[Eric R] Final Post from India

I apologize for not posting in the last couple weeks! My computer’s hard drive ended up failing, and getting your computer fixed is no simple matter in India. Fortunately I was in Delhi, where I found an IBM Corporate Office and Service Center! After receiving my computer back, I needed to finish and submit my medical school application (!), which I accomplished on Tuesday, June 26^th!

Since last posting, I settled into a fairly backpacker-centric neighborhood, filled with a number of fantastic little restaurants and a large bazaar. I enjoyed walking around in the cooler evenings to browse the wares being touted. Delhi was HOT! I understand why most people stay inside during the days, and was happy to join them!

My primary focus in Delhi was AIIMS, a very large government-run hospital with multiple campuses. Finding my way around was very much like being on the University of Michigan Medical Campus for the first time! The Delhi Metro, which is pristine and very well-developed, has a stop at AIIMS, so I thought it would be a simple matter of heading into the “main entrance,” visiting the “registration desk,” and asking for my contact person there. Turns out AIIMS doesn’t have a main entrance or a central registration desk, and nobody seems to know anybody else.

My trip to AIIMS was the first (true) government-run hospital; my visit to Tata Memorial Hospital in Mumbai was also to a government facility, but they have special historical status and fall under the Department of Atomic Energy. The stark contrast of AIIMS to every other hospital I’ve been to was astounding. Patients lined the halls, crowded each ward, and overwhelmed the doctors’ and nurses’ capabilities. I’ve come to admire the dedication required of healthcare workers in India, through the simple fact that their jobs seem twice as busy as any US doctor’s.

My stay in Delhi took a turn for the tourist towards its conclusion. I took a two-day trip to Amritsar to see the Golden Temple, the Jallianwala Bagh Memorial, and the Wagah boarder ceremony. This was followed by a day-trip to Agra to see the Fort and the Taj Mahal, of course! It truly is as remarkable as it seems. A trip to India without my picture “holding” the Taj would have been shameful, and I’m proud to include it for you all to see as evidence of my pilgrimage across the world.

I have less than 24 hours left in India. I feel good about the number of things I was able to accomplish during my short time here: riding the trains (local and long-distance, 2AC and 2^nd sitting), riding buses (local and long-distance), having a Delhi Metro Smart Card, visiting monuments, seeing three other CSAS fellows, attending two Indian weddings, conducting around 15 interviews with doctors and administrators, wandering neighborhoods, talking with locals, eating street-food, getting overcharged, bargaining to get a local’s price, getting sick, staying healthy, witnessing a street-fight (crowds, police, and all), visiting newfound friends’ homes for chai and food; the list goes on and on and on. I can hardly believe that my two months has gone by, but soon I will be boarding a plane bound for Detroit, where my grandmother will pick me up to return to my 2-bedroom-2-bath townhouse, with clean running water and fully functioning AC. I will never again take these small privileges for granted. I will hold close the memories of my experiences abroad, and can’t thank enough those responsible (especially the anonymous donor!) for enabling my travels. I look forward to writing up my paper for CSAS and presenting my findings in the fall!

Best of luck to the rest of the fellows, and please don’t hesitate to contact me if you have any problems, concerns, or questions!

-ericr

[Eric R.] Week 2

I had an extremely productive end to my week! It began quite slowly – I finished making calls to all of the hospitals that I hope to visit in the next five weeks. Hopefully I spoke to all the right people! It has been extremely difficult trying to navigate the various levels of bureaucracy of the Indian hospital system…

Yesterday, I had my first interview scheduled, at Sahyadri Specialty Hospital. I asked the two other interns in my office to come with me on my first visit, to ensure that I didn’t drown before learning to swim! They ended up being very helpful. I walked into the very busy hospital and approached the information counter. I let them know that I had an appointment with the Medical Director, who happens to be the head of neurosurgery as well. Turned out he was in surgery, and was unable to spend time with me. The woman at the information counter pointed us upstairs to the HR department, who told me that first, I needed approval from the Corporate Office, located five minutes down the road. Well. We took the trip to the CO, and were waved into the HR Manager’s office, a man named Mr. Moses. During introductions, he let us know that he spent some time in North Dakota during college as an exchange student, and after mentioning that I attend UofM, he said he was offered an American football scholarship there, and turned it down! I was shocked. Mr. Moses was very helpful, and after getting a better understanding of what my project was all about, informed me that Sahyadri doesn’t use an EMR system. Exasperated, we left the CO in search of other hospitals in Pune.

Yogendra, one of the other interns at OHUM, is also a doctor, and suggested we visit a few hospitals to see if they would grant me an interview on the spot. We were 0-for-2 when we rode into Sancheti Hospital, a more community-oriented hospital specializing in orthopedics. We went to the Administrative Offices, and were waved right into the Administrative Director’s office. Dr. Vaidya was gracious enough to let me have an interview with him, and I learned an immense amount in our short time together.

I’ve observed many things this week; most importantly, people here, although extremely gracious and pleasant, are extremely indirect and not proactive. 95% of my emails are ignored, and it takes going through six different people on the phone to get where I need to be. After reaching the correct person, they result in the classic, “Why don’t you email me?” There are N-number of times (to borrow a phrase I’ve heard often here) that someone along my journey could have said, “Oh, don’t bother with Sahyadri – they don’t have an EMR system,” or “Try Sancheti Hospital, I know they are generally very helpful.”

This observation directly affects my current opinion of EMR systems in India – I believe the country as a whole is simply unprepared and unwilling to adopt such systems. Until the government decides to take steps to enforce EMR adoption (unrealistic), only the biggest-and-richest hospitals are going to consider moving in that direction.  I’m excited to visit a Max Hospital – they are one of the largest hospital chains in India, if not the largest, and they have implemented an EMR system across all of their locations. I’m scheduled to meet with them at the end of my trip, in Delhi.

I am heading to Mumbai on Sunday to visit four hospitals. This will be the true test of my preparation, and I look forward to visiting larger hospitals there. And who knows, maybe one of them will be a full-fledged, model-EMR hospital? What’s that? You have another question for me? How ‘bout you send me an email, and I’ll get back to you…

-ericr

[Eric R.] Week 1

To make up for  my lost post, I will begin by introducing myself.

My name is Eric Raynal, and I am a senior studying Chemical Engineering. I will be graduating in December 2012, and plan to attend medical school in 2013. I'm in the process of finishing up my primary application, and will submit it before I return to the US on July 3rd. I'm from Petoskey, MI, but since matriculating, my parents moved to Ann Arbor! I am fortunate to have them close by, and try to visit once a week.

Just a touch on what I've been doing in my free time before discussing my project. Between my friends Grace and Sahil, and Wikipedia, I have learned quite a bit about the rules of cricket. The IPL playoffs are just about to start, and I can say with pride that I have a basic understanding of what's going on. In the evenings, I have been watching Mollywood/Bollywood/Tollywood/Kollywood/Lollywood/Sandalwood films on TV. Most are from the 60's/70's and none have subtitles, so it's been interesting trying to catch the differences in languages!

I cannot thank the generous donor enough for creating such a wonderful opportunity for students to travel to India. When I heard about the fellowship, I immediately began coming up with different topics and project ideas. I sought to create a project that used my engineering background to tackle a medically-related issue. What I came up with is a research project focused on electronic medical record systems in India. I am here to discover some of the challenges that Indian clinicians face using these systems. Do they successfully address the needs of the hospital? Is there sufficient ongoing IT support from EMR software companies? Do clinicians receive adequate training on their system? Are the systems even being used after their installation?

To determine the answers to these questions, I developed a set of questions to ask doctors during one-on-one interviews with them. I will be visiting hospitals in Pune, Mumbai, Delhi, and Bangalore. To get a better sense of the current environment and attitude towards EMR systems in India, I have begun my trip by spending some time with OHUM Healthcare Solutions, an EMR software provider in India. I have spent the last week playing in a training environment of their EMR software that has been slightly modified from the US Veterans Health Administrations's EMR software, VistA.

I've learned that things move slowly here! Not only the pace of life, but productivity as well. I have been towing the line between polite and pushy to accomplish the goals of my project. The two other interns that started with OHUM the same day as I did still have not been assigned a project. My primary contact at OHUM was suddenly and unexpectedly called back to his home in Chicago, and will not be returning to India for some months. I have been working with another chief staff member, Niteen, but he has been absent from the office twice this week. I have critiqued and finalized the outline I will use during interviews, and am prepared to begin as soon as possible.

Unfortunately in India, that is in all probability next Monday!

-eric
ericrayn@umich.edu

[Eric R.] Initial Post

So, apparently my previous post is lost. I apologize! It was mostly about packing, and my running around to prepare for departure. I also gave a quick introduction to my project, and what I'll be working on while here. I will be sure to write about my project in the future.

This has certainly been an adventure, so far! I landed in Mumbai at 11.15p last night, and made it through customs and immigration very quickly. I was supposed to be looking for my driver, Santosh, who had a placard with my name on it. I exited the airport into a square surrounded by people, all holding placards! I had been warned of the smell – that I’d want to walk back inside and fly home. I can officially say, it’s not worth all the hype. Mumbai smells…humid, and a touch musty. But not bad.

I ended up using my phone briefly to call Santosh, and found him standing shyly in the corner with my placard: “Ayrik Reylan.” I suppose that’s close enough. I went with him to his car, and began the drive to Pune. Let me tell you, easier said than done. At first, there was only one tiny road. It wound through the slums of Mumbai, and had potholes and construction everywhere. Bikes and auto-rickshaws were weaving in and out of traffic, and sometimes the cars would come into the wrong lane to avoid a particularly large pothole (don’t forget they drive on the left, with the steering wheel on the right!). After leaving the island that Mumbai is on, we began to travel up into the mountains. Despite being about 1am, traffic was gridlocked. Going up into the mountains was slow going; cars were in the minority, and large trucks carrying carefully-balanced loads blocked most of the road. Driving on the shoulders was commonplace. My favorite sign I saw: “over-speeding causes accidents. Slow down.” Not speeding, just over-speeding. I heard (and sang along to) a medley from Kal Ho Naa Ho on the drive, and a few others I recognized from the films I’ve seen.

I rolled into Pune at 3.40a, and was greeted by Malik, who has become my guide for the time being. He showed me my room, and I was pleasantly surprised when he turned on the A.C. before leaving me for the night. I am fortunate enough to enjoy sleeping on a firm mattress; I think my bed is more like a cushion on a piece of plywood!

I slept very well, but briefly. I woke up at 8.30a when Malik walked in and asked if I’d like some tea. I said yes, of course, and came downstairs for some tea and crackers. He likes the word “going,” and uses it synonymously with “coming.” It made for some interesting conversation this morning, and we ended up walking a couple blocks around the guesthouse due to a misunderstanding (on my part, clearly!).

Malik asked me this morning if I was married; after clarifying to ensure I understood him, I quickly told him no! He laughed a bit, and said at 25/26/27 he will get married (he’s 20, I think). I told him I was only 21, and he told me I should start looking! We talked a little about our families, and bonded a bit. I hope we become friends!

Mr. Kumar, my contact at OHUM, is in Delhi today, and will be returning Saturday. However, I visited the OHUM office for an orientation this afternoon. There are two other interns starting with me; they are Masters in Health Administration (MHA) students (Ketaki and Yogindra). Yogindra is a doctor already, but is interested in managing a hospital. Apparently, about half of all Indian medical students do not practice medicine after graduation, but continue on to receive their MHA's, MBA's, etc. The three of us met with a number of employees at OHUM, and learned about their mission statement and their main piece of software, VistA. My task for the rest of the afternoon: read the 144-page user's manual to have more background information when I go to meet with doctors starting next week...wooo!!!!

-eric