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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. |
MEDICAL CASE STUDY
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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. |
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