Cardiff University medical student Angelica Sharma completed her placement in Agra, India, with the help of the Ray Murray Travelling Fellowship at the start of 2020.
The Ray Murray Travelling Fellowship was introduced in 2016 to help medical students specialising in Urology to fund their elective studies in memory of Prostate Cymru’s founder chairman Ray Murray, along with the Ray Williams Travelling fellowship in memory of the founding Chairman of the Pembrokeshire Friends of Prostate Cymru, Ray Williams OBE.
The placement consisted of observing the Indian healthcare system, in particular Urology.
Angelica’s exciting journey saw her travelling to an array of different hospitals including Max Hospital and the All India Institute of Medical Sciences (AIIMS) in New Delhi; the Purushottam Das Savitri Devi Cancer Care Centre and Rainbow Hospital in her birth town of Agra.
Talking about Max Hospital Angelica said, “This is a super-specialty hospital including a state-of-the-art centre of Urology. This was of course very different to the common ward spaces I’m used to within the NHS! Each patient had their private room with en-suite and extra space for an ‘attendant’ (i.e. relative). The staff were very focussed at providing optimal patient care, and the outpatient clinics ran very smoothly despite the overwhelming large number of patients present.”
Angelica went on to visit the All India Institution of Medical Sciences in New Delhi. This is a public-sector hospital, medical school and prestigious research centre – ranked number 1 in India.
Angelica said, “I couldn’t leave New Delhi without a quick tour of the All India Institute of Medical Sciences, which was inaugurated by Her Majesty Queen Elizabeth II in 1960’s. I was able to observe a diverse sample of the population i.e. those from rural areas vs. urban areas. AIIMS has facilities for robotic prostatectomy for prostate cancer”.
The next stop on Angelica’s trip was in her birth town of Agra, city of the Taj Mahal, one of the Seven Wonders of the World.
The Purushottam Das Savitri Devi Cancer Care Centre specialises in a range of cancers including breast, prostate, bladder and oral cancers.
She explained, “On my first day, I observed a patient receiving external beam radiotherapy (EBRT) for a locally advanced prostatic adenocarcinoma with histological Gleason score of 5+5. I had the privilege of following the patient’s journey. Prior to delivering radiotherapy, a unique plastic mould is tailor-made for each patient over which the radiotherapy is delivered. The area requiring radiotherapy is marked to ensure it is accurately targeted. This was the first time I had seen the process of creating a mould for such purposes!”
Angelica interacted with inpatients and attended outpatient clinics. She mentioned, “Despite having a good grasp of Hindi, I was intrigued by the variety of local dialects. I could comfortably understand one patient, but another would explain symptoms in a slightly different dialect (or slang!) which was more difficult to follow”.
Angelica was invited to a dinner meeting organized by Agra Urology Association (AUA). This included a series of interactive talks including ‘Imaging of Genito-urinary fistulas’, ‘Coagulum Pyelolithotomy’ (presented by fellows from Portugal) and general case presentations. Angelica found the talks of value, enjoyed interacting with colleagues and found it gave her an overview of Urological investigations and techniques used in India. This was a nostalgic moment as the AUA was established by her father in 1992.
Her final stop was at Rainbow Hospital. This is a multi-specialty hospital in Agra, specialising in Urology, Obstetrics & Gynaecology, Neurosurgery and an award-winning centre for in-vitro fertilisation (IVF)/ assisted reproductive technology.
Angelica said, “I was most impressed by their infertility services. It was an honour to observe sensitive discussions with couples hoping to conceive and to share the joy of a positive pregnancy”.
She was given the opportunity to explore the field of Andrology, “I was able to appreciate the true sense of bench-to-bedside medicine. For example, a testicular biopsy was conducted in theatre and the sample was immediately analysed in the embryology laboratory. It was fascinating to then observe intracytoplasmic sperm injection (ICSI) procedure, this was my first time exploring assisted reproductive techniques up close”.
Furthermore, she claimed, “I was amazed by the size of their renal dialysis unit and interacted with patients and their families to elicit their experience of dialysis”.
When the Urology ward was quiet, Angelica attended teaching sessions with the junior doctors and was welcomed as an integral part of the team. She spent time in the intensive care unit (ICU) where she assisted in carrying out basic procedures such as venepuncture and cannulation.
Just towards the end of her elective, the COVID-19 outbreak hit the headlines. Angelica stated that the outbreak was a scary time for patients, “when I left in mid-March patients were attending hospital with face-masks and visors, the hospital staff were also trained on the use of personal protective equipment. The senior doctors organised an educational talk on ‘Coronavirus’, including its symptom presentation for patients and highlighted the importance of social distancing. These pre-emptive measures were introduced prior to any news of a confirmed case in Agra and a formal lockdown”.
Angelica would like to take this opportunity to thank Prostate Cymru. She highly appreciated their invaluable support in undertaking this elective, and notably: Dr Sandeep & Parul Agarwal (Oncologist & Directors of Purushottam Das Savitri Devi Das Cancer Care Centre), Dr Eeshita Agarwal (Junior Doctor), Dr Narendra & Jaideep Malhotra (Consultant Obs&Gynae, Directors of Rainbow Hospital), Dr MS Agrawal (Urologist, President of Urological Society of India), Agra Urological Association, Dr Vandana Kalra (ICU Consultant)and Dr Ajay & Shwetank Prakash (Laparoscopic/ Laser surgeons).
While the second half of Angelica’s elective in California (USA) was sadly cancelled due to COVID-19, it’s fantastic to hear about her travels through India and her experiences of the Indian healthcare system.
Currently, Angelica is volunteering in an NHS hospital until she starts her Junior Doctor Foundation Year which will be commencing in the next month at Northwick Park Hospital.