1. Himalayan Health Exchange

2. Expeditions Three medical expeditions during the summer Around 3 weeks each Spiti, Indo-Tibetan Borderlands Lahaul, Greater Himalayas Chang Thang Plateau, Tibetan Borderland

4. The Spiti Region of India Trans-Himalayan Region at the edge of the Western Tibetan Plateau Once part of the Guge region of Tibet An ancient Buddhist land Was once forbidden to outsiders

5. The Purpose of HHE Spiti region is sparsely populated 1 person/sq. mile Isolated towns Assist those in need with very little access to health facilities Often the closest hospital was 2 hours away from the village Region was not available to tourists until 1996, so not very accessible

6. Serving about 1,500 people Ultimate Hands-on Clinical Experience Taking a focused history and physical exam Developing a differential diagnosis Presenting patients to attendings One-on-one feedback with attendings and senior medical students Writing and filling prescriptions Independent work

7. Clinical Experience

8. A typical clinic day Our medical camps are set up in tents, old hospitals, and monasteries Clinical rotations between: Triage Multiple general medicine stations Pediatrics OB/Gyn Pharmacy Would generally work from 9-1, and 2-4pm on an average day depending on the population of the village

9. Nightly Grand Rounds Strep throat and rheumatic heart disease Altitude sickness Tuberculosis Culture Leismaniasis Traveler's diarrhea Headache Knee pain Hypothermia Shared interesting clinical cases from the day

10. GLAMping

11. Food Mostly Indian and Chinese influenced meals Chefs from Nepal traveled with us and cooked all our meals Mostly vegetarian All meals were planned - no extra costs while on the trip Every dinner had a soup course and a dessert! Chai Tea and snacks available in the morning and before dinner Birthdays celebrated + awesome desserts!.... you will not go hungry.

12. Travel Days lots, lots, lots of time in the car...

13. There are plenty of opportunities for both work and play! Bhangra dance parties! Shimla summer festival Lots of shopping in Manali Hiking before and after clinic CRICKET Hair dyeing... Ear piercing...

14. Visit the wonders of the world...

15. ... and breathtaking scenery

16. Time to travel around after the trip... This trip is the shortest for the amount of credit you receive (but is the most intensive). So there is plenty of time to travel anywhere you want! Here are places we went after: France Germany London THAILAND

17. UNC SOM and Wake Forest SOM

18. What we did, and who we helped Limited access to local healthcare providers and medical resources Primarily Buddhist area, home to many of the oldest monasteries in India Clinic sites inaccessible at least 6 mo/yr due to heavy snowfall

19. Trip Cost Base price of trip varies; last year was ~$3,500 Including a $500 deposit with application Airfare can be purchased alone or through program: - through HHE = $1,550- alone can be found for ~$1,200 (book early!!) Many other fees to take into account: - Indian VISA - Immunizations (Polio, Hep A, Typhoid…) - Gear!! (sleeping bag, backpack, mess kit, meds and MUCH more) - Travel, before or after program - trip insurance (evacuation) THE EARLIER YOU START, THE CHEAPER ALL THESE THINGS CAN BE! Ask people who went last year if you can borrow supplies!

20. Trip Credit 1. HHE trip is equivalent to 6 elective credits 2. This is the most credits that can be obtained in MS1/MS2 years 3. Amounts to a month of MS4 work 4. Dr. Martha Carlough is the HHE liaison for credit 5. Need to file paperwork before trip, and after – need to do “project” – like this talk!

21. Sign Up Timeline September/October/November: Figure out what you want to do with your summer! December (latest): send $500 deposit to HHE to hold spot (trips are capped usually with a low number of people from each school - we got lucky) February: Sign up for elective credit March 1: Final deadline for applying for Indian VISA. Balance remainder due for trip. March 21: All info sent to HHE Spring semester: Buy the things you need – don’t delay! Ravi Singh, HHE Founder

22. Our updated packing list: Things you need: Vaseline Chapstick Protein bars Long Underwear At least 15 pairs of underwear Hats, Gloves, Scarf Sweater Raincoat Tissues Toilet paper Hand Sanitizer Lotion Sunblock Water bottle Long sleeve shirts Tights Long socks A loofah or washcloth Flip flops for showering Good shoes Cash to exchange to rupees: best deal in Delhi airport after walking out of customs Some city clothes Nutella

23. Print out itinerary (you will need this for entering the airports in India) make 2 copies Make a copy of your passport as well Sleeping Bag Tripod Stool Small flashlight--- headlamp even better Snellen Chart Things to share: Outlet adaptor Camp Soap Books to read Things I wish I knew: Domestic flights had a lower weight limit in India (20kg vs. 23kg). Pack medical equipment in checked luggage. Pack clothes you don’t mind donating in the end so you have more room in your bag for things you buy. Call credit card/bank before you go to India. Or get a travel debit card. Look for banks that have no/low ATM fees.