Introduction
An English missionary, Dr Lehmann built Herbertpur Christian Hospital in the 1930s and ran it with his wife until it was taken over in 1986 by the Emmanuel Hospital Association. Statistics include up to 300 outpatients a day, 115 beds, four elective surgery sessions a week daily emergencies, and a medical staff 6 specialists and 4 junior doctors.
The Location
The hospital is set in a village in the foothills of the Himalayas, 160 miles north of Delhi and 25 miles west of Dehra Dun at 2,500 feet above sea level. Much of the nearby area is extremely beautiful. Because the hospital is close to the Tibet and Nepalese borders the people are ethnically diverse. Patients travel up to 300 miles and walk several days. Another group provides community services. The hospital is the main voluntary agency providing clinical care for a total population of three million.
Life in India
I don't think anything can prepare you for the differences in living conditions. The food was totally monotonous - rice and daal (lentils) every day. A hot shower on return to the UK seemed like the greatest luxury after 'bucket baths', which were cold unless you got up half an hour ahead to heat the water. But with no TV or radio, I read seven thick novels and made many friends amongst the doctors and their families. With extremely limited telephone services, I discovered the joys of writing, and receiving, long letters from family and friends. And with my fluctuating health, I lost loads of weight!
Members of the hospital staff are mainly Christian. I was often brought up short by how dedicated they are to their faith. There were daily devotions each morning, and a weekly service in the chapel. Before every operation, all the theatre staff would stop to pray for the patient's safe recovery, and in any situation where the course of action was unclear, staff frequently prayed for guidance. Many of the patients were from Hindu or Muslim families but their response to the hospital was often positive and accepting.
We led fairly sheltered lives, within the hospital grounds, and were only infrequently exposed to the conditions in which much of the population live. In the cities and towns, there are large numbers of homeless. As I travelled out of Delhi, the ring of slums that lies on its outskirts shocked me. Many of the children were sifting through rubbish on the sides of the railway for anything of value.
In the Dun valley, wheat is the main source of income. Although many of the villagers live in little more than mud huts, they have access to water drawn from wells, and can afford basic medical care. However, in the mountains the land is not so fertile, and the tribal communities who live here work tirelessly to scratch a living. However, when I compared the life that the agricultural workers lead to that of the beggars and squatters in the cities, it seemed that they had infinitely more dignity, hope and self respect, even though they were just as poor.
I came to India with many preconceived ideas. I found the people of India are incredibly diverse. One group are entirely nomadic, and always presented with the most neglected diseases. Another is polyandrous where the wife could have as many husbands as she liked! There are many different religious groups. I became a good friend with several of the doctors, and they seemed to enjoy discussing the differences between their culture and mine. The Indian media portrays the English and American societies as very materialistic (probably true) and having no real morals or family values, with which I had to disagree!
Medical Experience
The hospital has many departments, and the staff was keen for me to experience as much as possible. I spent half of the time on paediatrics, which included most of the adult medicine. I saw more signs in a week than I would in a month in the UK. It was another thing being able to treat them. I was frustrated by the limitations of the hospital.
TB formed a major part of the acute and long-term caseload. I began to realise that there are no limits to what organ can be affected. For the TB patients who were too frail to go home, or who were unlikely to comply with therapy at home, there was the TB hostel. This was a cheaper place to stay than the regular wards, had cooking and washing facilities for the patients, and also provided training in basic literacy. It was extremely popular, and many patients stayed for several months.
Problems Experienced
Medical Since Herbertpur is a mission hospital, its aim is to provide a service that even the poorest can access. So, although the poorest have subsidised care, the level provided still seemed to me far from ideal. Intensive care, investigations available on site and drugs were all limited. The majority of patients had operations under spinal or epidural analgesia. They were monitored clinically every 5 - 10 minutes by a technician looking after the patients in both theatres at once!
Language. In North India, most people speak Hindi. I hadn't learnt much before arrival. All the doctors spoke perfect English. But although I felt able to take on quite a lot of responsibility, I was prevented by language from doing anything without a doctor present. I soon picked up the basics but would strongly advise people coming to this area to practice with Indian friends, or go on a Hindi course before arrival.
Health. India is a huge place, so anyone going should really research the conditions in whichever state/s they will visit. Malaria and HIV infection were relatively uncommon.
Food hygiene. Eating only what is boiled or peeled is difficult to practice. Bottled water was not easily obtained so we relied on filtered water from the doctor's mess. I had four attacks of gastroenteritis. The first was quite severe, and I had to resort to IV fluids after three days, and take ciprofloxacin, which was surprisingly effective. However, the hospital staff said this was quite exceptional for a visitor. As a result I was invited to many people's houses, where they would prepare 'safe' food washed in boiled water especially for me to eat!
Conclusion
My experiences changed my future plans. I decided that paediatrics is the career for me - a decision I'd been wavering over for years. I also want to return to India and work as a doctor in the future, and know that my expectations of this work are now far more realistic than previously! To conclude, I'll quote the final pages of my elective diary:
"On leaving, Asha prayed privately for me in my room, then Dr Anorak came to carry my bags. Everyone came to see me off - even Dr Christopher slipped in at the last minute. Helen prayed a lovely prayer for my safe journey and described me as a ray of sunshine. I managed not to cry, and set off in the taxi. The taxi driver's wife came, who speaks English, so I had a relaxed trip to the station, where Famit met me and made sure I was on the right carriage.
"I really couldn't have hoped to meet any nicer or more caring people. They've all said so many nice things in the last week, and made me feel very special. I'll really miss them."
An English missionary, Dr Lehmann built Herbertpur Christian Hospital in the 1930s and ran it with his wife until it was taken over in 1986 by the Emmanuel Hospital Association. Statistics include up to 300 outpatients a day, 115 beds, four elective surgery sessions a week daily emergencies, and a medical staff 6 specialists and 4 junior doctors.
The Location
The hospital is set in a village in the foothills of the Himalayas, 160 miles north of Delhi and 25 miles west of Dehra Dun at 2,500 feet above sea level. Much of the nearby area is extremely beautiful. Because the hospital is close to the Tibet and Nepalese borders the people are ethnically diverse. Patients travel up to 300 miles and walk several days. Another group provides community services. The hospital is the main voluntary agency providing clinical care for a total population of three million.
Life in India
I don't think anything can prepare you for the differences in living conditions. The food was totally monotonous - rice and daal (lentils) every day. A hot shower on return to the UK seemed like the greatest luxury after 'bucket baths', which were cold unless you got up half an hour ahead to heat the water. But with no TV or radio, I read seven thick novels and made many friends amongst the doctors and their families. With extremely limited telephone services, I discovered the joys of writing, and receiving, long letters from family and friends. And with my fluctuating health, I lost loads of weight!
Members of the hospital staff are mainly Christian. I was often brought up short by how dedicated they are to their faith. There were daily devotions each morning, and a weekly service in the chapel. Before every operation, all the theatre staff would stop to pray for the patient's safe recovery, and in any situation where the course of action was unclear, staff frequently prayed for guidance. Many of the patients were from Hindu or Muslim families but their response to the hospital was often positive and accepting.
We led fairly sheltered lives, within the hospital grounds, and were only infrequently exposed to the conditions in which much of the population live. In the cities and towns, there are large numbers of homeless. As I travelled out of Delhi, the ring of slums that lies on its outskirts shocked me. Many of the children were sifting through rubbish on the sides of the railway for anything of value.
In the Dun valley, wheat is the main source of income. Although many of the villagers live in little more than mud huts, they have access to water drawn from wells, and can afford basic medical care. However, in the mountains the land is not so fertile, and the tribal communities who live here work tirelessly to scratch a living. However, when I compared the life that the agricultural workers lead to that of the beggars and squatters in the cities, it seemed that they had infinitely more dignity, hope and self respect, even though they were just as poor.
I came to India with many preconceived ideas. I found the people of India are incredibly diverse. One group are entirely nomadic, and always presented with the most neglected diseases. Another is polyandrous where the wife could have as many husbands as she liked! There are many different religious groups. I became a good friend with several of the doctors, and they seemed to enjoy discussing the differences between their culture and mine. The Indian media portrays the English and American societies as very materialistic (probably true) and having no real morals or family values, with which I had to disagree!
Medical Experience
The hospital has many departments, and the staff was keen for me to experience as much as possible. I spent half of the time on paediatrics, which included most of the adult medicine. I saw more signs in a week than I would in a month in the UK. It was another thing being able to treat them. I was frustrated by the limitations of the hospital.
TB formed a major part of the acute and long-term caseload. I began to realise that there are no limits to what organ can be affected. For the TB patients who were too frail to go home, or who were unlikely to comply with therapy at home, there was the TB hostel. This was a cheaper place to stay than the regular wards, had cooking and washing facilities for the patients, and also provided training in basic literacy. It was extremely popular, and many patients stayed for several months.
Problems Experienced
Medical Since Herbertpur is a mission hospital, its aim is to provide a service that even the poorest can access. So, although the poorest have subsidised care, the level provided still seemed to me far from ideal. Intensive care, investigations available on site and drugs were all limited. The majority of patients had operations under spinal or epidural analgesia. They were monitored clinically every 5 - 10 minutes by a technician looking after the patients in both theatres at once!
Language. In North India, most people speak Hindi. I hadn't learnt much before arrival. All the doctors spoke perfect English. But although I felt able to take on quite a lot of responsibility, I was prevented by language from doing anything without a doctor present. I soon picked up the basics but would strongly advise people coming to this area to practice with Indian friends, or go on a Hindi course before arrival.
Health. India is a huge place, so anyone going should really research the conditions in whichever state/s they will visit. Malaria and HIV infection were relatively uncommon.
Food hygiene. Eating only what is boiled or peeled is difficult to practice. Bottled water was not easily obtained so we relied on filtered water from the doctor's mess. I had four attacks of gastroenteritis. The first was quite severe, and I had to resort to IV fluids after three days, and take ciprofloxacin, which was surprisingly effective. However, the hospital staff said this was quite exceptional for a visitor. As a result I was invited to many people's houses, where they would prepare 'safe' food washed in boiled water especially for me to eat!
Conclusion
My experiences changed my future plans. I decided that paediatrics is the career for me - a decision I'd been wavering over for years. I also want to return to India and work as a doctor in the future, and know that my expectations of this work are now far more realistic than previously! To conclude, I'll quote the final pages of my elective diary:
"On leaving, Asha prayed privately for me in my room, then Dr Anorak came to carry my bags. Everyone came to see me off - even Dr Christopher slipped in at the last minute. Helen prayed a lovely prayer for my safe journey and described me as a ray of sunshine. I managed not to cry, and set off in the taxi. The taxi driver's wife came, who speaks English, so I had a relaxed trip to the station, where Famit met me and made sure I was on the right carriage.
"I really couldn't have hoped to meet any nicer or more caring people. They've all said so many nice things in the last week, and made me feel very special. I'll really miss them."
