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/
Birth Rate: 16.2%
Death Rate: 6.1%
Languages: Manchad dialects, Bhoti, Sanskrit, and
• 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
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