“Many are called but few are chosen,” is an aphorism with biblical references. The opportunity of learning from an existing institution that free medical care is both possible and sustainable is open to all. The choice to come and learn is left to the interest and commitment of the individual. People from many walks of life have visited the SSSIHMS both at Prasanthigram and Whitefield and the outcome of consequent interactions has definitely been synergistic.

The requirement for admission into medical schools is changing, especially in the West. Students are asked to get exposed to practical aspects in hospitals before embarking on a medical career. The making of a doctor requires unique skills and psychological makeup apart from sheer scholastic excellence. One student from the USA, Suraj Yalamuri, visited SSSIHMS Whitefield on that mission. He observed clinical work and participated in research. He also helped in preparing a presentation and participated in the symposium “Spirituality and Sai Health Mission.” This is his story in his own words.

Suraj Yalamuri Narrates His Story - The Preparation

		Over the last few years the number of students applying to medical schools has been on the rise. To choose from this sea of well-qualified applicants, school committees are increasingly relying on extracurricular activities. In a recent Kaplan University (USA) article, it mentioned the most sought after extracurricular activity was clinical experience. The article said: While not an official requirement, it's become increasingly difficult to get into a top med school without clinical experience. Whereas applicants were once asked, "Do you have any clinical experience?" they're now being told, "Please discuss your clinical experience.” The one phrase I kept hearing from medical applicants and professors was “intent to practice medicine.” How would I show the medical colleges I could handle the rigors of training and the resulting profession if I had never been exposed to it? How would I get across my passion for the field? Simply saying, “I want to help people,” is not enough.
Sri Suraj Yalamuri

The question becomes, “Why do you want to help people medically?” and “What experience have you had that makes you think so?” So how does one gain clinical experience even before entering medical school?

These questions racked my brain during the summer of 2005. My interest in medicine and my desire to help people began quite early. Coming from a devout Hindu family, we went to temple every Saturday. Outside the temple, there sat a group of disabled beggars and I always borrowed money from my dad and gave it to them. There was one man who sat at the very end. His legs looked normal but he could not walk. I asked my mom why and she simply said, “I don’t know. But I bet a doctor might.” Later, as I was putting on my shoes, she said, “You know a doctor is the only person who can directly make a difference in someone’s life.”

This incident inspired my interest in medicine. I remember at my first visit to the optometrist I was fascinated by the model of the eye resting on the reception counter. After coming home, I questioned my dad on how the eye worked. Being an engineer he drew an analogy between the parts of the video camera and those of the eye. I remember staying up past my bedtime learning about the differences and similarities between cameras and eyes. As I went to my room, my dad jokingly mentioned that if he were to replace my eyes with a camera I might not trip over myself and walk properly. Little did I know at the time that in the near future this would become a potential alternative for providing vision to blind people and I would be spending vast amounts of my free time researching the topic.

This initial kernel of interest in medicine developed into a passion. In high school, I took rigorous and Advanced Placement courses to learn the basics of physical and biological sciences to better prepare myself for college. Outside of school, I attended seminars and talks given by visiting scientists and medical doctors to the Portland Metropolitan area. One of my favorite and inspiring lectures was on medical engineering marvels. The topics covered included the artificial heart, artificial blood, and electronic glasses providing vision to blind people. These embodied the application of knowledge and drove my interest into research.

Throughout my junior and senior years in high school, I worked on a research project which resulted in a computer model of the environmental impact of greenhouse gases. The resulting project was awarded second place in the Intel Northwest Science Expo in the field of Chemistry and Environmental Sciences. Even though the project was not directly related to the field of medicine, it provided me with the basics of scientific inquiry and methods I now use regularly in the research lab at the Institute of Neuroscience at the University of Oregon. My research focuses on the synaptic cell adhesion molecule SynCAM and I am characterizing the six different isoforms of this molecule found in the brains of mice.

Having been involved in the technical and research area of biosciences, I was eager to gain clinical experience and have direct interaction with patients. The problem was I did not know what to look for in the profiles of the internships being offered. I made independent research and found programs designed for premedical students at Harvard, Duke, and the Oregon Health and Science University (OHSU).

But what caught my eye was the mention of the Sri Sathya Sai Institute of Higher Medical Sciences (SSSIHMS) in India, on the website of AID for India. Besides being a Super Specialty Neurosurgery and Cardiothoracic and Vascular surgery hospital, all the medical care provided to the patient is absolutely free. Immediately, I wanted to know more and understand the driving force and mechanism of such a concept. So I set up a self-arranged medical internship at the hospital through the University of Oregon with help from the chief surgeon, Dr. Anil Kumar Mulpur. I couldn’t wait for the summer to arrive! Interning at SSSIHMS A first look at the hospital will tell you it is unlike any other. The architecture escapes the normal constraints of a regular hospital. It is neither a steel high-rise building nor a concrete monolith. The first thing you notice is a huge dome and vast expansive lawn. The Hospital looks like a big home. This sense of space is prominent even inside with wide corridors and high ceilings. The building is divided so that half the space is used for the cardiac sciences and the other half for the neuro sciences. The majority of my internship was in the Cardiothoracic and Vascular Surgery Department. In the first few weeks I had the privilege of witnessing open-heart surgeries, went on rounds through the ICU and the CCU with resident doctors, and was exposed to many technological marvels that assist doctors in and out of the operating theater. I had the opportunity to follow the course of the patients pre-operatively, intra-operatively, and post-operatively. My most memorable experience was when the chief surgeon asked me to watch one of the surgeries on my first day. He explained the details of the operation, the anatomy of the heart, and the process of circulation during the procedure.
		Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield

At the beginning of my internship, I spent several days in the Neurology Department with Dr. Suresh. I observed clinical diagnosis of patients and consultations with the doctor. It was enlightening to see how a physician is able to get across the diagnosis to patients who are not well educated and from very poor backgrounds. Dr. Suresh took the time to help the patients understand. I was surprised he was able to speak many Indian languages and always asked the patient what language was best for them.

		He also explained the details of each case to me and discussed the differences in practicing medicine in the West and in India. As part of my stay at the Neurology Department, I was allowed to see an EEG and an ENMG actively performed on patients. Dr. Suresh clarified how these can be useful diagnostic tools in identifying neurological conditions. Since my interest lay in the technology that assisted doctors, I was glad to be given a tour of the Radiology Department. Here I saw the MRI, CT scan, X-ray, and ultrasound machines in action. I remember what Dr. Kumar told me my first day: “Gone are the days when the doctor goes around with a stethoscope and a flashlight providing a diagnosis.” Technology is being used to provide the best possible care for the patient. As mentioned, the bulk of my time was spent in Cardiothoracic Surgery. I gained more from this department and interaction with its staff than I did from my volunteer time at local hospitals and reading textbooks. What follows is a brief description of my daily routine.
EEG being performed on a patient

The Daily Routine

Each morning I checked in with the chief surgeon. He would go over the cases scheduled that day in the theater. If any one was of particular interest, he would go through the details of the procedure. He would explain the normal condition and compare it to that of the patient. He would then show how the surgery would correct the defect. I was then allowed to observe the procedure in the theater.

In the theater I interacted with the operating surgeon and the perfusionist [a trained health professional who runs the heart-lung machine during cardiac surgery]. I learned how the machines in the OT worked and their roles in the surgery. It was enlightening and educational to see the parts of the heart up close. I was privileged to witness a multitude of cases and the types are mentioned in the attached list. After observing a procedure, I would go to the library or on-line to study the theory behind it to obtain a deeper understanding. I was accumulating theoretical knowledge and also able to see the practical application. Besides watching surgical procedures, Dr. Kumar and I also discussed the clinical research work I was conducting during my stay. The research focused on the post-operative effects of doing the Modified Blalock-Taussig shunt on the left vs. the right side. We were examining the flows in 200 patients. I was also involved in creating presentations on various topics, both academic and administrative. These presentations helped in my education as I was exposed to new topics and facts regarding metabolic pathways within the body. The administrative presentations expanded my understanding of the profession of a doctor, the duties of a hospital, and how to perform those duties in the best possible manner. In doing these presentations, I read academic journals and books which provided new perspectives on the medical profession and cardiac surgery procedures and drugs.
		Cardiac operation in progress

Dr. Kumar and I did not stop here. Every week he gave me a list of new terms, basic biological pathways, medicines, and theories to study. I learned about Heparin and Protamine, two drugs used during cardiac surgery to control blood clotting. Learning these basic science terms improved my understanding of procedures in the OT and how they benefited the patient.

A Rare Rewarding Experience

Furthermore, during my ten weeks of internship I participated in a clinical research study and wrote an article about an uncommon case that could potentially be published in an academic journal. This is a rare and rewarding experience for a premedical student. To realize that the work you have done could be of value to other scientists and doctors is very gratifying.

At the end of my internship, I walked away with a mountain of knowledge, experience, and memories. However, it is not enough for one person to feel this way. The hospital is unique and has much to offer to someone interested in medicine. Now my anxious feelings about the practice of medicine have rational answers and I know for certain that I want to enter the field of medicine. I wish other premed students could experience this. I believe almost no other institution has a program as well knit as this one or provides more experience.

		For example, in the July 2006 volume of The Annals of Thoracic Surgery, an article appeared titled “Attracting Outstanding Students (Premedical and Medical) to a Career in Cardiothoracic Surgery.” The article is a summary of John Hopkins University’s intersession and summer session programs providing students with medical and clinical research practice in the Cardiothoracic Surgery Department. Over the past four years eighteen premed students have been admitted to the program. The following describes their daily schedule: Each day began with a cardiothoracic faculty person reviewing the operative cases for the day. Catheterization cines were reviewed for all cardiac cases and critical x-rays, cardiothoracic and magnetic resonance imaging scans were reviewed when appropriate. The students were able to observe the cardiac and thoracic operations each day. The students attended all clinical and teaching conferences on both of our services. They also met several times during their three-week rotation with members of our cardiac and thoracic faculty. These meetings included several “Recap Sessions” with each of the division chiefs and power-point presentations by faculty members on topics such as thoracic transplantation, ventricular assist devices, congenital cardiac surgery, and the history of cardiothoracic surgery.
The John Hopkins Seal

The students who participated in the program have been surveyed and report their rotation on [Hopkins’] services was the most rewarding experience they have had in three years of college. In addition, Hopkins also created a summer session program for both premedical and medical students to participate in clinical research. Following is the description of the program:

We have had a total of fourteen medical or premedical students in our laboratory during the past three summers. They have all commented on the unique opportunities they have had to participate in clinical database studies and in the writing of research publications. They also greatly appreciated the opportunity to attend our national cardiothoracic meetings and for a few, the opportunity to present a paper at one of these meetings.

The experience of conducting research is not easily obtainable for a premedical student and it is difficult to gain clinical exposure. Hopkins has created a way to gain experience in both fields. Its success stories require no embellishing. All of the eighteen premedical students are either currently in or have gained admission into competitive medical schools.

Unknowingly, Dr. Kumar and I followed the same outline during my internship. I met with him every morning to discuss the cases in OT for that day. I then saw the procedure. I also attended weekly cardiac audit meetings and was fortunate enough to give a presentation on Homocysteine, an amino acid that is a potential risk factor of cardiovascular disease. In addition, I sat in on teaching conferences where Dr. Kumar gave power point presentations on subjects such as esophageal dilation. This same format applied to my clinical research. I was given the opportunity to do data bank research and then observe the procedure firsthand. I was even lucky enough to catch up with a patient who had come in for a definitive surgery after having the LMBT. Similar to the students at Hopkins, I was given a chance to potentially publish my work. I am in the process of creating a presentation for the IE3 committee and surgeons’ conferences.
		Sri Suraj Yalamuri

"This Hospital Has Lot To Offer….”

Furthermore, the programs at Hopkins are independent and there is strict competition for admission. Therefore, a student may gain clinical exposure without research experience and vice versa. During my internship at SSSIHMS, I was able to do both. The time span of ten weeks was adequate and the pace was just right, without being too hectic to work or too slow as to be dull.

The incorporation of two success stories where students have repeatedly expressed their utmost satisfaction into one comprehensive program is something that has not been done before. I highly recommend this program to students considering medicine as their profession. I hope the Hospital has received at least a fraction of the benefit it has provided me. As said before, this Hospital has a lot to offer to an incoming premedical student in the way of experience. I hope more students can profit from such a program.

– Heart2Heart Team

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