My experience of JSS Health Centre, Bilaspur, India |
FOJSS Volunteer Medicine Internships Abroad | “Welcome to the real world”, Dr Yogesh Sir sighed after I had given him an account of what I had discovered during my first three weeks JSS, and indeed, in India. Conversely, this place felt like a different universe compared to what I knew to be the ‘real world’, but that wasn’t entirely a bad thing. Having done my fair share of travelling in the past, namely backpacking through China, South America, Australia, New Zealand, South Africa etc. I have always been in search of a place that truly was an escape from the ‘real world’, where you truly felt the distance from home, as opposed to what we now know as a lengthy flight and a couple of awkward transfers. Globalisation, the advent of the internet and social media pose a double-edged sword in this respect: Of course it’s great to be able to call home without worrying about roaming charges and facebook’s a convenient time-killer wherever you are, but as a result, can you ever really get lost somewhere with this overwhelming connectivity at your finger tips? It’s tricky. |
My generation was brought up on the radical notion that having fun, whether it be through exploring different cultures, meeting new people or seeing something interesting, isn’t satisfactory on it’s own – you have to demonstrate to others that this is the case. Hence why there’s such an emphasis on recording every moment when you go somewhere new or try something different. Of course it’s nice to have memories, but the pressure to document your travels and experiences in the most impressive way somewhat blunts the experience. However, what happens when the reality defies, and surpasses, the contents of a photograph? This paradox became quite clear to me as soon as I entered the establishment. Hungry and tired, I arrived at JSS at 11.30pm after a 3 hour taxi journey from the airport, covering 120km and costing only 2000 rupees (£25) – not bad compared to black cab charges! I was escorted to my room by the security guard, although given the number of people lying on the grounds of the health centre, I assumed security wasn’t too tight. I initially supposed my lodgings were basic but adequate – a single bed with a modest mattress and a fan suspended above it – although I soon realised that in terms of space and privacy, I had been afforded a very good deal. Coming from a country wherein a small spider creeping in the corner would be enough incentive to sound the alarm, the insects hopping and flying around the place were something that required a few days (and sleepless nights) of adaptation. However, I soon found that if I minimised the light exposure, and kept my distance, they would also keep theirs. | Exploring different cultures, meeting new people or seeing something interesting... |
JSS had all the investigative technology that we did back at home: An ultrasound machine, echocardiogram, X-ray, a modern HDU, extensive labs, you name it! | Over the coming days, I would realise that these people lying on the floor at night, along with the numerous stray dogs and free-roaming cows (who are protected from hunting and eating by law), were in fact patients or families of patients, who had travelled up to hundreds of kilometres from their small, isolated villages in search of the reputably honest and affordable care of the JSS practitioners. This image fitted together with my preconceptions, narrow-minded though they were, of what a rural health centre in central India would be like – crowded, old-fashioned and resource-deprived. Although in some respects I will admit this notion wasn’t too far off the mark – the general aesthetic of the establishment was a far cry from the reflective floors and asceptic interiors of the RVI in Newcastle – the presence of WIFI in all buildings and a sophisticated online patient documenting system caused me to question how archaic this establishment really was. Further, aside from certain amenities that one would only expect in the larger UK hospitals, such as MRI and CT scanners, endoscopy centres etc. JSS had all the investigative technology that we did back at home: An ultrasound machine, echocardiogram, X-ray, a modern HDU, extensive labs, you name it! |
In England, I envisage this scene would devolve into anarchy, with disgruntled patients shouting over each other about how their problem is the most urgent and that they have a bus to catch at 4 or a yoga class at 5. Here, however, the waiting room is silent. The reverence shown to those who work at JSS is astounding, as though patients’ haven’t been let it on the secret that healthcare is a right, not a privilege. Perhaps in this part of the world that isn’t the case. Perhaps the respect for and unquestioning obedience to the doctors is earned, as the patients here realise that any doctor who works here has made a conscious sacrifice – that of an easier, more luxurious and more affluent life. The doctors who work here have attained degrees from the best medical institutions, and their knowledge and skills are equally respected and coveted by the richest and poorest alike. And yet they choose to come to a place and people forgotten by the rest of society, and serve those who’s need is the greatest. However, maybe the need of the doctors to treat is equally as strong as the need of those to be treated? Maybe their decision to toil at their trade in an area beset with socioeconomic difficulties is less of a resentful capitulation to their social conscience, and more of a spiritual calling, that breeds inner peace? | The reverence shown to those who work at JSS is astounding. |
I can’t help but feel that the job of 10 surgeons at home, each having trained for years in their own specialty, is being performed over here by just one! | There is one full-time surgeon on-campus, and that is Dr Raman Sir, a fellow founder and a man who redefines my understanding of general surgery. With the help of a few assistants, and the occasional guest surgeon, it seems to me that he can tackle any surgical problem that comes through the doors. I have witnessed gastrostomies, gastro-jejunostomies, colostomies, nephrostomies, nephroplasties, hysterectomies, mastectomies, hernia repairs, fistula repairs, malrotated gut repairs, cyst removals, abscess debridements, pulmonary decortications, skin grafts, TURPs, the list could go on and on! I can’t help but feel that the job of 10 surgeons at home, each having trained for years in their own specialty, is being performed over here by just one! It leaves you in awe of the remarkable achievements that can be made in a low-resource setting such as this, but equally it makes you question whether things are being done efficiently back at home, with a £130 billion budget but a national health service still supposedly ‘in crisis’. |
Much like any other elective student travelling to an exotic, far-flung part of the world, I anticipated that I would be thrust in at the deep end, with responsibilities beyond my experience and a steep learning curve. At JSS, however, I soon realised that my role would be one of observance, and that my contribution to the every day running of the health centre would be minimal. Aside from my own low ranking in the medical hierarchy – being just a lowly medical student – the main barrier which impeded my ability to assist was the language: Even to have a grasp of Hindi (which I didn’t) was insufficient in this area, wherein a majority of patients spoke Chattisgarrhi, the local dialect. Although a little deflating at first, I soon came to appreciate the opportunity this provided for hassle-free learning: I had free reign to float between OPDs, wards and operating theatres, ensnaring any learning opportunity like a cunning thief! The doctors were more than happy to translate the pertinent information from any case, and I found myself increasingly able to corroborate my differential diagnoses with theirs. Indeed, having the luxury of sitting back and contemplating the information a patient gives you (history, examination, investigations etc.) without the need (or ability) to communicate, record and resolve affords one the opportunity to start creating mental diagnostic pathways which take up permanent residency! And at this stage in my learning, taking a break from constant assignments and assessments and instead focus on the crux of the matter – the patient – leads to crucial epiphany-like moments where you begin to realise that the knowledge you crammed into your brain prior to pass an exam is suddenly becoming relevant and contextualised, and the impossible dream of becoming a full-fledged doctor who can actually make a difference in the world realises itself as a visible – and reachable! - spec on the distant horizon (figuratively speaking). | I soon came to appreciate the opportunity this provided for hassle-free learning: I had free reign to float between OPDs, wards and operating theatres, ensnaring any learning opportunity like a cunning thief! |
I hope to escape here again as a qualified doctor, hopefully armed with a little more Hindi, so that I may fully contribute my service where the need is greatest. | On an irrelevant side note, a guilty pleasure of mine was engaging in the amenities intended only for doctors but afforded to myself, as that was the category I was affiliated closest with, namely: Being called ‘Sir’ by all the staff (after meagrely denying the title a couple of times, I soon gave in to the ego-trip and responded with a smiling nod and a ‘good morning/afternoon’ in return) and the regular cups of chai tea and coffee kindly served by the men working in the canteen, who’s presence were rewarded with overly-enthusiastic celebration and gratitude from myself! Circling back to my original point of escaping from ‘My’ real world to ‘The’ real world, it is my belief that, after having spent a month here (hardly an adequate amount of time to postulate on such matters, but I shall do regardless), it is the combined senses of purpose and necessity which provide that escapism-real world juxtaposition. To elaborate, the necessity for health care and medical expertise is so great here, that any external inputs from the outside world become unimportant and irrelevant, as nowhere else could possibly require your efforts more than those who flock here in their hundreds every day. Additionally, and consequentially, your purpose, and the purpose of the entire workforce, becomes singular and united: If those with the greatest need are here and in need of your help, then who else and what else matters? It is this shared mantra that pulses through JSS like a life force, and the camaraderie and team spirit it creates between those who work here is palpable. So appealing is this prospect, that one day I hope to escape here again as a qualified doctor, hopefully armed with a little more Hindi, so that I may fully contribute my service where the need is greatest. |
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! |
UK Medical Student Internships Trainee Blog
February 2019
October 2017
May 2017
March 2017
January 2017
|
Thanks to Tom Pietrasik for photographs of JSS
|