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Last month, the Medical Council of India, one of the country’s two medical boards, made a statement that it would recognize emergency medicine as an official specialty. The move followed a similar statement made in November by India’s other national board, and brought to fruition the decade-long struggle of a small band of American emergency physicians.

It started over tea. More than ten years ago, Kumar Alagappan, an emergency physician in New York, traveled to his native India in order to set up an international EM elective for one of his residents. While there, a colleague introduced him to the president of the National Boards. They met for tea at his home in Madras.

“It was a hot and dusty afternoon,” recalls Alagappan. “He lived on the second floor of a modest apartment building, in a very crowded part of town.” They discussed the need for formal emergency medicine training in India, but the president didn’t seem to grasp the difference between emergency medicine, critical care and trauma care. “I tried to explain that the EM physician manages and dispositions all comers in the ED, and passes on the care to specialists,” says Alagappan. “I also tried to tell him that not all patients in the ED are critical care or just trauma care. This was a new specialty.” And yet, despite Alagappan’s explanations, the president remained unconvinced that this new specialty was what India needed.

Ultimately, the meeting settled nothing except to solidified what Alagappan had to do. It marked the beginning of the movement to get emergency medicine recognized as an official specialty in India. He and a small group of colleagues campaigned year after year, meeting with physicians and politicians. In 2001, a group of these physicians got together in Pittsburgh and formed an alliance called the American Academy for Emergency Medicine in India (AAEMI). Physicians of Indian descent from every corner of the United States came together to organize efforts to promote the specialty in their homeland.

The November announcement – made by the same man Alagappan spoke with a decade ago – came as a much-welcomed surprise to the men and women of AAEMI. And yet, as much as it marked the end to a campaign, it was also just the beginning.

Once the specialty is officially recognized, the ball will really start rolling, says Alagappan.
 
“Residencies will be created, people will be trained in EM…There’s going to be a huge push to develop this field in India.” This push will have obvious affects on health care in the subcontinent – imagine the trauma load in a country with three times the population of the United States living in a third the space. But thanks to the growing network of international emergency medicine, improvements in India’s EM system will have an impact far beyond the country’s borders. Take, for instance, the creative ideas that could be generated from the region. “Once you open up the whole sub-continent, which has numerous problems, there are going to be innovative solutions coming out,” says Alagappan.

What’s more, since medical education and research in India is done in English, the knowledge and experiences of Indian EPs has the potential to filter into the United States extremely quickly.
 
 
 

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