Himalayan Clinic

Hello! I write to you now from the town of Manali, a city in the mountains. It's a big town for backpackers and adventure sports enthusiasts. There is plenty of access to internet, so I'm sitting in a travel agency/internet cafe, drinking a "maaza" (mango juice Coca-cola product) and finished a chocolate cake ball from the German bakery across the street.

Since I last wrote, I've gotten settled with our group, the Himalayan Health Exchange, Dharamsala team. There are 35 of us volunteers, 6 or so drivers (and translators during clinic), 6 or so cooks and other workers, and Ravi, the founder of the organization. Among the volunteers, there are 3 attending level physicians, 5 residents, and the rest are medical students, all but 3 are fourth years. We come from the U.S. mostly but also from Canada and Australia. A few students are from India, and their knowledge of Hindi helps immensely during clinics.

On day 3, I arrived in Bilaspur. On day 4, we head out from our hotel after some rooftop yoga and traveled further into the mountains along a river valley. At this level, it looked almost tropical. There were some palm trees and macaques! At the city of Aut, after maybe 3 hours, we crossed the river on a one-lane suspension bridge, then followed a winding road heading up, up, up. As we went, the views got more and more incredible until we could see snow-capped mountains north and west of us (it would have been east, too, but we ended on the west side of a mountain). Every view was a masterpiece. The driving would have been scary had I not had trust in our drivers who went slowly and gingerly. I was a little nervous, too, since the day before we had heard there was a landslide somewhere along the way that our cooks and other workers had to travel 6 hours out of the way to avoid. Fortunately, it had been cleared (and continued to be cleared; we waved at workers on our way). Finally, we reached the top and pulled into a gated area surrounded by trees (firs, pines). We reached the village of Jaipain.

Our accommodations were so great, considering we stayed in tents! We showed up, and all of our tents had been set up for us, including 2-person tents for the group, a large cafeteria tent, 2 shower tents (bucket baths), and tents for all the workers, all of which surrounded a building holding 3 rooms and 2 bathrooms. The building and land are part of the national forestry service.

That first day (day 4), we walked through the village and up the road a bit (all at 7,000 feet elevation), but returned to our grounds. I cannot believe how cushy this trip has been so far. The cook makes us DELICIOUS meals. We have mostly had awesome Indian food, but also some Chinese and a special night with pizza and pasta. We are also served 5 p.m. tea and cookies/crackers and 10:00 a.m. cold drinks or tea during clinic. Up in the mountains, it gets pretty cold at night, and we had a fierce wind that first night, so we all went to bed pretty early.

Day 5 was our first clinic day! We had clinics again on days 6, 7, and 8. Day 5 was in a village called Thachi, about a 20 minute drive further up the mountain, Day 6 was past Thachi held on a helicopter landing site so the views were even more amazing than usual, Day 7 was down the mountain at a school, and Day 8 we held on our camp grounds.

Clinic runs as follows: we have 8 large tents set up as stations (again, set up by HHE workers). The stations are registration (run by the Indian workers), triage (3 med students and a worker/translator/driver), 3 internal medicine tents (attending or resident plus 3-4 med students each), pediatrics (attending plus 4 med students), gyni (which is what they call ob/gyn here, also resident plus 3-4 students), and pharmacy (resident plus 3 students). So far, I have worked one day each on gyni (not my favorite, but there aren't enough ob/gyn patients so we also take general medicine patients), medicine (lots of fun!), triage (lots of blood pressure, temps, pulse checks), and peds (my favorite!!). After the first morning which was slow, things have run pretty smoothly. The attendings and Ravi (head of HHE) both say they are impressed and happy with how things are going.

The most frequent medical problems we see are eye problems (great after my Ghana experience, but mostly people have irritation from the dusty roads, in addition to some more unusual findings), joint pain (no surprise, these are farmers walking up and down mountains carrying 60-80 pounds on their back), and also a lot of gastroesophageal reflux disease (GERD). In addition to these more frequent diagnoses, I have also seen a few unusual cases. I had a patient with patellar dislocation, a woman with a corneal laceration obtained when a bird holding a stick dropped it into or scratched (unclear, the story was weird) her eye, a child with language delay, and a little girl with pica (eating soil: a sign of iron deficiency). The first we sent to the nearest hospital in Mandi, the second we patched and gave eye drops, the third we gave reassurance for now (18 months) though there's not much we can do for her, and the final one we gave iron replacement tablets. The attendings have all been awesome. They each have led fascinating lives filled with travel. I think I'm learning a lot with all of this clinical medicine practice; it's getting me re-charged and excited for residency. As a whole we have seen over 900 patients so far!!

A few more fun things. Every day, I wake up early and do "Insanity" workouts, which are a pre-set routine with an accompanying video that a friend plays on his iPod. Hopefully with the workout plus elevation plus walking home from clinic most days, I'll be in great shape when I return! Even despite eating lots and lots of delicious Indian food haha. Yesterday we also played cricket!! It's so funny to see all of the kids playing street cricket because everywhere else I have traveled, kids are always playing soccer. So, as a group of about 20, mixed volunteers, workers, and Ravi, we learned how to play then had a ferociously competitive game. I did well in the field, getting a couple people out. I played, well basically catcher, but it's really the wicket-keeper, or wicket defender, I can't remember... I had a good hit batting, but the rule is that you have to hold onto the bat as you run, which I completely forgot and instinctively dropped the bat after years of school gym class baseball and softball. Whoops, so they got me out as I was frantically running back to my bat and pick it up again haha.

Now, after 4 days of hard work in the clinics, we packed up our campsite (well, the workers really will do all of the work in taking down the tents and whatnot) and left, which was a little strange after getting so settled there, then traveled 3 hours to Manali. I spent the first half of the day walking from the main town to a beautiful temple the dates to 1533 A.D., then we walked to Old Manali and quickly found the bakery and internet cafe/travel agency.

Let me know what questions you have and I'll answer them either tomorrow morning before we leave for our next clinic site, or whenever I have internet again! We are 9.5 hours ahead here. You can either leave comments or e-mail. Talk to you later!!

Jackie, Day 9