Report from David FitzGerald

Site: Christian Medical College & Hospital, Vellore, Tamil Nadu, India 632 004.
Date: February 2000

CMC is a tertiary hospital that serves Tamil Nadu and large portions of India. Patients come from as far away as West Bengal and Bhutan to come to CMC.

Phil Ansalone at the Vellore CMC Board (USA) is the person to contact
Vellore Christian Medical College Board (USA), Inc.
475 Riverside Drive, Suite 243
New York, NY 10115
Tel: 212-870-2160
Fax: 212-870-2173
Email: phil@velloremcm.org

The experience was clinical rotations in Medicine, Neurology and Rural Medicine.
I recommend all three rotations.
The level of experience is applicable to a 4th year student.
There are no prerequisites for language or clinical proficiencies, just the willingness to go to a place with much more Spartan accommodations than one is used to in the USA.
The best place to start is Phil Ansalone who has a fact sheet for medical students interested in going to Vellore.
Cost of trip was $1200 for airfare and about $250 for incidentals, (food, lodging at Hospital Annexe and laundry).
Educational value was excellent.
Necessary health measures prior to, during and after experience. Visit the travel clinic! I got Hepatitis A, rabies, antiretroviral drugs for needle stick prophylaxis, levofloxacin for GI infections, mefloquine for antimalarial prophylaxis and booster for typhoid, diphtheria and tetanus. After returning, get PPD checked 2 months later.
Positive and negatives about the work site (e.g. supervision) The biggest frustration about the site was that I almost never got to work up patients on my own. This was partially due to the language, most patients spoke Tamil or Hindi, which I do not, some spoke English, but many did not. Almost all medical conversation was in English, which was helpful, as was the patient's chart and lab values and interpretations.
Positives and negatives about the living conditions (e.g. housing, safety): The Hospital Annexe is in the hospital compound and is quite safe and clean. One can also live at the Medical school campus, which should be about the same.

Degree to which your elective met your learning objectives and contributed to your medical education and career aspirations:

1. I expected that I would see diseases that would be different from those seen in my medical school/hospital.
2. I expected that diseases I would see would be at different stages of treatment than seen in my medical school/hospital.
3. I expected to see a different set of economic tradeoffs in providing medical care than in my medical school/hospital.
4. I expected to see a different approach to medicine based on different cultural expectations.

Impressions of visit:

1. I saw diseases that were quite different than those I had previously seen. Leprosy, various different presentations of tuberculosis, malnutrition, ADEM-acute demyelinating encephalitis, as well as morbid craniomegaly.
2. The diseases were indeed at different stages of treatment, with advanced hypertension, diabetes, malnutrition and craniomegaly (in a child) often being considerably more advanced than I had expected.
3. The method of treatment is different based on economics and availability of treatment outside the hospital. For example, Streptomycin is usually not used in the US as it requires an injection, but is often used here as a second line TB drug. Also infusion centers or rehabilitation centers seem to be less available in Vellore, resulting in longer stays than might be the case in the US.
4. Patients were considerably more respectful to physicians and seemingly less concerned about privacy than I was accustomed to in the US.

The trip contributed to my medical education by showing me how with really minimal resources, one could still help people get better. All of the objectives that I had for the trip were met and more by the site and the people there. I had an interest in tropical medicine before visiting India and now have more of an interest having visited. I hope to return as a resident and participate more in patient's care and hopefully work with neuroradiology staff on functional imaging and surgical pre-planning. I also learned a bit about hospital management through a side trip I made to Scudder Memorial Hospital in Ranipet for a day.

A FEW THOUGHTS ABOUT GOING TO INDIA

Planning
The paperwork is not too bad, but the lead times are punishing... It took 7 months for all of my paperwork to work its way through the bureaucracy in India. The visa is especially treacherous. I managed to avoid getting stuck, but one must use the tourist visa option to avoid problems. The student visa is intended for real medical student study (say for 4 1/2 years), not for the 1-2 month stays the overseas elective program has in mind.

Bring a flashlight with spare batteries, one can lose power pretty often.

Buy DEET with Sun Block.

I would bring a MCI or AT&T card or equivalent. Has to be cheaper than paying India phone rates and saves on foreign exchange while in India. One can make calling card calls from the post office located in the hospital compound. The shops outside the compound with STD/ISD signs do not understand how to make credit card calls and have no economic desire to learn.

CMC Vellore specific
CMC Vellore is really two campuses. The Hospital is in Vellore proper, the Medical College is about 6-7 km away, an easy bus ride, but not set up to facilitate communications about lodging.

Most things are closed on Sunday. The hospital library is open till midnight M-F, till 9:00 pm Sat.. But is closed on Sunday. The Chaplain's library is also closed on Sunday and has no escapist reading in it.

Hospital Annexe is a bit Spartan with only cold water in rooms, but one has buckets and there is a hot water tank on the top floor. No electrical outlets in the room, although one can buy an adapter and use the light bulb socket for an outlet. The staff is very pleasant, and can find taxis and auto-rickshaws for you.

Outpatient clinic is great in terms of acuity and strange things, but bring your ophthalmoscope, reflex hammer, flashlight as well as a stethoscope as they are not as available as I would have expected . I would leave the BP cuff at home. Also bring spare batteries for ophthalmoscope, as it runs on 110 volts but India runs on 220 Volts! Or plan ahead and bring converter or 220 Volt option from ophthalmoscope manufacturer.

I found it helpful to bring along a Tarascon's and a Sanford along with a Maxwell. Most other stuff is available in the library. However, one can not borrow books from the library as an elective student. Have a resident borrow them for you.

Internet access is limited, with some of the departments having access through a proxy server to VSNL, which until recently had a monopoly on international internet traffic, with predictable poor response times and availability. In Vellore, there are three internet access sites I have been able to identify, with the best being across the mosque on the Ghandi Road, on the 2nd floor. Four computers and A/C.

Food is at the YWCA Canteen right next to the Hospital Annexe and in the MIQ (Male Internees Quarters) in the basement.

Dress: Men, dress shirt - no tie, long slacks and either dress shoes or sandals.
Women - long slacks or very long skirts. Tamil Nadu is a very conservative portion of India. I do not recommend shorts or short skirts. There is virtually no skin showing except for the midriff on all of the women working in the hospital or as patients (except for arms).

Curriculum: I would strongly recommend spending a day at the leprosarium, the SLR&TC in Karigiri. The program is affiliated with CMC Vellore and does research on leprosy as well as treat patients with leprosy. Figuring out what to do once at SLR&TC is a bit tricky, but manageable. I got to see the outpatient clinic and a little bit of the inpatient wards. Quite amazing. There is a bus from CMC Vellore in the AM and one that returns in the PM, as well as private buses. Travel time is approximately 30 minutes. There is no equivalent in the US, except for Carverville, LA.

I would also recommend the CHAD program, which is a maternal and child health program for rural populations.

TV - in the basement of the MIQ, choice of Hindi, Tamil or English shows.

Vellore Specific
Vellore has no English language bookstore, except for the medical bookstore, which also sells Jackie Collins books and other things of that ilk, but not even much of that. I tried to find a map of Vellore, but had no success. There is a lending library, the Up Corner, on the Ghandi Road, the selection is a bit limited, but better than nothing.

Best Restaurant in Vellore is the Prince Manor, with choice of Indian and Chinese food. Very good.

Movies - We went to Vishnu (no idea where it is) and watched the latest James Bond movie, great fun to watch in Tamil, w/o English subtitles. Smoking in the movie theater, with intermission.