From Michelle Disher (NCFM R2)

Week 2: Mountains and Monasteries

We wrapped up our time in Bir, and the next chapter of our travels has led us to even more rural and mountainous regions in the Himalayas. To get to them, our team elected to hike over a mountain pass by following a 25km trail. The first 7km were incredibly arduous. It was almost entirely up a steep mountain slope covered in a slippery bed of dry pine needles. After making it to the top of the pass, we walked the rest of the way over gravel roads and down grassy fields to make it to the bottom of a valley where our drivers were waiting to pick us up. The hike was as breathtaking as it was exhausting. Our path was littered with rhododendron blossoms from overhanging trees, and we were surrounded by constant mountain vistas. It was the farthest I have ever hiked in day!

Several times over the course of our clinic days we have been able to intervene or diagnose some major conditions. Today I had a 9 year old pediatric patient who presented for a general check up but had a blood pressure of 140/80. He had no symptoms suggestive of heart or kidney disease, and his urinalysis was normal. Luckily we have a portable ultrasound with us, which we used to discover multiple bilateral renal cysts suspicious for poly cystic kidney disease. We were able to also scan his mother, and she had multiple cysts as well. Their family was referred to a local physician for definitive diagnosis and treatment. It was rewarding to make such a catch! Other diagnoses made by our team included a young boy with hypertrophic cardiomyopathy and an unfortunate older woman with likely endometrial cancer. 

The past few days have involved breathtaking mountain views and once in a lifetime experiences at Buddhist monasteries. We have stayed at two monasteries so far, which have been home to boys ranging from elementary school through high school age. It’s been heartwarming to see the  ancient Buddhist burgundy and gold robes dressing little boys playing with a deflated soccer ball and old cricket bat. I’ve learned that children can start training to become monks if they choose to leave their families by their own volition. They are then looked after by their older counterparts at the monastery.

Our clinic days have consisted of doing well-child checks on these boys. Perhaps it should be no surprise that these kiddos have a lot of cavities! They get soda and other sweet drinks as offerings that the local townsfolk bring to the monastery. They also apparently love to chew lots of gum. We also spent a day at a nunnery which looked and functioned analogously to the monastery of boys. Interestingly, tinea capitis is a recurrent issue for these ladies because they share the razor blades they use to shave their heads.