Remember ME - You Me and Dementia

Monday, May 23, 2011

Medical Student's Experience of Geriatrics in India: Summer 2011

India is big, crowded, and changing faster economically and socially than it can seem to keep up with.  The largest democracy in the world with over one billion people, it is completely overwhelming and exhilarating, but there is also a prevalent warmth and hospitality within the people wherever you go.  India’s history is as rich and colorful as you can get, with hundreds of different conquerors and border changes, the famous story of independence led by Mahatma Gandhi, and evidence of it all remaining in the temples, statues, and preservations of countless historical sites.  The culture is heavily influenced by religion and their daily rituals influence almost every part of the lives of the Hindu people I interacted with.  Muslims and Christians, along with Sikhs, Buddhists, Jains, Jews, and Zorastrians also are seen openly practicing their religions, and all living in relative peace and sybiosis with each other. 

The changes that the country is experiencing are palpable.  A brand new office building next to a rusty corrugated metal capped slum in Mumbai, a polished SUV on the road next too a cow, and of course the technology boom bringing western modernity into the developing world that is trying to keep up, are some of the obvious sites showcasing the new vs. the old.  Health issues are changing too- there is improvement in some public health measures, but there is still a long way to go; you’d be very adventurous to drink the tap water.  And with the large amount of people moving into the cities and greater availability of unhealthy foods, rates of diabetes and hypertension are on a dangerous incline.  But when talking to the locals about what is changing, especially from the elderly generation, you hear about the huge social changes taking place.  The breakdown of the Indian family model, which used to be comprised of a large household with all generations, is now becoming nuclear and leaving many from the silver generation without a home. 

My rotation focused on the health and social issues of the elderly population in India.  I worked with a multi-faceted medical NGO in Bangalore, the Nightingale Trust, whose realm includes home medical care, an inpatient dementia care unit, adult day care, and rural medical visits amongst other things.  I also worked with a newer NGO in Mumbai known as Silver Inning Foundation which uses social networking and media to help address multiple human rights issues and needs of the elderly.  My goals in this rotation were to learn about the health and human rights issues involving the elderly in India and compare them to the USA’s, share my knowledge and ideas with the Indian people I work with, and use my connections and what I learned in the future in some way to help address these and similar problems.

Before leaving, I had some grasp on the issues affecting the elderly.  I had heard that there were rising amounts of elderly people due to increasing life expectancy, and little infrastructure to support them.  Also I knew rates of diabetes were on the rise.  I wanted to explore the issues from a medical and human rights perspective, as are my interests.  When arriving, I found that these things were true, and more.  Again and again I heard the stories of children abandoning their parents, or moving away to the US.  There was no government support to help them finance their daily life.  Rates of depression have increased in the elderly as an outcome of the changing family structure too. 

The NGOs I worked with were helping to address these issues.  Nightingale Trust was providing home care to people in the cities and the rural areas that once had no access.  They also help underfunded people with adult daycare, abuse help lines, and sliding scale payments.  Silver Inning foundation was using social networking and media to connect elderly people with each other and with the help they needed.  They put poor people in touch with affordable old age homes, provided an elder abuse hotline, visited men’s and women’s group and provided them with information and ideas, and were constantly promoting awareness with innovative networking.  I was a part of these NGOs as an observer and short-term worker.  I think my presence benefitted the people I interacted with by sharing my knowledge of how the elderly are treated in America and by showing my support of the activities and the people in need.

I think the greatest benefit of students’ involvement in global health is the impact is has on the student herself.  I would not be the person or doctor that I am if it wasn’t for my community service and global health experiences.  My experience in India humbled me and took my breath away several times.  The family that I stayed with told me that instead of selling their printing company, they just gave it to their employers as a sign of gratitude for years of hard work.  Both NGOs I worked with were started by individuals who used all self-funding for years to keep them alive.  The fact that everything seems to work out so well in the face of so much constant chaos in India, I can only attribute to the amazing way everyone is constantly helping their fellow man.  As my rotation had a large focus on human rights, I think this observation of hospitality, selflessness, and charity made the largest impression on me. 

In terms of my professional career, experiences like this rotation benefit me greatly.  I am entering into a residency in Internal Medicine that focuses on helping a diverse and underserved population, and the more experience I get with other cultures and pathologies, the better I can treat each individual.  It also shapes my goals and reiterates my desires to help all people, regardless of class, race, and borders.  I will be more of an advocate for the elderly after interviewing and assisting so many in India.  And I will be much more mindful of human rights issues with the elderly such as abuse, lack of support and a home, depression and loneliness.  Also, I made a lot of connections with doctors and activists in India, and I have no doubts that we can continue to work together in the future.

In my time in India I worked in two large cities, visited rural sites surrounding them both, and traveled to 5 cities total.  I aimed to get as much possible out of my short time there and I think I succeeded.  The NGOs I worked with showed me a comprehensive view of the health and human rights issues affecting the elderly in India.  Most of the medical problems were similar to what we see here.  Diabetes is on the rise, mostly due to the influx of people into urban areas, and the availability of food, unhealthy food, in the cities.  Also with urbanization come many sedentary jobs leading to lack of exercise and obesity.  Other common things are common, such as hypertension, asthma, COPD, dementia, depression, and cancer.  Dementia is receiving growing attention, and the prevalence is increasing due to the increase in life expectancy and increase in awareness. 

When I explored the Indian people’s perception of health care in their country I was surprised at how little people complained, which was much less than I feel we do here in America.  I found myself looking for problems, asking leading questions to get to the bottom of it.  What I found is that most people say they get medical care when they need it, and at not too high of a cost.  Very few people have insurance, and there is no Medicaid or Medicare equivalent for the destitute and elderly.  However with the lower cost of health care due partly to the lack of insurance companies, most people get what they need.  I asked, “What if you get cancer?  What if you have diabetes?  What if you’re the poorest poor?”  Most of the responses were basically that if you have chronic diseases there are schemes available to help, and that there are good government hospitals that are free to the poor.  But when I got to the bottom of it I noticed that people were not getting the primary care they needed.  Indians would rather treat themselves at home, with naturopathic or Aruvedic medicine or an antibiotic they picked up at a pharmacy without a prescription, than go to a doctor.  With this pattern comes many late presentations of disease.  This problem is sure to get worse with the increasing levels of diabetes, and this does not seem to be being addressed as of now.

Having soaked in the sites, sounds, smells, and tastes of a country as large and busy as India gives me a great perspective on the rest of the world.  Almost 1/6th of the world’s people are on the subcontinent, and I have gained confidence after living how that huge chunk of the world lives.  Like any time I leave the USA, I am reminded of the incredible luxuries that we have here.  Potable water, roads that aren’t littered with garbage, potholes, cows, and unbelievably bad traffic, and decent access to health care.  Also my freedom as a woman and as an American are something I take for granted.  I was disappointed to see women not usually being treated as equals, and I constantly heard about the corruption of the government with attitudes of hopelessness to change.  But I will never forget the kindness I and incredible selflessness I witnessed by my mentors, my hosts, and even strangers in India.  Also there is great beauty in everything in India, from the temples, the delicious food, and the smells of jasmine and incense burning.  This global health experience has enriched my education in medicine and human rights, and also personally enriched my life.  

By Robin Reister
Medical Student
MEDI 7003 Reflective Essay

Forget yourself for others, and others will never forget you.

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