Wednesday, April 1, 2015

New Delhi, India

By: Alexander W. Aleem
I spent my international rotation observing at two separate hospitals in New Delhi, India. It wasn’t my first trip to India, but it was my first exposure to any kind of the healthcare that is delivered in India. India is a country of extremes…there is a large population of people that have all the monetary comforts they need and can access any kind of modern healthcare. However, the vast majority of the population is in dire poverty, and the healthcare provided to them by the government is limited in resources. I spent both weeks at publicly funded government teaching hospitals. The first of which was the Chacha Neru Baj Chikitsalia Hospital (CNBC), a pediatric multi-speciality hospital.

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.

I was struck by how well the orthopedic staff were able to treat such difficult diseases with limited resources. Cost is a big motivating factor for all patients, as there is really no insurance that can cover the cost of implants, treatments, etc. Patients are generally given the cheapest option, but still have excellent results.

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.

No comments: