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Three weeks as a clinical trainee in the countryside of Tamil Nadu (India)

Article by Lea Kübler (former travel participant)

Sarah und Lea auf ihrer Reise durch Kerala

Sarah and Lea on their journey through Kerala

I have been studying medicine for five years now. I have gained my practical experience so far in Hungarian and German hospitals, in health systems that meet a high standard in international comparison. CT and MRI devices are now part of our basic equipment in Europe. Efficiency and cost-effectiveness are paramount. Health insurance is compulsory. But how is basic health care guaranteed in countries that cannot afford it? In search of an internship where resources are limited, doctors only have to manage with simple, basic means, and the importance of listening and compassion by doctor is even greater than his efficiency, I came across the Tribal Health Initiative project in Sittilingi, India.

Praktikum Tamil Nadu

Sittilingi is one of 21 small villages in the Sittilingi Valley in the northern inland of Tamil Nadus in the middle of the Kalrayan and Sitheri mountain ranges. For more than 200 years, the valley was cut off from civilization until the Indian government commissioned the construction of a first road through the valley in the early 1990s. Medical care as such did not exist until that time, partly because there were no doctors in the area and partly because the majority of the rural population could not afford medical examinations, procedures and medicines. This was to change when two young doctors, Dr. Regi George and Dr. Lalitha Regi, opened the valley’s first medical practice in 1992. What initially consisted of a hut with four employees has developed over the last twenty years into a small polyclinic. Funded by donations, the hospital can now look after a 42-bed ward, has staff  on a maternity ward day and night, conduct consultations four days a week and perform two-day surgeries. Local women are trained as nurses and health workers in the clinic and support the doctors in their work in the laboratory, on the ward and in the operating room, in home visits and in the education work in the areas of family planning and hygiene.

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For ten years, the founding physicians of the THI (Tribal Health Initiative) have also been assisted by Dr. Ravikumar Manoharan, who with his wife Prema Ravikumar has now taken over the management of the medical and nursing work. The small team of doctors also receives reinforcements every year from several freshly baked assistant doctors who, after their medical studies, decide to work in Sittilingi for one to two years. Their help is particularly important because Dr. Regi George and Dr. Lalitha Regi have been focusing on the medical aspects of health promotion for several years, but have now set up initiatives to provide the local population with new and, above all, profitable sources of income. These include, for example, the Sittilingi Organic Famers Association, where local farmers learn to grow organically to save on expensive chemical pesticides, to market their crops in a market independent of large farmers, while promoting the health of local consumers. Another project to contribute to a healthy society is the so-called Tribal Craft Initiative. Here, women make clothes according to traditional techniques, embroider them and sell them at fairs across the country. Thus, women contribute to domestic income, are encouraged to be proud of their tradition and culture and play a new role in society. Last but not least, the THI project also includes an educational initiative, Thulir, which allows indigenous children to fill their educational gaps, which have unfortunately become the norm due to the government’s poorly organised education system. Recently, primary school pupils have also been able to obtain all their education independently of the government.

Praktikum tamil Nadu

Perhaps after reading this first section, it is obvious that Sittilingi is a very special place, with very special people. And I can only say that my experiences there were also very special.

Before I started my trip to India, I was surprisingly nervous. I had read little about the country and its people, had little planned and hardly dealt with my internship. And so at the end of December I got on the plane with a slightly queasy feeling in my stomach. My journey was marked by lack of sleep, nervousness and a feeling of overwhelmness, when processing the first impressions of this multifaceted country. But when, after a 40-hour journey at 6 o’clock in the morning, I got off the train into the sultry, thick morning air in Valappadi, a driver of the THI and Dr. Lalitha Regi invited me to my first chai on a dusty, dark gravel square, the so-called bus station, the efforts of the last two days had already gone. After all, the indescribable hospitality that was evident in the first few minutes of my stay in Sittilingi was ultimately intended to shape the entirety of my internship. Just two hours after my arrival, I was introduced to the staff during the morning meditation, then Dr. Ravi gave me the tour of the campus, explained the daily routine to me, and less than half an hour later I stood next to the two assistant doctors, Sharan and Sangeetha, in flip-flops and surgical clothing, at the operating table and stared into the open abdominal cavity of a young woman. My first female sterilization. And I was already part of the THI community.

Praktikum Tamil Nadu

In the coming weeks I could see many things in the operating room: hemorrhoid removals, abscess drainages, amputations, gynecological procedures, an operation on the intestine (gastrojejunostomi), caesarean sections. The spectrum was broad. A few times I was allowed to assist and if I had spent a little more time in Sittilingi, I would have liked to have been taught one or the other procedure. In addition to the hours in the operating room, I accompanied the doctors in their consultation hours. There I was always told the condition of the patients, I helped to examine them and the diagnoses were made. It did not matter whether, I accompanied the two assistant doctors, Dr. Ravi, Dr. Lalitha or Dr. Regi. Every single one of them made every effort to involve me in their work. I was called when there was something interesting to see in the emergency room, I was left with space wounds to sew and I was told to ask questions when things were unclear to me. For example, I have been able to learn a great deal about diseases that are not common in large parts of Europe: tuberculosis, leprosy, dengue fever, malaria are a few of these examples.

Praktikum Tamil Nadu

In general, I noticed in the consultation hours, that both, the daily work routine and the diagnostic approach of the Indian physicians are not very different from those of a German family doctor. Work is carried out until there are no more patients to be cared for and a detailed medical history and physical examination, ultrasound, blood values, ECG and X-rays are sufficient to make the majority of the diagnoses and initiate the appropriate treatment. Only in cases where it is absolutely necessary, will a patient be referred to the nearest major hospital, which is three hours’ bus ride from Sittilingi and which has the appropriate means and equipment at its disposal to perform complicated procedures.

Praktikum Tamil Nadu

What will be remembered as particularly positive from the work in Sittilingi is, that both the surgeon, the anesthesiologist or the nurse, knows the patient, his circumstances and medical history, as well as the general practitioner himself. This is, of course, due to the fact that the general practitioner is also a surgeon or anesthesiologist at the same time, but also because of the excellent communication between the doctors and the rest of the staff. The mood in the THI is collegial, the hierarchy is flat and so it happened, for example, that after the end of the working day I was able to end the evenings with the two assistant doctors, Sharan and Sangeetha, Dr. Ravi and his wife Prema. Over tea or coffee, they sat together and tried to find solutions to the world’s problems, spending time with Carrom (fingerbilliard) or card games, before finally cooking together and having dinner at a late hour. But not only the contact with the doctors was close, also the rest of the staff were just incredibly hospitable. When the Tamil Thanksgiving (Pongal) was celebrated towards the end of my internship, I had lunch and dinner for several days almost exclusively with different families, with families who all wanted to show me their home, their culture and their cooking skills proudly. And so time passed as if in flight. In the end, It was hard for me to leave.

In the three weeks I was allowed to be at home in Sittilingi, I got an astonishingly intense insight into the culture of Tamil Nadu and also the medical aspect of my time in the Tribal Health Initiative was exciting and enriching. But the most valuable thing for me in the long run, will be the many newly established social contacts that have given me incredibly fond memories of my internship in the hinterland of Tamil Nadu. For me, Sittilingi will always be a special place. A place where health is understood and implemented as a holistic concept. A place where the commitment of very special people try to improve the quality of life of an entire population.

Tribal Health Initiative website: http://www.tribalhealth.org

https://www.facebook.com/tribalhealthinitiative/

Website Friends of Sittilingi e.V.: http://www.sittilingi.de