This week was our FINAL week in India. It was a bittersweet experience, to say the least. Throughout the week we made it a point to take any last pictures and videos of things that felt important to us. I decided to title this blog “Sans,” as that is the Hindi word for “breath.” I heard my cardiology preceptor say it many times to his patients when he would listen to their lungs, and it got me thinking about a lot of things. Breathing is so essential to everything we do; whether it’s during yoga exercises, when we’re feeling anxious or upset, or when the doctor is asking us to do it to better auscultate lung sounds! Throughout this month in India there were so many exciting, memorable, and sometimes stressful occasions when I just needed to stop, reflect, and simply take a breath.

So, now I’ll tell you all about the last week! Since we were back in Dehradun (which is where we started out the trip three weeks before), we had a new set of preceptors and rotations. Every day, we were scheduled to rotate with a cardiologist for about 4 hours and then in the evening we rotated with a pediatrician for a couple hours. Both physicians were in private practice and eager to teach us everything they knew!

For the cardiology portion of the rotation, we observed our preceptor see patients with a multitude of illnesses including severe hypertension, “cardiac neurosis,” atrial fibrillation with and without rapid ventricular response, mitral regurgitation and stenosis due to prior infection with rheumatic fever, dilated cardiomyopathy, ischemic heart disease due to coronary artery disease, and many other conditions. In particular, there was one pediatric patient who presented with a blood pressure of 140/80 that had previously been 190/110. This type of blood pressure in a 16 year old was somewhat striking to see, especially as there was no underlying cause for the hypertension like coarctation of the aorta or renal artery stenosis. Our preceptor explained that if both a mother and father have hypertension, then their offspring will have a 50% chance of also being hypertensive at a much earlier age than average diagnosis. Otherwise, if ONLY a mother or the father are hypertensive, then there is only a 25% chance of also being hypertensive at a much earlier age.

We also saw patients with dyslipidemia, angina (precordial chest pain), aortic stenosis, and Gilbert syndrome. He discussed some of the differences between systolic and diastolic murmurs and how to best auscultate their sounds. We also saw patients with amoebic colitis, preventricular contractions, vitamin D deficiency, and allergic bronchitis. We reviewed myocardial perfusion scans, chest Xrays, and many many many EKGs. Overall, our preceptor stayed extremely busy in his work. He stated that he saw about 70 patients in the morning (11 am-2 pm), and then about 50 patients in the evening (2 pm-6 pm). This number seemed extremely high to us, but to our preceptor it seemed like any normal day and another part of his duty to serve healthcare to those in India.

For the pediatrics portion of the rotation, we mainly saw patients with viral upper respiratory infections and standard immunization visits. We also saw patients presenting with papillary urticaria, mucosal blisters from “lip sucking,” colic, gastroenteritis, and failure to thrive. In addition to medical education, our preceptor provided us with other information regarding healthcare in India. For example, he told us how India has become a huge hub for “medical tourism” because healthcare is so much less expensive to attain in India than other parts of the world. MRIs, invasive procedures, and other imaging are much more affordable in India. He also told us about some of the differences working in private practice in India versus working for the government. The government is implementing stricter parameters for private practitioners to follow in India, therefore making it more costly and challenging for them to go into private practice. He also told us that if doctors work at a government hospital they will likely see many many more patients and receive less pay, but are offered retirement pensions and aren’t required to spend years of time and money building up their own practice. The act of building up one’s practice is quite challenging in India as the government does not allow providers to advertise their practice, so they depend on word of mouth. In addition, our preceptor told us that patients can get prescriptions written from “quacks” claiming to be medical providers, and that a pharmacy will fill them. If a pharmacy knows that a particular provider writes certain prescriptions, then they might possibly sell it to a patient whether or not they have a prescription. Lastly, we learned that you do not need a referral to see a specialist in India. If a patient has a headache, they can go straight to a neurologist if they so choose.

In addition to rotations, our last week was filled with some last minute shopping at Fab India (round 2 for us), a return trip to a delicious restaurant called Kumar Veg, meeting another medical student in the program, and taking 6 am yoga classes in the morning. It was a fantastic final week.

-Meredith