Download I spent three months, the entirety of the summer following M1 year

I spent three months, the entirety of the summer following M1 year, with physicians at
two different NGOs in southern India. My personal goals for the summer were to learn about the
delivery of healthcare in rural or low resource settings, to participate in providing healthcare
under the guidance of physicians, and to immerse myself in a culture far different from Iowa. As
a believer in health as a human right, my purpose was to support and work within the healthcare
infrastructure, looking specifically at the mobile healthcare outreach provided to patients in their
homes and communities. Both organizations were excellent hosts, and provided a fascinating
perspective on the obstacles faced in India.
The Swami Vivekananda Youth Movement (SVYM) sought to support the development
and livelihood of tribal populations, a historically ostracized and disenfranchised collection of
villages in rural Karnataka. These tribes traditionally lived self-sufficiently and peacefully in the
forests, though were forced out due to government projects. The tribal people face grave poverty,
lack of education, unfamiliarity with governmental systems, and migratory labor that limits
infrastructure development. While SVYM initially focused efforts on providing healthcare, this
organization taught me the importance in holistic approaches to community development.
Deficient health education makes it difficult for patients to follow a clinician’s plan of treatment
or prevention strategies. Medications are only as effective as the patients’ adherence to the drug
regimen. Caring for a patient’s health cannot take that individual out of poverty, so widespread
programs that address economic empowerment, education, and sanitation must be put into place.
While the tribal populations have many rights granted via the Indian government, they have
historically lacked the familiarity with government systems to properly advocate for themselves.
Working with the tribal people to promote advocacy and protection of their own rights is perhaps
far more important than bestowing the right to health care on them. It allows them to take
ownership and action of their place in the world. SVYM has made great strides in the forward
movement of the tribal people. While my work primarily lay in the healthcare domain of SVYM,
many of the programs are integrated. I participated in events such as tribal meetings and visited
the tribal schools, developing an immense affection and awe for the compassion and talents of
the tribal people.
Pallium India (PI) is located in Kerala, India’s most developed and equitable state. PI
focuses on palliative care, a type of medicine that addresses irrevocable life-altering diagnoses.
These may range from terminal cancer diagnoses to stroke victims to paralysis from work-related
injuries. PI has developed a home-care visit model that allows clinicians and nursing staff to visit
patients in their homes and communities, overcoming the obstacle of travel which prohibits
many of these patients from reaching a doctor for adequate care. I participated in the daily care
structure, travelling with the care teams to visit patients in their homes. Having physicians see
patients in their typical settings provides great context and aids in providing adequate care. It
also offers numerous teaching moments for the family members, who provide the vast majority
of daily care to the patients. PI staff ensures that the family members are comfortable and
capable of tasks such as dispensing medications, cleaning wounds, and adjusting bed placement.
While much of the work in PI involves patient care, significant efforts are also made at a policy
level. In India, less than 1% of the population who need pain medications and relief receive
adequate care. This is not due to cost, as morphine is a powerful and cheap drug. The policy
actions of PI are centered on changing state and federal laws, in addition to physician training, to
integrate safe, effective, and low-cost pain management throughout the country. As pain affects
both the rich and poor of India, I was surprised that PI provided treatment to people of all income
levels. Those that could afford to pay for their care did pay for it, though it still took time and
energy from the organization. The PI staff felt that it was vitally important to show the middle
and upper class patients the importance of adequate pain management. These wealthier groups
have the political power and will to alter India’s strict morphine laws. Going into the summer, I
expected most well-intentioned NGOs to focus solely on the most impoverished. This strategic
path towards improving the long-term access to adequate pain medications was a surprise.
Wrapping up my experience, I did write up a comparison of each organization’s mobile
care teams, contrasting the different objectives and organization. After spending time with both
organizations, I was quite surprised at just how different the mobile care teams could be. While
each was effective in reaching the population and providing the care it sought, there was little
overlap for common practices. My paper covered general themes that overlapped, and the
differences between each organization were shared so as to provide possible suggestions for
improvement that each organization could learn from the other.