Reflections of a rural junior doctor in India

The first view of Gudalur as I got down from the Volvo is a memory etched in my mind. Mountains partially covered in clouds, their peaks visible just above the cloud cover, a slight drizzle welcoming me and fresh, cold air blowing across my face.

My first view of the hospital - a small, two-storey building with a clay-tiled roof - was from the auto, with the above-mentioned mountains rising behind it, as I mentally settled into the idea of calling this my workplace for the next year.

As any responsible, tech savvy human, I had done the diligent task of scouting the hospital on Google Satellite view. The one thing I hadn’t accounted for was that Satellite view doesn’t show the inclines involved. What showed up as a flat piece of land on Google Maps suddenly became an incline of 10 degrees. Hopefully, my calf muscles will thank me at the end of this adventure.

The folks here need to be talked about - the patients, the doctors, the health animators and the staff. Each of them carries a story of grit and determination, of circumstances and choices that brought them to where they are today. They carry with them, a treasure trove of knowledge, an incredible dedication to what they do and most importantly, a sense of purpose. In their own individual ways, they are all answering a calling.

Work in healthcare is often stressful, one often doesn't have the time to realize it, but you are seeing, day in and day out, patients walking in with their concerns, responsibilities and ideas; placing you in direct/indirect responsibility of the lives of a few hundred families. To deal with this stress, one is often taught (rather self learnt) as a defense mechanism to provide medical care with apathy. Hence, it was refreshing to see (and unlearn and relearn)how empathetic healthcare, looking beyond the patient and at the family, and going above and beyond your role as a physician, and respecting patient autonomy is practiced in a limited access secondary care setting. I have seen patients who refuse to go to other hospitals, including Ooty, even though it is closer to them, simply because we treat them better.

As an anesthetist who once worked here said, and I'm paraphrasing here “A single look is enough to shut up a patient in pain and distress and make them feel humiliated for seeking healthcare, always remember the privilege you have of being able to help alleviate someone's pain and suffering.”

I have become acutely aware of the privileges that I, as a socioeconomically forward male possess. Things such as autonomy and recognition that have come naturally to me, are often denied to these populations.

Work here has been interesting in several aspects.

The variety of patients you see here ranges from the rich and wealthy non tribals who want the latest and greatest in healthcare (while demanding a discount on your already discounted services), the estate workers, who just want something to help them continue going to work and then the tribals, who will take anything you give them, thank you for it and if it doesn’t work, continue living with the pain.

I have now, at the end of 4 months, learnt to recognize patterns among tribal patients, while at the same time not stereotyping them.

A Kattunayakan coming to the hospital at 10 PM in the night with fever for 3 days, is not coming because of the fever. He is coming because there is some severe pain bothering him for the last 1 week and hasn’t gotten better despite native treatment.

A young tribal teen who comes with a shy smile and history of vomiting and headache is probably a teenage pregnancy. Not every young teen is the same, but for every young menstruating teen, a UPT is a must.

Not all is lost however, the change that this hospital, staff and community has brought forth just by existing for the last 40 years is something that is appreciably palpable. There are entire villages free of chronic diseases because we took care to ensure nutrition and economic livelihoods. Entire villages that have collectively risen from abhorring institutionalized care to actively seeking it for the simplest of illnesses.

My core interest is in Surgery and is one of the primary reasons for me choosing this center. One would think twice before calling this a secondary care hospital, for some of the surgeries done here would elicit palpable hesitation in a few medical college hospitals. We have urologists who come and do RIRS and vascular surgeons who do laser ablations.

This is the one of the only centers providing endoscopy services in the entire Nilgiris district. Patients travel here from as far as Connoor for their endoscopy. What makes this especially remarkable is that most endoscopies are performed by us - the junior doctors.

One of the most visibly exciting things for me, was the ability to step into the OT nearly 4 years later and to be directly involved in assisting and at times, performing procedures on patients that my General Surgery friends would often be fighting for.

The responsibility that I carry now, as an independent junior physician, is also not lost on me. The ability to teach (and learn from) staff nurses and other consultants, manage patients independently and most importantly, how, at a few points, the only thing between you and the patient’s quality of life is what you read a few years ago, in a random internet article. This has prompted me to dedicate some time to improving my knowledge base.

Field visits have shown me the power of a stethoscope, BP apparatus, glucometer and torch, coupled with a few syringes, sample collection tubes and trained staff eliminate the need for most patients who are either surviving chronic disabling illnesses or in geographically challenging locations, to visit the hospital. As the community health program expands, I hope more devices can be added, which will further reduce the need for hospital visits.

Not all things in life should be a bed of roses, for then, life would be boring. However, the approach you take towards solving/ understanding a problem is something that can make or break your peace. (Quite remarkably, a patient in pain taught me this lesson)

The initial challenges that I faced here were the weather patterns, learning Malayalam, checking my legs for leeches, understanding I'm living at the edge of a forest and wildlife is common, improving my lung capacity (an ongoing struggle) and relearning how to survive long stressful days at the hospital.

Now I can hold a patient interaction almost entirely in Malayalam, avoid leeches, appreciate the beauty of wildlife, unwind after the hospital and definitely walk faster than when I first came here.