FIRST DUKE MEDICAL STUDENTS TO COMPLETE A ROTATION AT RUHUNA UNIVERSITY IN SRI LANKA

After a trip to the Tsunami affected region of Sri Lanka in 2005, Drs. Truls Ostbye and Chris Woods laid the groundwork for a collaboration with Ruhuna University.  This collaboration provides Duke funding to local investigators for three research projects that will help to address some of the health care needs in the community.  In addition, Duke and Ruhuna University agreed to establish an educational exchange for medical students.  In May of 2006, two of our medical students, Channa Jayasekera and Krupal Shah, spent their elective rotation at Ruhuna.  Both of these students then spent their research year overseas with the help of HYC and Fogerty funding; Channa in Bangladesh and Krupal in Thailand.  The story below was written by Krupal at the end of his rotation.

My Most Memorable Experience on My International Rotation

By Krupal Shah

I have found, perhaps as a result of my refined expertise in procrastination, that my most memorable experiences take place at times of departure. These include the end of academic courses, the end of clinical rotations, and in this case the end of my pediatric rotation at the end of my month at Karapitiya Hospital in Sri Lanka. I chose that day, of all days, to bring my camera to rounds. I wanted to capture the environment of controlled chaos that reigned on Ward 1: the mix of parents, crying babies, harried residents, imperial attendings, and anxious/over-eager medical students. The patients were certainly the most captivating, most of them exuding an aura of calm in the small radius around their ward bed: in this crafted bubble of serenity mothers nursed their infants, parents played with their toddlers and children entertained themselves with inflated gloves and other simple toys. It was easy to forget that they had arrived with illness, were in various stages of recovery, and could still be suffering -- until you focused on the image captured.
It was in this spate of photography that I took the picture of our ward’s somewhat famous nephrotic patient. His fame had nothing to do with his disease really – but his quote on arrival (keeping in mind that he does not speak English): “Cushing’s disease secondary to steroid therapy for nephrotic syndrome.” He had memorized his ‘history of present illness’, perhaps wisely, to shorten the length of the admission interview. His features presented a classic case of Cushing’s, with a moon face, nuchal hump and truncal obesity and some of the swelling was probably attributable to his nephrotic pathology. But the steroids had also stunted his growth and so he was also short, had a high pitched voice and looked about half of his 11 years of age. He was in the acute care side of the ward now, because he was beginning to exhibit signs of renal failure. The odds of his getting a renal transplant were slim because transplants were only done at two centers in the country, Karapitiya Hospital was not among them, and the waiting lists were terribly long.
He was not my patient and so I knew little about his history until I hunted down the student “owner” (as they were called). When I had my request for a photograph translated, the patient not only agreed but also threw himself into the act with flair – rolling his eyes, which on his round face made for quite a humorous spectacle that everyone (including his father) enjoyed. Everyone except myself, that was. I had to smile, stow the camera and leave the room because, to my own surprise, I felt myself on the verge of tears. The strength of my reaction still surprises me. At the time, I wondered if I was reacting to his poor prognosis, with tears of pity. As I reflect on the experience in the few weeks that I have had since my return, I can only postulate that I felt more like a voyeur at that single moment than during the entire month in Sri Lanka. This little boy’s acceptance of my request, ease of humor and lifelong length of illness just overwhelmed me. Especially since I was on the verge of departure and he had no such option to simply walk away. The situation was at odds with what I viewed as my role as a conclusion. I feel very fortunate to have spent these four weeks with inspiring patients, devoted families and exceptionally competent medical personnel in Sri Lanka. It is my sincere resolve that when I return to Sri Lanka in the course of my career, as surely I will, that I have more to offer in the way of resources and expertise than simply an emotional response.