Hello from Manali!

Welcome to the first entry in the 2012 blog of the MMAP travels and experience at the Lady Willingdon Hospital (LWH) in Manali, Himachal Pradesh, India. After 8 months of fundraising and generating awareness of the LWH at UQ and in the Brisbane community, we have finally arrived to Manali and are settling into our 4-week, first-year medical elective. We’re hoping to update this blog a few times a week about our activities here, our musings, and particular things we find interesting and noteworthy about our experience. This first entry is a cumulative effort, describing our first week in India.

After a whirlwind of final first-year exams, packing and traveling, we arrived in New Delhi on Oct 22 – all in one piece, and thankfully with all of our luggage in tow! Our impression of Delhi is that it is hot, over-crowded and polluted – there is really no other way to describe it. The city is a complete contradiction of   beauty amongst the poverty. While we walked and drove (in auto-rickshaws!) through a huge milieu of rich and poor communities ram shackled together, we were able to appreciate spectacular monuments such as the Jama Mashjid Mosque, which was built by Shah Jaham (same man who built the Taj Mahal), and see views of the city, including the Red Fort.

After a day in Delhi, we caught an overnight bus to Manali, arriving around 7am. Since it was so early, a lot of the town was sleeping, and we had a bit of fun finding the hospital (commonly known as the mission hospital in Manali). Our first impressions of LWH were amazing – it was such a sanctuary compared to the hustle-and-bustle of New Delhi and even the opening of storefronts in the main mall of Manali. We were lucky enough to meet another medical student from Melbourne while we were moving into our rooms, so she made the transition much easier for us. Unfortunately, she was finishing up her elective in the hospital, so we were only able to enjoy her company for a few days.

Here’s a bit about the hospital. The LWH is a Christian institution, which serves the greater Manali area (located in the Kullu district of Himachal Pradesh). Dr. Phillip Alexander is the senior doctor and superintendent, but unfortunately he and his wife, Dr. Anna Alexander (an internist), were away for our first week leaving a diminished patient load for the remaining doctors. We quickly learned the routine of the hospital – morning rounds begin in the ICU (1-4 patients only), and then go through other wards of the hospital before the outpatient clinic opens at 10:30 am. Throughout the day, most patients are seen in the outpatient department while more urgent cases are seen in the emergency department. Many patients are from the Manali/Kullu area, however, there are quite a number of tourists who seek treatment – Manali is a tourist mecca for many Indian couples on their honeymoon! Surgeries are performed on Tuesdays and Thursdays and we’re told that the number of surgeries will increase once Dr. Phillip returns – although the boys were able to observe a full hysterectomy (with ovarian teratomas) on our first day.

While we are all learning so much, we are bemoaning the fact that we didn’t learn Hindi before we arrived. All of the doctors and most of the nursing staff speak English, but unfortunately most of the patients don’t, meaning that all of the consults are performed in Hindi making it difficult to follow. Luckily, charts are written in English so we can read up on cases, but understanding Hindi would have made the process a lot easier. So far, the most useful Hindi we’ve learned is “teek hai”, with an associated head bob (http://en.wikipedia.org/wiki/Head_bobble), which means “okay, no problem”.

On our first Saturday, we traveled to LWH’s satellite clinic in Jibhi (approximately 3 hours from Manali) along very thin and windy roads – we were very grateful for our fantastic driver! Jibhi was a wonderful experience and luckily we’ll be able to go again before we leave. The scenery was breathtaking, but we were definitely confronted with the realities of rural health in India. We met one of the community health workers, who seemed to do everything in the clinic: patient registration, vital signs, ECG, X-rays, running the pharmacy, assisting with examinations, etc. It was incredible watching her work. She had a 2-year-old daughter who hung out in the clinic as well who was fun to play with on our breaks from observing the doctors, although it was humbling to see her play with a calculator for lack of her own toys.

Of the patients we saw in the Jibhi clinic, it was interesting to see how social constructs played into medicine. In that community, many of the women participate in manual labour and were therefore the patients complaining of aches, pains and arthritis. We saw many women with unresolved broken bones that they had just continued to work through. Also, we were able to see a few cases of advanced tuberculosis – both pulmonary and extra-pulmonary. Many patients first seek ayurvedic (traditional) medicine or make sacrifices to the gods, meaning that many diseases have progressed to advanced stages before medical treatment is sought. In addition to this, trust in the medical system and adherence to medical treatment is lacking, leading to many problems in continuing care of chronic conditions. Jibhi was definitely an eye-opening experience.

We’re now into our second week at the Lady Willingdon Hospital, and will be sure to update you all on our progress!!

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