Reflections from Osler’s Global Health India Trip

Deborah Churchill
William Osler Health System’s (Osler) Global Health team recently returned from an historic trip to Punjab, India where they formalized partnerships with three different hospitals in the region. The eight-member team returned to Toronto at the end of April after two intensive weeks in the northern Indian state – exhausted and exhilarated by the experience.
Launched in June 2014, the Global Health Program is the only one of its kind at a community hospital in Ontario, possibly Canada, and is part of Osler’s philosophy to ‘go beyond’ its borders and contribute and learn on a global scale. Dr. Naveed Mohammad, Osler’s Vice-President of Medical Affairs and the Physician Lead for the Global Health Program, says there is no doubt it is doing just that.
“In just a short amount of time we forged very strong relationships with colleagues at three hospitals in India and are now looking at how to action some of the key learnings and research opportunities to help improve patient care here at Osler and in India,” he said. Dr. Mohammad went on to say that the program is still in its infancy and that he looks forward to its continued growth in the years to come.
The team visited three vastly different hospitals over 10 days, focusing on patient care, education and training, and research and innovation predominantly in the areas of emergency medicine, and mental health and addiction.
The hospitals were selected following a 2015 exploratory tour by five Osler team members to identify health care organizations that best fit with the objectives of the Global Health Program, which is funded by generous donations from the community to Osler Foundation. Two of the hospitals – Dayanand Medical College & Hospital (DMCH) and ShaheedKartar Singh SarabhaAyurvedic Medical College & Hospital (SKSS) – are in the Ludhiana District. The last – Indraprastha Apollo Hospital – is located in New Delhi and is part of the multi-national hospital chain.
Sharing their on-the-ground experiences in India
The 2016 trip may be over, but the work is just beginning. And an important part of this work is educating people about the extraordinary on-the-ground experience in India and vision for the Global Health Program going forward. To this end, the team has spent the last two months sharing their personal reflections to Osler staff through a series of well-attended all-staff lunch and learns, departmental presentations and most recently, to the broader community.
One of the first questions that is often asked about the Global Health Program is why India and why the Punjab region? It was deliberately chosen as the first destination for the Global Health Program because it is the homeland of so many of those who live in the communities served by Osler’s three hospitals – Brampton Civic, Etobicoke General and, very soon, the new Peel
Memorial Centre for Integrated Health and Wellness. According to recent statistics, nearly 40 per cent of Brampton is South Asian, with Sikhs making up almost 20 per cent of the population.
While India will remain the core of the Global Health Program for the foreseeable future other partnerships are also being explored, including one with a well-respected charitable organization that is doing incredible work setting up care for children in the slums of Karachi, Pakistan. At every hospital, Osler team members equally contributed to and learned from the clinical environment. At DMCH, for example, Kim Maas O’Hearn, Clinical Services Manager, Emergency Medicine, shared some of Osler’s best practices on hand hygiene and introduced the practice of staff huddles to her nursing counterparts. Wendy Ross, Clinical Services Manager, Mental Health & Addictions, and ShubhjitMinhas, Geriatric Mental Health Nurse, were struck by the important role of family in the care process – an observation that is sparking new dialogue about how this can be more effectively accommodated here at home. The Osler team members representing mental health and addictions participated directly in inpatient rounds and case conferences, gaining a better understanding of the tremendous stigma around mental health and addiction that exists in the Punjab region and across India and how it influences patient care in both countries.
“I will definitely think more about … bias related to gender, culture or mental illness, the availability of caring relationships and how all of these factors affect my patient,” said Dr. David Koczerginski, Chief of Psychiatry and Medical Director of Mental Health & Addictions, when asked how what he learned on the trip will influence the way he provides care at Osler.
The team also spoke about the heartbreaking moments – the ones that reminded them of just how fortunate we are to have the kind of healthcare system we have in Canada. They spoke about the helplessness of seeing a family have to leave the hospital with their desperately ill child because they could not afford to pay the fees, modest by our standards but exorbitant for most of the population there.
Referring to a picture of a painfully thin young boy who was seen on the second of two days of Osler-led medical camps at SKSS, Darryl Yates, Clinical Director, Mental Health & Addictions, Oncology and Palliative Care, said: “If he looks brittle, that’s because he is.”
The 17-year-old’s blood sugar level was so high it couldn’t register on the glucometer. Despite the severity of his illness, which puts him at extremely high risk of kidney disease, blindness and premature death, he had had virtually no care to date. The Osler team was able to provide him with a free glucometer after assessing that his family would be able to purchase the strips necessary for its continued use and referred him to an endocrinologist at DMCH.
He was one of more than 500 patients, which included patients seeking care for mental health and addiction issues, seen at SKSS over two days by the Global Health team with the support of the
hospital’s nursing college students. “Despite the significant stigma around mental health and addiction in India, many villagers came to the camp to seek help in this area and Dr. Koczerginski and I were so pleased to be able to help them with these issues,” said Wendy. The medical camps were a first in Osler’s history and a life-changing opportunity for the team to provide care to a very needy population. SKSS is a charitable hospital serving more than 25 poor, rural villages.
“We are extremely fortunate to have access to the best health care in the world. And we do not have to sell our house to get it. I am incredibly pleased to be part of an organization that is thinking outside of its own confined borders. Selfless service is desperately needed in all corners of the world,” said Dr. GurjitBajwa, Emergency Medicine Physician, whose own family is from the small Punjabi farming village of Bhattian.
There are clear, tangible outcomes of the trip that will benefit patients from these two very different yet deeply connected continents – new policies and shared resources, joint educational initiatives and research collaborations. But equally important are the intangible learning that a Program like this evokes – the kind you can only get when you immerse yourself completely in a culture and ones that each team member say will make them a better, more culturally sensitive, person and staff member at Osler.
Osler is very pleased with the significant progress made to date on the Global Health Program and excited to say that plans are already underway for the next trip to India, expected to take place in April 2017 following an extensive application process.
Deborah Churchill is a writer with Osler Foundation and a member of the 2016 Global Health team.