Stories From the Field:

INDIA

Medical Mission Trip to India with the Himalayan Health Exchange

Jenny Sanford of MGH Department of Medicine received an MGH Global Health Travel Award to spend a month in India working with Himalayan Health Exchange (HHE) to help deliver basic healthcare services to remote villages in the Spiti Valley.

I spent the month of July with twenty medical students and physicians on an expedition led by the Himalayan Health Exchange (HHE) to help deliver basic healthcare services to remote villages in the Spiti Valley (Western Trans-Himalayan region of India). This region is among the most sparsely populated regions of India due to its terrain, altitude, and remoteness, and therefore has very limited healthcare resources. The purpose of the expedition was to set up outpatient, walk-in medical clinics at six villages over the three-week period: Nako, Chango, Kaza, Tabo, Kibber, Kye, and Rangrik. In total, the team provided free healthcare services to about 1,000 patients.

Each clinic day ran for about 8 hours. We were assigned on a rotating basis to work with either a supervising physician (cardiologist, family medicine doctor, obstetrician/gynecologist, or dermatologist), a dentist, or in the triage tent or pharmacy. The unpredictability of rural medicine does not always allow for schedules, however, and we often found ourselves shifting assignments or jogging between tents to meet the inherently variable needs of a clinic. We also faced challenges of our own, including high altitude (all clinics were hosted in villages over 12,000 feet), heat, issues related to translation, and barriers to road access (including a new river formed by a nearby melted glacier). I was so inspired by our clinical staff and the HHE team, who met the trying conditions with flexibility, patience, and an unwavering commitment to delivering high-quality care.

Patients arriving to a clinic were directed first to the triage tent, where we took blood pressure, temperature, pulse, oxygen saturation levels, and respiratory rate. I quickly became skilled at taking blood pressure without an automatic monitor—on my first day in triage, I took vitals for over 70 patients. But my favorite days were spent working under the direct supervision of one of the attending physicians, when I had opportunities to complete comprehensive medical evaluations on my own, make preliminary diagnoses, and suggest treatment plans.

The most common symptoms were eye pain (often due to cataracts) and back pain, reflecting the population’s long workdays outdoors, prolonged exposure to harsh UV rays, and lack of protective eyewear. We also found that many patients were quite dehydrated. In these cases, in addition to any specific diagnoses, we suggested preventative measures: wearing a hat and sunglasses (which we provided), how to lift a load using leg strength rather than back strength, and increasing water intake. Others came to us with more pressing concerns. One patient complained about a deep pain in his shin that had steadily grown worse over the course of 7 months following an injury from a fallen rock. The only imaging technique we had available was an ultrasound, which was inconclusive, but swelling in the area and a slight fever suggested the possibility of osteomyelitis. We sent him to the nearest hospital (many hours away) for further testing. I also learned quite a bit about heart disease and echocardiography. The supervising cardiologist gave each of us individual training on how to use the portable echo, and I had many opportunities to practice. In one young patient, I heard a loud heart murmur for the first time. Using the echo, we identified tricuspid valve regurgitation. In more severe cases like these, when our team couldn’t provide continued care, HHE covered any transportation and further hospital costs to ensure appropriate treatment.

In the evenings, we took turns leading discussions on topics relevant to our work in the region, including wilderness medicine, the diabetes epidemic in India, arthritis, ayurvedic medicine, nutrition, the public health consequences of untreated ear disease, and environmental eye conditions in Northern India. I was especially interested in learning about the nutritional deficiencies in the population given my role in supporting clinical research in diabetes prevention here at MGH. We saw a higher prevalence of diabetes than I had anticipated. The typical diet in the region is low in fruit and vegetables and high in refined carbohydrates (white rice and naan). The experience gave me a new, global outlook on diabetes prevention and has left me newly inspired to advocate for preventative healthcare on a global scale.

I am so grateful to the MGH Global Health team for supporting my travel, and to the Himalayan Health Exchange for the opportunity!