Name: Neha Deshpande
Year: Class of 2011
Hometown: Monmouth Junction, NJ
Major(s): Biology and French
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A 2005 report released at the National Conference on Child Survival and Development in New Delhi, India, claims that of the 26 million children born in India each year, about 1.2 million die during the first four weeks. This represents 30% of the 3.9 million global neonatal deaths. The report also states that approximately 47% of children under the age of five are malnourished, and 30% of babies are born underweight. The prevalence of infections, lack of prenatal care, and nutritional deficiencies, predisposes mothers from underdeveloped urban and rural areas to poor pregnancy outcomes and low birth weight babies. (Right: A severely preterm baby born at 29 weeks gestation in the KEMH NICU)
Through the Johns Hopkins Woodrow Wilson Undergraduate Research Fellowship Program, I spent this past winter break assessing neonatal and maternal health in Pune, India. An ancient city home to over five million people, Pune is ranked the third city in India with the greatest slum population, right after Mumbai and Meerut. According to a December 2007 Times of India article, “Pune Growing into City of Slums”, the city’s slum population has grown 176% since 1991. Born in Maharashtra India myself, it was of personal significance and concern to me that the first and third rank cities were located in my birth state. (Left: View of KEM Hospital in Pune, India)
During my month in Pune, I had the privilege of working at King Edward Memorial Hospital (KEMH), a non-government organization (NGO) whose primary purpose is to serve the lowest income bracket (poverty-line population) of the urban and rural areas of Pune. Built during the British rule of India in 1912, KEMH was once a four-bedded maternity hospital that eventually expanded into a three-story, 550-bedded institute with a Level III Neonatal Intensive Care Unit (NICU) comparable to the NICU at Johns Hopkins Hospital. Over the course of the month I was there, I studied social, clinical, and economic aspects of about 75 babies born during December 2008. (Left: Mothers were encouraged to “kangaroo care” their infants to better their development)
Social aspects I researched included the demographics of 
the babies’ families, the education level of the parents, the family’s income, and whether or not it was an extended (joint) or nuclear family. A majority of the parents were poor farmers and laborers who had received only a 5th or 6th grade education, and earned an average of fifty dollars a month to support their entire household. A month’s salary for these families was spent for a day’s care at the NICU. Babies that needed three-four months of care could only stay for a few days because their families could simply not afford the treatments they needed, even though they were significantly subsidized. I remember one father whose eyes brimmed with tears as he imagined how many years it would take him to pay back his medical debt for his daughter’s treatments. (Left: Me with KEMH’s NICU Director)
In terms of clinical aspects, I looked at the birth weight of the babies to determine whether they were small, average, or large for their gestational age (SGA, AGA, LGA). What I found extremely interesting was that a baby born at KEMH who was considered “AGA” or “LGA” based on the Indian growth chart, fell under a significantly smaller percentile if plotted on an American growth chart. Other clinical factors I researched included the mother’s number of prenatal-care visits and maternal risk factors. At the NICU in Baltimore City, the most common maternal risk factors I see are drugs, smoking, and alcohol. Surprisingly, none of the 75 mothers used any of these substances. Rather, common maternal risk factors were toxemia, previous abortions, stillbirths, and neonatal deaths, and antepartum– hemorrhages. Other clinical factors I researched included the mother’s past obstetric history (gravida, parity), her mode of delivery, as well as the Apgar, neuromuscular maturity, physical maturity, and overall maturity scores of the baby after birth. Economic aspects I researched included the medical, physician, and laboratory fees for each baby, and how the amount of money spent correlated to the final outcome of the infant. The outcome for a little less than half of the babies was death. (Right: A father with his two-year-old daughter diagnosed with a severe liver condition. Doctors say she will live for only a few more years)
I remember the first day I walked inside the KEMH NICU – dozens upon dozens of extended families were cramped into one small waiting room. Some sat barefoot, others slept on the ground, while others crouched on the floors. In the pediatric ward I worked at in the afternoons, I saw children with incredible diseases – Cobra bites, meningitis, pneumonia, rubella, typhoid, leukemia, among many others. What was most memorable from my trip was speaking with these families and learning about their life’s struggles. I spoke Marathi with all the families, and despite their village dialect and my Americanized-pronunciations, we understood everything about each other. I could see their fear in the way they lowered their eyes or never smiled in the photographs I took, but also their hope in the way they gazed at the physicians or held my hand. Many of the families thanked me for being the only foreigner they would ever have the chance of meeting in their lifetime. My favorite was a young boy who asked me, “Do you see a moon from your home?”, and when I replied yes, he said we would tell it messages to deliver to each other. Another woman told me I would always have a home in her village if I ever needed to escape my stressful life. There were two other mothers I met in the nursery, one twenty and the other twenty-two years old, who spoke with me for over two hours one day. Both had seen a camera for the first time, and when I took photos of their babies, they became very emotional at the mere thought that an instrument could capture reality so beautifully. All it took was a photograph of their baby to make their day. Another unforgettable experience was working in the operation theater where I shadowed KEMH’s pediatric surgeon and assisted in numerous pediatric surgeries. With the sheer number of patients that need operations, young first or second-year surgery residents handled tedious and lengthy operations. You would find it hard to believe that having the lights go off several times in the middle of a surgery was a common ordeal. One surgeon turned to me in the pitch -black and said, “Neha, simply hold your place with your fingers and hope the lights turn on soon”. (Right: Me with a pediatric surgeon in the OR, operating on an infant)
My experience at KEMH was inexpressibly eye-opening and life-changing. The doctors I worked with were the most honorable and selfless individuals I have ever encountered. An average day for a physician was 9am-11pm, seven days a week, and a medical fellow who worked 60-70 hours per week was paid only thirty dollars a month. Though they receive low compensation for their work, it is their desire to help others and better humanity that fuels their persistence. At KEMH, I witnessed the spirit of a physician in the truest sense, and for their hard work and devotion to human health, the respect and admiration these physicians received was unparalleled. Perhaps what struck me most was the humbleness and sense of satisfaction the patients and physicians had with their way of life, despite its limitations.
I conclude with Robert Frost’s poem called A Road Less Traveled: “And I took the one less traveled by, and that has made all the difference.”
March 2 2009 | 
Comments (2) 
By Manoj Gole, March 31, 2009 @ 12:38 AM
Good work Neha !Keep up and Best of Luck .
By Ishan Deshpande, June 11, 2009 @ 3:20 AM
Excellent Nehatai!!!I’m proud of you.Cheers for your next career!