Health Education on Hypertension in Remote Alpine Villages of Nepal

Katherine Garlo, MD

Nephrology Fellow at BWH/MGH

PGY 6

Health Education on Hypertension in Remote Alpine Villages of Nepal
Blog Entry 1

We set out from Kathmandu on March 24^th to complete the spring 2017 medical trek with Himalyan Healthcare (HHC). Our team consisted of eight American medical volunteers, eleven Nepali healthcare workers, eight kitchen staff including two cooks, thirty porters, and 46 mules. We brought expertise in pediatrics, internal medicine, emergency care, nephrology, and acupuncture.  This was the groups first experience working together and for many of us, our fist time meeting.  

Our mission was to provide medical care in the remote alpine villages in the Ganesh-Himal Mountain Range of Nepal. These villages are approximately 12,000 feet in elevation and only accessible by foot.  There is limited access to electricity, clean drinking water, and sewage disposal. Excepting helicopter transport, all transportation is completed by walking along trekking trails connecting the villages

Mules carrying village supplies crossing a bridge during the medical trek

Tamang Heritage Trail connecting villages of the Ganesh-Himal mountain range

After a thrilling and exhausting drive to the “place where the road ends” we would be trekking on foot. We would be sleeping in tents and our camping provisions would be provided by Nepali Sherpa porters.

Camping site arranged by the Sherpas and porters working with Himalayan Healthcare

Camping site arranged by the Sherpas and porters working with Himalayan Healthcare

Sertung village in the Ganesh-Himal mountain range. Population over 5,000

Our patients would be the Tamang villagers living in Shertung, Lapa, and the surrounding villages.  The Tamang migrated to Nepal from Tibet to flee Chinese rule. They are subsistence farmers who survive on agricultural crops and support from international aid. This area is classified as absolute poverty by the United Nations and World Bank due to the deprivation of basic human needs and living off less than 2$ / day. There is limited access to healthcare or education.  HHC has been working in these villages for over 25 years.  They have established a relationship built of trust, reliability, and commitment with the village people.  This gives foreigners the privilege to enter these communities with HHC to provide healthcare services.  Because of this trusting committed relationship, our services have a higher likelihood of creating sustainable change and creating a meaningful impact on the health of the communities.

Patients gathering in the morning before clinic in Sertung village

Medical education is a vital component of sustainable change.  I dedicated much of my efforts to teaching about hypertension to the village healthcare workers, translators, and patients. Chronic diseases such as HTN are becoming more common in Nepal. The Nepali Ministry of Health and Population prioritized HTN in the 2017 National Health Plan. I discussed a.) practical clinical skills of blood pressure recording, b.) pathophysiology of HTN, especially high salt intake, c.) consequences of uncontrolled HTN (e.g. stroke, heart disease, end stage renal disease), d.) HTN management with medications and follow up.

Patient examination room in the Sertung village clinic

Ganesh-Himal mountain range. Langtang pass