On our very first day at LSTM we were asked to ‘say something about ourselves’. One by one, staring nervously across the lecture theatre became a quick session in rapidly getting to know each other. Doctors from all walks of life, all stages of their careers, hailing from England to far-flung cities across the globe stood to share, discussing everything from specialist paediatric training and infectious disease vector biology to working in the midst of the Burmese jungle, from awaiting to fly out work in hospitals across Africa to aspirations for improving healthcare in rural Japan.
The first week quickly gathered pace, surrounded by inspirational colleagues and senior lecturers. Preparing blood films became learning to identify parasites on smears, which quickly sped in to an introduction to a metaphorical road map on public health.
However, nothing resonated more than listening to GP Dr Alex Duncan regale us with his tales, illustrated in beautiful technicolour, acquired from 6 years spent ensconced within a remote mountain district of Afghanistan, actively challenging us to realistically consider how we as medical practitioners could use the knowledge we garnered here to inform future work with rural communities facing a potential multitude of demanding public health issues and swathes of neglected tropical disease.
From this, I began reflecting on my own similar experiences gained from working in the slums of India, the frustrations and inadequacies I had felt and seen, coupled with the ambition I had to learn more, with the ultimate aim being able to constructively do more, all of which had brought me to pursue the DTMH at the world renowned Liverpool Institute.
In the midst of the Delhi slums, I had boarded the mobile NGO bus every day for three months; a small outpatient clinic on wheels.
As we rolled over un-surfaced potholed dust paths, we bypassed wandering wild dogs and washing hanging in lines in the middle of the road or strewn on tree branches. We bounced past multi-coloured brick villages with brown stagnant ponds of sewage for borders and thatched mud-huts clustered in the middle of yellow sprig mustard fields with layered plastic for roofing. Housing projects spilt from the ends of corridors of forgotten passageways and teetering homes were built upon skyscraper mounds of composting rubbish.
Aside from cholera, diptheria, TB, ringworm and hookworm, here alcohol and drug addiction was rife. This was a world of rag-pickers, chapatti makers, stall owners, rickshaw pullers and clothes-washers.
We stepped down daily before a muddy wasteland desecrated by tumbling paper plates, squashed aluminium cans and billowing plastic bags, all set in the shadows of clouds of grey acrid smoke piping from quickly darkening piles of burning trash whilst wild mud-slathered pigs trotted by roaming cows. Masked faces beat piles of dirt aside with tiny straw brooms as small children ran hand-in-hand along the brown sludgy ground, shoeless with torn clothes and dirty hair whilst men trawled burlap sacks of grain on carts and rickshaws, hurried women pulling saaris over tired mouths.
We had just one room with a blood-pressure monitor, a black examination table, an assortment of boxed medication, two stethoscopes, an X-Ray light box and four chairs. At every clinic, hundreds of waiting patients snaked in queues from the door, pounding on windows and waving name slips.
There were far more people than money could provide for, and over the season, we touched but a small, brief fragment of the vast slum population, most with no access to modern medical care, many seeking help from the temple or using herbal remedies as alternative.
Amongst the daily chesty coughs, foot infections, crusted scabies and poorly healed lacerations, we saw a jaundiced baby rushed over in desperation by parents who were feeding her herbal liver tonic to no avail, children with blackening stumps for teeth who avoided fluoride toothpaste for a plant-based paste and parents who took the water in which they bathed and swam in, to drink and cook. We saw diabetic patients with hypertension who felt they could not reduce their salt or sugar intake for cultural reasons and a 17 year old boy with Pott’s disease who felt he could not travel to the nearest TB clinic, for fear he would lose his job. We saw refugees who had escaped across the border from Myanamar and now faced significant malnutrition and workers from the red-light-district who would not visit the HIV testing centre, concerned that a diagnosis would mean they could not work again.
One day a small child pushed his paper in to my hand; 'Ankit, aged 8, leper colony' was looped in black spidery writing. His community in North-East Delhi housed children (regardless of their leprosy status) alongside parents who had contracted this still deeply stigmatised disease. He was but one of hundreds of families, seemingly ostracised from the normal hustle and bustle of the capital city, living on its edges in a hidden, oft forgotten community.
Later, as we finished clinic, the setting sun fell over the image of tiny children running, playing tug-of-war, making rock piles and sprinting over dirt mounds. Several, laughing, hopped on to our bus. Smiling, one, Ankit, fought to tie up the bundle of our patient notes as we departed.
As evening came and I later disembarked in a high-rise Delhi suburb, I started to think about everything that I had seen so far. I thought about what meaningful change needed to or could be made, and the sometimes seemingly insurmountable and diverse public health measures still facing NGOs working in Delhi. Feeling despondent in my own lack of experience of how to make a long-lasting difference, I unravelled the day’s bundle of clinical notes- out fell a beautiful string of tiny, crumpled, orange, paper flowers.
Several years later and I am here, at LSTM, a hugely important step in shedding light on implementing the above. Already, with the help of our esteemed faculty, we have started to thread together a framework of how to approach a similar situation with a greater position of understanding and I start this course with the hope, in the future, to be able to put the knowledge gained, in to practice.
With credit to ‘Smile Foundation India’