In this blog, medical student Libby Bryant describes her ethical elective in Uttarakhand, northern India, providing education about women’s health and taking steps towards setting up a professional bereavement service for palliative care staff.
“I wanted to do an elective that would have a wider impact and not only focus on treating the patient in front of you. I thought CGHP would be a good fit and when I met the trustees at the Rama Foundation, an organisation CGHP works with, I was sure that I wanted to travel to India to continue the good work they do.
The Rama Foundation is a family-run organisation working at a grass-roots level to support the delivery of education and healthcare to disadvantaged communities in India and Ella and I were the first medical students to do our elective with them.
During our first placement at Swami Vivekananda Health Mission in Haridwar, we aimed to increase awareness about women’s health issues by making information leaflets and running education sessions. We also helped continue the Rama Foundation’s hard work setting up a gynaecology service, which involved creating a questionnaire to gather information on the health needs of women in the local area.
During our second placement at Ganga Prem Hospice near Rishikesh, we conducted a staff survey to investigate the emotional impact of professional bereavement and found that there was a need for more support for the hospice’s nurses. We reached out to Arthur Rank Hospice in Cambridge, with whom Ganga Prem already have a relationship, for support and advice as to how GPH can best support their staff in what is a very emotionally taxing job.
In our third placement at the Himalayan Institute of Medical Sciences, we forged ties with local gynaecologists with the hope of recruiting someone who could work on a part time basis at the new gynaecology outpatient service at Swami Vivekananda.
Making small, positive impacts
For me, what was special about the project was how simple it was while still having a positive impact. To us, there is nothing unique about talking about periods, contraception or common gynaecological symptoms. However, for some of the girls and women we spoke to, these subjects had never been touched on before. In our sessions, the participants were very interactive and had lots of questions, and the feedback we received was positive since they do not receive much education on these issues, which are considered taboo.
We were lucky to have the gift of time, which meant we could spend longer periods speaking to patients and educating them about health – whether it be women’s health issues or the core values of palliative care. I feel we made the biggest impact via the education sessions we ran for girls and young women (between the ages of 12-20), since we were able to give objective information and non-judgemental advice at a very important time of their development.
As it was just my fellow medical student Ella and I, we had to take on the responsibility of enacting our plans and overcoming any obstacles ourselves, with remote guidance from our supervisors. From a clinical perspective, we rotated round the A&E, outpatient department, ophthalmology service, physiotherapy department and even led our own ward rounds at the hospice!
Adjusting to a different way of life
It was rewarding to build connections with our colleagues and the patients, and the kindness and hospitality of so many of the people we met far exceeded our expectations. We had so many offers of invitations to people’s houses, where they cooked for us and really made us feel like family. They have a Sanskrit saying, ‘Atithi Devo Bhava’, which means ‘guest is like god’ – honestly, we were treated with unbelievable kindness!
It wasn’t smooth sailing all the time though. We struggled with the heat, especially at first, with temperatures reaching 45 degrees Celsius which is something I couldn’t even imagine before travelling to India! Given that we visited areas that are not used to foreigners, we struggled sometimes with language, cultural barriers and building trust with people. Adapting to the hierarchical structure in the workplace and learning the appropriate level of respect to apply was also challenging. Finally, and maybe inevitably, I ended up getting food poisoning which knocked me out for a few days.
My single most memorable moment of the elective has to be bathing in the Ganges – the most sacred river in Hinduism which was right on the doorstep of our placement! After a day in the sweltering heat, it was unbelievably refreshing and a fun activity to do with our new colleagues.
Personal and professional growth
Despite the challenges, the visit has been a time of great personal growth for me and we have both learned to become more resilient when things do not go our way. I have also witnessed first-hand how people with so little can be so generous. The kindness we experienced has inspired me to try and give as much as I can – whether it be time, energy or money.
Professionally, I’ve learned about how to deliver high quality healthcare in a resource poor setting. I’ve also learned that healthcare can be much more holistic than what we’re used to in the UK. Since we were in an area of such religious and spiritual importance, many of the patients had spiritual needs that were tied in with their health issues. Particularly for the palliative care patients, the importance of having a temple nearby and a religious figure (Swami or Saddhu) to confide in was paramount. In religiously diverse country like the UK, I think there could be more effort made to ensure the spiritual needs of patients are taken care of. We also learned about the role of Ayuvedic medicine, as well as the healing properties of Pranayama breathing. I had not been exposed to these before and in the future I’d like to think about how they could fit with our model of healthcare in the UK.
The experience has broadened my horizons about the value of healthcare and it was very rewarding to be able to have a small but important impact on the local communities. Through completing the elective, we made strong ties with local doctors and healthcare professionals in Uttarakhand and are already planning our next visit. This will likely be when we are qualified and can help more with the Rama Foundation’s endeavours.”
Libby’s trip was made possible by funding from the Thriplow Charitable Trust.
Find out more about ethical elective opportunities with CGHP’s partnership programmes, or contact us at info@cghp.org.uk
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