Jonathan Youngs, UK Medical Trainee, Jan-March 2017

My experience of JSS Health Centre, Bilaspur, India
- Jonathan Youngs 

At the beginning of this year I found myself arriving at the gates of JSS in the middle of the night. My journey from London had been a long one with various delays along the way and I was probably feeling a little sorry for myself when, somewhat exhausted, I finally arrived at my new home for the next few months. I had been feeling a mixture of excitement and trepidation in the run up to the trip and JSS did not waste a chance to make an immediate impression. As I entered in search of someone to help show me to my bed for the night I found myself trying desperately not to trip over the rows of patients and their loved ones huddled together, sleeping outside within the hospital grounds. These people, I later came to understand, must often travel great distances despite their ailments in the hope that JSS might be able to offer them some relief. I quickly realised that the next few months were going to be a humbling experience and very different to the shiny floored, blue curtained UK hospitals that I was used to.

I quickly realised that the next few months were going to be a humbling experience...

The next day I met one of JSS’s founders and lead clinicians Dr. Yogesh Sir. He asked me about my experience so that we could work out how best I might spend my time with JSS. I explained that I had just finished core medical training and a diploma in tropical medicine and that I was currently taking some time out of training before going on specialise in Infectious Diseases. “Wonderful! An internist!” was his eager response. “Take a few days to settle in and then we’ll get you seeing some of our medical patients”. This suited me fine. Pediatrics, Surgery, Obstetrics and Gynecology, these were areas that I had little experience in. But adult medicine, that was what I was used to. I would surely feel comfortable advising on the usual cocktail of patients suffering from UTIs, confusion, chest pain and falls. What I got instead was rather different; within an hour I think I was asked about second-line treatment for Lupus nephritis, how to confirm a new possible diagnosis of motor neuron disease and whether to start vasopressors in someone with HIV-TB co-infection and septic shock. I very quickly felt out of my depth. These were questions I would normally put to specialists. I suddenly realised how narrow and sheltered my role as an SHO in the NHS had been.

Within an hour I think I was asked about second-line treatment for Lupus nephritis, how to confirm a new possible diagnosis of motor neuron disease...

Dr Yogesh is a fountain of knowledge in most specialties, and there is barely an operation that Dr. Raman Sir cannot turn his hands to! 

But it is exactly these challenges that JSS provides daily that make it such a rewarding experience. When there is no specialist registrar a bleep away there is only one thing to do, and that is to engage with the medical literature and do the best you can. You can learn more in a week at JSS than six months in a UK placement. It is because of such regular practice of true ‘evidence-based medicine’ that Dr. Yogesh, originally a pediatrician is now a fountain of knowledge in most specialties, and there is barely an operation that Dr. Raman Sir cannot turn his hands to! Of course, there is also the vast network of specialist doctors, inspired by the incredible work of JSS, that are available through skype clinics and email to lend their expertise if needed.

I have no doubt that my time at JSS was incredibly rewarding for myself. As someone interested in infectious diseases I saw and cared for patients with HIV, tropical pulmonary eosinophilia, leprosy and there is barely an inch of the body I didn’t see affected by TB. But the question I kept asking myself is, what am I giving back? It is an important thing to consider before embarking to volunteer in any resource-limited setting, especially one like JSS that provides such an incredible learning opportunity alongside three meals a day and accommodation.

So, what can a UK medical student give back to JSS? If you have a particular skill, or knowledge in a certain area already, then pass it on! There are lots of slots to give some teaching. Most of all though, try to support JSS’s dedicated residents. These doctors work from dusk till dawn practically seven days a week, and somehow find time to revise for exams, write their thesis and prepare teaching. Despite such an exhausting schedule these inspiring clinicians still have the energy to spend evenings contemplating the Indian health care system and how they can best spend their future to ease the suffering of the rural poor. If you can, try to do small things to help them; perhaps help look up evidence and guidelines for patients they are seeing, or prepare cases for a skype clinic they are running. Anything you can do to help take some of the strain off.

My time at JSS was an incredible experience that I will not forget, not just the medicine I saw but the wonderful friends I made …and the food I consumed!

Even better though would be to undertake a quality improvement project – something that means you make a difference to JSS that won’t leave when you do. It is amazing how quickly your time will go once you arrive, especially since your first week will mainly be spent getting your bearings, so it is best to try and have a good think about this before you go. Of course, it’s difficult to know how to improve a place you’ve never been, within a context you’re not familiar with, so perhaps try to get in touch with one someone at JSS to see whether they have any ideas. A small but achievable project is probably better than starting something you can’t finish before you leave.
 
Most important of all though is remember to have fun! My time at JSS was an incredible experience that I will not forget, not just the medicine I saw but the wonderful friends I made …and the food I consumed!

Jonathan Youngs
Combined Infection Trainee at St. George’s Hospital, London.
At JSS 2nd January – 20th March 2017
 
 Top Tips
Take some FFP-3 masks with you. JSS doesn’t have them and you will be seeing lots of patients with TB (the surgical masks they have don’t offer any real protection).

• There is no HIV PEP at  JSS so take your own if you are planning on doing any procedures like venipuncture on patients that may have HIV. It’s also a nice gift to leave behind.
• There is filtered water available on site so no real need to take chlorine tablets.
• There are lots of mosquitos, check with Dr. Sushil if they will have a bed net for you and if not take your own.
• If you can learn a little Hindi it will go a long way!
• There are lots of wild dogs in both in and around the hospital, personally I would consider the rabies vaccine for peace of mind.

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