My journey as a Travel Fellow – Dr. Niranjana

It was year 2021, after the second wave of Covid-19, and I had decided not to be a doctor anymore. I felt invisible, overlooked and overworked. I did not want to prepare for a memory-based entrance exam that had nothing to do with healing and train further to be part of a system that has been designed with productivity and money in mind, not health, not humanity, not even basic courtesy or care, either for the different kinds of healthcare workers or the patients.

I worked in a corporate hospital for three months during the second wave of Covid-19 when my two-year long preparation for post-graduate entrance exams was inconveniently suspended due to the lockdown.

I quit after three months in the middle of a full-blown existential crisis , I did not know what else to do if I had chosen not to be a doctor anymore.

I traveled aimlessly with the money I had earned for the first time in my life, the one up-side to the exhausting, thankless hours spent roaming inside the glaringly bright hallways and wards and ICUs of the hospital that heartlessly churned out births and deaths by the hour.

There were gaping holes in my life, in my heart, in my future, and I had to obey the emptiness that demanded to be filled and I left home, alone, and in search of I do not know what, but I couldn’t go on in the road that had been so earmarked for me so well, perfectly chiseled out for a privileged medical graduate who had nothing to lose and everything to gain. None of my family or friends understood what was wrong with me. Neither did I have a clue , for that matter.

My wandering lead me to a village in the interior of the Kodaikanal hills, a small, remote village, cold and wet , a first for a girl like me who had grown up in the city, who had only seen villages and rice-fields flash by during road trips , well inside airconditioned vehicles not sparing even one thought about them.

The two days I spent there flushed my heart with the warmth I had sought, the people received me as their own, fed and sheltered me , a stranger who had nothing to offer them except her silent company and bewilderment at their openness and welcome.

Later, when I went back to the hostel I was staying at , in the main part of the city where I happened to narrate this bizarre flow of events to a fellow traveller and doctor , I heard the names of two hospitals who worked with rural communities that appealed to my newfound desire to work with people like these, who had provided unquestioningly in my darkest hour, quelling my desperate need for warmth and love that I didn’t know I had craved all this while.

One of those hospitals was Gudalur Adivasi Hospital, and the other was Tribal Health Initiative, Sittlingi.

When I visited Sittlingi two months later, the lush green valley opened her arms to me as I basked in her forests , sunsets and streams and showed me a path I chose to take , the Travel fellowship program.

The fellowship is born out of the Rural Sensitisation Program- a three day workshop, where medical students, interns, postgraduates from any field of healthcare come to discuss and experience medicine being practiced a much different way than how it is usually taught and practiced in medical colleges and tertiary care hospitals.

The Travel Fellowship in its second batch at 2021, had 11 centres , most of which were primary care centres with a handful of secondary care hospitals where each of the five travel fellows can choose to spend 2-3 months in , exploring health and healthcare in different communities and organisation which do not work for profit. We were encouraged to make our own decisions and choose our own centres, in our own time, exploring our own particular interests , as doctors and humans.

We had four mentors , doctors Lalitha and Regi , who had started Tribal Health Initiative at Sittlingi in 1993, doctors Sara Bhattacharji and Anand Zachariah from Christian Medical College, Vellore.

They mentored and listened to us, respecting our views and thoughts, emotions and judgements. We discussed with them our learnings in each place we spent time in, related to them our stories as we traveled, and gradually unraveled what it means to be a doctor in a system that privatises healthcare and sells health where only the affordable and privileged can access it, leaving the marginalised and oppressed to fend for themselves as they see fit.

Each of us gave different things of ourselves to the fellowship and took different things back into ourselves and our path thereon. It was a bizarrely new way of learning, unlearning and exploration that proceeded at our own pace, in sharp contrast to the hustle-culture that pervades our generation, regardless of whichever field and stage of education we are stuck inside, rattling and racing.

As I traveled, I racked my brains , worrying sick over if I was doing what was expected out of me , if I was getting the “best” out of the fellowship , disbelief was my immediate response when Dr Ravi, a Rural surgeon at Tribal Health Initiative wished me luck on my travels and said “ Be sure to have fun!”

Whichever course had ever asked , or allowed their attendees to have any amount of fun ?

But have fun I did, when I realised eventually that there really were no expectations burdened on me, and that these adults in my life were in fact, actually trusting me to do the right things, make mistakes, learn and walk at my own pace , look at the world with my own eyes, open my heart at my own will , taste  and digest the experiences in my own individual way and listen with great attentiveness and humour when I narrated them in exhausting detail.

I started trusting myself and my perceptions more as a consequence of the trust my numerous mentors extended towards me and their genuine interest in my story as I travelled, haltingly and then with increasing enjoyment and curiosity. There were no wrong turns, only a limitless space of safety and security in which I unfurled by degrees and formed my own opinions and discovered the things that made me feel alive.

There formed a steady thread of people from all the places I travelled through, that I let into my life and heart, innumerable homes I was and still am a part of regardless of time and space, tendrils of friendships and roots of belonging that firmly grounded me, quietly nestling into the vacancies in my life and heart and holding me irrevocably captive.

I slowly found a place in the communities I lived in, exploring my role as a healthcare practitioner inside and outside the system, and understood the necessity of a robust primary healthcare , especially in remote and rural areas , that can care for and address the needs of its target population effectively , working in curative and more importantly preventative aspects that will inevitably curb the load of patients reaching secondary and tertiary care centres.

I understood that there is more to health and healthcare than clinical expertise, writing elaborate prescriptions and authoritatively rebuking patients for lack of awareness on health conditions which is what most colleges including my own teach, not to mention the lack of role-models and spaces practicing ethical, humane medicine .

I began to see that the health of a person or community has deep-rooted reaches into whichever group they belong to- class, caste , gender, culture, religion and especially geography, equivocally temper how a person perceives and reaches for and successfully accesses healthcare.

Our nation’s healthcare systems are built with only the privileged in mind, deciding for the oppressed and marginalised regardless of the context of class, caste or gender , taking sparing effort to consult and engage with the communities themselves to speak and ask for their own needs in health, education and other aspects thereon.

A person can be privileged in one aspect and be oppressed in another context and the concept of intersectionality , the multitudes of identity within a single person obviously affects their health, has since generations, and possibly will for many generations to come.

Health need not necessarily be in the hands of the privileged- the allopathic doctors who have supreme confidence in their clinical knowledge and are taught to dismiss other forms and shapes of medicine as untrustworthy, trained to disregard other healthcare providers as lesser beings who are merely present to carry out their orders .

Healthcare systems are rigidly hierarchical and redundant, lacking creativity , inclusivity and promoting flagrant oppression of those within the system and the healthcare seekers as well. The system is predominantly run by people who are overworked, stressed and no closer to health than its own patients, but who do well to dictate the terms and forms of healthcare to all that are forced to enter it.

The best healthcare providers are people from the community itself, who when empowered with the exclusive knowledge of health that is choiced upon only the doctors , take up the mantle of responsibility with much courage and strength , painstakingly bringing into their own communities the torches of health and awareness to much respect and well-deserving trust effecting staggering progress and wholesomeness of health to their communities which no top-down approach of health programs can ever hope to achieve.

The decentralisation of health and the role of doctors in educating patients in health, sensitive to the socio-political determinants of that particular community or person is vital , which begins with healthcare providers ourselves opening up to experience the larger , diverse population of our country and its humans, doing whatever is necessary to widen the trickle of healthcare to a steady and sustainable flow where it can reach the last person alive.

The travel fellowship in one of the few non-judgemental , open and interactive spaces to explore our own selves and our role in the larger scheme of things, especially if we are healthcare workers, where the responsibility of the health of our patients, especially the voiceless, lie in our hands and hearts.

I welcome all those who choose to embark upon this courageous, heartening journey, within or without the fellowship program, to remember that it is right and sane to feel uncomfortable or stifled inside a system that is built without human interests at its core and to take heart in the existence of places and people that satisfying break us in all the right places if and when we open ourselves to experiences that nourish us, no matter where we are in our journey as doctors.

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