Shimshal Pass summer pasture at 4700m.We woke up to a crisp morning with scattered clouds. At 5am women were milking their sheep/goats and yaks in the stone walled enclosures in subzero temperatures. There was a calm, focused silence among the shepherds in the animal enclosures. By 8am the milking was finished and the women headed back to their houses for chai and chappatis and start the process of making cheese and butter.
At 9am we met with community leaders who welcomed us to the summer pasture with very kind words. We started our mobile health clinic at 10am.Our aim was to complete health assessments on all of the shepherds at the summer pasture. To make this happen we extended our clinic to 10.30pm to assess the shepherds who were away from the settlement during the day. We saw a number of cases of hypertension, skin and eye infections, one case of jaundice (likely HepB), some anemia and depression.
Later that day while working in the sheep/goat enclosure a young 17 year old woman had a seizure. I saw her just after she collapsed. She showed signs of a non-tonic/clonic seizure. She had significant post ictal drowsiness, which lasted approximately one hour. She apparently had been having similar events over the previous month. Based on her living /work circumstances, there is a good chance that she has neurocysticercosis. This is a disease caused by the ingestion of the worm Taenia soleum, which travels to organs such as the brain, produces cysts that calcify and become the focus of seizure activity. It is a disease associated with people working in close contact with animals such as sheep and goats. Arrangements were made for this lady to travel to Gilgit for further diagnosis and treatment. I recommended a lady with jaundice and fatigue go down to the Shimshal HC for further investigations and treatment. We ended up seeing all the shepherds in the summer pasture over a 12 hour period.
My overall impression was that those people working in the pasture were generally in good health despite their harsh life and poor nutrition. The more healthy in the Shimshal community were more likely to travel to the Pamir. The diet of the shepherds consisted mainly of chappatis/cheese and chai. It lacked protein and many micronutrients. We saw no evidence of fruit or vegetable consumption. On special occasions people will eat yak/sheep or goat meat. There is too much salt + chai consumed, which likely contributes to the large amount of hypertension and heart disease seen. Common health problems included headaches, “breathing problems”, “asthma” (which often turned out to be gastroesophageal reflux), gastritis, hypertension, backpain/arthritis (knees especially), eye, skin infections, cataracts (high UV exposure with little protection), gastroenteritis, anxiety and depression. There was little discussion on menstrual or gynaecological issues because of cultural reasons. Our next visit should include a female midwife/nurse or doctor so these female related issues can be explored further. Some potential medical problems include brucellosis, tuberculosis and anthrax.
A number of recommendations were made to improve the overall health of the shepherds in the summer pasture of Shimshal Pamir.
- Increased water intake and less chai to reduce headaches and prevent dehydration…people are working hard physically at a high altitude.
- Eliminate or at least reduce salt in chai.
- Increase ventilation in the house while cooking.
- Improved attention to hand washing/personal hygiene/sanitation and disposal of human waste i.e. recommend the installation of a number of latrines in the summer pasture so human waste can be concentrated in one area away from human dwellings and water source.
- We stressed the importance of separation of livestock from human living quarters to prevent the spread of worms/parasites such as Taenia and Echinococcus.
- We discussed the construction of basic greenhouse structures to experiment with growing vegetables at a higher altitude.
I think it is worth further exploring the health benefits of local herbs/wild flowers and other plants i.e. Bozlenj (tea used to lower blood pressure) and Banafsha (used for altitude illness and blood pressure)
We did leave a solar lantern to be used by the community as needed.
We left funds to purchase sunglasses for all 35 shepherds living in the summer pasture. These sunglasses would be signed out from the community leaders each spring and returned to the community leaders in the autumn before people head back to Shimshal. The aim of this program is to reduce the incidence of premature cataracts in the community. Zulfi agreed to purchase the sunglasses in Gilgit and return them to the summer pasture.
We discussed the use of solar powered electric fences to rotate yak grazing habitat and reduce the amount of back and forth travel each day by shepherds and animals to find suitable grazing. We noted a lot of the land close to the shepherd’s summer settlement was overgrazed.
We discussed the future use of satellite supported e health connectivity between the shepherds in the pasture, Shimshal HC, Gulmit HC and Gilgit specialist health services.
During our visit, Zulfi donated one of his sheep to the community to celebrate our visit. The sheep was cooked and shared by all.