Medical Trip to Vellore, India
The last time I participated in a mission trip was back in January 2008 in Cambodia. That was part of my church’s 14-day evangelical and medical outreach. This time round, the medical trip had no religious component; it was organised by a student-run organisation – Singapore Medical Society of Victoria (SMSV). SMSV aims to bridge the gap between medical students in Victoria and the healthcare industry in Singapore. They had previously organised a trip to Hainan Island, China. Past participants have commented they were able to step above and beyond their usual roles as medical students and do ’so much more’, e.g. perform a lipoma excision. As such, when I heard about an upcoming trip to India, I did not pass up the opportunity.
Vellore is a city in the state of Tamil Nadu, India. The name, Vellore, is derived from the Tamil words : Vel and uur, means city of spears. Ancient history shows that Vellore was a battle field, where the warriors used to fight. As of the 2001 India census, Vellore City had a population of above 900,000. Vellore has an average literacy rate of 74%, higher than the national average of 59.5%: male literacy is 80%, and female literacy is 68%. In Vellore, 11% of the population is under 6 years of age.
About 15 students (all from Melbourne) were accompanied by a team of doctors and nurses from Singapore, led by Professor Fong Poh Him, a renowned plastic surgeon from the Institute of Plastic Surgery, Singapore. The aims of the trip were two-fold. Firstly, a surgical team performed surgery at the Sri Narayani Hospital & Research Center to supplement the services available there. Whilst the hospital is multi-specialty, they do not have what the local medical fraternity term super-specialties, like plastic and reconstructive surgery. A couple of cleft palate cases were arranged beforehand for Professor Fong to operate on. In line with one of the mission’s objective of capacity building, a local ENT surgeon also scrubbed in to learn the procedure from Professor Fong. I heard reports from the Director that the ENT surgeon learnt very fast, and was essentially doing the second procedure himself with Professor Fong supervising. Secondly, we ventured out into a preselected village in the state of Tamil Nadu, where we set up a makeshift clinic to provide locals with primary health screening, antenatal screening for pregnant women and basic dispensing services. There were several healthcare professionals including a gynaecologist, general practitioners, and surgical nurses. We had some basic operating sets to do simple local-anaesthesia based procedures if necessary.
Primary healthcare in rural Vellore
The village center we visited was more than 50 kilometres away from Vellore city centre. The estimated village size was about 150. The makeshift clinic was situated in a local primary school. We know that because during break time, lots of curious little ones poured out to the clinic area, eager to see who these foreigners were and what they were doing.
When it comes to the spectrum of diseases that the medical team come across here in rural Vellore, one might expect late presentation of illnesses and exotic infections only mentioned in the fineprint of general medical texts like the handy Oxford Handbook of Clinical Medicine. For the large part this was not so. The same chronic diseases that afflict any developed population also apply here: heart disease, diabetes, osteoarthritis, etc. Many did present with polyarthritis and a preceding viral illness. Only after 30 or so patients did someone with better English told us he was diagnosed with chikungunya, a type of alpha-viral arthropathy, at the hospital. Chikungunya (CHIK) is a mosquito-borne viral illness which manifests itself with an acute febrile phase lasting only two to five days, followed by a prolonged arthralgic disease affecting the joints of the extremities. The pain associated with CHIKV infection of the joints persists for weeks or months, or in some cases years. When I hear some of them make a living as farmers, and bemoan in Tamil their plight, I cannot help but fill with heartfelt sympathy.
I was told universal healthcare exists in India, and these villagers get their usual primary care from a similar mobile clinic, staffed by only a local doctor and several nurses/students from the College of Nursing. When necessary, a referral is made to the Sri Narayani Hospital or the larger tertiary referral center at Vellore Christian Medical Centre. Also, when something emergent or troubling occurs, the locals do know how to seek help at the hospital. Access to healthcare is limited but not totally absent.
Our involvement here however, was not entirely superfluous. For these 2 sessions of clinics (9am to 1pm), the medical team saw over 250 patients. Patients were first pre-clerked by senior medical students (years 3 and 4) to quickly obtain a history of presenting complaint. I was stationed here. I spent no more than 3 minutes on each. This also took into account the time taken for translation from the local language Tamil to English and vice versa. They were then directed to a blood pressure check. Time-permitting, we got the junior medical students (years 1 and 2) to listen to their chest and lungs. Our team also brought glucometers, so all had their random blood glucose tested. Next, there were 3 doctors who each had the final say in diagnosis and management. Finally, a local nurse was in charge of dispensing any prescribed medication.
An acute case lit up the second day we were there. A 4-year-old boy presented with an infected burn over his left axillary region. Thankfully Professor Fong was around so we promptly referred it over to him. Oh, did I mention there was a Channel News Asia video crew there? They focussed all their attention on that poor little boy. Essentially they cleaned up the wound and dressed it. At the same time, the nurses were educating the parents about the importance of keeping the wound clean and teaching them how to dress it.
Sri Narayani Hospital
After a sumptuous Indian-inspired vegetarian lunch, I spent some time in the hospital. I went into the General Surgical Outpatient Clinic (unfortunately their operating list was over) and joined the consultant. This was familiar territory once again – tertiary level care, general surgery, outpatient clinics. Almost everything was similar, other than the language.
One interesting thing I saw was this elderly gentleman who presented with some GIT complaint and yet he was walking around with this external fixator with no qualms whatsoever. If I am not mistaken, he had a fractured tibia in an accident several months back. I would have thought someone like this would be one some sort of bed rest. Perhaps his abdominal complaints were too much.
Future mission trips and educational opportunities
This operation is projected to span five years, with 1 to 2 trips made per year. Throughout our involvement, the team hopes to share our clinical expertise and practices with the local healthcare providers (especially in the subspecialties), and also provide primary health services and advice to selected villages which do not readily have access to health services otherwise. Talks were held to discuss the possibility of CME sessions like conferences or seminars conducted by specialists from Singapore. The Director of Sri Narayani Hospital also welcomed medical students to spend a longer period of time (2-3 weeks) at the hospital to experience the pathology unique to India. Through SMSV, future students might be able to do so A big plus for student opportunities is that S.N. Hospital is private and only staffs consultants. This means that there are no other medical students, interns or residents roaming the hospital.
Vellore CMC – World-Class Hospital
Perhaps the most well known thing that comes to mind when one speaks of Vellore to a health professional will be a Vellore Christian Medical Center (popularly known as CMC). Vellore CMC is a referral tertiary hospital and one of the largest and most renowened hospitals in India. It attracts a floating population of at least 5000 persons every day. The hospital was founded in the early part of the 20th century by a Cornell-educated medical missionary Dr. Ida S. Scudder. It is a very popular elective location for medical students from all over the world because one can experience unique Indian pathology being tended to by world-class medical and surgical teams. Since I was there, I did not pass up the opportunity to at least pay a visit.
India is a fascinating tourist destination but also a great place to see the stark contrasts between health outcomes of the poor and underserved and the rich who can afford private healthcare or health insurance. I would recommend either of the above hospitals for your elective. I for one will surely be back for more.
Jeffrey Leow is a final year medical student at Monash University in Australia
jeffrey.leow(at)gmail.com