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Here is a page from the journal of Dr. Ashish Goyal. Soon we will add more pages from the journals of AVSAR'sHealth Care Rotation volunteers. It's your last day as an AVSAR ( uhv-sir ) student-doctor working in Mumbai , India . You've been volunteering in a not-for-profit medical clinic run by the Niramaya Health Foundation and located in the world's largest slum-area, Dharavi. The day had been a little slow, but now a 12-year old child-laborer has been brought to the clinic by his sweatshop-employer. Although the child appears very ill, he denies having any complaints. During your physical exam, however, you note that he has a high fever, an increased heart rate, an increased respiratory rate, signs of dehydration, a noticeable cough, audible crackles throughout the lung fields, and that he can't seem to stop shaking because of “the chills.” You also notice that he is underweight, generally weak, and shows various signs of vitamin and mineral deficiencies; which, until now, you had only read about. You're obviously concerned and would like to know more about the child's symptoms. You ask him if any “green stuff” is coming up with his cough, but he quickly says no. You ask him about his fever and the chills which you noticed, but again he states that he has no complaints. He seems a bit nervous, and then you note that the child's employer is standing directly behind him. You now suspect some form of abuse as well. You approach “Dr. Amit,” the clinic's attending physician with your recommendations: “I'm really concerned that this child has gone so long without treatment. Among other things, he has a severe case of pneumonia that I don't think we are equipped to handle. He needs to be admitted to the closest hospitals for immediate administration of IV fluids, antibiotics, close monitoring, and a bunch of other stuff...” He tells you that he understands your concerns, but explains that the two of you will have to find another solution because making such recommendations would work against the child's interests. The employer would simply say “thanks,” and then take the child to a clinic that “knows how to treat patients,” or take him back to the sweatshop and deal with the problem later. “Well, then we have to make sure that he at least gets broad-spectrum antibiotics. Also, he needs to stay hydrated and have proper follow-up. I've written down a few of the medications and electrolyte solutions that I think he should get; what do you think?” Just as you start to convince yourself that you're four years of medical training have prepared you for just about anything, Dr. Amit reminds you that “outside medicines” cost money. “We can't assume that a prescription will get filled just because we want it get filled. Even now, the child's employer he has only come to us because he knows we give these kids free medical services and medications. But the system isn't perfect and we can't afford everything; and we know that they are unlikely to pay for medications themselves. As for close follow-up, that's not going to be possible either. We can only afford to have a part-time doctor at our clinics, and even then we're only open 3 days per week. The follow-up will have to wait until Monday.” You're frustrated, and you know that this clinic is a blessing for these children, but you want to do even more… “I understand what you're saying about the money, the medications, the holidays, the abuse, and everything, but there has to be something we can do …” (This story is based on the personal experiences of the Founder of AVSAR. The creation of AVSAR is an attempt to help shift the momentum of reform in India through partnerships which utilize the resources of a global collective. Through the help of AVSAR, a new clinic has already opened, old clinics have been reformed, and in February, 2004, five medical students and Masters in Public Health degree-holder began the AVSAR Pilot Healthcare Rotation for a month of intense community service in India . Healthcare is only the beginning. Take a chance and find out how you can help. Join us by sending an email to AVSAR-subscribe@yahoogroups.com )
Ashish Goyal Program Director, AVSAR
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