Planning your elective - India

Mark Wilson gives you some tips on arranging an elective in India

India is a truly fascinating country. It is huge and its culture and medicine are widely diverse. Do not underestimate the size of India; even comparatively short train journeys can take days to complete.

The range of experiences to be had within India is also vast, from the extreme hustle of polluted Delhi to the tranquil and spectacular Himalayas. Southern India, where there are more vegetarians, differs subtly from northern India. This dates back to 1000 bc when the original Indian civilisation was pushed south by invaders from central Asia. Arab, Turk, European, and, most notably, British invasions have left their marks on Indian culture. The British influence seems to have left a love of bureaucracy; to get a train ticket you will often have to show your passport and fill out forms in triplicate (but at least you'll get there).

Health problems in India

The government provides healthcare, but it only stretches to one doctor for every 2000 people and is limited in resources. There are private hospitals, but in a country where the average wage is 12 000 rupees (£160; $250; a250) a year (70 pence per day), such options are for the select few only. A number of hospitals ask for a contribution.

Malnutrition is still common, contributing to an infant mortality of 80 in 1000. Infectious diseases, especially respiratory, diarrhoeal, and malaria are also big killers. Multidrug resistant tuberculosis (Koch's disease) is common as people tend to stop treatment as soon as symptoms disappear. Conditions commonly present late. Prevalence of HIV is relatively low--0.7% in 1999. The massive population growth is one of the biggest drains on health care. Forced sterilisation and campaigns such as giving away transistor radios in exchange for sterilisation have all failed to reduce growth rates. Education is really what is needed.

As Indian culture is diverse, so is the medicine. In the north you can visit the centre of Tibetan medicine in Dharamsala. Tuberculosis and injuries from torture inflicted by the Chinese are not uncommon in the refugees that manage to get across the border. Government run hospitals tend to be overcrowded and inefficient. Christian hospitals and those run by charities tend to be just as overcrowded but a bit more efficient.

You may think that the situation is so desperate in India that they'll be grateful for all the help they can get--"see a couple of appendicectomies and then start doing them" sort of thing. This is not so. With more than 100 medical schools and a training system much like ours they have their own juniors to teach.

Visas

A three month visa is available from the High Commission (High Commission of India, India House, Aldwych, London WC2B; tel 020 7936 8484; www.hcilondon.org). The vast majority of students have previously gone with just a visitor's visa. Occasionally, however, they have been asked to obtain permission from the government and the Ministry of Health in India. This is Indian bureaucracy at its best and can take six months to sort out--so start planning early.

Vaccinations

Consult your occupational health department for up to date advice but usually typhoid, hepatitis A and B, diphtheria, rabies, and, in some mountainous areas, Japanese encephalitis, are recommended. You should also take malaria prophylactic. Remember that "Delhi belly" is also a worry; eat only things you can peel or packaged foods, watch the water, and say no to ice.

Hospitals and medical schools

There are over a hundred medical schools and thousands of hospitals; they cannot all be listed here. A huge list is on www.medicstravel.com and more information on individual hospitals can be found in The Medic's Guide to Work and Electives Around the World. Most people go to small(ish) hospitals, and usually charity ones at that, rather than medical schools. Some of the most frequently visited and most highly recommended hospitals are listed (not in order of size) below.

Delhi

All India Insitute of Medical Sciences (AIIMS) Ansari Nagar, New Delhi 110 029 (tel 11 661 123 or 11 686 45 851; fax 11 686 26 630) is Located in the capital (30 minutes' bus ride from the centre), it is India's premier teaching hospital and medical research institution.St Stephen's Hospital Tis Hazari, Old Delhi, is a large general hospital founded by British missionaries to provide subsidised health care for working class Indians in north Delhi.

Punjab and Haryana

The Christian Medical College and Hospital, Punjab University, Ludhiana, 141 001, has 600 beds, is run jointly by a mission and the government, and has its own medical school. It is linked to the British Medical Fellowship and is a popular elective destination.The Postgraduate Institute of Medical Education and Research Sector 10, Chandigarh (VT), Haryana.Macrobert Hospital, Chariwai District, Gurdaspur, Punjab, is run by the Salvation Army and has 110 beds providing general medical and surgical needs.

Maharashtra

Jamkhed Hospital, Jamkhed, Ahmed Najar District, Maharashtra.Richardson Leprosy Hospital, Miraj 416 410, Sangl District, Maharashtra.

West Bengal (Calcutta)

The Ramakrishna Seva Pratishtan (RKSP) Hospital, 99 Sarat Bose Road, Calcutta 700 026 (tel 33 475 3636/37/38/39; fax 33 475 4351) is a charitable hospital but is also recognised as a postgraduate training institute by the University of Calcutta.

Karnataka

Church of South India Hospital, 2 Col Hill Road, Chikballapur 562 101, Karnataka (tel 08 156 72 269), is an overcrowded self funded hospital with 175 beds in Chikballapur, a small town 60 km north of Bangalore.

Tamil Nadu

Christian Medical College and Hospital Vellore, University of Madras, Ida Scudder Road, Post Box 3, Vellore 632 004, Tamil Nadu (tel 416 22 603; www.cmch-vellore.edu), is a missionary hospital with a medical school. It is the biggest hospital in south India with 1700 beds and has specialities such as cardiothoracic and plastic surgery.Sri Ramachandra Medical College and Research Institute, 1 Ramachandra Nagar, Porur, Madras/Chennai 600 116, Tamij Nadu (tel 4828027-29; fax: 44 4827008)Christian Fellowship Hospital, Oddanchatram, Anna District, Tamil Nadu 624 619, is a mission hospital in rural Tamil Nadu very popular for electives and voluntary work.

Kerala

Lal Memorial Hospital, Asan Nagar, Maddayikonam Irinjalakuda, Trichur Kerala.Mar Kurilose Mission Hospital, Anjoor, PO Thozhiyur 680 520, Trissur Dt, Kerala.

Himachal Pradesh

Tibetan Delek Hospital Gangchen Kyishong, Dharamsala 176 215, Dist. Kangra, Himachal Pradesh, is run by the Tibetan community but serves the needs of the Tibetans, Indian people, and Westerners living in the area. The doctors are mainly unpaid Western volunteers.Men-Tsee-Khang, Tibetan Medical and Astrological Institute of HH the Dalai Lama, Gangchen Kyishong, Dharamsala 176 215, Dist. Kangra, Himachal Pradesh, is the institute for the preservation and further investigation into Tibetan medicine.

Mark Wilson, author of Medic's Guide to Work and Electives Around the World, Royal London Hospital, London
Email: mark@medicstravel.com


studentBMJ 2002;10:397-440 November ISSN 0966-6494

1. Mark Wilson runs www.medicstravel.com