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Plunged in at the deep end

BMJ 1998; 316 doi: (Published 09 May 1998) Cite this as: BMJ 1998;316:1466
  1. Kevin Molloy, final year medical student
  1. Leicester

    Editorial by Bantvala and Doyal

    On the first morning of my elective, I turned up at the outpatient clinic expecting an introduction on how the hospital was run and what would be expected of me. Instead, I was simply told to “see patients.” I was at the Lady Willingdon hospital, a Christian charitable institution serving the people of Manali, a small town at the base of the Himalayas, and surrounding regions in northern India. It is run by a married couple, Laji and Sheila Varghese, who first came to the mission in 1979.

    The workload is huge. Although it is a 35 bed hospital, extra space is often made for another 10 patients. About 150 patients are seen in outpatient clinics every day. The medical staff consists of three doctors, nine nurses (only one with official nursing qualifications), and 10 assistant nurses.

    For the outpatient clinic I shared a small room with another doctor. The patients would have one or two relatives accompanying them. All but the most private examinations were carried out on a couch in the corner of the room. Rectal and vaginal examinations were performed behind a flimsy curtain.

    One day each week was put aside for elective surgery. Emergency operations were carried out whenever necessary. Almost all the surgery I saw performed was under spinal anaesthesia. Without hi tech monitoring …

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