Christian Medical Center
Vellore, India
The main hospital of the Christian Medical College is 8 km away from the medical school campus, which entails a 25 minute ride in jam packed bus through the intense potholes of the streets of Vellore. My first time seeing the hospital was a sweltering mid-afternoon in June, after a morning full of administrative madness. I was struck by the towering blue buildings and the sprawling maze of departments. However, the size of the building immediately paled in comparison to the sheer mass of people present in and around the hospital. It’s not an exaggeration in the slightest to say every surface in the hospital was occupied by all kinds of individuals – patients, family, employees, etc. Imagine the madness of Times Square on a summer weekend. Now multiply that by 5 and make every second person sick and very much in need of help. During my first day in outpatient pediatrics, I learned that parents travel for days to bring their sick children to CMC, and line up the night before clinic to give their kids a fighting chance to see a specialist. Suddenly, the scores of men and women I witnessed sleeping in corridors and eating their meals in the Pediatric building stairwells made complete, heart wrenching sense.
I think it’s important that I clarify the admittedly grim picture I just painted, which seems to be a very common and easy pitfall in global health. CMC is one of the largest and most esteemed medical institutions in India, and as such it serves a diverse load of patients from all over the subcontinent and surrounding countries. Every doctor in the hospital speaks at least 3 languages, and switches seamlessly when communicating with the patients. On top of that, the physicians manage a massive volume of patients daily, and still maintain the utmost professionalism.
On the general pediatrics wards, I would best describe my presence as constantly in the way. The wards have lines of metal beds next to each other, with open windows and no air conditioning. During rounds, the team consisted of an average of 10 people at minimum (1 attending, 3-4 residents, 2 interns, multiple medical students, and me). As a visitor, I would often just find myself shuffling to the least obtrusive positions. From a learning perspective, I saw pathologies that I will likely never see on the wards in the US – the first patient I saw was a 5 month old baby with severe malnutrition, and his mother had bitot spots from Vitamin A deficiency. I quickly grew used to how commonplace severe bacterial sepsis and tuberculosis were in the pediatric populace. I spent my first few weeks splitting my time between general pediatrics wards, outpatient clinics, and my research project. But then I stumbled upon the community health division, and I swear I lost my mind.
The two staples of CMC’s community health division are nurse house visits and mobile clinics. I started off in the nurse visits, where a few nurses go into the surrounding villages and take care of prenatal and antenatal visits. The nurse I happened to go with had grown up in that village, and had been working with that community for 30+ years. To put it in perspective, we went to a house for an antenatal visit, and the new mother told me the same nurse had been there for the birth of that baby’s father. House visits are one of the most fulfilling experiences – we went to 5 different houses, and in every single one the families would not let us leave without having something to eat or drink. But more importantly, the nurses performing these house visits have detailed registries of all the families in the area with their various illnesses and health concerns, acting as trusted primary providers.
A common (possibly subtle) theme that I might have conveyed so far is that as a medical student, you are largely useless on the wards and in outpatient clinics for any practical purpose. My job was to learn, and my Tamil skills proved useful just to keep up and stay clued in. It’s easy to get frustrated ever so often, because didn’t we all cross that premed-useless bridge already? Why aren’t we useful yet, right? (Answer – we know nothing.) Mobile clinic changed that very, very quickly. My motto for mobile clinic was a simple one to start – there’s always a BP to be taken. It’s a fabulous equation because the patient load is massive, there is only one intern seeing all of them, they all need their BPs taken manually, and guess what? As a medical student, that is the one thing you actually are qualified to do. There was a day where I legitimately took 86 blood pressures (trust me, they were all logged). So suddenly on top of learning, I had some practical use. However, mobile clinic is where I found my other use as well.
As the career BP girl, I was the first person to talk to the patients coming to these mobile clinics. For the most part, they were elderly men and women with diabetes and hypertension, with a few seizure disorders and other chronic issues sprinkled in. Almost none of the patients spoke English, and a majority of them were illiterate as well. I often ended up taking their chief complaints, reviewing medication compliance, and glucose test results with them. What I quickly realized is that they seldom had time to chat with their healthcare providers, who changed every single time. A simple “eppadi irrukinga” (how are you doing?) gave them a moment of surprised pause, before the floodgates opened. And I loved it. This proved to be a symbiotic relationship –I loved talking to them and practicing physical exams, and in turn they had extra time to talk about all of their concerns, health and otherwise.
There was one patient in particular who I definitely won’t ever forget. Mrs. S was a quiet, slight woman in her late 50s. She had poorly controlled hypertension, and her glucose test results were quite high. I conveyed as much to her, and asked her about her diet and lifestyle. “I don’t even eat that much madam, and I work all day long,” she said. Rice? Salt? I started asking her about the standard issues with a Tamil diet, when all of a sudden she looked at me.
“My daughter had a lot of problems in school, and now she’s gone.”
“Gone?”
“She died two years ago.”
She broke down, crying right there. We just sat there together for a bit, before I asked her if she had people to talk to about this. Tamil culture is not particularly inclined towards discussing depression and mental health, so I struggled to find the right words to communicate the importance of talking about her grief and feelings of hopelessness to her loved ones. Mrs. S is one of a multitude of patients that challenged me and forced my perspective this summer.
Shortly after I left CMC, I read Atul Gawande’s book, Being Mortal. A quote that I kept coming back to (in fact I have it typed out in my phone now) was “If to be human is limited, then the role of caring professions and institution – from surgeons to nursing homes – ought to aiding people in their struggle with those limits.” I won’t insult actual physicians by suggesting that I have the qualifications to act anywhere near their level at this point in my training. However, I would like to think that in a small way, I was able to help a few patients in that struggle with limitations, just by being there and listening.
I am writing all of this almost on a whim as I sit on my plane back to New York, as a reflection of sorts. I’m thinking back to the end of my second semester of first year, specifically my head space at the time. School life felt cyclical and pointless, as if I was stuck on a hamster wheel and too fatigued and careless to really run. I was anxious all the time because I had almost no motivation to study for my exams, and my only light at the end of the tunnel was my escape to India. I truly cannot express in words what this summer experience has done for me. I found myself wanting to read my textbooks and learn more about things I was seeing in the hospital, and every patient I saw motivated me a little bit more and forced my perspective constantly. I read a biography of Dr. Ida Scudder, the trailblazing founder of CMC. Dr. Ida was one of the first women to graduate from Cornell Medicine, and she was a pioneer for women in medicine.
The combination of her story and experiencing her legacy is going to be a driving force for me for a very long time, as cheesy as that may sound. My return to New York is a bittersweet feeling – I will miss CMC and my experiences endlessly, but I am more clearheaded and motivated than ever to start on the next three years.