An enduring partnership in India continues to spark exchange

Increasingly, medical schools are recognizing the importance of providing an international component to undergraduate medical education. This May Vignesh Narayanan and Ramanathan Seshadri, two students from Sri Ramachandra Medical College & Research Institute (SRMC&RI) in Chennai, India, will come to Boston to experience how medicine is taught and practiced in the U.S. "The health problems faced both in India and the U.S. are handled quite differently," said Seshadri. "It will be interesting to experience both approaches." Narayanan and Ramanathan are both in their final year of study and hope to obtain placements in residency programs in the U.S., traditionally a highly competitive process for international medical graduates.

Medical students Vignesh Narayanan, left, and Ramanathan Seshadri are recipients of the May 2002 clerkship at Harvard hospitals

This opportunity comes as part of a long-term alliance between SRMC&RI and Harvard Medical International (HMI). The alliance was formed in 1997 with the goal of helping to fulfill the vision set forth by SRMC&RI's founding trustees: to build an institution that would serve as a global leader in health care, research and medical education, while at the same time provide for the health care needs of its local community. Having reached the end of its initial five-year term, the HMI-SRMC&RI alliance has made significant strides toward fulfilling its mission. Since first helping SRMC&RI create a framework for growth through an intensive self-assessment process, it has established a range of educational initiatives, and has spurred development in research and clinical care.

One of the top priorities of the alliance since its inception has been to enhance the medical student learning experience through an inter-institutional student exchange program. Under the direction of Dr. Krishna Seshadri, assistant professor of medicine at SRMC&RI, the program comprises three main components. The first and longest running, in which Narayanan and Seshadri are the latest benefactors, has provided opportunities for twelve SRMC&RI students to enroll in one- to three-month subspecialty clinical clerkships at Harvard-affiliated teaching hospitals. The alliance also established a program based at SRMC&RI that provides HMS students with the unique opportunity to experience medical education and care in India. Harvard Medical students learn about and engage in health care in a different setting and culture, see diseases that are uncommon in the U.S., and observe how health care is delivered with limited access to advanced technologies.

Dr. Mitchell Spellman, an HMI director who oversees the SRMC&RI-HMI alliance, believes that such experiences can help clinicians provide the highest quality care. "The primary benefit for our students is that it expands the diversity of the Harvard educational experience, and contributes to the generation of 'culturally sensitive' physicians who understand and respect the traditions, values and beliefs of other populations. Appropriate care, regardless of where in the world one practices, requires physicians who are open to the perceptions, realities, and expectations of communities that may be different from her or his own."

Members of the SRMC&RI-HMI alliance committee meet with students, faculty and administrators in India

A third facet of the HMI-SRMC&RI student exchange program is a unique year-long medical student research fellowship that was awarded to SRMC&RI student Silpa Gadiraju in 1998. Gadiraju spent a year as a research assistant in transplantation biology and immunology at Harvard Medical School under the mentorship of Dr. Mary Russell, assistant professor of medicine at HMS and Brigham and Women's Hospital, and at the Harvard School of Public Health. Her work focused the biological mechanisms of the immune system that contribute to vessel thickening, or arteriosclerosis.

In addition to student exchange programs, several HMS faculty members have traveled to India to participate in educational programs hosted by SRMC&RI. Faculty from SRMC&RI have also visited Harvard-affiliated hospitals as participants and observers in programs relating to their fields of expertise (see sidebar).

Fueling partnerships in research
The HMI alliance has led SRMC&RI to focus on research, encouraged largely by Dr. T.K. Sarathy, former SRMC&RI vice chancellor. "At the time the alliance was formed, academic research at SRMC&RI was still at its infancy," said Dr. Kalpana Balakrishnan, biophysicist and head of the Department of Environmental Health and Engineering at SRMC&RI. "Although the management was supportive and keen to enhance research, having endorsement from HMI faculty really made the difference."

	Dr. Kalpana Balakrishnan, Head of SRMC&RI's Department of Environmental Health and Engineering, collaborates with Harvard faculty on public health research initiatives

The alliance has also sparked collaborations in environmental health research, which may ultimately impact public policy debates. Most recently, Balakrishnan has completed a pilot study with Dr. Howard Hu, associate professor of occupational medicine in the Department of Environmental Health at the Harvard School of Public Health, on the impact of lead exposure on children in India. Additional projects are also underway. Stressing the importance of international collaborations in research, Balakrishnan notes, "environmental health risks are poorly understood in India and there is tremendous need to build capacities at all levels to begin addressing these concerns. Collaborations of this sort build academic capacities without waiting for big institutional or national alliances that can involve considerable bureaucratic delays."

Supporting high quality, multidisciplinary care
In 2000, HMI was able to provide support for the Sri Ramachandra Cleft & Craniofacial Center's successful application for funding to expand care for children with cleft lip. Under the leadership of Dr. Jyotsna Murthy, the Center provides free surgery to hundreds of children each year. Every child who receives surgery works with a multidisciplinary team of specialists that includes pediatricians, surgeons, geneticists, and speech therapists. "There are very few multispecialty clinics currently operating in India. Many patients either cannot get access to treatment, or receive incomplete treatment," said Murthy. The funding from Smile Train, a global, nonprofit organization that helps clinicians who are working to eradicate cleft lip problems, enabled the Center to dramatically increase the number of free surgeries they provide and to augment community education initiatives.

Members of the alliance committee meet to discuss future directions of the program. From left to right: Shri. V.R. Venkatachalam, chancellor of SRMC&RI; Dr. Robert Crone, HMI’s president and CEO; Dr. Tom Aretz, HMI director of medical education

During her visit in April 2000, Dr. Murthy met with Dr. John Mulliken, Director of the Cranial Facial Center in the Division of Plastic Surgery at Children's Hospital in Boston, and observed a special clinic he led on vascular anomalies. "It was like a dream come true!....a tremendous experience," Murthy said about this opportunity to exchange scholarship with other specialists in her field.

Prof. K. V. Somasundarum, SRMC&RI dean of faculties who will succeed Dr. Sarathy in administering the alliance, shares Sarathy's vision for moving forward, emphasizing a continued focus on initiatives designed to sustain student and faculty enrichment programs and building capacities in research.