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Medical team in Pangi valley

Posted by: Philip Alex | Posted on: July 2nd, 2015 | 0 Comments

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The district of Lahaul and Chamba in Himachal stretches west across the Rohtang pass, which is the lifeline providing access into the region populated by about thirty five thousand people. For about five months of the year, this snaking mountain pass is blocked with snow, rendering urgent access impossible. The mountainous terrain has precipitous gorges enfolding rushing streams that flow into the Chandra, and the Bagha rivers. These rivers join at Tandi to form the ChandraBhaga which later becomes the Chenab. The Chenab cuts like a knife through sheer rock in the Pangi valley towering above its rushing flow. A semblance of a road has been blasted along these sheer cliff faces, and is the only access into the Pangi valley. This trip was a first for the Mission hospital staff. A team of nineteen people in three vehicles pushed our way into this valley. Thankfully, all the vehicles made it without incident, though we were delayed by incessant rain that had caused landslides and closed the road for a day.


The team was composed of a gynaecologist (Dr. Sailesh), and radiologist from CMC Ludhiana (Dr. Pyares), a medicine consultant from C.M.C. Vellore (Dr. Abhilash), eye technician (Mr. Anil Kumar), dentist (Dr. Riya), laboratory staff, nurses, pharmacist, and a cook. Dr. Bishan Shasni, our Community consultant led and organized the whole endeavour. We stayed in a variety of government guest houses all along the way. The first two days was at Keylong, in the district hospital, and subsequent camps were in Udaipur, Killad, Sach, and Purthi.


A total of 1410 patients were seen. 296 ultrasound examinations were performed. All patients were screened for hypertension and diabetes. 94 dental procedures were performed. Every camp day consisted of the team organizing themselves in the government facilities, moving tables and chairs into position, setting up the pharmacy, and eye equipment, and settling down to see long lines of patients till the evening. A quick lunch break was a welcome interruption during which the team cook Punchok kept our spirits up by conjuring up exotic dishes out of very makeshift kitchens.


Two of our team members came down with altitude sickness, which we were able to detect and treat early. No one fell ill subsequently which was a blessing.


In Keylong, the response was lukewarm. Trifling complaints were an indication that the people here had access to health providers elswehere and had been obtaining treatment for themselves. The potato farmers in this region have money that permits them to access health care in Chandigarh and Simla, which is their recourse in the face of any medical emergency. We were able to care for a number of Nepali patients here who are employed as daily labour. Some of their stories in the setting of the recent earthquake in their homeland were heartwrenching. A little boy came and sat in my opd, unable to open his mouth at all. He had fallen from a tree and had probably fractured his temporomandibular joint which had subsequently fused, closing his jaws permanently in a locked position. The surgery he needed would be a challenge anywhere. We said we could consider attempting this in Manali, at which his uncle began to weep. His entire home was wiped out in the earthquake, and his family members were now all with him here in Keylong.


Stories of desperation continued to pull at my heart strings as we made our way across the valley. The further we went, the deeper was the desperation. We entered the Pangi valley late at night, which was probably fortunate for most of the group as the dark obscured the precipitous drop into the gorge as our vehicles careened round the sliver on the mountainsides that serves as a road.


We were consistently overwhelmed every subsequent day with large numbers of patients in Udaipur, Killad, Sach and Purthi. Despite the crowds, the people were most respectful and considerate to each other, waiting patiently in long lines and permitting precedence to the aged and the young for treatment. The people are very gentle, and simple. A peculiar notched white cap characterises the Pangi man, and the women are adorned with necklaces and a multicolored cap called a joji that rises above their jet black hair like the hood of a cobra. They wear the traditional pattoo (or woven blanket) in a peculiar underarm fashion, with a fringe that is tossed over the other shoulder. They have peaked features, aquiline noses and sharp chins that permit easy identification. Their origins are ill defined, with some murky reference to their ancestors being driven out by the Chamba mountain kings. It is easy to imagine that desperation or a desire to hide would have driven these folk into their mountain hideaway, isolated and inaccessible.


Those characteristics many generations later has worked against them. Nature’s havoc and the ravages of ill health has caused them to see their own die from preventable and treatable diseases. Childbirth is an event with an unpredictable outcome for mother and child. Injury and trauma is a pathway to the grave. Most accidents on these roads are fatal, since no one can survive the precipitous drop into the gorge. The government hospital is staffed by two enthusiastic but inexperienced doctors, who do the best they can. With no access to surgery, or advanced medicine, they feel helpless more often than not, since their nearest referral hospital with a hope of treatment is eight to ten hours away on these roads. There is no postgraduate in the entire region.


As patients came to us, I sensed a deep and indolent sorrow that has permeated the fabric of life. A sorrow probably birthed from helplessness and bereft of hope. It surfaced in the tears of a mother being told her baby was well. Was it relief? Or was it from months of not knowing and imagining the worst? A man who was over a hundred had a carcinoma on his ear for two years. On being told we will return to operate on it, he reached down to touch my feet, a person who was half his age. What can do that to a man who is over a hundred? The people were most grateful for any treatment given to them.


The government NRHM program permits teams to operate in Killad and Udaipur annually and we saw quite a few who had their surgery at these camps. These camps had been conducted by other teams in the past. This seems to be an avenue of hope for them to obtain treatment. For most of them, the possibility of leaving the valley to go for treatment at bigger centres is like being advised a trip to the moon. Yet, we also were witness to questionable practices at these camps, like a twenty six year old lady whose uterus was removed, and another thirty five year old lady whose ovaries were also simultaneously removed. There were stories of some of these surgeries going very wrong. A lady had become septic and continued to bleed post operatively from a previous camp and required referral, large amounts of blood transfusion and a month in another centre before she was well enough to return. All this was very sobering to me, because the onus of providing surgical services in such an environment safely is an onerous one, not only to ensure that we are able to provide a service, but more importantly to provide it safely.


One thousand four hundred patients later, we leave with a sense of fulfillment, but we also carry with us some of the sorrrow of the people, which is an impetus for us to return, and hold out hope. That is what the gospel is for all desperate mankind, a hope, a message that God has opened a way for a desperate people, holding out a hope for healing and wholeness, the substitution of a smile for rivulets of sorrow. We hope to be back, very soon.

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Written by Dr. Philip Alexander, Medical Superintendent,

Lady Willingdon Hospital, Manali




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