Ho Chi Ming City- Did someone say overwhelming?
We arrived friday evening 20:00, and made our way directly to the visa application queue- a scene of quaint kafkaesque antiquity. We gave in our passports with our application forms and the 2 requiseted passport photos. Now came the inevitable, interminable wait, hearing a Vietenamese border control clerk calling out butchered and mangled names in her broken English. Amazingly, allthe visa applicants were able to recognize their names- ours’ sounded something like Or…na Vulso and Simo Vulso.
Anyway from there it was a quick passport control, pick up luggage and get to the hotel- all “chik chak” as we say in the holyland. Next came the nightnarket, 5 minutes from the hotel, followed by a hot bowel of pho ba- traditional vietnanese beef noodle soup. We were soon back at the hotel an sound asleep.
This morning we set about exploring the city. We has read that the trafic was a nightmare in HCMH and that crossing the streets akin to traversing a mine field. No such thing my dears!! Simple and easy peasy! Just step out into the road, walk steadily and with confidence. The locqls will accomodate you for the most part. Don’t hestiate when crossing the road. This is most confusing for the native driver be him (or her) behind the wheel of an SUV or a moped.
Where the hell is MUGU?
Me? in a helicopter? with 3.5 tons of rice going to where? Where the hell is MUGU?
I suppose that most of us have fantasized about going somewhere remote, really remote and seeing how the ‘real’ natives live. I was dished up Mugu on a silver platter and I wasn’t going to pass up the opportunity to visit a place that takes 7 days to walk to from the nearest road. This is the story.
There is an Israeli NGO, (Tevel b’Tzedek- or ‘Universal Justice’ for those who don’t know Hebrew) working in Kathmandu valley, Nepal. Orna, my wife, spent 4 months volunteering with them last winter, so when one of the staff, Yotam Politser, heard that I was traveling in the area he sent me a cunningly worded invitation to drop in and partake in a health camp leaving for the most remote, isolated, poorly developed district of Nepal. Well this is really like dangling candy in front of a baby- or in India dangling baksheesh in front of a rickshaw driver. How could I refuse? I arrived in Kathmandu, was whisked around the various offices of the WFP (world food program and major ‘shakers and movers’ of this initiative), the Israeli embassy (the other ‘shaker and mover’ in the figure of the most delightful ambassador Mr. Dan Stav), and BP Smirti Hospital ( a small ‘shaker and smoocher’). With Nepali medical registration in hand, procured in record time with a hell of a lot of shaking, moving and begging on the part of Yotam and the Israeli Embassy, I found my self on the 11th of November in a small two propeller plane, accompanied by 18 exuberant Nepalis, on my way to Mugu district via Nepalganj. The next day I was flown, with 3.5 tons of rice, to an airstrip called Thalsa airport in the middle of nowhere. Well actually not nowhere, but 2.5 hours walking distance down a very steed incline (Nepal is all steep inclines and declines of various challenging degrees) to Gamgadhi, the district headquarters of Mugu.
Down the steep incline to Gamgadhi- yes those are 50 kg sacks of rice and that is a woman carrying it!!
Nepal runs on a different clock to the one that we are used to in the west and Nepali time means that everything is slower, toned down and less stressful. The next 3 days we spent in relaxing, meeting local figures and officials and visiting Rara lake (plenty of inclines and declines), the largest lake in Nepal and probably the only highlight in Mugu’s favour.
Rara Lake, Mugu district, west Nepal
Sunday the 16th came and with it endless misery in the form of hordes of Nepali villagers who had arrived to receive medical care. This was not just a health camp, it was a happening and there were long queues and crowds filling the grounds of the usually defunct district hospital. We had a bare minimum of equipment, basically stethoscopes, BP gauges and an assortment of medications. We also had a small mobile lab and a minimum of surgical equipment for minor surgery.
Queuing to be seen
The patients were simple villagers with and endless array of complaints ranging from epigastric pain (‘epigastric destruction’, as my Nepali health worker cum translator kept on misnaming it), backache, headache, burning eyes, burning urination, cough etc, etc. Well really, could you tell any of them that if they continued eating hot (spicy) food, consuming copious amounts of potent home made millet whiskey (vile stuff but carries a punch), carrying 50 kgs of rice up and down the mountains, smoking and sleeping in smoke filled houses, then what was to be expected? How about a little life style change? Lets get real here! The pitiful thing is that there is almost no hope for any change and therefore these afflictions will continue to affect them.
Examining a patient- does he have 'epigastric destruction'?
There were the occasional ‘real’ cases such as fractures, severe infections (surprisingly few except for intestinal parasite infestation), and simple surgical cases that did in fact benefit from our presence, but unfortunately the vast majority of the patients will continue to suffer from their endless list of complaints. Actually, we in the west also suffer from an endless list of complaints due to life style but we call the afflictions Diabetes, hypertension, obesity, migraines, heart disease, depression and constipation (no constipation in Nepal- quite the contrary).
A real case at last!! Fracture of the forearm. One can see that I have orthopaedic genes in me
After 3 days we had seen 1700 patients, of which 450 were gynecological cases. The average time per patient was 3.75 minutes. I spent 5 minutes per patient because I had to work with a translator.
My two health workers, translators and friends. Pashupati on the left and NB Karki on the right. Note the 'Tevel b'Tzedek' t-shirts given to them at the end of the camp after all their help.
So where is Mugu? look at a map of Nepal, find Nepalganj on the Indian border in the west. Look north until you find Rara Lake (towards the border with Tibet). There you will find Mugu district and that is where I’ve been and come back from.
Gamgadhi, Mugu district headquarters, as seen from above
Oops!! one of Leron's brethren found himself in Gamgadhi. He has aged on the way!
Chillum out (Chilling out) in Rishikesh- The hummus trail part 2
Taking a small methodical break between Delek Hospital and Pregnant Tibetans to high adventures in Nepal (installment to come-keep posted!!), I decided to spend a few days in Rishikesh. This was a necessity- especially after my trip with the suicidal maniacal taxi driver that had flown me to Chukki-Bank. There was another important aspect to my few days in Rishikesh- I wanted to join my nephew, Leron, who is also traveling at the moment in India.
I arrived in Rishikesh on Saturday morning after an uneventful night on a sleeper train from Pathankot. I found Leron waiting for me at Divya guest house and realized that I had dropped into little Israel. Three floors of Israeli’s- up and down the stairs, all already on “brother status”. This was going to be different and I decided to try and enjoy it and maybe learn something about this young sector of the Israeli population.
Rishikesh- bustling and colourful
Rishikesh itself is a lovely, lively place. It is very touristy- both foreigners and local Indians- this due to the town itself situated on the beautiful Ganges river. It is one of the holy cities of India- thus there are multitudes of Indians, blaring Indian music, colour everywhere and some beautiful and quite garish temples. I felt at home immediately amidst all the loud noise and the never ending procession of cows shitting everywhere. This was where the term “holy shit” originated, but I, for one, was not going to put my foot in it!
One of my nephew Leron's 'brothers' on the banks of the great river Ganges.
Chilling out
What is that and what does it mean? As far as I know, chilling out means arriving somewhere that is conducive to rest and relaxation after a period of more active participation in the game of life. It involves lying around in restaurants with low set tables and countless cushions on carpets, preferably with a good view and of course the right ambiance. The food served should be good, relatively cheap, and if we’re speaking about Israelis there should be a good selection of Hummus, Sabich, Malawach, Israeli salad, Israeli breakfast not to mention techina and felafel- these just to name a few!! Chilling out is an almost universal activity of travelers- we all need time to just unwind from the road, preferably in a place that becomes immediately familiar and homely by the second visit.
Leron and his extensive group of post army mates had settled and occupied the “Freedom Cafe”. This sounds slightly unsettling and actually very reminiscent of life in Israel- but I can’t for the life of me fathom why that is!! I do know that they had hit on “Little Buddha Cafe” first. Apparently the food is better there, but the Freedom with its’ spectacular view of the Ganges flowing past could not be beat. There they chilled in droves, a veritable migrating horde, having moved down from Bagsu and Dharamcot (Dharmasala area), on their way to Goa, some via Pushkar in Rajasthan. I was fascinated by this phenomena and spent a good few hours eavesdropping, under the “protection” of my nephew. What did they talk about? What interested them? How long were they here for? Some answers I got such as; “rehabilitating after the army”, taking a break before studying”, great way to meet the opposite sex” and “practice be fruitful and multiply” which does happen to be a very important commandment taken quite literally by these youths.
The freedom cafe, Rishikesh
Some, actually quite a few added another dimension to their chilling- it is called chilluming and deserves some mention as a particularly fascinating phenomena
Chillum Out
The chillum is a cunning device, originating somewhere in the upper Indian subcontinent. I was sure that it had it’s origins somewhere here and indeed a few weeks later I found the original chillum among the Nepali hill-men of west Nepal. Back to the chillum out. It involves certain paraphernalia- shown in the accompanying picture, and a variety of herbs, some with interesting qualities of which I am not at liberty to expound in this blog. Those familiar with the herbs and spices will recognise the pictures- others will have to use their imagination.
The chillum
Now the Israeli tribal customs consists of a large group of brothers and sisters (not necessarily same mother and father), lounging around in a place such as the freedom cafe and generously passing around the famous chillum. as the days wear on these youngsters often age dramatically, as seen in the photos. These brothers and sisters ( achi and achoti in Hebrew), usually have very little to say to each other during these ceremonies, but food due to “the munchies” and laughter is very common.
One of Leron's 'brothers' after months of touring India- chilluming ages one quickely
I was most intrigued by these rituals and documented some for further contemplation.
Swami Krishna Chandran
Rishikesh happens to be one of the yoga capitals of the world and I found a truly wonderful teacher- Swami Krishna. He is a delightful character, practising a very moderate form of yoga while expounding all the time on the truths of life- as seen through the eyes of a hindu. I didn’t miss a lesson with him, and we became quite friendly. If you are looking for a good yoga teacher in Rishikesh- he can be found on the far side of laxman jhula, about ten minutes walk towards ram jhula, just behind the police station.
Swami Krishna Chandran
3 Weeks in Tibetan Delek Hospital or How to Hypnotize a Pregnant Tibetan part III
I’ve spent 3 wonderful weeks working at the hopital in Dharamsala. Although I had written beforehand and had tried to organize myself for the time here, I really had no idea what I would do on a day to day basis. The original plan of one hour teaching, four days a weeks turned into a full eight hour day five days a week of work, teaching, and supervising pain therapy. Three weeks appear now to me, in early retrospect, as a series of pictures- and this is what I’ll try and convey. Just read the topics that interest you!
The staff
I met Dr. Tsering, Passang and Yangsum on the first monday afternoon. We discussed pain and pain medicine in general and it immediately became clear to me that there was huge scope for teaching- especially in the field of Musculoskeletal, Cancer and Obstetric Pain. On the following day I met the others- Dr. Sonam and Dr. Tashi. In general the doctors were all relatively new graduates- from 8 months up to 2 years- except for Dr. Tsering who has about 6 years experience as a doctor. These are the doctors who run the hospital on a day to day basis. They do the morning rounds, deal with admissions and discharges and also run the outpatient clinics in the hospital itself, at the old peoples home and at the outpatent clinic in McLeod Ganj. I was pleasantly surprised by their good command of general medicine. They are good doctors and during my time here I enjoyed exploring with them such topics as diagnosis, clinical reasoning, differential diagnosis and the formulation of plans- both diagnostic and therapeutic. I was ably assisted by Dr. Morag McDowall a specialist GP from Yorkshire who has come out here for 4 months volunteer work. Morag is a fine doctor with a very dry and quite wicked sense of humour and I thoroughly enjoyed working with her.
The Crew: from left to right, Lynne,Matron Shitzu, Dr. sonam, dr. Tsering, Dr. Passang, Dr. Yangsum, Dr. Tashi (kneeling), Dr. Morag Mcdowall
I felt that the doctors lacked a clear hierarchy system of “Consultant, Senior Resident, Junior Resident”. Hierarchy at the early stages of medical training is important in order to learn “The art of medicine”. The science is in the books and journals, but how to put this into clinical practice is actually something quite different. I believe in the apprenticeship and tutorship method as a good sound way to learn. We all need teachers at every stage- even those who teach. I’m sure that Dr. Morag will help much in that capacity.
The nurses, actually called sisters here, are really well trained and a lot of fun to work with. They are lead by Matron Shitzu, who has the rare ability to combine professionalism, compassion and leadership.
The volunteers
Delek hospital has had many volunteers over the years, and during the time I was there, there were a few very interesting and delightful characters with me.
The day I started I met Dr. Morag whom I mentioned above. Quiet waters run deep, so they say, and it is definately true for Morag. As the days passed by I came to find her very knowledgable, and very sensible. She has the art of medicine at her fingertips and I’m sure that Delek hospital will benefit from her stay.
Lynne is a very experienced physiotherapist from New Zealand who has just about finished 6 months here as a volunteer. There is here a new young tibetan physiotherapist, Phintsuk by name, and Lynne has been helping him set up a physiotherapy service. Lynnes’ very good friend is Ande from Dallas Texas via Seattle. Ande is tall thin and delightful. Lynne is short, slightly stouter than Ande, a few years older (34 vs 60) and equally delightful. They call themselves the twins (after Danny Devito and Arnold Shwartzeneger). I called them tweedledee and tweedledum- to which Lynne always replied- “I’m Dee”, only to hear Ande call out “and I’m not dum!!”.
TweedleDee and TweedleDum. "I'm Dee!", "and I'm not Dumb!!!".
I was allocated the only available room in the volunteer block- a tiny pokey hole previously inhabited by Renata, the German pharmacologist volunteer who came, saw (that she was superfluous), and moved on to conquer elsewere. My hole in the wall was fine, situated next to the kitchenette and equidistant from the western (turn right out of the room) and the eastern toilet (turn left). I usually chose the eastern toilet for my early morning appointment with my bladder until one morning I passed Tashi, the cooks’ room, as he stepped out to greet the day, wearing his birthday suit, morning glory proudly presented. We were both quite surprised- I don’t think that he intended to greet me with all his family jewels in display and whenever our paths crossed after that he just giggled and blushed. He dosen’t speak any english- but then some things are lost in the translation.
Tashi the cook, doing a "tea lady" impersonation. Note the coy smile he gives me-this is after our early morning clandestine meeting.
The kitchenette was a great congregation area, and I, of course, spent time teaching my new friends and fellow volunteers how to make Israeli salad, Jerusalem artichokes (so I thought) and Tehini (Techina) salad. I think that they were quite relieved to see me go and to get back control of the kitchen- especially Lynne who is a great cook.
Foxtrot Oscar
Those who don’t recognize these words, they are taken out of the phonetic alphabet used when spelling out aloud over the radio ( “do you read me Foxtrot Oscar 157?”). Foxtrot stands for “F”, Oscar for “O”.
Well I was introduced to the other, more graphic use of foxtrot oscar when I met another long term volunteer here- Andrea a retired airstewardess from British Airways, who is now a nurse in London and has a house in Mcleod Ganj. She devotes a lot of her time volunteering with the nurses and healthcarers. Andrea or Andy, does a lot of work with AIDS prevention, and taught me that if you’ve had enough you can always “foxtrot oscar” or “f..k off” out of here.
By the way, how do you say foxtrot oscaar in India? Well imagine that you are trying to find something obscure in one of the shops in the market- let’s say a darning needle. You might ask a shopkeeper and he will invariably say, with a subtle sideways nod of his head, “I do not keep this item Sir, but you can look two stores downside”. You then go down two stores and repete the ritual, only to get the same reply. This ritual can be replayed continuously by a variety of shopkeepers until you feel truly foxtrotted. Well…. that’s foxtrot oscar in India!!
The patients
After Israel, where no-one has time to wait, it is a pleasure to meet people who come to the clinic or hospital, and just sit patiently- their time will come, it is all in their Karma. There is no pressure- the patients, at least in Delek hospital, are very relaxed and also very appreciative of our help. The wards are filled with men, women, youngsters and women after birth. The families are often present, and all this takes place quietly, with a lot of humour and laughter. In general the tibetans love to laugh, and they love a practical joke. I saw many patients over the 3 weeks. They were all so nice, gentle and appreciative. It made a change from the somewhat abrupt population that I am used to.
Sitting waiting for morning rounds
The Boss
The Chief Medical Officer (CMO) is Dr. Tsetan Sadutshang.
Dr. Tsetan or Dr. Tsetan La which is the appropriate term of honour for a tibetan is a very charming an impressive man. He not only holds the post of CMO of the hospital with all the responsibilities of that task, he is also the chief physician to his holiness, the Dalai Lama. hus when i arrived he was not there- due to the extended stay that the Dalai Lama took in Delhi while parting with his gallbladder. Dr. Tsetan La has two clinical mornings where endless lines of patients wait patiently to see him, and he treats everyone with patience, compassion and not a little humour. It was a great joy for me to work, however briefly, alongside Dr. Tsetan La- and I was so honoured to reciev from him a gift from the hospital when I left- a book of the dalai lama about buddhism and modern science, and also a traditional white cloth scarf- similar to the Jewish “Talith”.
Dr. Tsetan La Sadutshang
How to hypnotize a pregnant tibetan part III
For those who didn’t read my first post about the hospital here is a brief summary: There is no form of pain control used here for childbirth. In fact the only form of anesthsia or analgesia is when the women undergo Cesarean sections- and that is not a common occurance. So Already on the first day at the hospital I discussed with the doctors the possibility of teaching self hypnosis at the ante-natal classes. This involved a 3 step approach.
Step 1: Teaching the medical staff including doctors, nurses and physiotherapist the general concepts of medical hypnosis. This was just a basic introduction to the idea that there is a lot of connection between mind control and pain. these concepts are not foriegn to buddhist tibetans- especially those who have had some sort of training in meditation but here the mind is focused towards various pain control strategies. The first session took one and a half hours with a lot of practice.
Step 2: Applying the concepts of step 1 to the process of childbirth- especially the first stage during which the uterus needs to relax and the cervix to eface in preparation for the expulsion of the baby. Thus we praticed a simulated birth, with the doctors and nurses all taking the part of “therapist” and the part of “woman in labour”. It was a lot of fun, and the ice really broke over the laughs and giggles from the doctors who are usually quite formal. The nurses really enjoyed themselves- they so much identify with the situation.
Step 3: i was so happy that we were able to implement, in my third week here, this step whereby the physiotherapist Lynne worked with the nurses at the ante-natal clinic and taught a whole group of pregnant tibetans, and willing husbands, to enter a state of self-hypnosis, literally at the touch of fingertips. The women were very interested and immediately realized the potential for some sort of pain control during their upcoming deliveries.
So how do you hypnotize a pregnant tibetan? Actually the same way all over the world- a soothing musical voice, a bit of humour, and a birth looming in the not too distant future.
Hypnotizing a pregnant tibetan
Russian Roulette Indian Style
3 weeks of volunteer work have finished and I’m on my way to Rishikseh, the yoga and meditation capital of India made famous by the Beetles in the late 60’s.
In order to get there from Dharamsala, one needs to take a taxi to Chakki Bank railway station in Pathankot, Punjab state.
I’m picked up by my Punjabi taxi driver (PTD for short) whose only word in english is O.K. O.K. The journey starts inauspiciously, as we wind our way down through sleepy Dharamsala and take the Pathankot road. Once out of town things turn suicidal.
Firstly the music: PTD puts on a continuous play tape of Indian trance music. Imagine heavy base going “Dhum Dhum tara, Dhum Dhum tara” Now add in a nasal male voice with a strong hindi accent chanting “borak shama, ani yani” and then add some cymbals and flutes and a hysterical squeal in a women doing something like “hajubi lachtili baba ya”. All this comes blaring out of a speaker system with ruptured membranes. Adrenaline levels rise and PTD turns positively fiendish.
We tear through the countryside, screeching around corners and trying to establish our position on the indian road pecking order. The order is governed by size, with the top occupied by the bus followed, in descending order, by the large truck, medium truck, large taxi (I’m in one of those), small truck, small car, tuktuk rickshaw, motorbike, bicycle, pedestrian and dog. The one exception being the cow which reigns supreme, stupidly roaming the roads oblivious to the darwinian survival of the fittest struggle taking place.
The indian cow-top or bottom of the indian road pecking order?
I sit riveted to my seat, my levels of terror bordering on the hyterical. As daylight dwindles and twilight descends, I realize that night will bring further hair-raising experiences. Headlights are optional, as are having two lamps in working condition. We know what is coming towards us when it arrives- a small motor bike or a large single lamped truck both look alike. This is russian roulette.
Blow your horn and use your dipper at night (I always do!!)
I feel that I’ve got myself under control when suddenly my PTD attemps the impossible. He tries to overtake a bus, overtaking a truck, overtaking a motor bike, all this around a corner. This is exciting stuff but suddenly I see coming towards us my driver’s twin attempting the same feat in our direction. I grip the chair, close my eyes and start a quick discussion with my maker with whom I’m soon to meet.
Maybe my driver’s karma is to come back as an Indian Airlines pilot with all the perks included. I’m in Punjab and praying that I won’t come back as a Dhobi wallah or may be one of those stupid cows.
Probably what I'll look like in my next life- a dhobi wallah laundryman
Happy Diwali -my word!
I think I have a slight idea about how Bob Simon, the famous CBC reporter felt when trapped under a table in a hotel room during the first Iraq-American war in 1991. For the last few hours India has erupted with sounds of bombs going off all the time and rockets bsing launched from every garden. No, it is not all out war with Pakistan. It is Diwali, the festival of lights.
Diwali it seems is celebrated by Hindus, Jains, and Sikhs across the globe as the “Festival of Lights,” where the lights or lamps signify victory of good over the evil within every human being. (http://en.wikipedia.org/wiki/Diwali)
It all started a few days ago when I started seeing firecrackers of all sorts and sizes being sold in any and every shop around. Of course these firecrackers all sport the picture of lovely innocent children who just happen to be there for the fun of it. If the amount of booms that I can hear in Dharamsala are any indication, then throughout India there must be more gunpowder burnt tonight than in the second world war.
Yes, you too can bomb your neighbour with this innocent little boy!
There are of course no restrictions whatsoever about who or at what age one can set of these awful contraptions. The roaming dogs are petrified, and even I felt today that I was more in danger than during the recent Hizbolla- katyusha war we had 2 years ago in Israel.
I went to buy a few vegetables from a nearby greengrocer when suddenly a huge explosion took off behind my back. Some fuckwit had put a huge firecracker into an empty barrel and had then put the barrel upside down. This in fact simulated a real bomb. I tried to catch the silly twit but he slimily slipped through my fingers laughing all the way.
In town, people were mad- all out and about and the foot traffic was bumper to bumper( if you get my meaning). Bands were playing a cacaphony of sounds. Imagine if you may a band of 3 trumpeteeres, 2 drummers and a few whistlers- all playing there own thing in unison at the top of their decibel capacity- yes you get the message.
Diwali festivities in Dharamsala today
So hopefully tomorrow it all ends.
It seems ironic that in our festival of lights (hanucca), we light up a few candles, sit around stuffing our faces with doughnuts and sing about how G-d, our saviour is the rock of steadfastness (Maoz Tsur Yeshuati in hebrew). Here it is all about bombing the hell out of your next door neighbour.
A thought aside: So many of the beggars here have various degrees of limb amputation- no fingers, toes, hands etc. Maybe they are a result of Diwali gone mad!!
“ShivaZorbing” -a way to go
Two weeks of my time here in the hospital have passed and I decided to take off the weekend for some sight seeing. There are a few more volunteers here, so we commandeered a large taxi for the weekend and on friday afternoon set our sights for Dalhousie, a beautiful hill station in the Chamba Valley. The group consisted of Andrea-nurse from London, Morag- GP from Leeds, Lynne-Physio from New Zealand, Andy- Ultrasound technician from Seattle and myself. The first part of the trip was uneventful but most enjoyable. Getting out of Dharamsala and Mcleod Ganj is refreshing- these areas are so touristy, that I was happy to be travelling in a taxi and seeing the rural indian countryside- so colourful and full of people and vitality. One see’s no beggars in the countryside- they are obviously part of the city tourist scene.
My companions for the trip. From left to right: Lynne, Andy, Ragish the driver, Andrea and Morag.
The way up to Dalhousie is beautiful- and nerve racking. The single lane, semipaved, pottholed road curves up the sides of the great himachal pradesh mountains in a never ending route of curves, blind turns and overtaking trucks and busses. Our driver Ragish, was fabulous. He drove very confidently, was very careful on the bends and had endless patience for the traffic. I would look out of the window occasionally and see sheer drops of up to 1000 meters, only to swear in a stream of English and Hebrew-depending on my level of terror. I ended up turning on my MP3 player, listening to morbidly depressing songs by Leonard Cohen and realizing that maybe flying over the edge is not the worst thing that can happen to one (try listening to 2 hours of Leonard Cohen straight!!). Actually all was fine and we found ourselves in the early evening in Dalhousie in a beautiful hotel dating back to the Raj era of yesteryear. It was pricy by Indian standards- about 80$ US but worth the one night extravagance. I was reminded that for that price per night I spent a week in a grotty little bedsitter in Glasgow about 2 months ago at a conference.
Buffet Dinner at Grandview hotel, Dalhousie
A long way down- on the road to Khajjair
Yesterday we made our way through Chamba, a lively non touristy town through to the local national park at Khajjiar. This proved to be delightful. A short walk from the hotel brought us to the most garish, vulgar, perfectly indian mother of all Shiva statues. It stands about 20 meters tall, amidst a lovely temple complex in the middle of a national park. The sight is stunning and quite amazing.
Left: Shiva Temple and complex in the National Park Above: If you think I'm big, look at Shiva behind me.
Here I am negotiating my downfall
Can you guess which one I'm in? The zorb in action!!
Back to the Hustle and Bustle
It’s been a weekand a half , the weekend has come and gone and the week is really just flowing along. Monday went by in a blur of consultations. Tuesday and Wedneday followed at a slightly slower pace. I’m now also suffering from a mild bout of “Delhi Belly”- nothing to make me sick enough to stay in bed- but enough so that my appetite is off (and that for me is serious). I actually may be losing weight- so who knows? I may come back from this trip lighter and fitter!!
The week started with the usual staff meeting. A minutes’ silence followed by a brief summary of the inpatients. Mr tibet had departed, the nightwatchman was gone and a nice chap admitted on friday with a facial infection left soon after the day stared- he had overpicked his nose and developed an infection of his face. This responded well to antibiotics and a regimen of ” do not pick your nose!!!” We needed some more patients!!! Luckily the outpatient clinic was bustling on monday morning.
Ward round- on the balcony
I started off with Dr. Tashi down at the outpatient clinic. I quite enjoy this as there are quite a lot of opportunities for teaching. Dr. Tashi is a lovely young doctor originally from the south of india. That sounded strange to me until he explained that in the late 1950’s, the Indian government set up 4 tibetan refugee communities in Karnataka, basically in the jungles. These tibetans did well- mainly with business and so their childern are receiving a good education. Tashi is a very kind and generous chap- also quite funny with a good sense of humour. We get on well together and the patients blur by us.
Teaching Dr. Tashi to make a patient laugh while being needled
I was suddenly called to see the chief medical officer who has made it back to here from Delhi. He is back to work, seeing patients and seems to be very busy.
2 minutes of introduction are all he has time for with me- and immediately I am requested to see a young women with back and leg pain of 3 months duration. The chief says that she has an MRI showing a disc lesion- so he wants my advice. Now this is the stuff I’m made of and I spend a good half an hour with the lady- luckily she speaks a reasonable english. Did I say disc problem on MRI? -well…. the problem is on the other side so that is obviously not what is bothering her. I’ll leave the medical jargon out of this blog- suffice it to say that the problem was muscular, treated by a few needles, and today, wednesday, she is pain free on follow up.
What else did I see of note? Oh yes yesterday I laughed so hard. At about 14:30, after lunch, in walked 3 tourists- and just 1 glance confirmed my suspicians- Israelies, semi religious and fully stoned!!. One of them proceeded to say in very broken english that his friend, the one with the problem, spoke no english at all- he would translate. I thought that I’d humour them for a few minutes but I realized that they were in severe stress so I just turned to them in Hebrew and said “Hello, how can I be of assistance to you?” -they almost fainted and their jaws just hit the ground. Their story was that on the previous friday the patient had fallen into a hole 1 meter deep while on his way to Chabad house for friday night dinner. He had been there for half an hour until someone helped him back to his room- now he was suffering from severe back ache. I called Tashi, we examined the poor chap, and decided that he had not really done any damage- just some blunt contusions. So he left, feeling very happy and much relieved- he didn’t even really want any pain killers. He also promised not to spread the word about me here- I’ve already said in a previous post that the Israelies are fiercely tribal and if word gets around that I’m here I’ll probably see millions of them!!
The tibetan "tea lady". Comes around at 11:00 and offers "sweet tea"- or is it "sweety"?
I’ve been doing a lot of teaching. Here, as in Israel, a lot of the patients suffer from various symptoms of the musculo-skeletal system. Also here, as in Israel, the doctors are taught nothing about the diagnosis and treament of these problems. What is so gratifying is that the doctors and nurses are very happy to have me here, and we do teaching rounds and cases all the time- they are even learning to stick needles in their patients- with good results.
I finished the second part of “how to hypnotize a pregnant tibetan” this morning. It was fun to give this training and tomorrow we will do some further training, mainly with the nurses because they are the ones who do the ante-natal clinics. They seem very enthusiastic. The on-call doctor of last night, Dr. Yangsum said that she had helped deliver a baby in the night and had used a “hypnotic voice” when talking to the new mother during the birth. It had helped calm her down ( the future mother- not the doctor!!!).
Applying a cast for a fracture- on the balcony
So- half my time has gone, I’m enjoying every minute ( except those spent in the toilet) and I’m glad I came.
So what did we have today?
Ward round Delek Hospital, Dharamsala
Let’s see: early staff meeting, ward rounds, outpatient clinic and part 1 of a seminar- “how to hypnotize a pregnant tibetan”. I really think though that all this needs a wee introduction- pacing is the real key to it all.
Life has a pace of its’ own. Try to prod it along and invariablly you’ll find something to slow you down. Go too slowly and you’re rushed off your feet. So was my first week in Dharamsala.
Ostensibly, I came to volunteer at the local tibetan hospital- the Delek Hospital. I arrived a week ago, slept fitfully during the first night and made an appearance, bright and early the next morning in Tashi, the volunteer volunteer’s office. (Have you worked it out? if not.. Tashi is a volunteer worker at the hospital responsible for volunteers coming to the hospital). He told me that Dr. Sadutshang, the hospital’s director was in Delhi on urgent business- we knew that the Dalai Lama was hospitalized for gall stones. This was on tuesday and Tashi gave me Dr. Sadutshang’s number and told me to call him after he returned on friday morning. Life has a way of slowing one down. Friday morning came, the said phone call was placed to the said Doctor, only to hear that the Dalai Lama was still in need of further treatment, thus he, the director, would be away indefinately. I was to call Tashi (remember him from the volunteers office?), and he would arrange everything. Well Tashi promised to get back to me (don’t call us-we’ll call you). So here I was, 4 days nothing had happened, haven’t saved a life or eased a pain or even seen something meaningful, except the local lepers outside my hotel (do I note a touch of egocentric hysteria entering this blog?)
I was faced with a weekend of waiting and thus mercifully contracted my sickman’s flu (see previous post- a sickman’s egg). The weekend passed in a pleasant fluish haze, punctuated by lots of dozing off in front of the cricket and copious amounts of honey, lemon, ginger tea (recipe to follow). Life seemed to be slowing me down to a full stop.
Yesterday, monday it was, I was back to normal, Tashi the “vv” has been in touch, I’ve met with some of the hospital doctors (pleasant youngsters) and things are perking up.
Today- full steam ahead.
So what did we have today?
08:30-08:35 staff arrive, take their seats, a few pleasantries and 1 minute of silence. I must say that the minute silence is quite amazing- a sudden quiet amid the hustle and bustle of the morning to center yourself.
08:35-09:15 The doctor on duty the night before goes over the admissions- a young tibetan gentleman who got drunk during the Miss Tibet 2008 contest and then proceeded to contract multiple stab wounds from an unnamed assailant using a swiss army knife (very sharp but thankfully not very long-bladed so the wounds were all superficial). I am informed that Mr Tibet will be staying for the duration of his wound healing- to keep him out of trouble- also to clean him up a bit from the alcohol consumed the previous evening. The oncall doctor goes through the rest of the cases- all in all there are about 12 hospitalized patients- not a heavy work load by anyones’ standards.
09:15-10:30 ward rounds. This is where the fun really starts. The ward rooms ar a hodge-podge of beds- about 6-7 to a room. Men and women and families all together in wonderful harmony. The first patient is one of the hospitals night watchmen who slipped on a rainy night and hurt his back. He has been here already for a few days with backache- no neurological symptoms and x-ray normal. I examine him- give a good acounting of the basic back examination and pronounce him ‘fit to be kicked out and back to work- thank you very much’!! The senior doctor tells me that he will be staying on for a few more days- he practially lives at the hospital and it is more convenient for him.
On we go through this melee of patients. An elderly man with end-stage liver disease is lying surrounded by friends and family. He is quite cntent with the large entourage we make as we discuss his condition- not really much to do, except keep him comfortable. Next to him is a young girl with severe anemia. I thought that a hemoglobin count of 3 was incompatible with life. We will definately discuss her case later in the staff room. Then it is on to 2 post surgery cases- a young woman after removal of her gallbladder and a middle-aged man after hernia repair. They have been here already 6 days post surgery. In Israel they would have gone home same or next day with a “see your family doctor for further follow-up care”. Here…. there is absolutely no rush and all are quite happy with the pace so I intend to slow down.
Treating a knee
10:30- 11:00 lemon tea and shoot the shit a bit with the doctors and then I’m invited down to the outpatient department.
11:00-13:00 outpatient- this is back in my line as a Macabbi primary care doctor of 12 years experience. Aches, pains, coughs, colds, worries- and who said that there are no worried well in the 3rd world. The amount of patients with nothing at all wrong with them amazes me. Maybe it is the availability of very cheap medical aid- 10 rupies for a visit to the hosptial. We work our way through the seemingly endless waiting room, and I am surprised that at 13:00 everything is quiet- everyone has gone for lunch including doctors, patients, auxillary staff- the works!
13:00-14:00 The lunch takes place at the confectory. This is a large dinning room servicing the entire complex of the hospital and the tibetan government-in-exile. Here we eat with the ministers, aids, secretaries and general staff of the tibetan administrative center. The food is surpirsingly good- rice, vegetable curries, something hot, wacking hot even for my palate.
14:00-14:30 Tea in the doctors staff room and i’m approached by Tsering, the most senior of the doctors who informs we that there has been a change of plans and the doctors have some time off this afternoon- could I put on a seminar at a moments notice? Of course I can and we decide on part 1 of hypnosis in childbirth or “How to swing a pendulum in front of a pregnant tibetan”.
14:30-16:00 Imagine, if you may, a room 4X3 meters, filled with 6 doctors (including 1 volunteer GP from Britain), 2 physiotherapists ( 1 volunteer from New Zealand), 4 nurses, one 6th year medical student from Imperial College, London, doing a rotation here in Dharamsala. The scene is set for a brief intro to hypnosis- one doesn’t lose or gain control of others, one doesn’t fall asleep, it is all about the power of concentration, and there is a certain pace, rhythm and musicality to your voice. We go through the basics, and start doing formal hypnotic inductions (or how to deeply relax in three easy steps). The class is fun, the students enthusiastic and at 16:00 we are all deeply relaxed and ready to start part 2 of the hypnotized tibetan- I’ll keep you posted.
The day has ended, I’m happy to have been part of it and I can’t wait to see what tomorrow brings.
Recipe for honey, lemon, ginger tea
1 flu with a mild fever, a sore throat is optional
1 large mug of black tea
2-3 tablespoons of honey (more if you like it very sweet)
1 lemon sliced and crushed
2 cm ginger root- sliced in to chunky pieces
A warm bed, lots of pillows and blankets, a few books strewn around (optional).
Mr Tibet- after the Miss Tibet 2008 contest- see above
Docsimon's photos
-
Archives
- January 2018 (2)
- December 2008 (1)
- November 2008 (3)
- October 2008 (8)
- September 2008 (3)
-
Categories
-
RSS
Entries RSS
Comments RSS
DocSimon's Weblog 
Good Morning Vietnam!!
Not the most original title-I admit, but it still sums up the feelings that Yor (my faithful better half-she who must be obeyed) and I were experiencing, a week before travelling for 3 weeks to south and central Vietnam. With tickets in order, we were getting as aquainted as possible with Vietnam, planning our route, surfing the web for ideas, places and of course tips for food.
Generally, we decided on an entrance through Ho Chi minh City (former Saigon). After a few days we would fly to Hue in Central Vietnam, on the coast. Then, via Hoi An across to the central highlands and an exploration of the Ho chi minh trail. Finally, an exploration of the Mekong delta before returning home.
So now we are really on the way, sitting in the Dan lounge in Natbag (Ben Guriona Airport). Soon to board, courtesy of the Jordanian Monarch.
Tomorrow hopefully streetfood😉😉
See you then
Simon
January 11, 2018 Posted by Docsimon | General Comments | Leave a comment