I recently completed a four-week medical elective at CRHP, with the intention to gain exposure to medicine in a developing country. I thought that most of my training would be through the hospital in an observatory role. However, I soon realised that curative medicine and secondary health care was only a small aspect of the holistic health care provided by CRHP. It was time to get my hands dirty and get involved wherever I could.
Over the next 4 weeks, I learnt what Dr’s Mabelle and Raj Arole discovered 40 years ago; the communities served by CRHP needed development as much as they needed healthcare. Poor health stemmed primarily from abject poverty and that the population didn’t have access to food, clean drinking water, shelter and sanitation. In these circumstances, development projects providing these basic human requirements provided far greater improvement in morbidly and mortality, than any curative treatment. As such, I spent my four weeks being involved with all aspects of CRHP’s work.
Firstly, I spent time with the village health workers in their local villages to understand their way of life and the issues they faced. It was eye opening to see their simple way of life, humble surrounds and the cottage industries which are their livelihood. I saw first-hand the health issues caused by poor sanitation, public defecation and roaming animals. I also witnessed health initiatives which were working well including, provision of safe drinking water, waste water drainage and a vaccination program. I also had the opportunity to hear their individual stories, triumphs and challenges. The women were inspiring and empowering, having triumphed through adversity to make meaningful change in the community.
I also spent much of my time at the Julia Hospital, a 50-bed hospital with 3 operating theatres. The first thing that struck me was how involved peoples’ family and friends are in each other’s health; it was heartening to see the support for one another. I also really enjoyed focusing on clinical aspects of medicine rather than investigations, it was truly people centric medicine. The staff knew the patients and their backgrounds, individual challenges and financial situations. Payment was scaled accordingly to paying affordability.
My most enjoyable memory from CRHP was conducting health checks on the pre-schoolers who attended our campus school. Children were aged 2-5 years and were extremely poor, living with their families in cramped accommodation in a nearby rural slum. Whilst the children didn’t have a lot they were extremely happy, playful and appreciative children who enjoyed thoughtful attention and were fascinated to listen to their heart, lungs and belly sounds. We diagnosed many medical conditions and provided treatment in the Julia Hospital, at no cost.
My experience in Jamkhed has been completely immersive and I was grateful to have a unique opportunity to be included in a remote rural Indian community from both a medical and cultural perspective. Medically, I learnt what it was like to practice in a poor, remote community with limited access to resources and technology. I learnt the importance of a thorough clinical examination, and was amazed at the scope of service that could be provided in the context of limited investigations and resources. I also experienced the challenges of working with a culturally and linguistically diverse community, many of whom were illiterate, superstitious and had limited medical understanding.
Culturally, I have witnessed the beauty and devastation of religious and cultural traditions and the difficulties inherent in providing for a developing nation of 1.3 billion people. My elective has been a challenging, humbling and enlightening experience and I will take with me many memories that will be formative for my years ahead.