I felt the blazing heat slap my face as I got off my small plane in the city of Vijaywada, state of Andhra Pradesh, India. Being accustomed to the comforts of living in North America I asked myself why and how I ended up in a place where the airport was still under construction and there was no path for me to lug my luggage. Despite the heat, the warm welcome I received from the locals waiting to receive me put my thoughts away from the discomfort I was experiencing. Many people questioned why I was choosing to leave North America to volunteer my time when there were plenty of opportunities at home. I always responded saying, we are privileged to be living in first-world country but it was time for me to experience medicine elsewhere. In spite of medicine being universal, there were sundry diseases to learn more about and experience to gain from observing medicine being practiced in a third-world country. What better place to revisit than the land of my birth. I remembered why I was here: To step out of my comfort zone and serve those who needed my time and skills the most and to acquire new skills that could apply in my future medicinal training as a resident in the United States.
Our journey was a two and half hour drive through rural villages and roads after we exited the main city. We got to our base, the village of Peddakorukondi in the state of Telangana three and a half hours later due to horrendous traffic involving casual strolling buffalos, locals, and barely any road to drive on at times. Regardless of the traffic, the view was breathtaking. I got to gaze at the evening sunset on that white-gray horizon sitting perfectly between two mountain humps like a child's painting personified. I am constantly awed by the beauty of Mother Nature so the ride home felt short due to the scenery. After finally getting to our village we had to settle down with a warm welcome and quick dinner and early rest beause we had a busy day scheduled for tomorrow.
The next day began the first of my service and observation at St Joseph's Sevalinaya Health Center. Since I was already working in a missionary health center set up by the nuns from St Joseph's convent, we did not have to travel to local villages-the villagers came to us. Our day usually started with morning prayers, breakfast, and then we settled down at our desks ready to see patients already triaged by the staff. We did daily urine dipsticks and glucometer readings for those who required them and then we assessed patients during patient encounters. Our health center was comprised of a patient encounter room with two examination beds, a waiting room and triage station, an operating room, pharmacy, patient ward, and ultrasound room. The rural hospital could not admit even 10 patients at once.
Some patients traveled over 1000 miles to visit our health center in Telangana because they had heard of the kindness and affordable health care available at our facility. Therefore, the first day involved seeing 105 patients. We worked from 9 a.m. in the morning until 6 p.m. at night with minimal breaks so the patients could travel home on time and comfortably. We never denied any patients health care, hence our hours were determined by when we saw the last patient for the day. In order to allow for a quick inflow of patient encounters we sat three patients in the encounter room to assist their needs. Though the space was limited they were tolerant.
Most of these underprivileged individuals were in the age range of 40-60 years where their constant operational lifestyles have subjected them to a lifetime of unbearable joint pain. We focused on attending to these problems with intra-articular WHO-approved remedies that seemed to relieve the pain and keep these patients happy for months. We addressed all sorts of joint pains since most of these patients suffered from polyarthritis. We performed thorough history and physicals on new patients to ensure no contraindications with these medications. Our remedy was highly effective, hence our large pool of patients were mostly there through word of mouth. The trust the center managed to build over the years was the reason patients used to travel many miles to seek care at the facility. We believed health care to be a patient's right and therefore did not deny them any service even if they could not pay their dues for the day. We modified our treatment to ensure they received some service for their visit to the health center and always dispensed vitamin B complex since a large percentage of patients were malnourished. Even though rheumatology was our primary focus we still offered services in general surgery, obstetrics and gynecology, general medicine, cardiology, urology, and wound care.
It was interesting to see what patients did to distract themselves from the excruciating arthritic pain they were experiencing chronically or intermittently. Patients would use iron rods and rat poison to displace the pain they were suffering especially when the pain was in their knees. It was truly a sad sight. Some of the young women suffered from severe cases of rheumatoid arthritis subjecting them to lifelong deformities of the hand joints and all they sought was comfort.
In fact, we solely focused on patient comfort at the health center, yet we saw an assortment of cases. I got to see some of the local diseases, such as filiariasis, which resulted in massive lymphedema in the arm and left lower extremity of two female patients. I got to see a 7-year-old boy suffering from scabies and a 62-year-old suffering from severe cellulitis. We had many alcoholics coming in for treatment due to withdrawal tremors. We also did prenatal screenings as our facility had the tools and equipment to conduct deliveries and C-sections if needed. We saw patients for anything unless we did not have the equipment to hold them at our facility in which case we referred them to the city hospitals.
We also traveled to a neighboring hospital to offer our services and knowledge in rheumatology to aid them in proper care and treatment of pain management as the cases of arthritis in rural India were numerous. Overall the experience and skills I gained from observing local professionals and performing routine tasks in various departments was an exhilarating experience. Rural medicine is indeed distinct. It requires you to be more knowledgeable of diseases and be very skilled in taking and performing thorough history and physical exams due to lack of access to diagnostic tests and equipment that would easily be available at city hospitals. I had the opportunity not just to help with assessments but to diagnose and assist with the treatment plan with the attending in charge.
The journey to rural India was not an easy experience. I suffered from heat exhaustion twice during my stay; I took two showers per day so I could stay cool as the nights were as hot as the days. Overall my experience made me realize how privileged I was to live North America amidst modern medicine. Although I was able to reinforce the knowledge and training I had acquired and received as a medical student, this experience made me realize how much I want to help local communities in third-world countries with not just my wealth but, more important, with my skills and time. As I continue to further my training in the United States of America I vow to help the village of Peddakorokundi whenever I can and never to forget the piece of my heart they have helped me mold.