Situated around a star-shaped lake and nestled amongst a colorful array of jungles, Kodaikanal (commonly referred to as “Kodi” by the locals) felt like an oasis from the moment I arrived. It was February during my final year of residency, and I had decided to travel to southern India to work with an organization called the Foundation for the International Medical Relief of Children (FIMRC). Grateful to be free of the sound of beeping pagers and cardiac alarms, I embraced the city and its culture eagerly, energized by the sound of musical horns on passing trucks, the patter of feet shuffling quickly together among crowded streets, and the vibratory hum of conversation in unfamiliar tongues.
While staying in Kodi, the majority of my time was spent working with FIMRC. Through their network of physicians and public health workers, I had the opportunity to rotate in a variety of different healthcare settings including private and public hospitals, as well as several different outpatient settings. The interactions I had with the staff, physicians and patients at each site was overwhelmingly positive and both academically and personally enlightening.
Though I learned a lot of medicine from the generous patients who shared their grueling experiences of enduring Typhoid fever, the effects of severe vitamin deficiencies and a host of other ailments, it was FIMRC’s additional focus on public health that had the greatest impact on me. In the afternoons, I often traveled to a local creche (the local word for “preschool”) to perform health screenings, to hand out vitamin D tablets, and to ensure that all of the kids received three meals a day. As I later learned, these interventions have been shown to significantly reduce the incidence of malnutrition among the creche’s school-aged children. Other afternoons were spent visiting rural schools where we taught lessons on basic feminine hygiene and provided boxes of menstrual pads, a simple action that goes a long way to combat the high rates of pelvic inflammatory disease that are prevalent in this area. We also spent time building chimneys for families living in a single room home with an open, wood burning stove in order to reduce the amount of smoke inhalation that contributes to a high incidence of chronic lung disease.
While this concept is not novel to most of us, these experiences severed as a good reminder that sometimes, in order to truly help a patient, you need to go directly to the source of the problem. Though the disease pathology may differ from country to country, this lesson remains true universally. Treating recurrent bouts of Malaria is a fruitless endeavor if a clean water source is never obtained. Inhaled corticosteroids can offer only limited benefit at treating asthma if exposure to secondhand smoke, whether from a parent’s cigarette or an indoor stove, is not eliminated. Insulin may keep blood sugars in check, but until processed foods are similar in price to fresh, real food, the diabetes epidemic will continue. And while taking on an additional role as a public health servant may be too much given our ever-expanding professional sphere of clinical responsibilities, it is important that we as physicians work in tandem with public health officials in order to achieve sustainable health outcomes, both at home and abroad. In doing so, we might just be able to prevent the development and spread of disease before it even begins.