I approached Project Kodaikanal with a touch of trepidation. I was excited, of course, about the field experience I would gain, my first true insider's look at becoming the doctor I always wanted to be. But I was also aware of the language barriers, cultural differences and unfamiliar medical procedures that might hinder my complete appreciation of this experience.
I was unsure how I would communicate with the children without being fluent in Tamil, the native language of Kodaikanal, a town situated in the southern state of Tamil Nadu, India. I was to visit crèches and spend time with them in the mornings, teaching them general hygiene principles and applying preventative health care. I was pondering how to approach this as we walked down a hill to Betsy Elizabeth Trust Creche on a breezy Kodai day. The kids greeted me with a united and cheery, “Good Morning Akka” (Sister) and continued with their chatter. A little girl walked towards me, tugged at my shirt and said, “Akka, intha poo pidikutha?” I looked at her, trying to figure out what she was saying. She sensed my confusion because she pointed to the rose in her hair and said again, “Akka, intha poo pidikutha?” She pointed to her pink skirt that matched the bright pink in her hair. I put the pieces together and deciphered that she wanted me to appreciate her dressing skills and her apt attention to detailed matching. I smiled and raised my eyebrows, trying to give her a meaningful expression and said, “Ahh, pretty!” She smiled delightedly and skipped away. It was with that brief encounter that I realized how a simple smile or nod could encourage a child to continue cleaning after themselves; how furrowed eyebrows and a frown could make them stop and wonder what was wrong with putting unclean toys in their mouth; how welcoming eyes and a wave could make them slip their hand into yours and walk with you up the hills of Kodaikanal to reach the jeep to go to the hospital. They were interested in learning and were soon swarming around me with their hands raised, eager to learn games like patty-cake. As we played I attempted to incorporate concepts of general hygiene.
After spending the mornings in the crèche, we took a group of the children to the Kodaikanal Health and Medical Services for their physical check-ups. I watched intently as the doctor examined them one by one and questioned me on the medical aspects of the exams. Having recently completed my second year of medical school, this was my first experience applying theoretical knowledge in a clinical setting. I was surprised to find that the majority of situations were something I would not be likely to come across in America. I saw multiple cases of pyoderma and staphylococcal infections because of poor sanitary conditions, helminthic infections because of unclean water, and even cases like umbilical hernia that often fail to be treated in the earliest of stages and are only bought to the doctor when the pain becomes unbearable for the child. Throughout the week, the pediatric surgeon constantly reminded me to observe the stark contrast between Western medicine and the more situation-specific approach in Kodai. I learnt, for instance, that anesthesia does not have to be the only source of ameliorating pain in an in-patient diabetic man undergoing surgical debridement of his gangrenous foot. Speaking about his family, showing interest in his activities for the day, giving him hope that his doctors will do the best they can to preserve his big toe so he can at least walk, gently reassuring him that the pain will subside and encouraging him to be strong while actively removing bone and gangrenous tissue -- these soft psychological undertones can do wonders as an anesthetic. It never failed to amaze me how the staff made full use of the limited medical resources available to them, complementing them with their creativity.
Along with the sheer efficiency of medicine, I also had the unique opportunity to witness the beauty of the culture in the daily interactions. The way they worked up innovative ways to examine women patients who were uncomfortable with revealing any part of their body, the immense respect they gave to each other with the cordial swish of the fingers to be seated, the polite extending of a plate of rice and piling more to fill any hunger, the hand of an older woman patient on my head, bestowing a blessing for success on my future as a doctor – these nuances allowed me to immerse myself fully in the cultural aspect of India. As a medical student, I had always imagined finding a place where I could pursue my dream of rural medicine, and Kodaikanal Health and Medical Services gave me a snapshot of the reality that dream might become. Its projects on tele-medicine, expansion of health care for the nearby villages surrounding Kodaikanal, and dedicated attempts to constantly improve its medical resources reassured me that my dream is indeed possible.