Death, Life, and Inequality

Because class and rotations are over, I assumed that the last week of my trip would have less of an impact on me compared to the rest of my time in India. But the past day has impacted me the most, and it has actually been the first time I’ve cried this whole trip. In span of 24 hours I have unexpectedly witnessed Death, Life, and Inequality all through three powerful experiences that I am sure I will never forget.

Death:  Last night, a few of my friends and I were waiting in the hospital courtyard for some of the hospital staff to join us for dinner. While we waited, we saw a bunch of people gathering and a distraught woman leaving the ER.  At first I acknowledged the situation, but did not think too much of it. As more people gathered I noticed that the nurses and doctors began to come out of the ER blessing and comforting the mother. I was now intrigued, concerned, and anxious. Finally, we see the father carrying out a small girl in his arms with a white cloth draped over her body. Everyone dropped their heads and prayed. He cried and slowly placed the small body in the car to drive home. Watching the father cry with his dead daughter in his hands on Father’s Day was one of the most difficult scenes I’ve seen in my life.  

Dr. Pravesh then came to meet us and when he realized what had happened, he went to give his condolences to the family. Turns out that the family was driving somewhere for Father’s Day and they got into minor car accident. The young girl was hanging her head out the window and suffered a head injury at impact that killed her later that day. Her twin sister sat next to her in the car and seemed to be okay.

Witnessing this gave me a reminder on how fragile life really is. Everyone hears terrible stories of accidents involving young children. The reaction typically is a heavy sigh, a second of reflection, and then on with your life. But seeing the defeat and helplessness of the young girl’s family last night shook me up inside. I found myself up at night, disturbed of the horror this family is facing.

Death is the part of medicine. It is the most difficult aspect and has me a little hesitant about the profession. There are no words to console a mother or father who has just lost a child.

Life: The next experience occurred today, and it reminded me of the benefits of practicing medicine. We were all sitting around when some of our staff announced that there was going to be an emergency caesarian (Sea Section) for a woman with pre-eclampsia, a dangerous hypertensive condition for the mother and baby. The mother came into the hospital in the morning with edema and swelling of the legs and arms. The OBGYN decided it was necessary for an emergency caesarian in order to save the mother and the baby. Once again, I was intrigued and anxious. I was going to be able to see a baby being born! I was very excited. We scrubbed up and entered the Operating Theater. After the incision was made, they found out that the baby was breech, so they had to pull him out legs first. The baby boy was born without any major complications for the mother or baby. It was such a relief to hear the first cry of the baby’s life. It was an amazing and beautiful thing to witness.

Inequality:  I was honored to hear Dr. Sanjay, a professor from Varanasi and director of Men’s Action for Stopping Violence Against Women (MASVAW), his wife, Madhu, a professor in secondary education and gender, and their son discuss their lives leading the state wide campaign stopping violence against women. Their focus is on informing men about the issue of violence against women, a very progressive and socially unacceptable concept for many traditional Indians to grasp. Dr. Sanjay discussed his experience with cases of dowry burnings, rape, and mental/physical abuse. A dowry burning happens often when the groom’s family is not happy with the dowry given by the bride’s family. The groom’s family will place the woman in the kitchen and burn her…it is typically shrugged off by the authorities as a kitchen accident. They also focus on emphasizing to young boys the inequalities between boys and girls in the education system through coloring book. MASVAW has been effective in helping men recognize the inequalities that women face and in changing the hegemonic mindset that society has engrained in their heads.

Dr. Sanjay and his family have an inspiring passion and dedication to the campaign. They have been looked down upon by society and seen as rebellious. Dr. Sanjay told me that he often feels threatened by society and his family. He had to dissociate from his family because they disagreed with how Mandhu practiced feminism and how Dr. Sanjay did not set her in her place. His father would harass Dr. Sanjay’s son about feminism. When we were told this story during the lecture, I looked over at the son and saw him crying.

I loved meeting such a powerful family. They had remarkable knowledge, courage, and persistence to take on such a difficult issue in India. After the talk, I spoke with Dr. Sanjay about how I was taking a year between undergraduate and graduate school. He told me that he would be happy to have me come to Varanasi for as many months as I wished to help work with the program and peers in the universities holding focus groups and qualitative research on violence against women. We exchanged information and promised to be in touch!

So it was quite a day…to top it off, I just returned from a traditional Indian Mundan Ceremony. The ceremony celebrates a baby’s first haircut at age one. The entire town was invited. All the girls got dressed in their best Indian wear and accessories. The boys looked snazzy in their dress shirts, ties, and pants. We ate on the ground, with our fingers, on a plate made of leaves. There was so much delicious food served. Afterwards Mili taught us how to Bollywood dance and all the locals watched laughing/taking pictures.

The past 24hrs was quite the rollercoaster ride and was a lot to digest. I am gaining invaluable perspective here in India that will shape my choices going forward in life.

Jibhi Chai Clinic

My last rotation was in a remote village in the Himalayas called Jibhi! I was very excited to escape busy, smelly Manali for a week.

Jibhi Chai Clinic is a health clinic about 4 hours away from Lady Willingdon Hospital in Manali. It is located in a utopia, on a clean stream in the Himalayas next to a butterfly infested rainforest with a waterfall. Even the beds felt like clouds. Rinya, a social worker, lives there and manages the health workers in the region. Charlie, a small yellow lab puppy lives there too!

During our stay we attended the Health Mela (health fair) with the staff. A health mela is held once a year for each council of remote villages. The idea of the Mela is to bring the education and clinic to the remote villages for school aged children. They generate awareness through the street play called a kalajata promoting healthy eating and nutrition. The most prevalent medical issues referred and treated were malnutrition, typhoid, UTIs, scabies, pica, anemia, and infected wounds. One of the days we hiked up the mountain with supplies, a doctor, a dental hygienist, social workers, and medicines for over an hour until we reached the village. We saw around 115-160 children each day. We were allowed to take pulses and pictures for the staff. We were exhausted, but we felt it was important to bring the medical care to the villagers who typically cannot make it to the doctor safely.

Rinya discussed with me the importance of reaching out to the remote villages that cannot access medical care or health education. She also emphasized that both health education and clinical medicine are equally as important to the people of these remote villages. One without the other does not sustain the community health. Clinical medicine treats the immediate problem/pain but does not prevent the problem from reoccurring. Basic health education (nutrition, hygiene) teaches but does not treat the immediate problem or relieve from pain. Both clinical medicine and health education are crucial to improving the health of these communities of Northern India.

This topic really sparked my interest in possibly doing a joint degree in a Masters in Public Health and Physician’s Assistant. A MPH would help me to understand how health care works on the large scale. Being a Physician’s Assistant, I would be able to treat patients and work clinically. Both of these degrees would work well together and broaden my perspective on health. I also decided to do my research project for this trip on the Health Mela and its social/medical benefits for these remote villages.

Another reason I really enjoyed Jibhi was because we were able to work with people from India our own age. One of the doctors was young, and the two social worker interns were our age. We had a small cultural exchange with them, we taught them to swim and they taught us to Bollywood dance! We had such a wonderful time together. We also went swimming in the waterfall!

Not having internet for the week was refreshing. It was good to just get away from everyone and everything and focus on where I was at that moment.

Hospital Week

This week my rotation was at the Lady Willingdon Mission Hospital in Manali.  I spent my time observing surgery, rounds, the outpatient clinic, and the antenatal clinic.

Our day began at 8:30am at Devotion, where the staff gathered daily for singing, a prayer, and announcements.  Dr. Philip Alexander (the hospital’s superintendent) would speak about decision making, kindness, and how doing the right thing isn’t always easy. This was a very peaceful and refreshing way to start the day, no matter what religion was being practiced. I found this to be a great way to remind the staff, and myself, of the sole purpose behind practicing medicine: compassion, healing, and as a way to give back to the community.

There are so many people who are sick in India, and only so many hands and resources available to provide treatment. Because of this, I noticed different dynamics in the hospital that I was not used to seeing in the US. First being, the hospital’s mission is to make the sick healthy without the concern of profits and gains for themselves…

During devotion, Dr. Philip made it clear to the staff that he is doing his best to give them an annual raise, but it is difficult because there is such a need for medical supplies and a new ambulance. He does anything he can to keep a balance between the happy staff/healthy patients. The staff calmly accepted and did not complain or roll their eyes. Everyone was there for the same purpose and that was to treat the patients. Dr. Philip and his wife, Dr. Anna (an American doctor from Louisiana), live on site and are available 24 hours/ 7 days a week if needed. They pour their heart and souls into the hospital, and it shows in how the staff, patients, and community respect them. They are both amazing individuals, we could use more of them on this earth.

This is a stark contrast from medicine that I have witnessed back home. There are a lot of medical practices and hospitals available for people to choose from in the US. Because of this, there seems to be more of a concern for competition, profit, and productivity compared to what I have seen here at the hospital. Another difference that was noticeable was that in the US, many patients take medicine for granted…I know I am guilty of this. From what I could tell this week, every individual who walked onto the hospital grounds was appreciative and grateful of their treatment no matter what the outcome.  It was great to see the sincere efforts of the staff and in return, the appreciation of the patients.

Because of the lack of resources and money, the hospital was very inventive when it came to making due with what they had. Some examples include: using a mosquito net for a gastric surgery instead of the expensive material used in Western hospitals, taping a plastic chair to wheels for a wheelchair, and using poles with a sheet between it to transport patients.

                The cases I saw really blew me away. There was a significant amount of recurrent cases of TB, ischemic heart attacks, and COPD. Seeing this emphasized to me Dr. Philip’s reasoning for wanting the group to do research on TB. Many of the patients were young and had severe pulmonary TB. We also saw a significant amount of extra-pulmonary TB, which was very interesting.

                I really loved this part of the trip and I am a little sad that it is over. I learned so much about myself and why I really want to go into the health care field.

Community Health Rotation

My first week’s rotation was in the community with the health care workers and a doctor. We visited day schools for children under 5, where their monthly heights, weights, and basic medical exams are taken. We saw anemia in almost every child, ring worm, a potential TB diagnosis, severe respiratory illnesses, and many complaints of diarrhea/fever.  It was very interesting to see how the health of the children was correlated to their living conditions. Daycares closer to the towns and main roads tended to be unclean, crowded, and less healthy.  In the mountains, the more remote villages had cleaner and smaller daycares with significantly healthier children. Most of them still had anemia, but they were not as sick the others.
Some children’s conditions stuck with me:

1.       Lucy (one of the med students from New Zealand) flagged a few of us over to listen to this boy’s lungs who was about 3 or 4 years old. We could hear his lungs without the stethoscope, they crackled every time he took a breath. We found out that he has been sounding like that for over a year and they hadn’t done anything about it. He was immediately referred to the hospital for a same day visit. When we left, we discussed how most of the children who are referred never show to the clinic. Most people can’t afford the hospital fees or the time away from the fields to trek the kids to the hospital.

2.       Another girl, around the age of 2 or 3, was severely anemic and had been seen eating mud for the past 2-3 weeks. The doctor diagnosed pica, a condition where the individual eats dirt/mud when lacking iron due to anemia. Anemia is extremely high in India because the majority of the population is Hindi and does not eat meat, therefore they lack iron in their diet.

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Baby waiting for his check up in the village.


In the community, we were not able to be as helpful as we had hoped. The doctors encouraged us to practice taking vital signs, but with few translators and little room we were unable to contribute as much as we had wished. So, we let the Doc and the health workers do their thing. This was extremely frustrating at times because I want to help anyway possible. But there are times when you have to just let it be. It’s a difficult concept to grasp. With little direction and miscommunication we were unsure of our place in the community. We see these sick children, and we know there is not much we can do as undergraduate students to help. So we sit with them, play with them, and make them smile.


I found a cuddler :)



Saying goodbye

I have learned a lot about the health care system in India through observation. The most noteworthy problem that I have notices was the lack of education and service available for the large Indian population.  *a very matter of fact story of how many of the villagers don’t understand the human body* Dr. Kathleen shared with us a complaint from this very concerned man that his wife had white fluid coming from her genitals:

 When did it start?...When we married. //Are you sexually active?...Yes//When do you see it?....after sex.

He didn’t know what ejaculation was… basic physiology. Now imagine the other types of infectious disease, non-communicable disease, and ailments that occur in an underdeveloped country. This place is a medical mess due to: lack of education of simple health and cleanliness (hygiene, nutrition), environment, and resources.

I am grateful for my health and education that I have received growing up as a kid. As an American growing up as the doctor’s daughter, I have taken health and medicine for granted. These couple weeks in India have completely shifted my view. In many of the villages I saw this week, it was a miracle to be a healthy, well nourished child. Gives me a lot of perspective.

 I am excited to begin my hospital rotation in the morning. We have heard some very impressive stories so far, I’ll be sure to keep note of mine so that I can put them in my blog! We also had our new supervisor arrive, Lis, who we are all very excited about! She loves to trek and brings a great dynamic to the group.

The orphanage was amazing. Clean, educated, happy children.

Some of the kids from the orphanage.

PS: I love the students in my group! We all get along very well. Some fun things we have done so far…

-a 6hour trek uphill through the meadows. Very beautiful views…sore legs.

-a trip to Naggar, a neighboring village, where we had some sweets, sandwiches, and milkshakes!

-many many walks to Old Manali. Dylan’s is my favorite café so far. It has paintings of Bob Dylan lyrics all over the walls, hippies lounging, and the aroma of sweets fills the air. The best warm chocolate chip cookies and real black coffee!

The group got lazy on the trek...we hitched a ride.

Woman knitting near the river during our trek

The boys looking epic on the trek.

the incline!

good sweaty fun

the view