From Michelle Disher, M.D. (NCFM, R2)

First Week: Dharamshala and Bir

I’m coming near the end of my first week working with a great group of people from all over the US to offer clinical evaluations to children and adults living in local villages nearby. Himalayan Health Exchange has designated areas that are filled with medical providers every couple months or so. This month I have the privilege of being one of them . 

Alongside me are U.S medical students, a fellow resident, and a few attendings who supervise our work. 

Our journey started in Dharamshala, the sacred home of the Dalai Lama. We spent our first day here resting from a long trip that involved a total of 19 hours flying and 2 hours of driving on winding roads. There was a rather chaotic and smoggy trip from Delhi to the Dharamshala airport that I’ll spare you the details of. The area of Dharamshala  is mountainous and serene. We had the honor of getting to tour the compound of the Dalai Lama and ride a gondola to tour the rural towns scattered nearby. 

From Dharamshala we traveled to Bir, another rural town that is famous for its paragliding. The town is surrounded by small farms and prayer flags, with towering mountains of the Himalayas in the backdrop. There are small clinics in town, but they can be a challenge to get to both from a financial and a transportation standpoint.

We hit the ground running on our first day with pediatric screenings at one of the local schools here. The goal was to see nearly 600 students over the next couple days between 13 providers: 4 attendings, 2 residents, 7 medical students. 

The schools here are like boarding schools, with the students living together on a large campus overseen by teachers and “house-mother.” Overall, the children are relatively healthy here, though they do have some issues that are more common in low income countries. A handful of them had scabies. Parasites are a ubiquitous issue, which the government has started addressing by giving all children yearly albendazole treatments. Malnutrition and stunted growth is also much more common. Many of the students I saw were < 10%ile for their weight/BMI on their growth chart! Finally, my pediatric exams weren’t complete without noting numerous cavities and rotten holes in their molars. 

Over the course of the week, out team brought pediatric screenings to two large boarding schools. We saw over 400 students in two days at the first school, a bit shy of our goal of 600. We managed to see all of the students at the next school, which was more that 500 patients. 

In between pediatric screening days, we set up health outposts in fields of rural villages that were open to everyone. Evaluating and treating adults introduced several new challenges. Often patients would come to us with chronic conditions such as hypertension or poorly controlled diabetes, which we could not properly treat with a few weeks worth of medications. Sometimes they would have conditions that were being managed by a physician already but the patients were still struggling with their condition. 

In many of these cases, we play an important role keeping these patients looped in with their doctor. One of my patients came to me with terrible joint pain and psoriatic plaques on his extremities. He brought with him a packet containing physical X-rays, as well as physician reports and medication list from a rheumatologist. The medicines he was on either ran out or weren’t working. There was nothing in our traveling pharmacy I could offer him besides a wimpy hydrocortisone cream. I encouraged him to return to his rheumatologist, who would know his medical course and have a better idea about what immunologic to put him on.