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Thursday, 21 August 2014 18:14
 

 

 

 

 

SIU -2014

Neal Dodia

Rotation in India Reflection Paper !


One of my favorite parts about this last year of medical school is the ability to customize
my schedule and choose my rotations. Not only do I get to focus on my chosen field, internal
medicine, but I also get to explore some unique aspects of medicine. In 2008, I spent a month in
Capetown, South Africa as a volunteer in a large tertiary hospital as well as in a small HIV clinic.
That experience was incredibly rich and rewarding, thereafter I knew I wanted to return to an
underdeveloped country as part a medical student rotation. Fortunately, this past month I had the
privilege of traveling to the Prathima Institute of Medical Sciences, a medical school in the
southern region of India.
One of the reasons I thought this rotation would be particularly beneficial to me,
especially as I go on to pursue internal medicine, was the diverse disease pathology I was certain
to encounter. I had some expectation as to what I was going to see. I saw several cases of
malaria, tuberculosis, dengue fever, snake bites, filarias, and numerous other zoonotic and
infectious diseases. Witnessing these cases was not only fascinating but a great learning
experience. I had read about many of these diseases but admittedly only in a cursory manner. As
many of these diseases are incredibly rare they are generally not the focus of learning here in the
United States. This was a great opportunity to really pause and give these diseases my undivided
attention. In addition, physicians who deal with them on a regular basis exposed me to the
practical management of these diseases. In just four weeks I have not become an expert on these
pathologies but I certainly have a better grasp on how they would present.
While I expected to see many of these infectious diseases I was surprised to see some
familiar problems. While malaria and TB are major causes of morbidity and mortality it is still
the chronic diseases of hypertension or diabetes that reign supreme. During my time at PIMS, I
saw more cases of chronic kidney disease and cerebrovascular accidents than anything else. If
one really wants to get a grasp on the importance of public health initiatives and primary care
than you need only look at the health of India’s population. Because of the poverty and general
wariness of western medication, many people have completely uncontrolled chronic diseases and
present with late stage disease manifestations. It was not uncommon for me to see a chief
complaint of shortness of breath for 2-3 months or patient’s presenting with a hemoglobin of 1 or 2.

I remember seeing one case of hypothyroidism, a common diagnosis in the US, but it
presented at a point so late in the disease course I cannot imagine I will see something similar
ever again. The patient was a middle aged woman complaining of shortness of breath that had
been progressing for some time and she was forced to seek treatment. On exam she had jugular
venous distension and distant heart sounds and a bedside echo showed pericardial tamponade.
After emergent management, she was assessed further to find a source. Pericardial effusions are
common in India but they often see not only viral causes but also TB and malignancy regularly.
However, this woman had constipation, weakness, poor concentration, cold paper thin skin with
areas of thickening, and brittle hair. Her labs came back and she had a TSH of over 100! I did not
know that myxedema pericarditis even existed until that case. In the end, this patient’s case is an
example of public health provlem. It did not dawn on me until later that day while I was reading
that her hypothyroidism was most likely a result of iodine deficiency than hashimoto’s
thyroiditis. This was just one of many examples of seeing fairly common diseases in the United
States but with a later stage presentation.
Mostly what I take away from my trip to India was a general enduring spirit from both
the patients and healthcare workers. Doctors there do the best they can with what resources they
have. They do not have high-resolution images or sophisticated tests one mouse click away.
Often they have to discuss the costs and how tests will change management more rigorously than
we have to. Many times without the definitive tests they have had to strengthen their clinical
judgment and really hone their physical exam skills. They often must implement treatment
without the comfort of having a definitive diagnosis. Patients too are very tough and willing to
tolerate a great deal of adversity. They must consider the financial burden of every test and
medication and how it will impact feeding their family. They will live with their symptoms for a
very long time before requiring assistance and continue to work through a great deal of pain and
fatigue. I saw patient’s travel all day for a ten minute appointment and at the end bow to the
physician in appreciation before leaving the room.
My trip was rich with education and gave me a deep appreciation for the American
system that we often take for granted. I will never forget my experience and I am truly
appreciative to all the wonderful physicians and residents I worked with at PIMS. They were
incredibly hospitable and kind to me throughout my stay.

 

Neal Dodia
ndodia2@gmail.com
February 2014 !


Guide to the Medical Student Rotation in India at PIMS !


I'm writing this guide for medical students interested in the 3-4 week medical student
rotation at the Prathima Institute of Medical Sciences (PIMS). I found my own 3.5 week
experience rotating through their General Medicine, Cardiology, and ICU/ER
departments a fascinating and unique learning experience. If you have always wondered
how medicine is practiced in a developing country and want to see pathology you may
never see here in the United States then this is the rotation for you. I guarantee you will
experience something most people never get the opportunity to during their medical
career. This guide will serve as a way for you to learn from some of my pitfalls and feel a
little more prepared before starting your rotation. It certainly will not be comprehensive
so I have included my email if you have any specific questions or concerns about the trip. !
Going alone or going in a pair? When to go?
You have the option of going on this rotation by yourself or with a fellow SIU student. I
have traveled abroad before to India with family, and I have gone on volunteering trips
with a group from the US to a foreign country. Personally, I wanted to see what the
experience of traveling by myself to a foreign country would be like. I won't act like
socially it wasn't difficult not having someone from my own culture to talk to and debrief
with on a daily basis. However, I also feel as though being by myself forced me to make
a greater effort to interact with the other students there rather than withdrawing into the
comfort zone of having a traveling companion.
If you are new to traveling and have a lot of reservations then I would encourage you to
go with someone else. However, don't be afraid to venture out by yourself. The staff,
residents, physicians, and students are very kind and hospitable. They made a lot of effort
to include me in their social circles, and look out for anything I needed or wanted to do.
When to go is a much more important question. The best time to go weather wise is
during our winter months, and as a 4th year you also need to complete your interviews
during that time. The best time to go is definitely February. The weather is wonderful
ranging from 65-90F in South India and you will be definitely done with interviews by
then. I went in January and it was a bit of a risk since I could have gotten some late
interview invites with dates only available in January. However, for internal medicine I
was able to do them all in Nov-Dec. Be sure to ask your advisor for their opinion since
interviewing season seems to change every few years.

Logistics
During my elective, PIMS was kind enough to pay for my travel expenses and booked a
plane ticket on my behalf. However, while I provided my availability months in advance
the final booking did not happen until a few weeks before leaving. It was frustrating to
send multiple emails without much solution, but in the end they booked tickets without
an issue. Don’t get stressed out by the lack of pre travel communication and organization
because they will work it out in time. Just stay diligent and keep reminding your contacts
that certain things need to get done. !
Language
All of the students, residents, and physicians speak English so language is not an issue.
The patients rarely speak English and most of the discussions with patients will be in the
local language. If you know Hindi that will of course help with communication and make
a big difference, but I only knew English and I was still able to have a good experience.

Food
Food in South India is delicious but VERY spicy! I'm Indian and I have never
experienced food that spicy. It took about 10 days for my stomach to handle it. If you are
sensitive to spicy food you can request to have food prepared mildly and try to put yogurt
on everything. In addition, I think it would be wise to bring pepto bismol and a Zantac/
PPI. I wish I had packed more snacks and granola bars. Prepared meals are available to
you for free from the hospital cafeteria. However, try to take advantage of eating outside
whenever you can. You should only be drinking bottled water and access to that is never
an issue. You don’t need to bring any water filtration devices or chemicals.
Internet Access/Calling Home
Wifi is available in spots in the hospital and medical school, but not in the hostels (at
least as of Feb 2014). You will not be able to surf the web but I found I was able to go to
the school in the morning at around 7am and Skype family back home. It wasn't always
reliable and at times would not work. In fact you can expect the power and water to go
out regularly. (Don't worry it always comes back in a reasonable time frame) I would also
recommend requesting a phone/sim card from the school. It will take only a few days to
get, it’s cheap and this will allow you to contact people on campus. In addition, it is very
cheap to call back to the US. If you have an unlocked smartphone that is even better and
you can get a cheap sim card with data too.

Keeping Busy
The atmosphere of medicine is a little more laid back and I had to find things to do to
stay busy. Rounds can go by quickly on general medicine so I would always spend
afternoons/evenings in the ICU and ER looking at cases. Ask the residents what they are
up to and what interesting cases they have. In addition, be sure to explore different
departments even if it isn't your specialty. I went into the NICU/PICU and saw a surgery
just to see something different. The staff and physicians love having people from the US
so take advantage of that. Be sure to bring a laptop/books/movies etc to pass time in the
evenings.

Living Situation
You will most likely be given a room in the postgraduate hostel. It is a 1bed/1bath and its
pretty well maintained and comfortable. Be sure to bring your own towel. There is a
personal hot water heater on the wall which will allows you to have a warm bucket of
water. There is a shower head but the hot water only lasts 4 minutes therefore it is
common practice to use a bucket of hot water to wash yourself with. Some of the seals on
the window frame are exposed so bring tape to close those areas. They provide a
chemical mosquito repellant for the room, and there are workers there to clean the room
and do laundry.

Attire
Bring a white coat and your stethoscope. Men wear collared shirts (casual and dress) and
slacks (casual and dress), No one wears a tie. The women there wear something called
punjabis (google image it). I would not recommend skirts unless they are floor length.
Slacks and a top would be appropriate.
Safety/Health
In terms of Infectious Disease, you will see everything under the sun. Malaria is endemic
to the area so be sure to take malaria prophylaxis. Tuberculosis is also all over the wards
so wear a mask whenever you can. I would try to get a respirator mask here before you
go if you are very concerned about TB. A box of gloves would be a good idea too but not
necessary.

Traveling
PIMS is located in a small town in South India and would be considered a rural city.
Essentially, Karimnagar and Springfield share a lot of similarities in terms of size and
level of interesting things to do. Karimnagar is not a tourist destination, and doesn't have
a lot of appealing landmarks. So keep in mind this trip will be more about the medicine
and less about the traveling. However, you will be flying into Hyderabad that is a lively
city with many interesting things to see. Be sure to request at least 1 or 2 days in
Hyderabad. I recommend seeing Golconda Fort, Salar Jung Museum, Birla Temple, and
Charminar. Charminar is mostly a place to buy a lot of goods for cheap. If you want
something with a flavor of India ask where you get "handicrafts" and they will point you
in the right direction. Whenever I wanted to visit Hyderabad I was accompanied by a
resident and driver who took me wherever I wanted to go. They also took charge when it
came to places to eat or things to see. You will be very well taken care of.

 

A life-long memory of two brothers, SushantDuddala and NerinDuddala

Summer of 2013

PIMS STUDENTS EXPERIENCE AT SIU

When we first heard about PIMS' student exchange program with SIU-SOM in IL, USA, little did we know how this brief program can influence and change our perspectives altogether. Coming from Boston as NRI students into PIMS, we were greatly excited to be selected for this program and looked forward to learning the US healthcare systems in terms of diagnostic methodology and treatment strategies, and also to compare these to Indian healthcare systems. From day one, and even well before that, we were pleasantly surprised at the faculty and staff who were over whelmingly cordial and receptive and did everything to facilitate our program in a short period of time. From day one, we received clear guidance on every process that helped us tremendously. We met highly accomplished faculty who treated us on par with their students and taught us great clinical material. The best learning occurred during the clinical assignments that were given to us to present to the faculty and followed by faculty comments and guidance. Given a chance, we would definitely come back for a second round of clinical rotation at SIU-SOM.

After our rotation at SIU, we decided that we would work very hard and achieve high USMLE scores to be able to apply and get accepted in SIU-SOM residency program which would be our first preference. We would also encourage our fellow students at PIMS to apply for this rich learning opportunity. On the other hand, we would like to reciprocate and welcome students coming from SIU-SOM to PIMS for the exchange program. We would like to personally thank Dr. Kevin Dorsey (Dean), Dr. Erik Constance (Associate Dean), Dr. Andrew Varney (Program Director), Dr. JaganAilinani, Dr.Ranga Reddy, Ms. Jennifer Worley, Ms. Cherie Forsyth, Ms. Jennifer Coyle at SIU-SOM and Mr. B. Srinivas Rao (MD), Dr. Achanta Vivekananda (Dean), Ms. Lakshmi (PA to Dean) at PIMS and all other faculty members, residents and staff.

For students who wish to know more about the SIU-SOM and PIMS exchange program, they   can contact us directly at sushant.duddala@gmail.com or nerin.duddala@gmail.com.

PIMS - SIU STUDENT EXCHANGE PORGRAM

You should arrive in Springfield,Illinoisaiport.Take a cab/taxi from Springfield airport to hotel

You will be staying at home style inn hotel ,500 North 6 th street,springfield,phone217-522-1100.Hotel is very close to memorial hospital and SIU medical school

You all will have orientation and HIPPA training

You all will be at SIU for 4 weeks doing externship in Internal Medicine and family medicine.

Springfield is the capital city of Illinois state with population of approximately 150,000 is 1 hr 45 mn drive from st.louis, about 2.5 hr drive from chicago and 3 hr drive to carbondale..Main SIU campus (20,000 students) is located in carbondale where 1st year SIU medical students are taught basic sciences ,then they will come to springfield where they spent final 3 yrs of medical school.Main medical school is located in springfield which has 2 large hospitals ,memorial and st.johns.There is Amtrak train service between st.louis and chicago via springfield.Springfield also has small airport

Main contact&coordinator

Dr.JaganAilinani ,Carbondale,IL 618-201-5742( cell) 618-529-1208( home)

jmailinani@gmail.com

Contact numbers in Springfield

Dr.Ranga Reddy, 217-741-1885(cell) 217-793-3517 home.

He is your liaison with medical school deans in Springfield

Mr.Gopal Reddy 217-753-3390 home

Mr.Surender (Suri) Cheruku 217-801-3212 home

Mr.SureshArshanapally 217-793-8754 home 217-622-5289

Mr.AkashGajera owner of home style inn hotel 217-522-1100

General guidelines:

Come well prepared.

Bring your white coats with PIMS logo

Be professional. Respect not only doctors but also nonmedical staff like nurses.

Be punctual. Be there 15 minutes earlier. Be honest

Good communication with everyone involved is very important.You need to be in contact with me all the time.You need working cell phoness.

Dr.Ranga Reddy and others are your local contacts but call them only when you need help

You have to stay only in home style inn hotel in springfiled where i negotiated very good rate of $35 + taxes but you need to pay full amount in advance. Rate includes free continental break fast.

You cannot move to other place.If any problems without informing Dr.JaganAilinani

Buy visitor health insurance in india which will cover medical emrgenicies in USA.

Bring few pocket medical books like Washington manual.

Be safe.Don't be wrong places at wrong times

Represent PIMS well and take full advantage of this wonderful opportunity

If you need any further information please contact Dr.JaganAilinani

Dr.JaganAilinani ,Carbondale,IL 618-201-5742( cell) 618-529-1208( home)

jmailinani@gmail.com

Main contactperson at SIU

Jennifer Worley,Registrar SIU Medical School,Springfield,IL

217-545-0890,jworley@siumed.edu

Dr.ErikConstance,Associate Dean-in -charge of externship program

217-545-0326 ,econstance@siumed.edu

Dr.KevinDorsey,Dean SIU School of Medicine

217-545-3625,kdorsey@siumed.edu

 

Students Exchange program at ITS SIU, USA

SIU

 

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Last Updated on Monday, 02 March 2015 13:06