Conclusions

1
Clinical and Cultural Experience in the
Himalayas Jaya Kanduri Rutgers- Robert Wood
Johnson Medical School, Piscataway, NJ 08854
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!

• 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.
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