My first clinical assignment during our month long stay in Manipal, India was at Kasturba Hospital. Referred to as “postings” by the College of Nursing, these short visits to floors such as the ICUs and Causalities (equivalent to our Emergency Departments) provided us with much insight to the differences between healthcare here in India and the United States.
For myself, I had no idea what the hospital conditions would be like or what type of patients we would see. It was necessary to acknowledge our own privilege before analyzing the healthcare setting. Studying in Boston, we had the privilege during nursing school to train at some of the best hospitals in the world. We come from a country with many alternative adversities. India has many more people, strong beliefs and culture, alternative resources, and different presenting health conditions. All of these factors influence how their healthcare system is set up and maintained.
One of the initial thoughts I had when walking through the hospital was that it was extremely crowded. The halls were packed with people, mostly standing around outside of doors leading to other wings and wards. These groups of people are the family members of the hospital patients. They are usually not allowed in certain wards, but they remain in the hospital, in the halls, in support of their sick or injured loved one. The family members are responsible for daily care for the patient, such as feeding and bathing. They will also do laundry for the patient while the patient is in the hospital. The medications are prescribed within the hospital, but then the family members need to go purchase the medications (out-of-pocket) and bring them back to the hospital for administration.
There are certain standards of healthcare that I became accustomed to in the United States that were not observed during our postings within the hospital. Hand hygiene is crucial across the globe, and while there are signs in the wards about proper hand hygiene, it was not always followed appropriately by staff. Gloves are not worn as frequently as they are in the U.S. for patient and provider protection. Hospital acquired infection is a concern, but when we asked the Indian nursing students about infections such as MRSA and C. diff, they stated that these are not as big priorities. Patients with these infections will remain on the wards with other patients, not necessarily in isolation with contact precautions. Tuberculosis infection is a higher concern in India and one of our group members is focusing on TB diagnosis, treatment, and care for her Scholarly Project topic.
Upon entering the ICUs, everyone must remove their footwear and don flip-flops. These flip-flops remain in the ICUs and are worn by everyone without cleaning in between wears. The same procedure is done in the operation theaters (surgery). This is done in an effort for cleanliness and to reduce infection. We are so used to wearing closed-toe footwear in the U.S. for both infection control and to reduce injuries.
The most common presenting cases that we observed in the Causalities department as show differences between the United States and India. One of the largest shocks was how common suicide attempts are in this country. A common method for suicide is poisoning, often with organophosphates or pesticides. The causalities department had a large poster outlining each type of poison, with symptoms, and with antidotes if available. Road-traffic accidents (RTAs) are also very common. Closed head injuries, lacerations, fractures, and deaths result from unsafe driving conditions. Many people ride mopeds or motorcycles in the roads, however it is very uncommon to see anyone wearing a helmet. Multiple members of a family, including children, will all sit on one motorcycle without head protection. It is also common to see over 10 people in one motor vehicle, without seatbelt use. These “norms” seen in the community provide insight as to the frequent presenting cases in the ER.