Vijal Patel, Morgan Wilbanks MSEP Experience

VijalPatel,MorganWilbanksMSEPExperience–NewDelhi/Faridabad,India

VolunteerOrganization–InternationalVolunteerHQ

Introduction

We each spent four weeks in Faridabad, India for our MSEP experience with Vijal

staying from 29 May to 26 June, and Morgan staying from 11 June to 9 July. We used the

volunteer organization International Volunteer Headquarters (IVHQ) since they had the cheapest

program fees that we could find and they were flexible on start dates. However, these two items

proved to be the downfall of the program and our experience in India.

In short, we found the program to be poorly run with little interaction from the local

“coordinators.” As it turns out, IVHQ’s business model involves various “partner organizations”

that actually run the volunteering (medical, orphanage, education, etc) programs in the given

country with IVHQ’s personal staff being located in New Zealand; IVHQ (and numerous other

entities, all charging their own fees) merely serve as go-betweens between the students and local

programs. The entire four-week experience proved to be a drawn out test of patience and

fortitude, due to the area we stayed in, the weather, and our hospital experience.

Patel/WilbanksMSEPExperience:Page2

Preparations

Preparing for the trip was pretty straightforward; both of us made appointments at the

UAB Travel Clinic (part of the Kirklin Clinic), where we received all of the appropriate

vaccinations (Typhoid, Hepatitis series, tetanus) and medicines (mefloquine, azithromycin,

ciprofloxacin). The only drawback is that we had to pay out-of-pocket, because insurance (Viva)

did not cover the visit. After the partial reimbursement for the immunizations, the cost for being

seen in the clinic was about $250. VIVA also does not cover mefloquine, which cost $120 for a

twelve-week course. One might consider getting just enough mefloquine stateside to get your

two pre-departure doses and a pill for the first week in India, and get the rest of the pills you

need for cheap at a local pharmacy. For example, since Air France had lost one our bags, we

were able to replace all the lost medications for less than $10 by simply walking up to a

pharmacy counter and requesting the specific medication and the number of pills, no prescription

needed.

Mosquito nets and bug spray were recommended for the trip, but at the time that we

went, we saw maybe a handful of mosquitoes the entire time, being before monsoon season

(after the rains begin, they are much more numerous). Neither of us used any of it, and returned

our unopened mosquito nets when we got back.

As far as clothing goes, cool apparel is a must. Since we were in a hospital, we had to

wear collared shirts (polo shirts are fine) and long pants, but most sporting goods stores sell

decent-looking khaki cargos that are lightweight and will not leave you as sweaty as cotton pants

might. Linen pants are also a great choice to consider. All in all, summer can get pretty hot, so

it’s best to prepare for weather over 110°. Also, since we were washing our clothes in a bucket,

be prepared to be wearing dirty clothes for the duration of your trip. We each ended up leaving a

lot of clothes in India, rather than trucking a bag full of detergent-scented but still soiled clothes

back across half the globe.

Stranger in a Strange Land

The thing about visiting India is that as soon as you are labeled as a foreigner, everyone

starts treating you differently, from the rickshaw drivers in Dharamshala to the patients we

encountered in Faridabad. Streetside vendors raised their prices, and panhandlers sought us out


to sell things or to offer to take us places (Never follow someone to a “tourism office” in India).

For me (Morgan), it was immediately evident that I was a foreigner, but Vijal had the same thing

happen to him as soon as he started

talking, because he did not speak

Hindi. Oftentimes I would find

them looking at us more during an

interview than the physician asking

them questions. We were both

targets and outsiders, intruders and

oddities.

Immediately, the country

did not agree with me.

Unaccustomed to the climate, the 97’F midnight air hit me like a brick wall as I left the airport,

after spending more than a day in various airports and airplanes spanning three continents. The

summer’s heat was hitting its peak in the days before the monsoon began and the first two days

in the country were the worst of my trip as my body slowly adjusted. It was not until the

afternoon of the third day, after a night of fitful, sweaty sleep punctuated by dry heaves and

power outages, that I began to acclimate.

Fortunately for me, I was staying in the home of an extremely hospitable and gracious

Indian family. Despite my frustrations with being gawked at and swindled outside the home,

inside the home (and I stayed with two different families over the course of the month) the

hospitality shown me was unparalleled. If they knew I was sick, they would make sure I had

enough water, meds, or anything else I needed. They would go out of the way to prepare me

something that would not upset my system too much. Even on a day-to-day basis we were told

that we were “members of the family” and could come and go as we pleased, had our privacy

respected at all times, and generally had our needs put before those of the rest of the family.

Government Hospitals—Failed States

Most of what we learned about the Indian healthcare system came through our

discussions with the pediatrician, Dr. Santosh Kumar Seth. He worked at one of the private


hospitals where I spent my time and broke down the distinctions between the private and public

sector, in terms of healthcare. The public hospitals, while mainly free, are constantly swamped

with patients for that reason. Even arriving at 9 AM might not guarantee you a chance to see the

physician until late in the evening. To make matters worse, the staff are too few, their demands

too many, and their general level of training is by far inferior to their counterparts at private

hospitals.

For Dr. Seth, the entire system is plagued by mismanagement and a general “laziness” by

the staff to do their jobs efficiently. Most of the skilled doctors and nurses either end up in

private clinics or go abroad like another doctor that we met on the trip, Dr. Prabhat who planned

on emigrating to Toronto. Those who cannot find work in the less frenzied (and more lucrative)

private sector or who do not have the means to expatriate are forced into the government-run

hospitals, which he described as “failed states where chaos rules, much like in the [sic]

Afghanistan.”

India is a country plagued by a widespread

lack of infrastructure from utilities and sanitation to

healthcare and education, the latter of the two being

the “root cause” for the rest of the country’s

deficiencies. When the British left India to be an

independent nation, that first generation of

politicians, bureaucrats, and administrators did not

take the opportunity to put sufficient resources into

those realms, resulting in the country’s current

problems. His cynicism was evident, but well-

reasoned and informed due to his lifetime of

education and experience.

Dr. Seth had his complaints about the private sphere as well. Healthcare, despite its

relatively cheap cost resulting in widespread affordability, is nonetheless considered a luxury

rather than a necessity. The lack of urgency coupled with the existence of government facilities

results in many going untreated voluntarily. Ironically, the existence of free healthcare providers

keep people from going to private clinics, even though those same people refuse to utilize them

due to crowding and generally run-down facilities. “If it’s not free they don’t want to pay for it,”


even if they know they can afford it. This was the mentality across our experiences in India and

that was a sad fact. Millions are plagued by illnesses born from unsanitary practices and lack of

hygiene; things that do not have to

exist if the country with the 11th

largest economy in the world would

think about the basics of the people

rather than their own personal pockets

(India is a very corrupt country, with

everyone from policemen to politicians

able to be bribed).

Ghai Hospital

All in all, the two of us had a very negative experience with IVHQ and their partner

organization that ran things on the ground at our placement. The program had been advertised as

taking place in New Delhi, but we were not informed until after we had already paid our fees

(now adding to almost $1000) that we were, in fact, to be placed in Faridabad; the information

was sent to us in a word document that contained minimal information to begin with, and no

information about the city. Rather, we learned about Faridabad by doing searches on Google and

looking it up on Wikipedia.

We had also been promised some sort of orientation on our first day, which was also

misrepresented. What we had instead was an extremely informal conversation with one of the

local coordinators where he spent about 15 minutes telling us a little bit about India, most of it

being common knowledge to us anyway.

Our volunteering placement,

however, was the biggest letdown from

IVHQ. Vijal was the first to arrive, and he

was simply dropped off without an

introduction at a hospital that neither knew

that he was coming nor was made aware

that they were partners in any sort of

volunteering program. It was just by luck


and hospitality that they graciously let us hang out with them. I use the word hang out, because

it’s appropriate for the level of activity we actually had while we were there; the majority of our

time was spent watching the doctors round (in Hindi, which neither of us speak and which often

was not repeated in English) or sitting in one of the administrative offices with nothing to do

because nothing was happening in the hospital. Most occasions, when rounding, the physician

would converse with the patient in Hindi and then continue to write notes/orders to the hospital

staff. If he had a spare moment, he would mention a few side facts in English or simply state a

quick phrase, “enteric positive”. There was usually little chance to interject questions. The only

doctor who made our experience close to worthwhile was Dr. Seth (pictured on the previous

page), who spoke the best English in the building, and was willing to talk us in greater depth

about his patients than the other physicians on staff. However, even our conversations with Dr.

Seth proved to have minimal medical relevance, being more focused on the current situations in

India since it was the summer and the bulk of their patients leave for cooler climates during that

time.

We believe the reason for our distanced shadowing and “hanging out” was that the

hospital had no financial incentive for us being there. Despite our paying hundreds of dollars,

only a pittance, it seemed, went to the host families to cover our room and board, and none of it

went to the volunteer placements. After talking with volunteers who were on other projects,

including a school in the slums that did not even have a roof, we discovered the same was true

across the board. What we had thought to be a legitimate-looking volunteering organization now

appears to be more like a pyramid scheme than anything else. Since the hospital received no

incentive for having us there nor did they request for us to be there in the first place, there was no

reason for them to take time out of their workdays to deal with us and prolong their workdays.

In light of the numerous downsides, the hospital did offer some interesting experiences.

We observed a patient with second and third

degree electrical burns across his hands and

his face, a three-inch deep abscess in a

diabetic patient, a large toe amputation,

laparoscopic cholecystectomy/appendectomy,

and a Cesarean section. We saw a baby with


total situs inversus and others with typhoid and marasmus. We were able to feel an enlarged

spleen, liver, and inflamed appendix. And we were able to feel the enlarged liver of a child with

NAFLD. Sterility was an interesting concept. In surgeries, it was understood that the conditions

were less than sterile and so patients would receive broad-spectrum antibiotics by IV

immediately following an operation. Most patients with any GI disturbances were started on

metronidazole or ceftriaxone drips, especially since bacterial illness was much more prevalent

than viral. Also in the surgical OR, we were not required to scrub in, only change our street

shoes to slippers. Surgical masks sometimes did not cover the nose or even taken off mid

procedure, and during the closing of a C-section, a nurse sat in a chair by the operating table,

took off her mask, and talked on her cell phone. There was little use of gloves during bedside

procedures, unless the patient was extremely bloody and scrubbing/cleaning of a wound was

required. If a dressing was being removed or placed, no gloves were required. Also, it seemed as

though glove re-use was occurring; we saw large numbers of gloves drying out like on a

clothesline.

Provided Housing

The housing situation was interesting and varying, going from extremely enjoyable

experiences to moments of depression. Initially, I (Vijal) arrived two weeks earlier than Morgan

and stayed with a family for 4 weeks (the same family to where Morgan later moved). When I

arrived at the house, I was met by an extremely friendly host family who—for the most part—

treated me as one of their own. I was offered water and food, and was treated with nothing but

respect and kindness for my well-being. When Morgan was feeling ill, the host family he stayed

with made sure to cook foods that would not upset his stomach and offered him medicines. They

took genuine interest and care in his well-being. This was the case with all homestays that we

experienced with our trip, in that you honestly felt as though they cared about what happened to

you. You were not simply a tenant, instead, something more akin to a family member.


The housing had its faults however, and this would be more attributed to the volunteer

program and the local coordinators. For example, at times, the housing was quite crowded.

When I (Vijal) started my stay, there were 2 other volunteers plus the host family of Rakesh Raj

(husband, wife, and young child). We stayed in the house that consisted of two bedrooms, one

bathroom, a living room, and a kitchen. Each of the bedrooms had two plywood bed platforms

and an overhead fan. The living room is where the

host family stayed, sleeping on the ground in front

of the “cooler” (a unit similar to a watercooler for

a car that would chill the air by 10 degrees or so,

and blow into the room). The cooler’s effects did

not reach the bedrooms however, and so where

the volunteers slept remained extremely muggy

and humid, especially in the evenings. After a few

days, another volunteer was added who slept in a

bedroom. During the second week, two more volunteers were added to the house and an

additional bed was brought in. This bed was shared by the volunteers and was placed in the

living room. So now we were 7 volunteers and 3 host family members living in a small single-

story, 2 bedroom, 1 bathroom apartment. During the third week of my stay, we had downsized

once more to 3 volunteers staying in the home, and eventually 4 when Morgan arrived later that

week.

Another complaint regarding the housing situation was the bedding. We slept on raised

plywood platforms with no more than a blanket separating our bodies from the wood. Initially,


we had thought that might be the norm in the area; however, our hospital mentor (Dr. SK Seth)

was quite surprising to learn that we were not given mattresses. Needless to say, every morning

we awoke with stiff backs and sore muscles. Each mini-vacation we took on the weekends was a

welcome relief when we slept in beds with actual mattresses.

The food provided by the host family was tasty but many times devoid of basic nutrition.

I (Vijal) did not consume one green vegetable for the first 1.5 weeks of staying with Rakesh Raj

and his family. There were no fruits either. Eventually, more greens began entering our diet,

however it was still mainly white rice, some flour breads, and lentils. Fruits were only bought by

the host family one time during those 4 weeks. As such, we would go to the market where

mangoes and bananas were plentiful and cheap and purchase our own.

Weekend Adventures

Our weekends were our own: it was up to us as volunteers to plan and organize any trip

we took. As such, it was both quite a hassle and quite enjoyable. One weekend, I (Vijal) flew to

Baroda, Gujarat to visit some very distant

relatives who had not seen me since I was baby.

The surprising thing about that trip was learning

that the domestic airport is entirely separate from

the international airport, and the actual facilities

of the domestic airport (seating, dining,

cleanliness, etc) were much nicer than the

international (After we left, the city opened up the

brand new Terminal 3, a huge modern expansion

of the airport that was built to accommodate the travelers coming for the Commonwealth Games

in the fall). Another weekend went to visiting Agra and New Delhi, with the major attractions

being the Taj Mahal (one of the 7 wonders

of the world), Akshardam Temple (the

world’s largest comprehensive Hindu

temple, pictured left), Red Fort, and


Gandhi’s tomb.

The most memorable and enjoyable adventure was our trip to McLeod Ganj (above, near

Dharamsala, in the foothills of the Himalayas). While the 14-hour bus ride from Delhi to

McLeod was less than enjoyable (involving quite a bit of motion sickness out of bus windows

and inside the bus as well), the destination was worth it. McLeod is home to the exiled Tibetan

government and a place of beauty. Cooler weather and friendly people immediately greeted us.

Street vendors were much friendlier than the rest of India I had visited and honestly seemed to

respect you as a tourist. You could see hundreds of monks of all ages throughout the city, all

being quite friendly and jovial. We stayed in a hotel overlooking the valley where McLeod is

nestled and had an amazing view for less than $10 USD per night! We hiked up the Himalayas

and swam in a waterfall fed by snow runoff from the mountain peaks, ascending over 1 mile in

elevation with a total distance estimated at 7 miles roundtrip across half the day.


APPENDIX

Operation Room-Ghai Hospital


Hospital rate chart


Drawing blood on a young patient, without gloves

Note: After the procedure, Dr. Hem wiped the patient’s blood off his hands; he didn’t immediately wash them.


Proper OR footwear, Ghai Hospital

Vijal Patel, Morgan Wilbanks MSEP Experience

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