Pediatric Cardiac Care in Kerala, India. Jennifer Lewey, MD

Introduction to pediatric cardiac care in India

Walking into the hospital in the morning, I immediately begin to feel calm.  The busy hustle of patients and providers rushing to their appointments; academic presentations of recent journal articles during morning conference; the complex yet highly structured ways in which medical information is communicated: these are things I know.  Having arrived in India just this week, I am grateful for these familiar rituals.  For the next 4 weeks I will be based in Kerala, the southwestern most state, at the India at the Amrita Institute of Medical Sciences.  A private hospital with over 1,000 beds, Amrita has a strong charitable program that helps to serve those who cannot afford healthcare. 

In the past week, I have had just enough time to see one cardiac surgery, five complicated procedures in the cardiac catheterization lab, and over 50 echocardiograms of children with incredibly complex congenital heart disease.  I have shadowed rounds in the pediatric cardiac intensive care unit, impressed that I understand as little here as I would have in the CICU in Boston.  I have met an incredible team of attending physicians and fellows, whose physical exam skills give me pause about what I have been learning in my medical training for the past eight years.

Yet why travel so far when I work with some of the world’s leading experts in cardiology in Boston?  The fact is that the majority of people who have heart disease do not live in Boston.  They do not live in developed countries with functioning healthcare systems that allow access to high-quality, sub-specialized care.  They live in poor countries that often lack access to even basic medical services.  I came to India to learn how pediatric cardiac care might be realistically delivered in poor countries, where access to highly trained medical staff exist- but resources are profoundly limited.

Although comforted by the daily routine of the hospital, there is nothing routine about the practice of medicine that I am witnessing here.  

Jennifer Lewey

Resident in the Brigham and Women's/ Children's Hospital Hospital Med-Peds Program

Jonathan Reisman, Pneumococcal colonization in Alaska Native people

I visited two Yup'ik eskimo villages in the Bristol Bay watershed of Alaska - Manokotak and Koliganek. While there, I participated in interviewing household members to collect data on in-home running water, household crowding, and recent infections and antibiotic use. Our team performed nasopharyngeal swabs on roughly 450 residents of the two villages. I also was able to participate in a traditional steam bath, and to try local foods such as moose meat, caribou meat, and agutak ("Eskimo ice cream") made with seal oil. I also learned about mushing and dogsleds and ice fishing, and witnessed the beginning of the massive spring migration of water birds back to the soggy tundra of Alaska. Back in Anchorage, I worked with a statistician to analyze data from similar interviews and nasopharyngeal swabs from the previous 4 years. We found that this population lives in severely crowded conditions and only 52% of all households in the eight villages of our study had running water. We found that the risk of colonization of the nasopharynx with pneumococcus was significantly increased in children living in households with no in-home running water and with household crowding. Given that Alaska Native people have some of the highest rates of invasive pneumococcal disease, getting running water to every household and encouraging birth spacing may be important interventions to reduce this health disparity.