Tents, Pit Toilets and Bovine Neighbors

14-18 February 2012

Tents, Pit Toilets and Bovine Neighbors

It was a long drive from the Dhakpo monastery to the campsite where we would spend the next five nights.  We slowly descended through the Kullu valley to a lower elevation, eventually ending up on road that circled the perimeter of a large reservoir.  After about 4 hours of driving, the caravan of cars stopped at a pedestrian only suspension bridge and we got out and walked the last mile to the campsite.

We could see our bright yellow tents from afar; they were set up in a neat row near the bank of the reservoir.  The campsite was located about 500 feet below the level of the road.  We all carried our heavy bags and suitcases down a narrow dusty trail, pausing to let a herd of cows pass us.  I was thankful to have a backpack I could carry easily on my back instead of a suitcase.  It was humorous to watch some of the others attempt to wheel their suitcases down the trail.

It was a beautiful afternoon, and we all settled into the campsite.  I was pleased that the weather at this lower elevation was at least 10 degrees higher.  Feeling quite sedentary, Karen and I decided to do some strength training like sprints, squats and push-ups on the edge of the water.  It was great to feel hot and sweaty instead of numb and shivering.

Throughout the course of our five night stay we worked four clinics.  The first was about a 45 minute drive away in a more remote section of the valley.  It was a beautiful site, surrounded by terraced fields and stone and thatched roof buildings.  The weather was gorgeous that day and we sat outside as we interviewed our patients.  There was a brief interruption of our clinic when a big local politician arrived for a rally.  There were firecrackers, horns and lots of fanfare.  The patients and our translator all momentarily left to listen to the speech.

I had quite a few interesting gynecological cases that day instead of predominantly primary care issues.  At the end of the day, we were even sent a male patient.  This was the first time I had seen a penis, in a medical setting, since medical school.  I quickly called Max, the ER resident, over for a consultation about the man's penile lesion-I was way out of my league there.

The second clinic was located 40 minutes away in an even tinier town than the first one.  Our examination tents were set up next to a small farm lot.  We ate lunch on the roof top of a box-like building.  I was really getting spoiled on the concept of an outdoor clinic--seeings patients while basking in the sunlight.  Why can't we do this at home?

The other two clinics were located at a school within walking distance of our campsite just near the foot bridge we had crossed on the first day.  The school site offered a great view of the reservoir and valley as it was set higher above the level of the water.  The school children were very curious about us the first day.  The giggled and posed for pictures, clearly we had distracted them from learning.  My gynecology exam table was placed in a dark smokey room the size of a closet.  The room was normally used as a kitchen and it had no electricity so we needed a camping headlamp to do exams.

On that day, our group provided a lunch for all of the school children and locals who visited the clinic.  A man had come down from one of the local Hindu temples to help prepare the meal and was wearing a special outfit.  I spent awhile in the "kitchen" which was just an abandoned building, watching the meal preparations.  When lunchtime finally arrived, the children sat on the ground, neatly lined up in rows.  They were served heaping mounds of rice, at least the amount of 4 servings.  They were also given lentils, a fried yogurt dish, and a salad.  Many of them had seconds.  It was probably one of the largest meals they had had in a long time.  It was also apparent why most of them had vitamin deficiencies and cavities from their unbalanced high glycemic index carbohydrate-laden diet.

The second day of our clinic at the school site, we had a small turnout of patients.  The villagers told us that there had been a suicide in one of the nearby towns.  A 23 year old man had hung himself and they'd found him that morning.  He had a one year old child.  They were preparing for his cremation.  When there was downtime in the afternoon, the children performed a song and dance routine for us.  Apparently it was a dance that is often done at Indian weddings.  In return, they asked us to perform for them.  Mandy, Karen, and Jess did some kind of aerobic dance routine for them to the tune of some '90's music playing on an iPhone.

In the afternoons and evenings, we got creative with different ways to entertain ourselves.  For some people, I think it was difficult to feel entertained without television or internet so a few resorted to drinking cheap vodka and rum in their tents or by the water.

During the afternoons, we might sit around on our camping stools, reading our respective books.  It was refreshing to finally be able to spend time reading a book for pleasure and not for study.  One afternoon, half a dozen of us visited the local Hindu temple where a man in some sporty sunglasses gave us a blessing.  The blessing consisted of some orange paint on our foreheads, sweet water to drink (or in our case, pretend to drink), flower petals, and sugary sweet rice puffs.  There was usually an afternoon cricket game being played in the large field by our tents.  The Americans were learning how to play the game from Ravi, the drivers, and the local kids.  Karen and I did yoga one afternoon by the water.  Another day, Jess and I went for a run along the main road.  In a matter of 2 weeks, I had already lost a lot of endurance and what would have normally been a simple 5 mile run turned into a challenging event.  The hill climbs didn't help either.

There were Hearts and other card game tournaments.  Some people went into the kitchen tent and helped the cooks prepare the night's meal.  One night we celebrated one of the medical student's, Shaneel's, birthday.  Ravi had brought birthday cake mix from the US and the cooks did a good job preparing the cake in their rudimentary propane-powered oven.  We drank beer and played music in our dinner tent and even had a little dance party.

There were periodic visitors to our campsite, both human and animal.  Besides the boys coming for a cricket game, some of the other villagers would also walk through the campsite, curiously looking at our tents.  Many times they were in the process of herding cattle.  Other times, the cows showed up alone; they didn't do much besides stand there and poop.  A few dogs took a liking to us, in fact one shaggy black dog ran along with Jess and me while we went out on our run.  He was a very good companion.  There was a little girl with a unibrow who we spotted many times at our site.  Sometimes she was collecting sticks, other times she was kicking cow piles around.  She always seem to show up out of nowhere, it was actually kind of creepy.  She seemed a little "off."  Max was even a bit frightened.

I enjoyed the camping experiences, overall, but was also glad to go back to some of the daily "luxuries" that we take for granted at home.  I had not had a proper shower in about six days.  Our version of a bath or shower was a large bucket of hot water in a "shower tent."  It was difficult to even get all of the soap off of the body, it was cold, and at the end, there was dirt and grass on my feet.  I had gotten used to squatting over a pit toilet, also known as a dirt hole, to go to the bathroom, but my knees were starting to feel sore.  There is something wonderful about a proper western toilet.  

Three nights at a Buddhist Monastery

11-13 February 2012

Three nights at a Buddhist Monastery

I was sure I had the flu when I woke up that morning in Manali.  My entire body was sore from shivering throughout the night and lying curled up in the fetal position.  I had tossed and turned, at times feeling like I was burning hot too-clearly I had had a fever.  The hotel room was still frightfully cold when I woke up, so cold, in fact, that I needed to psych myself up to just emerge from the bed covers.  I forced down some porridge in the cold dining room.  When one of the servers asked me how I was doing that morning, I responded that I was cold.  He agreed and said, "Too much cold, ma'am!"

It was a 45 minute drive from Manali to the site of our clinic that day.  We were headed for a government-funded Buddhist cultural school to do check-ups on the children there.  Our cars stopped at the bank of a river, just next to a narrow suspension bridge over a crevice at least 4 stories deep.  We were instructed to take our belongings and walk across the bridge and down hill a short distance to the school.

When we arrived, we found a long table set out in the sun.  The school teachers greeted us with warm, sweet chai and an assortment of biscuits.  We reveled in these treats while basking the the late morning sun.  Ravi took us on a short tour of the facilities.  Besides the classrooms and dormitories, there was also the beginnings of a clinic on site.  Ravi had been working closely with a local doctor to set up a general medicine clinic to service not only the Buddhist and Tibetan refugee population but also any local indigent patients.  It was a basic but clean clinic and Ravi promised that on future trips, we could work there.

After the tour everyone scattered to different stations.  I had Vik working with me for the day and together we did mostly a lot of well-child exams.  I have to give credit to Vik for doing the majority of the work, and doing it well, because half the time I felt sickly and exhausted.  Throughout the course of the day, we saw a lot of children with fungal skin infections resulting in hair loss, scabies bites, and awful dentition.  The children were quite shy but adorable.  They looked a lot more Asian than Indian, or at least what one normally thinks of as an Indian-looking person.

There were half a dozen people doing manual labor at the school while we worked at the clinic.  There were a few women carrying large rocks from one area to another and a couple of ragamuffin children running around or staring at us westerners.  I had noticed that one of the women appeared to be pregnant as I saw her transporting the large rocks on her shoulder and head.  Right as we got ready to close up the clinic for the day, I was sent one final patient; it was the pregnant worker.

I could tell that the female teachers at the school were quite worried about her.  They informed me that she had never seen a doctor before for her pregnancy and that everyday she was doing heavy labor.  "Please give her some good medicines!" they women pleaded.

According to the pregnant woman, she was about 27 weeks gestation.  Fortunately she had no complaints at all and had had 3 other normal healthy pregnancies.  I was the first and likely only OBGYN she would ever see.  I measured the height of her uterine fundus, easily felt the position of the fetus through her thin abdominal wall, and was just barely able to hear the fetal heart beat through my stethoscope.  I reassured her, and the teachers, that everything seemed to be fine.  We loaded her up with prenatal vitamins and recommended she see a local doctor.  The teachers kept asking me if it was okay for her to keep working. How do you tell a poor woman to cut out her source of income when she has 3 other children to feed?  The fact of the matter is that her body is used to this level of manual labor and thus it was unlikely to pose much of an ill effect on her.  Sometimes reassurance goes a lot further than any medical treatment.  I was glad I got to meet her.

At the day's end, we took another hour long drive to Dhakpo Monastery where we would be spending the next three nights.  It was a simple and fairly small monastery complex located in the Kullu valley surrounded by snow-capped mountains.  We found the place quite quiet when we arrived and we were told that this was due to the soon approaching Tibetan new year celebrations.  Some Tibetans celebrated for up to 15 days for the new year and so many of the monks, or lamas, had left for bigger monasteries or others were home for holiday.

Beth and I had a simple room consisting of two twin beds with thin foam mattresses and a shared bathroom without hot water.  After we dropped off our bags, some of us took a tour with one of the lamas.  He brought us into the main temple; it was colorful and ornate with large gold statues of Buddha and big photographs of the Dalai Lama and other important head lamas.  The temple was littered with many offerings to Buddha, mostly in the form of food items.

After our tour of the temple, I few of us lingered to wander around.  In the basement of the building, we found about thirty young monks chanting methodically.  A few of us peer back at us while we watched them.  They were clearly just as curious about us as we were about them.

It wasn't long before they all broke out of their chants and went from solemn Buddhist monks to mischievous little boys.  They all ran out of the room, fooling around, hitting each other with their books or cushions as they rushed out.  A few minutes later a bell sounded and a few of us followed the noise.  It was the dinner bell and slowly the monks all lined up with their own respective eating utensils.  Some had large colorful bowls, others had plates, and one even had a bucket.  Some older lamas served up dinner out of huge vats.  The amount of white rice they were given was quite impressive.  In addition, they also received lentils and spinach and potatoes.  There wasn't much protein in this diet.

The following day, our clinic was held at a Buddhist nunnery.  The girls were all shy and demure and with their shaved heads, it was hard to even distinguish some of them from boys.  The site was ridden with puppies and kittens, between that and the young nuns, it was like cute-ness overload.  But these nuns  were not as innocent as one would think.  When we were preparing to leave the clinic for the evening, one of our cars starting blaring loud 1990s music, like the Macarena.  A few of the nuns broke into dance which was, at times, quite seductive.  The others laughed and cheered them on.  A few of the medical students in our group joined in on the fun.

We had our next clinic at the Dhakpo monastery where we saw all of the young lamas and a few of the local villagers.  It was a very cold clinic located in the damp ground floor of the temple with no electricity due to heavy rains.   We had to wear hats and all of our layers to be comfortable; it didn't make my flu-like illness any better, especially now that the diarrhea had started.  I knew a GI bug was inevitable in India!  The cold weather seemed to keep a lot of locals away and we heard they got 2 feet of snow in Manali.  While there was downtime at the clinic, we huddled around the furnace, read books, and listened to an impromptu drumming and singing session by some of our drivers.

One afternoon, the drivers took us for an outing in the town of Kullu, located, of course, in the Kullu valley of Himachal Pradesh.  Kullu valley is often called the Valley of the Gods as it is home to 360 different Hindu temple gods.  Kullu valley was largely unknown to the western world until it was discovered by traveling hippies in the 1960s.  They were attracted to the region not only for its mountainous splendor, but also for the plentiful cannibas that grew on hillsides.  The town of Kullu is not a very exciting or classically picturesque town, but there was still much to observe with its many tiny box-like shops, street food vendors, and grungy alleys.  We walked through a produce market where brightly colored fruits and vegetables were sold out of carts.  The vendors were happy to pose for pictures too and laughed when I showed them the end result.  A visit to the butchery market was fascinating and slightly disgusting.  Half a dozen slaughtered goats hung on racks, some of them still dripping blood.  Their decapitated heads were available for sale, as were their innards.  There was also a nice selection of plump chickens and their feet too.  But of course, there was no beef to be found!

Ravi took us all to a confectioner shop where we tried a bunch of Indian sweets.  The Indians don't mess around with their sugar, these desserts were sweet enough to actually rot your teeth on the spot.  When we looked for our drivers, we found them not at the designated meeting spot but standing outside an open air liquor store where they were watching a cricket game on TV.  India was playing against Australia and the game was almost over.  Most of us had no idea what was happening with the game, but it was fun just to watch the crowd of men slowly accumulate, pouring into the street to watch the end of the big match.  They all had a big cheer when India won the game and then quickly went on their ways.

A Cold Night in Manali

10 February 2012

A Cold Night in Manali

After 3 days of camping in the snow and slush, we were all thrilled to go to Manali, a small city that used to be a British hill station at the base of the mountains in the Kullu valley, to sleep in a proper bed and have a hot shower. The sun was shining when we arrived about 3 hours later. Our hotel was located in the center of town on a pedestrian only street. There were at least a dozen mangy and likely rabid dogs sleeping in the sunshine in the street.

The afternoon was spent exploring the small town which is a popular tourist destination for Indians and westerners as they head further into the Himalayas or come for winter sports. We heard that for about $60, one could take a helicopter ride to the mountains and ski in the fresh powder.

Caroline, Max, Beth, Karen, Jen, Jess and I set out in search of a coffee shop we'd read about in the travel guide. After nothing but tea for the last week, we were ready for our coffee fix. We failed at finding the coffee shop, but we did get a walk around town. There were lots of small alley ways lined with one room shops or eateries. The roads were narrow and packed with snow so there was very little space for us to walk without nearly getting run over by cars, motorbikes and auto-rickshaws. We walked up the hill above the main town next to large parks filled with tall pine trees and snow banks. It was cold but at least the sun was shining.

On our way back, we finally found a shop with an espresso machine. We all savored our lattes and cappuccinos and even pieces of chocolate cake. I almost felt like home.

We ran into the rest of the group wandering around as well. Together we weaved our way through the heart of Manali which was brimming with action and livestock. We saw a cow, covered in her own diarrhea, who appeared to be close to dying while she lay in the middle of a busy street. Aren't cows sacred in this country? There was a group of donkeys eating voraciously out of a dumpster. We almost ran into a cow who was nearly the size of a small car as she stood guard over a fruit stand.

The store fronts were all fascinating to peer into. There were confectioners filled with brightly colored squares of sugary treats. The barber shops were he size of stalls and each contained a lathered-up man getting a straight razor shave. We tried some freshly fried samosas and the Indian equivalent. of funnel cake. Interspersed throughout the town, we found Buddhist temples, Tibetan shops, and food stalls selling Chinese food and momo dumplings.

My camera sporadically stopped working despite a full battery so I found a camera shop to buy a new battery in hopes that it would solve my problem. While I was out on my quest, I bumped into Brett who had just come back from wandering around town with Nick. They had visited one of the many parks in town and found not only a temple but a yak they rode for about $2.

When Beth and I reconnected, we decided it wasn't everyday that one had the opportunity to ride a yak so we thought we'd go find it. We tried not to slip on the icy streets and steps as we walked uphill as fast as we could; there was only about an hour of sunlight left so we had to beat the clock. In a deodar tree thicket, we found a pair of yak with saddles. While we negotiated the price of a short ride, we were harassed by women holding fluffy white bunnies. Even as Beth and I mounted the yaks, the women still tried to shove their rabbits at us so that we'd pay them for photographs. We needed to be firm to reject here advances. Our yak herders moved things along as the large stout animals plodded uphill towards the temple. It was a short ride but we got our touristy photos for the cost of a few dollars.

We took a brief look at Harimba temple, a simple wooden structure built in 1553. There were some brightly colored statues inside but it was an overall simple Hindu temple compared to others we'd seen. After leaving the temple, Beth and I caught beautiful pink sunset that illuminated the snow-capped mountains and the Kullu valley below.

It was a brisk walk down to make it in time for the group dinner at the hotel. We had a few mangy dogs who tried to follow us home so we also figured the speed-walking might help us lose the dogs too. No such luck.

Back the hotel, we found the entire group eating dinner, still bundled up in their jackets. The hotel had no central heating and to make matters worse, it had the worlds worst insulation. A few space heaters were on in our dining room but the temperature was still frigid.

After dinner, Ravi, our tour leader, invited us into the adjacent bar area for a drink on him. I ordered a scotch, hoping it might warm me up. While we all sipped our complimentary drinks, we huddled around the radiant space heaters, fighting over who got to sit closest. After the bar shut down, a few of us plotted to steal the large heaters from the bar for the night. The hotel had provided each room with a heater that put out about as much heat as a hairdryer. Beth and I had had the heater running all day and it was still freezing in our room. It was cold enough that we could see our breath when we spoke. Even with our new, large heater running all night, the thermals I wore under my pajamas, the thick fleece jacket and wool hat I slept in, I was still painfully cold. The only way I could get a little comfortable was if I lay in the fetal position but eventually my body would cramp up and I'd awake. I tried to inch closer to Beth for body warmth. It was one of the worst sleeps I'd had in a very long time. We'd have to wait another week to fulfill our dreams of hot showers and comfortable beds.

A Snowy Trek through the lower Himalayas

7-9 February 2012

A Snowy Trek through the lower Himalayas

It was a four hour drive from from Bilaspur to the mountainous location of our first campsite.  The first portion of the ride was on a well-paved highway that ran along a river below.  After about 2 hours, we turned off the highway onto a dirt road the rose steeply up the mountain.  Our caravan of cars climbed up the switchback roads under the shadow of tall pine trees.  The views became more and more beautiful as we rose higher until finally we could just make out massive snow-capped mountains in the distance.  

The cars pulled off the road on the top of a mountain ridge.  We could see the trucks of the kitchen and housing staff already unloaded.  It was a short hike down a steep hill to the campsite.  While we had been driving to the site, the rest of the staff had created a small village of tents.  There was a kitchen and food preparation tent where the men were already busy chopping vegetables and making chapatti bread for lunch.   Next door to the food tent was a dining tent with a propane powered furnace in the middle.  Past two canvas shower tents we found a cluster of yellow LL Bean tents.  Beth and I chose a tent in the sunshine.  From the thick tree cover around the campsite, it was hard to see the mountains around us.

After lunch a group of us took a walk down the road to explore the area or perhaps find a trail for hiking.  We found a narrow trail that veered off the road and appeared to lead to a small rustic village below.  We passed by small one room houses made of clay walls and thatched roofs with cows tied to the sides.  The cows stared blanking and carelessly at us as we continued on.

There was a two-story building further down the trail where we encountered a family.  The grandmother was hanging out in the front patio with the children while the mother worked with the cows in the back.  The children stared inquisitively at us, hesitant and timid.  Their faces and hands were brown and dirty, their nosed crusted with snot, they wore tattered clothing and sandals on their feet despite the cold.  Brett and Nick started playing with the kids, tickling them, fooling around.  Their shyness quickly evaporated and more children came out of the neighboring houses.  The grandmother brought out a tray of steaming cups of chai for us to drink.   

As we walked further into the village of just 250 people, we amassed quite a following of children until we had at least a dozen.  They led us through the tiny town that was perched on a mountain ridge; there were gorgeous views of the valleys on either side.  We passed by rustic farm houses made of stones with hay roofs.  There were a few small two-story apartment buildings that were painted in bright colors.  Goats, sheep and cows would intermittently walk out in front of us.  The villagers stood outside their door staring at the foreigners who passed through their small town.  Avi, one of the Hindi speakers in our group, told us that the villagers hadn't seen any white people in their town for many years.   

One side of the mountain was covered in terraced fields.  There was nothing but grass growing presently due to the winter season.  We followed a narrow concrete trail through the fields.  Further down below there were workers creating more terraces; they were literally using hammers and pick-axes to break up the mountainside.  

As we neared the end of the village, a woman in a house yelled to the children in Hindi, it was clear that she was telling them to stop walking and go back to the center of the village. The children complied along with the rest of our group.  Brett and I continued to walk a bit further.  We came along a group of three women who were sitting in a circle breaking up large rocks into small stones with tiny pick-axes.  There were two cows tied up next to them and a few goats scurried at their feet.  They giggled as we took photographs of them.  I encouraged Brett to try his hand at rock-breaking.  He motioned for the hammer; the woman smiled broadly and handed it over, laughing.  Brett struggled to get into a comfortable kneeling position and then got to work on the to rocks.  It was harder than it looked.  The women all had a good hard laugh at him, I couldn't help but to laugh along too.  

When we got back to the main square of the village, we found Avi and the others who had taught the village children how to play Duck, Duck, Goose.  The kids caught on fast and before long there was a big game going with some of the adults from our group joining in too.  After they tired of Duck, Duck, Goose, we played Red Light/Green Light and Freeze Tag.  The rest of the villagers came to watch the spectacle while they drank chai, swatted at their livestock, or knitted sweaters.  We stayed and played in the village until the air became distinctly colder and we could see our own breath.  

By the time we made it back it camp, the sun was down and the air was crisp.  The sounds and smells of dinner preparations wafted out  of the kitchen tent.  I could hear the cooks slapping dough back and forth between their hands as they prepared tonight's chapatti.  It was warm inside the dining tent where most of the group was circled around the furnace for warmth and the others were playing a card game.  After a delicious dinner, we played some camping games to pass the time until we went to bed.  It was cold in the tents that night and I wore most of the warm clothes I had.

I woke up sometime around 4am when my bladder just couldn't hold it any longer.  I had heard rain drops hitting our tent earlier in the night, an that was preceded by thunder, so I was surprised to find about 2 inches of snow on the ground when I walked out of the tent. 

A few hours later when we emerged to start our day, there were about 4 inches of snow on the ground and it was still falling steadily in big wet flakes.  When the Australians, Caroline, Beth, and Karen came out of the tents they squealed with delight as it was the first time in their lives that they had ever seen real falling snow.  

We warmed ourselves in the dining tent with multiple cups of tea and a big hot breakfast.  Ravi came and announced that we would be canceling clinic due to the weather.  We were supposed to about 12km up the mountain to work in a clinic that would serve this remote population.  With the inclement weather, not only would the village at a higher elevation be difficult to access, but the villagers would not be likely to trek that long distance in the snow.

The branches of the pine trees were heavy with wet snow as we all set off for a morning hike.  There was snowman-building and a snowball fight along the way.  The following night, a few of the guys had taken a hike up to a Hindu temple on a mountain ridge otherwise the path would have been impossible to find.  They led our entire group of 18 to the trail that snaked upwards.  I quickly became hot in all of my layers as we made our way up. 

By the time we reached the summit, it was difficult to even seen the temple under all of the snow that continued to accumulate.  We all took some photos while we waited for the stragglers of the group to make their way up.  The entire valley below us was beautifully covered in snow.  

To get back to the campsite, we took a different path which was quite a bit steeper.  As the hill became sheer, most of us lost our footing and tumbled down the slope.  I have a good sized bruise on my right elbow and butt cheek to prove it.  The snow finally stopped falling on the way and the sky turned brilliant blue.  We finally emerged on the main road and already the snow was turning to slush.  Further downhill there was a large truck stuck in the ice.  Men were using dirt shovels and other random tools to try to clear the path for the truck to continue on.  Two guys tried to make it up the hill in a tiny hatchback car that probably weighed all of 300lbs itself.  When the driver couldn't manage to make it up the hill driving forward, he did a K-turn and attempted to go up the switchback road with no guardrails in reverse.  

Over our lunch break at the campsite, we warmed up around the furnace with hot food and tea before setting off on another hike.  This time about half a dozen of us set out on a 10K walk to the next town further up the mountain.  The sun was out and it was actually quite pleasant as we made our way up hill.  It was already apparent that the snow at lower elevations had all but melted away but where we were there was at least 4 inches still on the ground. 

On the way up, we passed through a few tiny villages.  The inhabitants were mostly outdoors already, but when they saw us, they came out into the street.  They stared curiously at us and we took pictures of them.  They were not shy about posing for the camera and were in fact excited to look on the camera displays to view their photos.  A few of the women even tried to instigate a snowball fight while others shyly watched from the side-line while continuing their knitting.  A few men sat outside a shop playing a heated game of cards.  At another store front we saw a man working on a loom making a traditional shawl.  He used both his hands and bare feet to work the loom.  An elderly man with a deeply wrinkled face sat in front of the loom, winding string around a spool.  He stopped working while we were there to ogle the westerners.

Although these towns were small and simple with meager and rustic homes, they were perched on the ridge of a mountain with amazing views at all angles.  If I had to be a peasant in a developing country, I would at least be glad to live in the mountains.  

As we neared the main village, the sun started to get low in the sky and the temperature began to drop.  We decided it was probably about time we turned around to head back to camp before it was too dark to see.   The downhill trip took about half the time and we made it back to our cozy campsite just as the sun set.  The stars were shining brightly overhead. 

The following day we attended to a clinic in a village called Saroa which was an 8km walk from our campsite.  We all decided to commute on foot and it was quite a vigorous hike but the sights along the way were fascinating.  We saw farmers bringing containers of fresh milk to large receptacles on the road side where they would be picked up and brought to a processing center.  There were women herding their cows and children carrying baby goats.  

The hike back home from the clinic was pretty challenging as it was about an hour of steep steps the entire way.  There was a little bit of evening traffic as the villagers came home from work.  People who looked to be in their 60s or 70s were walking up the steep steps with us as they carried large shovels or bundles of wood on their backs. They women giggled when they saw us and followed close by.  One women of about 50 years of age started throwing snowballs at us, laughing and playfully taunting a fight.  Then she invited us in for tea.  We continued on. 

When we returned to the village square where we'd played games with the children the prior day, we were greeted by some faces we had seen before, both at clinic and in the village.  We stood around in the square, watching the activities of the day's end.  Goats jumped through the square, children played, women fetched water.  A village women went around serving hot chai to us and to a few of the elder men.  We found Nick and Brett further uphill, horsing around with half a dozen children.  They had taught them some American songs and the children were singing and laughing.  You could tell they were sad to see us all go, especially Nick and Brett. I was impressed with the people we encountered in this region.  They had been the friendliest and most gracious of hosts, and even if we spoke no common language, the connection was still tangible. These villagers had few material possessions and amenities, but they were clearly happier than most of us.  It was easy to sense the strong community bond within the small villages where it was apparent that everyone looked after each other.  I don't mean to glorify their existence, as it was clear that they lived hand-to-mouth with only but a few pairs of clothes, working hard labor, but they seemed not to take life too seriously still.  They should serve as a lesson to all of us in the western world. 

Clinic Day in Bilaspur

4 February 2012

Clinic Day in Bilaspur

It was a one hour drive to reach our first clinic site of the month. We had a delicious and filling lunch at the hotel before we left, complete with bananas, porridge, eggs and chapatti. It was another bumpy ride through dirt roads to reach the clinic on the other side of the valley. We were using a small local hospital as our clinic for the day. I was to be completely in charge of the gynecology clinic with two medical students working with me. We had some dusty speculums, lubricant, cotton swabs, urinalysis dipsticks, and hemoglobin finger sticks.

By the time arrived, the porters had already set up a large canvas tent that would be used as the pharmacy. They had unloaded lots of large metal chests filled with different medications. The staff took us on a tour of the rest of the hospital. The hospital was tiny deserted. It was cold and damp inside with concrete floors and walls; some rooms lacked electricity. Triage was set up in the foyer, medical and pediatric clinics were in bare rooms upstairs, and my gynecology clinic was delegated to the labour ward.

In the labour ward there was a small damp room with two single beds. The mattresses were sagging in middle and there was dirt and debris on them. A used syringe sat on the window sill. This was a recovery room. The next room was the Labour Room/O.T. (Operating Theatre). It was a large room with one ancient appearing OR light. There was a barbaric old delivery bed/OR table with an IV poll attached at the top. The room reeked of toxic smelling antiseptics.

There was a metal shelf at the end of the OR table with some steel trays. Inside of one tray were some rusty and dusty instruments that were far from sterile. There was a faded red rubber catheter, lots of clamps, ring forceps, and curettes. Another tray had two small sets of delivery forceps. There were lots of gauze pads. By one of the windows was another shelf with a baby scale. I was impressed with the tray full of medications which had most of the obstetrical drugs that one would need in an emergency including oxytocin and every other uterotonic, magnesium sulfate, anti hypertensive medications, steroids, and a small selection of antibiotics. There was even a neonatal endotracheal tube and some IV tubing. In a closet we found some IV fluid bottles; they only came in 500ml amounts unlike the standard 1 liter in the US.

A group of women who were nurses at this local hospital came by to meet us. They were curious to see what a western doctor thought of their facilities. Frankly, the delivery room scared the shit out of me; it was something out of a medical horror movie. If this room scared and obstetrician who is used to seeing massive amounts of bleeding and other gory sights, then you can only imagine how frightening this place would be for a patient. Many of these village women have likely never set foot into a hospital in their life before they are brought in, in painful labor, to push out a baby. I felt scared for them because there was nothing at all comforting or welcoming about that room. I asked when the room had been used last; they said they'd had a delivery just yesterday.

We had a steady flow of GYN patients throughout the day. The complaints were pretty standard to what I am used to having at home: heavy periods, itching, vaginal discharge, irregular cycles, pelvic pain, post menopausal bleeding. The difference was that I had even less resources here than I was used to even at my very basic US public hospital. There was no way to do pap smears or endometrial biopsies. The oral contraceptive pills in our pharmacy had recently expired so I had little to offer the women with heavy or irregular bleeding besides a prescription to go to local pharmacy. We had one woman who had become anemic enough that she was eating "soft rocks" off three ground. Anemia seemed to be quite prevalent here, likely exacerbated by the vegetarian diet low in green leafy vegetables and high in rice and potatoes.

It was awfully damp in cold in our examination room. As the day wore on, I borrowed more and more additional clothing layers from my co-workers. I looked like a bag lady towards the end and even wrapped a shawl around my head. It didn't help that the jet-lag was so powerful either; I had trouble even keeping my eyes open while the medical students, Vikram and Jen, were interviewing patients. It felt like a particularly rough post-call day. All I wanted was a nice big cup of chai tea and a bed. I fell fast asleep on the car ride home, despite the incessant bumps and holes on the road.