vijal patel, morgan wilbanks msep experience
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VijalPatel,MorganWilbanksMSEPExperience–NewDelhi/Faridabad,India
VolunteerOrganization–InternationalVolunteerHQ
Introduction
We each spent four weeks in Faridabad, India for our MSEP experience with Vijal
staying from 29 May to 26 June, and Morgan staying from 11 June to 9 July. We used the
volunteer organization International Volunteer Headquarters (IVHQ) since they had the cheapest
program fees that we could find and they were flexible on start dates. However, these two items
proved to be the downfall of the program and our experience in India.
In short, we found the program to be poorly run with little interaction from the local
“coordinators.” As it turns out, IVHQ’s business model involves various “partner organizations”
that actually run the volunteering (medical, orphanage, education, etc) programs in the given
country with IVHQ’s personal staff being located in New Zealand; IVHQ (and numerous other
entities, all charging their own fees) merely serve as go-betweens between the students and local
programs. The entire four-week experience proved to be a drawn out test of patience and
fortitude, due to the area we stayed in, the weather, and our hospital experience.
Patel/WilbanksMSEPExperience:Page2
Preparations
Preparing for the trip was pretty straightforward; both of us made appointments at the
UAB Travel Clinic (part of the Kirklin Clinic), where we received all of the appropriate
vaccinations (Typhoid, Hepatitis series, tetanus) and medicines (mefloquine, azithromycin,
ciprofloxacin). The only drawback is that we had to pay out-of-pocket, because insurance (Viva)
did not cover the visit. After the partial reimbursement for the immunizations, the cost for being
seen in the clinic was about $250. VIVA also does not cover mefloquine, which cost $120 for a
twelve-week course. One might consider getting just enough mefloquine stateside to get your
two pre-departure doses and a pill for the first week in India, and get the rest of the pills you
need for cheap at a local pharmacy. For example, since Air France had lost one our bags, we
were able to replace all the lost medications for less than $10 by simply walking up to a
pharmacy counter and requesting the specific medication and the number of pills, no prescription
needed.
Mosquito nets and bug spray were recommended for the trip, but at the time that we
went, we saw maybe a handful of mosquitoes the entire time, being before monsoon season
(after the rains begin, they are much more numerous). Neither of us used any of it, and returned
our unopened mosquito nets when we got back.
As far as clothing goes, cool apparel is a must. Since we were in a hospital, we had to
wear collared shirts (polo shirts are fine) and long pants, but most sporting goods stores sell
decent-looking khaki cargos that are lightweight and will not leave you as sweaty as cotton pants
might. Linen pants are also a great choice to consider. All in all, summer can get pretty hot, so
it’s best to prepare for weather over 110°. Also, since we were washing our clothes in a bucket,
be prepared to be wearing dirty clothes for the duration of your trip. We each ended up leaving a
lot of clothes in India, rather than trucking a bag full of detergent-scented but still soiled clothes
back across half the globe.
Stranger in a Strange Land
The thing about visiting India is that as soon as you are labeled as a foreigner, everyone
starts treating you differently, from the rickshaw drivers in Dharamshala to the patients we
encountered in Faridabad. Streetside vendors raised their prices, and panhandlers sought us out
Patel/WilbanksMSEPExperience:Page3
to sell things or to offer to take us places (Never follow someone to a “tourism office” in India).
For me (Morgan), it was immediately evident that I was a foreigner, but Vijal had the same thing
happen to him as soon as he started
talking, because he did not speak
Hindi. Oftentimes I would find
them looking at us more during an
interview than the physician asking
them questions. We were both
targets and outsiders, intruders and
oddities.
Immediately, the country
did not agree with me.
Unaccustomed to the climate, the 97’F midnight air hit me like a brick wall as I left the airport,
after spending more than a day in various airports and airplanes spanning three continents. The
summer’s heat was hitting its peak in the days before the monsoon began and the first two days
in the country were the worst of my trip as my body slowly adjusted. It was not until the
afternoon of the third day, after a night of fitful, sweaty sleep punctuated by dry heaves and
power outages, that I began to acclimate.
Fortunately for me, I was staying in the home of an extremely hospitable and gracious
Indian family. Despite my frustrations with being gawked at and swindled outside the home,
inside the home (and I stayed with two different families over the course of the month) the
hospitality shown me was unparalleled. If they knew I was sick, they would make sure I had
enough water, meds, or anything else I needed. They would go out of the way to prepare me
something that would not upset my system too much. Even on a day-to-day basis we were told
that we were “members of the family” and could come and go as we pleased, had our privacy
respected at all times, and generally had our needs put before those of the rest of the family.
Government Hospitals—Failed States
Most of what we learned about the Indian healthcare system came through our
discussions with the pediatrician, Dr. Santosh Kumar Seth. He worked at one of the private
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hospitals where I spent my time and broke down the distinctions between the private and public
sector, in terms of healthcare. The public hospitals, while mainly free, are constantly swamped
with patients for that reason. Even arriving at 9 AM might not guarantee you a chance to see the
physician until late in the evening. To make matters worse, the staff are too few, their demands
too many, and their general level of training is by far inferior to their counterparts at private
hospitals.
For Dr. Seth, the entire system is plagued by mismanagement and a general “laziness” by
the staff to do their jobs efficiently. Most of the skilled doctors and nurses either end up in
private clinics or go abroad like another doctor that we met on the trip, Dr. Prabhat who planned
on emigrating to Toronto. Those who cannot find work in the less frenzied (and more lucrative)
private sector or who do not have the means to expatriate are forced into the government-run
hospitals, which he described as “failed states where chaos rules, much like in the [sic]
Afghanistan.”
India is a country plagued by a widespread
lack of infrastructure from utilities and sanitation to
healthcare and education, the latter of the two being
the “root cause” for the rest of the country’s
deficiencies. When the British left India to be an
independent nation, that first generation of
politicians, bureaucrats, and administrators did not
take the opportunity to put sufficient resources into
those realms, resulting in the country’s current
problems. His cynicism was evident, but well-
reasoned and informed due to his lifetime of
education and experience.
Dr. Seth had his complaints about the private sphere as well. Healthcare, despite its
relatively cheap cost resulting in widespread affordability, is nonetheless considered a luxury
rather than a necessity. The lack of urgency coupled with the existence of government facilities
results in many going untreated voluntarily. Ironically, the existence of free healthcare providers
keep people from going to private clinics, even though those same people refuse to utilize them
due to crowding and generally run-down facilities. “If it’s not free they don’t want to pay for it,”
Patel/WilbanksMSEPExperience:Page5
even if they know they can afford it. This was the mentality across our experiences in India and
that was a sad fact. Millions are plagued by illnesses born from unsanitary practices and lack of
hygiene; things that do not have to
exist if the country with the 11th
largest economy in the world would
think about the basics of the people
rather than their own personal pockets
(India is a very corrupt country, with
everyone from policemen to politicians
able to be bribed).
Ghai Hospital
All in all, the two of us had a very negative experience with IVHQ and their partner
organization that ran things on the ground at our placement. The program had been advertised as
taking place in New Delhi, but we were not informed until after we had already paid our fees
(now adding to almost $1000) that we were, in fact, to be placed in Faridabad; the information
was sent to us in a word document that contained minimal information to begin with, and no
information about the city. Rather, we learned about Faridabad by doing searches on Google and
looking it up on Wikipedia.
We had also been promised some sort of orientation on our first day, which was also
misrepresented. What we had instead was an extremely informal conversation with one of the
local coordinators where he spent about 15 minutes telling us a little bit about India, most of it
being common knowledge to us anyway.
Our volunteering placement,
however, was the biggest letdown from
IVHQ. Vijal was the first to arrive, and he
was simply dropped off without an
introduction at a hospital that neither knew
that he was coming nor was made aware
that they were partners in any sort of
volunteering program. It was just by luck
Patel/WilbanksMSEPExperience:Page6
and hospitality that they graciously let us hang out with them. I use the word hang out, because
it’s appropriate for the level of activity we actually had while we were there; the majority of our
time was spent watching the doctors round (in Hindi, which neither of us speak and which often
was not repeated in English) or sitting in one of the administrative offices with nothing to do
because nothing was happening in the hospital. Most occasions, when rounding, the physician
would converse with the patient in Hindi and then continue to write notes/orders to the hospital
staff. If he had a spare moment, he would mention a few side facts in English or simply state a
quick phrase, “enteric positive”. There was usually little chance to interject questions. The only
doctor who made our experience close to worthwhile was Dr. Seth (pictured on the previous
page), who spoke the best English in the building, and was willing to talk us in greater depth
about his patients than the other physicians on staff. However, even our conversations with Dr.
Seth proved to have minimal medical relevance, being more focused on the current situations in
India since it was the summer and the bulk of their patients leave for cooler climates during that
time.
We believe the reason for our distanced shadowing and “hanging out” was that the
hospital had no financial incentive for us being there. Despite our paying hundreds of dollars,
only a pittance, it seemed, went to the host families to cover our room and board, and none of it
went to the volunteer placements. After talking with volunteers who were on other projects,
including a school in the slums that did not even have a roof, we discovered the same was true
across the board. What we had thought to be a legitimate-looking volunteering organization now
appears to be more like a pyramid scheme than anything else. Since the hospital received no
incentive for having us there nor did they request for us to be there in the first place, there was no
reason for them to take time out of their workdays to deal with us and prolong their workdays.
In light of the numerous downsides, the hospital did offer some interesting experiences.
We observed a patient with second and third
degree electrical burns across his hands and
his face, a three-inch deep abscess in a
diabetic patient, a large toe amputation,
laparoscopic cholecystectomy/appendectomy,
and a Cesarean section. We saw a baby with
Patel/WilbanksMSEPExperience:Page7
total situs inversus and others with typhoid and marasmus. We were able to feel an enlarged
spleen, liver, and inflamed appendix. And we were able to feel the enlarged liver of a child with
NAFLD. Sterility was an interesting concept. In surgeries, it was understood that the conditions
were less than sterile and so patients would receive broad-spectrum antibiotics by IV
immediately following an operation. Most patients with any GI disturbances were started on
metronidazole or ceftriaxone drips, especially since bacterial illness was much more prevalent
than viral. Also in the surgical OR, we were not required to scrub in, only change our street
shoes to slippers. Surgical masks sometimes did not cover the nose or even taken off mid
procedure, and during the closing of a C-section, a nurse sat in a chair by the operating table,
took off her mask, and talked on her cell phone. There was little use of gloves during bedside
procedures, unless the patient was extremely bloody and scrubbing/cleaning of a wound was
required. If a dressing was being removed or placed, no gloves were required. Also, it seemed as
though glove re-use was occurring; we saw large numbers of gloves drying out like on a
clothesline.
Provided Housing
The housing situation was interesting and varying, going from extremely enjoyable
experiences to moments of depression. Initially, I (Vijal) arrived two weeks earlier than Morgan
and stayed with a family for 4 weeks (the same family to where Morgan later moved). When I
arrived at the house, I was met by an extremely friendly host family who—for the most part—
treated me as one of their own. I was offered water and food, and was treated with nothing but
respect and kindness for my well-being. When Morgan was feeling ill, the host family he stayed
with made sure to cook foods that would not upset his stomach and offered him medicines. They
took genuine interest and care in his well-being. This was the case with all homestays that we
experienced with our trip, in that you honestly felt as though they cared about what happened to
you. You were not simply a tenant, instead, something more akin to a family member.
Patel/WilbanksMSEPExperience:Page8
The housing had its faults however, and this would be more attributed to the volunteer
program and the local coordinators. For example, at times, the housing was quite crowded.
When I (Vijal) started my stay, there were 2 other volunteers plus the host family of Rakesh Raj
(husband, wife, and young child). We stayed in the house that consisted of two bedrooms, one
bathroom, a living room, and a kitchen. Each of the bedrooms had two plywood bed platforms
and an overhead fan. The living room is where the
host family stayed, sleeping on the ground in front
of the “cooler” (a unit similar to a watercooler for
a car that would chill the air by 10 degrees or so,
and blow into the room). The cooler’s effects did
not reach the bedrooms however, and so where
the volunteers slept remained extremely muggy
and humid, especially in the evenings. After a few
days, another volunteer was added who slept in a
bedroom. During the second week, two more volunteers were added to the house and an
additional bed was brought in. This bed was shared by the volunteers and was placed in the
living room. So now we were 7 volunteers and 3 host family members living in a small single-
story, 2 bedroom, 1 bathroom apartment. During the third week of my stay, we had downsized
once more to 3 volunteers staying in the home, and eventually 4 when Morgan arrived later that
week.
Another complaint regarding the housing situation was the bedding. We slept on raised
plywood platforms with no more than a blanket separating our bodies from the wood. Initially,
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we had thought that might be the norm in the area; however, our hospital mentor (Dr. SK Seth)
was quite surprising to learn that we were not given mattresses. Needless to say, every morning
we awoke with stiff backs and sore muscles. Each mini-vacation we took on the weekends was a
welcome relief when we slept in beds with actual mattresses.
The food provided by the host family was tasty but many times devoid of basic nutrition.
I (Vijal) did not consume one green vegetable for the first 1.5 weeks of staying with Rakesh Raj
and his family. There were no fruits either. Eventually, more greens began entering our diet,
however it was still mainly white rice, some flour breads, and lentils. Fruits were only bought by
the host family one time during those 4 weeks. As such, we would go to the market where
mangoes and bananas were plentiful and cheap and purchase our own.
Weekend Adventures
Our weekends were our own: it was up to us as volunteers to plan and organize any trip
we took. As such, it was both quite a hassle and quite enjoyable. One weekend, I (Vijal) flew to
Baroda, Gujarat to visit some very distant
relatives who had not seen me since I was baby.
The surprising thing about that trip was learning
that the domestic airport is entirely separate from
the international airport, and the actual facilities
of the domestic airport (seating, dining,
cleanliness, etc) were much nicer than the
international (After we left, the city opened up the
brand new Terminal 3, a huge modern expansion
of the airport that was built to accommodate the travelers coming for the Commonwealth Games
in the fall). Another weekend went to visiting Agra and New Delhi, with the major attractions
being the Taj Mahal (one of the 7 wonders
of the world), Akshardam Temple (the
world’s largest comprehensive Hindu
temple, pictured left), Red Fort, and
Patel/WilbanksMSEPExperience:Page10
Gandhi’s tomb.
The most memorable and enjoyable adventure was our trip to McLeod Ganj (above, near
Dharamsala, in the foothills of the Himalayas). While the 14-hour bus ride from Delhi to
McLeod was less than enjoyable (involving quite a bit of motion sickness out of bus windows
and inside the bus as well), the destination was worth it. McLeod is home to the exiled Tibetan
government and a place of beauty. Cooler weather and friendly people immediately greeted us.
Street vendors were much friendlier than the rest of India I had visited and honestly seemed to
respect you as a tourist. You could see hundreds of monks of all ages throughout the city, all
being quite friendly and jovial. We stayed in a hotel overlooking the valley where McLeod is
nestled and had an amazing view for less than $10 USD per night! We hiked up the Himalayas
and swam in a waterfall fed by snow runoff from the mountain peaks, ascending over 1 mile in
elevation with a total distance estimated at 7 miles roundtrip across half the day.
Patel/WilbanksMSEPExperience:Page11
APPENDIX
Operation Room-Ghai Hospital
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Hospital rate chart
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Drawing blood on a young patient, without gloves
Note: After the procedure, Dr. Hem wiped the patient’s blood off his hands; he didn’t immediately wash them.
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Proper OR footwear, Ghai Hospital
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