Our third week of the rotation took us to the mountain village of Mussoorie which is one of Dehradun’s many “Hill stations.” After an hour and a half drive up the winding mountain roads (which left all of us feeling somewhat nauseated) we arrived at Landour Community Hospital (LCH) which sits on top of a hill cut into the side of the mountain. The hospital is a Christian mission hospital run by the Emmanuel Health Association. Its goal is to provide quality care at minimal cost to the patients of the surrounding area.

To be honest, I had very low expectations for the hospital. After seeing what hospitals looked like in Dehradun, I thought this rural mission hospital would be far worse than what we had seen. Much to my surprise, it was perhaps the nicest hospital I have been in since arriving in India. Apparently, one of the local resort owners had provided a $500,000 donation about five years ago to completely renovate the hospital. Now, LCH is very clean, well-kept, and “state-of-the-art” (as far as rural mission hospitals are concerned). The facilities include a small emergency department, two operating theaters, Digital x-ray facilities, a labor and delivery hall, a very well-stocked pharmacy, and a small ICU (which is about equivalent to a step down unit in the US). The hospital has one orthopedic surgeon, two house medical officers, and one general practice physician. We spent the majority of our time with the two house medical officers and a visiting surgeon. Otherwise, the hospital is staffed by locals from the community, who have had some (but not much) medical training.

The main operating theater at LCH. They would usually turn on the heaters about 2 hours before surgery so that the room wasn’t freezing cold.

As I mentioned before, we spent the bulk of our time with the two house medical officers and the visiting surgeon. Because it is winter, the patient volumes are very low and so we got to spend a lot of time talking to the local doctors about their life stories and what it is like to practice medicine in India. The two medical officers, Alan and Naveen, were quite young. Both were around 23 years old, had completed medical school, and finished their intern year. This was their first of two years of mandatory service obligations. Alan has aspirations to be an orthopedic surgeon while Naveen would like to be either a neurologist or neurosurgeon. It was neat to see these two work after have only having had one year of experience practicing medicine independently. Their fund of knowledge was impressive and their scope of practice quite broad (out of necessity). Given the rural nature of the hospital, these two have performed many minor operations including tubal ligations and C-sections. I’d consider giving up my left arm if I could be half as good as these two by the end of my intern year.

The visiting surgeon, Dr. Bona, was an incredibly interesting man to talk to. In short, he is a general surgeon turned plastic surgeon who has dedicated his life to mission work. He has had the chance to travel the globe with an organization called Smile Train performing cleft palate surgery for children in need. I’ll spare you some repetition and instead point you to my other post that describes our conversations with Dr. Bona.

To be honest, I did find it a little odd to see a Christian Mission Hospital in the middle of rural India. But, after asking about the hospital’s history, we learned that this area was important while under British control not so long ago and therefore there was an influx of Christianity and Christian missions. The daily devotionals certainly were an interesting experience where we heard Christian prayers and hymns recited in Hindi rather than English.

The small ED at LCH. They had just recently printed out large posters with ACLS algorithms to hang on the walls.
The main first floor corridor of the hospital.

For as much good as the hospital does, there is so much more that they could potentially do. LCH is plagued by a lack of resources, and no means acquire more. Most of their surgical instruments are 50 years old, they have to reuse sutures from patient to patient because they can’t afford new ones, their monitors are 20-year-old imports from China that can’t be trusted, and the support staff, despite trying their best, aren’t always able to provide good care. Seeing hospitals such as this has become part of my inspiration for pursuing global health as part of my career. The foundations are present at LCH for something big. The doctors are eager to serve and the staff is incredibly dedicated (they’ve gone without pay for months at a time during financial rough patches). With some good education and even just a few more resources this hospital can go from being good to great and have an even larger impact on the community.

Countless times I found myself wondering about small changes that could have a massive impact at the hospital. Even in our one short week of working at the hospital, it was readily apparent that they could stand to benefit from protocols and pathways for emergency care. Ultrasound training for the physicians could save them from having to refer patients to Dehradun for a scan – LCH even has an ultrasound, but nobody is certified! The nurses could benefit from advanced training and the system as a whole could use some operational improvements. Despite the room for improvement, the medicine being practiced by the physicians is great and is up to first world standards.

Sunset from the front stoop of LCH.

What I see in LCH is the perfect example of how mission medicine can have a huge impact. Yes…. it is great to have doctors from foreign countries come and provide care for a week or two and then leave. But LCH is so much more than that. They are an institution in their community and are able to provide long-term care by locals who know the patients and understand what problems they face on a daily basis. For those interested in mission medicine consider the following (shout out to Bill Nye the Science Guy!)…… Rather than having foreign physicians come in and provide medicines or medical care, they can come provide training and resources to improve the already existing facilities. They can use their knowledge and experience to better the local staff and physicians. By doing so, they are going to have a much larger and longer lasting impact in the community than if they were to hold a couple of clinics or do a handful of surgeries. This, in my opinion, is what mission medicine is really about – finding ways to make a lasting and sustainable impact on a community rather than temporary solutions.