Wrapping up our time in India, I reflect on the unique opportunity we have had here. There cannot be many residency programs offering an inside look into the functioning of NGOs and hospitals in a developing country. Moreover, visiting such a place usually includes navigating various inefficiencies and impediments. Apart from traffic, we have had very few of those. This is in large part due to the connections Gopal has made in Hyderabad from 5 prior such trips. These working relationships create opportunities for residents that are much appreciated. Because of them, we minimized the time spent waiting in rooms to see administrators, and found doctors who had prepared for our visit and thought ahead for how to integrate us into their daily routines – particularly at Sivananda and NIMS.
I envisioned a trip that focused on two institutions, but we have been fortunate enough to visit six. These have provided an interesting mix both in terms of funding (i.e. public vs. private) and location – from busy inner city to rural clinic. They are, in no particular order, the very polished private KIMS hospital, the Nizam’s Institute for medical sciences (NIMS, public-private), the Rao Hospital and Sivananda Rehabilitation home for lepers, the rural HIV NGO Snehakiran outside the city limits, and the Ronald Ross Institute for Tropical and Communicable Diseases – otherwise known as the government “Fever Hospital.” Seeing so many different places allowed us to appreciate the range of options for medical care in India (understanding those options narrow quickly depending on socioeconomic status). We did not personally witness intensely crowded larger government centers such as Osmania General Hospital. However, we understood that this is the only type of care available to the majority of the population, who cannot afford to pay medical bills, and that the placed we had seen played an important role in taking pressure off of the government system.
Shared reflection upon our experiences formed a large element of the trip (being also the purpose of this blog) and allowed us to greater appreciate what we had observed and the implications. For this we also have to thank Dr. James who led our afternoon didactic sessions with thoughtfully selected pieces. These articles allowed us to frame our while providing a broader background context for medical care in India and global health in general. Our thanks go to him and Gopal for a well-paced trip that kept us well-hydrated and well-rested. And we are grateful to our cook Lakshmi who kept us well-fed for the bulk of the trip. Multiple lunch trips to Chutney’s and Paradise also helped… and of course the Marriot buffet. Additionally, we were also honored to be invited to dinner twice, by our contact at KIMS and by the family who had arranged our driver and cook.
Everywhere we went we were treated with the utmost respect. Although we provided no clinical care and must have taken time from the normal day’s work, people welcomed us with smiles and were excited to show us their facilities. Dr. Reddy took great pleasure in teaching us about leprosy and then having us demonstrate our newfound knowledge with individual patients. Dr. Subalakshmi at KIMS brought us on rounds and explained the ins and outs of dengue fever, scrub typhus, and chikungunya, which must have been already well known to the house staff. Dr. Ravi Kiran and his wife Marguerite punctuated their outpatient HIV visits at Snehakiran to give us valuable insight into the social factors that complicated their patients’ care. Dr. Chandra and others did the same at NIMS. We would not have learned half as much without such enthusiasm on the part of our hosts. These people are an inspiration. I can only hope to have such dedicated and wonderful partners for global health endeavors in the future.