On June 25th I leave for the 4th year of the GHI: India Spiti Health Project with a team of medical students, one resident, one architect, and one engineer. The project began with a visit to the community in 2006 with myself and three medical students when we first travelled to this high Himalayan community in Northern India to meet the children at Munsel-ling School in Rangrik, Spiti Valley, Himachal Pradesh.
Spiti is a remote region in the Indian Himalayas – so remote that many Indians haven’t heard of Spiti. The Valley is closed to access for seven to eight months of the year due to snow on the high mountain passes. Rock slides keep the road to Spiti in a constant state of breakdown and repair. Altitudes range from 3700 to 6000 metres and according to the locals, the highest village in the world at 4500 metres, is located in Spiti. Like any remote community, access to health care is limited. The nearest hospital is a fifteen hour bus ride on the unpredictable roads out of Spiti. On our visit in 2006, we toured the valley, meeting the local community, living in villages of 50 to 200 inhabitants, mostly subsistence farmers. The government centre of Spiti is Kaza, where a health centre is located government doctors are commissioned for rural service. Due to the severe winters where temperatures can drop to -35 degrees C, the health centre is closed in December and January. Similarly, the government schools in the villages are often closed due to lack of teachers.
In 1996, a local visionary, Lama Tashi Namgyal, Chair of the Rinchen Zangpo Society for Spiti Development, built the Munsel-ling School in the village of Rangrik. Munsel-ling is a Tibetan-derived phrase meaning “Place Illuminating the Darkness” – a metaphor for the attainment of knowledge as a way out of the dark. The school which runs from Kindergarten to Grade 10 boards about two thirds of its 400 students who come from all over the valley, from villages as far as 4 hours away on foot. By its 10 year anniversary, Munsel-ling students were achieving and surpassing the Indian Board exam standards and Lama Tashi was able to find sponsorship funding to support higher education for graduating students in Dharamsala, Delhi, and Shimla. In fact, last summer, our UBC team worked with Delhi nursing students (some of who were Munsel-ling graduates) on an alcohol and tobacco study.
Since 2006, a GHI team has worked with the Munsel-ling School to improve health through health screens, health education, prevention programs, and water and sanitation projects. In 2007, GHI implemented health booklets for each child documenting the results of the health and dental screens. Results of Hemoglobin testing demonstrated over 70 % of the school children were anemic. In 2008, blood smears done on the 200 most anemic children suggested a mixed Iron and multivitamin deficiency. Over 40 % of the children had dental caries, and lice, scabies, and intestinal helminths were rampant. Tuberculosis is also highly prevalent in the community, however since the implementation of the WHO TB DOTS program by the government public health officer, TB rates are being better controlled.
The GHI teams have done several community surveys regarding water access, vaccination knowledge, handwashing and sanitation, greenhouse use, and alcohol and tobacco use. The results of these surveys obtained valuable community input and helped the teams concentrate their efforts on community interest. Using the results of the health screens and survey analysis, the GHI students have written proposals on behalf of the Munsel-ling school which were successful in obtaining funding for the a new water storage tank, new bedding for the school dormitories (from the Canadian NGO Sleeping Children Around the World SCAW), and a greenhouse.
GHI also funded three greenhouses, toilet facilities, school nurse training salaries, and the school medical dispensary.
In 2009, the team piloted a health education curriculum for the school and were helped by student nurses from Delhi in delivering it to the children. Simple things like handwashing and toothbrushing require more than education because the infrastructure to carry out these activities is lacking. In the last three years, the GHI team has built toothbrush storage racks and ensured that all children had toothbrushes. Similarly, handwashing infrastructure has been put in place. We have been fortunate to have a couple of engineers on our team who are working with the school to develop a water purification system.
Global Health requires a multidisciplinary approach and a strong community partnership. We have been lucky to have students from many UBC faculties work with the Munsel-ling School and enrich the learning experience as well as the outcomes of our projects. GHI has also collaborated with a Dutch Medical Team (Medical Checks for Children), an Australian dental team who set up mobile clinics in the Spiti Valley, and a Vancouver-based NGO – Trans Himalayan Aid Society (TRAS).
In the last four years, our data show that anemia prevalence has decreased by 16 % through a multi-pronged approach of supplementation combined with addressing linked causes (deworming, enhancing dietary diversity through greenhouse farming, decreasing intestinal infestations through handwashing infrastructure and water and sanitation projects, and health education). The school principal reports that scabies and lice infestations have significantly reduced.
This will my third visit to Spiti since 2006 and it has been inspiring working with students who have formed a sustainable bond with the community and a genuine interest in a little remote school around the world.