Global and Cross-Cultural Mental Health in India
By Neil Aggarwal, MD, MBA, MA, 2011 India Elective Scholarship Recipient
In December 2010 and January 2011, I traveled to India for two psychiatric rotations at Sangath in Goa and Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar. Throughout my residency, I have explored issues in cross-cultural and global mental health, specifically among South Asian populations. The AAPI MSRF International Externship program supplemented additional funding from the American Psychiatric Association to provide me with field experiences.
I spent the first three weeks in December at Sangath, a non-profit organization devoted to clinical research in Goa. A team of researchers and I debated findings from the latest studies and worked on a research design and implementation for a future randomized controlled trial of psychotherapeutic treatments in resource-challenged settings. The work was difficult, but stimulating, as we struggled to apply the latest scientific findings to real world problems. Hopefully, our efforts will be rewarded with the publication of a systematic literature review.
After a month of intense research, I spent two weeks working at a public outpatient clinic in Amritsar affiliated with Sri Guru Ram Das Institute of Medical Sciences and Research. Everyday, I saw between fifty and eighty patients in seven hours, conducting evaluations and consultations in Hindi and Punjabi under the supervision of an attending physician. A number of fascinating cross-cultural differences emerged such as the unconcern for patient privacy, patient control of medical records, and reduced physician documentation. I saw a variety of patients with depressive, bipolar, anxiety, psychotic, and substance abuse disorders, but not those with personality disorders. Finally, psychiatrists and patients often devised innovative clinical solutions around the immense expenses of transportation and medications: psychiatrists often started medications at higher doses and patients preferred brief directive recommendations rather than exploratory psychotherapy.
Such international experiences are invaluable for future clinical researchers. Next year, I will start a fellowship at Columbia University specifically to research the prevalence and treatment of mood and anxiety disorders among South Asians in the United States. These rotations were indispensable in helping me understand how to conduct research on the expectations of treatment among South Asian patients. I am grateful to AAPI MSRF for generously underwriting a portion of my visit which exposed me to the Indian academic environment and to Indian community psychiatry.