Dispatch from India
http://www.100md.com
《新英格兰医药杂志》
To the Editor: Although we applaud the insights in Gawande's Perspective article, "Dispatch from India" (Dec. 18 issue),1 we would like to point out that his experience of conditions in Indian hospitals was, of necessity, a limited one. A two-month visit is not adequate to obtain a complete picture of a health care system that is as diverse as the vast population that it serves. Had Gawande's involvement been more extensive, he would have seen, as we did during our 12 years as medical students and physicians in India, that there are many hospitals in the country where the average person can obtain, without resorting to bribery or political influence, a level of medical attention that rivals the best available. Doctors at these institutions are dedicated, compassionate, and well versed in the use of both bedside clinical methods and sophisticated medical technology. Their ability to care effectively for their patients under difficult circumstances — not just in the sense of "making do" (as Gawande puts it), but by the creative application of limited resources — is a testament to their extraordinary skills.
Bobby J. Cherayil, M.D.
Massachusetts General Hospital
Boston, MA 02114
cherayil@helix.mgh.harvard.edu
Nandini Sengupta, M.D., M.P.H.
Dimock Community Health Center
Boston, MA 02119
References
Gawande A. Dispatch from India. N Engl J Med 2003;349:2383-2386.
To the Editor: The scenario painted so vividly by Gawande exists even in medical specialties in India. We have worked as pediatricians in India, and it now seems surreal that we evaluated approximately 300 children in one eight-hour shift with little additional help. The only triage possible was to send a resident down the thronging line of patients often and to bring any gasping child to the treatment room. What usually followed an emergency intubation was a crash course for the parents in the technique of assisted ventilation with a self-inflating bag. Often, a dozen children would be lying side by side, all being bagged patiently by their parents, since ventilators were scarce. Diarrheal diseases during summers and pneumonias during winters, interspersed with encephalitis seasons, would test the limits of available resources. Tetanus, poliomyelitis, measles, malaria, rheumatic heart disease, and meningitis are common, greatly contributing to mortality and morbidity.
Practicing medicine in India represents an experience of extremes: exhilaration from saving lives but frustration from often being a helpless spectator — both in the same day, many times over. Gawande's article brings back those memories.
Naveen Manohar, M.D.
Parthak Prodhan, M.D.
Massachusetts General Hospital
Boston, MA 02114
pprodhan@partners.org
Bobby J. Cherayil, M.D.
Massachusetts General Hospital
Boston, MA 02114
cherayil@helix.mgh.harvard.edu
Nandini Sengupta, M.D., M.P.H.
Dimock Community Health Center
Boston, MA 02119
References
Gawande A. Dispatch from India. N Engl J Med 2003;349:2383-2386.
To the Editor: The scenario painted so vividly by Gawande exists even in medical specialties in India. We have worked as pediatricians in India, and it now seems surreal that we evaluated approximately 300 children in one eight-hour shift with little additional help. The only triage possible was to send a resident down the thronging line of patients often and to bring any gasping child to the treatment room. What usually followed an emergency intubation was a crash course for the parents in the technique of assisted ventilation with a self-inflating bag. Often, a dozen children would be lying side by side, all being bagged patiently by their parents, since ventilators were scarce. Diarrheal diseases during summers and pneumonias during winters, interspersed with encephalitis seasons, would test the limits of available resources. Tetanus, poliomyelitis, measles, malaria, rheumatic heart disease, and meningitis are common, greatly contributing to mortality and morbidity.
Practicing medicine in India represents an experience of extremes: exhilaration from saving lives but frustration from often being a helpless spectator — both in the same day, many times over. Gawande's article brings back those memories.
Naveen Manohar, M.D.
Parthak Prodhan, M.D.
Massachusetts General Hospital
Boston, MA 02114
pprodhan@partners.org