Even before they came to WMed in 2017, Pooja Avula and Brinda Ryali shared a strong and common interest in global medicine, in using their talents and aspirations of a future in medicine to impact the health of people around the world.
That passion led them to team up with Dr. Priscilla Woodhams, an assistant professor in the Department of Pediatric and Adolescent Medicine, to launch a new global health elective for first- and second-year medical students that is helping improve women’s health in India.
“It was really important to us to create an international health rotation for pre-clinical students at WMed with a focus on increasing cultural sensitivity and providing care to underserved and vulnerable communities,” said Ryali who, along with Avula, is set to graduate from the medical school in May.
To make the global health elective in India a reality, Avula and Ryali worked with Dr. Woodhams and collaborated with the Institute for Rural Health Studies (IRHS), an organization that provides preventive healthcare services to poor communities in Telangana, South India. Avula and Ryali traveled to India in the fall of 2018 and spent a week at a primary care clinic in the village of Dokur, as well as a hospital in Mahbubnagar, learning about the most prevalent health issues and the needs of those who call the community home.
During that initial visit two years ago, Avula and Ryali got an up-close look at how the IRHS helped train local paramedics and community health workers to care for residents in what is a resource-poor region of India.
“We looked at the most prevalent issues in the community and created projects to address those community needs,” Ryali said.
The visit in 2018 laid the groundwork for the new global health elective and provided direction for how Avula, Ryali, and other students at WMed could work with the IRHS and help improve women’s health in India through education and breast cancer screenings.
While mammograms are common in the U.S., Avula said very few women in India get regular screenings, a trend that stems from cultural beliefs around modesty. That reality has led to a five-year breast cancer survival rate in India of just 66 percent, compared to 90 percent in the U.S., Ryali said.
“We want to bring a greater awareness of what breast cancer is and we hope that more women will be screened,” Avula said. “To us, that education and the growth of screenings is the basis of everything that we are doing.”
For Avula and Ryali, India and the work they have helped start there holds special importance. They both have family in Hyderabad, India, and Avula lived there with her grandparents until she was six years old. Ryali, meanwhile, lived in India for more than four years and attended middle school and high school there. She visits the country regularly with her family in the summer.
“It’s very close to our hearts, we grew up there,” Ryali said. “We just want to give back because it is a big part of who we are.”
In March 2019, Avula and Ryali returned to India, this time with seven classmates and Dr. Woodhams. During what was a busy week, they talked with physicians and community health workers in Dokur and Mahbubnagar about incorporating routine breast exams into the cervical exam services that are already in place at the hospital in Mahbubnagar. Additionally, Avula and Ryali said a mobile mammogram unit provided breast cancer screenings to 30 women in a single day.
Students also got the chance to provide breast exams under the supervision of Dr. Woodhams and they visited an Indian school where they provided education to young girls about an array of topics, including reproductive health and cardiac health.
“One aspect of the education is empowering these young girls and telling them they can do whatever they put their minds to,” Ryali said. “We tell them to dream big and that there are opportunities out there. In terms of what we want to do in India, that empowerment is part of a tangible impact that we can have.”
The students and Dr. Woodhams also took part in a two-day pediatric camp at the clinic in Dokur where they saw 200 children who were in need of acute care and well-child exams, and Dr. Woodhams provided education for local paramedics who regularly treat villagers.
“Not only was she treating the children but she was also giving the paramedics more tools for their toolkit,” Avula said of Dr. Woodhams.
Dr. Woodhams praised Avula and Ryali for what they have accomplished during their time at WMed and bringing their vision of the global health elective in India to life. She said that as the elective continues, care providers and patients in India will benefit from the care and education that WMed students and faculty will provide. And students at WMed will be able to gain experience and hone their physical exam and clinical reasoning skills early on in their medical school careers.
“When you start medical school, everyone has different expectations and most students don’t have a chance to see firsthand what it’s like to take care of patients in a resource-poor setting,” Dr. Woodhams said. “It gives you a chance to see early on in your training how and why the skills you are learning are so important for those times when you can’t get an MRI or a CT scan, or an X-ray.”
As they near the end of their time as students at WMed, Avula and Ryali said they have plans and hopes of continuing to work with Dr. Woodhams and be a part of the annual visits to India even after they have entered residency training.
Dr. Woodhams, as well as other WMed faculty and 10 students were set to return to India in March but the trip was canceled because of the COVID-19 pandemic. Plans for a visit in March 2021 have also been canceled.
In the midst of those challenges, the work that Avula and Ryali started will continue. They are working with Dr. Woodhams to put together a virtual elective that will allow more students to learn about India and its healthcare system, and they remain hopeful that students and faculty will be able to return to India in 2022.
“We want to give students that perspective and increase their awareness of things like culture and language sensitivities,” Ryali said. “Global health is not just about international trips, it’s about improving the health of people around the world and promoting health equity whether that’s locally or internationally.”
Dr. Woodhams said that despite the challenges posed currently by the pandemic, she also wants to continue to provide education to care providers in India this year through virtual platforms. WMed students will play a key role in putting that educational experience together, she said.
“It’s incredibly important when you’re thinking about health equity and those who don’t have resources to think about what is or might be possible instead of what’s not possible,” Dr. Woodhams said. “It’s really important to think outside the box and it takes an incredible amount of perseverance. The quality that led Brinda and Pooja to make this global health elective a reality is they have outstanding perseverance.
“Perseverance is key.”