By: Alexander W. Aleem
There the orthopedic service is run by Dr. Anil Agarwal. He is the only pediatric orthopedist on staff; he along with 4 residents make up the entire orthopedics team. He is an incredibly well-respected orthopedist in India, and has authored several articles/book chapters in Western literature. They see on average between 70-120 patients in their OPD (outpatient clinic) a day, and operate 2 days a weeks as well. The hospital is entirely government funded and provides free care for all patients. Patients
are incredibly poor.
Most of the pathologies seen at CNBC are related to the vast poverty encountered. Nutritional ricketts, a virtually unheard of pathology in the US, is probably the most common encountered disease in the OPD. An infant that presents with swelling in the metaphyseal region of all extremities is pathognomic for the disease. Additionally, infection (including TB) is very common, and is thought to be secondary to nutritional deficiencies in the patient population.
Clubfoot is also commonly seen. A national association known as CURE, helps coordinate cast and bracing treatment of over 900 patients at CNBC. All the logs are kept in handwritten notebooks, and care is coordinated by several counselors. Patients’ families are incredibly grateful for all care provided, and show a rate of compliance with treatment that puts the US to shame.
I spent my second week at the All India Institute of Medical Sciences (AIIMS), a large teaching hospital. AIIMS is considered one of the best teaching hospitals in all India, so even though it is government funded hospital, it remains a large referral center. I spent my time there with the orthopedic oncology team, led by Dr. Shirshir Rastogi and Dr. Shah Alam Khan.
At AIIMS, I was once again struck by the different types of pathologies encountered. In addition, the presentations were so much different. Large, aggressive tumors presented to clinic after growing to an incredibly large size, and were often not diagnosed until almost untreatable.
Overall, my experience in India was invaluable. I was exposed to an entirely different side of orthopedics that I could not see in the US. I made a lot of great friendships, and am looking forward to incorporating international service into my career.