Today is our third day in Hyderabad. We’ve had a host of unique experiences so far, each wonderful in their own way. We bonded over a 7-hour layover in Dubai, all of us loopy from jet lag and sleep deprivation. We’ve experienced an array of South Indian flavors, from chole bhatura to mounds of biryani and spoonfuls of sambar. I’ve also found the constant movement and flow of people in this city of nearly 8 million to be fascinating. The auto rickshaws and tiny motorcycles squeeze their way through cars and trucks that seem far too close to each other, while flocks of pedestrians – speckled by the brightly beautiful colors of saris – somehow make their way through the congestion.
Our most current unique experience (at least from an American vantage) is being out of running water. The tank that holds the water is apparently empty, and seven neighbors have notified someone who will supposedly get it filled overnight. We’ll likely have water in the morning. In the interim, we have many filled buckets for flushing and bottles for drinking. I don’t feel too threatened by not having running water, but it has made me contrmplate the many things in my daily life that I take for granted, the things I don’t think about because they are always there.
Having now spent a couple of days shadowing in a local hospital and clinic, I’ve been thinking a lot about the things we take for granted in the American healthcare system. Our system is by no means perfect, but we do have many services and tests that we can provide without thinking twice. We have the liberty of doing things like checking electrolytes twice daily on patients who are being diuresed or monitoring PTTs every six hours on patients who require a heparin drip. In India, the frequency of these tests are limited by cost, and often the patient’s ability to pay comes into play. Realistically, increasing their frequency isn’t even an option.
Yesterday, we saw a patient who was horribly sick from infections with both HIV and MDR TB. Her sunken cheekbones, thin extremities, and glazed eyes were evidence enough of how severely ill she was. Tuberculosis is highly prevalent in India. About 40% of its population has either latent or active TB, accounting for about a quarter of the world’s cases. MDR is also becoming a worsening burden, with nearly 256,000 reported cases in 2014. The WHO recommends that patients with MDR receive treatment with five medications. This patient was only on three, and her compliance was intermittent.
This suboptimal treatment was in part why she was so sick. It’s hard to know exactly why her treatment was so inadequate. What I do know, though, is that in the United States, there are multiple checkpoints in place that would most likely have prevented such profound progression of her illness. In the states, it’s required to report all cases of TB, and MDR is certainly no exception. In many institutions, this is done by networks already in place in the hospital. After reporting, there are also mechanisms in place to make sure that patients take their medications, such as case workers who follow up with the patients regularly.
Being deprived of running water was a reminder that many things that are simple and accessible in my daily life are a much more complicated luxury for others. Similarly, the patient with HIV and TB has given me a greater appreciation for the structures that we have in our healthcare system to help patients get the treatment they need. Both of these experiences have heightened my awareness of the differences between the United States and India, and I plan to carry this sentiment with me as the trip continues.