Helping, and learning, through disaster relief in India

After an earthquake and as many as 60,000 deaths, Yale students and physicians help shore up health system.

Midway through their 10-day trip to western India in March to help with earthquake-relief efforts, a team of Yale students and physicians visited the Children’s Hospital in Bhuj, a city near the earthquake’s epicenter. Shantiben Patel, M.D., the hospital director, had set up tents outside the damaged building and was seeing patients when the team arrived. “She had been working six weeks straight, day and night,” said Raj Krishnamurthy, M.D., who practices internal medicine at the VA hospital in West Haven and was a preceptor for the team. “She didn’t have a day off. She was the only pediatrician in the whole area.”

Patel quickly put the Yale team to work seeing outpatient visitors while she tended to the neonatal intensive care unit in one of the many tents on the street. Over the next four hours the five students and their two preceptors tended to about 25 children, most suffering from diarrhea, dehydration, upper respiratory tract infections, malnutrition and urinary tract infections.

The earthquake that struck the western Indian region of Kachchh, on January 26, measured 7.9 on the Richter scale. Estimates of the death toll vary, with the government estimating between 20,000 and 30,000 deaths and relief workers saying as many as 60,000 people may have died. The Yale team, made up of five medical students, a public health student and two physicians, arrived six weeks later to scenes of rubble and ruin. They also found an already fragile health care system in shambles.

In New Haven, students’ initial response was a fund-raising drive that netted about $1,000 for earthquake relief. The students wanted to do more and approached Dean David A. Kessler, M.D., who agreed to send six students to India. It was up to the students to organize the trip. Seventeen students applied to go, and six, all but one of Indian heritage, were chosen through an application process. After securing their preceptors—Krishnamurthy and David Litvak, M.D., a third-year resident in internal medicine—and finding a nongovernmental organization to work with, the students were on their way. Upon their return, the students filed a report with the dean’s office.

Kachchh is 17,000 square miles of plains, desert and salt flats bounded on the north by Pakistan and on the south by the Arabian Sea. Most of its inhabitants farm grains, cotton and lentils. Some work in limestone, marble and gypsum mines. In recent years the region has suffered two droughts and a cyclone. “It’s a very difficult state to live in as it is,” said student Simran Singh.

The team’s guide to the region and its medical needs was Anupam Banerjee, M.D., an intern in India fresh out of medical school who had begun a term of service in Kachchh just after the earthquake hit. Banerjee, in turn, was working with the Shrujan Trust, an organization founded in 1969 to provide famine relief. The trust branched out into economic aid by marketing embroideries made by 2,500 craftswomen in 85 villages. It also began medical outreach and provided the van that took Banerjee’s mobile medical unit into the countryside to provide primary care.

The students arrived at the Shrujan compound about 20 miles west of the city of Bhuj ready to work, despite a 36-hour trip from New Haven and a 10-and-a-half-hour time difference. Their new home was a one-room, thatched-roof hut with a single bed. (Most of the team slept on the floor or outdoors in their sleeping bags.) The next day half the team joined Banerjee on the medical van, while the other half went to the nearby village of Ghada to organize activities for schoolchildren.

Although several members of the group spoke Hindi and one spoke Gujarati, language remained a problem in this country with more than 800 dialects. The dialect spoken in Kachchh was at times incomprehensible to the one Gujarati speaker on the team, Rupal Badani, a third-year medical student. Nevertheless, because of their knowledge of Indian languages and with the help of interpreters, the students managed to communicate.

Within a few days of their arrival, the team undertook a health assessment for Ghada, looking into nutritional patterns and access to health care, prenatal care and primary care. They also organized diabetes and hypertension screenings at a health camp at Shrujan. When it was time to leave, team members felt they had contributed something of value to the relief effort. The presence of the students and physicians on the medical van allowed more patients to be seen. Their survey left health workers a tool for providing medical care to villages. Their diabetes and hypertension screenings were the first for many patients and included follow-up via the mobile unit. And they established a program for children that others would continue after they left.

They also returned to New Haven with valuable experience, having been able to participate in emergency and primary care in a remote setting with limited resources. “We felt like we were doing something for someone, but we were also really learning,” said third-year student Vivek Murthy.

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