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Going Global

The Going Global blog is an opportunity for emergency physicians to share their experiences practicing and teaching outside the United States. Submit an article about your experience to EMN at emn@lww.com. Be sure to include a brief biography and photographs of the authors. Photos taken during time spent abroad are also welcome, and should be 300 dpi and in jpg, tif, or gif format.

This blog was started by the emergency medicine residents of Palmetto Health Richland in Columbia, SC, who travel the globe on medical missions. The program is under the direction of Thomas Cook, MD, who oversees one of more than 40 academic departments of emergency medicine that sponsors Global International Emergency Medicine Fellowships.

Tuesday, December 12, 2017

The Joy and Challenge of Simple Medicine in India

BY KATE BANKS, MD

The Himalayan Health Exchange (HHE) is an organization that assembles volunteers and health care providers from all over the world to deliver care in underserved areas in northern India. I had the amazing opportunity in my second year of residency to spend a month delivering medical care with HHE in the beautiful inner Himalayan mountains. The month was full of exploring, trekking, camping, learning, doctoring, and personal and professional growth.

The clinics were scattered throughout different areas in the state of Himachal Pradesh. Our convoy of interpreters, cooks, volunteers, and health care professionals made camp in remote villages or in the mountains near small towns. Clinics were generally held in the areas close to our campsite. HHE visits these sites several times a year, so the local residents are familiar with their group and there is a small degree of continuity. Patients came from all over to see the physicians at our clinics. One patient, who was in the second trimester of pregnancy, walked more than 18 kilometers through the mountainous terrain to see a doctor. We also held clinics at schools and orphanages. After clinic, we had educational sessions about hygiene and dental care.

Luckily for our patients, physicians and government hospitals will see them for free or at reduced rates. Access to health care, however, can be quite far geographically, and may require a one- or two-day trip. Most people cannot afford the transportation fare or missing several days of farming or work to see a physician, unless it is very serious. Most patients had benign complaints such as poor vision, arthritis, or gastritis. These people were so thankful when we provided them with simple remedies such as reading glasses, ibuprofen, or Zantac. It was refreshing to see how grateful they were for medications that we have readily available in the United States and take for granted.

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The simplicity of medicine in India was sometimes invigorating, but I found myself yearning for modern technology several times. I had a teenager with mastoiditis who could not go to a hospital for several weeks, so I placed him on an oral third-generation cephalosporin. I still agonize over that case, and wish I'd done a CT scan to determine if the patient needed surgical debridement or if antibiotics were sufficient to treat his condition. Another patient presented with a benign complaint, but had a pulsatile abdominal mass on exam. I wanted to perform a bedside ultrasound so badly to confirm my suspicion of an abdominal aortic aneurysm, but that was impossible. We stressed the importance of going to a hospital for evaluation of this potential ticking time bomb, but I don't know if she was able to make it.

Besides treating Indian and Himalayan patients, our trip also provided care to Tibetan refugees. Many Tibetan refugees followed the Dalai Lama to northern India when he was exiled. Because of this, a large Tibetan and Buddhist population mixed with the traditional Indian Hindu population in Himachal Pradesh. This made for a very interesting and varied cultural experience. We held clinics at Buddhist nunneries, monasteries, and schools where Tibetan children study while preserving their language and culture.

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Our group consisted of undergraduate students, medical students, residents, and attending physicians from all over the world. We had people from the United States, England, Australia, Italy, Canada, and India. It was so interesting to learn the way medical education and health care work in each of these diverse countries. We would often sit around the campfire and talk about our respective cultures. I learned a lot about these different cultures' philosophies, food, language, and so much more.

This trip was truly once in a lifetime. Looking back on my residency, I will always remember my month-long journey trekking through the Himalayas and providing care to such wonderful patients. I am blessed that the Himalayan Health Exchange and my residency program allowed me to have such a gratifying and life-changing experience.​

Dr. Banks is a graduate of the University of Kentucky College of Medicine and a member of the Palmetto Health EM class of 2018.