Clinical and Cultural Experience in the Himalayas Jaya

Clinical and Cultural Experience in the Himalayas Jaya

Clinical and Cultural Experience in the Himalayas
Jaya Kanduri
Rutgers- Robert Wood Johnson Medical School, Piscataway, NJ 08854
Trip Summary

Background Information on Spiti Valley

Total Population: 12, 445 (2011)
Density of Population: 2 person/sq.km
Birth Rate: 16.2%
Death Rate: 6.1%
Languages: Manchad dialects, Bhoti, Sanskrit, and
Hindi
Literacy Rate: 77.24%
Rural Health Centers: 10

At elevations ranging from 11,00014,000 ft, Spiti Valley communities
are exposed to strong UV rays,
which contribute to the high
prevalence of pterygium and irritated
eyes in farmers. The elevation was
also responsible for causing
newcomers to experience altitude
sickness symptoms like headaches,
lightheadedness, and nausea.

The universal problems of hygieneignorance and contamination took
their toll in the remote Himalayas as
well, as indicated by the intestinal
worms and tinea fungal infections.
Due to their physically demanding
professions as farmers/construction
laborers, the villagers of Spiti Valley
work tirelessly in the sun and are
subject to dehydration and
musculoskeletal strain. Dehydration
was a very common diagnosis,
presenting as headaches and fatigue.

Despite the medical issues we
encountered, the majority of
villagers in Spiti Valley appeared fit
and resilient, confirmed by high
hematocrit values and lack of
chronic diseases like hypertension
and diabetes which are rampant in
the Western world. This was
pleasantly shocking to me, as I was
reminded how physically active
routines and fresh foods can increase
quality of life.

We handed out sunglasses to almost
every patient in an effort to decrease
UV exposure and prevent
exacerbation of pterygium. All
children were given multivitamins,
and pregnant women were given
prenatal vitamins.

Himalayan Health Exchange (HHE)
HHE is an organization dedicated to providing
medical and dental care while promoting preventative
health measures, to remote areas of the Indian
Himalayas. For each expedition, a team of health care
professionals including medical students, residents,
physicians, etc., set up health camps in village health
centers, local schools, and monasteries. In addition to
providing immediate care and referrals for more
serious cases, HHE focuses on educating patients on
various public health issues like oral and general
hygiene, nutrition, and pterygium prevention. Free
medical and dental care is provided to underserved
individuals of the Himalayas, and it is done so in a
culturally sensitive manner by employing the help of
local physicians and interpreters. HHE is also able to
distribute free medicines, toothbrushes, toothpaste,
reading glasses, and sun glasses to patients. HHE is in
the process of establishing a permanent clinic at a
monastery in Manali.

RWJMS group after clinic day 4

Line at the registration table

Personal Goals for the Trip

To experience how healthcare is delivered in
such a rural and inaccessible region of India
To immerse myself in the culture of Spiti
Valley, where both Hinduism and Buddhism
traditions are recognized by locals
To be exposed to clinical knowledge,
customs, and environmental conditions
unique to Spiti Valley and Himachal Pradesh
To improve history-taking and physician
exam skills by seeing patients and learning
from physicians on the team
View from the Dhankar Monastery roof

We set up clinics in 8 remote
villages of Spiti Valley, offering
clinical consults, access to
medications, and basic clinical
services. The prevailing medical
problems I encountered were
pterygium, intestinal worms, tinea
manifestations, musculoskeletal
pain, and dehydration.

Conclusions & Lessons Learned
This experience was meaningful in so many different
ways, and I couldnt imagine it being any
more fulfilling. I improved my clinical
skills tremendously by seeing many
patients on my own and by being expected
to run through a full history, physical, and
differential diagnosis before presenting the
case. The residents and physicians on the
trip were so knowledgeable and helpful in
their roles, as they not only provided
valuable feedback and confirmed our
patient evaluations, but pushed us to our
potential by not treating us like first year
medical students. I was also really happy
with the presentations students gave after
clinic every day, each one focusing on a
different aspect of care relevant to our time
in Spiti Valley.. Aside from the clinical
growth I experienced, I met students from
around the world and made many new
friends. I embraced the culture and enjoyed
improving my Hindi, playing cricket, and
eating amazing food. I was fully immersed
in the tremendous beauty of the Himalayas,
as we were given the opportunity to camp
in valleys with flowing rivers surrounded
by snow-capped mountains. Camping was
a first time experience for me, and it was
definitely one of my favorite parts of the
trip. Overall, HHE gave me an
unforgettable experience and I highly
recommend this trip to any medical student
looking for a global health adventure!

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