India- Characterization of pulmonary and extrapulmonary tuberculosis among adult patients admitted to Sassoon General Hospital, Pune, India
The diagnosis of pulmonary and extrapulmonary tuberculosis is usually made clinically in addition to laboratory testings, however the sensitivity of diagnostics are poor. TB diagnostics are still evolving and in resource poor settings diagnostic availabilty are limited. Therefore, it is important to undestand factors associated with worse outcomes among patients diagnosed with pulmonary and extrapulmonary tuberculosis. Therefore, our project aims to characterize the demographic, clinical characteristics and outcomes among patients hospitalized for pulmonary and extrapulmonary tuberculosis at Sassoon General hospital, Pune, India. A retrospective chart review is planned to extract the demographic and clinical data from patient medical records among patients admitted with suspected pulmonary and extrapulmonary tuberculosis between 2005-2010.
I was born in the city of Pune in India. When I was 11 years old, my parents and I moved to the United States. I have visited India many times since then but only for a few weeks at a time. Most of that time was spent in the company of relatives, all of whom are extremely protective. Rarely had I travelled anywhere alone or by public transport. Although I aspired to work in global health and to contribute to public health in India, I did not know what it would be like to live the life of an adult in a developing country, what it would be like to work in India and to conduct scientific research there. That is why I applied for a GHEFP in Pune. The three-month internship at Sassoon General Hospital helped me re-affirm my belief that I do want to make a career out of serving the poor in India. And more importantly, that this is something I am capable of doing.
Although I had visited hospitals in India before, all of them were the private hospitals where middle-class Indians often seek treatment. Sassoon General, on the other hand, is a government hospital and many of the patients there receive free treatment under government programs for citizens falling below the poverty line. Perhaps due to the fact that limited government resources are used for patient care rather than for maintenance of hospital buildings and grounds, the hospital itself looks very different than any Indian hospital I had visited in the past.
Whenever, I informed my relatives in Pune that my internship was at Sassoon, many of them brought an expression of fear to their face and warned me that it was a filthy place and that I would need to shower every day right after I got home. They asked me repeatedly, “But of all the hospitals in Pune, why choose Sassoon?” Many of my relatives couldn’t quite understand why anyone who had the opportunity to study in the United States would come to India for their internship at all. But for me, it was important to experience what it would be like to work in the service of the poorest classes in India. The truth is I don’t think that India is lacking in health services for the middle class. Quality doctors and state of the art services are available in the cities of India for those who can afford them. Yet, much is lacking in terms of services for the poor. That is why I wanted to focus my career on serving this segment of society and my internship helped to re-enforce this belief.
Of course not all of the experience was pleasant. There were days when I went 10 hours without relieving my bladder simply because I could not get myself to use the restrooms available in the hospital or nearby. And the patient medical records I had to abstract for my study were buried under so much dust that often I was left sneezing for minutes on end despite wearing a heavy-duty mask. There were of course those Indian colleagues who were confused by my American-ness and advised me that as a married woman I should try to look more like one by wearing toe-rings and a mangalsutra with two-pronged gold pendant. There were those who were short with me because I was young or because I was a woman. Coming across un-hygienic conditions, and narrow-minded people, the troubles of a long commute in over-crowded public transport were some of the things I worried about when I thought of working in India. I encountered them during my internship and I was still able to get my work done and have a pleasant time overall. For this experience and for providing me with the confidence that despite everything, I can handle working in India, I am thankful for my GHEFP.