April 11, 2011
By C.J. Janovy
|Some of this year's Robinson Scholars: (back row) Jessica Bonovich, Shanna Doering, Dr. Mani Mani; (front row) Heather Wurtz, Lauren Hansen, Nathan Cuka.|
The program was started in 2006 by Mani Mani, MD, professor emeritus in general surgery at the School of Medicine. Mani created the scholarship to honor his mentor, Dr. David Robinson, one of the medical center's most distinguished professors, whom he met in India in the late 1960s and who convinced Mani to come to KU Medical Center for training. The Robinson Scholars program is KU Medical Center's only endowed scholarship fund for international student travel.
Each year, three students each from KU's School of Medicine, School of Nursing and School of Allied Health do a six-week clinical rotation at the Christian Medical College in Vellore, India. There, they experience a larger number of clinical cases than they would see in a typical clinical rotation here.
Traveling to India allowed Cuka to experience a culture he had only imagined. Before coming to medical school, he had worked as a software developer and had friends from India. "As a kid, I loved the legends of Indian literature," he says. "And I'm a foodie, so I love Indian food."
Though billions of dollars are flowing into India, Cuka says, he was surprised that it was still a developing country. The gap between the rich and the poor — and its implications for public health — was obvious. "Their civic programs, such as sewers, are not as developed," he says.
"The population overload was more than I anticipated," says Jessica Bonovich, a School of Nursing student who was also part of this year's Robinsons Scholars program. "With so many people and so few resources, there are a lot of repercussions — malnutrition, sanitation, problems with waste removal."
And solutions to one problem can only make another problem worse. "For clean water, they'll drink bottled water — but that just adds to the waste-removal problem," notes nursing student Shanna Doering.
The nursing students were also struck by cultural differences involving gender. For example, they were shocked to see a woman's family refuse to allow her to have a hysterectomy, even though she had given birth to a stillborn infant and was losing blood. Because it was her first child, her family worried that she would not be value in her community if she couldn't reproduce.
On the other hand, nursing students were impressed by development projects intended to help women gain greater independence, such as microloan programs that allowed them to start small businesses that might also help solve some of the country's problems — such as waste-management companies, childcare centers or homes for the elderly.
And, the nursing students say, their Indian peers were ahead of them in some ways.
"The education system is amazing," says Lauren Hansen. "To get their bachelor's degrees, nursing students also study midwifery. There's a whole course on it — delivery, episiotomies, managing active labor on their own. Students who were younger than we are were showing us how to do exams.
|Third-year resident Carrie Pohl in Velore, India.|
Carrie Pohl, a third-year resident in Internal Medicine who received her MD from the School of Medicine, says her biggest surprise in India was the similarity between factors that affect access to health care in India and the United States.
"The differences between the two health care systems were remarkable, yet both systems have many of the same problems. Transportation, language barriers, financial and educational barriers all affect patients' access to health care," she says. "Urban Kansas City and rural Kansas are not unlike urban and rural India."
To overcome many of these barriers, Christian Medial College physicians and nurses explore ways to provide care to underserved populations, through urban safety net clinics and mobile clinics that travel to the surrounding villages to provide primary care.
One of Pohl's most memorable experiences was the time she spent in a leprosy clinic.
Though leprosy is now a curable disease, it still has the stigma of being contagious and disfiguring. To overcome that prejudice, Pohl says, clinic workers now call it Hanson's disease — but they still have a long way to go in dispelling the stigma. "Despite patient and community education, patients who carry the diagnosis will often be cast out of their family and village," Pohl says.
At Christian Medical College, Pohl says, once a patient is diagnosed with Hanson's disease, that person is provided with free health care for life. But health care organizations still struggle to find housing for patients who can't go home because of the stigma.
Her experience, Pohl says, taught her that "every diagnosis carries with it some level of social, environmental and psychological factors that affect patients. I learned and will take home a greater appreciation for the ways that I, as a physician, can recognize these barriers to care, and address them in my practice."