Closing Thoughts

With the preceding questions about big-picture stuff raised, the last question is a bit smaller. What about me personally? What have I learned? And what might I do differently as a result?

I decided to do this trip for a couple reasons, in vague order of priority:

1. Getting some sense of what health care is like in the developing world.
   
2. Experiencing what it really means to try to deliver public health interventions in the field.
   
3. Getting back in touch with my cultural roots (sort of) and having a deeper understanding of what it's like to live in India (outside my family's bubble of AC and servants).
   
4. Doing the whole "travel broadens the mind" thing, i.e. absorbing experiences, having some discomfort, and building up stories to tell friends and family over the next few years.
   
5. Having some impact on an otherwise underserved population's health.
   

It may seem strange that the last item is, in fact, last, but I had realistic expectations going in. I don't speak the language, I don't truly understand the culture, and I was there for three months. Anyone who thinks he's going to make any major impact in that situation is delusional. Therefore, the goal was not to change the health care system here, but to change me, so that over the course of the rest of my life I take actions that will improve global health.

Of the metrics above, the only one where I don't think I met my aim was #1. With no medical license in the US, it wouldn't really be ethical for me to be delivering patient care, and I chose not to be in or near a major hospital where I could do much observation (because I wanted to see the village side of things). So, I have a good handle on how we try to keep people from getting sick, but my understanding of what happens to the average Indian when he/she falls ill remains a bit sketchy.

On the rest, I definitely feel more Indian than I have in a long time (look it, too, after all this sun exposure), and I have a deeper (not deep, but deeper) understanding of what "most people live on under $2 a day" really means. I have a much greater appreciation for all the things we take for granted in the West, and a much better tolerance for the boredoms and physical discomforts of travel. Now that I've seen what things are "really" like, I do feel much more motivated to help.

The question now is how, exactly, to help. Giving money (once I have some) would work, but that's kind of a cop-out. Doing another kind of immersive project like this probably isn't the best use of my time/skills, because one-offs don't produce enduring change. Long-term involvement does. I could come back as a clinical volunteer, but psychiatry isn't general surgery -- it requires long-term involvement of the physician, and I certainly would not be able to give psychiatric care in a rural setting without a LOT of intensive language training. My best guess would be that I might be of use as a consultant or project assistant to organizations working in addictions/alcoholism or something else on the "behavioral medicine" side. That's not even remotely close to my research or any of my clinical focus, so we'll see how it might come to fruition, but I know I can make something happen if I commit to finding the time. Plus, now I've got links to two different NGOs, and through them to a very wide network of NRI involvement/philanthropy. Somewhere in there, there's got to be a project that matches my skills -- for all my frustrations, it's turned out that I was probably about the best guy available for the job I've just finished doing.

I wouldn't call the experience "fun" exactly; at times, it was downright stressful, physically painful, and frustrating. But, that pretty describes every significant effort to improve the human condition. The word I'd use is "rewarding". I feel like a better person for having done this, and I hope I'll act like a better person as well.

And now, the next question: having gotten used to blogging about the interesting bits of my daily work, what should I title a blog about the experiences of a psychiatrist in training?