I applied to the All India Institute of Medical Sciences (AIIMS) in Delhi, India due to my interest in paediatrics, desire to appreciate healthcare in a developing country, and wish to meet my India-based family and friends.
My time was spent with the Institute’s paediatric department in an urban and rural setting – the urban placement in the tertiary centre in Delhi, and the rural in a primary health centre (PHC) in Dayalpur and a secondary care centre in Ballabgarh.
My timetable at the tertiary centre was divided into general and speciality paediatric clinics in the outpatient department and attending wards for inpatients. General paediatric clinics took place in the morning, where I reported to the senior resident, while speciality paediatric clinics took place in the afternoon, ranging from neurology, gastroenterology, nephrology, endocrinology, genetics, pulmonology and haematology.
The pattern of diseases presenting to the urban institute were predominantly complex, atypical and specialist cases, which provided an unforgettable and diverse learning experience.
In one afternoon in the paediatric neurology clinic, I saw patients with West syndrome, tuberous sclerosis, hypoxic-ischemic encephalopathy (HIE), global developmental delay (GDD), Sturge-Weber syndrome, encephalitis, cerebral palsy and much more. This developed my appreciation for the breadth of paediatric illnesses presenting within each sub-specialty, the long-term sequelae into adulthood, and the need for a multi-disciplinary approach.
Educational and humbling
My observations in the rural environment were both educational and humbling. I was surprised to learn that 68% of India’s population lives rurally, however only 2% of the country’s doctors work in the rural setting, and many doctors posted in the community do not show up.
Unsurprisingly, this has led to a broken healthcare system, with many individuals in the community not able to access healthcare, and an increased dependence on private and non-governmental organisations and charities for healthcare.
68% of India's population lives rurally, however only 2% of the country's doctors work in the rural setting.
The majority of doctors in the community are newly qualified doctors, called ‘interns’. I soon realised that they were expected to take on a huge responsibility – from running antenatal and paediatric clinics to delivering babies, performing episiotomies if needed, and manning the emergency department in 24-hour shifts.
Although the interns were not very experienced, they had support from a senior resident. Unfortunately, this is not always the case in other parts of India.
Presentation at the primary healthcare centre included basic medicine, immunisation, antenatal, perinatal and postnatal care, and common childhood diseases such as URTI, gastroenteritis and malnutrition.
The emergencies ranged from minor trauma, severe dehydration, myocardial infarctions and, surprisingly, dog bites. During my community antenatal clinic visit, I observed a high prevalence of iron deficiency anaemia, which had been associated with increased maternal morbidity, mortality, and impaired foetal mental development.
I would highly recommend this medical elective. The hospital is nationally and internationally known, and offers a rich clinical, teaching and academic experience. Delhi as a city also has a lot to offer.
The general paediatric clinic was perhaps where I received some of my best clinical experience. I was allowed to take histories from patients, perform a clinical examination and present to the senior resident. This really helped me acknowledge my strengths and weaknesses, which I will take into consideration for my future professional practice.
Delhi as a city has a lot to offer.
I learnt that my clinical knowledge and examinations are not too far from that of junior residents, giving me confidence in my clinical skills. However, I also noticed gaps in my knowledge, especially foundation topics like microbiology, pharmacology and physiology, which are taught and examined more vigilantly in India.
Putting myself out of my comfort zone in terms of environment, culture, language and social circle helped me to become more comfortable with myself and with uncertainty. Living with medical interns and junior residents on my community placement taught me more about local culture and social and environmental influences on healthcare.
The not so good
A typical week would be from Monday to Saturday, with residents getting two days off a month (alternate Sundays). I was not anticipating coming into hospital on Saturdays, which took some time to get used to! I was also surprised to observe the level of responsibility interns (recently graduated medical students) were given on their community placement, ranging from deliveries and minor trauma to antenatal, paediatric and community medicine.
I would also add that the weather was borderline unbearable at times due to the heat (I was there between April and May) which often made travel difficult.
It’s important not to underestimate the risk of dehydration, as well as the importance of clean water sources. I was lucky and put efforts into staying healthy throughout my elective, with no bouts of Delhi belly – or dog bites!
Send your application early; they take some time to respond, but they definitely respond, and it is worth waiting for!
I was very grateful to receive a bursary of £500 through my university as I was visiting a developing country, so check with your university if they have something similar available.
I highly recommend observing one week in the community, as that will give you a good perspective of healthcare and its challenges to the majority of patients in India. Rural placements also gave me a good chance to socialise with the interns and junior/senior residents, as they were relatively less busy compared to doctors in the urban hospital.
If you can speak or understand Hindi you will be at an advantage, and can spend more time in the clinics.
Finally, think carefully about what you would like to achieve from your medical elective before you apply, and talk to as many people as possible who have already been on elective. And use The Electives Network; reading the experiences of a student who had already completed his elective at AIIMS was very helpful in my application, and I'm grateful to have chosen this hospital and location for my placement.