Health Care in the Himalayas

Save paper and follow @newyorker on Twitter Our Far-Flung Correspondents DECEMBER 21, 2015 ISSUE Medical Mountaineers Delivering basic care to the remote Himalayas. BY REBECCA SOLNIT Pasang Lhamu Sherpa, a record-breaking climber from northeastern Nepal. She and her husband, a physical therapist, began working with the Nomads Clinic in 2013. PHOTOGRAPH BY CHIARA GOIA FOR THE NEW YORKER o get to Saldang is simple, if not exactly easy. You walk. The nearest airport, many days away by foot, is a rough dirt strip at an altitude of about eight thousand feet. TIt sits on the side of a Himalayan mountain in the Dolpo district of northwest Nepal, on the border with Tibet. Heading north from the village of Juphal, a labyrinth of small houses on a steep slope, you encounter a place where fossil fuels are not part of daily life. In much of the region, there are no roads. Horses, mules, and yaks—and men, women, and children—carry goods on trails. One autumn day, the Nomads Clinic, a medical-service trip, pilgrimage, and adventure expedition, set off from Juphal with six riding horses, and fifty pack mules laden with a month’s worth of food, cooking equipment, camping gear, and clothing. Six duffels were stuffed with medicine and medical equipment— asthma inhalers, deworming pills, vitamins, analgesics, antibiotics. Others held hundreds of solar lights, toothbrushes, sunglasses, and reading glasses, to be given away. It was the 2015 edition of a mobile clinic that Joan Halifax, a seventy-three-year-old American teacher of Zen Buddhism, has been coördinating since the nineteen-eighties, to provide medical care in places where there is little or none. This year, after the earthquake in Nepal, Halifax contemplated scrapping plans for the trek to Dolpo. But she considers poverty and lack of resources to be an ongoing disaster in Nepal, and she decided that there was no reason to neglect Dolpo, which is as materially poor as it is culturally rich. (In the meantime, she organized Kathmandu-based earthquake relief efforts from afar.) Our group included a doctor, four nurses, and a nurse practitioner from North America; a young lama, and a Nepali nurse born in Saldang; a German acupuncturist; and an amchi, or practitioner of Tibetan medicine. There were also a thirty-year- old, record-breaking mountaineer named Pasang Lhamu Sherpa and her husband, Tora Akita, a physical therapist from Kathmandu; a number of Westerners; and Nepali mule men, horsemen, cooks, guides, and translators. The first day, the caravan travelled north through fields where wild hemp and pomegranate trees were growing on a slope that descended to the Tarap River. The second day, we continued through groves of wild walnuts and small stands of bamboo. The third day, there were apricots hanging on gangly young trees along the hillsides and cliffs. The fourth day, the terrain became more arid, and the plant species fewer and more sparsely distributed. We climbed high above the river and then, by a roaring waterfall, found the riverbed again. Finally, at an altitude of almost twelve thousand feet, we arrived at Lake Phoksundo, which is sacred to locals and is the approximate turquoise shade of a Las Vegas swimming pool. (Photographs of it look badly manipulated.) We were now in upper Dolpo, on the southern rim of the Tibetan plateau, one of the highest, harshest inhabited areas on earth. The trail to the lake passed through Ringmo, a village of two-story stone houses. Men walked down from the heights with huge loads of hay on their backs. Along the main path, an old woman dug tiny potatoes out of the soil with her hands. Later, we saw men behind wooden plows pulled by yaks, the shaggy, humpbacked beasts that roam everywhere in upper Dolpo, and whose milk is used to make yogurt, cheese, and butter. The butter is stirred into tea and burned in lamps. Women used handmade wooden rakes, and after threshing the barley they tossed the results into the wind, letting the chaff blow away and the grain fall back into baskets. BUY THE PRINT » Before the Chinese invasion of Tibet, in 1950, the herds of yaks, horses, sheep, and goats were larger, and people moved freely between Dolpo and Tibet, where salt mined from the dry bed of an ancient sea was traded for grain, which the high plateau lacked. But, as China clamped down on the border, the Dolpo population’s longtime use of Tibetan winter pastures ended. And the market for Tibetan salt was undermined by subsidized imports from India. The residents of lower Dolpo, some Hindu and others Buddhist, mostly speak Nepali, and greeted us with “Namaste” (“I bow to you”). Past Ringmo, in upper Dolpo, the principal language is Tibetan, and the greeting is “Tashi delek,” meaning something like “blessings and good luck.” Both Buddhism and Bon, a religion indigenous to Tibet, are practiced there. The landscape is studded with gompas, fortresslike structures combining the functions of library, seminary, and temple. Some date back several hundred years, and many have a pair of seated golden deer on their entry gates. The lama accompanying us said that deer were among the first creatures to listen to the Buddha. In the course of nearly four weeks, our group walked between four and ten hours on the days when clinics were not held. We followed a steep oval circuit through the mountains, covering about a hundred and forty miles. A few nurses were stationed in the towns in Dolpo, but we heard that they never stayed long, and for most inhabitants the nearest hospital was too far away. There were five clinics, and we treated almost seven hundred people, out of an estimated five thousand residents of the upper Dolpo region. he first clinic was set up at Lake Phoksundo. Patients came in with digestive troubles, infections, and, often, strained necks and sore joints from a lifetime of carrying big open baskets full of apples or Tfirewood or household goods. Alcoholism is widespread in Dolpo, and the few tiny shops we saw offered Chinese liquor among their meagre wares, though most people drank homemade raksi, a hard liquor made from grain. One morning, we went to the Bon monastery, on a promontory above Lake Phoksundo, where a smiling, red-clad monk showed us the four-hundred-year-old rooms, with murals of lamas on horseback and painted Buddhas in the lotus position—the colors were blue, green, yellow, red, and white, like those of the prayer flags fluttering in the sunshine. Then he apologized for being drunk. The abbot told us that the monastery had been built to protect the blue sheep, creatures related to mountain goats and ibexes, from hunters who would drive them down the mountains and then herd them over the bluff to their death. Occasionally, during the two days we were camped there, we gazed across the blue water at the trail that awaited us on the steep hillside beyond. It looked as though someone had casually scratched it with a stick, the way you might draw on a map with a pencil, not like something you should trust with your life. The term “trade routes” may summon up visions of broad paths, but thousand- pound yaks can traverse faint, canted trails the width of your outspread hands. From Phoksundo, Saldang was still a week away, over one pass that rose to more than 17,600 feet and another to about 16,700 feet. Our sirdar, or head guide, noted that years ago there was a great deal of ice at the highest pass, but we found only a retreating mass of snow in a shadowy stretch of the path. We all got used to moving steadily along, amid the scree, the dust, the ruts, the trails built to hang out over the abyss, the slippery slabs of rock, the staircases of irregular stones, the rickety bridges of logs or old wood patched with flat stones. There was rarely a phone signal in the regions where we ventured, though at one of the high passes the young Nepali men in our expedition lined up to make calls, looking like regulars at a bar three miles high, scoured by wind, with hundred-mile views. “Am I getting Between the two passes lay Shey warmer?” Gompa, the ancient monastery of the Crystal Mountain, one of the holiest BUY THE PRINT » peaks in Tibetan Buddhism. The old abbot told us about a predecessor, hundreds of years earlier, who had first recognized that the mountain was sacred, and about the ability to recognize the sacred as a special gift or talent. Tenzin Norbu, the outfitter for our expedition, told us that prayers here had several thousand times the power they have elsewhere. Inside, we saw ranks of butter lamps burning before golden Buddhas on an altar flanked by gaily painted shelves of sacred texts bound in bright silk. Outside, we saw people who had walked there from fuel-starved Saldang to gather dung from the ample supply that passing mules provided. The abbot welcomed the Nomads Clinic into the temple, and locals asked the doctor and the nurses to treat wounds, address pains, listen to stories. The first evening, a horseman brought in a comrade, who was too sick to walk. “He was such a beautiful man, and he was almost dead when I first saw him,” the doctor, who diagnosed a severe kidney infection and treated him with antibiotics, said. The man, who was in his early forties, had a drawn, sun- darkened face, a faint mustache, the high cheekbones of most of the Nepalis in the region, and a thick coil of crimson strands of wool around his braided black hair.

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