I was nearly asleep by the time we flew over Boston, and as I looked down I might as well have been looking heavenly as the twinkling lights below could have been mistaken for the Milky Way.
At this point, there were no more plans to be made, no more arrangements and no turning back, for we were now in motion. Every immunization had been taken, all emergency supplies and medication were packed, leaving behind the one thing that puts yourself at greatest risk if it should surface… ones ego. Like all other ventures of this nature I was resigned to merely doing my best and hoping my best was good enough. I then drifted into a restful sleep in reflection of the two sweet ladies who suffered to see me off at the airport.
My first stop-over in London was delayed and I failed to make connections with Hazel, who had worked with me in Africa, but I still made ample use of my time visiting the National Art Gallery, attending a concert at St. Martin’s of the Field, and cruising the Themes before departing that evening for New Delhi.
I was met in New Delhi by my articulate guide Tajudin Sheik, who wasted no time introducing me to the highlights of the city with its temples, forts, markets, and parliament. A flat tire on the way back to the airport gave me an opportunity to jump onto a roadside cricket game.
We landed in Katmandu at midday, and were swarmed by baggage handlers as we tried to make our way from the airport. The whole team arrived within an hour of each other with some coming from Bangkok, Singapore New Delhi and China. Pete Obregon’s flight from Beijing was cancelled, so he failed to meet up with us. Those of us who made h, then coursed our way toward our over night quarters down a narrow, winding labyrinth that left me geographically disoriented.
We were briefed on the project by our only contact in Katmandu, Dick Mathurn, a seventy-year physician who had spent twenty years working in Nepal. Without Pete Obregon, our project director, there was no one fully informed as to the details of the mountain village project. Dick, who was full of skepticism about our safety, filled us in on what little he knew. The mountain village project was at about 8500 feet in elevation, and a three-day trek (for a strong Nepali) to the nearest road. Two translators, Jit Bdr Rai Gyan Dip ( Gyanny for short) and Sahng Dip, along with two porters, had started trekking up with our supplies (food, medicine) to the village of Jharlang three days before we arrived. This portion of the Annapurna range was home to the Tamang mountain dwellers.
Dick was concerned that the monsoons had arrived early and that there might be landslides and a significant temperature difference at 8500 feet. A torrential rain storm that evening in Katmandu piqued our concern. Dick was likewise unsure about our reception in the village, the availability of shelter, and facilities in which to cook The village is isolated from all communication in that there is no electricity or phones, and lies three days walk from any communication link.
Our full team consisted of two physicians. Bilk a rugged emergency room doctor from California who had been on other MMI missions, Dawn a first time family doctor from NJ, three nurses; Jannny, Susan, and Annette, a dental assistant, Liz, and myself, the only dentist. Since the first team would be helicoptering up to Jharlang the following morning, we had to quickly decide which four members of the team would both provide the necessary medical service in addition to being fit enough to endure the hostile conditions and possible three day trek out of the mountains if bad weather prevented a pick-up. The need for a physician and a dentist was a priority so it was a given that Bill and I would make the trip. Janny, a Canadian nurse and Susan a nurse from Kentucky, were two hardy and delightful women who complimented the team.
We were allowed 5-10 Kilo or 20-25 lbs. per person but the necessary medical and dental supplies would likely test that limit. Dick was anxious to helicopter up to the village with us as a scout for the second team I suggested that the helicopter make it’s first attempt to relieve us on the sixth day, weather allowing, thereby giving us a two day window for relief When we weighed in at the airport we were overweight by about 60 kilos or 150 lbs. Since we felt the supplies were more critical than Dick’s observation journey to the mountain site he was scratched from the roster. He was understandably disappointed.. We lifted out of Katmandu in the early morning haze and carefully carved our way through the 80 miles of mountainous terrain. Finally, a white letter. It appeared etched into a cliff edge which was our touchdown site.
Below, hundreds of colorfully dressed Nepali scurried across the farms and hillsides to witness the arrival of the wonderbird. We were greeted with the phrase “Namaste” uttered by our Tamang hosts in this village of Jharlang as they placed garlands around our necks, bowing gracefully with folded hands. We wove our way along narrow, manicured trails past pristine, yet rustic, farmhouses. The tiered farm? used every inch of soil for crops.
Our clinic facility consisted of two dirt floor huts with sturdy walls and majestic views of the veiled peaks of the Annapurna range. Within an hour of our arrival, the clinic was in operation. With no roads or transportation, people who came had begun their treks on foot from valleys and other mountain villages as far as five hours away.
If the volume of patients by itself were not overwhelming, the fascination with our eclectic and very likely bizarre features made the gawking and inquisitive stares a claustrophobic experience that drained us physically and emotionally.
We found it necessary to force each other to pause from the pressing demands of patient care to acknowledge that, in fact, we were in the snow temple – the Himalayas. And, as others who have found some reason for great inflection in this granite forest, whether on an expedition to the summit of Everest or merely a glimpse of Shangri-La, we too had our moments of fantasy and reverie. Informed that I was the first dentist to ever visit this range, I allowed myself a fleeting kinship with Livingston and Neil Armstrong.
As Bill was inundated with volume, my endurance was tested by trying to do surgery while surrounded by peering eyes – so close that the radiant body heat became oppressive. For both Bill and myself; our sanity and strength was sustained only by our teammates Susan and Janny. These women of quiet strength, good humor, and a gift for caring were themselves an inspiration for Bill and I.
Rice and curry with potatoes were the staple as we ate two meals a day. Lunch at ten AM. and dinner at six in the evening. A walk to the spring for bathing at 7:00 p.m. preceded a quiet candlelight reflection of our day, our health, our water, our project, and our thanksgiving for the opportunity to serve this people. By 8:30, our eyelids succumbed to the weight of the day’s work, only to re-open and begin the adventure anew at 4:30 a.m. the following morning.
As we would sit on the hilltop looking across the valley, Nepali farmers worked quietly with a pace that betrayed any hint of urgency. Unable to read or write, the fields and their daily tribulation were the only classroom As romantic as this pastoral image suggests, the existence is shrouded by the sobering observation of our interpreter, “Here the solution for sickness is death.” Their faith in our ability to diminish their pain or suffering was demonstrated by a man who carried his terminally ill wife for five hours to reach our camp when, in fact, we could offer little more than comfort and a few days of pain medication.
Tomorrow will be a welcomed relief in that we will work a half day, after which, our translators and porters will guide us over the mountain trails to savor the lost horizon. Our energies will certainly be sapped by then given the volume of work we have encountered so far. I have learned never to underestimate the challenge of oral surgery and extraction procedures especially operating in the absence of light, water, and power instruments. Every case becomes a potential land-mine turning what you hoped would be an efficient procedure into a quagmire of broken root this necessitating mat bone be removed by hand instruments. Beyond that lurks fatigue and self-doubt, the second of which is paralyzing if you entertain the thought during a crisis.
Thankfully the R&R we planned has arrived and so, as we planned, we trekked up another 2000 ft. to the ridge with a majestic view of the Annapurna Range. Gyanny and Sang joined us on what turned out to be an almost constant vertical climb through another small village and on to the ridge. As we passed through the highest village of 5 or 6 farmhouses, there was chatter about an occasional tiger or bear in the area. No lions? Oh my! The pace was brisk and we used up all of our water, but gratefully found a mountain spring and treated the water with iodine before quenching our thirst.
Bill and Janny have begun to show symptoms of what everybody else on the mountainside has, respiratory distress, running noses, coughing, and flu symptoms. With an extremely high incidence of TB here, these symptoms certainly became a concern. Bill had just treated a man lying on the ground outside the clinic who was in the final stages of TB. After a period of rest the patient was hoisted onto the back of his son and ported around the mountain trails back to his village. When we marveled at that, our translator, Gyanny, remarked that walking with heavy loads over rugged hilly terrain is our life.
Gyanny confessed, however, that to hike up here in the three days allotted, he found himself in tears keeping a torrid pace over mountain crests, back down to the valleys and repeating the tortuous ascent and decent over the full course of his journey. He modestly claimed to only be able to carry 100 kilo now, which left me dumbfounded when I made the conversion to pounds.
These certainly were a honed people, chiseled and worn by the rigors of a Spartan existence. When I asked how people deal with dental pain, he said if a tooth abscessed enough to be mobile, they would try to pull it out with a string. Otherwise, they lie on the floor of their huts and cry for two weeks. Third molars caused them the most problems since they were difficult to clean and couched so inaccessibly in the deepest recesses of the mouth. Although we try to avoid getting involved in the type of surgical complications one encounters in third molar removal, the fact that none that I treated were impacted made me a bit bolder and good hick remained on my side throughout the projects.
On our final clinical day, we had mixed emotions about our impact on this commune of mountain dwellers hidden from the world. I sat and contemplated this simple life that has all the romance that novelists have touched upon, yet these people could neither read nor write, there were no schools, there were almost no games played by children, and social gatherings were infrequent. As neat and orderly as were their homes and colorful their dress, poor sanitation and hygiene habits have resulted in worms, T.B., scabies, and all the disease and misery associated with poor hygiene.
From a treatment perspective, dental extractions offer the unique benefit of intercepting or draining an infected area while providing pain relief that is fairly immediate and lasting. Bill however, was frustrated by the limitations of the medical care he could provide, acknowledging that although treatment would resolve or diminish today’s symptoms only to recur again in the months following our departure. Bill underestimated, however, the significance of the comfort his patients derived from a caring heart, which Bill had in abundance.
From my cliff-edge perch, I spent my last few hours of sunlight gazing down upon the hillside below watching the bustle of mountain people coursing the various tracks; some in lines of five or six, shouldering food supplies, others packing wood, straw, water, grain. Livestock was being herded down lesser trails away from the crops. All the merchandise of their life was flowing on these superhighways on the shoulders and grit of a people who had learned to endure in this harsh mountain terrain.
Our endurance test in the mountains, at least, was coming to a close as we prepared to break camp the following morning and shared our last bowl of dolbot rice and lentils by an open fire.
At 4:30, sunrise, the snow-capped tip of Ganish Himal was aglow, but we would have to wait nearly an hour for the sunlight to catch us on our western slope. The campsite was unusually deserted this morning with the curious eyes of the villagers being conspicuously absent. They must have known, as we did, that our phase of the project was closing.
By the time, however, we began backpacking our equipment and supplies down to the helicopter pick-up zone, hundreds of villagers streamed from their huts to follow us as we snaked our way down the winding trails. Dozens of others stood in long rows on the terraced cliffs waiting for a reenactment of the previous week’s helicopter phenomenon.
We stood waiting for about an hour with equal anticipation for the relief team’s arrival. To diminish the anxiety, we all picked a time of first sighting, which Susan won with a guess of 8:41a.m We could actually hear the muffled, churning of the helicopter engine in the distance before it came into view, gently banking around the distant mountainside. Easing carefully over mis, the site of one of the largest landslide disasters in Asia, the pilot selected an alternative to our original landing spot, which he considered to be unstable. The hordes streamed down from our perch, trampling everything in sight to get closer to this amazing flying machine and to greet the new team with colorful garland necklaces, folded hands and the welcome… “Namaste”. We then briefed the new team, which was brirmming with controlled excitement.
As our helicopter lifted off, our team’s response was nothing more than a hushed sigh – yet a sigh we didn’t bother to characterize because of the complexity of its meaning.
Back in Katmandu, we were operating out of Dick’s clinic by noon. The following morning, I took the one hour Everest flight at 7:00 a.m., and was back at the clinic working by 9:00 – made it to 11:00 Mass at the Jesuit house, finished my afternoon patients, and went to relax at the zoo; the most tranquil spot in Katmandu. Marvelous visits to temples, marketplaces, and the cremation site of Pasu Parti filled in the spare moments.
I was invited to attend, and address a class at St. Xavier Jesuit School, where I was inspired to see such capable, industrious young scholars taking their education so seriously. I spoke to the class about my mountain experience and advised them of the responsibility that was theirs through this gift of education.
The sad reality of the harsh world faced by the missionaries who stand toe to toe with vice and injustice, became apparent with the telling of the recent grizzly decapitation of one of the priests who had been an activist against the Nepal drug cartel.
After three attempts, I managed to track down Mother Theresa’s home for the disabled and her orphanage. I volunteered at the home for the disabled where I, very ineptly, was to shave heads for lice control. My shaving mentor was a young orthopedic surgeon who was taken in from the streets of Calcutta, as an orphan himself, by Mother Theresa who eventually nurtured him on to medical school He returns to the hospice to volunteer for two months each year in whatever capacity he is needed.
I pushed myself too far on this last day and contracted a paralyzing headache. My flight to India was due to leave the following morning but Bill was concerned that I might have contracted meningitis given the lack of relief I was getting from of doses of codeine I had already taken.
By morning, I was feeling better and assured Bill that I’d seek immediate medical attention if symptoms persisted through the day. Tajudin Sheik was waiting for me in New Delhi, and we quickly sped away for the 5-6 hour drive to Jaipur. I slept for three hours in the back seat waiting for these multiple doses of codeine to flush through my system.
My day was filled with elephant rides up to fortress walls, tours of palaces, museums, observatories, and a visit to the tragic fortress where Akbar the III was held prisoner by his son in his own palace. From his balcony Akbar could only cast his gaze out across the sun baked lakebed to the marvelous burial shrine of his most beloved wife, entombed within the Taj Mahal. Standing here in the tower, the site of his mournful longing, the 120-degree temperature shrouded me in ghastly heat with every breath of wind.
Somewhat weary by this second five-hour drive and the humbling heat, the respite of my hotel was welcomed with the vision a long shower to work its therapeutic magic. As in South Africa, as well as here, however, it is to be remembered that “water is life.” So the soothing shower became short and utilitarian.
I can not recall having been on a journey, filled with so much majesty, mystery, and romance. Yet, as I wind down to these final hours I am looking forward to getting home.. .to my family. With all the splendor of the Himalayas, the simplicity and quietness of people in their lost horizon, the charm of the Nepal and Indian markets as they lay juxtaposed against opulent temples, forts, and mysterious wonders – if I had to select one place as my choice of Shangri-La… I suppose it would be… as it should be… my own home.