MEDICAL REPORTS

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Katherine Myall

I got some really good hands on medical experience which I could never have got at home and made some really good friends among the staff. I didn’t really know what to expect before I went, but it was definitely very worthwhile.

I really enjoyed interacting with the children in the hospital. They were all so responsive despite their illness and you really felt like you were making a difference to them. I gained a lot of practical experience and also learnt ways of communicating despite the language barrier!

I had an amazing time in India and I have memories which I will carry with me always. India is a fascinating country… I’ve been boring my friends about it ever since!

I spent from the beginning of January 2008 to the end of March 2008 in Madurai, southern India, pursuing my interest in medicine by doing work experience in a hospital there.

I went with a company called Travellers Worldwide, which I found on the Internet while looking for medical work experience abroad. It had a variety of projects located in Madurai. When I arrived I was given the choice to stay in the same hospital for the whole three months or to move around. I chose to stay in one hospital for all three months, which I’m glad I did since the longer I was there the more interesting were the activities that I was allowed to do.

The Hospitals: Health care in India is predominantly privately run so, apart from the few government hospitals, all the ‘hospitals’ in Madurai were more like clinics with just a few specialist doctors working in each. The government hospitals are more similar to our picture of a hospital, with many specialities under one roof. The services here are much cheaper than elsewhere, but the conditions and hygiene of the hospital are very poor.

The hospital that I was placed in was called Harley Rram Nursing Home and was run by two doctors who were husband and wife, an Urologist and a Gynaecologist. Dr Ramesh, the doctor that I shadowed for the three months, owned the hospital and specialised in Urology, but he also did general practice. His wife took paediatric cases as well as the gynaecological cases. This was one of the bigger privately owned hospitals in Madurai and had about fifty beds for in-patients, a laboratory, x-ray and ultrasound scan rooms, an operating theatre and a labour room. The hospital was also in the process of building a large new wing.

My Work: My schedule consisted of going into the hospital for about two and a half hours in the morning where I would sit in on patient consultations. All these consultations where in Tamil, the state language, but Dr Ramesh spoke excellent English and he always explained what had been going on afterwards. If there was a particularly interesting case I would be asked to come and observe or feel the problem. Dr Ramesh would describe what I was looking at or feeling and he would also direct me what to feel for in relevant cases. This way I became familiar with recognising hernias and swollen abdominal organs.

From the beginning I was taught how to take a blood pressure manually and in consultations it became normal practice for me to take the patients’ blood pressure. In the afternoon there would often be surgery of various kinds occurring and if so I would go into the hospital around 3:30pm until 7pm. The exact times used to vary depending on how many surgeries where going on that day or if a visiting surgeon wanted to do the surgery earlier in the afternoon.

Many of the patients attending the consultations came regularly every day to have the dressings on their diabetic ulcers changed. The majority of the population have diabetes in India since they are genetically more at risk, eat a great deal of sweet food and have a high carbohydrate diet. A high proportion of patients came in with ulcers on their feet since most people seemed to walk everywhere bare foot. With all ailments, but especially these ulcers, patients didn’t come to the doctor until they absolutely had to, so their symptoms were almost always acute. This was particularly instructive for me, however, as the worse the case the more interesting the diagnostic and treatment processes. I particularly liked to see patients during consultations and then see them a few days later in surgery, as I then knew exactly what was wrong with them and what was being done to correct the problem.

I enjoyed watching the surgery more than observing consultations as I found seeing the many structures and organs in their proper places within the body fascinating. Although I am not very keen on dissecting dead organs, surgery on live bodies is completely different, with all the tissues such a healthy colour and none of the off-putting smell experienced with dissection. At first I was only allowed to watch from the side-lines, but I was in the operating theatre and could see well since I could move to any position around the table and come as close as I wanted, providing I didn’t get in the way or touch the sterile area of the table. This was perfect at the beginning since I had never seen human surgery and didn’t know how I would react to it the first few times.

After a month or so I was allowed to scrub up occasionally and helped the surgeon by holding instruments and grips and passing items to the operating staff. I loved this as I was as close as possible to the action and could see exactly what was happening inside. On these occasions I was also allowed to gently probe inside and actually feel what the various tissues were like. Most of them felt much tougher than I expected. Dr Ramesh and his anaesthetist always explained to me what was going on, as did his wife whenever I watched one of her surgeries, and I was encouraged to ask questions. Towards the end of the three months I was scrubbing up for almost every surgery and on one occasion I was allowed to do a few stitches.

I was so lucky to be able to experience a range of surgical techniques as the Indian medical profession are in no way behind the West in this respect. I saw key hole surgery since, unless there was a complication, Dr Ramesh always removed the Gall Bladder in this way from patients with gall stones. I saw many laposcopic and siscopic surgeries for bladder stones and reduction of the prostate. All kinds of stones were a common complaint of patients coming into the hospital. The local water contains a high percentage of calcium and so the calcium deposits in the bladder and gall bladder where larger than would be found in England. I also saw open surgery in many areas of the body.

Since the operating theatre at Harley Rram was so good Dr Ramesh would often get visiting surgeons in to perform surgeries that were not his speciality or that he could not perform himself. I also saw all his wife’s surgeries that included hysterectomies, terminations and caesareans and witnessed orthopaedic surgery and a few different kinds of plastic surgeries. Since Dr Ramesh was an urologist I saw a great deal of abdominal surgery such as hernia reparations. I really enjoyed watching an appendix removal as that is the only major surgery that I’ve experienced and seeing what it entailed was fascinating.

Accommodation: Travellers Worldwide offered the option of living with a host family or living in the Travellers house, which was in one of the nicer suburbs of Madurai. I chose to live in the house which consisted of a three bedroom house and a two bedroom flat just across the road. There are many projects that Travellers offer and so the people I shared the house with were very diverse. When I first arrived one girl had been working in the orphanage for six months, but the majority of the volunteers stayed anywhere between one and two months with a few staying just two weeks and a few others doing three months like me. I really enjoyed living with other westerners as I think I would have been lonelier with a host family.

The locals were all friendly and accommodating, but their culture is so different from our own that they find it difficult to understand concepts we would think normal. In the house we had a lady who cooked for us and was always in the house. She was called Jeya and acted a little like a mother, cooking our favourite meals and so on. We also had a cleaner who came in every day to clean both houses and a rotation of security guards outside both houses day and night. The houses were comfortable and really quite western. Also, there was no washing machine so I was immediately introduced to washing my clothes by hand.

My travelling to and from work was almost always done in “autos”. These were small, three wheeled motor vehicles, which were driven within an inch of all other obstacles, animals, people or other vehicles, but never exceeded about 15 mph. The roads were fun since they were packed with other vehicles and few rules of the roads, except not to hit the cows, which were left free to wander wherever they pleased including across the main roads! We had regular drivers, organised and paid for by Travellers. The other type of transport was a small people carrier plus driver owned by Pradeep, our local adviser and aide. I enjoyed being driven in the autos for all their shortcomings since they had open sides and the ride was never dull.

Travel around India: During the three months I was in Madurai I took the opportunities provided at weekends to travel around the south of India a little bit. I managed to get away four times. Two of the places I visited where close by, by which I mean just four hours drive on a crowed government bus, while the other two were at least ten-hour overnight journeys. For the longer weekends I took the Friday off work.

India is a great deal cheaper than England and at the beginning of the trip I kept converting prices back into pounds and thinking how cheap they were, but I soon realised that I had to start thinking in rupees or I would be constantly short changed.

Safety: While I was preparing to go to India over Christmas, I made a decision not to take anything of value with me. I had heard many tales of possessions being stolen from one’s room, one’s bag and just about everywhere else. I think I was luckier than most since I lived in a fixed home and knew from the beginning that anything I left in the house would be safe since Jeya was nearly always in the house. There was always a security man on duty and everyone who worked in the house, like the cleaner, knew it was more than their job was worth to steal anything. I always kept my bag close to me when I was out and about and I never experienced any attempts to grab it. Once, when on a train, I saw a fellow traveller drop a purse on the ground and an Indian man picked it up and gave it back. The only other place I left my bag unattended was at my hospital and in the last few weeks of my stay I had 1000 rupees stolen. Dr Ramesh, however, refunded me on my last day, which I hadn’t expected at all and felt it was very kind of him. My advice would be never to carry large sums around, unless of course essential for travelling. I usually carried a maximum of 500 rupees, but on that occasion I had been planning to pay the local tailor who had made up some dresses and trousers for me.

Conclusion: I strongly feel that my time in India was everything I hoped it would be. I managed to see and experience so many medical and surgical procedures and cases that would never have been possible in the UK and I had a fantastic time as well. I’ve stayed in touch with many of the people I met in the house and I hope to remain in touch with Dr Ramesh and the Harley Rram Nursing Home. I would certainly like to re-visit and explore more of southern India as I didn’t do much travelling and I would also love to go back to Harley Rram in the future, perhaps on my elective period during medical training. I am certain that this unusual experience helped me to obtain the three offers that I have received following interviews at my chosen universities. I am grateful to all the sponsors who have shown interest and provided financial support to allow me to complete this very worthwhile and unforgettable project.

What experience do you feel you are gaining? I gained an excellent exp of the culture and about how hospitals are run in India and how it is different to that in England. Living in India is so cheap. I only spent £20 living there for two weeks, which included going out for dinner twice and going sight seeing and internet place almost everyday.

I also gained the experience of travelling on my own, both in India and back home to the UK.

So far what is the best thing about your placement? Being able to make friends at work and with other volunteers. I really enjoyed being able to celebrate pongal with the rest of the people. 

Would you recommend this placement to anyone else? Definitely! It was so much fun and I really wish I could have stayed there for longer. The other volunteers and so nice and the people there are so welcoming. They really do go out of their way to help you.

What type of person do you think this placement would suit? People who are willing to experience new cultures and enjoy hot weather. You also need to be prepared to get a lot of attention from the locals.

Overall it was a fantastic placement and I really enjoyed myself.

Work started at 11, so until then, I’d get ready and have breakfast, and lunch just before I left, so I could make the most of the time I had at work. Once I’d finished work at 4, I’d come home and usually have a nap, as the heat was really tiring. Then in the evening if a friend and I were up for it we'd take a tuk tuk to the market or go somewhere. In the evening usually before dinner I’d go to the internet place and check e-mails. After dinner, we'd all just sit together play cards and have fun, until it was bed time (about 11).

Thank you for organising my placement. I had an excellent time and I’d love to go back when the opportunity arises.

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Last modified: August 22, 2008