Dr. Krishnan Raghavendran is a Professor of Surgery, Division Chief of Acute Care Surgery, and Director of the Michigan Center for Global Surgery at the University of Michigan Medical School. Raghu, as his friends call him, seldom stands still—his energy and positive attitude is infectious.
Among the many other things he does, Raghu has been instrumental in establishing research collaborations between the medical school at U-M and several institutions in India, including the prestigious All India Institute of Medical Sciences (AIIMS) in New Delhi, India’s premier academic medical center. U-M’s partnership with AIIMS focuses on a range of medical and surgery specialties, and includes both research and practice components. In 2010, Dr. Raghavendran helped initiate a bi-lateral project on trauma care, which brought several AIIMS faculty to study and work at UM in the Trauma Burn and Critical Care program. Since that initial visit, many more AIIMS faculty have studied, done research, and attended workshops at U-M, and these visits have paid off in terms of increased success in securing research funding in India.
Yet another important benefit of the joint trauma project is that it allows medical students from U-M to spend time at AIIMS in New Delhi, working with local surgeons who practice in a resource-limited environment. We recently talked to Tessa Adzemovic – a fourth-year medical student at the University of Michigan – who interned at AIIMS’s trauma center in the summer of 2018.
CSAS: Welcome, Tessa! Please tell us something about yourself and your interest in studying medicine.
Tessa Adzemovic: I was born in Toronto to Bosnian immigrants. I lived there for about seven years before moving to Ann Arbor, Michigan. I went to the University of Michigan for my undergrad and then I pursued medical school there. During my time on campus as an undergraduate, I was lucky enough to receive a Center for South Asian Studies Summer in South Asia Undergraduate Fellowship, which allowed me to go to India for the first time. I was able to work in Nizamuddin Basti in South East Delhi, where I worked for the Hope Clinic. My role was to do qualitative inquiry into the nursery and the health clinic. I found myself grad7ually gravitating more to the health clinic, so I spent more and more time there in the evening hours and on the weekends. While working there, and seeing those unique patient interactions with a very vulnerable population that originally inspired me, I discovered that I wanted to be a doctor. I returned to the U-M campus and decided to pursue medicine.
CSAS: Is it true that you hadn’t thought about going to medical school before you got the fellowship from the Center for South Asian Studies? In other words, did CSAS help you decide that you wanted to study medicine?
TA: That's right. I had been interested in global health, but I was actually a French major, so most of my education before that had been in French. So, through French I discovered my love for languages and I love having interactions with people from different cultures. But at that time I had not declared myself as a pre-med.
CSAS: How did you learn about All India Institute of Medical Sciences collaboration?
TA: I had done my two years of book work at U-M and I felt that I really wanted to go back to India during my medical training, because that was where I had decided that I wanted to be a physician. I did some googling and found Krishnan Raghavendran, a professor of surgery at U-M. I learned that in 2010 a partnership was created between All India Institute of Medical Sciences and University of Michigan. This global reach platform had the ability to sponsor students to go to India. I contacted Raghu, and we created a research thesis situated at AIIMS.
CSAS: Can you tell me about some of the differences and similarities between US and Michigan hospital and AIIMS?
TA: I grew up in Ann Arbor which is a town of about one hundred thousand, and Delhi’s population is about 20 million. AIIMS has amazing technology and they have incredible physicians, but their physicians work about two times more than we do. It is difficult to work in a country that has more than a billion people, even when you have all the resources. And that becomes 10 times harder when you go to a clinic or a hospital that does not have the same resources that AIIMS does. What I constantly felt in India was that I was very similar to the Indian medical students and medical residents that I was working with. As far apart as we may be geographically, we are all very similar as humans on this earth.
CSAS: Did anything surprise you while working at AIIMS?
TA: I think one of the most surprising elements was the amount of responsibilities that some of these young Indian physicians took on. In the United States, there's a lot of liability around medicine that is not necessarily there in India. Some of my colleagues were taking care of 7-8 trauma patients overnight, because that is what they have to do there.
CSAS: How does that compare to the trauma center at the University of Michigan?
TA: I was working at a 200-bed trauma hospital in Delhi. And of course, we don't have 200 beds dedicated to trauma patients by any means at the U-M, because we do not have that need. The reason for that is the number of motor vehicle accidents is much greater in India. Most of the accidents occur with two-wheelers or three-wheelers and auto-rickshaws. India is also a story of resilience, where these young Indian physicians are stepping up to what they have to do.
CSAS: What did you learn while working at AIIMS?
TA: I learned several things. I was very grateful for the experience, and I think it has definitely changed my point of view. I think it has allowed me to better take care of the patients that I see as a medical student on my internships and the patients that I will see during my residency. It has taught me a lot about cultural humility, rather than cultural competency.
CSAS: What do you think is the solution for Indian hospitals?
TA: I think the solution for India would be to train more physicians and get more ambulances on the road, because at this point patients are being brought in either by private parties or families in their own private vehicles, or by autorickshaws which really aren't meant to bring in patients. I think we could help by giving resources, but also by teaching about how to get resources, receiving grants and funding from large research institutions and by creating partnerships between our medical schools and their medical schools.
CSAS: Do you think more medical students like you should go and spend time in Indian hospitals?
TA: Absolutely. Although, we have to be careful about how much of their time we’re taking and ensure that we are gracious for the time they’re giving us.