Throughout my childhood, my mother always reminded me that, as a first generation Indian-American, I should, “take what is best from each culture and leave the rest behind”. My father, the high-energy physicist, gave me considerable room to explore, allowing me to take apart electronics or furniture and reassemble it. It was little surprise to them that, before I learned to read, I figured out how to use my dad’s socket wrench to take off the training wheels on my bike. Nevertheless, I do not believe we would have predicted the incredible journey around the world I would take over the next 25 years, becoming the first doctor in the family.

One small step: Emergency Medical Technician (EMT-B) at Washington University in St. Louis

I signed the application for the Emergency Support Team (EST), Washington University’s volunteer EMS service staffed exclusively by undergraduates. My first exposure to the world of medicine was perfect. As an EMT-Basic, I learned to manage traumas with the equipment we carried or treat medical emergencies within our limited scope of practice. It was a collaborative environment, with a crew of two experienced EMTs and one in training.  I discovered a new passion to teach, training the new recruits and the rising EMTs practicing for “mock calls”. Over the years, I grew confident in EST’s capabilities. After logging over 2800 hours on duty and rising to the role of Field Director (chief), I realized the extent of my hubris. Following a shift change one April afternoon, I watched the news with my colleague, Jeremy, as every resource in his hometown was deployed following the bombing of the Boston Marathon.Describe EST.

One giant leap: Moving to India

A couple weeks prior to the bombing, I received a letter inviting me to join the MBBS program at Manipal. For some time, I imagined spending a year in India as a ‘clinical sabbatical’ from a future medical school career. There is a common trait among EMTs and Indian physicians – jugaad. Though no exact translation for this Hindi word exists, jugaad describes an unconventional, often cost-effective hack to a problem. When applied to medicine, Stanford’s Dr. Manu Prakash coined it “frugal science”. Coincidentally, Manipal alumnus Dr. Devi Shetty gained further international attention for his profitable sub-$2000 coronary artery bypass surgeries. Conceptually, I knew that this financial efficiency could not be explained merely by currency exchange rates and cheap labor. That month, several Boston doctors wrote about the preparedness and coordination after the attack. Massachusetts General’s Dr. Alasdair Conn credited a visiting team of Israeli physicians whose training two years prior improved disaster response. It became clear to me that healthcare could benefit by sharing international medical wisdom. I hoped India’s jugaad could improve the efficiency and cost-effectiveness of American healthcare.

Seeing my home from afar: MBBS at Kasturba Medical College, Manipal

Like its national flower growing in an unforgiving environment, India’s lotus is jugaad – finding the path of least resistance needed to accomplish its goal. Our main hospital at Kasturba Medical College, Manipal, sees 2,800 out-patients per day, with over 200 admissions to the 2030 beds. A tiered room system bridges the wealth gap. Faculty emphasize that knowing an investigation’s cost is equally important as its sensitivity. There is continuous community surveillance monitoring endemic disease and its social determinants. I struggled knowing that many Americans did not have third world country resources.

The return home: Applying for post-graduate training in the US

In this next chapter, I look forward to developing my skills as a safe and competent doctor. I am excited to bridge my experiences as an EMT and India-trained physician towards a career in trauma. Through clinical research, I hope to determine the validity of various frugal medicine techniques I learned abroad. Together, I hope we make a positive impact on American healthcare, improving its efficiency and cost-effectiveness. Perhaps all we need is some jugaad, bringing the best of Indian creativity to the best of American ingenuity.

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