Clinical and Cultural Experience in the Himalayas Jaya Kanduri Rutgers- Robert Wood Johnson Medical School, Piscataway, NJ 08854 Background Information on Spiti Valley Trip Summary • • • • • 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 • 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. 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 • 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. 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 • 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. Conclusions & Lessons Learned This experience was meaningful in so many different ways, and I couldn’t 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!