Bridging the gap

As I sit here, almost a thousand miles away from where most of you must be reading this, the compounding question is what on earth I could write that would be relevant to a cohort of medical students on a different continent across the globe, that speak a language that I cannot even begin to make sense of and probably have a vastly different medical culture than the one I have been nurtured in for close to a decade, here in India. Lisandra (your editor) and I met on our most memorable trip to Harvard, Boston earlier in June this year. There were more than a hundred young medical graduates there from almost as many countries, and perhaps it was incredibly fortunate that we stayed in touch (thank you facebook). Never able to refuse a pretty girl anything (so far) when she asked me to write this article I of course agreed. So you must forgive my shortcomings on this piece, for I have never met you, nor have I ever been to Mexico and Spanish is all Greek to me!

India is not quite what most people that haven’t made it here in person would imagine it to be. Surprisingly we don’t have elephants in the streets, or snake charmers on our sidewalks. We wouldn’t expect to meet gold clad Maharajas or doe eyed beauty queens in our lifetime, and unlike our movies I have never seen people burst into song, and bystanders miraculously dancing a choreographed sequence in the middle of nowhere. The real India is probably like everywhere else constantly changing and growing. We find ourselves in a transition between skyscrapers and slums, between Louis Vuitton’s and dhotis and it still does not raise eyebrows when a flashy Lamborghini has to wait for a couple of cows to cross the road. Needless to say, this huge division is seen as much in health care as it is everywhere else.

Our health system works on a first-party payment system. Most of the population would use private hospitals and be able to pay for it. However, for those that cannot afford it, there is always what is called ‘Government hospitals’. These huge giants hold close to a thousand beds a day and an outpatient department 5 to 10 times that. They are usually the teaching hospitals where undergraduates and residents train and work. And they, being practically free, are usually swamped with a patient load that stretches the resources to their seams. I write to you from one such ‘little’ institute about a thousand kilometers north of Mumbai, in a not so small city of Vadodara.

I am again unclear as to how medical education is structured in Mexico, but being under the British rule for a really long time has left its mark most clearly on our education system. The medium of instruction is almost uniformly English across the map of the subcontinent. We are awarded a bachelor in Medicine and a Bachelor in Surgery (MBBS) after 4.5 years of med school and 2 years of internship (including a whole year in a rural posting). The MBBS graduates are licensed practioners and in fact the primary care physicians. Lucky (and smart) ones work really hard for a three year residency program in a larger institute, and further fellowships and super specializations are even tougher and rarer. Although more than 2/3rd of the population is in the villages, most health care is concentrated in the urban areas, causing political campaigns and periodic media outcries that are almost as regular as the monsoon rains (that are getting notoriously unpredictable by the way). Recent proposals are being made to change the basic fabric of the system to amend this, but in India a billion opinions make political change rarely an overnight possibility or even perhaps a lifetime event.

We of course see a rather ‘tropical’ spectrum of diseases too. A routine visit to my ward, and chances are you’ll ‘trip’ over one of the hundreds there being treated for Falciparum malaria, or be in time to greet the flood of enteric fever that is admitted and discharged on an almost daily basis. Tuberculosis remains the number one cause of chronic cough, and mosquitoes the deadliest creatures in the land. While as in most developing countries, the falling statistics of undernourished children are being rapidly matched with the widening waist lines of youth, and the rising incidences of diabetes, hypertension and the rest of their colleagues in tow.

While we constantly strive to improve, it was perhaps not surprising that the first thing that struck me wandering the streets of Boston were the spotless streets and the shiny buildings, the greener lawns and bluer skies. It was difficult not to be in awe of the classic towering building at Harvard undoubtedly the ‘mecca’ for medical students, or not to whisper in respectful tones around people so far you only saw on the spines of your textbooks. But after the first couple of hours, and the stardust rubbed off a little, it suddenly struck me how similar things were too.

A visit to their hospital, lead to pretty much the same exact sequence of events. Suddenly I recognized the faint but determined cries of the newborn babies in the labor room, the wrinkles of worry of the nursing mother, and the optimistic but weary trudge of the recovering hemiplegic. Sure the walls were sterile, the temperatures bearable and the white coats actually white, but wasn’t that the familiar hum of a busy nursing bustling at her station or the exhausted look of a resident who has obviously been on call for too long.

Undoubtedly as a profession we have a noble calling. We serve many roles: a healer, a teacher, a protector and even a friend. We do what we can and however we can and like everyone else, we get tired and make mistakes. And it seems those days are common everywhere, however different the names of your patients or the color of their skin. I came to realize that we were more than a profession, more like a cult; with hundreds of differences between us but those were just the hundreds of things we could learn from each other.

And so my dear readers, or shall I say brothers and sisters in arms, all I want to say is that we live in different worlds perhaps, maybe even poles apart, but Medicine will always be fundamentally the same. It will and has always been about making people better, getting them back on their feet or perhaps just easing the pain and restoring the faith. We live in different worlds perhaps, but there is no doubt that there are countless things we need to learn from each other. Research, drug trials, journals and portals form important means to that end, but also lurking in that arena are the rapidly rusting tools of an examination and a good history, the basis of making a diagnosis and formulating a treatment plan. We live in different worlds perhaps, but there is always time to meet, to talk, to learn and to love. Always time to build a bridge…

Autor: Dr. Rushad Patell

Dr. Rushad Patell is a NEJM Platinum Scholar. He is originally from India and finished his residency in Internal Medicine in May of this year at Baroda Medical College, The Maharaja Sayajirao University. He ranked in the 99th Percentile in the All India Postgraduate Medical Entrance Exam in 2009, and has five publications to his name, some of which can be found in PubMed. Currently he has just passed the USMLE Step 2 Clinical Skills in his pursuit of a residency program in Internal Medicine in the United States.