Today was an incredible day at the Christian Medical College in Vellore, India, where ten of us arrived last Friday. We have done nothing but learning and experiencing this new and exciting place with all of our senses since we arrived. Today, we had the opportunity to learn about the Indian health care system and travel with public health care workers to a community clinic and the homes of a few patients in one of the villages. The community clinic consisted of two tiny rooms in the center of a village, crowded with women sitting on the floor, waiting for their turn to see the doctor. In one room, a physician was evaluating pregnant women for their blood pressures and overall health statuses and in the other room, an intern was writing prescriptions for medications for chronic illnesses (specifically type 2 diabetes, thyroid disorders, hypertension, and depression), which patients picked up at the mobile clinic van parked just outside. Of the many things I learned during this encounter (such as how to determine the exact gestational age of a fetus by simple palpation), I observed the incredible work these doctors do in the community. They are truly missionaries. These patients would not be able to to travel to the health center because they live off of the main road and are unable to pay full price for their medications ( 60% of the population in India is below the poverty line.) These doctors see at least 30-40 patients per day and get paid very little because the majority of the funds go to subsidize the care of poor Indians.
This morning, before we went into the field, we had a chance to sit in on a lecture by Indian medical students, interns, and residents at the Christian Medical College. Before the lecture, a prayer was offered. The first thing the speaker said was, “What is that in your hand?” She proceeded to say that too often we waste time worrying about the things we don’t have and focusing on our limitations, rather than doing the best with the resources and abilities that we possess and focusing on fulfilling our own purpose to help others. These physicians at the community clinic are incredible in their ability to diagnose and treat with limited resources. They have perfected the physical exam; when they are in rural areas, they cannot depend on CT scans and X-rays as a crutch, but rather must use their intuition, skills, and experience to help patients. They can ultimately refer them to the hospital if there is a serious problem, but most of the care takes place in the community. I will always remember her words and apply them to any situation in which I find myself.
Being at the clinic made me ponder what community healthcare would look like in America, for there are still so many Americans who have little access to care. Physicians in a time not too long ago would routinely make house calls, especially if their patients were no longer ambulatory. I was inspired today to try to preserve this community-minded doctoring and to support mobile clinics, community health education, and any programs that bring nurses and doctors to patients in need, rather than the other way around. When doctors are part of the community, rather than separate from it in their sterile offices and hospitals, greater trust can be established and sometimes greater care can be given.
We then went to a small village, to the homes of three patients: one with COPD (Chronic Obstructive Pulmonary Disease), a pregnant woman, and a man with tuberculosis. We accompanied one of the village nurses, who sees each member in the village at least twice per month. The village members were gracious and allowed us to listen and touch, just as the nurse did, learning through her and learning by doing (something we have little of in our early medical years). At the pregnant woman’s tiny home (a single room for 6 people) I was able to touch her pregnant belly, feeling for the spine and head of the fetus (who is due July 22nd) as well as listen for the fetal heart beat. It was an incredibly moving experience. This woman smiled so big, so happy that we were there to visit and so thankful to have the blessing of being pregnant with her third child. She had so little, yet she was giving so much.
We learned that this woman was in a different situation than most of her fellow Indian women; she married for love and her husband is supporting her through a college degree in business. On the back wall in her hut, were posters of the Tamil and English alphabets, a sign that her appreciation of education is bring transferred to her children. We learned today that the government of India, mostly in the South, has realized that the education level of women is one of the most important determinants of infant health and survival. In places where most women are illiterate and prevented from being educated by overbearing husbands or families who force them to marry at 16 or 17, the infant mortality rate is incredibly high. This woman was an inspiration for her resolve to value education. I wish her health and happiness and a good delivery of her child!
After visiting the village, we went back to the wards and observed pediatric patients in the children’s ward. It is so terribly hard to see children in distress (we saw children with pneumonia, hepatitis, typhoid fever, and other infections), but it was so motivating that highly skilled physicians are charged with their care. One thing that will stick with me is the scared look in the eyes of the mothers of these children. I have realized that saving the life of a child is one of the most noble endeavors on this Earth. I hope to be able to do that some day, and give parents relief and comfort.
There is no possible way to document every single thing I witness. But, allow me to end by saying that here in India, the common greeting and farewell is placing both palms together in the prayer position and bowing in gratitude and fellowship. My advisor explained to me today that it means, “my unity of soul honors your unity of soul.” That powerful greeting demonstrates so clearly the goodness I witnessed today and the good hearts of the village inhabitants in India. They are motivated out of their hearts to help patients in need, not by money. We did learn today that corruption still exists, that government physicians sometimes will leave their hospitals without having seen all of their patients to conduct their profitable private practices and in some parts of the country, families of students who do not get into public medical schools can buy their way in to private medical schools. However, for the most part, this is not the norm. The norm is love and charity and kindness in the face of limited resources and poverty, which I so vividly saw today, and what I will take with me long into the future.
I thank the workers and physicians I met today for teaching us, letting us observe, and for all the good work they do.
Thank you for reading and I hope you are inspired as well.