Final Week: Rural Villages
Another several hour drive over mountain passes brought us to Garagusain, which has been our base for camping and lodging. From here we took short car trips to nearby villages and set up health posts. Yesterday, we went to a larger village and actually worked in the local clinic there. It was reassuring, although somewhat surprising, to see consistent access to local health care available here. There is a pharmacist who sees patients there on a daily basis and provides medications. We took over the clinic for the day and saw all of the patients that came, but the pharmacist hung around as a consultant. I appreciated this, as he is familiar with the patients, their language, and the diseases that more commonly occur in the area.
Dermatologic complaints have been a bane for our team. Many patients present with unusual rashes, and it is difficult to get a thorough history translated in Hindi to understand much more than whether it itches and how long ago it appeared. It would be great to know how the rash started, whether insect bites were involved, and if the patient has underlying chronic conditions, but these sorts of questions get mangled in translation. For significant rashes, we end up taking a shot gun approach of treating with oral anti fungals and/or topical steroids. We have seen a consistent amount of scabies, which usually has a more straightforward presentation and treatment.
One day in clinic we saw a middle-aged woman who had a rash all over her trunk that had been there for a month and was itchy. She had scaly scab-looking lesions scattered all over her flanks and backside. Unsure of the diagnosis, we treated with with fluconazole and topical hydrocortisone. One of our attendings sent a picture of the rash to a dermatologist friend of hers, who didn’t know what it was and recommended we biopsy it. If only we had that sort of luxury!
Our last couple days of clinic were at an orphanage in a small village. We had the fortune of getting to host our clinic alongside a popup dental clinic hosted by the local dental college as part of a public health outreach project. I envied their ability to thoroughly educate their patients without a language barrier and with props! The orphan patients we examined had surprisingly better teeth than I expected, even better than the children at the monasteries. Together with the dental students we probably saw almost 200 patients over two clinic days. We even made the local paper!
We also examined many adult patients, who typically presented with vision complaints. Presbyopia and cataracts were the most common diagnoses. It was striking to me how much constant sun exposure without hats/sunglasses caused so many vision complaints, from watery eyes to pterygium to cataracts. This was a consistent pattern we have seen throughout the Himalayan villages.
Once our last day of clinic was over, we inventoried all of our medicines and made a list of what would be needed for the next trip coming up in July. It’s exciting and reassuring to know there will be a team following us in a few short months, to carry on the work.
As our trip comes to an end, I am humbled by how much there is still to learn- about medicine; about culture; about people. I feel invigorated to stay curious and absorb as much of my medical and life experiences as possible. The main goal for me for these sorts of trips is to do more good than harm for patients, and to open myself up to their world. I feel like I accomplished this, although there is still so much more to do!
The Route: Map of our travels in northern India in Himachal Pradesh
