Amlan Basu spent four weeks at the Christian Medical College Hospital, Vellore, India, discovering an ethos of medicine that was totally different to anything that he had ever come across before
It would be a waste of time and energy to go to a hospital in India with any expectations or preconceived ideas. Is that too bold an opening statement? Then let me qualify it, if only to appease the anti-sensationalists. Preconceptions would be a waste of time and energy if your medical knowledge was confined to the developed Western world, as mine was.
Sensory and emotional bombardment
To anticipate the experience that India offers is a mistake because, even within the hospital setting, India is an unpredictable bombardment of the senses.
Sights
Many of us remember our lives as a series of snapshots that never fade: the silent tears of a mother who has just lost her child; a waiting area in a clinic so full of people--I still cannot say if the area actually had any seats; stairs lined with patients on both sides; mothers breast feeding their children; others eating lunch off banana leaves; nurses with brilliant white saris draped over dark glowing skin.
Sounds
The incessant undulating hum of the waiting room; the whirring of the ceiling fans; the imperative and often impatient doctors; the penetrating cry of not just one child but a multitude; the complete lack of silence.
Smells
The acid-vinegar of disinfectant for wiping floors; "diarrhoea ward"; the sharp odour of sewers that run at the back of the hospital and yet, just around the corner, the sweetest warmest most enticing fragrance of freshly prepared food for sale on the street. But be warned that if you were to be seduced by these heavenly aromas, you may find yourself back where you started: diarrhoea ward.
You are also likely to feel bombarded at an emotional level: I have never felt such highs, nor have I felt such lows.
Money talks
The hospital that I visited, although essentially a fee paying hospital, prides itself on the fact that people only pay what they can afford. Some facilities though--for example, paediatric intensive care--come at a definite cost.
A baby is admitted gasping for air and is at first manually ventilated ("bagged") by a junior doctor. Before transferring the baby to intensive care, the parents are asked whether they can afford the treatment and are asked to pay an initial amount. If they cannot afford the treatment, the junior doctor is asked to stop ventilating the baby. The baby should be transferred to a free government hospital, where treatment can be continued, but everyone knows that as soon as ventilation stops the baby will die. These scenarios are common.
Once the immense tragedy of such a situation has been fully realised you are left with many questions. Why did the parents of the child bring the baby to a private hospital, when they knew that they could not afford to pay? Probably it was the closest hospital to them. How could anyone ask a junior doctor to stop ventilating a baby? Unfortunately, this is down to simple economics; eventually, the bill will arrive for the baby's treatment and if the parents cannot pay it then who will? If nobody pays the bills then hospitals would have to shut down. After all, they receive no government funding.
Gaining some perspective
Herein lies the beauty of the NHS in the United Kingdom. I know those three letters inevitably arouse feelings of dismay in Britain, the proverbial shake of the head, the obligatory deep sigh, "What a complete mess." But even the tiniest sense of perspective should be enough to stop us trashing what we have. Just stop and think about that baby facing death for no reason other than lack of money. Two things become clear. Firstly, we live in a ludicrously unjust world, and, secondly, to complain about the health services in the Western world is nothing short of sickening.
The doctor-patient relationship
So many things were phenomenally uplifting, particularly the people that I met, patients and doctors alike. In retrospect, the startling differences between medicine in India and in the West are almost entirely due to overpopulation and the massive number of patients that a doctor in India has to see in such a short amount of time. Doctors have no choice but to be paternalistic in their approach to patients. After all, there is no time for friendly discussion as to the different treatment options, no time for the natural course and pathology of the condition to be explained, no time for the patient to ask questions.
By Western standards, patients were treated abruptly and directly but were so appreciative despite this. I know that if a doctor in Britain adopted a similar attitude it would be greeted with only a letter of complaint. Patients in India understand the ridiculous pressures that doctors are under, and even though many of them have
travelled for three or four days for just a 30 second consultation, their gratitude is undiminished.
Most doctors I met were inspirational. After 12 hour clinics and ward rounds of epic proportions they still had the energy to pay attention to visiting elective students and still had the desire to teach us. This is just
as well, because there is so much to learn from them, not least their clinical skills, which perhaps because of the scarcity of
hi-tech investigations available to them, have become finely tuned to a remarkable degree.
I wish visiting a developing country was a compulsory part of medical education. Not only would it inspire us, but it would also impart to us a "global perspective," which is the most valid perspective we can hope to gain.
