A Tale of Two Rural Health Facilities

For the second time this year, a stomach bug transformed my digestive system

into the Niagara Falls. The first time, I was treated at a rural hospital in rural

Massachusetts in the US; the second time, I was treated at a small hospital in Rishi

Valley, a village in South India. These two experiences led to two short hospitalizations

because of dehydration, and showed me how medicine can be practiced so differently

in the U.S. and India.

My first gastrointestinal infection attacked during the middle of winter in

Massachusetts. Shortly after 5:00 P.M. after what was easily one of the worst days of

my life, I gathered the strength to see the school nurse. She told me that the doctor

leaves by 5:00 pm precisely and couldn't see me; however, she was very diligent about

examining me, and referred me to a local hospital for rehydration. A security guard

wearing a surgical mask came with a minivan, and handed me one to wear as well.

Upon arrival at the emergency room, I was first asked to fill out a series of papers. I was

too dehydrated and weary at the time to realize what exactly I was writing. I was the

only patient in the emergency room. After half an hour, I was taken to a room with a bed

where I could rest. Some time later a nurse came in and hooked me up to an I.V. She

left me alone and I fell asleep within a few minutes. I saw her twice more that night: she

came in once to collect a blood sample, and once to tell me in a very irritated tone that

my mother was on the phone. After a few hours, I was feeling more myself again, and

before I was discharged, I filled out seemingly endless paperwork, but did not see a

single doctor. I am sure my dehydration was well managed, as I recovered rapidly after

I was discharged. The bill was several hundred dollars.

My next gastrointestinal infection occurred during the middle of monsoon in India.

I came to experience what it was like to live in rural India, but I didn't anticipate having to

experience rural illnesses. I suppose it is fitting that I too should suffer from the one of

the world's leading causes of morbidity and mortality in a rural setting.

A driver took me to my room to gather my personal necessities for bed rest and

then to the hospital. The hospital had two nurses and a doctor on staff. The doctor

examined me as one nurse prepared oral rehydration solution and the other made up

a bed in the adjoining room. A maid cleaned the room meticulously, and I was given

a special bland diet that I could force down. A nurse continually checked up on me,

and coaxed me to sip the rehydration solution and eat a few bites despite my nausea.

There were no call buttons, and I did not need to ask for attention. I saw the doctor

three times, and I never had to fill out any paperwork. Nevertheless, they explained my

discharge instructions to me in great detail before I was sent home. This time around, I

did not need intravenous fluids. The combination of oral rehydration, medications and

supportive care led to recovery in a couple of days. The entire hospitalization cost under

twenty five dollars.

During both my brief hospitalizations, I was given the appropriate medical care,

but how the care was delivered was very different. In the US, care was impersonal,

efficient, and involved extensive documentation. In India, I had greater contact

with medical staff, and I felt that they were more involved in my care. Each had its

advantages, but I would rather not think about which I would prefer next my body turns

into a petri dish.