For my international experience, I participated in an ICU rotation at Anandrishiji Hospital, in Ahmednagar, India. This experience not only provided me with valuable clinical exposure but also allowed me to witness the stark differences in practicing medicine between the United States and India.

Anandrishiji Hospital serves a diverse patient population, ranging from rural to middle-class individuals. On average, I was part of a team that rounded and cared for anywhere from 30 to 45 patients daily. Typically, patients would present with severe respiratory infections, cardiac conditions and acute exacerbation of chronic diseases, such as chronic obstructive pulmonary disease, heart failure and diabetes. However, I observed a much greater burden of infectious diseases, such as tuberculosis, and many more incidences of traumatic injuries because of workplace accidents. Furthermore, poverty and lack of awareness were significant barriers to timely health care access resulting in many patients arriving at the ICU in the advanced stages of their illness due to financial constraints or delayed recognition of symptoms. This highlighted the importance of primary health care, public health initiatives and patient education to alleviate the burden on tertiary care facilities.

During my rotation, I observed and participated in numerous procedures. The ICU team regularly performed intubations, central line placements and arterial line insertions to monitor patients’ hemodynamic status. Mechanical ventilation and noninvasive ventilation were frequently employed to manage respiratory distress. Because of limited resources, the use of high-end technology and advanced procedures, such as extracorporeal membrane oxygenation, was minimal. As a result, health care professionals relied on their clinical acumen and expertise to manage critical patients effectively to prevent further deterioration and had to anticipate which patients should proactively be transferred to a more specialized hospital.

The contrast between practicing medicine in the United States and India was evident throughout my rotation. In the U.S., health care resources are more abundant, and patients have relatively easier access to advanced diagnostic tests, medications, and specialized consultations. However, in India, resource constraints and the burden of patient volume often compelled healthcare professionals to rely more heavily on clinical judgment and basic investigations. As a result, there was less of an emphasis on ordering diagnostic imaging and labs were not ordered as frequently. Limited insurance coverage and high out-of-pocket expenses often led to financial strain on families. This sometimes resulted in families having to make difficult decisions regarding the extent of medical intervention and the duration of ICU care. Because patients and their families had to pay for most tests/medications up front, doctors created treatment plans based on what was financially feasible rather than defaulting to prescribing the “gold standard” of care. Witnessing these challenging circumstances emphasized the need for health care policies aimed at providing comprehensive coverage and affordable health care services for all segments of the population.

Overall, my ICU rotation at Anandrishiji Hospital provided me with invaluable insights into the challenges and differences in practicing medicine between the United States and India. Further, it was clinically beneficial to be exposed to a different patient population, and different types of procedures, and to practice under a different economic system of medicine. This experience reinforced the importance of resource management, primary health care and public health initiatives in bridging the gaps in health care delivery and improving patient outcomes. I am grateful for this opportunity, which has undoubtedly broadened my perspective as a future healthcare professional.

 
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