I left for India fully confident only in my own incompetence. Not to say that I had not learned a lot during my first year of medical school: twelve months of memorizing Netter sketches, the full range of glucose metabolism and the microscopic differences between eosinophils and basophils had shown me a fascinating world. But it had been a tough year, and I wanted to be reminded why I had signed up at all. So I decided to return to India, where I had first fallen in love with medicine.

Two years ago, after graduating from Pepperdine University, I volunteered with Unite for Sight to get my feet wet in the clinic and in international public health. I travelled to Bihar, one of the poorest states in India, to serve a population with an ophthalmologist to patient ratio of less than 1/800,000¹. I spent three weeks abroad at the A.B Eye Institute living with the Sinha family. My last night, I left during a full monsoon, my feet wet up to my knees as water flooded into the car on the way to the station. I also left with an infatuation for ophthalmology. While sharing my account of my time in the operating room and clinic to my friends, family and sponsors, I would often become ecstatic while describing how a twenty-minute, under $20 surgery could really restore someone’s vision.

When it rained, it often poured, and the drainage system in the city was not equipped to accommodate sudden increases in water, though the monsoon season returned each year. Streets that were habitually filled with people, food carts, shack-like barber shops, cows and groups of children playing in the dust would become empty and quiet after the rains. It was during these rainy times that people would fail to show up for appointments or even procedures because of difficulty traveling.

While in Bihar, I had also observed several mascara-drenched babies who had been treated holistically to ward off evil spirits. Though the babies were brought to the clinics free of evil spirits, they had often developed severe conjunctivitis. When I returned to the United States this past summer, I decided to explore the practice of alternative treatments. While training in Manhattan and Bellevue Hospital, I was exposed to a great diversity of nationalities, cultures and beliefs. As medical students, we are taught the importance of recognizing other culture’s practices and perceptions. In order to explore the use of clinical alternative medicine (CAM) in Bihar, my volunteer partner, Vivian Chin, and I prepared a two-page survey regarding CAM use. We were concerned that some of the natural treatments may actually be harmful, but also curious whether or not some of the treatments could be beneficial. I thought the project was feasible since I knew the environment and knew there were lags in the clinic schedule that would allow time for interviewing.

We arrived in Bihar in the middle of summer with the humidity, heat, colors and dust welcoming us to our adventure. Each afternoon, we would visit different clinics in the city and the village. Driving out to the clinics meant packing too many adults into a five passenger car and driving for over an hour on undeveloped roads in heat rising above one hundred degrees. The air conditioning was often an open window, where the dust and smells from the nearby people, carts, cows, rickshaws and bicycles reminded us that we were in a country with a population of over a billion. When the rains came, the streets flooded and the hundreds of men, women and children we would drive by each day, in makeshift shacks and tents or attending to carts of mangos along the road, seemed to disappear. But even on those days the clinic would be full, as many patients were often escorted by family members.

Here, in the cramped and humid room, the optometrist instructs me on using the autorefractometer, and though it’s over ten years old, it still does the job! After examining the patients and filling out paperwork, we would sometimes have a few minutes to distribute the survey with the optometrist as our translator.

Vivian and I assisted the doctors and their optometrists in performing visual acuity exams, taking blood pressure and obtaining a personal history. The plan was to administer our questionnaire regarding CAM’s while patients waited to see the doctors. We quickly realized that, even though the physicians had discussed the most recent breakthroughs in monoclonal antibody therapies for macular degeneration and held monthly Continuing Medical Education sessions at their hospital, less than 50% of their patient population was literate and few had interacted with someone from the United States. The language barrier proved to be an even greater challenge than we had anticipated, even with the help of the optometrists turned translators. It was difficult to gather the motives of an Indian woman who chose to use CAM treatments before seeing a physician, let alone get an accurate picture of her educational level. We had planned to have our translators help us during the collection process and found, more often than not, questions regarding glucose control in glaucoma patients or the duration of fever took priority in the few minutes the optometrists had to see each patient. My own futile attempts to mold some Hindi phrases were only discouraging as my mouth refused to soften and accommodate the tones and shapes of the beautiful language. Suddenly, our survey became less about CAM therapy and more about patient communication.

In the cramped rooms of clinics and the dimly lit offices of the hospital, we visited with patients, the electricity disappearing and reappearing without notice. We struggled daily to check off the boxes in the questionnaire, ensuring that no Excel cell be left behind while always putting the patient first and learning how to ask a question to get an answer. Our initial unfamiliarity with the culture of our subject pool made the research especially challenging; it also made it an excellent test of patience, innovation and flexibility that taught us both how to really listen. We left India with a packet full of completed questionnaires and a new sensitivity for and awareness of patient communication.

I also left with the same feelings of curiosity and interest in medicine that had been kindled two years earlier on my first trip to Bihar. I realized when dramatist John Galsworthy said, “Idealism increases in direct proportion to one’s distance from the problem²” he may have been reflecting on a similar adventure. I appreciate the opportunity I had to pilot a simple project abroad, and I believe, though the project itself may have been insignificant, my personal experience was not. It will have a lasting impact on how I manage to keep my idealism balanced with practicality and adaptability. My experience this past summer in Bihar helped me to calibrate my allopathic perspective to the real world and the needs of non- textbook people. It was an experience that was both frustrating and difficult, but one that also challenged me to explore more deeply the issues of international aid, cross-cultural differences and the multiple roles of a physician.

1. “National Program for Control of Blindness.” Department of Health and Family Welfare of Bihar. (2006). http://shsbihar.org/blindness/prog.pdf.
2. Sung, Kyu-taik, and Kim, Bum Jung. Respect for the Elderly: Implications for Human Service Providers. Lanham, MD: University Press of America, 2009. 86.