I struggled to comprehend the scene before me as the oppressive midday Bengaluru sun turned anything beyond my immediate vision into shimmering waves. A patient with a blood glucose level of 600 mg/dL, fatal hyperglycemia, stood smiling before me, eager to receive treatment from the only clinic in the far flung rural outskirts of Bangalore. I was fifteen years old, and trying to cope with the competing realities that this man, who had walked miles, was in desperate and immediate need of medication that we could not provide because the clinic had run out of insulin hours earlier. I felt a new and unfamiliar level of hopelessness as I realized there was a chance he might not survive until the clinic reopened next Sunday.

At the age of seven, my family moved from Chicago to Bangalore, India, where millions live in urban poverty, lacking proper sanitation, education, and food. My grandfather visited Bangalore when I was eleven, and after observing him measure his blood sugar using glucometer strips, I noticed a discarded vial that had expired. My grandfather explained that he could not afford to throw away expired test strips and insisted they were accurate. As the son of a doctor, it was unsettling to hear that he did not have access to the same quality of healthcare I was used to.

My grandfather’s health remained in the forefront of my mind, and in high school I was excited to have the opportunity to travel back to India to conduct research in a clinic testing the accuracy of expired glucometer strips. On my first day, I was astonished to see eight hundred people lined up outside the gate, some of whom walked barefoot for over five miles to seek medical care. In Bangalore, I witnessed urban poverty from afar, but I hadn’t yet confronted the humanity of those living in despair; the divide between my circumstances and those standing in line was impossible to ignore. 

I sat with this unease when Dr. Ramana Rao, the clinic’s only physician, greeted me as we walked through each makeshift station: medication, intramuscular injections, blood sugar and blood pressure. He introduced me to other volunteers, who were local teenagers trying to make a difference in their community. As patients entered and were examined, I was impressed with his ability to quickly build trust and rapport with each patient. I set up my blood sugar measurement experiment at one of the available stations collecting data for active, one month, and three month expired test strips.

As the noon sun beat down, I examined one of my last patients, a tall, burly, middle-aged man. When I measured his thick, syrup-like blood, the glucometer read “hi”, signifying he had a blood sugar in excess of 600 mg/dL. I had difficulty making eye contact as I explained “Sir, insulin illa,” we have no more insulin. I ran out of insulin to distribute earlier in the day, and my heart sank with hopelessness knowing he may end up in the same position next week when he arrived for treatment. The reality of such bleak choices stunned me. As the patient walked away quietly, my concern about expired test strips seemed insignificant in comparison to the seemingly insurmountable challenges the clinic faced.

I walked into the clinic with a single goal: to complete my experiment. However, after volunteering for four weeks, and personally administering grassroots medicine, I was humbled by the overwhelming unmet need of underserved patients. The clinic made me appreciate the skill and commitment of Dr. Rao and the volunteers, who persist working despite the frustration and hopelessness, and find satisfaction in their contribution, however small. This passion and sense of purpose inspires me to pursue a career in medicine with the goal of making a contribution to the needs of the underserved around the world.