Each one had a different question – and each one found the hoped-for answer.
Four University of Missouri-Kansas City students – Divya Igwe and Vaishnavi Vaidyanathan, School of Medicine fourth-year students; and Joe Jeffrey and Tim Williams, pre-med seniors in the School of Biological Sciences – went to Mumbai, India, to shadow surgeons and clinicians and observe the Indian healthcare system.
For Tim, who is drawn to international medicine and organizations like Doctors Without Borders, the trip could help him resolve any self-doubt about his decision.
Joe was also considering public health, and knew that the treatments and surgical procedures he would see would be anything but routine. Was he prepared?
For Vaishnavi, the experience might answer her questions about self-confidence and relating well to patients.
And Divya believed she was self-reliant and independent, but would those qualities stand up in trying situations?
Ted White, Ph.D., Dean of the School of Biological Sciences, promoted the service learning opportunity, particularly the chance to see real-life medical procedures in the operating theatres. It was also an ideal time for a reality check.
Mumbai is India’s most populous city and in many ways is a typical modern urban scene. It is home to more than 21 million people, and it is also India’s financial capital. There, as it is throughout India, education is valued and supported. Women make up about half of the medical students in India, although there are few male nurses. American influence is seen everywhere, in fashion, entertainment and shopping.
But there the similarities end.
In a city such as Mumbai, there is no “personal space.” Air conditioning is for the wealthy few. Bottled water is the prudent choice, even for brushing teeth. Other students advised Tim and Joe that the food was not always to their liking, so Tim had filled a carryon with snacks for just such emergencies.
Joe and Tim were in a group of nine students visiting in July. Their first impressions were shaped by the unending stream of people walking, driving, riding elephants and scooting around in the omnipresent auto-rickshaws. And dogs everywhere – not pets, just dogs wandering the streets, the shops, even the upper floors of the hospitals.
Joe did not expect the local people to openly stare at him; but, tall and fair, Joe stood out in almost any crowd. And in an area where tourists were rare, he was a still greater rarity. Sometimes, people shyly approached him to offer food or drink.
Divya and Vaishnavi spent the month of June in Mumbai, part of a group of five.
As they traveled to their assigned hospitals and interacted with patients, Divya’s admiration for the Indian education process grew. She noted that Indian schools made provisions to give students the education most suited to their talents.
Vaishnavi’s adjustment was not as challenging as it was for the others. She felt a sense of comfort when she arrived in India, her parents’ birthplace and a “second home” where she had visited often since she was two months old. She was accustomed to the different standard of living, able to cope without air conditioning and other conveniences that Americans take for granted. Coinciding with her trip, her family was there for a cousin’s coming-of-age ceremony.
For Divya, it was often unsettling to be in the minority. Despite being a woman of Indian-Nigerian heritage whose name is Indian, she sometimes felt ignored in groups. After watching local Mumbai TV shows featuring light-skinned heroes and dark villains, she had a moment of clarity: in a nation where all people were people of color, skin tone was used by some to set them apart. Others in Divya’s group felt the same sense of exclusion.
These feelings gave Divya a new-found respect for her own mother’s journey. An Indian by birth, her mother had little in the way of material goods or possessions. Still, she made her way. Her mother’s self-determination and personal freedom stood in contrast to the subservience Divya saw in some Indian women
Joe and Tim’s group was assigned to a Sanjeevani Hospital, where they would make rounds and observe surgeries. India has tiered hospital options: private hospitals in cities, private hospitals in rural areas, and government-run hospitals in both.
The surgeries they witnessed were far from routine. In many cases, the patient did not have dependable transportation or the finances to seek treatment, and only arrived at the hospital when the condition was advanced.
In India, medicine sometimes clashes with cultural mores and complicated traditions. Dr. Datar, an academic advisor, told Tim’s group that it was illegal to tell prospective parents the sex of their baby. Sonograms could be misused by parents who preferred sons to daughters and might abort a female fetus. And yet, during religious observations or festivals, doctors made accommodations for their patients’ cultural practices, such as fasting or praying.
Another difference is the practice of telling the family what the diagnosis is before the patient is informed. Usually, one member of a family speaks for everyone; but they all hear the options and offer opinions as to what’s best. In Indian hospitals, “Do Not Resuscitate” is illegal. The staff is obligated to provide care to the patient while they are in the hospital, although the family might ask the physicians not to give their “best effort.”
Shadowing Dr. Agrawal was eye-opening for the American students. His case load was very large and most of his patients’ illnesses were serious. But by the end of the day, which sometimes ran until 11 p.m., he was able to reconstruct the particulars of each case and make careful notes about what he found and what he prescribed.
The level of care seemed equivalent to what one would find in an American hospital. Vaishnavi saw some advantages to the high numbers of patients seen in the Mumbai clinics.
“We might see these ailments once,” she said, “but the Indian physicians see them constantly. So they are not intimidated by the difficulty or the severity of a patient’s condition – they have seen it many times before, and they take care of it.”
Vaishnavi was touched by the earnest, gentle care that the physicians dispensed to each patient, even going so far as to use family diminutives like “nani” (grandmother) or “bhai” (brother) with their patients.
Even with language barriers, the students could visually follow what was happening. And those fortunate enough to make rounds with Vaishnavi heard her translations. She had picked up passable Hindi from her UMKC roommate. Vaishnavi even interviewed a psychiatric patient in Hindi, a real test of her abilities with language and with medical protocols.
Entertainment was plentiful. Tim watched cricket matches, but with a measure of envy. He didn’t have the chance – or maybe the nerve – to try his hand. One weekend, Dr. Agrawal treated his students to dinner and a night out at the Rude Lounge.
Both groups made some short trips to nearby spectacular sites, including the Taj Mahal and the Sanjay Gandhi National Park. They took side trips to Punjab, a neighboring state, and some botanical gardens.
They bargained at local shops and visited some upscale malls and elegant restaurants. By contrast, in one section of Mumbai, Dharivi, fairly rudimentary housing is built on public lands. One million people live in a space half the size of New York’s Central Park.
Some in the student groups were studying special education, microfinance, and even Bollywood. The area in Mumbai where Bollywood movies and TV series are shot was not far from the student quarters, so they went there to look it over. Although most of the American students didn’t recognize any of the Indian celebrities, Vaishnavi was star-struck.
“I’ve grown up watching these people! It’s like meeting a rock star or movie actor. I couldn’t believe I was standing in the same room with them,” she said.
Before the trip ended, almost everyone was sick at least once but recovered quickly. Joe and Tim were sick the same day, so sympathy for the other was in short supply. They called that the “Worst Wednesday Ever.
Divya, Joe, Tim and Vaishnavi are sure they are on the right path, and medicine remains their chosen field.
Vaishnavi described medicine as subtle, but she experienced moments when the palpable effects of treatment left her stunned. One such event was a kidney transplant. The patient’s diseased kidney was removed. The live donor’s kidney was taken out and cleaned; at that point, the new kidney was completely pale. After transferring the healthy kidney to the patient and connecting it to the renal artery, the new kidney immediately turned a bright red.
“Like UMKC’s Sojourner Clinic,” Vaishnavi said, “at Sanjeevani the very ill and elderly are treated at no cost. What they do pay is respect. They are almost reverent in a way, and touch the feet of their doctors as a sign of gratitude.”
In the neurology outpatient department, Vaishnavi met a patient who had experienced numbness and tingling for the past year. After getting lab results, the doctor figured out that the patient had a vitamin B12 deficiency, which can be easily cured with an injection. This patient would recover in a matter of weeks, a potent sign of the difference doctors can make in a patient’s quality of life.
The trip reinforced all that the students were learning at UMKC, and their experiences were effective reminders of why they chose medicine in the first place.