India Reports
Introduction
This section contains elective reports from India. Use the menu above to select a particular hospital/region.
Vellore
Christian Medical College (CMC), Vellore
| Submitted by: |
S.Abraham |
| Date of visit: |
Dec 2004 |
Destination contact(email):
>none available
Destination website:
>none available
Languages spoken
Tamil is the language spoken by most of the people in the state of Tamil Nadu (where Vellore is located). The other South Indian languages of Telugu, Malayalam and Kannada and the national language of Hindi are also spoken.
Whilst speaking/understanding these is, of course, an advantage, it is not essential, as the doctors all speak good English.
About the CMC
The Christian Medical College Vellore occupies a prominent place among medical institutions in India (and in the world) as a 2,000-bed multi-campus complex that is a vital, diverse, inter-denominational community. Vellore town is the head quarters of Vellore District. Its population is about 200,000. It is a marketing centre for a fairly prosperous agricultural area. CMC is a tertiary hospital that serves Tamil Nadu and large portions of India. Patients come from as far away as West Bengal and Bhutan to come to CMC. I was amazed to see patients would travel for up to 5 days on a train to come and get expert health care at CMC.
I spent some time in Endocrinology, The endocrine services in CMC Hospital started as an Endocrine clinic under the department of Medicine in 1985. A separate department of Endocrinology and Metabolism came into being in 1995. This department caters to referred patients with endocrine and metabolic problems from all over India and is a tertiary care department. The annual outpatient attendance in 2001-2002 was 19,000, registering a 16% growth rate over the previous year. I was amazed about how busy the outpatients departments were, as I had never seen anything like this before. The workload for the staff is huge. About 150 patients are seen in outpatient clinics every day. The medical staff consists of eight doctors, two diabetes educators and a dietician. The clinic starts at 8am and normally goes on till 8pm if not later.
For the outpatient clinic some doctors shared a small room with another doctor, in which separate consultations were held. Each patient had a couple of relatives accompanying them. The next couple of patients (and their relatives) would also wait in the room, which made confidentiality and privacy difficult.
The Endocrinology Department at the CMC
The range of services provided by the unit includes the management of Diabetes, Pituitary, Thyroid, Metabolic Bone Disease, Adrenal and Gonadal dysfunction. The most significant clinical development in the year 2001-2002 was the marked expansion and diversification in the area of Diabetology. Diabetes Mellitus affects about 11% of the South Indian Urban Population. Bearing this is mind; the Department has initiated a Diabetic Outpatient Clinic on a twice-weekly basis. This is a unique Integrated Diabetes Clinic which includes the Endocrinologists, Diabetes Educators, Dieticians and Physiotherapists who emphasize the holistic concepts in management of diabetes mellitus: inclusive of diet, exercise, change in lifestyle, and medications.
The concept of the integrated clinic was extended in the form of integrated outreach camps, in and around Vellore. The department has four full time diabetes educators who have developed the diabetology infrastructure and provided the changes required in successful management of inpatient and outpatient handling of diabetes to the patients.
The Department has a modern Endocrine laboratory with automated clinical chemistry analyzers. It has facilities for doing the following assays: Radioimmunoassay, Competitive protein - binding assay, Chemiluminescence assay and Enzyme immunoassay. The department of Nuclear Medicine has all the facilities for imaging endocrine tumours. These include facilities for Thyroid uptake and scanning, Sestamibi scans for imaging parathyroid adenomas. MIBG scans for evaluation of Pheochromocytomas and other neuroendocrine tumours, Bone scan and other facilities are also available. The radiopharmaceruticals tracers for these scans are prepared within the department.
How did I spend my time?
During my time at CMC, I took part in the Endocrinology and diabetes outpatients, went on ward rounds, attended the multi disciplinary meetings and the teaching sessions with the other medical student which was invaluable. I was able to examine some very interesting cases which I had only read about in books in the UK. For example, the department was equipped to perform advanced procedures, like Inferior Petrosal Sinus sampling for locating ACTH producing pituitary adenomas, selective digital subtraction angiographic procedures and selective venous catherization for locating ectopic endocrine tumours.
At the CMC I was able to see rare conditions first-hand, such as; insulinomas, multiple endocrine neoplasias, type B insulin resistant, brown tumors, onchogenic osteolomalacia. I also undertook a power point presentation for the doctors about the iodinisation of salt and the problems it has on the thyroid gland. I was unaware that this was such a controversy before coming here. I was able to carry out a research project titled ‘Comparing the Indian immigrant patients with type 2 Diabetes Mellitus living in the East London with those living in India’.
I certainly did not expect the hospital's computer system to be as good as it was - in some ways it is more advanced than in the UK. And there are fewer administrative problems than in the UK. All the patients’ investigations are available on the computers, all of which are easily accessible and it actually works, so there is no losing the x-rays and CT’s hard copy as the investigations are paperless.
I was also able to spend some time at the leprosarium, in Karigiri. The program is affiliated with CMC Vellore and does research on leprosy as well as treat patients them. I got to see the outpatient clinic and the inpatient wards. It was very interesting, as I did not realize how mutilating leposy could be.
My rotation at CHAD, which is a maternal and child health program for rural populations was unique and rewarding in many ways. It included traveling into surrounding villages with the College of Nursing Community Health program (CONCH) to visit patients in their homes. Typical visits included prenatal exams (performed by nurses with female medical students), well-child exams, and dispensing medications at roadside. I was struck by the kindness and generosity of villagers who often invited us into their homes and would not let us leave without gifts of food in spite of the fact that many of them live well below the Indian standard of poverty level.
What were the people like?
The staff and students were all very helpful and friendly and eager to teach, which I thoroughly enjoyed and have learnt a lot, of which I can go back and teach my colleagues. The Educational value was excellent. I also found the doctors healthcare to be extraordinary, they really listened to each individual patient and found out what their main concerns were and helped them till their problems were resolved. Some patient consultations would last up to an hour, as the doctors were so thorough in taking a history and examination. The morale of the staff, patients, and their relatives in the hospital seemed good. Most people accepted disease and death as part of life. Patients were grateful for the care provided by the Mission hospital, and in contrast to the expectation in the Western world that doctors should be able to cure all illnesses, they considered it a bonus when something could be done.
Did I enjoy my elective?
The CMC provides medical students with an opportunity to see medicine in India practiced at the highest standards, and a taste of India in an atmosphere which I found to be kind and very accommodating.
I thoroughly enjoyed my time at CMC and would recommend it to anyone considering an elective in India.
