My experience in Kerala

Medical students in the UK are supposed to work in a hospital somewhere else as a final year elective. This may be in a hospital in the UK, but generally, students go abroad. Sunil chose Trivandrum Medical College and spent eight weeks in Kerala. This is his account of his experiences there.

The Hospital
I started working in the college in November and completed the elective at the end of December. The temperature in Trivandrum was 32 C almost throughout the eight weeks. The hospital and medical college covers a vast area. The entire complex must be three times bigger than most colleges in the UK. Outside the hospital, there are always a large number of people. Most just standing around trying to get passes to enter the hospital. A few just stand around watching what is going on!

The inside of the hospital is completely different from what people in the West expect in India. I expected to see crowded corridors with rubbish strewn over the floor; doctors rushing all over the hospital trying to cope with large numbers of patients; hot and stuffy wards; smells of unkempt utensils and rotting waste. However most this is not true. Exceptions to this are outside surgery theatres and outpatients. I expected to have to push through crowds of people to go from ward to ward, but this wasn't the case.

Each ward is probably about twice the size of a ward in a typical London hospital. There are about 60 beds on each ward. Sometimes, there were too many patients and then new patients would have to sleep on the floor. The ward isn't normally very hot due to the presence of ceiling above the beds. Everywhere in the hospital was neat and clean. In fact, the smell of disinfectant was always quite strong, especially in the corridors. There are no curtains between beds for privacy. This could cause problems sometimes, as for example; a suspected HIV case came onto the ward. Everyone knew that person's problem! However, some patients are very ill, and not having curtains allows the doctors to keep an eye on all these patients!

The Doctors
On each ward there are about four or five junior doctors. This comes to about fifteen patients per doctor. Junior doctors in the UK can have as many as forty patients per doctor. So it is easy to understand why doctors in Trivandrum are slightly more relaxed than their counterparts in the UK. However it is not all easy going for them. Doctors in the UK have a standard five-day week. In Trivandrum, they work Monday toSaturday every week. Weekend calls are worse, though, in the UK. A team usually has just the Sunday on-call in Trivandrum, whereas in most London hospitals, the weekend call starts on Friday and finishes on Monday morning.There were three students from the UK. Some of the doctors were friendly to us and willing to help. Others had a short conversation with us and then never spoke to us again. Apparently, this was because they couldn't understand our English and so kept their distance. Senior doctors were normally quite friendly to us and would give us a lot of teaching. Sometimes professors would compare medicine in India with that in the UK and ask us what we do in similar situations. They would sometimes spent hours asking us questions on medicine in London and how our hospitals and teaching differed.

The Students
In Trivandrum, as well as in London, there are two types or medical students. The first is the hard-working individual, who always turns up and writes down everything consultants say. The second type are those who virtually never turn up and if they do, will stay five minutes just to give party invitation to their friends on the ward! They are normally in jeans and T-shirts. The group I was with was supposed to be fourteen in number. I saw ten! The students who turned up at college were very friendly to say the least.

A day at college consists of ward-work and teachings in the mornings, and lectures in the afternoons. Monday was the big day for us. It consisted of outpatients in the mornings and the big ward teaching in the afternoon. Outpatients took place in a room, which was the size of an average living room. Six students and three doctors would see a patient each, at the same time in this, crowded, room, However, it is a very quick and efficient system, which in India is very important. In the UK, outpatients consist of three or four doctors in a room each, seeing one patient at a lime. An outpatient clinic in my college sees on average thirty patients in one session. In Trivandrum, there could be at least double this number.

The big afternoon ward teaching was sometimes a torture session for the students. Each student had to see one of the new admissions and present the case to the consultant in front of the rest of the group. An example of this was when the consultant spent one-and-a-half hours asking one student questions and then making fun of him if he got the answers wrong. In my college we too have one or two consultants who use the same principles of "teaching by humiliation". It is therefore not a surprise that the students in Trivandrum are scared of their professors.

Students in Trivandrum, spend more time studying for medicine than most students in London. Their knowledge base is therefore very good.

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