2011 Expedition Report. Nubra Valley Ladakh

Date February 7, 2012

Building upon the progress made on previous medical missions to the remote Nubra Valley of Ladakh, The Himalayan Health Project undertook it’s largest and most ambitious expedition to date in the summer of 2011. A talented and diverse team of 33 dedicated surgeons, ophthalmologists, optometrists, physicians, gynecologists, nurses and a virtual army of local and international volunteers provided excellent quality vision and women’s health care examinations and treatments for over 4,000 patients in little over two weeks time.

A brief summary of the work and results:

Himalayan Vision Project

Total number of patients examined:  2,800

Cataract surgeries performed:  38

Prescription eyeglasses measured for and distributed:  275

Reading glasses measured for and distributed:  1,200

Sunglasses distributed:  800

High impact safety glasses distributed:  200

Himalayan Women’s Health Project

Total number of female patients examined:  1,900

Number of pre-cancerous lesions diagnosed and treated:  100

Cases of cervical cancer confirmed:  2

Women sent to New Delhi for advanced surgical treatment:  3

Medications distributed:  $20,000

The 2011 Himalayan Health Project Expedition to Nubra Valley, Ladakh

Based on post-expedition analysis from the spectacular results of the 2010 team, it was decided that the 2011 mission statement would be to accentuate wide scale vision and women’s health care for as many people as possible living in the remote Nubra Valley of Ladakh.  In particular, the opportunity to have a break-through impact in the long neglected field of women’s health care was at hand.  For the entire year following the successful Himalayan Women’s Health project clinic in 2010, the extraordinary efforts of our Ladakh based ally physician Dr Nordan Otzer made a historic impact possible.  Doctor Nordan tirelessly traveled by foot to each of the 35 remote villages in Nubra Valley and did presentations for the local women on the basics of their reproductive anatomy as well as advocating regular screening as an imperative intervention in the epidemic rate of cervical cancer among the female population of Ladakh.  Because of his efforts and announcements on All India Radio, the women of Nubra Valley enthusiastically awaited the arrival of the international gynecology team that traveled to Disket in August 2011.

Dr Nordan Otzer instructing the local women of Nubra Valley on the basics of women’s health care

The team of 33 dedicated physicians traveled from Singapore and the USA with an enormous amount of diagnostic and treatment equipment, supplies and capability.  After arriving in the capital city of Leh, we once again needed to transport the team over the highest motorable road in the world to Nubra Valley.

The road from Leh over the 18,380ft Kardong La pass to Disket, Nubra Valley

On arrival in Disket, the team immediately set up in three primary work locations that provided specialized screening & treatment venues for the vision and women’s health care objectives of the expedition:

  • The Himalayan Women’s Health Project team of gynecologists set up a private clinic that had separate stations for registration, screening, treatment and education. This was located at a guest house compound that afforded privacy and singular focus.
  • The Himalayan Vision Project team set up 8 separate clinic stations at the classroom complex of the local Lamdon School.  Individual screening stations were set up for registration, basic visual acuity examination, specialized examination for cataracts, glaucoma and other eye maladies, measurement of reading glasses, optometry measurement for prescription eyeglasses and distribution of an enormous amount of eye medication.  In addition, patients who required surgery for cataract conditions were identified and prepared for the surgical team
  • The team of four optical surgeons and a full support nursing staff were stationed out of the local hospital where they operated on patients utilizing the two OTs and patient wards.

The Himalayan Women’s Heath Care Project – 2011

 

Dr Nordan's heroic efforts to journey to each of the 35 villages of Nubra Valley in order to educate the local women in basic women's health care and also urge them to attend the 2011 Himalayan Women's Health Project camp in August 2011 produced an overwhelming and historic response.

 

Over 2,000 local women travelled from as far away as 100km to attend the camp and receive what for many of them was the first gynecological examination of their lives.

 

Patient #1 for the 2011 Mission

Dr Chua Yang (pictured), Dr Swee Chong and Dr Veronica Ventura teamed together with local gynecologists, nurses, health care workers and volunteers to tirelessly endeavor to exam and treat as many of the women who had travelled so far as possible. Often working 12>15 hours a day, the women's health care team provided excellent personalized screening and treatments for almost 2,000 women. These numbers represent almost 50% of the entire female population of Nubra Valley. It was a historic breakthrough and monumental success on every level.

 

Education

A major component of the overall mission statement was women’s health care education.  Dr Swee Chong conducted daily lectures and discussions with hundreds of local women before and after their examinations and treatments.  Working together with the local doctors and nurses provided translation capability as well as to encourage the local woman to continue to come in to see their local physicians on a regular basis.

During the 7 day camp almost 2,000 women where screened and received treatments and vital information. Approximately 100 women were diagnosed with pre-cancerous lesions.  The skilled surgeons performed many relatively minor excisions and biopsies of these women and the vast majority were considered cured of their potentially serious conditions.

Three women, however, were found to have advanced cases that required major surgical procedures.  We made all necessary arrangements for them to be flown down to New Delhi along with their husbands and they were admitted to the excellent facilities at The All India Institute of Medical Sciences.  There, they received wonderful care led by the head of the women’s health department at the hospital Dr Neerja Bhatla.  Dr Bhatla has committed to being available to extend the full capability of her skills and the AIIMS hospital to provide surgical care for Ladakhi patients who’s conditions require more complex treatments and procedures than are available in Ladakh.

Dr Nordan will continue his efforts to journey to each village on a regular basis to continue the positive momentum established with The Himalayan Women’s Health Project.

Himalayan Vision Project – 2011

 

As a result of the enormous benefits shared with the people of Nubra Valley in 2010 as well as daily announcements on All India Radio leading up to the arrival of the vision team, hundreds of local people travelled to Disket to be examined and treated by the 25 doctors.

We set up the 2011 Himalayan Vision Project camp at the local Lamdon School which provided 14 separate classrooms that were converted into individual clinics and treatment stations.

Lamdon School-Disket / Site of the 2011 Himalayan Vision Project camp.

The setting of the camp was truly spectacular

The first step was to triage every patient.  Each patient had to fill out a form and was given a number so that they could move through the separate examination and treatment stations of the camp and also so we could keep permanent records for follow-up treatments and eyeglass distribution.  The system worked very well.

First everyone filled out a patient identity form and were assigned a number that was on the form and also written on their arm
Then everyone was given a basic eye acuity exam.  Here Dr Nordan and the head of the optometry team Dr James Chong, train the volunteers who administered the preliminary vision exams.

Patients were then given a more thorough examination for cataract conditions, glaucoma or injuries due to illness or accident.

Depending on the results of those examinations, the patients were given medications, registered for cataract surgery or sent to be measured for reading or prescription eyeglasses.

A vital member of the Himalayan Vision Project team Mrs Pennie Jackson and a local volunteer measure a woman for reading glasses.  A very generous supporter in Singapore, Mrs Wong Sioe Hong, donated several thousand pairs of reading glasses which helped the team restore the practical eyesight of many men and women over 40 years of age.
Perhaps the most dramatic and cost effective intervention was that in the field of optometry.  Dr James Chong and his team examined and measured hundreds of people during the camp and found over 275 who could greatly benefit from correctly prescribed custom eyeglasses.

Over 275 patients young and old were measured for prescription eyeglasses.  The order was placed with an optical supplier in New Delhi and then returned to the patients in Nubra Valley in less than three weeks.  As a result of the accurate patient records kept during the camp, each pair of prescription eyeglasses were distributed to their very happy new owners by Dr Nordan before the onset of winter.  Many of the patients went from functionally blind to fully restored vision as a result of their new eyeglasses.

New Eyeglasses

With the help of our friends and supporters Mr Jatinder Dhingra and Mr Rajesh Kumar in Delhi, who coordinated the deliveries, the 275 pairs of eyeglasses were perfectly fabricated and returned to Ladakh in less than three weeks. Dr Nordan then was able to distribute them to the patients and perform a basic eye test to confirm the dramatic improvement they brought to each patient.

Other patients required surgery for their cataract conditions.  The skilled surgical team of Dr Pauline Cheong, Dr Romesh Angunawela, Dr Marcus Ang and Dr. Jod Mehta, along with the seamless support team led by Sister Low, performed 37 sight restoring cataract operations.

The gratitude of the patients was heartwarming and inspirational to the entire team.

The Chief Executive Hill Councilor Mr Ringzin Spalbar as well as the Councilor for Health of Ladakh, Dr Wangchok paid an official visit to the camp and expressed the gratitude of the local government to the team for the benefits they brought to their constituents.

To continue the progress and momentum established by the international vision health care teams that have come to Ladakh over the last four years, we are now moving towards the next level of progress.  In conjunction with the world renown Tilganga Institute of Ophthalmology in Kathmandu, Nepal we are now sending students and health care workers to TIO for training in basic vision health care.  After completion of their training, the students will return to Ladakh to work with The Himalayan Vision Project and endeavor to bring adequate vision care to virtually every remote village in Ladakh.

The dedicated nurse and dental technician at Lamdon School in Leh, Mrs Yangchan Dolma is now studying at TIO and will return to Ladakh with greatly enhanced skills to help the people of Ladakh.
The team also included two dedicated physicians who examined hundreds of patients for a wide range of general maladies.  One of the most common ailments found was degenerative arthritis caused by a lifetime of climbing the mountainous terrain of Ladakh.  The doctors prescribed 175 knee braces and walking sticks for some of the most severe cases and we will purchase them and have them delivered to the patients in the spring of 2012.

The 2011 Himalayan Medical Project Expedition Team

Dr Ang Han Nian Marcus

Dr Cheong Yeem Yoong Pauline

Dr. Romesh Indika Angunawela

Dr. Jodhbir Mehta

Dr. Chua Yang

Dr. Quek Swee Chong

Dr. Veronica Ventura

Dr Chong Shujuan Rachel

Dr Chung Hsi-Wei Yvonne

Dr Tan Boon Ya Petrina

Dr Pek Chern Kuok Don

Dr Lam Sing Harn Janice

Dr. Fu Raw Yueh Esther

Dr Cheryl Agnes Sng Chelvin

Dr Pang Wee Yang

Dr. Low Kiang Wee

Ms Low Siew Ngim

Ms Khor Sia Liew

Ms Tan Que Choo

Ms Chan Sau Yue

Mr James Chong

Ms Tan Lay San Carin

Ms Tan Zhen Kiat

Mr Zheng Jie

Ms Chua Soh Cheng

Ms Yeow Liew Soo

Ms Mei Wai Lin

Ms Yeo Liew Chay

Ms Chan Pei Shan Janice

Mr Leow Ter Lee Alvin

Ms Quek Kiah Jye (Jamie)

Ms Tay Eng Choo Jane

Ms. Joanne Calley

Mrs Pennie Jackson

Ladakh Team

Dr Nordan Otzer

Dr Padma Chosden

Nuri Sherpa

Duti Rai

Bhim Thapa

Nirku Rai

Delhi Team

Mr Jatinder Dhingra

Rajesh Kumar

Singapore Team

Mrs Manjeet Kaur


In Inspiration & Memory

Sonam Dolma

 1999 > 2011

May her spirit ride the wings of the angels


Erik Koto’s documentary on the 2011 Nubra Valley medical dental expedition.

2010 Dental / Medical / Surgical Expedition to Nubra Valley Ladakh

Date September 6, 2010

On July 17, 2010, Dr. Myra Elliott returned to Ladakh for the third consecutive year in order to continue her follow-up efforts to bring a wide range of dental and medical health care treatment to the people living in one of the most remote areas of the Himalayas.

After a year of post-expedition analysis and objective planning upon returning to Singapore from the 2009 dental/medical camp in Nubra Valley, Dr. Elliott once again mobilized a team of skilled and dedicated specialists to return in 2010 and aggressively address many of the vision related, gynecological and medical maladies that her team from the previous year discovered during the 2009 camp.

In preparation for the ambitious objective to perform as many cataract operations as possible,a portable optical microscope was purchased from an internationally renowned manufacturer of precision surgical equipment located in India. The Appasamy Optical Company headed by Mr. Jeyaraj, played a wonderfully supportive role in making it possible to purchase and take delivery of this invaluable surgical component prior to the team’s arrival from Singapore.

Dr. Elliott arrived in Leh on July 17, 2010. After an entire day of packing, sorting and loading three large cargo trucks with over 1,000 kg of portable dental and medical equipment, medications and surgical supplies, the entire team of 22 dentists, physicians, gynecologists, dermatologists and surgeons once again drove over the highest motorable road in the world to the remote region of Nubra Valley.

Dr Elliott and her team of 22 physicians, dentists & surgeons arrive in Leh, Ladakh

Because of the ambitious objectives of the 2010 expedition which included surgical procedures for the treatment of cataract patients, it was necessary to seek the invitation and authorization from the highest level political and medical leaders in Ladakh. Unconditional cooperation was extended and the team was able to utilize the surgical theaters, examination and treatment rooms as well as the trained medical staff of the small government hospital in the village of Disket.

After once again driving from Leh over the 19,000 ft Kardong la pass, Dr Elliott and her team were welcomed at the hospital in Disket, Nubra Valley

Dr. Elliott met with the hospital director Dr Manzoor, to plan the most effect strategy for utilizing the skills of her team members as well as the facilities at the hospital to treat the hundreds of locals who came to be examined and treated for a wide range of injuries and ailments

The team immediately broke up into their specialties and went to work setting up micro clinics within the hospital to offer their skills to the local people who waited patiently for the opportunity to be seen by the individual physicians
As had been reveled and clearly understood from the two previous expeditions to Ladakh, dental problems were severe, wide spread and epidemic among the entire Ladakhi population. The dedicated team of 6 dentists treated over 700 patients during the week in Nubra Valley

One of the most deficient areas of medical care in the remote region of Ladakh is that of women’s health. In a ground breaking initiative, gynecologists Dr. Chua Yang and Dr. Quek Swee Chong initiated public teaching efforts and also examined and treated over 300 woman of all ages and cultural backgrounds. Thirty patients with pre-cancerous lesions were diagnosed and were surgically treated during the camp. On the final day of the treatments, the doctors were receiving young female patients who were coming to the hospital for routine examinations which was a ground breaking cultural development. Every effort will be supported to continue this trend of preventative examination andtreatment to help stem the epidemic tide of fatal cervical cancer rates amongst the women of Ladakh.

The doctors conducting basic women’s health care instruction to the patients at the hospital

Dr. Nordan, Dr. Chua Yang and Dr Elliott discussing strategies for making the women’s health aspect of the expedition more effective and far reaching

The team of three general physicians examined hundreds of patients with a wide range of illnesses and injuries. Very often patients came into the hospital from distant village locations with a multitude of complaints. They were offered treatments and free medications by Dr Siang-Yo Kung and his colleagues or referred to other members of the team for their more specialized treatments.

In some cases the patients required emergency surgery and arrangements were made for them to be flown to Chandigarh or Delhi for their more advanced and complicated conditions.

Hundreds of people came to the hospital for treatments after hearing about the opportunity over region-wide broadcasts over All India Radio

Dermatologist Dr. Wong Siew Nee examined and treated many patients who came to the hospital with severe skin afflictions. The harsh environmental conditions, lack of hygiene and congenital predispositions made this specialty one of the most actively sought out by the patients. Especially heartbreaking was this young boy who was completely covered in a growth of unknown origin. His excruciating physical and emotional discomfort touched everyone connected with his case. We will do everything possible to see that he receives follow up treatment and care.

Dr Myra Elliott and other skilled physicians on the team also performed many surgeries for local people suffering from small tumors, lesions and injuries

Certainly the most ambitious aspect of the 2010 medical expedition was in the field of vision care. In previous years of mobilizing the dental/medical camps it was abundantly clear that even the most basic optical care was tragically lacking throughout the region. Local Ladakhi people urgently required not only corrective eyeglasses, but also surgical treatments for more severe conditions such as cataracts.

During the July 17>23, 2010 expedition another major effort was made to examine and treat hundreds of people who required simple eyeglass prescriptions and/or reading glasses. Over 700 pairs of reading glasses were distributed and 100 additional patients will be re-examined by a trained optometrist and provided with their new prescription eyeglasses free of charge.

Volunteer Pennie Jackson helping to conduct the 100s of eye exams that were performed

Over 700 pair of corrective eyeglasses and sunglasses were distributed after the examinations

The most ambitious effort of the entire expedition was the mobilization of a complete surgical team led by Dr. Pauline Cheong and Dr Ranjana Mathur to undertake the sight restoring procedure of cataract surgery. Because of the complete lack of an adequate surgical microscope at the hospital in Disket, a new one had to be purchased for the surgeon’s use. Special gratitude must be extended to Mr. Jeyaraj of the Appasamy Optical Company in India for his efforts to facilitate this purchase and assure that it was delivered to Ladakh in time to be utilized by the surgeons. It performed brilliantly despite the basic conditions of the Disket Hospital.

Dr. Ranjana examining a patient prior to cataract surgery

Dr. Pauline Cheong conducting preoperative ultrasound test on a patient in Nubra Valley

Utilizing the new Appasamy surgical microscope, as well as the skilled members of their support team, Dr Ranjana and Dr Cheong performed many successful cataract surgeries

The heartfelt gratitude of the patients who received complex eye surgeries or procedures as simple as filling a decayed tooth, were the ultimate reward for the dedicated members of the team

The entire 2010 Dental / Medical Expedition team back in Stok Village ready to return to Singapore, the UK, the USA, Nepal and New Zealand after another successful mission to Ladakh

Team leader and inspiration Dr. Myra Elliott

(click to enlarge)

 

 

 

2010 Dental / Medical / Surgical Team

 

Dr Myra Elliott Team Leader / Surgeon Singapore
Dr Pauline Cheong Ophthalmic Surgeon Singapore
Dr Ranjana Mathur Ophthalmic Surgeon Singapore
Dr Chua Yang Gynecologist Singapore
Dr Quek Swee Chong Gynecologist Singapore
Dr Wong Siew Nee Dermatologist Singapore
Dr Kung Siang Yo Physician Singapore
Dr See Yong Pey Physician Singapore
Dr Chong Yeen Yoong Anesthetist Singapore
Dr Seow Onn Choong Dentist Singapore
Dr Ong Teng Sin Dentist Singapore
Dr. Leonard Lim Dentist Singapore
Dr Chan Ai Ding Dentist Malaysia
Dr Tiju Krishnan Dentist Singapore
Ms Low Siew Ngim Surgical nurse Singapore
Ms Khor Sia Liew Surgical nurse Singapore
Ms Tan Que Choo Surgical nurse Singapore
Ms Chan Sau Yue ICU nurse Singapore
Ms Preeti Chaudhri Logistical Assistant UK
Ms Hannah Jackman Dental team UK
Ms Kate Yeaton Dental team UK
Ms Jane Lovell Dental team UK
Dr. Cathy Hsu Dentist USA
Support Team
Bill Kite Project coordinator New Zealand
Pennie Jackson Logistical & vision team Singapore
Nuri Sherpa Logistical assistant Nepal
Duti Rai Logistical assistant Nepal
Nirku Rai Logistical assistant Nepal
Shyam karki Logistical assistant Nepal
Bhim Thapa Logistical assistant Nepal
Sincere Gratitudes
Dr Nordan Otzer Physician Nubra Valley Ladakh
Dr Ramesh Murthy Surgeon Axis Eye Foundation
Mr Alagarsamy Jeyaraj Managing Director Appasamy Optical Co.
Mr Morup Namgyal Chief advisor-LSWS Ladakh
Mr. Eshey Tundup Principal Lamdon School – Leh
Ms Manjeet Kaur Managing Director Costsavers Travel-SIN
Mr Jatinder Dhingra Managing Director Impact Travels-Delhi
Andrew Spencer Website designer AS Photography-NZ
Erik Koto Documentary film maker USA

 


Erik Koto’s excellent short documentary on the 2010 Nubra Valley medical dental expedition.

Feel free to download your personal PDF copy of this post.

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2010 Nubra Valley Volunteers and Donors