Below is an update from one of our students Benjamin Creswell who is currently taking his elective at CMC Vellore in India. For more information on our International links with CMC Vellore, please see: http://research.hyms.ac.uk/researchcentres/ced/international-links
. I spent this week in the emergency department at the main CMC hospital in the centre of Vellore. Eating my staple canteen breakfast of dosai and pineapple juice on my first day I was slightly apprehensive about what to expect from this placement. My only real experience of emergency medicine thus far had been in Scunthorpe, where the clinicians' daily bread and butter consisted of dealing with alcoholism, paracetamol overdoses and the odd minor trauma. I was excited but nervous about being exposed to the major trauma aspect of this branch of medicine; having experienced the driving in India I had an idea of what to expect! The department itself was in fact not dissimilar from one we might be accustomed to in the UK. 3 wards separated according to priority (1 - most serious, 3 - least serious), a 10 bed resuscitation room and a trauma ward were all well staffed and equipped. A collection of bottled snakes and scorpions menacingly overlooked the entrance to the department and were used for bite and sting identification so the right anti-venom could be administered. Over the week there was a rich variety of patient presentations; from mild chest pain to cardiac arrest and from minor lacerations to open fractures from serious road traffic accidents, all dealt with competently (in my opinion) by the tireless staff. One aspect of care that surprised me was the willingness of the staff to use restraints on patients, even when it did not always seem necessary. Of course with my incredibly limited knowledge of the local languages it was sometimes hard to discern whether there had been attempts to reassure and calm the patient, however it often appeared that no or remarkably little effort was made before the restraints were deployed. Nonetheless, the staff were remarkably laid back and willing to answer any questions we had as observers and it was of enormous use to be able to look up patient investigations on the department computers. The week as a whole was incredibly useful as I was able to familiarize myself with a plethora of common presentations in emergency medicine in India, and I would definitely recommend spending at least a week in the department at CMC to future elective students, even if you do not have an inclination towards this branch of medicine.