Rural medicine in India: What American health care can learn

Many premeds take time during their undergraduate careers to volunteer abroad. Popular destinations include Mexico, various Central and Southern American countries, and Africa. These are great opportunities to discover more about underserved care and, more importantly, what you are made of. I just thought I would share my reflections on volunteering abroad during college. Hopefully, you can glean something from them.

In the backcountry of India, in the state of Maharashtra, just north of Warora (a town a quarter the size of Lubbock, Texas), there is a leprosy colony called Anandwan. I visited this leprosy colony during a month-long trip with a college organization dedicated to alleviating health care disparities in rural India.

Aside from the routine preparation that goes into trips abroad, like proper packing, arranging automated replies, and receiving booster shots from the doctor, I had to go through some mental preparation as well. Everything I had ever heard about leprosy, from the media, physicians, friends, and family, painted the leper grotesque. I was told to expect ghastly boils, missing limbs, and deformities that would make my stomach roil. Culturally speaking, India is not very fond of lepers. Once a person contracts leprosy, often times their families and friends abandon them. The society they built up over years slowly crumbles because of a disease they couldn’t control. Without home or help, these lepers come together to Anandwan, one of India’s largest colonies. Founded by Dr. Babe Amte, and maintained today by his physician sons, Anandwan remains a sanctuary to those in need.

My prior experiences in India had colored my image of Anandwan. I pictured a destitute and largely underdeveloped area, where lepers slept in mud huts and overworked physicians scurried about trying to help as many lepers as possible. My version of Anandwan seemed so stereotypically third-world that it could have been featured on some charity documentary asking for donations. Call it my sheltered American upbringing, but I was, thankfully, proven incredibly wrong. My time there was a much needed lesson in humility, healing, and hope.

When I first stepped first into Anandwan on that muggy monsoon season afternoon, I was astounded at the colony’s level of development. They had built two hospitals, a clinic, gender-specific dormitories, a guest hostel, manufacturing warehouses, gardens, and much more. They had built all this with their own hands, however disfigured they may have been. My image of “mud huts” washed away and was replaced with something much more magnificent. Granted, the quality of these facilities was nowhere near the quality found in America, but that really didn’t matter. The fact that they went through with building them in the first place was amazing.

As a premed, I was looking forward to hands-on clinical experiences. One of those experiences took place at a 5 AM wound wrapping clinic. Everyday, I would wake up at 4 AM to get ready to treat lepers who would walk into this clinic and have their badly ulcerated limbs wrapped with gauze, padding, and a bit of powder. The treatment was meager, but it was better than nothing.

I remember coming into this clinic thinking that I would be teach the native volunteers a thing or two about first aid. Little did I know how wrong I was. These native volunteers knew more about first aid and basic primary care procedures than I did, even though they had little more than an eighth grade education. In the time I managed to clumsily wrap one wound using tools, they had wrapped two with their bare hands. I chuckled at how ignorant I was, thinking gloves, forceps, and two years of a university education would somehow make me a boon to these people. When my “first patient” came in, though, I had my first encounter with real humility.

He was a man who looked middle-aged but worn from work. His hair was straight silver and his once-white cotton clothes were stained two shades darker thanks to his outdoor labors. He struggled onto the tiled table and laid his foot out for me to bandage without so much as a word. It was obvious that he was no stranger to this clinic. All of this was normal, routine even.

I used to volunteer at a local hospital, near my college, where I was taught to greet every patient with “Hello, my name is Roheet. I’m a volunteer here. How are you today?” I thought it would be a good idea to ask my first patient this same exact phrase. Luckily, I know Marathi, the regional dialect that most everyone in Anandwan spoke. Thus, I roughly recited the same greeting to him in the hopes of starting a little dialogue.

He looked at me with some confusion, as if someone talking to him was anomalous in itself. I repeated the question, only to be greeted with an annoyed expression. He looked at me, then to his ulcerated foot, and then back to me and said, “I live with leprosy everyday. I don’t have anyone with me. No friends, no family. How can you even ask how I am doing? I am not doing well at all.” The pain in his voice was palpable.

His reply caught me completely off guard. I had no idea how to respond to his grief, so I silently continued to wrap his wound, beating myself over the head for being so stupid. How could I have not considered the assumptions that go into a question like “How are you today?” It assumes a normalcy that we here in America take for granted. A kind of steadiness to life that always opens the possibility of hope. We can ask American patients this question because we have the medicine and technology to substantiate the hope of a return to normalcy. Not so with leprosy in India.

I finished wrapping his wound and sent him on his way, wishing not to repeat the mistake with other lepers. It occurred to me how important it was not to make assumptions about patients. Rather, it’s critical that we be genuinely curious about them, their situations, and their stories. That is the humanistic basis of individualized care.

Some things in Anandwan, though, did bestow hope upon its patients. One such thing was Anandwan’s rehabilitation efforts. After healing patients with a two month antibiotic regimen, cured lepers would be allowed to learn a new trade. They had clothing manufacture, leather works, mattress construction, weaving and more vocations where patients could get valuable skills to reintegrate themselves into society. Afterwards they were given a choice – either stay with Anandwan and contribute to its success, or return to your society and be valued again. Many chose to stay and I had the opportunity to view their skills. Lepers with missing digits handled welding torches to build hand-pedaled bicycles for double-leg amputees. A woman with no control over her arms weaved needle and thread using her toes, all with a smile on her face. Impressive didn’t begin to describe it.

Anandwan’s orchestra, manned entirely by patients who were blind, mute, handicapped, or generally affected by leprosy, was another sight to behold. The orchestra practiced in a recital hall that housed donated instruments and a hodgepodge collection of amps, speakers, and microphones. A local college decided to field trip their way into Anandwan’s recital hall one night and I was able to attend the orchestra’s performance with them. The recital hall, ventilated by a few ceiling fans, was absolutely packed with around two hundred students. It was standing room only.

A singer was led to center stage and a microphone placed into his hands. From the opacity of his eyes, you could tell he was blind. He stood there timidly, gripping the microphone as his only anchor in a world he couldn’t see. The band behind him started up and at the moment he sang the first melodic notes, the crowd roared. A smile spread across the singer’s face and his new found confidence subtly reflected in his posture. Hoots, hollers, and whistles emanated behind me as eager college students joined up in the chorus, singing along to a Bollywood classic deeply embedded in their musical vernacular. Cries of “once more!” were taken up when the song ended and the next singer was allowed on stage. Apparently, the orchestra learned that its visually impaired patients were some of their best singers.

No one cared that he was blind. No one cared that they were in a leper colony. Not a soul judged the performance based on societal stigmas. It was amazing and that was all anyone could comprehend.

Painted on a wall behind the orchestra was a slogan, “Give them a chance, not charity.” Below it was a picture of a clenched fist rising upwards, somehow in defiance and solidarity. This college crowd had given them a chance, instead of writing them off as a unsalvageable cause to throw money at so you could feel good for a couple of days. No, they gave Anandwan’s orchestra something much more powerful – belief. Twenty years ago this would have never been possible with India’s cultural stigmas. Anandwan’s persistent efforts eroded, at least to a small degree, some of the bias, and society was more than happy to accept the offering.

It took time but physicians, working alongside patients, were able to change society’s perception, at least on a local level there in rural India. If you didn’t get the obvious double entendre of the post’s title, the word “patient” is meant in both senses of the word. Through treatment and rehabilitation, Anandwan’s doctors allowed their patients’ spirits to soar, often times to the applause of a society that once shunned them. But, it has taken time, and it will take more patient persistence until all of Indian society reincorporates and restores the former leprosy patient to his or her rightful place.

Together, Anandwan’s physicians, volunteers, and patients literally built a symbol of hope and normalcy that was absent before. Together, they progressed. Indeed, Anandwan epitomizes the power of patient collaboration in a developing nation.

One great thing about volunteering abroad is that it can give context to your nation’s health care system. What are we doing, what are we not doing, and where are we going? Right now, there are a lot of buzzwords flying around the health care world. ‘Open access’, ‘patient centeredness’, ‘collaboration’, ‘multidisciplinary’, and more. Hopefully, their lifespan as buzzwords will be curtailed by their metamorphosis into concrete applications. It will, however, require the patient spirit.

I ask, if they can reform cultural orthodoxy in a developing nation, what can we do here in America? The possibilities are many and that makes me very excited.

Roheet Kakaday is a pre-medical student who blogs at The Biopsy.

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