Alasdair Menzies describes his elective with The Leprosy Mission.
My interest in tropical and infectious diseases made India my obvious choice for the medical elective so I applied to The Leprosy Mission England and Wales to work in the hospital and clinics it supports.
August, I have been told, is not the ideal time to visit Delhi - although it is the beginning of the nominal Monsoon season, it is still hot and humid.
I am usually fine living and traveling around the place by myself but I felt lonely at first, mainly because the hospital shut at 5pm and there was nowhere you could go. So you learn to pray a lot.
The training began with a ten day course on leprosy management and dermatology, which proved very useful. It was followed by placements at Shadhara Hospital, in a deprived area of Delhi and Purulia hospital, in West Bengal.
What I witnessed and experienced during the next three months shocked, surprised, touched and humbled me. The scale of suffering and poverty was beyond my imagination. Yet people's positive attitudes, resilience and generosity, despite owning very little, was humbling.
When you first enter the wards for leprosy patients, it doesn't take you by surprise, probably, because the patients are friendly and polite and smile. But once the enormity of what some of them are facing dawns on you, it is pretty shocking.
The extreme disability, psychological distress and social stigma are stark. Most had so few material possessions, yet they always seemed positive.
Patients I met may face disfigurement, disability, blindness, significant psychological and social issues, yet it's unlikely they would have a fraction of the support in place that we have in the UK.
Leprosy still has huge stigma
Leprosy is completely curable but there is still huge stigma attached to it. Whole families can be thrown out of their village because of the ancient belief that it is a curse. The consequence is that many people hide the symptoms until it is too late and their hands and feet become deformed. In some cases their leg may need to be amputated.
In 2014 there were 213,899 new cases of leprosy diagnosed world wide - one every two minutes. More than half of these were in India.
Over the two months I had the opportunity to observe and assist physiotherapists, help with assessments and splinting, and shadow doctors in outpatients. I also accompanied medics to a community clinic where people who could not afford to travel or were too frightened to seek treatment were given care.
I'd often shake the hands of patients, which may not seem a big thing. But not too long ago the general belief was that leprosy was spread by touch (which we now know not to be the case). It is also not hereditary and is most common in places of poverty where there is overcrowding and poor nutrition.
Commitment of Christian staff
The commitment of the staff was touching. Many of them have chosen to work their whole careers in the service of The Leprosy Mission because of their Christian faith.
The language barrier was frustrating, though. I wanted to know more about the patients - what did they do? What was their favourite sport? I learned a few phrases, which went a long way.
The mental and physical challenges are many. In the early days I had lots of doubts particularly when I saw pictures on social media of course mates enjoying warm beaches during their electives, while my surroundings were the slums of Delhi.
But the great thing is you overcome all that. Soon I began to understand the culture, and a little of the language, and that made me confident of my surroundings. I began to see that there was a purpose to my being there.
Getting hands on experience of examining patients and talking to them is great. Even though I am just a medical student, the doctors would often ask for my opinion - 'what do you think this could be?' - or they'd ask me to show them how to examine the posterior tibialis pulse. I felt integrated, wanted, and that I had some sort of purpose. I even had the opportunity to become involved in research into relapse of leprosy, and assisted other researchers with writing their papers.
Overall it has been edifying for my faith. I think because you really have to trust in God the whole time. It has also reaffirmed my vocation to become a doctor.
Distributing medicine is a challenge
Leprosy can be treated easily with Multidrug Therapy (MDT) - a combination of a combination of rifampicin, clofazimine and dapsone. The drugs are provided free in all affected countries by the World Health Organisation. Before I went to India I naively thought 'surely then treating leprosy shouldn't be such an issue'?
I soon learned about the logistical nightmare of getting the medicine to the patient, and challenges for the patient to return for treatment if there is a reaction. Access to transport is extremely limited, and many patients will wait in the heat for hours, with little food or water. Their resilience and determination was humbling.
Lucky to have the NHS
My experience has really made me grateful and thankful for the National Health Service. Seeing the stark difference has made me realise we are fortunate in comparison and we should not take it for granted.
Alasdair Menzies is a clinical medical student at Peninsula School of Medicine.and Dentistry, Plymouth University. He arranged his elective through The Leprosy Mission: www.leprosymission.org.uk