I was fortunate enough to spend the last six weeks in Pune, Maharashtra, India, completing Maternal and Child Health clinical rotations and learning about India's healthcare system. In Pune, I lived in a guesthouse with several other college students from across the globe, as well as a host family.
Our days began at 5:30 A.M. with sunrise yoga, followed by traditional Indian breakfast with the program's medical director (I was always hoping for vada, or potato fritters). Then we headed out to our clinical site for the day. The sites ranged from rural, government-funded free clinics to high-end, urban hospitals.
Healthcare in India feels significantly more utilitarian than it does in the U.S.; patient encounters are extremely brief, and healthcare is very much a business. Only five percent of the Indian population has health insurance, as it is a fairly new concept there. Therefore, everything is paid out of pocket. This means that patients in private practices often demand medications or injections and threaten to take their business elsewhere if their requests are denied. In the rural areas, we observed an overwhelming belief that injections are more effective than oral medications; patients are sometimes given saline injections just for the placebo effect. During my time in Pune, I saw several vaginal deliveries, numerous laparoscopic operations (including appendectomies, hysterectomies, tubal ligations, and tumor resections), and a couple of C-sections.
As an anthropology major, I found India to be endlessly fascinating. Particularly, observing the intersection of culture and family planning practices firsthand enabled me to better understand the extent to which local beliefs and traditions dictate healthcare processes. For example, several doctors I spoke with stated that the majority of their patients want two children, who are 3-4 years apart in age. This underlying assumption about a couple's plans often leads doctors to recommend an IUD for contraception after the first child, and a tubal ligation after the second. Furthermore, a desire in Indian culture for male children previously resulted in an outbreak of sex-selective abortions. Now, a couple is not legally permitted to know the sex of their child prior to its birth. These are two concrete examples of how a cultural climate can dictate medical practices; previously this was a concept that I only understood in an abstract sense.
Following graduation from W&L, I intend to enter a combined MD/MPH program. My ultimate goal is to consult on culturally appropriate strategies for improving women's healthcare in underserved communities. I am so thankful for my summer in Pune, because it showed me just how important cultural awareness and local knowledge (two topics frequently discussed in the classroom) are to healthcare systems.
On the weekends, we took trips to Agra, Delhi, Jaipur, Aurangabad, and Lonavla to see landmarks such as the Taj Mahal, Amer Fort, the Palace of the Winds, and the Ajanta and Ellora Caves. I am so grateful for the Johnson Opportunity Grant that made this incredible trip possible, as it really helped to clarify and confirm my career ambitions.