I am a pediatric oncology fellow at Stanford, who is committed to improving research and outcomes for children with cancer in resource-limited settings. My trip will be under guidance of Dr. Venkatraman Radhakrishnan who is a leading pediatric oncologist in India. I plan to provide clinical care and immerse in quality-improvement during my clinical rotation to Adyar Cancer Institute Madras. By doing so, I aim to develop strong partnerships, mentors and improve patient outcomes
Pediatric cancer patients, stem cell transplant recipients, and patients with hematological conditions
I expect that this rotation will give me insight into the ground-reality in a resource-limited pediatric oncology hospital, with insights into the health system and the gaps that need to be filled. I hope to use these learnings to design interventions to improve supportive care and quality of care delivery moving forward
Before Adyar, I thought of doctoring mainly as making the right diagnosis and choosing the right treatment. My rotation at the Cancer Institute Adyar broadened that view. I watched physicians care for complex, immunocompromised patients despite heavy workloads, investigations scattered across outside labs, and families who had travelled from distant districts and were often paying out of pocket. Good doctoring there meant sound clinical reasoning under uncertainty, but also judging what a family could afford, what follow-up was realistic, and how to explain risk honestly in limited time. In my own practice, I will ask earlier about the practical realities of patients’ lives, not just their symptoms. The rotation also changed my understanding of global health. It is less about bringing expertise to under-resourced settings than about learning from clinicians who deliver excellent care under constraints I rarely face. It has strengthened my wish to work internationally, through long-term partnerships rather than brief visits.
Cost and access often shaped diagnostic decisions. Physicians had to weigh each test’s value against its financial burden, and sometimes treated empirically instead. These decisions were usually made by the team and explained to families.
The patient I will remember is an adolescent boy with T-cell lymphoblastic lymphoma who had suffered repeated episodes of meningitis during treatment. He presented with headache, double vision and unsteadiness. Imaging showed strokes in his cerebellum and occipital lobes, caused by inflammation of the arteries at the base of his brain, probably secondary to chronic meningitis. The challenge was deciding whether this was infection, lymphoma relapse or something else. His cultures were repeatedly negative, and an advanced sequencing test gave results of doubtful significance. The team coordinated imaging, CSF studies, and vascular and autoimmune work-up across several institutions, reconciled conflicting findings, and treated him while the picture evolved. We compiled his previous episodes and serial imaging into a timeline that helped the team compare findings. His symptoms settled quickly, and he restarted chemotherapy, though I left before learning his final outcome. What stayed with me was how much his care depended on persistence and on careful synthesis of a fragmented history as no diagnostic test gave the answer.
I left Adyar humbled by what its clinicians achieve and clearer about the kind of doctor I want to be: thorough, honest about uncertainty, and attentive to everything a patient brings beyond the diagnosis.
