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Vivekananda Memorial Hospital – Morgan Gilani, MD

Written by Morgan Gilani, MD PGY2 at San Francisco Internal Medicine on a Global Health rotation in Sargur, India with the Swami Vivekananda Youth Movement.

Gratitude.  My time working with the Swami Vivekananada Youth Movement (SVYM) this spring has been an integral part of my residency training. I joined a group from Kaiser Woodland Hills which included mostly family practice doctors, some in training, a rheumatologist, a pre-PA student, and an attorney. We were greeted at the airport in Bangalore and quickly whisked off to Mysore, currently ranked the cleanest city in India on a very hot and humid Sunday morning at 4 AM. Our visit in Mysore was brief and only a layover on our journey farther south to Sargur.  However, during our brief day and a half, we were very graciously introduced to SVYM, its main campus, and had the honor of meeting with two of the doctors who had founded the NGO about 30 years ago including Dr. Balasurbramaniam, or as he shortens- Dr. Balu. What started as a 9 bed hospital on the forest’s edge outside of Sargur has grown into a 90 bed hospital with subspecialty care. The populations served includes rural and 5 different tribal communities which have been displaced from the forest, now two National Reserves. In their longitudinal involvement and growth over the past 30 years in working with these communities it was interesting to hear how their perspectives have evolved having been at the grass roots level throughout this time. With the providers from a medical background, development initially meant to them improving the health of the community. Each physician focused on different subspecialty care for a wider breath of practice provided. Shortly thereafter, infrastructure and education were identified as necessary components for the success of the community. SVYM broadened into a vast network of schools, research and policy from the main campus in Mysore to tribal schools near the forest which have mindfully integrated tribal core values. After reflection from this time, Dr. Balu continues to work tirelessly and has come to recognize citizen engagement, as he eloquently discusses in his book i, the citizen, to be the true underpinning to the community and the best suited to drive the development process. He discussed some of the difficulties of transition during this time and draws upon his many relationships formed within the community. Our group was very warmly welcomed as the start of a new partnership with this same sense.

In Sargur we were welcomed to the campus which included the hospital and a school, however with few children as we were there during summer break. We stayed on campus and were divided between call rooms and a 1 bedroom cottage, quietly placed on the edge of the property. Arriving in the evening, we quickly found ourselves joining in activities with the rotating interns which became nightly cricket or volleyball games after work.  Clinic days at the hospital were of quick pace with providers seeing more than 60 patients per day. Mobile clinics were run out of a van that went further into remote areas.

Our group’s role was to participate in outreach clinics in small neighboring villages and connect patients to the hospital system for follow up of more acute needs and chronic management. Most were run at SVYM schools and one was at a community clinic. The disease processes were varied in acuity and chronicity. Malnutrition was a common theme, yet interestingly diabetes has been recently and somewhat surprisingly to the local doctors been identified at a high prevalence rate among field laborers. Most of our days we saw about 100 patients with our busiest day capping at 240. While the hospital has hosted some visiting practitioners, they have not had a group come to volunteer. In a unique partnership, we worked with the new medical interns as a pair. Accounting for differences in medical training, the intern year is most similar to our 3rd and 4th year of medical school albeit with more clinic exposure prior to this. The interns were invaluable in translating, understanding commonly encountered diseases, and deciphering medications. There were challenges of being unfamiliar with medications—a British system with different brand names and complete unfamiliarity with Ayurvedic ones. We were able to provide deeper clinical insight and inquiry; together we were a well- balanced pairing and able to provide complete care.

At the request of the local doctors, we also were responsible for presenting on the CME lecture day. CME lectures are four times per year, thus it was a special honor to fulfill this request and provide updates on current practice in the US. It began with a ~1.5 hour bedside presentation on a tribal patient with sickle cell crisis. In the spirit of mutual learning, the Ayuvedic principles and approach for diagnosis were the focus of his evaluation. We then sat down to have breakfast together in the cafeteria (our daily restaurant) with fantastic dosas. The reminder of the day was held in the lecture hall which was thankfully one of the two air-conditioned rooms in the hospital, donated by a visitor from Florida no less. The other room was the small 10 x 10 radio station room at the top of the hospital from which they broadcasted many shows to the surrounding villages. Each of us had a 1 hour presentation and we covered a many topics: heart failure, cancer screening, diabetes, back pain and the US health system. There were engaged discussions after each and comparison between our experiences. A full, late lunch was brought in after with a variety of amazing food.

There were so many elements of this global health elective of which I am grateful. Our group became our own supportive network during this time and in our dinner time sharing of our favorite part of the day, we collectively kept a positive outlook throughout the trip. We were lucky to have one of the physicians in the group who had completed medical school in Mysore prior to her training in the US. She provided insider knowledge—taught us about history and culture, how to eat properly with our hands and simple phrases in Kanada.  In general, the community was so warm and welcoming, including the doctors who integrated us into their team and welcomed us into their homes. Gratitude was expressed with nearly every action and time was never rushed at its expense. There was ceremony before every clinic and on our CME day. It cultivated respect and honor for the work and learning that we are privileged to do. It was seen in the eyes and smiles with every patient. At the end of each clinic day, the group leader thanked each person for their involvement and contribution in both Kanada and English. These traditions and mindfulness, while seemingly overlooked at times while at home in the US, truly allowed for more human connection. While there is still much work to do in improving health outcomes and the advancement of the communities around Sargur, I am inspired by the thoughtfulness and guidance of SVYM and forever grateful in having been a part of their growth and integration within the community.

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  1. On the matter of sickle cell disease, this bit of news might be of interest to you if, as a physician, you treat SCD patients:

    Sickle cell disease patients and those who stand with them are invited to pre-register for free access to oneSCDvoice.com, an empowering online community launching later this month (December).

    Promoted as “A Sickle Cell Community Tailored to You,” oneSCDvoice will deliver trustworthy information to help people affected by sickle cell disease know more about it, learn of promising new treatments being tested in clinical trials (and how to access those new treatments as a clinical trial participant), more easily tap into needed support, and above all improve the quality of their lives.

    oneSCDvoice.com is the creation of sickle cell healthcare providers, advocacy leaders, pharmaceutical manufacturer Pfizer, Inc. and health technology company rareLife solutions.

    This collaborative digital education platform provides professionally vetted links to credible information about SCD, about lifestyle issues related to the disease, and about how to get more and better help coping with this devastating genetic condition.

    Read full details at: http://www.prweb.com/releases/2017/11/prweb14939636.htm

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