Yellow-topped autorickshaws vie for space with cyclists, taxis, cows and pedestrians in the seething mass of traffic below.
It is hard to believe we are here in Delhi for the first part of an adventure that has been two years in the planning. It seems like a long time ago that my wife Laura and I first discussed taking some time out of our respective medical training to fulfil an ambition of spending time volunteering in a medical capacity in the developing world.
Our appetites whetted by previous experiences as students working with local non-government organisations (myself with an HIV/AIDS programme in Ghana and Laura at orphanages and providing basic healthcare in India and Malawi), we resolved to make it happen.
Identify a time to go
In the medical training timeline, there seems to be no ideal time for such an experience, so while relatively unbound and without mortgage or dependants, we plumped for August 2009. This would be at the end of my GP ST1 year and at the conclusion of Laura's foundation training; as good a time as any.
After navigating through a good deal of paperwork and with a lot of support from my educational supervisors, my out of programme experience application was approved by my deanery. Once Laura had completed her foundation competences, we were ready to go.
The previous year had involved much research and correspondence with various organisations, culminating in an itinerary that would take us to India, Nepal and Belize with a stop back in the UK for a few weeks in early 2010 for Laura to apply for specialty training.
Our Indian summer
We organised our first placement with the Salaam Baalak Trust (SBT) by contacting Youthreach India, an organisation that helps to place volunteers with NGOs.
SBT is an organisation whose aim is to find and help street children, giving them access to shelter, education, food and healthcare. It has branches in Delhi and Mumbai, and operates a small outreach health post at New Delhi railway station on the border of Paharganj, one of Delhi's poorest areas.
Early in August, under a corrugated tin roof on the first floor overlooking the freight depot of the station, we absorb our new surroundings.
The health post comprises a small room containing a doctor's chair and desk, medicine cabinet, first aid table, a rudimentary examination couch with screen and a small sink.
Laminated pictures of Hindu deities adorn the walls and are interspersed with wires, cables and photos.
The small adjoining room doubles as both waiting room and day room for the children and typically houses 10-20 children, playing, eating or receiving lessons in maths, Hindi or English from the resident teacher.
Running the clinic
On our first day we meet the staff - a youth worker, social worker, the teacher and SBT's co-ordinator. The doctor has been off for a week with suspected swine flu, so there is plenty for us to do.
Daily clinics vary, with between six and 25 patients seen in a three-hour period. Common complaints include injuries (usually from train or rickshaw accidents), respiratory infections, scabies and mite infestations, staphylococcal skin infections, diarrhoeal illnesses and malnutrition-related problems.
One 14-year-old girl presents with a month's history of fever and cough. Sputum is sent for microscopy and copious mycobacteria are seen under Ziehl-Neelsen staining. The next problem was how to manage her infectivity. Fortunately, we are able to admit her to the TB hospital for directly observed treatment (short course) but this is the exception rather than the rule.
Once the resident doctor returns, we all operate the clinic together and she explains some of the difficulties.
About 130 new children arrive at the station each week on trains from all over India. Many refuse to go to shelter homes for a variety of reasons. Some value the freedom a life on the street affords them; they get the chance to earn money by collecting plastic bottles for recycling or acting as a runner for a vendor.
This money is often used to buy cheap toluene-containing solvents. Such addiction is a widespread problem among the children and to address this, drug awareness workshops have been provided by the All India Institute of Medical Sciences as a joint initiative with SBT.
Stories of physical and sexual abuse from children who have been in government homes are not uncommon, and SBT is fortunate to have a counsellor. We reflect on the similarities and differences between patients here and in the UK.
A valuable experience
In the current climate of concern over junior doctor training posts, our thoughts are, on occasion, understandably drawn to the future implications of our time away. Throughout this process, we have both remained thoroughly committed to our medical training in the UK.
In just a short time away, we have felt the value of working in such a different setting and are confident that we can learn from these extraordinary experiences and look forward to enhancing our practice upon our return.
- Dr Reeves is a GP ST1 and Dr Stirling is a foundation doctor
Planning a gap year
1. Plan early, liaise with relevant bodies (supervisor/deanery) and explain your plans and intentions.
2. Identify where you want to go and who you need to speak to - correspondence, even email replies, will not be quick and you will need to send copies of key documents.