​My time at JSS opened my eyes both to the difficulties of healthcare provision in the rural setting with finite resources and also, the ingenuity and development that can be fostered in consequence.
 
With tribal villagers travelling in from hundreds of kilometres to access JSS’s healthcare I was reminded of the sheer privilege British citizens enjoy of having access to universally free healthcare practically at their doorstep. Efficiency was fundamental to the day-to-day practice of medicine at JSS to overcome the heavy workload, where it was usual for doctors to see up to 40 patients a day in clinic. I was made sensible of the comparatively unlimited resources us medical practitioners enjoy within the NHS, such as being able to order investigations relatively freely, having large teams to share vast workloads, as well as simply being able to use a pair of gloves without a second thought!
 
The team were incredibly welcoming and I was able to experience a huge breadth of surgeries, many which form the bread and butter of daily practice. I was invited to assist in theatres on operations such as cholecystectomies, hernia repairs and cyst removals in both the adult and paediatric populations. With the OBGYN team I was allowed to assist in hysterectomies, D&Cs, tubal ligations and caesarean sections. I was able to learn and practice different suturing techniques, the principles of opening and closing surgical incisions as well as recognising key anatomical structures during the operations. This was a hugely valuable learning experience for me and I hope to further these skills during my surgical placements in my foundation years.
 

​It was another scalding hot day as we disembarked the train at Bilaspur Junction station. The journey from Kolkata had been comfortable, but long and we had whiled away the hours watching TV and chatting with the other passengers. One elderly gentleman was a retired engineer on his way to visit family who had shared lunch with us and debated politics with Alok, our resident small talker. As Dr Yogesh later told us in one of our many morning discussions, Indian trains had a way of drawing the deepest conversations about passenger’s lives. People often finish the journey having revealed secrets about themselves that their own friends and family may be unaware of.

​If you have never visited India before or you haven’t had much experience on the roads there, this will be a quintessential experience. A narrow road carries traffic to and from Ganiyari with slow moving and larger vehicles blockading the whole lane, leaving only enough room for dangerous and erratic overtaking manoeuvres as you weave in and out of oncoming traffic. This led to several near misses as suicidal drivers on two wheelers passed too close for comfort considering the speed and lack of protection their vehicle afforded them.
 
As we pulled into the campus for the first time I was taken aback by the size of the whole operation. The site is made of a pleasing red brick and I was interested to learn that even this choice was a conscientious decision. The buildings were designed as they were to reduce the paranoia and suspicion associated with modern healthcare by the population that frequented JSS. I was even more interested to learn that this medium sized clinic by western standards covered a population an order of magnitude greater than several of the largest hospitals in London combined. With a total coverage of 1.5 million residents of Chhattisgarh and Madhya Pradesh, the limited number of beds were stretched to the limit 100% of the time.
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​Outside both the outpatient centre and booking reception, stretched a large queue of patients hoping to be seen during that day’s outpatient clinic. This was not like any other queue I had ever seen. The waiting area for the OPD was more likened to a campsite than a doctor's waiting room. People had bedding, cooking utensils and food supplies and were often accompanied by several members of their family. This was a part of the patient journey (more literally than figuratively) that Dr Yogesh emphasised on an almost daily basis. The cost of travel and opportunity cost (in terms of income lost) of attending JSS was often too high for many of these people to attend until the illness had progressed to the point of being debilitating. People were having to wait in line for upwards of a week in addition to undertaking journeys taking in excess of days and costing more than the household’s entire weekly income. All this effort to be seen in the ever-surging outpatient department. The disruption this had on their lives was almost too much in some cases and often illness was left alone until it was too late. As someone trained in a system of relative plenty, this experience could only be described as a medical culture shock.
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​It would be extremely cliché to say that visiting JSS changed my life but it would be a lie to disregard the impact it had on me. From the moment I started medicine I had the intention, as many of my selfless colleagues share, to take part in providing care to an underserviced community. I had assumed that I would join one of the common and famous institutions that specialise in such provision such as MSF but now having spent time in Chhattisgarh I have no doubt that I will make every effort to return. In the 17 years since its inception, JSS has made strides towards its key objectives. Yet I feel there is, as always in the medical field, huge room for improvement which, in part, drives my desire to return as I gain experience throughout my own medical career. And I hope that I can play a meaningful part in something as important as what JSS is aiming to achieve in the heartland of my country.

Coming from a (relatively) well-resourced healthcare system to the unforgivingly hot and rural destination of Bilaspur certainly gave us a lot to ponder. I don’t think I’ll ever forget the scene of rolling into work, in the hospital jeep - to scores of people camping outside the hospital complex. Only then do you realise what real medicine and really being a doctor is about. When Dr Yogesh told us that the hospital caters for around 1.5 million people, I didn’t quite believe him but what’s more amazing is how such a small team manages it.

A lesson I learnt from the experience was how resource-conscious all the staff had to be - whether it be reusing clinical gloves or autoclaving instruments, or being very judicious in the choice of medical tests and investigations. It really showed the clinical skills of all the doctors, that they would correctly diagnose many conditions in the absence of certain tests. Indeed, when Sushil (basically the fixer of the whole place) showed us around the applied technology unit, I was honestly taken aback by the ingenuity of the whole operation. Spacer devices in the UK for respiratory conditions that cost an arm and a leg, had been replaced by a sealed metal tumbler. Simple, effective and cheap - we could certainly use a dose of that kind of lean thinking in the NHS.

It’s a Saturday morning on the JSS campus and this morning we are driving out to visit the community centres where doctors hold their weekly clinics. From the Jeep’s rear seat, I peer out across the northern Chhattisgarhi farmlands – the pace of life is quieter compared to the bustle of Bilaspur and Ganiyari.

We hop off the jeep at the community clinic and have a quick tour of the centre. A sheltered area where all of the notes are kept, a kitchen, a basic laboratory and finally the consultation room. It is a small centre but busy nonetheless with patients sat out in the yard waiting their turn to be seen. I seek refuge under the ceiling fan which blows a cooling breeze as the first patients are seen. ​