Goal of this Blog: Entertain, Enlighten, and Educate!
Personal Caveat to this Blog: This is my first blog post EVER…so please do not mind my lack of creativity, details, or shear lack of quality… and definitely excuse my enumerable grammatical mistakes. My future posts will include more pictures, a more creative title and it will hopefully be shorter…
India is like a home that is very far away from my house. I have many family members that reside in Ahmedabad, Gujarat, India. I was also born there and immigrated to the US at the very young age of four. Nonetheless, I have gone back many times for the purposes of vacationing, visiting family and attending wedding festivities. That being said, this is the first time that I will be traveling to south India, and I am very eager and excited to see what is in store for more. Another aspect that makes this trip different is that I am specifically going to gain exposure to healthcare within India, which makes this trip even more exciting and adventurous!
Along with that introduction, I think it is also important to blog about why I am interested in learning about global health in India. The quick answer is: I believe it (India) is inevitably going to be a part of my future career as a physician. The more pertinent question and conversation that may not be resolved for some time is: to what extent and how can I incorporate global health? I have had some GLOCAL (global-local – credit to Dr. Hudspeth for the introduction to that term) experience – medical education with newly immigrated refugees in St. Louis. However, now I am looking forward to getting my feet wet in Hyderabad and I am especially looking forward to seeing what roles physicians can play within the healthcare system in India.
Pit Stop in Gujarat – Unexpected Health Encounter
Prior to arriving in Hyderabad, I made a quick weekend pit stop to my hometown of Ahmedabad to visit family. On my last full day there my grandmother and my uncle came over to visit. My uncle looked uncomfortable, diaphoretic and pale and he stated that he was not feeling well for the past 2 days. We decided to check his blood pressure with an electronic machine that they had purchased and kept in their house. The BP machine read: 100/70 with a pulse of 180. Now I won’t get into the nitty-gritty of my differential diagnosis but I thought the first thing to do was to recheck his BP and HR, which came back as 95/70 and 170. Everyone in the house was now concerned (especially my dear grandma) and turned to me for advice. I told them, “If I were in America, I would take you directly to the hospital.” Following that statement, we took him into the hospital and luckily the closest hospital was directly across the street. An EKG was done that showed Supraventricular Tachycardia. His blood pressure had improved to 120/80 on arrival to the ED. Given these findings, they performed carotid massage and gave him his beta-blocker. His repeat EKG showed normal sinus rhythm. No labs were collected. He was observed for 1 hour, paid his hospital bill and was discharged home with close follow up for workup of his SVT.
Take home points from my first encounter with healthcare in India:
- This example comes from the viewpoint of an upper middle class citizen and therefore is vastly different than what a majority of the people of India would experience. He had quick access to a private hospital that had no lines for waiting and he was treated very quickly (This encounter was quicker than the ED at BMC, as well!).
- I do not know what patients of lower classes do in these situations. I presume they would go to a government hospital but at that point my knowledge would all be assumption.
- Although it is probably not ideal to compare what would happen at BMC to an Indian hospital, I must note:
- @BMC my uncle probably would have gotten the “Rainbow” labs (CMP, CBC, Coags, Cardiac Enzymes, etc.), most likely a chest x-ray and probably been observed overnight in the ED or IP.
- @BMC he would have been in the ED for a longer period of time before any disposition was determined (either due to shear number of patients, because of all the tests, or other factors)
- During this encounter it seemed that cost-conscious care played a greater role in their (Physicians) decision making process in comparison to how things work in the US. I even asked the physician whether he felt it appropriate to get cardiac enzymes to look for precipitating factors causing this new onset SVT. He looked at me and said, “No, this is outpatient management.”
- Support Staff at a private hospital – from the short emergency room visit that I was able to witness, I was amazed by how involved and helpful the nurses and other staff were in the care of my uncle – from performing EKGs to assisting the physician in the initial evaluation. This is all presumably relative to my personal expectations…
- Physician’s Role – as alluded to earlier this is something I am looking very closely at – honestly, the physician I encountered here at the private hospital did not seem to play a very different role than any physician at BMC. In other words, I believe the training we receive could easily be used to work as a private hospital physician here in India. Now that being said, my aims in global health are not to just work in private hospitals treating the upper class citizens.
- Finally, patients here in India pay on the spot for their healthcare before discharge. This brings on a whole different and larger topic of the economics of healthcare systems, which I will not dive into at this time. However, I would be interested to see how government hospitals function with regards to this point. One interesting example of some of the pros and cons associated with government hospitals can be found in the recent NEJM article on universal health care in India – Pregnancy and Child Birth (Reddy, Jul 2015).
Topics for This Coming Week:
- Hyderabad – First Impressions
- Sivananda Rehabilitation Home – Leprosy
- Getting Sick in India
- Much more…