The lure of rural medicine and the possibility of using what I have learnt to improve the lives of others was what started of my relationship with medicine. Even after graduation, the thoughts of working in a place where help was most needed continued to preoccupy me.
I was elated when I had the chance to organise my own medical trip together with my other half. He had plans to climb Mt Everest while I had plans to join a NGO in Nepal. Our plans merged together when he had visited the village of Phortse on one of his climbing trips, where he uncovered some of the medical needs of the villagers. Hence we decided to be our own NGO and head down to the village ourselves.
We rallied people and companies to supply products to meet the needs of the villagers. However, just donating medications and equipment is not sufficient. We should aim to empower them and build up something that is sustainable. But what can 2 medical officers (junior residents) do? I tried my best and decided that the plan was to refurbish the existing health post and work alongside the healthcare assistant in managing various ailments. A big chunk of time was spent preparing teaching materials to help educate the villagers about first aid, nutrition, women and children's health and safe deliveries. These were prepared in Nepalese language and laminated which meant they can remain in the clinic once we leave. Powerpoint presentations and animations were also used on site as teaching aids.
I was based in the village of Phortse in Khumbu Valley. Khumbu is located in Northwest Nepal and is home to the maginificent mountains, including Mt Everest. There are about 13-14 villages in the region itself- each about 4-5 hours walk away from each other. The only form of transport is by foot.
While Kumaran was climbing Mt Everest, I spent 2 months in the Khumbu Valley travelling to the other villages with medical supplies where I would work with the healthcare assisstant. The healthcare assistants run the healthpost and are an equivalent to a nurse clinician. When we left, we became facebook friends, enabling us to keep in touch.
After he summitted Everest, we both made our way back to Kathmandu, where we met up with Mr Krishnan (from Singapore) and Netra Mani (ex-headmaster of Saraswoti High School). Cerebros had raised a sum via their facebook page, enabling us to purchase 20 laptops from Kathmandu. These laptops were used to set up a computer laboratory in Saraswoti School in Aahale in Gorkha district.
Why Saraswoti School? Well....this was the same school that Kumaran had helped refurbish when he was in secondary school. In 1999, led by Mr Krishnan, their group visited the school as part of their community service project.
And now, nearly 14 years later, they were revisiting the school and I had the honour of joining them on this trip down memory lane. The education funds raised by Cerebros enabled us to set up 20 computers in the lab, where initially there were 3 computers.
This was a priceless experience. It was more than a medical trip... I learnt so much about the Nepalese people and myself. It was a spiritual journey. I learnt how we have evolved into a society of extravagance- that actually we only need the basics to be happy. I learnt that communication goes beyond what we speak.... and that as humans, we all have common needs and emotions that need to be addressed. I felt that I gained more from these people than what I had given.
The following is a journal narrative of my experience in Nepal...
Pre trip phase
1 more month to go before I head off to Nepal for our medical trip.
The plan is to bring medical equipment and medications to the village of Phortse, where we will be based. In the period of 2 months, we will be travelling to nearby villages, donating medical supplies, conduct health screening as well as teach the villagers basic health education.
Briefly about Phortse
It is a small sherpa village in Nepal. Located at 3840m, it lies along the route of the Everest Base Camp Trek. It has a population of about 370. The village has 1 school, and a clinic with basic facilities run by a nurse. The nearest hospital and doctor is at Khunde, which is about 3 hour trek away. (by sherpa standards... longer for me)
Thanks to generous companies in Singapore, we have collected equipment such as pulse oximeter, blood pressure machines, stretchers which the village nurses had requested for. Besides that we have also collected basic medications which would be useful to the villagers.
Collection done.. now we are in the process of packing. D-day is 1st April 2012.
23/3/12
1 More Week to Nepal
1 more week to go... and there is so much to pack. Everything has been compartmentalised but the quantity is huge. Besides my own stuff, there are a fare bit of medication and equipment as well as Kumaran's climbing supplements. I am definitely going to exceed the weight. I wonder if the Nepalese Consulate's letter will help.Kumaran has arrived in Phortse and the clinic has started off with a bang (after many hiccups) in the town of Phortse. People are flooding from nearby villages to see the new doctor in town.
This is going to be a short week indeed. Its finally here.. years of planning put into reality....
31/3/12
Few more hours to go...
Have to be up in 2 hours to get to the airport. Finally the packing is all done. My bags are still overweight. Let hope I manage to pull through at the airport. Nepal... here I come!!
17/4/12
The Journey to Everest Base Camp
Day 16 in Nepal. I have finally reached the Phortse clinic after Everest Base Camp. As most people have commented, EBC is not as spectacular as one makes it out to be. For starters, one can’t really see Everest from the base camp (except for the western shoulder of the mountain).
Kala Patthar boasts a much better view of Everest. Kala Patthar means black rock in Hindi, as it appears as a black hill standing on Gorak Shep, just beneath the south face of Pumori. Many climb it to catch sunrise or sunset where the views of Mt Everest is magnificent. 5545m tall, we climbed it to catch the sunrise. Never underestimate any mountain was what I have learnt. From Gorak Shep, I thought it looked like Bukit Timah Hill… however, it was a steep never ending incline up to the summit. And it was too cold for comfort. The views were worth the cold winds though.
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| Sun rising just above Mt Everest |
This is my journey so far
Lukla- Phakding- Namche- Phortse- Periche- Lobuche- EBC
EBC- Periche- Phortse
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| Simplified map. We walk from 1 village to the other and usually rest at the village for the night. |
As we walked to EBC, we met a large number of trekkers and climbers heading in the same direction. It almost felt like we were heading towards a carnival. I half expected to see balloons, cotton candy and game stands at EBC.
The sight I was greeted with was close to that… full of colourful tents., each belonging to a different trekking company. The campsite was huge and sophisticated. IMG campsite (where I was) was very impressive indeed, with their dining room, bathroom, makeshift toilets, communication tents and even an entertainment tent.
Life in EBC
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| Makeshift bathroom |
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| Washing my cloths |
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| Makeshift toilet |
The 4 night stay at EBC itself was an experience I’ll never forget. I finally had my shower after a week. (It felt like a spa as the 'bathroom' was a tent over the rocks.. and during the day, it traps the heat from the sun, keeping the inside warm. However, the amazing experience was cut short when the bucket ran out of water just after I soaped) I got to finally wash my cloths (which turned hard the next day as they froze… and thawing them meant that the tent got wet)
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| The puja, which is a prayer that is done before they start climbing. They pray to the Gods for safety and put forward their equipments for blessings. The Sherpas are very spiritual people and the mountains are believed to be guarded by the Gods. Mt Everest is believed to be guarded by Miyolangsangma, the Tibetan Goddess. |
And now I am finally back in Phortse. The porter who accompanied me only had slippers on. I tried to ask him how he did it.. only to realise he doesn't speak any English, except say 'Ok'.
The most interesting thing he asked me was 'This Phortse?' at the top of the village. (his task was to lead me to the village btw) I thanked Kumaran for having brought me to the village earlier on, allowing me to recognise the route back to phortse....
So things are not as underdeveloped as I thought they would be. The children are taught English at school and many of them are tech saavy with facebook accounts!
Life
Sherpas are very simple people. They are an incredibly strong and resilient group. They speak the Sherpa language, which varies slightly from the Nepali language. The Khumbu climbing school is based in this region. It was started by Conrad to develop a formal method to train the sherpas in climbing. A second climbing school is being set up in Phortse, just next to the Namaste Lodge.
21/4/12
Week 1 in Phortse
It has been a week in Phortse… the Sherpa people are one of the most homeliest people I have met. They are not true Nepalese as such but are of Tibetan origin that have settled in the mountain regions. They are well renowned for their climbing skills.
As it is the climbing season now, all the young and middle-aged men are out with the trekkers and climbers. Most of them are at Everest base camp. Occasionally they pop by the village to visit their family on their rest days. (It’s a 2-day walk from EBC to Phortse)
Apologies for the lack of pictures. I have limited internet data.
Clinic
I have been seeing mainly children, women and monks (lamas) from nearby villages. With the change of the weather (its getting warmer), most people are arriving with runny nose, cough and sore throats as well as skin rashes. While Kumaran treated all the body aches that the men have (from carrying heavy loads and climbing), I am treating the wave of URTI as well as replenishing their stock of Ninja gel (diclofenac gel)
Interestingly, a lot of people here suffer from dyspepsia (indigestion). I wonder if a large proportion of it is due to H Pylori. (shall have to do a lit search on it once back home)
Besides the local population, there have been a couple of trekkers and porters passing by. Word has travelled about the foreign doctor living in Namaste Lodge… and on some days I have been woken up with a loud banging on my door requesting for the doctor’s attention. (Usually it’s the porters requiring medications for the common cold)
The children are simply adorable. They have started to hang out just outside my clinic during the day. When not seeing patients, I attempt to teach them simple English words. One of the girls just kept laughing at me…. I later discovered she can recite A to Z… and the English words I was teaching her was a bit too simple.
So things are not as underdeveloped as I thought they would be. The children are taught English at school and many of them are tech saavy with facebook accounts!
Food
The food is great. Usually its Dhal Bhat. (dhal, rice and vegetables) The staple food is potato and buckwheat. I ate this potato buckwheat pancake with their homemade chili (mixture of garlic, salt and pepper) (pictures will be up later due to limited data space that I have). The people were reluctant to let me try it as they thought my stomach wouldn’t be able to digest it. So far… so good.
Sherpas are very simple people. They are an incredibly strong and resilient group. They speak the Sherpa language, which varies slightly from the Nepali language. The Khumbu climbing school is based in this region. It was started by Conrad to develop a formal method to train the sherpas in climbing. A second climbing school is being set up in Phortse, just next to the Namaste Lodge.
The sherpas are the true heroes of the mountain. They have summited many of these mountains numerous times and yet remain humble to their conquests. Nearly every house has an Everest summitter. (they get a certificate from the government when they summit) Some have even summited Everest 10 times. The international trekking groups employ them. They lead the climbers as well as set up ropes and do nearly everything else required for the backbone of any expedition.
I will be heading to Kunde village in 2 days time, where I'll be there for a week plus. After that, it will be back to Phortse to continue our work.
I will be heading to Kunde village in 2 days time, where I'll be there for a week plus. After that, it will be back to Phortse to continue our work.
30/4/12
Khumbu Healthcare System
Finally having good internet connection! A bit about my experience last week…
On my first day at Kunde Hospital, I was faced with a patient carried on a stretcher. The patient was being carried from a nearby village, which is about 2 hours walk for me (mainly uphill). My heart sank when I saw the stretcher from afar as the other doctor wasn’t on site that afternoon and it was my 1st day!!! (I found out today that the stretcher used was the one we had donated)
Thankfully, I was with the hospital assistants who were amazing. She was carried in, writhing in pain, mainly around the abdomen and back. With the electronic machine, her pressure measured 70/35. Immediately the intravenous fluids went up. However, a repeat reading on the traditional manual machine was slightly reassuring at 90/50. The young lady turned out to have pyelonephritis (UTI leading to infection of the kidneys). I admitted her to the inpatient ward and she recovered well with intravenous antibiotics. Her blood pressure remained low thoughout though. She was eventually discharged well. I found out from the local doctor that people of their races tend to have lower blood pressures. Right.. enough of medical anecdotes and a bit about the Kunde Hospital!
About Kunde Hospital
Sir Edmund Hillary set up Kunde Hospital in 1966. It was inititally run by overseas volunteer doctors for periods of 2 years. Eventually, a local doctor from the village nearby took over and he has been in charge for many years. 2 doctors, a healthcare assistant, a lab technician, a midwife, a cook and helper run the hospital. It is still funded by the Edmund Hillary Fund.
At the hospital, we can do simple blood tests and x-rays. Simple minor surgery can be done too (such as toilet and suture). Major surgical cases are flown out to Kathmandu on a helicopter. (Which costs a bomb for the locals). However, according to the team, the rate of appendicitis and emergency caesarean section is low and has not been a problem.
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| Located at an altitude of 3840m |
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| View from the hospital |
One of the bigger problems is gastritis. Last night we had another patient brought in on a stretcher from a village 3 hours walk away with haematemesis (vomiting blood). I did find out from the doctor that the incidence of H. Pylori is high even among the young people.
Kunde Hospital has been very successful with their immunization, family planning, antenatal and iodine therapy programs. The main mode of family planning is the depot form of contraception. Their programs appear to be rather successful. Most families have 2-3 children. I haven’t seen any goiters and most ladies who need an elective caesarean head down to Kathmandu early in the pregnancy.
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| Partial thickness burn on the face. Ideally, he should immediately be transferred to a Burns Unit. But we don't have such luxury here. We have been dressing the wound and preventing it from being infected. He has done well. |
The problem- It is the only hospital that covers such a large area of over 14 villages. The furthest village is about 5 hours walk away (full of upslopes and downslopes) I find it hard enough carrying myself on these slopes let alone carrying a patient on a stretcher on this terrain!!!
Each village has a health post, which is run by a health worker, who does very basic medical care. We have been helping to train these health care workers and promote health education, such as simple first aid, safe delivery at home, maternal health and children health and hygiene.
While at Kunde, I had the chance to learn more about the healthcare system in the Khumbu region. Working with the local doctor gave me an opportunity to integrate into the system and to understand more about the common medical ailments, the people’s attitude towards healthcare and areas of healthcare that lack in the villages.
From Kunde, I walked over to Thame (about 3 hrs walk West of Kunde). There I had a chance to meet their health worker and stay in the local doctor’s lodge. However, I forgot to visit Tenzing Norgay’s house!!!
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| View from the monastery of Thame Valley |
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| Thame Valley- near the passes to Tibet |
I’m back in Phortse, where I’ll continue running the clinic and promote health education among the villagers. I will be heading to the nearby village of Pangboche in a couple of days.
1/5/12
Helicopter rescues in Khumbu
After witnessing a few helicopter rescues, and being involved in one, I have learnt a bit about the system which surprises me to some extent. There is a very low threshold to evacuate tourists visiting this region, which makes sense, considering the array of problems that can be faced in such harsh conditions.
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| Evacuating a tourist to Kathmandu |
However, when it comes to the locals, who may have to be evacuated to Kathmandu for even lifesaving treatment (due to limitations in the hospital), they have to bear the local cost, which for many, is a lifetime worth of savings! Perhaps a helicopter for the locals may be of great benefit.... but the government does little to help. Where then does the money from the permit to climb Everest goes to?
I learnt that a large proportion of the permit to climb Mt Everest (around USD10,000) goes to Kathmandu's office, not the National Park itself or to the sherpa people. Hence, many of the basic necessities I have seen in this region so far (electricity, schools, healthcare) bear the name of overseas sponsors. (The Austrians set up the hydroelectric power station and is maintained by the Sherpa people, Khumjung school was set up by the Edmund Hillary Foundation).
A large number of people pay to climb Everest each year- a portion of the income from a year of climbing may be sufficient to support a helicopter for the local population. Just a thought...
6/5/12
Mount Everest Sherpas
3 sherpas have died so far in this 2012 Mt Everest expedition. The first had premorbidities such as liver cirrhosis. The cause of death is presumed to be altitude sickness. The 2nd was from an accident in the Khumbu icefall and the 3rd, just recently, after being rescued to Kathmandu by a helicopter (we are still unsure about the cause of death)
The 3rd death is close to home as he is from the village of Phortse. 2 days ago whilst in the clinic, I first received news that a Phortse sherpa was being rescued from Everest by a helicopter to the ICU in Kathmandu. Throughout the day, tension built up in the village. Though I can’t fully understand the Sherpa language, their body language and creases on their faces gave away the anxiety. Just a few hours ago, we had a helter skelter of people, reporting the man had passed away in Kathmandu. A cloud of gloom hangs over the village. A deep sorrow overwhelms me for this stranger I have never met. All I know is that he is between 30 and 40 and has 2 very young children.
Nearly every house has a son, husband or father on the Mount Everest Expedition. There is a baseline level of anxiety during the expedition period. Though the sherpas are renowned for their strength, agility and adaptability on the mountains, the amount of danger they are exposed to is much more than the foreign climbers. This is because the sherpas are the ones who set up the ropes for the route to transport logistics between the different camps on the way to Everest summit. However unlike the foreign climbers, for the sherpas, this is a risk they cannot avoid as these expeditions are a source of their incomes. This is such a tragic situation indeed.
Sherpas on expedition
Once on an expedition, the sherpas guide, transport supplies, set up campsites and fix ropes between the camps on the route to the summit of Mt Everest. In these days there are 4 camps between the base camp and the summit. These sherpas will have to make repeated trips up and between the camps, which means they are constantly exposed to the dangerous terrain of the mountain. (also crossing the Khumbu icefalls numerous times, where the highest no. of deaths ensues)
On the other hand, the number of times the foreign climbers have to go up are limited to avoid exposure to dangerous situations.
While Kumaran is climbing Everest with IMG, the Sherpa family I live with, have a son on the same team too. As one can imagine, there is some level of anxiety in the house. The fear and anxiety we feel for our loved ones crosses the language and cultural barrier.... eventually we are all ONE... hoping and praying for their safe return.....
2012 Everest Climbing season
From what we have heard so far, it appears that the weather has been rather dry, which results in the rock being loose. This has been a source of accidents and worry. A new route has been fixed up to camp 3, which appears to be safer. The winds have also been very strong and unfavourable. Hopefully the weather improves this coming week.
The lure of Everest
What makes one want to climb Everest? George Mallory climbed it because, ‘It is there’. (which to me seems like a pompous reason). During Edmund Hillary’s and Tenzing Norgay summit, the British team tried to coincide the summit day with with the birthday of the Queen. (However, the New Zealander and Nepalese summited on 29th May 1953) If anything, perhaps people take pride in saying they have summited Mount Everest.
The views along the treks here are magnificent. Despite hours and hours of walking, hypoxia at higher altitudes and the harsh weathers, the amazing scenery and the peace one feels with themselves makes it all worthwhile. A rare moment to hear the winds, to hear your foot steps, to feel the ground with each step and to be at one with all the elements of nature.....
Well, this sport has in many ways benefitted the population of the Khumbu region. It has brought tourism and income to the people. It has also allowed some of their children to be educated overseas (as some of the climbers have sponsored the education of the children). However, this has placed some pressure on the people- when 2 sherpas go on similar expeditions and only 1 get extra benefits, unhappiness ensues.
When Tenzing’s son, Jamling wanted to climb Everest at a young age, his father said he climbed Everest so that his children won’t have to. Essentially he did go on to climb Everest in 1996 because he wanted to experience what his father did… and wrote a book, ‘Touching my father’s soul: A sherpa’s journey to the top of Everest’. It is an amazing book which explains why he climbed and what happened in the tragic incident in 1996. But most importantly, it was written from the sherpa’s point of view and had a good spiritual aspect to it, which is hard to come by in mountaineering books.
Lets just hope this season improves…..
25/5/12
Health Education in Phortse
While at Pangboche for the past 2 weeks, I have not been able to have good internet access. My minimal access has only allowed me to check and send 1 mail a day, let alone update my blog.
Now tracing back my steps and days… I last stopped at my ramble about climbing Mt Everest. Lets divert from the mountains and move back to the medical work….
After Kunde Hospital, I returned to Phortse to continue running the clinic as well as start with the health education sessions that I had been planning for months prior to the trip.
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| My tools for the job- powerpoint and posters printed and laminated in Singapore |
Combining forces with the Phortse healthcare worker!!
Lhakpa Yangjee the designated health worker returned after her much prolonged maternity leave. She returned with a very healthy, pretty baby girl, called Pasang Doma, after having an emergency caesarean section in Kathmandu.
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| Lhakpa and her daughter, who accompanied us in the clinc |
It was great to have her back in the village as now we can proceed with the main plan, which was to work together and to educate the villagers as well as see patients together and help train them be more confident with prescribing medications.
These health posts were set up to oversee the villagers’ healthcare needs, health education and family planning. They are part of the Kunde Hospital. Inadvertently, these health posts become the general practice or polyclinic for the villagers. However, chronic illnesses such as hypertension or diabetes mellitus are still managed in Kunde hospital as the patient’s records are stored there. This can have some disadvantages though, as some old patients have too severe knee osteoarthritis to walk to Kunde. (average of 3 hrs from most villages)
The health workers are trained for 18 months in Kathmandu and can see to basic healthcare needs.
Our Role in Phortse
From our side, we had stocked the clinic up with an array of medication, dressing sets, a stretcher, wooden splints, blood glucose machine, oxygen saturation machine and blood pressure machine. (I still remember trying to load 90kg worth of medical supplies on board the domestic flight from Kathmandu to Lukla. Thanks to our Nepalese contacts, they came on separate flights on the same day)
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| When we 1st arrived, it was snowing in Phortse. Kumaran had the honour of lugging the bag of medications up the hill to the clinic. He had to stop to catch his breath! |
While seeing patients with Lhakpa, we discussed the management of various ailments, the prescription of antibiotics, symptomatic treatments for URTI (as usually only paracetamol is prescribed), as well as learn about the different aspects of chronic disease management (besides drug prescription, there is the counseling and compliance aspect). I also gave her the blood glucose machine, such that now, the villagers can have their blood sugars tested rather than travel 4 hours to Kunde.
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| Shuwei and I counting our stocks and arranging them in the clinic. A big problem was the lack of running water in the clinic. Hence every morning, we have to lug a bucket of water up. We have flagged it up to the people in charge. |
Naturally, a larger number of villagers visited the clinic as there were new ‘goodies’ as well as a foreign doctor.
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| One of my favorite visitor to the clinic!! |
Women’s Health Education
The most interesting area was the health education aspect. As I had mentioned before, 50% of deliveries take place at home. Usually the lady’s mother and husband help to deliver the baby. Antenatally, they will visit Kunde hospital, where they will be scanned for presentation as well as triaged for potential delivery complications (usually about 4-5 visits). If complications are expected, they are then advised to head to Kathmandu for delivery. They are given a sterile set to help cut the cord too. Then… when the water bag bursts, if the mother can’t make it on time to Kunde, the action takes place at home. (The mother ‘pops’ and the family ‘catches’) Even breech deliveries (foot presentation) takes place at home.
Coming from Singapore, where all deliveries are doctor led as well as being trained in the UK, where a large proportion of deliveries are mid wife led, this was not all too surprising to me. However, what was surprising was the lack of knowledge most had regarding the potential complications during childbirth itself. Hence I showed them pictures as well as a power point presentation on delivery, potential complications and how to best manage them.
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| One of the many pictures I use |
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| Using technology and powerpoint presentations. Teaching was mainly outside the clinic, in the sunshine |
The turnout and response was great. Most of the ladies from the village turned up with their children. As well as a teaching session, it turned out to be an opportunity for the ladies to socialize between their household chores. Lhakpa was great in helping me translate, even with her crying baby in the basket. The posters I had were mainly pictures with Nepalese writings. Hence, they helped to reinforce the information.
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| Nepalese text |
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| Lhakpa helping me to translate teachings on antenatal care and delivery complications. The basket hanging from her head contains her baby. |
It was an engaging crowd, where questions were asked as well as experiences shared. There were women of all age group. Hence the older ladies shared their delivery stories with the rest.
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| Other ladies also came with their babies |
It was a great opportunity to reinforce the importance of antenatal care, postnatal problems (including depression), family planning and vaccination.
I must say I am impressed with the depot uptake rate here. In Singapore, I remember counselling patients after a termination of pregnancy on contraceptive methods. However, the response was poor- people were resistant to it for various reasons. (Common being the avoidance of chemicals in their body) The sherpa ladies were more open to the idea of contraception.
Children’s health
Children’s health education then seemed to be the natural follow up to the teachings on maternal health. I touched on children’s nutrition and hygiene, importance of breastfeeding, and early recognition of a sick baby.
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| Another one of my posters |
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| The children audience were captivated by the new addition to the village |
Teenagers
For the younger women crowd, we talked about problems faced during puberty, especially acne as well as menstruation related problems. Being an all lady crowd definitely helped approach this topic.
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| Despite the all ladies group, there were many giggles when squeamish topics were approached |
Basic first aid and wound care
Lhakpa had her CPR training a few years ago. Hence we refreshed her knowledge on it. We then went on to teach the villagers some basic skills- such as how to save a choking person, wound care (from lacerations, bites, burns) and the importance of tetanus vaccination.
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| Showing them pictures on my laptop on wound care and tetany |
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| Don't be alarmed- we were standing on a slope! |
Following my sessions in Phortse, I then headed up to Pangboche with some of our medical supplies, to meet the health worker based there. It was also a chance to catch up with Kumaran who was at that time on his break from his Everest rotations. (he is now on his summit push)
26/5/12
Spiritual Quest
Straying away from the medical work, I have to mention 2 highlighted days during my stay there. Mainly for the reason that one cannot avoid mentioning spiritualism during their stay in the Khumbu Valley. And also because I am a strong believer that different religions are different paths to the same destination… though a Hindu, I have great respect for Buddhism. Here in the Khumbu valley, in every task and every trek one takes, religion takes great priority.
Its also a perfect time to also thank the Gods of this valley for protecting Kumaran during his ascent and summit at Everest today. May his descent be just as safe!!!
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| Ancient Tibetan scriptures on the stones. Usually found along paths and at the entrance to each village |
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| The colourful flags are the tibetan prayer flags. They are placed at the highest point, so that the winds blow the mantras and spread compassion and good will in all directions. It symbolises peace, compassion, strength and wisdom. |
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| One has to always walk on the right of mani walls & prayer flags. The path always splits into 2 around mani walls. Apparently, it aids to test the concentration of the walker. |
Right, so the first highlight is a Friday 11th May when we decided to walk to Tengboche. The day itself had a spiritual start. Apparently it was an important day in the calendar and the gompa (monastery) idols were being brought around the villages.
At the start of the day we ran into a friend who brought us to visit Lama Geishe, a very powerful and renowned Lama. We both received blessings from him. Most climbers will stop enroute to get their blessings from Lama Geishe. Walls of his room are filled with pictures of those who had received his blessings and summited.
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| Lama Geishe's blessings |
Tengboche Monastery
We then walked to Tengboche monastery. It’s a pleasant 1-hour walk with beautiful views of Ama Dablam. I kept stopping just to absorb the amazing views of Ama Dablam.
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| Stupa with Ama Dablam in the background |
It is located on a hill at the confluence of the Dudh Kosi and Imja Khola rivers. It is enroute on the Everest Base Camp trail. (we had missed it earlier as we went on a different trail) Hence visited by most trekkers. It was first built in 1916 but then got rebuilt after an earthquake in 1934 and then in 1989 after a fire.
Ancient Tibetan scriptures described Khumbu valley, together with Rowlang and Khanbalung valleys as sacred places. (not surprising, considering the beauty of Khumbu). Tengboche gompa was found by Lama Gulu, with the blessings of Ngawang Tenzin Norbu (considered the 5th incarnation of Lama Sangwa Dorje who founded Pangboche monastery). It is also closely related to Rongbuk Monastery in Tibet (on the Northern face of Everest)
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| Footprints of Sangwa Dorje |
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| Always turn it in a clockwise direction |
The village and the monastery are splendidly beautiful. Sitting in front of the large Buddha, in the Khumbu Valley, one is reminded how small we are in the grand scheme of things in this universe.
Back in Pangboche
When we returned that evening, we learnt that the villagers were awaiting the return of the idols to the gompa. So we waited with them. Finally we heard chantings and ‘dongs’ around dinnertime. We scrambled to the gompa and were ushered to the 2nd floor, where we found ourselves seated with the villagers. We waited for the elaborate prayers and instead found that we were being served food. The guy next to us asked me if I was the foreign doctor in town. We took the opportunity to find out what was happening. Apparently, prayers were over and now; they were serving food as well as tea and chang (the local equivalent of beer… in the monastery!!! We were also served buff, yak meat.. in the monastery!!!!) We ended up having dinner in the gompa.
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| Pangboche Monastery- one of the oldest in Khumbu |
It was a memorable moment, sitting with the vllagers, having daal baat and tea. It was priceless. The cohesiveness and spirit of the village was impressive. Each year, a group of families are picked to host this special event… hence the food and drinks will be prepared by them. It reminded me of home… being served food in the temple after Friday prayers. (minus the beer and meat of course)
The Sunday of 20th May, just like the previous Friday turned out to be a spiritual day. As Kumaran was supposed to start his summit push that night, I thought I would pay Guru Rinpoche a visit. In Pangboche, there is a main gompa housing Guru Rinpoche- it is most well known to trekkers passing by. It is one of the oldest gompa in Khumbu, found by Lama Sangwa Dorje.
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| Guru Rinpoche and Ama Dablam in the background |
What many don’t know is that there is another huge Guru Rinpoche sitting on a hill above the whole village of Pangboche. It is right next to the ‘Pangboche Human School’ (which is actually a school set up by the Koreans.)
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| Guru Rinpoche |
Anyhow, the temple housing the Guru is half completed. But upon setting foot in his vicinity, one cannot deny the feeling of peace and serenity in his magnificent presence. An enlightening place indeed. With the great mountains on my right, the bronze statue in front of me and the strong winds blowing the prayer flags, everything fell into place. I’m sure the climbers will be safe…
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| The great mountains in the background |
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| Ama Dablam |
The day went by. As I was about to have dinner, the lodge owner, Jima commented on how many of her friends have been visiting her. When I asked her why, I believe she said something about it being a special day where people are here to place lights in the temple. (btw, communication between me and her has been the most interesting as she speaks minimal English and I can only say pain and thank you in Sherpa language! But I have learnt one doesn’t need language to understand a person’s life story... this story shall be for another chapter)
Anyway, she brought me to the gompa, where we met Lama Panju who brought out a whole row of butter lamps to light up. It was just us 3 in the Gomba. I still have yet to find out the significance of that day in the Buddhist calendar.
There is something very special, spiritual and rustic about the village of Pangboche indeed… or maybe it is the Khumbu Valley itself.....
28/5/12
Chronic Illness Management
Pangboche is a village at an altitude of 3985m. A village very much like Phortse, where the staple farming is potato and buckwheat and most of the men are climbing sherpas. Lower Pangboche is a village most commonly encountered by the trekkers enroute to base camp. I was residing in Upper Pangboche where the clinic and the Pangboche Monastery (Gompa) is.
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| Me with the health worker |
I was at the clinic with Shiva, the health post worker. I ran the clinic together with him, teaching him along the way as well as conducting the health education sessions similar to the ones in Phortse.
Unlike Lhakpa, Shiva is not of Sherpa origin. He is from lower valley and speaks Nepalese. Hence he communicated with the patients in Nepalese, except for the older ones who only spoke Sherpa language.
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| Faces of Pangboche |
The villagers of Pangboche and Phortse are closely related. Many are in laws. I feel like I have come a full circle as now, many are becoming familiar faces. I had seen a lady a few weeks ago at Kunde, with a terrible wound. At Pangboche, I got to follow up on her wound healing, which is doing well.
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| Wound initially |
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| Wound a week later |
Management of chronic illness
I saw my first diabetic patient. According to her, she was found to be diabetic, started on medication and then stopped. She decided to just come by today for a ‘checkup’ (as what most of my patients have been telling me for the past few days) since she heard the doctor was in town. Her random capillary blood sugar was 29.1!!!!! My heart sank. Unfortunately we do not have any insulin or antidiabetic in the healthpost. Hence, we had to send her to Kunde Hospital to initiate treatment as soon as possible.
Managing chronic illness is a problem. People find it hard to grasp on the idea that if you have hypertension, diabetes or ischaemic heart disease you have to be on lifelong medications. It was easier in the Western world (while I was in the UK) as people understood they needed to be on lifelong medications and kept to one family doctor, which allowed good continuity of care.
However, in Nepal and even in Singapore, there are a couple of problems. Firstly, people think that if they have no symptoms, they don’t need to continue on medications. Which is totally wrong, especially in the case of diabetes…. Diabetes KILLS SLOWLY…. One may have no symptoms, yet over the years, it slowly damages your organs…. The eyes, kidney, heart, nerves, legs and eventually one suffers a slow painful death. It frustrates me when I see patients with sky high blood glucose and the reason is because they have ran out of medications for a week and hence have not been taking them.
Secondly, people doctor hop and hence either get prescribed different family of anti hypertensives, lose the continuity with their doctors and end up collecting all the various antihypertensives in their drug cupboard at home.
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| Clarifying medication doses |
Here in the Khumbu region, many take medications from Kathmandu… but stop taking them once its finish and then randomly appear for a blood pressure check in the clinic. This is a very familiar problem we face in Singapore too…… but yet, we are a much smaller and developed country.
Right, I have totally strayed from my Pangboche experience and rambled on about challenges in chronic illness management.
Anyway, I did my best to emphasise to my diabetic and anti hypertensive patients about the importance of follow up in Kunde Hospital…. I hope I manage to get the message across. (Language is a great barrier for such purposes but hopefully my tone of voice and body language gives away the seriousness of the matter)
It was great to see my diabetic patient a week later. She had visited Kunde and was started on antidiabetic medication. We gave her diabetes counseling as well as the potential side effects of the medication. Her husband was with her, which was perfect for the counseling.
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| Shiva counselling our diabetic patient |
Another patient was also found to by hypertensive on 4 occasions. She had initially been on medications from Kathmandu (4 yrs ago) but had stopped once she ran out of it) As as she had problems walking, she couldn’t make it to Kunde to have her BP checked and medications started. Thankfully we had some antihypertensives, which we started her on. The following week, she returned for her BP check and it has come down nicely.
It felt like a full circle indeed!!!
But we managed to gather a few people and conduct the sessions, similar to the ones in Phortse. Below are a collection of pictures of the session as well as faces of Pangboche that I managed to capture along the way...
28/5/12
Pangboche Health Education
Once again, with the help of Shiva, we conducted our health education sessions. It was harder to gather a crowd in Pangboche as the women folk were busy on the fields as well as scattered between upper and lower Pangboche.
But we managed to gather a few people and conduct the sessions, similar to the ones in Phortse. Below are a collection of pictures of the session as well as faces of Pangboche that I managed to capture along the way...
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| Teaching the villagers |
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| The villagers got rather gigglish when Shiva discussed delivery positions |
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| I brought some medications along |
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| Sherpa man who didn't speak Nepalese. Even Shiva needed a sherpa translator |
8/6/12
Special People of Khumbu
It is hard to believe that only this time last week, I was at Gorkha village with Kumaran, Mr Krishnan and the amazing teachers and students of Saraswoti High School. We completed the 3rd and final task of our journey and returned back to Singapore on 2nd June. Finally getting some time to update on our journey.
There is so much to share, I don't know where to start. Perhaps explaining the events of the past few weeks in chronological order might be a good idea.
My last ramble was about the clinic I ran in Pangboche. This post will be dedicated to a special person I met on this trip.... and how she made me see that difference in language, ethnicity and culture do not stand as barriers to integrating into a community. A person's warmth and positive personality alone is sufficient for one to feel at home in an alien community.
Throughout the trip, I had been traveling alone (except for the journey to base camp). Though language can be an issue, I didn't have much problem as the people I always lived with spoke a little English. Except for in Pangboche.
Throughout the trip, I had been traveling alone (except for the journey to base camp). Though language can be an issue, I didn't have much problem as the people I always lived with spoke a little English. Except for in Pangboche.
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| View of Pangboche |
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| My residence |
This is a dedication to Jima. She is the owner of Gomba lodge in Pangboche. I was recommended to live there as it is close to the clinic.
When I met her, I realized that her helper Kanji and her can’t speak much English. However, she understood that I was a doctor at the health post.
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| Kanji on the right and Jima on the left |
During my 2 weeks stay there, I learnt that knowledge of a common language is not necessary to understand where someone has been and what they have been through. From the pictures in the lodge, I had the impression that her husband was well known in the community. His name was Namkha Sherpa and he was a Himalayan Rescue Association medical assistant for over 20 years. Hanging in the lodge were many certificates of appreciation as well as photos of many merry times.
Pictures paint a thousand words- her life with her husband appeared rich and colourful. I later found out that they used to be very prominent people in the community and everyone liked her husband and her. However her husband passed away a year ago and she runs the lodge alone. She has 3 children, 1 of whom is residing in America with her family. She then excitedly showed me a photo album of her daughter in America. However, she has not been to America before, for the reason that it is ‘Big money’ (in her words).
As there were no other lodgers during my stay there, every night, I ended up having dinner with them in their cosy, warm kitchen, where I got to try their food. (which was usually potato in all different forms) I would be reading on my laptop while she and Kanji would be cooking or looking at my photographs on the laptop. Whenever she saw my parents’ photograph, she would say, ’Awww!!! Good people’ which just makes me smile to myself. Though we couldn’t hold a full conversation, her warmth and chirpiness was contagious. Through pictures, we both learnt a lot about each other and shared a part of our lives.
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| My hangout- the kitchen |
Then one day she brings out this plastic bag filled with wires and a small laptop. She said someone gave it to her husband. She also said her husband was very smart and could speak both English and Japanese, while she can’t even speak English. I laughed and told her that her English is better than my Sherpa or Nepalese.
Anyway, that was the start of our after dinner documentary sessions. In the laptop, there was an array of pictures, documentaries, American dramas and cartoons.
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| Our after dinner movie sessions |
I made the mistake of showing them an episode of Family Guy (thinking that a cartoon might be entertaining) However it is the episode where Meg likes Brian, She kidnaps him and strips to her undergarments to seduce him. The horrified look on their face was alarming. I decided not to show them Family Guy again.
On the laptop, I also discovered BBC planet documentaries on various natural landscapes (jungle, mountain, ocean, snow, dessert) Kanji and Jima loved it! These sights and sounds were new to them. (I also got to learn the names of some animals in Nepalese too!) They would watch at least 2 documentaries a night!!
It was their entertainment every night after dinner. And each night, a different friend would be invited to watch the documentary. Eventually on my last night, Lama Penju (the local monk) was invited for dinner and a dose of BBC documentary. Jima was really excited about inviting the Lama for dinner and elaborate preparations were made beforehand.
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| Lama Panju of Pangboche |
I tried to teach her how to operate the laptop in my absence so that she is still able to watch the documentaries. However, it was a challenging task indeed- when not only it’s a 65-year-old lady’s first time using a laptop, she couldn’t read English either. I managed to teach her the basics.
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| Jima practicing on the laptop. I do hope my lessons have helped. |
Leaving her the next day was unexpectedly sad. Her warmth, simplicity, generosity, kindness and chirpiness was beyond what we spoke. She didn’t even count the cash when I gave it to her. She presented me with a Katar (white scarf given in respect and appreciation by the Sherpa people). I hugged her and we said our goodbyes. I know I would return to Khumbu one day in the late future… but am not sure if I’ll see her again. My heart felt heavy as I left Pangboche…..
18/11/12
Kumaran summitted Everest!!
Apologies for the abruptness of the blog.... since returning to Singapore and starting work, it has been hard finding time to put the photos together and pen down the rest of the journey. There has been so much to do since arriving home, it is easy to get lost in the sea responsibilities and this fast paced city life.
Perhaps it is about time, I complete the narration of our journey. It has been almost 6 months since our return from Nepal... so much has happened in Singapore and our journey seems so far away. However, events, reflections and strong emotions from the trip remain so embedded, it is unsettling not to pen these down.
My last blog entry ended in Pangboche.
After 2 weeks in Pangboche, I had returned with a heavy heart to Phortse. It was time to round things up in Phortse. The 3rd part of the journey was drawing close. The 3rd part of the journey involved travelling back to Kathmandu, where we will meet Mr Krishnan (Kumaran's ex secondary school teacher) and travelling together to the village of Gorkha.
As I returned to Phortse, Kumaran was about to start his summit push on Mount Everest. Once he had summited, the plan was for him to meet me in Phortse and then travel together to Kathmandu to meet Mr Krishnan.
Kumaran's Everest summit push
At this juncture, it is time to talk about Kumaran's Everest espedition. Kumaran was the only Singaporean climbing this season, with IMG (International Mountaineering Group). There are usually 2 climbing seasons for Everest- one starting in April and the other in October (which is colder and harder). There were about 30 grounps and 300 climbers stationed at Everest Base Camp, waiting to reach the summit of Mt Everest.
After having trained in many different countries on many mountains, these climbers arrive at Everest Base Camp. They spend about 6 weeks at Base camp preparing to reach the mighty summit of Mount Everest
There are 4 camps along the mountain before the summit itself. Initially some groups will bring their climbers to a smaller peak nearby to acclimitise (about 3-5 days). After a few days of rest they would start their 1st cycle to camp 1.
This is one of the more exciting parts as it will be the first time they get to cross the legendary Khumbu Ice falls, where the highest number of deaths on Everest occurs. The ice falls are basically stacks and stacks of ice with crevassses that needs to be crossed. Ladders are placed across the crevass for people to cross. There are sherpas who are called 'ice doctors' who have to check the ladders daily. This is because the ice fall is a dynamic place where the ice is constantly melting and forming; essentially resulting in the movement of the ladders.
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| Climbing the ice falls |
The 1st cycle (going too and fro) takes about a week, after which they rest. The next cycle is to camp 2. Besides base camp, camp 2 is the other site where tents can be set up and helicopters can land (very cautiously of course). This cycle too, takes about a week, after which they rest.
During their break at base camp, the climbers will receive training on using the oxygen tank and masks and wait patiently for a date where the weather will allow them to reach the summit of Mt Everest.
And no.. this is not an auspicious date. It is a date of clear skies and low winds. Essentially good and safe weather for the sherpa to put the ropes as well as for the climbers to climb.
While I was in the villages running the clinics, I would get firsthand updates of the Everest expedition. In Phortse, nearly all the men were away on the expedition. We would get news about any sherpa accidents or mishaps via word of mouth.
And before each cycle, I would get to talk to Kumaran and receive updates on the situation at Everest. Then it would be a week before I speak to him again.
The wait can be nerve wrecking indeed... not just for the climbers.. but for loved ones waiting for them back home...
Kumaran summited!!!
This year saw particularly bad weather. The weather was too warm and hence the snow was not formed well. The summit date was delayed terrible. Eventually, there were 2 windows for the summit push.
Right.. so after all the wait and delays, Kumaran finally summitted on the morning of 26th May 2012 at 0650hrs.
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| Kumaran Rasappan on the summit of Everest. Brands was the official sponsor of his climb. |
He set off at night from camp 4 to reach the summit. The trek up takes about 12 hrs. Throughout the night, I kept waking up thinking that he may have summitted at any point now. Funnily, I received news of his summit from Singapore as it was up on the internet almost immediately (via IMG blog). His sister, Kumutha, had seen it and rang me almost immediately.
Finally, after 4 years of planning, Kumaran reached the summit of Mt Everest. Words cannot describe how I felt at that point.. but the fear was still there as he had to return to base camp safely. Finally he did so safely.. and it was a huge sense of relief to hear his voice again.
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| A day we will never forget. His name on the IMG website. |
The next crazy part
While he took 3 days to climb up Everest, he had to rush to return to base camp in 2 days. We had to reach Lukla within 2 days in order to catch our flight to make it on time to the school in Gorkha. This meant that he had to walk to Phortse in 1 day. It was a long 9 hr walk uphill and downhill. Normally people would take 2 days to walk from Base camp to Phortse.
Throughout the day, sherpa's started trickling into the villlage of Phortse from Base camp. And eventually Kumaran arrived, drenched in sweat despite it being 4 degrees outside. His 1 day journey was crazy.. and his determination and resilience to return on time was even more impressive than him summiting Everest.
Now for the airport adventure
Indian S'porean climbs Everest
Right... so his craziness had led him to be the 1st Singaporean Indian and 1st Singaporean doctor to reach the summit of Everest. While we were in Khumbu, little did we expect how excited Singapore would be excited about this. I was just glad to see him safe with all body parts intact after weeks of waiting for him to reach the summit of Everest.
Now for the airport adventure
Indian S'porean climbs Everest
Right... so his craziness had led him to be the 1st Singaporean Indian and 1st Singaporean doctor to reach the summit of Everest. While we were in Khumbu, little did we expect how excited Singapore would be excited about this. I was just glad to see him safe with all body parts intact after weeks of waiting for him to reach the summit of Everest.
Our schedule was very tight from then on. While people usually take 2 days to return from summit to base camp, Kumaran had to do it in a day (together with the sherpas) and the following day he was at Phortse. Once he returned to Phortse on 27th May, we had one night of rest and planning. The next day we had to head off for our crazy walk to the airport (which is usually done in 2 days at least, but we had to do it in a day, on order to catch our flight on the morning of 29th May). For me, this walk would take about 11-12hrs, uphill and downhill!
The journey to the airport was an adventure that deserves an entry of its own. Firstly we had difficulties finding a porter, as most of the men were still out on expedition. Finally Lhakpa found us one and told us he couldn't speak much English. We had to detour to the Kunde hospital to drop off our extra medications, before heading to the airport. Oh... yes.. we have to walk to the airport! There are no taxi, buses or animals to bring us to the airport! Its all by foot!
Usually, despite the heavy load, porters are usually fast and tough. However, we reached Kunde hospital only to find that or porter was missing. We spent about 3-4 hours looking for him in Kunde and Namche. Eventually he was found soaking in the atmosphere at an open air concert in Namche. This 4 hour delay meant that we would not be able to reach Lukla (where the airport was). Hence we decided to walk to the village of Phakding and spend the night there. Following which, we would have to set off at 4am the next morning to reach the airport to catch our 8am flight. The walk to Phakding was exhausting. We were walking till 11pm (which is illegal btw as trekkers are not allowed to walk after sunset). During the walk, I thought back on how I would just flag a taxi to get to the airport in Singapore. The simple things in life that makes a great difference... and which we take for granted!
Hence on the morning of 29th May, we set off to the airport, only to find that our flights were cancelled because of the bad winds!! What luck!!!! But he had to reach Kathmandu as we were setting off to Gorkha the next day. Hence we had to get the helicopter out of Lukla to Kathmandu. What an adventure! Those 2 days felt like 2 weeks!!!
This is being written back home in Singapore as things evolved so fast once in Kathmandu, I had no time to update my blog.
Cerebros, being the main sponsor of Kumaran's climb wanted to sponsor an educational activity. Based on the number of 'likes' they got on facebook, they rasied a good sum of money, which enabled us to set up a computer lab in Saraswothi High School.
The school conducts computer classes but there were only 3 computers in their lab. Hence they were elated when we brought 20 computers over. We also bought them stationary packets as well as printed out photos for each of the classes.
Our arrival into the school was a grand occasion.... where lessons were stopped and the students stood in a line, with flowers in hand. Apparently, this was what had happened in 1999. We were ushered to the school assembly for the speeches and acceptance of our gifts. It was a rather overwhelming moment. But that just reminded me of how warm and hospitable the Nepalese are... and that one doesn't need very much to be content with life.
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| Starbucks at Lukla (actually an imitation) |
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| Boarding the helicopter from Lukla to KTM |
PART 2- Gorkha
This is being written back home in Singapore as things evolved so fast once in Kathmandu, I had no time to update my blog.
Cerebros, being the main sponsor of Kumaran's climb wanted to sponsor an educational activity. Based on the number of 'likes' they got on facebook, they rasied a good sum of money, which enabled us to set up a computer lab in Saraswothi High School.
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| Old friends- Mr Krishnan and the Ex-headmaster |
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| Kumaran, me and Mr Krishnan |
The school has done very well and has come very far since Kumaran and Mr Krishnan visited it in 1999.
The school conducts computer classes but there were only 3 computers in their lab. Hence they were elated when we brought 20 computers over. We also bought them stationary packets as well as printed out photos for each of the classes.
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| Children receiving stationery |
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| Shree Saraswoti School |
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| The new computer lab |
Our arrival into the school was a grand occasion.... where lessons were stopped and the students stood in a line, with flowers in hand. Apparently, this was what had happened in 1999. We were ushered to the school assembly for the speeches and acceptance of our gifts. It was a rather overwhelming moment. But that just reminded me of how warm and hospitable the Nepalese are... and that one doesn't need very much to be content with life.
