Moving away from the comforts of home is very difficult. Being away from my family and friends when Im sick in a foreign country is even more difficult. I have come down with my fourth sickness since returning to India a little over a month ago. I have been under a lot of stress since moving for a number of reasons, all for a later post. I know this has been effecting my poor immune system. Trying to remember to relaxed and remember that I can do this!  But this post is about  my experience with Indian Healthcare.

The healthcare system is different from the US. Coming down with a stomach bug or high fever is so common its hard to tell when you have a 24hr illness or something requiring more attention. This past illness I had was the worst yet. I had a 103 fever for 3 days and realized it may be more serious. Blessed with the knowledge of Nursing I took myself to a pathology lab and had CBC blood test done. I was able to look at the results, consult a Doctor friend on whatsapp and determine I will get a culture analysis done to see what antibiotic I need. Ive learned a lot in Nursing and I am happy to have the knowledge to help myself and my fellow Fulbrighters here as we embark on our year long adventure.

Being able to be my own advocate is crucial in the Indian health system. I cannot speak for every hospital, but based on the experiences I have had with friends here, Hospitals are really only able to a lot time to treat your symptoms and if they do not see an obvious life threatening correlation they will send you home or move on. There is a lot of overcrowding and waitlisting for rooms as it is, even in the ‘fancy’ private hospitals that they recommend expats go to. 

Everyone have time for a quick-ish anecdote? 

Its 2015. Im a 21 year old who moved herself to India, straight out of a business major at App State. I had been living in India for about 9 months, and was currently staying with 3 boys (Kinda like 'New Girl' haha). We were all expats living and working around Delhi. One day, one of the boys was having GI complaints of constipation and we all did not think anything of it. I, at the time, had whatever medical knowledge one gets from television and webMD. All of us decided he should just take a laxative and quit complaining about his bathroom troubles. By nightfall he seemed very uncomfortable and insisted we take him to the hospital. So we took him to Moolchand Private Hospital near our apartment. We arrived and he told them his complaint of yes “Constipation”, so without performing any tests, and honestly to my memory without any vitals, they decided to give him an…. Enema! Oh the dreaded enema the dirty word of the medical world that makes just about everyone cringe at the mention. Even as a naive 21 year old I had a good laugh with everyone else in the waiting room. So after 30 minutes (with no um ‘results’) they sent us on our merry way. I never thought anything was odd about this whole medical encounter until I really reflected on it in nursing school, but thats not the end of the medical catastrophe. 

Its 4 am and my friend comes to wake me up, “Is it odd that I still haven't um gone to the bathroom?”. Now I have seen enough medical shows to know if there is one thing about enemas its that they are effective. So I knew something was amiss. He then kept telling me his stomach was cramping as well.  I thought lets go to a radiological clinic (a hospital seemed to be to big deal for this). We had an ultrasound done of his abdomen but they kept saying he was fine its clear no problem, but even I could tell they weren't going over the area he was pointing to... his lower right pelvis….(even this did no send off major red flags to me). I still asked if a doctor could consult, so we waited an hour for their clinical doctor to come in. My friend began turning a bit more ghostly by this point. On exam the doctor said you know I'm not really sure. He could just be constipated but maybe it could be an appendicitis, you should just go to Max Hospital in Saket. 

On arrival we went to the basement floor into the admission waiting room. And we waited. And waited. After about an hour, I went up because my friend had started looking really grim and sweaty. They took his vitals, he had a 102 fever. We were moved up to be seen. The admission doctor did a quick exam and sat down with me at the table. He said “Your friend is having an appendicitis he needs surgery, now”. Fear.  The room began to sway I said “I think I am going to pass out?” Doctor said” NO, ITS AN EARTHQUAKE YOU GUYS HAVE TO GET OUT!”.  I grabbed my friend's hand and helped him get up the stairs and outside. He collapsed on the lawn in front of the hospital. We waited for an all clear. 20 minutes later we were told to go back inside. But at this point my friend had turned. We wobbled into the Emergency department and that is when it happened. A blood curdling scream. It had burst. Were then working against time. A random nurse who didn't know us came by and injected my friend with something and he went to sleep.

I told a doctor where we came from and his diagnosis. We waited 2 hours for the CT scan, we were continually bumped by more severe cases. CT scan revealed a very much ruptured appendix. Now in the US, they would whisk you off to surgery and figure the rest later thanks to a law called EMTALA. But in India (at that time) there was no law that a hospital has to treat if you can't pay. So they demanded 10,000$ from my friend before the could do the surgery. My friend did not have that much money. We begged them to do the surgery now and we could figure out the money when his parents woke up back home, or if we just had more time to get that amount together. But they refused. It was the first time I had every felt like health care was a luxury and one that neither me nor my friend could afford. A service he desperately needed to survive was being held ransom by the very entity 'dedicated' to saving him. We were told then that we must leave and go to AIIMS Hospital (about a 30 minute drive). Now a couple of things. AIIMS Delhi is one of the best or arguable the best pubic hospital in India, but it also has lines swirling around every building at all times for people to get treatment (see pictures below). To my knowledge all the “rooms” are four beds grouped and separated by a curtain which means infection containment is difficult. Also even if we got to AIIMS my friend could have died waiting to be seen and reevaluated. So we had to come up with the money or my friend was going to die. 

We got a hold of his boss who is an amazing man and resident Indian. He drove to the hospital (another hour passed) and was able to work out a deal, so my friend could put down a % and his company would like to speak on his ability to pay the rest.  So a little over 4 hours after his appendix burst my friend goes in for surgery. It’s the longest wait of my life. What I was told was a 2 hours surgery turned into nearly 6 hours. I was convinced he died and they were trying to find out how to tell me… Eventually the doctor emerged from the double doors and with the look of pure exhaustion said “This was way worse than I had known. there was so much infection spread into his abdomen we couldn't get all of it. We have put in drains. I have to go back and finish but he will be done in 45 minutes. The nurse will let you know what room is his when we get one”. Relief met with concern as I realize all he said. 

My friend came back very out of it, and I see all the tubes coming out of his stomach. It was horrifying. Such major surgery so far away from his home and his friends and family. My heart hurt for him. In India, it is required that someone stay, at all times, with the patient in the Hospital. For my friend, I was that person. Checking on him, taking him to the bathroom, checking his vitals actually preforming many of the roles a CNA in the US would perform. I was happy to help him I felt such purpose being there making sure he was staying health and healing. On a personal note, at this time I had already made plans to return to the US, I had been accepted to nursing at UNCC. This whole experience solidified in my heart on a deep level that this was without a doubt my life's passion. 

My friend stayed in the hospital for 6 days. He was not given any food the whole time and was only hooked up to antibiotics and fluids. There was little to know communication from the providers about his progress. He was discharged without eating, and with two drains still attached! (for my medical folks: a penrose and a JP). His stipulation for being discharged was that he thinks he might have passed gas, and that was good enough for the Doctor there.  He was, by a miracle of God’s, able to avoid major complications post-hospitilization. There were minor complications but he was able to avoid readmission. Looking back on this experience as a Nurse I am stricken with fear at how this whole case was handled and how many things could have lead to horrible complications, even death. 

I have not shared this store with many people before. I only share it now because I think it paints an important picture of the contrast of healthcare systems. I will say that in 2016 India passed an act similar to our EMTALA requiring hospitals to treat patients in emergency situations. I think to myself if this is how and expat is treated how are the poor people here treated? The people with no resources to come up with 10000$. My mission is to bring my knowledge to increase advocacy for children. I will be strengthened by each personal and professional experience I have here. Many people ask "Why India?" I can never give a direct answer because truthfully it is the simple fact that I see a need and I feel called to help. I do not have all the answers, but I have passion for a population of children who are constantly being overlooked and discredited. I still have so much to learn, Hindi included, but I am a willing student. I am here to take in whatever experiences and information come along to help me grow into a strong knowledgeable culturally competent provider. 

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Aside from a few days of illness (hurray for Delhi Belly!) I have spent almost 50 hours over the last 3 weeks in Hindi Classes. Monday - Friday 4 hours a day in school and 4 hours doing homework and studying. I have completely immersed myself, changing my phone into devanagari script and using duo-lingo and Rosetta stone on the weekends! 

I am so happy to say I am finally able to form sentences on my own. I am even able to read and write in Hindi now. Although no where near where I need to be before the start of my research, this November, I am beyond thankful for what I have been able to accomplish so far. I have never thought of myself as a particularly language savvy person but somehow I am able to get a grasp of this very complex language.  Even my instructor is impressed with how I have been able to pick up and accept new concepts that many times are counterintuitive to English concepts. 

I feel like each day I push myself out of my comfort zone I discover new strength and ability. The confidence with which I can embrace all that I have faced and will face is rooted in my faith. I know God has a plan for me and when I am on the path he planned I know he will let it be known to me. I feel this ability to take on Hindi is another outstretched hand telling me this is indeed the way. This past year I have faced tumultuous times and difficult decisions, but putting my faith in 'my path' has brought me the peace I need to continue to pursue my mission to impact children and their families here in India and hopefully the world!

It has been two weeks since I landed back in India. Its my 3rd time back in this beautifully chaotic and often times smelly city of New Delhi. I began this time differently than my other journeys as I am returning this time not as an independent spirit but a scholar of a Fulbright Research grant. Not having to worry about airport transportation or where I was going to stay was a lovely experience. All the grantees were put up at a hotel here in Delhi for our 4 day orientation. I met a number of smart and talented grantees all with very specific and elaborate research interests to be conducted around India. Soon after orientation I headed down to the home I would be hosted in during my year long grant period which is conveniently located near to my Hindi School and affiliate research site. 

Part of my grant pays for 180 hours of intensive language training! So my first full week back I began Hindi Classes. I have a private tutor who immediately threw me into the deep end of Hindi language. I spend 4 hours a day/5 days a week in school and have been focusing much of my free time studying. It is absolutely critical that I am able to converse in Hindi before I begin my research towards the end of November. Hindi is a completely different language that uses devanagari script instead of the roman alphabet. Having to learn a whole new alphabet and writing style has brought me down to an elementary foundation of learning. I know that time alone will be my greatest friend during this time. After my 4 hours of class I spend 2 hours doing homework. That is about 30 hours a week! 

एक नई भाषा सीखो
(Learn a new Language)

After working alongside families in India, both this past summer and during my first move to India, I have fully realized how different health services are revealed, explained, complied with, and utilized. I wanted to understand how families in India are receiving health information and plans of care for their child. Navigating healthcare systems as a family is difficult even with an average abled child or even a neurotypically developed child, but throwing in a complex genetic or neurologic diagnosis quickly turns difficult into almost impossible. Especially when a parent has low health literacy skills. I proposed to Fulbright a study that tell the families side of the story by observing their experiences with navigating health care providers, therapies, and public health care services offered in India.  

In March of 2019, I was awarded a Fulbright Student Research Grant to return to India and completed this proposed project over the next year (Aug '19-Aug 20'). I am beyond excited to have this opportunity to return and gain a better understanding of the barrier families I work with at the clinic are facing. I plan to become a Family Nurse Practitioner and Disability Researcher. This experience from "the other side of the desk" will allow me an invaluable perspective of families trials and triumph in health care navigation. 

Part of my grant is fulfilling a Critical Language Enhancement Award, to learn Hindi. I must be able to speak Hindi in order to engage with and form trust with the families participating in my study. I am very excited to spend three months of intensive study to become proficient in this new and different language. I will be posting about the beautiful process of an American learning a language with devanagari script instead of english characters... this should be quite a fun journey :)

I plan to keep this blog updated on my research progress, and I pray I am able to conduct this at a high enough proficiency to publish my results and make an impact on the world of disability advocacy as well as make an impact on the facilitation in navigating public health care systems.