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!

Trip Summary• 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.

• At elevations ranging from 11,000-14,000 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 hygiene-ignorance 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.

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

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.

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

Clinical and Cultural Experience in the Himalayas Jaya Kanduri

Rutgers- Robert Wood Johnson Medical School, Piscataway, NJ 08854

RWJMS group after clinic day 4

Line at the registration table

View from the Dhankar Monastery roof