled “Spiritual Religious Practices & Physical Mental
Health and Well being” and “Spiritual Health Education for Life Style Diseases and Chronic Illness”
were given to the participants during introduction. They were informed that they are free to answer
or not to answer any of the questions. Patients were given a questionnaire with FICA tool printed in
English. They answered without any interference from the staff. Convenience sampling method was
adopted, because no one (either patient or health worker) should feel pressure of time or other
urgency or stress.
Figure: 1. FICA TOOL FOR SPIRITUAL ASSESSMENT
F- Faith and Belief

• Do you consider yourself religious /spiritual?
• Do you have religious / spiritual beliefs that help you cope with stress in difficult
time?
• What gives your life meaning
I-Importance
• What importance does your faith or belief have in your life?
• Have your beliefs influenced how you take care of yourself in this illness?
• What role do your beliefs play in regaining your health?
C- Community
• Are you a part of a religious / spiritual community? (e.g. churches, temples,
mosques etc.)
• Is this of support to you, and how?
• Is there a group of people you really love or who are important to you?
A- Address in care
• How would you like your doctor to address these issues in your treatment?
Adopted from ISPEC 2018
Results
Table 1.
DEMOGTAPHIC OF PARTICIPANTS (n=117)
Sex wise n %
Male 59 50.4
Female 58 49.6
Age wise
Age range (Years) 18-56
Mean (Years) 34
Age Group n %
< 20 years 8 6.8
20-30 Years 37 31.6
30-40 Years 49 41.9
40-50 Years 17 14.5
50-60 Years 6 5.1
Religion wise n %
Christian 100 85.5
Hindu 2 1.7
Zlow 1 0.9
Tswana 1 0.9
Traditional 1 0.9
Catholic 1 0.9
Spiritual healing 1 0.9
Higher being 1 0.9
Religious without specification 4 3.4
No religious /spiritual 5 4.3
Diseases wise n %
Respiratory problems ( URTI, chest infection, cough, chest pain) 16 13.7
Headache, Dizziness, body pain 13 11.1
Back pain ( Lower back pain , upper back pain) 12 10.3
Skin problems (skin bacterial infection, skin rash, achene, skin fungal infection 11 9.4
Heart burn , Gastritis 10 8.5
Gastrointestinal problems ( gastroenteritis, diarrhea, vomiting, dysentery) 9 7.7
Anxiety , depression 7 6
Tonsillitis & Laryngopharyngitis 7 6
Sexually transmitted infections , vulvovaginitis 6 5.1
Eye problems ( conjunctivitis, blephritis) 5 4.3
Hypertension, diabetes 4 3.4
Injury 4 3.4
Dysmenorrhea 3 2.6
Urinary tract infection 2 1.7
Miscellaneous (dog bite, human bite, exhausted, breast lump, cervical lymphadenopathy,
erectile dysfunction, arthritis, ear pain, hemorrhoids, anemia ) 8 6.8
Table 1 presents the demographic characteristics of the participants. Patients were
from both sexes approximately equal. Female and male were 49.6% and 50.4%
respectively. Participants’ age range varies from 18 years to 56 years with mean age
34 years. Eighty percent (94/117) population is below 40 years of age. Majority are
Christian faith followers are 85.5% (100/117), and less than five percent (5/117)
consider themselves neither spiritual nor religious.
Table 2
Response for closed end questions (n=117)
THEMES YES NO
n % n %
• Do you consider yourself religious 112 95.4 5 4.6
/ spiritual?
• Do you have religious / spiritual 102 87.2 15 12.8
beliefs that help you cope with
stress in difficult time?
• Have your beliefs influenced how 89 76.1 12 7.9
You take decision for illness
treatment*
• Are you part of a religious 99 84.6 18 15.4
/spiritual community?
(*About belief influence on care decision 16 have unclear opinion.)

Table 3
Quantitative Summary of Key Issues in Response to the “Faith/Belief/Meaning”
Themes
Faith/Belief/ Meaning Themes n=117 (100%)

• (God related faith or love or purpose or praise or worship
or relationship 56 (47.9%)
• Prayer or meditation 23 (19.7%)
• My family and kids 15 (12.8%)
• Reading bible or word of God 12 (10.3%)
• Appreciation of life activity 7 (6.0%)
• Positive state of mind 5 (4.3%)
• Love, hope and happiness 5 (4.3%)
• No answer (spiritual or non spiritual or not clear) 9 (7.7%)
(Non believers are in no answer).
Examples:
FICA 001: Living to do my God given purpose.
FICA 002: The word of God.
FICA 004: Faith in GOD and praise gives a meaningful life.
FICA 007: Believing in God, being hopeful, praying daily.
FICA 015: Believe in God (my faith God) Watching my kids growing up under the Grace of God.
FICA 024: Prayer and meditation.
FICA 030: Being a committed Christian and submitting to God as well as my well being.
FICA 032: Life to me means the healthy body and soul that is active breathing and feeding.
FICA 036: By reading the bible and listening to any religious channels to cope myself or listening
to Gospel music.
FICA 037: Love gives my life meaning.
FICA 056: Respect, love, trust and faithfulness.
FICA 065: God and family.
FICA 83: Praying and caring a lot to my family.
FICA 86: Living according to God way and reading the bible.
FICA 90: The purpose to serve what God sent me for.
FICA 99: I always going to church when I am low in mood.
FICA 109: Hope faith and religion.
FICA 111: Girlfriend and brother.
FICA 115: Believing in God for prosperity and good life.
FICA 117: God.
Table 4
Quantitative Summary of the Response to the Question of
"I- Importance and Influence" Themes
I- Importance and Influence Themes in Life n=117 (100%)
• Faith provides courage, protection, hope, strength in tough time in life 39 (33.3%)
• Faith inspires, motivate for making life better 14 (12.0%)
• Faith is important, very important 14 12.0%)
• Faith gives meaning, purpose in life 11 (9.4%)
• Faith brings close, connect to God 11 (9.4%
• Faith provides guidance, teaching in life activities 09 (7.7%)
• Faith refrain from smoking, alcohol, bad behaviour 06 (5.1%)
• Faith helps for better decision making 04 (3.4%)
• Faith boosts moral or confidence or determines values or principles 03 (2.6%)
• Faith helps control depression 03 (2.6%)
• Faith motivates for bible life 02 (1.7%)
• No answer 05 (4.3)
Examples:
FICA 001: It is important it guides me.
FICA 002: Gives me a meaning.
FICA 004: It teaches me on how i am suppose to do to live an active and healthy all times
FICA 006: It guides me in every aspects of my life.
FICA 012: To live a better life.
FICA 017: It is vital in my life for it gives me a reason to live life that is meaningful and purposely.
FICA 022: It helps in case of depression.
FICA 031: It brings me close to my God.
FICA 032: Guides me through life on daily bases.
FICA033: Help in reducing depression and improves social functioning.
FICA 034: It gives me hope and courage in times of sadness.
FICA 035: Having faith is important in my life as it give me courage to work at things positivity.
FICA 039: It helps me manage the trials and tribulation of life.
FICA 045: My faith or belief I have in my life, every time I pray to God I get what I want or ask.
FICA 051: Helps me to be able to survive every situation I face.
FICA 055: It gives me faith to carry on with life and cherish the presence of God in my life.
FICA 057: It prevents me from doing bad things.
FICA 062: It gives me courage, guides me and mostly helps me to be at peace.
FICA 082: It guides me to live righteously.
FICA 094: It gives me divine guidance, counsels and wisdom.
FICA 102: It keeps me grounded and helps me cope in difficult times.
FICA 110: Great impact to my life.
FICA 112: It helps me to cope with all the situation I come across.
FICA 115: It motivates me and give counseling .
Table 5
"I- Importance and Influence" Themes
I- Importance and Influence Themes in Regaining Health n=117 (100%)
• Faith encourage to prayer which brings healing 25 (21.4%)
• God related healing 22 (18.8%)
• Faith gives hope, courage, perseverance, strength 15 (12.8%)
• Faith brings peace of mind or Positivity 10 (8.5%)
• Adherence to medication 6 (5.1%)
• Eating healthy food 6 (5.1%)
• Faith reduces stress 3 (2.6%)
• Mixed views 23 (19.7%)
• No answer 10 (8.5%)
(Forty point two percent (47/117) People have faith in healing
power of prayer + God).
Examples:
FICA 001: Gives me hope.
FICA 003: I like Apostle Paul in the book of Thessalonians that we Christian will suffer but it will
come to pass.
FICA 006: They bring me peace of mind and healing.
FICA 013: Reinforces my physical and social being.
FICA 017: I worry not for, I know that God will heal me and it helps me to be positive until I recover.
FICA 021: Religious support and encouragement to others through prayers.
FICA 030: My beliefs discourage abuse of substance that allows me keep well.
FICA 032: They play a very important role.
FICA 036: Doctor treats and God heals.
FICA 039: You pray and leave it upto God to help and deal with your situation.
FICA 042: It restricts me from drinking alcohol and indulging in adultery.
FICA 053: It reduces stress.
FICA 060: That by his strips I am healed.
FICA 061: Through by praying and eating healthy food.
FICA 068: It strengthen me during my sickness.
FICA 077: If I am not well am checking the doctor.
FICA 088: Staying away from bad behaviour and bad food.
FICA 089: I pray, fast and meditate in the word of God.
FICA 094: It has given me strength, patience and perseverance. I believe I am an over comer.
FICA 095: I believe prayer conquers all which is why i always pray for good health and recover.
FICA 103: Some of our health issues need Doctors.
FICA 107: Praying soothes me.
FICA 111: Give me strength to adhere to my medicine.
FICA 113: Relieving stress
FICA 115: It gives me path to health good decision.
Table 6
Quantitative Summary of the Response to the
Key Issues in Response to the "C-Community" Themes
Community Key Themes n=117 (100%)
Religious Community Key Theme

• Christian Church 90 (76.9%)
• Other Churches 6 (5.1%)
• Unidentified religious community 3 (2.6%)
• Does not identify with a religious community 18 (15.3%)
Out of 18 who does not belong to any religious / spiritual community 10 are Christian, 5 non
believers, 2 non Christian religious, 1 unidentified religious / spiritual.
Believers received religious community supports.
Examples:
FICA 003: By their prayers and teachings.
FICA 006: My faith regain after church meetings.
FICA 009: It gives me meaning of life and socialize with people.
FICA 011: Refrain from alcohol.
FICA 014: Helps to pray and know that god heals every disease.
FICA 017: It provides a place to fellowship with other brethren and share word.
FICA 018: It gives me support as I have people to talk to in terms of need and they wont judge.
FICA026: It helps me in socializing with community.
FICA 030: When I feel down I will visit my church where I will gain strength.
FICA 031: They visit me at my place they pray with me and talk to me.
FICA 039: Share ideas, teach and motivate others.
FICA 044: During my lowest moments they motivate me and held me to cope.
FICA 045: Its support to me because it keeps me busy from alcohol abuse.
FICA 059: There is spiritual and moral support I get from other believes.
FICA 063: Yes it does. It gives me peace of mind.
FICA 065: I believe in my churchmates they wont judge me during my problems they will help me.
FICA 068: During my difficult time they are always there for me.
FICA 080: Curchmates give me support and courage.
FICA 092: Yes, it gives me support, I grow spiritually by hearing the word of God and also produce
what it talks about.
FICA 094: It provides a platform for tackling challenges through the word.
FICA 095: It influences the way I live my life positively and Godly.
FICA 102: Yes, because it helps me cope.
FICA 106: Sometimes when have activity at home they help me.
FICA 112: They support me in many ways they are like family to me.
Table 7
How Would You Like Your Doctor to Address These Issues in Treatment
Themes n=117 (100%)
Pray with me or for me 18 (15.4%)
What doctor thinks best or Any how or Any way 17 (14.5%)
Concentrating on medical treatment 16 (13.7%)
Be supportive 11 (9.4%)
Both medically and spiritual way 10 (8.5%)
Health education or counseling or guidance 9 (7.7%)
Encouragement or spiritual advice or motivation 5 (4.3%)
Explanation of medicine or sickness 4 (3.4%)
Bible or scripture reading 4 (3.4%)
Accepting my belief 4 (3.4%)
None specific 16 (13.7%)
No answer 5 (4.3%)
Examples:
FICA 003: By accepting my believes
FICA 006: Both in spiritual and medical manner
FICA 010: Giving me good treatment and good advice in advance
FICA 017: By giving prescribed medicines and spiritual advice
FICA 020 : Keep us close to God and always support us
FICA 024: To pray for me
FICA 025: Pray before listening to my issue and after giving prescription
FICA 030: Well my Doctor should treat me according to his knowledge and experience I will take
my belief aside
FICA 034: I would like Dr to consider my believes in regard to healing
FICA 035: To me Doctor is a God messenger, his or her prescription are determined by God
FICA 036: Prayer treatment and well in giving courage
FICA 039: Not sure, Give me medication the rest is up to God.
FICA 050: Encourage praying and meditation skills
FICA 052: The way he feels comfortable
FICA 055: To always give advice when needed to ensure his patients are well taken of both
spiritually and physically
FICA 063: To give me the best medication
FICA 065: Visit our churches , pray with us when we come to the clinic
FICA 066: The way the Doctor sees befitting
FICA 080: My Doctor may advice me accordingly and if i believe in religious belief then will be
healed
FICA 083: By always praying with me when visit him
FICA 084: To pray for me and diagnose, treat my condition
FICA 091: To encourage me to continue to live for God and that with God nothing is impossible
FICA 094: The Doctor can administer his treatment to the best of his knowledge. He cures and
God heals.
FICA 095: Encourage me to live a positive and healthy lifestyle positively and Godly
FICA 106: I prefer Doctor to do his job what he knows most
FICA 111: Praying with us and encourage us take care of our health
FICA 117: Pray with us and teach us how take of our health
Discussion
This endeavours to know the feasibility of FICA spiritual history tool in primary health care,
and the use of findings for better health care in African cultural and religious context.
Participants were able to complete most of the self- administered questions on FICA spiritual
history tool, and to share their religious beliefs and practice. They have also shared believe
about prayer and God healing power. They recognise faith as very important or important
factor in life.
Overall it shows that administration of FICA tool is simple, patients friendly and feasible to
share religious / spiritual belief in Botswana context. It was able to find out people view on
importance of faith in difficult situation of life. It has also demonstrated influence of faith on
recovery from illness, prevention from depression and hope for recovery. The tool is able to
address the wish of patients to get both medical help and spiritual support as supplement.
They wish physician should perform prayer for them or with them, as they believe that prayer
has healing power. Participants’ beliefs influence decision making for disease management.
Faith promotes adherence with physician prescription, because of believers think that doctor’s
prescription is as God’s instruction.
It has brought much valuable information which can be used for patients’ management in
primary health care. It will help to enhance patients’ doctor relationship and recovery from
illness. Important findings have come out in the study, which can be used to enhance quality
of care. Gaborone population is mostly Christian, therefore, a diverse religious study
population is not expected. Because of, most study population is Christian, the result cannot
be generalized. However, the result may be true representative of Christian population .
Conclusion
Observations suggest that FICA spiritual history tool is a user friendly, simple and informative
tool for assessment of spirituality in primary health care setting. Addressing spiritual needs
and concerns of patients is very important in enhancing quality of life in term of health and
happiness. Evaluation of FICA in different clinical settings is suggested.
References:
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Conference. Representatives of 61 States. New York: Official Records of the World Health
Organization; 1946, 1948. p. 100
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perspective. WHO South East Asia J Public Health 2013;2:3-5.
3. Ali SM. Spiritual well-being: The fourth dimension of health. Indian J Public Health
2012;56:257-8.
4. Koenig HG, Lewis G. The Healing Connection. Philadelphia, Templeton Foundation Press,
2000.
5. Koenig HG, McCullough ME, Larson DB. Handbook of religion and health. New York: Oxford
University Press, 2001.
6. Sithey G, Li M, Wen LM, Kelly PJ, Clarke K. Socioeconomic, religious, spiritual and health
factors associated with symptoms of common mental disorders: A cross-sectional secondary
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practical guide for physicians. JAMA 2002;287:749-754.
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14. Sulmasy DP. A biopsychosocial-spiritual model for the care of patients at the end of life.
Gerontologist 2002;42(Spec 3):24-33.
15. Steinhauser KE, Christakis NA, Clipp EC, et al. Factors considered important at the end of
life by patients, family, physicians, and other care providers. JAMA 2000;284:2476-2482.
16. Walter T. Spirituality in palliative care: opportunity or burden? Palliat Med 2002;16:133-
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22. https://en.wikipedia.org/wiki/Freedom_of_religion_in_Botswana
Table: SPIRITUAL HISTORY USING FICA @ KBMC GABORONE BOTSWANA
FEM
Patient’s name: Date of birth SEX ALE
MALE
Cell no. Medical Aid Date
Diagnosis / C/O
F – Faith and Belief

1 Do you consider yourself religious / spiritual? YES NO
2 If question 1 is YES, then which religion do you practice?.........
3 Do you have religious / spiritual beliefs that help you cope with stress in difficult time? YES NO
4 What gives your life meaning?
I – Importance
5 What importance does your faith or belief have in your life?
6 Have your beliefs influenced how you take care of yourself in this illness?
7 What role do your beliefs play in regaining your health?
C – Community
8 YES
"Are you part of a religious /spiritual community?(e.g. churches, temples, and mosques, etc )
NO
Is this of support to you and how?
9 Is there a group of people you really love or who are important to you? YES NO
A – Address in Care
10 "How would you like your doctor to address these issues in your treatment
BELOW NUMBER 11 & 12 WILL BE FILLED BY THE CLINIC HEALTH /SPIRITUAL EDUCATOR
11 Spiritual intervention
12 Outcome/ level of satisfaction : Satisfied / Unsatisfied Satisfied Unsati.

Adopted from ISPEC 2018
Some samples of FICA data collection sheet.
(2) Prayer as a spiritual intervention in primary health care
as a pilot project
Background
Primary health care
The Declaration of Alma-Ata international conference (1978) defines Primary health care as “
Primary health care is essential health care based on practical, scientifically sound, and socially
acceptable methods and technology made universally accessible to individuals and families in the
community through their full participation and at a cost that the community and country can afford
to maintain at every stage of their development in the spirit of self-reliance and self-determination.
The Declaration of Alma-Ata was clear about the
values pursued:right to better health for all and social justice, participation and solidarity (1).
Spirituality definition
A global consensus derived definition of spirituality is:
“Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate
meaning, purpose, and transcendence, and experience relationship to self, family, others,
community, society, nature, and the significant or scared. Spirituality is expressed through beliefs,
values, traditions, and practices.” (2).
Importance of spirituality in health care
Since ancient time human beings have been using spiritual practices to recover from illness and for
well being. Spirituality by means of prayer is beneficial, for it leads to tension relief, increased hope
and reduced anxiety (3). Koening G has concluded that Many patients are in spiritual, and religious
needs related to their disease can affect their mental health, and failure to meet these needs may
impact their quality of life (4).
Prayer can be significant practice for stabilizing vital signs, not only for people receiving
chemotherapy, but also for other patients or even people in good health. The result displayed that
prayer reduced respiratory rate and improved cardiac function parameters (5). Prayer is a spiritual
activity often used by patients, which seems to facilitate the health /disease transition process and
promote health (6). Studies have documented the role of spiritual well being in improving health and
reduction of mental disorder significantly (7,8, 9).
Puchalski et al (2014) has found that prayer / reading sacred text can have salutary effects on
physical and mental health, and they have suggested that (i) Health care systems and settings focus
on health and wellness and not just on disease; and (ii) Spiritual care is integral to compassionate ,
person centred health care, and is standard for all health settings (2). Studies indicate that Australian
patients want their clinicians to incorporate spirituality into their treatment (10, 11).
Health care status in Botswana
Botswana is passing through epidemiological transition. Non communicable life style diseases and
traffic accident are coming up, while country is facing heavy burden of HIV /AIDS epidemic and
communicable diseases. Public health facilities are feeling serious pressure to meet medicine need
for the common sick population. Further, private health sectors are very expensive, out of reach of
common people. In conventional health care institutions health professionals do not address the
spiritual need of patients.There is no study on Spirituality and Health outcome on Botswana
population.
Botswana demography
The population of Botswana has been estimated at 2,024,904 in 2011 (12). An estimated 70 per cent
of the country's citizens identify themselves as Christians. Government meetings begin with a
Christian prayer. Religious education is part of the curriculum in public schools; it emphasizes
Christianity. Only Christian holy days are recognized as public holidays (13). Mother tongue of
Batswana is Setswana, but English is country official language.
The goals of the study are:
(1) Educate staff regarding importance of integrating spiritual care into primary health care of
patients.
(2) Implement a model of medical prescription with prayer.
(3) Demonstrateacceptance of prayer by the people in primary health care.
Materials and Methods
This study is a part of Demonstration project guided and supervised by the Dr Christina Puchalski
and the ISPEC team.
Setting and participants
Site: Sri KB Medical Clinic, Gaborone, Botswana
Participants: Patients attending out door clinic for primary health care services.
Personal:
Dr Christina Puchalski
ISPEC Team members as necessary (KINDLY PUT THEIR NAMES?

Mrs Tshenolo Kgoladisa Primary health care service provider
Activities carried out:
Step 1.Training of primary health care provider.
Step 2. Permission from Dr Christina Puchalski , and Dr Koenig HG were obtained to use materials
from the ISPEC 2018 and the book “The Healing Connection” respectively for pamphlets and
teaching purposes.
Step 3.Intervention with prayers along with conventional medical prescription.
Step 4. Follow up
Resources:
1. ISPEC (Interprofessional Spiritual Care Education Curriculum) COURSE SYLLABUS George

Washington University, Washington DC. 2018.
2. “AN URGENT CALL FOR HEALTH WORKRS /PROFESSIONALS FOR PATIENTS CARE” (Box 1).
3. “MAY WE TAKE TOGETHER MODERN MEDICINE AND PRAYER TO HAVE BETTER PHYSICAL &
MENTAL HEALTH AND WELL BEING (Box 2).
4. Spiritual Health Education Pamphlet : Spiritual religious practises &
Physical mental health and well being.
5. Spiritual Health Education Pamphlet:Spiritual health education for life style diseases and
chronic illness (hypertension, diabetes, arthritis, cancer and other diseases).
6. Spiritual Health Education Pamphlet:Spiritual health education to prevent HIV transmission
and drugs misuse.
7. “The Healing Connection” book by Harold G. Koenig.
8. “You are My Beloved. Really?” book by Harold G. Koenig.
Activity 1: Training of personnel:
• Director of the clinic (Dr B P Yadav) has received “Train-the-Trainer” training from the
University of Washington, Washington DC on July 10-12, 2018.
• With aim to recognize the role of health workers own spirituality to serve their patients need
better a summary paper sheet of 8 research findings was prepared which contains health
related benefits of spiritual / religious practices. It was named
“AN URGENT CALL FOR HEALTH WORKRS /PROFESSIONALS FOR PATIENTS CARE” (Box 1).
• With aim to enhance knowledge on health benefits of spiritual / religious practices of

patients and care givers a summary sheet with research findings was prepared which
contains health related benefits of spiritual / religious practices. It was named “MAY WE
TAKE TOGETHER MODERN MEDICINE AND PRAYER TO HAVE BETTER PHYSICAL & MENTAL
HEALTH AND WELL BEING (Box 2).
• With help of selected slides from ISPEC 2018, staffs were trained.
Box 1. For health workers / professionals
BOX. 1. : AN URGENT CALL FOR HEALTH WORKRS /PROFESSIONALS FOR PATIENTS CARE
1 Improved health related quality of life
2 Improved coping strength during serious illness
3 Decreased depression / anxiety
4 Increased adherence to treatment
5 Improved social functioning and maintaining social relationships
6 Yoga are helpful in lowering Anxiety level, burn out and stress related health problems
Mindfulness Meditation has positive impact on burnout, anxiety, depression, sense of
7 well-being, and empathy
8 Prayer / reading a sacred text can have salutary effects on physical and mental health
FROM BOOK: “ Interprofessional Spiritual Care Education Curriculum ISPEC)
COURSE SYLLABUS 2018
For Patients and patients’ care takers (Box 2)
BOX.2. MAY WE TAKE TOGETHER MODERN MEDICINE AND PRAYER

TO HAVE BETTER PHYSICAL & MENTAL HEALTH AND WELL BEING
1 Religious / Spiritual practice improves health related quality of life
2 Religious / Spiritual practice improves coping strength during serious illness
3 Religious / Spiritual practice decreased depression / anxiety effect
4 Religious / Spiritual practice increases adherence to treatment
Religious / Spiritual practice improves social functioning and maintaining social
5 relationships
Religious / Spiritual practice - Yoga are helpful in lowering Anxiety level, and stress
6 related health problems
Religious / Spiritual practice - Mindfulness Meditation has positive impact on anxiety,
7 stress and depression.
Religious / Spiritual practice- Prayer / reading a sacred text can have beneficial effects on
8 physical and mental health
FROM BOOK: “ISPEC Interprofessional Spiritual Care Education Curriculum”
COURSE SYLLABUS 2018
Further, pamphlets printed with proven health benefits of spiritual / religious practice were
given to patients to take home.
Design of the prayer:
With aim to promote spirituality of both health service providers and patients of primary health
care receivers below prayer for the first group was designed.
First Prayer is following:
“We, staffs, patients, and well- wishers of KB Medical Clinic, pray to the All Mighty God for:
Dedication towards patient’s service, Trust to God’s & Soul’s healing power, and to develop
our Spiritual Well being for Health, Healing & Wellness.”
The prayer was tested. The prayer intervention was introduced to patients from 21
September 2018 to 11 October 2018.
Interaction with participants
Participants were given Box 2 material (which describes health benefits of religious /spiritual
practices) to read and understand. They were allowed to ask questions and clarification.
Further, they were requested to read the prayer. They were also requested to sign a
signature sheet if they liked the prayer intervention. Those who liked were asked to write
the reason to like.
They were free to disagree and not to sign. It was not going to affect their treatment.
A follow up was made during next visit.
Evolution of 2nd prayer
Some patients asked us to pray for them. Once we got opportunity to hear a prayer of a
patient suffering with severe arthritis pain.
She prayed, I am asking God:

“God if you are helping others, you should leave them.
I am asking a favour from you because I am in pain.
You should come and help me.”
This made us to realise the need to educate people about omnipresence God who has
infinite helping capacity, and is always present everywhere to help the needy human being
irrespective of number.
Inspired with above event further on dated October 12, 2018, we developed a new prayer
with reference to Omnipotent (all powerful), Omniscient (all knowing), Omnipresent
(everywhere present) nature of God, Who has unlimited healing power.
The 2nd prayer reads,

“Al Mighty God, You are present everywhere all the time, you are greatest healer. We pray
to you,
“Kindly strengthen our trust in Your healing power.”
“Kindly, help us to develop our Spiritual well-being for good health, happiness and wellness.
AMEN.”
Interaction with participants of 2nd prayer group
Above activities were repeated.
Participants were given Box 2 material (which describes health benefits of religious /spiritual
practices) to read and understand. They were allowed to ask questions and clarification.
Further, they were requested to read the prayer. They were also requested to sign a
signature sheet if they liked the prayer intervention. Those who liked were asked to write
the reason to like.
They were free to disagree and not to sign. It was not going to affect their treatment.
A follow up was made during next visit of the participants.

Results
For first prayer, from 21 September 2018 to 11 October 2018, out of 108 people advised 107
voluntarily read the above prayer and signed as agreed. 1 person disagreed.
For second prayer, from 12 October 2018 to 20 December 2018, out of 158 people advised
156 people read the above prayer and signed as agreed. 2 people disagreed.
Table 1. Age Sex Characteristics of Participants

First Prayer Second Prayer
Sex N= 106 (%) N= 156 (%)
Male 54 (51) 83 (53)
Female 52 (49) 73 (47)
Age Group
< 20 Years 5 (5) 3 (2)
20-30 Years 14 (13) 36 (23)
30-40 Years 58 (55) 81 (52)
40-50 Years 24 (23) 25 (16)
50-60 Years 4 (4) 8 (5)
> 60 Years 1 (1) 3 (2)
In first prayer sex wise male female are 51 and 49 percent respectively. Age between 20 and 40 age
group are more than two third of study population.
In second prayer sex wise male female are 53 and 47 percent respectively. Age between 20 and 40
age group are three fourth (seventy five percent) of study population.
Common Disease Condition
Common disease conditions in both groups noted were followings: Headache, Influenza, Acute
respiratory infection, Cough, Back pain , Body pain, Arthritis, Gastroenteritis, Dizziness,
Dysmenorrhoea, Anxiety, Sexually transmitted infection, Skin infection, Fungal infection,
Hypertension, Diabetes, injury .
Key Findings:
Strength during study
Value of the primary health care facility Sri K B Medical Clinic has strength in following ways:
• Daily patientsservice in the clinic begins with prayer.

• The clinic has 2 mottos. One reads “We treat God heals”, and second reads “May All Mighty
bless you with optimal Physical, Mental, Social and Spiritual health.”
• Health care providers’ uplifted spirituality
• Patients religion and spirituality: Most patients practice Christian religion.
• Recognition of prayer by the Botswana Ministry of Health & Wellness.
Each and every government’s meeting begins with prayer.
• Most people liked very much the prayer. Some took photo on phone to carry with them.
Important participants’ expressions to like the prayer
People replied as reasons to like the prayer. Examples of common responses are followings
• The prayer is very powerful.

• The prayer gives me power.
• I feel healed after reading this prayer.
• The prayer gives us strength to get healed and be strong.
• The prayer encourages me to allow seek the healing power for God.
• It takes out the pain that is on me and gives me hope that all is well with our soul.
• It revives my spiritual, Because it talks about we need spiritual healing that we believe we
are healed. It reminds us that God loves us always and that God heals. It makes me believe
in God, have hope and to never give up in life.
• Prayer touched me, it makes me understand the importance of knowing God that God loves
us always.
• The prayer made me to pray more and attend church services. I am more connected to God.
• The prayer gives me trust in God. Without God there is no life.
• It gives me hope, knowing that the almighty God is there for our health. He heals, and our
doctors treat.
• Believe through our prayers God empowers doctors with knowledge
• Prayer is greatest healing weapon of universe .
• The prayer gives me total faith in God and gives me hope since God is good all time so I am
healed.
• It makes everything of my life to be super obedient to God, God heals and no struggles.
• It gives me faith and build trust to the Lord. God is powerful and healing comes Him.
• I believe in prayers we need to pray with our Doctors it gives us hope to care for people and
God bless you for loving patients
• Relevant to my situation it gives hope that I am going to find some help in my situation
• It is through Jesus our healer that all treatment and healing our successful. It frees us from
stress and depression.
Findings of follow up
During follow up, 98 out of 106 (92.6%) and 141 out of 156 (90.4%) participants were in first and
second prayer groups were contacted. All have expressed their satisfaction. Because of they
recognise importance of prayer and practice in their daily life.
Discussion
In this demonstration study most patients were happy with address of their spiritual care in the
disease management. However, 3 people (1 in first prayer and 2 in second prayer) disagreed.
Sometimes peoples asked, “Why do you ask to sign.” Our answer was “Signature reminds you to
pray at home”. Considering several factors we decided to take convenience sampling from
participants.
Spirituality is important for both patients as well as health service providers. First prayer was
designed to elevate spirituality of both health care service providers and patients. This study also
experienced value difference. Three participants disagreed with to pray, because of, they thought
that prayers do nothing. They were reluctant to pray. Further, 9 patients (2 in first group and 7 in
second group) asked us to pray with them for fast recovery, as in Australian studies (10, 11). Gladly,
we offered prayer with them. It did not cause any dispute or distress among us. We accepted and
respected patients view without disturbing our peace of mind, based on spiritual teaching from
Bhagavad Gita, “Perform your duties equipoised. Such state of mind is called yoga (14). One who is
unaffected by whatever good or evil may obtain, neither praising it nor despising it, is firmly fixed in
perfect knowledge (15).
The follow up finding shows that most of times they prayed with medicine intake; however,
sometimes they missed prayer. It is because of, earlier practice of medicine intake without prayer.
Over all they expressed satisfaction.
“I went clinic in the morning; was examined late afternoon, and came back home without medicines.
Clinic has no medicine; and I have no money to buy.” Nowadays most patients in Botswana tell
their similar experiences. Therefore, evidence based physical mental health benefits of spiritual
intervention are needed for welfare of the people.
Prayer can bring change in attitude and practice for healthy life style, which will help in prevention
and management of non communicable chronic diseases and psychological disorders. Other
dimensions of spiritual intervention, such as yoga, meditation, mantra recitation, and pranayam can
be used. Cost effectiveness study can be done on patients with and without spiritual intervention. In
view of the proven role of spiritual well-being in achieving better health outcomes, it is important to
mainstream prayer as an integral part of health –care delivery in primary health care.
Study limitations
The study has adopted non probability convenience sampling method because of convenience
accessibility. Sample size is not large enough, therefore findings of the study cannot be
representative of the general population.
Implications for practice
This project demonstrates for amalgamating prayer as spiritual intervention to uplift patients
spirituality, which acts as catalyst for better health care delivery in primary health care setting. The
demonstration project has realized importance and need of integrating prayer with primary health
care service delivery. Training and motivation of supportive staffs are as an important factor.
Pamphlets with health benefits of spiritual / religious practice have also played significant role to win
patients confidence. Prayer intervention is well suited strategy in primary health care definition.
Value difference may occur between service provider and clients, but it can be resolved without
dispute.
Findings of the study may contribute in policy and strategy formulation for mainstreaming of
spiritual intervention such as prayer as complementary therapy in primary health clinic for quality
health care, as well as in public health with no additional cost and no risk of side effects.
The demonstration project seeks to establish the feasibility of spiritual care assessment in the
African cultural context.
Conclusion
This demonstration project is a local company “Life And Living Pty Ltd” funded with a small grant.
We encourage other primary health care institutions to replicate this work and spiritual assessment
and prayer intervention as a supportive therapy for recovery from illness as well as for well being.
Acknowledgement
We acknowledge the patience and supports of the participants; as well as direct and indirect
contribution of local staffs.
Author disclosure statement

No competing financial interest exists.
References:
1. Primary health care: report of the International Conference on Primary HealthCare, Alma-Ata,
USSR, 6–12 September, 1978, jointly sponsored by the WorldHealth Organization and the United
Nations Children’s Fund. Geneva, World HealthOrganization, 1978 (Health for All Series No. 1).
2.Puchalaski C.M., Vitillo, R., Hull, S. K., & Reller, N. (2014). Improving the spiritual dimension of
whole person care: Reaching national and international consensus. Journal of Palliative Medicine.
2014.17(6).642-656.
3. Zenevicz L, Moriguchi Y, Madureira VSF. The religiosity in the process of living getting old. Rev Esc
Enferm USP. 2013; 47(2):433-9.
4. Koenig HG . Research on religion, spirituality, and mental health: a review. Can J Psychiatry 2009.
54: 283–291. pmid:19497160
5.Bernardi L, Sleight P, Bandinelli G, Cencetti S, Fattorini Let al. Effect of rosary prayer and yoga
mantras on autonomic cardiovascular rhythms: comparative study. BMJ. 2001;323(7327):1446-49.
6. Mary Rute G. Esperandio, amd Kelvin L.Ladd. I Heard the Voice. I Felt the Presence: Prayer, Health
and Implications for Clinical Practice. Religion (2015) 6.670-85 (Cross Ref).
7. Koenig HG, Lewis G. The Healing Connection. Philadelphia, Templeton Foundation Press, 2000.
8. Koenig HG, McCullough ME, Larson DB. Handbook of religion and health. New York: Oxford
University Press, 2001.
9. Sithey G, Li M, Wen LM, Kelly PJ, Clarke K. Socioeconomic, religious, spiritual and health factors
associated with symptoms of common mental disorders: A cross-sectional secondary analysis of data
from Bhutan’s gross national happiness study, 2015. BMJ Open 2018;8:e018202.
10. D’Souza R, George K. Spirituality, religion and psychiatry: its application to clinical practice.
Australas Psychiatry 2006; 14: 408-412.
11. Mohr WK. Spiritual issues in psychiatric care. Perspect Psychiatr Care 2006; 42:74- 83.
12. Central Statistics Office, Government of Botswana. Census preliminary brief, 2011
13. https://en.wikipedia.org/wiki/Freedom_of_religion_in_Botswana.
14. Prabhupada A C BV. Bhagavad Gita as it is, Second edition. The Bhaktivendanta Book Trust, Los
Angeles, California, USA, 1972, Contents of Gita Summarized; Chapter 2.48,P120-121.
15. Prabhupada A C BV. Bhagavad Gita as it is, Second edition. The Bhaktivendanta Book Trust , Los
Angeles, California, USA, 1972, Contents of Geeta Summarized; Chapter 2.57,P129-30.
A Man taking photo of the prayer
A hypertensive diabetic patient is reading the prayer.

A woman with broken bone signing the prayer signature sheet
Young boy reading health prayer along with his traditional home
prayer
A family taking home prayer in cell phone
Sample of first prayer signature sheet
Sample of second prayer signature sheet
WHY DO I LIKE PRAYER?
OPENIONS OF SOME PARTICIPANTS (N=49)
• When praying I feel relieved during difficult times and prayer bring peace, I feel close
so close to God were I trust help is offered from
• The prayer gives me total faith in God and gives me hope since God is good all time
so I am healed
• In life you need to surround yourself without for your to be healed spiritual. In the
beginning God created everything that way I have more faith towards him
• It makes everything of my life to be super obedient to God, God heals and no
struggles
• Gives thanks to the Lord
• It gives me faith and build trust to the Lord. God is powerful and healing comes him
• The prayer is very powerful
• The prayer gives me power
• I feel healed after reading this prayer
• The prayer gives us strength to get healed and be strong
• Prayer strength overcome all odds
• It gives me hope
• The prayer encourage me to allow seek the healing power for God
• It inspires me and gives me courage
• It takes out the pain that is on me and gives me hope that all is well with our soul
• It revives my spiritual, Because it talks about we need spiritual healing that we
believe we are healed. It reminds us that God loves us always and that God heals. It
makes me believe in God, have hope and to never give up in life.
• The prayers makes me to feel hopeful, to have no fear because in the presence of
the Lord I always know there is healing.
• Prayer touched me, it makes me understand the importance of knowing God that
God loves us always.
• The prayer makes me to belief everywhere there is God whatever the situation is I
am going to pray.
• The prayer made me to pray more and attend church services. I am more connected
to God. Pray more and attend church services
• It gives hope to life and assurance that God is there
• The prayer is encouraging and giving hope
• The prayer gives me hope and feeling that there is a supreme being watching over
me
• The prayer is giving more hope and gives strength to the one who accepts and know
that God is a God that can do anything impossibilities with man he does everything
and anything. He is a God who answer prayers
• Our God is always present and greatest healer listening for our prayers
• The prayer in giving strength in difficult situation and encouraging me to take ahead
in life and give peace in my mind
• It gives me trust in God, without God there is no life
• It gives hope that we are all taken care of all the time. It keeps my mind going.
• I am a great believer of God and with him everything is possible
• I believe with prayer, we can all be healed God heals
• It gives me hope, knowing that the almighty God is there for our health. He heals our
Doctors treat
• It shows that in did the Lord Jesus Christ is the healer
• I love praying because God exist and has the power over everything that happens in
our life
• Believe through our prayers God empowers Doctors with knowledge
• Prayer is greatest healing weapon of universe
• Through prayer it gives us power to trust in God and have faith he will answer our
prayers
• It keeps close to God all time
• It gives courage to know that God is our creator and we should believe in him he
promised us internal life
• There is power in God tha brings healing mentality and spiritually
• I believe in prayers we need to pray with our Doctors it gives us hope to care for
people and God bless you for loving patients
• Relevant to my situation it gives hope that I am going to find some help in my
situation
• It gives me hope that God is our server will heal me he will not want my soul to
suffer because I was made from his image
• It is through Jesus our healer that all treatment and healing our successful. It free us
from stress and depression.
• It gives me motivation and feel calm relieved
• It gives me hope that with God healing will be realized
• Prayer gives me belief and power
• It gives me strength and power
Peoples comments on prayer and Spiritual health education messages
Below are some people’s question, comments and appreciation:
1. Few people asked, “Why do you ask to sign?”
Answer: “Our sign remind you to pray. Just as a reminder.”
Patient, “Where will you sent it?”
Answer. “Nowhere. It will remain with us here.”
2. Appreciations:
Many people appreciated the prayer.
3. Some people after signing noted on a separate paper to carry with him.
I asked, “Why did you note it?”
They expressed their desire to read at home, because they felt good. ”
4. People liked prayer. Somebody took photo on cell phone.
5. A teacher he read prayer ,

“Al Mighty God, You are present everywhere all the time, you are greatest healer.
We pray to you,
“Kindly strengthen our trust in Your healing power.”
“Kindly, help us to develop our Spiritual well-being for good health, happiness and
wellness.”
AMEN.
He told, “I want to internalise this prayer. It is fine, straight to the point.”
6. It is very true. It is very good.

“In this way we are winning many lost souls through Christ through this guidance
and discussions.”
The wining many lost souls to Christ emphasizes on teaching people the importance
of living for Christ, a life without Christ is meaningless. Believing and trusting in
Christ build a person’s faith that with Christ is everything is possible. Christ is the
healer, provider. He heals all kinds of sickness and illness. We are healed by His
stripes. Put God first and seek His kingdom first and His righteousness and all the
good things will follow.
– Eric / 23 October 2018 (Cell_ 72871409)
7. I have passion of reading words of God. When I open bible to read, I read one
two verse then I feel sleepy. I am Seventh Adventist Church member. We don’t
have time for God. But I am interested in reading bible. I read newspaper and
finish it. Pray for me, so that I develop interest for reading bible and understand
it. Because, I really want.
- Motsumi Tsenang /23 October 2018
(cell_72236571)
8. Till dated October 23, 2018 out request to patients to 2 persons hesitated to
sign. They said latter. They believe, for them, signing means commitment to pray
regularly daily. However, they don’t pray daily on regular basis; and they are not
prepared presently to pray regularly daily basis.
Due to lack of time and patients crowd time we missed to request /inform some
patients to inform health benefits of prayers, as well as their opinion towards prayer.
9. A Mother asked us to advice daughter to visit church on Sunday
A 16 years old girl student came with c/o of recurrent headache, vomiting and pain
abdomen. She was accompanied by her mother. She blamed mother as a cause for
her physical and emotional problems. The girl does not attend church service,
although she is born in Christianity religion practicing family. In response mother
requested to advise the student to attend church service on weekend.
In other circumstances we also received request from parents to advise child to

attend church service. This motivated us to look for evidence based health benefits
of church visit for prayer.
Case reports
1. Earlier I used to go church but now I don’t want
An young lady aged 31 year said that earlier she regularly used to go to church.
Church teaches, “No sex without marriage”.
However I wanted my motherhood to flourish; I wanted to have a child.
I got a child without marriage. Socially presently in Botswana, it is hard to get

married. Marriage institution in Botswana has declined significantly. But sexual
relationship and having a child without marriage are socially and culturally well
accepted. When I attended church after becoming a mother, church people were not
happy. They were judgemental; they were not the same as they were earlier. I could
not cope with the situation and stopped going to church. Now, I don’t want to go to
church anymore.
Now, I am looking for Spiritual development without going to church.
Me: Her story explains that desire for spiritual growth is within her. “Love for God” is
within her. A thrust to love God is with her.
It indicates :
• Not attending church does not mean person is not religious /spiritual.
• A person is a spiritual being irrespective of whether a person attend church or

not.
2. Recurrent severe pains of big joints depress me, and reduces quality of my life
Last year 2017 April, one morning she woke up and found her four fingers (Thumb,
index finger, middle and ring finger) of left hand were painful and swollen. She
visited local government health clinic. She was given analgesic and anti-inflammatory
medicines: Paracetamol and Ibuprofen. While she used medicines she got relief from
pain; but latter on pain came back. Latter she experienced that pain had migrated
from left hand to right hand. Last week of September 2018, she experienced big toe
and other two inner toes of left foot were swollen and painful. It was also associated
with low back pain.
She feels stressed and depressed, because this pain interfare with her work
performance, which creates a threat to her employment. It has reduced her quality
of life as she is just 29 year old lady. (DOB : 12/05/1989).
Cell: +267 76069702.

3. Employee experiences burn out and stressed due to over work and lack of
sufficient rest
Mr LetsoPhukula, 44 year old, an Information Technology Officer, moves in field for

long days. In field his works demand long hours working with not enough rest. Due
to shortage of technician personnel (in compare to work demand) he experiences
burn out and stress and anxiety. He fears to go to office because of immediate field
order given by boss irrespective of his body and mind status. His blood pressure
measures 147 /109 mm Hg on September 24, 2018.He believes his blood pressure is
high because of work pressure and lack of rest. He rechecked his blood pressure on
October 03, 2018, which reads 149/109 mm Hg. Still he believes his blood pressure is
high because of work pressure and lack of rest.
Cell : 72311222.
4. A 35 year old lady with a child and a boy friend (step father of the child) came with
c/o palpitation and chest pain under left breast for 2 days. She also experiences
difficulty in breathing during chest pain. She expressed recent history of job threat
added with quarrelling with boy friend for money. She expressed that she has
suspicion that boy friend has affairs with another woman, although she has no
proof. We discussed on relationship issue. …i..Love and forgiveness nurture our
relationship. Ii. Suspicion / doubt kills relationship. Although he is step father of the
child , he takes care of both- child and you. We need to appreciate it. Iii. In
relationship, no me, no you, me and you are replaced by we. Me and you die, and
we survive. Iv. A happy satisfied life goes on with little money. However, with more
money an unsatisfied people can’t live happy life. Money issues can be talked, need
will be fulfilled. Greed will never be satisfied. Finally she became convinced and
satisfied. Cel: 77078229
5. A 40 years old lady experiences right intercostal pain and difficult breathing while
coughing. She consider herself religious /Spiritual. However, she considers religion
not important to her. She believes that religion does not help her cope with stress
and life difficult situation. She believes that religion neither influence her for health
care nor treatment in case of illness. She is Christian, but not a part of church or any
religious community. Cell: 77110539.
After reading the note consisting health benefits of religious practices, she told, “Are
you partnering with traditional healer?”
I replied, “No.”
She asked, “After consulting, will you send me to traditional healer?”
I replied, ”No, I will provide medicines to you. I wish to inform you that prayer and
other religious practices are effective like a very good medicines to cure our
diseases.
She, “replied. Yes. Prayer is very important. You and me will pray, I will be healed.”
Finally, we both prayed,
Al Mighty God, You are present everywhere all the time, You are great healer. We
pray to you,
“ Kindly strengthen our trust in your healing power and the soul’s / spirit’s healing
power.” “Kindly, help us to develop our Spiritualwell being for good health,
happiness and wellness.” AMEN.
6. During consultation and discussion on health benefits of spiritual practices we

realised that people trust in PRAYER whether she / he is a member of church or not.
People have faith in prayer’s healing power irrespective of membership of a religious
community. This fact motivated us to promote prayer for health, happiness, healing
and wellness. Getting motivated we designed a prayer for staffs, patients and
patient’s care givers jointly. Prayer is following:
“We, staffs, patients, and well- wishers of KB Medical Clinic, pray to the All Mighty
God for:
• Dedication towards patient’s service,
• Trust to develop God’s & Soul’s healing power,
• To develop our Spiritual Well being for Health, Healing & Wellness.”
AMEN.
On September 21, 2018 this prayer came in practice. Children, old, youths, adults,
male female have practiced the prayer.
To promote prayer we ask patients, “ Please read the prayer, if you agree, write
your name and sign. If you don’t feel good about it, leave it, no need to sign.”
Challenges: we received (from few people) are followings:
Few people asked, “Why do you ask to sign?”
Answer: I replied, “Our sign remind us to pray. Just as a reminder.”
Patient, “Where will you sent it?”
Answer. I replied, “Nowhere. It will remain with us here.”
Till dated October 23, 2018 out ……request to patients to 2 person hesitated to sign.
They said latter. They believe, for them, signing means commitment to pray regularly
daily. However, they don’t pray daily on regular basis; and they are not prepared
presently to pray regularly daily basis.
This presentation contains slides from ISPEC 2018 and the activities on spirituality in
primary health care done in the K B Medical Clinic.
Spiritual Health Education about Drugs Alcohol Abuse Prevention Campaign 2018
Distribution of Spiritual Health Education pamphlets to community members 2019

By products of the project
Development of leadership quality in spiritual well being in health care

Over all the entire project has help to grow my leadership in spiritual care. My own
spirituality has got opportunity to flourish and to use in health care. The project has
contributed staffs to recognise their spirituality in favour to serve humanity better. I feel
pleasure to ratemy confidence in my leadership skills in spiritual care as 90% (while 100%
indicates very confident). Based on following factors I find myself able to say 90% confident
in spiritual care leadership:
• Training, reading and teaching ISPEC course syllabus.
• I have good knowledge of Hindu’s spiritual scriptures, such as BhagawatGeeta,

Ramayana and Mahabharat
• On request of patient and family members, I regularly do spiritual practice, such as

Prayer, Recitation of Mantra, and Worship, for recovery of a patient from severe illness.
• I practice Spirituality in my daily life. My day begins with early morning with Prayer,
Mantra recitation and Temple-service. (Temple is Hindu’s worship place).
• My day ends with prayer. (Sleeping time prayer)
• I actively and confidently share spiritual stories, facts, other knowledge with others
fellows in view to develop people’s spirituality.
• I am a life member of ISKCON (International Society for Krisna Consciousness).
• I am a life member of Botswana Hindu Society.
• I advise and train people on Yoga, Meditation, Prayer and Mantra recitation for
Health, Wellness and Happiness.
• On basis of Botswana practical experience I have published 2 e-books named:
i. A Way to Wellness: Yoga (A Glimpse in Botswana)
ii. Assess Your Wellness & Spiritual Wellbeing

Experiences of working with professionals of different fields
Strengths
Partner with positive look for spirituality works as catalyst to promote program. it motivates
us.
Challenges
Partner with negative view for spirituality sometimes become an obstacles in progress of
work. it demands more energy and time to achieve the similar goal.
Future plan for using this curriculum

1. To develop a model of “CLINIC WITH COMPASSION”.
In other words “NO CLINIC WITHOUT COMPASSION”. (In the present materialistic world
most of clinics are lacking compassion)
2. To develop a Manual to encourage Spirituality Knowledge, Skills and Practices
to prevent life style illness, to promote health & wellness, and happiness.
ISPEC Train-the Trainer Group Photo 12 July, 2018, at Washington DC.
Class Photo_ 5-day Summer Research Course-Spirituality, Theology and Health, Duke
University, Durham, August 13-17, 2018.
Very exciting information has come out from the pilot project. Most people consider they are
religious / spiritual, and they are member of religious / spiritual community. They revealed
that their beliefs help them to cope with stress during difficult time and influence their
decision for management of illness. They believe in healing power of prayers, and disease-
curing magic of God. People coming for primary health care liked most message on first pamphlet
“Spiritual religious practices & physical mental health and well being”. Patients
suffering from chronic diseases such as hypertension, diabetes, arthritis were comfortable
with message on second pamphlet “Spiritual health education for life style diseases and
chronic illness (hypertension, diabetes, arthritis, cancer and other diseases). High school
students acknowledged usefulness of message on third pamphlet “Spiritual health
education to prevent HIV transmission and drugs misuse”. Some have acknowledged the
role of faith in prevention of bad practice, such as alcohol or adultery; and promotion
of good health friendly practice. For management of illness some patients wished
that the physician should pray for or with them (of course, this wish is additional than
regular prescription). Addressing spiritual needs and concerns of patients is very
important in enhancing quality of life in term of health and happiness. It has been
realised that health workers are more inclined towards prescription of modern
medicines rather than spending time on spiritual health education teaching to
patients. More training should be organised for health care workers. Designed
prayers were liked by people. People expressed their opinions that prayers were
powerful healing provider, strength giver as well as a tool for spiritual awakening. For
some prayers worked as catalyst to increase faith in God, and attendance to religious
community periodically. It seems that spiritual health education has profound
potential to contribute towards achievement of optimum health and wellness, and
its organized practice can shorten the days of illness and reduce the economic burden
during sickness for health care.
ISBN no. 978-99968-61-79-6

Ispec A Blessed Experience in Botswana

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ISPEC IN BOTSWANA: A BLESSED EXPERIENCE

[An experience following ISPEC Interprofessional Spiritual Care Education

@ KB MEDICAL CLINIC GABORONE BOTSWANA

[An experience following ISPEC Interprofessional Spiritual Care Education

Author: Dr Bindeshwar Prasad Yadav

Copyrights ©: Dr Bindeshwar Prasad Yadav

Published by: Self, electronically

Author’s contact details:

Dr Bindeshwar Prasad Yadav

By Products of the Project

• Development of leadership quality in “Spiritual wellbeing in health care” 62

Interprofessional Spiritual Care Education Curriculum “Train-the Trainer” Course Syllabus”

It was a blissful experience, as most participants were having religious / spiritual

Step 1: The book ISPEC (Interprofessional Spiritual Care Education Curriculum)COURSE

Instruction / suggestion were given to them:

• Firstly be friend with the book

AN URGENT CALL FOR HEALTH WORKRS /PROFESSIONALS FOR PATIENTS CARE

• The book ISPEC (Interprofessional Spiritual Care Education Curriculum)COURSE

• Within 12 months period 4 sessions have been conducted.

• Health care providers agreed to promote prayer among patients in form of a

M1-6 U DEFINITION OF HEALTH

• Within 12 months period 4 sessions have been conducted.

• People expressed their satisfaction towards spiritual message addition with

• People have different views of prayers

• Some seniors people afraid of misinterpretation of spiritual messages with

In K B Medical Clinic the young lady is reading the spiritual health

Medical sciences researches show beneficial effects of

• Within 12 months period 4 sessions have been conducted in a small group of

• Students / youths seems less inclined towards spiritual practices

• They less visit church for prayer.

Spiritual Health Education to Students on HIV prevention and Drug Misuse

Be aware of hormonal changes in your body, which is responsible of emotional changes

Adoption of the FICA spiritual history tool

Materials and Methods

Figure: 1. FICA TOOL FOR SPIRITUAL ASSESSMENT

F- Faith and Belief

(*About belief influence on care decision 16 have unclear opinion.)

Faith/Belief/ Meaning Themes n=117 (100%)

(Non believers are in no answer).

Religious Community Key Theme

1.Preamble to the Constitution of the World Health Organization. International Health

11. Puchalski C. Spiritual assessment in clinical practice. Psychiatr Ann 2006;36:150-155.

F – Faith and Belief

7 What role do your beliefs play in regaining your health?

12 Outcome/ level of satisfaction : Satisfied / Unsatisfied Satisfied Unsati.

A global consensus derived definition of spirituality is:

Importance of spirituality in health care

The goals of the study are:

Materials and Methods

Setting and participants

Site: Sri KB Medical Clinic, Gaborone, Botswana

ISPEC Team members as necessary (KINDLY PUT THEIR NAMES?

Dr Bindeshwar Prasad Yadav

1. ISPEC (Interprofessional Spiritual Care Education Curriculum) COURSE SYLLABUS George

Activity 1: Training of personnel:

• With aim to enhance knowledge on health benefits of spiritual / religious practices of

BOX.2. MAY WE TAKE TOGETHER MODERN MEDICINE AND PRAYER

Design of the prayer:

First Prayer is following:

Interaction with participants

A follow up was made during next visit.

Evolution of 2nd prayer

She prayed, I am asking God: