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Resident good

More and more, hospitals see the upside of global health programs

By Laura Ungar and Sujoy Dhar
Globe Correspondents / January 10, 2011

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KOLKATA, India — Patients in worn, simple clothes arrived at the school-turned-clinic long before the doctors. They gathered on benches, near a staircase and in a courtyard, waiting quietly. For many, the free weekly clinic in the humble neighborhood of Kestopur provides the only chance for professional medical care.

It’s a reality Dr. Gina Rae Kruse, a medical resident at Massachusetts General Hospital and Harvard Medical School, came to know while working in India — a reality rooted in poverty and a severely overburdened health care system in this land of a billion-plus people.

Kruse recently spent a month in Kolkata helping with a health-needs assessment program run by her mentor, Dr. Stephanie Moore, an instructor at Harvard Medical School and cardiologist at Mass. General. The project is a partnership between MGH and Mission of Mercy Hospital & Research Centre in Kolkata, the hospital that once cared for Mother Teresa.

“So many of us go into medicine because we want to help people,’’ said Kruse. “This gives us a chance to reach out.’’

Mass. General’s department of medicine sends about 30 medical residents abroad each year through various programs, said Dr. Vanessa Bradford Kerry, associate director of education and external affairs in the hospital’s Center for Global Health. The hospital is among a growing number offering international experiences for medical residents, said Dr. Joanne Conroy, chief health care officer for the Association of American Medical Colleges. She said as many as a fourth of residents express interest in such programs.

According to a March 2010 article in the American Medical Association Journal of Ethics, the percentage of graduating medical students participating in global health electives has risen from 6 to 30 percent in the past 25 years. The American Academy of Family Physicians lists almost 80 international programs for residents, some with rotations in several countries. The Global Medicine Network, a service of the Massachusetts Medical Society, also maintains lists for interested residents.

Doctors who practice abroad “learn how to do more with less,’’ Conroy said. “They form some lasting friendships. And they often return to give back in these countries. . . . Every physician is just a patchwork of the places they’ve been and the work they’ve done.’’

Kruse, for example, has also done volunteer work in Russia, Liberia, and elsewhere. The 32-year-old said she hopes to use what she’s learned as a primary care doctor working with the underserved in the United States and abroad.

As part of the assessment project, medical residents talk with patients and doctors at 14 Mercy clinics about the challenges they face and how care could be improved. Needs can be as basic as a place for doctors to wash their hands or as complicated as getting a mobile ultrasound machine to remote rural areas.

Renubala Haldar, a 50-year-old housewife waiting in the courtyard, said people like her can’t afford to visit the private doctors that wealthier Indians see. The Kestopur clinic, she said, “spares us from visiting government hospitals,’’ which are so crowded that patients often lie on the floor or even camp outside.

Moore’s project grew out of a trip to Kolkata in May 2009, when she accompanied a friend, Bonnie Buntain Long, who traveled there frequently with her husband to provide free care through Mercy.

A 2009 report by Save the Children said nearly 2 million Indians under age 5 die from lack of care every year. And a 2010 World Health Organization report said India had the most maternal deaths in the world, 63,000 a year.

Moore, 43, of Concord, recalled seeing people sleeping in the streets and living in tiny shacks with garbage bags for roofs. She watched a man shower himself by standing beneath a tipped-over can of water. She saw girls barely in their teens working in Sonagachi, Kolkata’s infamous red light district, where run-down houses serve as brothels for nearly 10,000 sex workers.

But even among the poorest residents, she found smiles and sensed a joy and a love of life.

“I hadn’t seen anything like it. I thought, How do people get by with nothing?’’ Moore said. “You can’t go over there and come back the same.’’

Moore has been working since April with Mass. General residents to establish the health needs at each of Mercy’s primary care clinics and make suggestions to improve care there.

“We are to give them a summary of the residents’ data collection, present our findings, and make recommendations on how Mercy can serve the clinics and communities,’’ Moore said. “We also help identify resources, novel delivery of care, and brainstorm how a global health team based in the US can partner with them going forward.’’

Officials at Mercy said they welcome the partnership and believe it will help them achieve their mission of providing free care in the clinics.

“Our aim is to reach primary care to the poor people,’’ said Sanjay Prasad, Mercy’s chief executive officer.

Moore called Mercy’s work “a noble mission.’’ Kruse said the same about Moore’s efforts.

“She’s an inspiration,’’ said Kruse, the sixth resident to go to India. “She’s great about getting us excited about our ability to come out and do something that’s worthwhile.’’

Resident Aparna Raj, 28, said her experience solidified a lifelong interest in global medicine. The daughter of two physicians who emigrated from India, Raj recalled watching her parents and grandfather, a surgeon, volunteer their services during childhood visits to their native land.

But she’d never been to Kolkata until she traveled there for Moore’s project. She recalled one young woman who walked more than two hours with her son to get care.

Since returning to Boston, Raj has been considering a long-term relationship with Mercy, perhaps in her chosen field of cancer care. In the meantime, she said, she is more attuned to the larger needs and home lives of the Boston-area patients she serves.

“In my opinion, one of the most important factors to consider when working in the developing world that also applies here is that clinical medicine does not stand independently,’’ she said. “It is intricately linked to the political, economic, and cultural contexts in which that society exists.’’

Dr. Sonali Paul, an aspiring gastroenterologist whose family is from Kolkata and who served there in mid-July, said the experience helped her in two ways: “On the inpatient side, it has made me think about the necessity of each and every test we order for our patients. On the outpatient side . . . I try to focus more on preventative screening and really talk to them about their health care, whether it be surrounding chronic diseases or weight loss or smoking cessation.’’

Moore said wherever residents wind up practicing, their experiences in India have helped prepare them to live out their true calling as healers.

“You took an oath to help people, and we do that,’’ she said. “We are all world citizens, born with a responsibility. . . . We are all human beings.’’

Laura Ungar and Sujoy Dhar can be reached at indiaungar@gmail.com

Some area resident-abroad programs

MASSACHUSETTS GENERAL HOSPITAL
Up to 30 residents a year travel abroad for “away electives’’ of four to six weeks. Most travel to sites in South Africa and Uganda, but they occasionally travel to other sites. In the India project, six residents traveled to Kolkata to help with a health needs assessment in the past year. Mass. General is also launching a new four-year program in global primary care. (Mass. General Center for Global Health: www.mgh.harvard.edu/globalhealth)

BETH ISRAEL DEACONESS MEDICAL CENTER
A hospital-wide global health program for residents sends them to all continents except Antarctica. (For more information on the global health program, go to www.bidmc.org/medicaleducation/globalhealthprogram.aspx.) In the Department of Medicine, residents also have the option of the Global Health Track, which combines an international experience with a seminar series, a journal club, and a three-week summer course given at the Harvard School of Public Health.

CHILDREN’S HOSPITAL BOSTON
About 20-30 residents travel to a variety of countries each year. The hospital currently has more formal relationships with a hospital in Liberia, a hospital in Tanzania, and with the Indian Health Service, Northern Navajo Medical Center in Shiprock, N.M. (More information is available at www.bcrpglobalhealth.org.)

MASSACHUSETTS EYE AND EAR INFIRMARY
Ophthalmology residents participate in an elective rotation four weeks long, when senior residents can go to the Aravind Eye Hospital in Madurai, India. About half the seniors go each year, or about four residents. www.masseyeandear.org/for-professionals/ophthalmology/residency-program/curriculum-year-3