Healing Across Borders:

Stories of Indian Culture and Care in Modern Medicine

Picture of Siva Collecting Curry Leaves

Source: Nikitha Bhimireddy

The first time Siva felt the sharp pang of pain in his chest, he was picking up vegetables—a strange heavy feeling that would appear and disappear. At first he didn’t think much of it. Just part of aging, he thought. But soon the heavy feeling grew, and simple movements like bending down became daunting.

Just when he thought the feeling couldn’t get worse came his shortness of breath. He found himself stopping and struggling to breathe, especially in labor-intensive work. Siva spends his days doing agricultural work, growing fruits, vegetables, and crops.

His heaving aso kept him up at night. “I had a tight feeling in my chest, and couldn’t sleep well,” he says.

In his rural village in India, Palem, people often wait to see if their health will naturally improve. This was partly because receiving timely care with few hospitals or medical clinics nearby was difficult. The people in the area would have to find transportation and commute at least an hour to reach the nearest hospital.

After several days of severe pain, Siva called his son in the United States. Siva only speaks Telugu and can’t read or write. “I started to worry and didn’t know what to do,” Siva says.

Siva’s journey is not uncommon in rural India and beyond, where limited access to healthcare often means delaying care until symptoms become unbearable. According to the World Health Organization, about 4.5 billion people, nearly half the world’s population, are not covered by essential health services. Rural areas are disproportionately affected. Many people ignore or tolerate symptoms until they become severe, often leaving no chance for preventative care.

Cultural and language barriers exacerbate these problems. The people profiled here—Siva, Lakshmi, Raina, Devan, and Gagan—all experienced struggles in navigating healthcare systems in both rural India and urban America while ill.

Worldwide, cultural identity and social status shape the experiences of people from the Indian diaspora in navigating healthcare. These five patients of Indian descent encountered cultural barriers: They felt overlooked, misunderstood, and marginalized.

Picture of Siva's Neighborhood in Palem, India Source: Nikitha Bhimireddy

“I was not young, or a child, or someone who couldn't think for myself." But, Raina said, “she wouldn't address me. Everything she said was to my mom.”

The patients' stories show that clinical expertise often fails to account for patients’ own cultural understandings of disease. Their stories demonstrate the importance of moments when providers do offer empathetic, culturally sensitive care—and of family support when doctors don’t.

Plaque Blockage in Coronary Artery

Source: NYU Health

Balloon Angioplasty Procedure

Source: John Hopkins Medicine

Two days after Siva spoke to his son over the phone, he decided to visit the doctor. The physician brushed off Siva’s pain as a part of aging and prescribed him painkillers. He told Siva his symptoms would likely ease with time.

“But I still felt the pain and nothing much changed,” Siva says. The pain was only getting worse and Siva felt something was seriously wrong.

Siva arranged transportation to a hospital an hour away in the city of Vijayawada. There, the cardiologist conducted a series of tests to look for abnormalities.

“I ran on a belt and they hooked me up to a machine with wires,” Siva says. His doctors had likely ordered a treadmill stress test. The physicians also conducted an angiogram, a procedure to see inside Siva’s coronary arteries.

The results showed that Siva’s symptoms were not just “a part of aging.” Plaque had collected in one of Siva’s coronary arteries, restricting blood flow to his heart. Restricted blood flow can lead to chest pain, shortness of breath, and in severe cases, a heart attack or heart failure. He would need a balloon angioplasty to clear the blockage.

Given the dearth of healthcare resources in Palem, it’s likely that Siva’s persistence—and the support he received from his family—saved Siva’s life.

Lakshmi

Lakshmi is also from the small village of Palem and, about ten years ago, faced similar difficulties accessing care. During this time, “sugars,” or diabetes, was the talk of the town. Many older people in the village, including Lakshmi’s relatives, were being diagnosed with the disease Lakshmi herself was experiencing symptoms: She felt tired all the time and felt thirsty all the time.

Her family took her to a diabetes specialist, also in the city of Vijayawada an hour away, and her test results came back “borderline diabetic.” Doctors prescribed her 500 mg of Metformin, to take twice a day—even though she did not have the disease.

Soon, her health worsened. “I started feeling weak and lightheaded. I even fell in the bathroom once. I knew something wasn’t right,” she says.

Taking medicine through a prescription was new to Lakshmi.

Picture of Lakshmi

“I’ve always trusted natural remedies like hot water, honey, and lemon when I was sick. I never took pills, so when they gave me all those medicines, I felt scared,” she says.

A year later, Lakshmi’s family decided to take her to another doctor in Vijayawada for a check-up. Her son stayed on the phone with her to interpret medical jargon and translate English words into Telugu.

The new doctor conducted the tests for diabetes again and found that Lakshmi did not have diabetes. The physician was concerned. Taking diabetes medication when she didn’t have diabetes was ill-advised, he said, and told her to stop taking the drug immediately.

A Picture from Palem, India Source: Nikitha Bhimireddy

Unfortunately, Lakshmi’s poor experiences with overprescription didn’t end there. A few years later, during the COVID-19 pandemic, Lakshmi was tested for high blood pressure and prescribed a pill that contained several medications. She would learn later that the pills provided three times the recommended dosage, given her condition. “I didn’t understand why they were giving me more pills. This new combination drug made everything worse. My legs were swollen and I was always really cold,” she says.

The cardiologist who prescribed her the combination pill, she says, never physically examined her and always spoke to her from a COVID-mandated distance. When Lakshmi expressed concern about the swelling in her legs, the cardiologist told her it was normal and would go away with time. Her symptoms only grew worse.

Lakshmi later discovered that the combination drug she was prescribed was a brand-new trial drug that was not FDA-approved.

A 2013 study examined prescription practices among urban and rural practitioners in Tamil Nadu, India. One of the study areas was rural, with a population of 11,506 people across nine villages. The researchers tracked 300 prescriptions and found that only 50 percent of practitioners in rural areas had signed the prescriptions, raising concerns about the accountability and the legitimacy of medical advice. Only 0.7 percent of prescriptions contained drug strength information and dosage schedules for the patients. In nearly half of the prescriptions, there were five or more drugs, a practice called “poly-pharmacy” that is prevalent in India and other similar settings.

This practice of “poly-pharmacy” contributes to confusion and increased risks for patients like Lakshmi who endured unnecessary suffering from overprescription and lack of follow-up care in rural India.

Raina

Raina grew up in the United States, but she, too, experienced challenges in accessing proper care and being taken seriously by medical professionals. When Raina was eleven, she had debilitating menstrual cramps; doctors dismissed them as hereditary and routine. But Raina’s pain was severe, and her periods occurred every two weeks. She was often bedridden with pain.

Raina says her family has strong cultural values and believes in natural forms of healing. Her family’s first resort was usually never to visit a doctor. Medication to alleviate symptoms was not an option either. Instead of taking a Tylenol or another over-the-counter painkiller to ease her menstrual cramps, Raina often resorted to using a heating pad, coping with her pain naturally.

The natural remedies weren’t working; Raina’s pain persisted.

Raina finally decided to visit a gynecologist and felt hopeful that her physician, who was a woman of color, would understand her struggles. Her hope quickly turned to disappointment.

The physician wouldn’t look at and speak to Raina directly, Raina says. “Everything she said was to my mom. She assumed this topic”—talking about menstruation—“was ‘taboo’ in my culture.”

Period Cramps Visual

Source: Cleveland Clinic

Misunderstandings often arise when providers assume “common” cultural beliefs and values based solely on physical appearance, race, or ethnic affiliation, say the authors of “‘Don’t let me be misunderstood’: communication with patients from a different cultural background” from a 2023 issue of the Journal of the International Pediatric Nephrology Association. They emphasize how even individuals from the same ethnic or social group can have vastly different beliefs and values. It is important, they argue, for providers to avoid cultural stereotyping in interactions with patients.

Even though Raina didn’t have a positive experience during her visit, she and her mom decided to proceed with surgery to remove an obstruction that the doctor believed was causing her pain. The surgery only worsened her experience with healthcare.

During an exam after the surgery, Raina says, she pleaded with the doctor to stop a painful procedure. The physician, Raina says, ignored her.

If the doctor had correctly diagnosed the source of Raina's pain, Raina still doesn't know, nor does she understand what that diagnosis was. She is still in pain.

“To this day, I don’t know what was wrong,” Raina says.

Raina’s story emphasizes how cultural stereotyping and dismissive care can alienate patients and lead to mistrust in the healthcare system. As Raina left the physician’s office, she said she vowed to never return to a gynecologist again.

An X-Ray of Devan's Jaw and Temporomandibular Joints

Devan

Devan is a 20-year-old Indian-American male, born and raised in Columbus, Ohio. He has received care in both the United States and India.

Like Raina, Devan felt dismissed in his early interactions with healthcare providers in the United States.

Devan had chronic migraines and jaw pain that made it difficult to eat, speak, or concentrate on his daily tasks. He says that eventually the pain was diagnosed as temporomandibular jaw (TMJ) pain. But the first provider he consulted about the pain, a neurologist took a rushed, trial-and-error approach, Devan says.

The neurologist prescribed an antidepressant and anti-epileptic drugs for Devan’s migraines. The drugs only worsened his symptoms. He lost his appetite, felt nauseated much of the time, and vomited frequently.

At a return visit, Devan expressed concern that the prescriptions weren’t working. They were causing negative side effects, he told the neurologist. She suggested they try new drugs or go up the dosage of the previous ones.

“I felt like she just wanted to prescribe something and move on,” Devan says.

Rushed interactions and a lack of communication can exacerbate patient distress, leading to patients feeling unheard and disempowered, according to a 2011 article in the Annals of Family Medicine. The authors emphasize the importance of shared decision-making, especially in managing chronic conditions, to improve patient satisfaction and outcomes.

Like Raina, Devan felt that his provider did not take the time necessary to understand his condition fully. He says he became increasingly wary of his medications.

Devan began to research connections between his headaches and jaw pain. He found that TMJ pain could be related to certain muscles connected to both the jaw and the head, like the temporalis, tension in which, can contribute to migraines.

TMJ Pain and Common Causes

Source: Healthline

Arthocentesis Procedure

Source: Mayo Clinic

Eventually, Devan sought care in India for his jaw pain. Devan’s family speaks Telugu, but the hospital he received care from was in a Tamil-speaking area. The nurses and other staff spoke Tamil. Devan’s dad was able to translate for him. “Luckily, the surgeon and other doctors spoke English,” Devan says. But he felt comforted by having his father translate for him; the interpretation helped bridge the language barrier with staff.

An oral and maxillofacial surgeon confirmed Devan’s diagnosis of TMJ pain and recommended TMJ arthrocentesis, a minimally invasive procedure common in India. To ensure Devan and his family understood the diagnosis, the doctor and his residents used visuals to simplify the procedure. They patiently described how scar tissue had built up from his frequent jaw movements, causing pain. Small gestures from the providers, such as making eye contact and asking about his life, made him feel more comfortable. They also showed him a before and after video of the procedure which eased his worries, Devan said.

The procedure alleviated much of his jaw pain, and over time, his migraines diminished as well. Devan says he took away more than just a successful treatment plan from his visit to India. He believes the compassionate and clear communication he received had a tangible effect on his pain.

Gagan

Gagan also grew up in the rural village of Palem, India, and lived there for 25 years before migrating to the United States. During his childhood, he walked 4 miles to high school every day carrying his textbooks and school supplies. He owned a single pair of sandals and would stub his left, second toe repeatedly while walking over the unpaved, rocky ground.

Over time, the repeated injuries led to a severe toe wound that became infected.

Like Siva and Lakshmi, members of Gagan’s family rarely visited the hospital in distant Vijayawada for what they perceived as minor, physical wounds.

“We had little money, and no car, or even bicycle, to get to the hospital,” Gagan says. “There was also a mindset in the village that hospitals were only for emergencies or people who were very sick. You didn’t go unless you had no other choice.”

The only realistic solution for Gagan was to let the wound heal on its own. His mother resorted to natural remedies, a common practice in his rural community. She dressed his wound with honey, known for its antibacterial properties, and wrapped it with a thin cotton cloth.

The infection did eventually go away. But Gagan’s toe healed abnormally and caused him discomfort for years.

Gagan's High School: Zilla Parishad High School (ZPHS)

In conversations with these five people, a common theme emerged—healthcare was often seen as a last resort, a system they felt was not designed for them. Gagan said his family only went to the hospital if it seemed like a life-or-death situation. Lakshmi and Raina look towards natural forms of healing first.

Even those who did access care faced obstacles that made their experiences alienating. For Devan faced rushed appointments and overprescription in the U.S. healthcare system, so he sought care in Tamil Nadu, India. There, he experienced a slower more personal approach that he says helped him feel heard. Devan says this was the first time he felt a part of the solution in his care.

Each individual’s story reveals more than personal struggles. It exposes gaps in healthcare systems meant to heal. Whether a language barrier, a systemic inefficiency, or a cultural misunderstanding, each challenge left the person feeling isolated and disempowered.

“If I hadn’t called my son that day, I don’t know if I would still be here,” Siva says, grateful for the family support he received after the doctor brushed off his chest pain. “Doctors should listen more,” Devan says. “Sometimes that’s all it takes to save a life.”

Multimedia Piece

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Healthcare Journalism Multimedia Piece.mp3

Commentary

This piece was truly so fun to work on and provided me with a personal opportunity to speak with and reconnect with a few people from the rural village of Palem, India who I interacted with during my visit in the summer of 2024. Through these interviews, I enjoyed learning a bit about the differences and similarities between the healthcare systems and the care experiences of patients in rural India vs urban America. My goal while writing was really to listen, reflect, and present these patients’ narratives in the most authentic voice possible. I wanted to do justice to each story they shared with me, and this initially led me to struggle as I didn’t want to part ways with a lot of the interview material. In the interview write-ups, I tried to fully flush out the healthcare journeys each person shared with me, and I carried this with me when initially approaching this final piece as well. However, after a few rounds of revisions and spending quality time with the interview material, I was able to choose the most important aspects and find a balance between personalized storytelling and connecting to the broader stakes and implications of each person’s experiences with external sources and studies. Overall, I had a wonderful experience speaking with all of these individuals and challenging myself to connect and build on the themes shared in each narrative.

Source List

Interviews

Siva, Lakshmi, and Gagan’s interviews were conducted in Telugu and translated into English.

Siva: 10/15/24

Lakshmi: 11/22/24

Raina: 10/2/24

Devan: 11/9/24

Gagan: 12/2/24

Documents

Epstein, R. M., & Street, R. L., Jr (2011). The values and value of patient-centered care. Annals of family medicine, 9(2), 100–103. https://doi.org/10.1370/afm.1239

Flores G. (2006). Language barriers to health care in the United States. The New England journal of medicine, 355(3), 229–231. https://doi.org/10.1056/NEJMp058316

Gopalakrishnan, S., Ganeshkumar, P., & Katta, A. (2013). Assessment of prescribing practices among urban and rural general practitioners in Tamil Nadu. Indian journal of pharmacology, 45(3), 252–257. https://doi.org/10.4103/0253-7613.111931

Taylan, C., & Weber, L. T. (2023). "Don't let me be misunderstood": communication with patients from a different cultural background. Pediatric nephrology (Berlin, Germany), 38(3), 643–649. https://doi.org/10.1007/s00467-022-05573-7

World Health Organization. (2023, September 18). Billions left behind on the path to Universal Health Coverage. World Health Organization. https://www.who.int/news/item/18-09-2023-billions-left-behind-on-the-path-to-universal-health-coverage#:~:text=In%202021%2C%20about%204.5%20billion,of%20the%20COVID%2D19%20pandemic

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