A Medical Student's Six Weeks Journey to Re-Discover India
By Ankita Sagar, MD/MPH, 2011 India Elective Scholarship Recipient
“Ladies and Gentlemen, we would like to welcome you to India.” The plane roared with applause and laughter, and I could not help but grin at the thought of being home. I remember growing up in India remarkably well. I remember the tropical winters and the monsoon rains in the summer. I remember the city streets and rural villages. But most of all, I remember the people and the generosity of their spirit.
After spending a few days in New Delhi, I made my way to Chandigarh, home to the Post Graduate Institute of Medical Education and Research (PGI). PGI was founded by the late Sardar Pratap Singh Kairon, the former Chief Minister of Punjab (1952 to 1964). Inaugurated on July 7th, 1963, PGI and its associated Nehru Hospital is now globally recognized as one of the premier institutes for medical education, research, and service. Nehru Hospital now boasts a record 1402 bed capacity for adult patients and many more in the Advanced Pediatric Centre. With a busy Emergency Department, Cardiac Care Center, Advanced Eye Centre, Centre of Gastroenterology, Centre for Community Medicine and School of Public Health, Research Institute, and the Out-Patient Department (OPD), PGI is an institution providing all aspects of medical care to the community. My rotation in the department of medicine allowed me to explore various divisions and interact closely with training postgraduate doctors and subspecialists.
.jpg)
One of the most dynamic aspects of medical training at PGI is the rotation through the Out-Patient Department. My rotation through the OPD involved three disciplines of medicine: Hematology/Oncology, General Internal Medicine, and Hypertension. On average, my patient case load ranged from twenty to twenty five patients a day, some of whom traveled up to 400 kms to visit the OPD. The vast pathology and the co-morbidities present in the patient population increased my depth of medical knowledge. In addition, observing and engaging in treating such patients increased my ability to both diagnose and manage patients in this short period of time.
PGI is one of the few institutes in India which hosts a medical Clinico-Pathology Conference (CPC) three days a week. Attending the CPCs gave me the opportunity to learn from world-renowned physicians and develop a greater curiosity about the topics discussed and debated during the CPCs. In these sessions, I witnessed the blending of the science of pathology and the art of medicine.
The environment at PGI emphasizes the combination of academia and service. As I became acquainted with the hospital, I began to recognize the subtle indications reaffirming the institute's commitment to providing the highest standard of care to their community and region. Often visitors can find a placard on the wall reminding staff to “Smile and Serve.” It is an utterly simple idea, however immensely effective. In an environment where frustration can overcome patience quickly, the sign reminds us of the goal of the institute: to serve. The physicians, nurses, hospital staff, and the community recognize that the patients are the center of health care.
With limited resources, the physicians make a significant effort in providing the best medical care afforded by the patient, the family, and the institute. Unfortunately, scenarios where finances limit the abilities of the physicians to prescribe medications are common. I encountered this on the very first day of my rotation. A 30 year old man was admitted with acute fever and non-resolving stomach aches. However, his recent lab reports indicated the diagnosis of acute myeloid leukemia (AML). The house-staff team discussed various aspects of the clinical presentation, the diagnosis, and the management required for this patient. To my surprise, they next discussed whether it is appropriate to inform him about the treatment even though he would not be able to afford it. In that moment, I began to realize the reality of health care access in India. Our patient was a farmer, who owns a modest home and lives with his parents, his wife, three children, and a younger brother. Unfortunately, he does not own the farm he tends, and has no other property or assets. For the past few days, he was unable to tend his farm and the responsibility has been given to his elderly father, his younger brother, and his 12 years old son. If they are able to earn profit from the harvest, the family would probably collect close to the average Indian income: Rs. 43,749. In this sum, our patient must provide food, seeds for the next cropping season, necessary supplies, as well as the treatment for AML. It is essentially implausible. Unfortunately, this is a common scenario in many institutes of India. Nevertheless, new funding programs are being developed in conjunction with private organizations and pharmaceutical companies. The progress on this front is moderate, but it holds immense potential for the future of health care access in India. Meanwhile, the dedication and commitment to address the needs of the patients and to provide high standard medical care remains resolute. It is commendable to observe the method by which physicians and hospital leadership focus on conserving funds and resources, in order to utilize them for essential medical care and management. These are the sentiments that bring great regard and repute to institutes of India, such as PGI.
Aside from visiting PGI, on the weekends, I had the opportunity to travel to four fabulous North Indian cities: Delhi, Amritsar, Agra, and Jaipur. Each city was vibrant, lively, entertaining, historic, and memorable in its own way. In Delhi, I visited the famous Chandni Chok., an expansive market with intricate, winding streets. It is truly a treasure trove of history, culture, and shopping. In Amritsar, I witnessed the devotion of Amritsari people to seva, the act of serving or making an environment more hospitable for visitors and residents alike. Of course, a trip to Amritsar entails visiting the Jallianwala Bagh and Wagah Border, Attari. Learning about the sacrifices of brave men and women left me with a sense of gratitude and responsibility towards the future of Indians world-wide. Visiting Agra further satisfied my desire for discovering historical landmarks. I had the opportunity to visit historical sites under three Mughal rulers: Fatehpur Sikri, the Agra Red Fort, and the famed Taj Mahal. My trip to India concluded with a visit to Jaipur, the Pink City. Visiting and touring Amber Fort and Hawa Mahal reminded me of fairy tales, castles, and royalty. At the Anokhi Museum, also known as Chanwar Palkiwalon ki Haveli, I witnessed the process of block printing on fabrics, starting from the carving of the block to the blotting of the ink. My visit left me with great regard for the artisans to manually block print fabrics and continue this ancient art form. Touring the four cities showed me the beauty and history of India. Through my visit, I was able to imagine a world where opulence, poetry and love, mingled with military and monetary might.
Sometimes I imagine that my trip to India has only happened in my dreams. But I wake up to find the precious tokens of my trip in the form of photographs, memories, and sentiments. The trip helped me grow on a personal, professional, and academic level. I witnessed the resounding effects of hard work, commitment, service, laughter, and love on health care in a struggling system. The facilities and infrastructure may need some aid, but the good will and dedication of the providers and communities promises a brighter future for India. At the conclusion of my trip, I realized that I will be a better physician, a better citizen, and a better person because of my experiences in India. And for this, I will always be grateful.
I would like to acknowledge the support and funding of American Association of Physicians of Indian Origin (AAPI) and AAPI-MSRF for making this trip possible. A special thanks are due to Dr. Subhash Varma, Dr. Sanjay Jain, and the entire House-staff Team at the Department of Medicine at PGI. Their kindness, enthusiasm for teaching, and support throughout my stay made my trip a memorable journey. Lastly, I would like to dedicate this article to the spirit of perseverance and dedication in all those I encountered throughout my time in India.
