Telemedicine gone wild

The train was supposed to leave at 7 pm. When, in fact, it didn't leave until 8:45… no one made a fuss. Many people in India, according to our host, are the wealthiest in the world. Not in the sense that they have the most money, but they have unlimited access to the most valuable good in the universe that money cannot buy - time.  As a result, everything runs on IST (India Stretchable Time), which seems to be more of a philosophy than an exact science.  Varanasi, among other attractions, is at the intersection of several train routes, so people from all over India wind up with day long layovers here.  The train station was so crowded that families lay on mats all over the ground, resting or eating a homemade Indian meal packed for the journey or cooked between the cows and motorcycles on the platform.  

Finally, the old blue train pulled along the platform and we looked through the open, barred windows to see crowds of people sitting, standing and hanging out on open car doorways. Seeing the worried look on our faces, Dr. Subodh reassured us that we had the best seats on the train in the "AC 2 tier".  These high class cars permit reservations with fold out beds, whereas the general class ticket is a complete free-for all. An unlimited number of general class tickets are sold and some people must stand for an entire 36 hour trip to Mumbai!  

Once onboard, our car was nice and cool, and we each had a bed in a sort of cubicle looking space which had a curtain for privacy.  Dr. Subodh and his staff unpacked a gourmet feast put together for us by Dr. Subodh's talented wife.  Yum!  We ate and chatted with them about the camp the next day and then everyone “slept” for a few hours.  

We arrived in Muzaffarpur around 6:30 am and went to a hotel across the street from the train station to clean up and eat breakfast before heading to the charitable hospital where the camp was held.  Once at the hospital, we met with the chief administrator and trustee who told us about the hospital, which has been a great partner for G S Memorial.  The hospital specializes in pediatric and gynecological services offered at a steep discount to Bihar's poor.  The hospital is set up as a trust and though it operates on razor thin margins to provide incredibly high value care, like GS Memorial, it also boasts impressive financial stability. It was standing room only as we followed Dr. Subodh into the hospital. His entrance was prolonged by the large crowd extending from the hospital entrance to his office, as his patients blessed his feet as a sign of respect. Some even blessed our feet by association with him.

We set up our telemedicine clinic in a room near Dr. Subodh’s. The hospital had set up a new table and office chair and they had brought in a computer and internet wiring the day before.  Word of the talking computer spread like wildfire and before we could finish setting up, a crowd of patients anxiously surrounded the room pushing towards the entrance. It was at that point that KC quickly and naturally transitioned from surgical resident/MBA student into bouncer. We were so surprised and so thrilled that the patients adopted telemedicine so quickly!  Especially since in this region, not only had many of these people never seen a foreigner before (let alone 4 in a room!) but they had never used a computer or accessed the internet.  

After a few technological hiccups and dropped internet availability, we started telemedicine.  Parents came in and encouraged their children, who were follow-up cleft lip and palate surgery patients, to speak loudly to the speech therapist on the screen. The therapist analyzed the patient’s speech and introduced some to the concept of speech therapy.  After each patient had their telemedicine session, they were directed to a table where Cassie and Michelle conducted post-telemedicine interviews.  Due to a stroke of genius by clever Cassie, we had the G S Memorial social worker translate our interview questions to Hindi and recorded his voice so we could play each question to the parent or patient. Since most of the answers to our questions were either yes or no, we had the social worker write out yes/no in Hindi on a paper so patients could point to their answer. Our workaround for not speaking Hindi worked like a charm to get answers to all of our questions…except when they only spoke a local dialect and did not understand the recorded questions in Hindi…then there was a lot of confused looks on both ends! Luckily the social worker stepped in again to help, what would we have done without him!?

Even after the surgeon and speech therapist at GS Memorial logged off and we closed up our telemedicine pilot for the day, people were still coming to our room hoping to get a glimpse of the talking computer.  Our results…patient adoption couldn't have gone any better!  People love it!  And, they're willing to pay to use it (because it’s cheaper and more comfortable than a 9 hour train)!  This is great news for Dr. Subodh and his plan to launch a robust network of telemedicine clinics.

Between patients, we had the chance to walk around the camp and take it all in. Dr. Subodh expected about 150 patients, but ended up with 300!  They were mostly follow-up patients, but he did have plenty of new patients as well.  With about 6 hours to see patients, he was only able to spend about 1 minute with each patient, but that was enough for him to analyze their condition, note their charts, and, more importantly, build a connection with the patients and their families.  At one point the crowd around his door, so eager to see him, could not be contained by the guards and army officials.  It was time for Dr. Subodh to maintain the peace, so he emerged from his room to address the crowd, promising to examine every patient, regardless of how long it may take. Order had been restored at least temporarily…        

It’s clear to anyone who has the opportunity to meet Dr. Subodh that he is truly passionate about his work.  He improves patient lives and those of their families, to him this impact is the ultimate reward. He feels as though he has been given a gift and should use his talents to help as many people as he can.  An otherwise joyous and friendly doctor, Dr. Subodh scolds patients when they return for follow-up and are clearly not taking the right care of their children or themselves. This sternness is out of love because he deeply cares about his patients and their wellbeing.

With only 1 hour until our train departed we left the camp with one of the hospital staff.  We were onboard and all settled in, convinced that Dr. Subodh would remain at the camp until midnight evaluating patients. The conductor released the brakes and the train started crawling forward when, suddenly, we heard a laugh and saw a familiar smile. Dr. Subodh saw three patients per minute for the last hour of the clinic and miraculously made the train!  Both children and adults spent the next eight hours peeking around corners to catch a glimpse of the foreigners. Just before midnight, we reached Varanasi, tired, dusty, and elated that telemedicine would soon help us bring the specialized plastic surgical care to the people of Bihar.