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The miniscule plane flew just high enough over the Himalayan passes to deliver us to Mustang. Were it not for the soul-swelling effect that the view had upon us, fear just might have at some point overcome our wonderment. A Top Gun-esque pitch into our landing path instilled both nausea and thrill as we passed over the homes with bright orange corn drying on the rooftops, to a place so different in feeling (and climate, flora, and fauna) from the Pokhara we had just left scarcely one half hour before. After 30+ hours of travel and 5 legs of flight we finally are delivered to our (almost) final destination.
Shadow of Death?
The beathtaking Himalayas. I guess if it's the last thing you have to see before you die, you could do worse.We arrived in Pokhara yesterday to a very moving reception by the members of the Pokhara Lion's Club (an embrace that was to be warm and extended, to hear the account of the Pokhara team.) 6 million welcomes, Namastes, handshakes, and 100 plus photos ensued. Gorgeous leis of plump pumpkin-hued marigolds, which evidently love the climate here, were bestowed upon every neck. We were feeling very welcome indeed. The country itself is beautiful, even if Kathmandu doesn't get to shine through its chipped paint of smogged and clusterous living. It's warm in this city and far more lush and tropical than I could have imagined. It's reminiscent of a calmer, cooler, and somewhat less horn-honking-happy Cambodia or Thailand.
L to R: Pokhara Paparazzi/welcoming tarmac ; Namaste ; The Lions Club Wel Come us
This environ took an almost bewildering turn when we landed in a scrubby and very mountainous land in the Kingdom of Mustang (“Land of Fascination”, as an airport ad dubbed it.) Mustang is just what you would think of when thinking of Nepal. It's also rather emblematic of life's dichotomies of grandeur and humility, when we came to know the people of the agrarian society cradled by these grandiose mountains. The sheer enormity of the peaks surrounding us, much larger than anything I had ever personally witnessed, was an instant reminder to the self of one's own smallness. It's no wonder that this is one of the cultural seats of Buddhism—it gives the impression that one is just upon the highest precipice of this particular realm of consciousness. The people themselves reflect this disposition—traditional and self-sustaining, they are of this earth in ways that many in places like the U.S. are no longer. And for that, their lives are hard-lived, with few creature comforts and with a great need for increased medical services. The people are reserved, but they warm much more quickly to us than we ourselves could physically upon entering bed at night in our unheated accommodations. They are beautiful and resilient, the brightness of their clothing against the monochromatic rockiness surrounding them emblematic of their inner fire and stolid natures, if I might run the risk of typecasting. And like anywhere in the world there is a palpable difference between city and country folk—from Kathmandu to Pokhara to here. The pace of life is slower in this region, so remote and not 2 hours walk south of Tibet, unlike the relentless hustling that must be done in the more competitive environment of Kathmandu. The joke about “Nepal Time” (normal time slowed down from 78 to 33 RPMs, to employ a metaphor) becomes a theme for our group while out here, and it's a real phenomenon. That, however, is not to detract from the fact that the people here work extremely hard all day to make a living, mostly through backbreaking and unforgiving work that makes me feel like a complete jerk to have ever complained about my office job back home.
L to R: Wel-Come to Mustang ; First view of Annapurna Range ; First arrivals of the the Mustang Crew ; The Land of Fascination! ; Jomsom Airport (best tarmac ever) ; 8,976 feet above mean sea level - we're so high!
Our digs are themselves simple and it suits our mission in many respects. Word has come that all of the delayed baggage and supplies would arrive later in the day after us (they did not) and we hoped/ prayed/etc that the clouds would lift to allow our weather-waylaid doctors to arrive for a busy day at the hospital tomorrow (they did.)
We visit the hospital and settle in, with Henna, Amy, Mary Ann, and others unpacking and organizing the bags that we do have for the day. The Mustang Hospital is a simple building, but with limited resources they seem to do many things besides surgery (for which they really do not have the equipment. They definitely do not have the anesthesia equipment, and neither did we for the majority of the trip—which became Bob's Lament. Further coverage on this point later.) The hospital's white structure, which I am told is the largest/best hospital in all of Mustang, is set in front of a sheer brown mountainside tagged with mysterious sanskrit. It winnows around in long hallways forming a simple bracket, and all the rooms are functional yet incredibly austere. We were given a general tour, and later Sr. Goma, the head nurse, gave me, Theresa and Bridget a more in-depth excursion of the areas where obstetrics and childbirth take place. (Note: all nurses are given the prefix title of 'Sister' in Nepal—the designation does not equal their nuptials to a Christian G-d, as in the U.S.!) Sr. Goma and the hospital, and thus by extension the Nepalese government, one imagines, is quite supportive of giving women family planning options as well as healthy prenatal care and safe childbirth. (Out in the country here, unlike probably even in Pokhara, most women are not trying to limit their family size too intensely; it is traditional to be prolific in procreation and it is still a simple aggregate of labor for the family unit in traditional farming communities, not unlike the way it was in the United States less than a century ago.) In addition to some intensely graphic anti-smoking PSA posters, the hospital is rife with visual encouragements towards women, inviting them to come to the hospital to deliver. Sr. Goma herself delivers over 100 babies per year at this hospital. I never get the story on the alternatives—if home births are more common due to distance or culture or etcetera. I do hear a story from somewhere that at times groups of pregnant country-dwelling ladies will travel to Kathmandu near to their due dates in order to have access to the hospitals there. I am not sure how true or common this is, though it makes sense. In any case, as an incentive the Mustang Hospital has a program that pays 1,500 rupees (about $18.50 USDs) to every woman who gives birth here. The hospital is government funded and care for Nepalese patients is free. There are about 20 or so on staff here; 7 or so are nurses. There are also assistants, pharmacy techs—they are the young men who dispense medications from the stock, which fit into a large armoire in a small room.
L to R: Mary Ann and Bridget in front of the Mustang Airport emergency area ; M.A. in front of the hospital ; the part of the Mustang Hospital ; Sr. Goma shows her assistant for the week, Teresa, around the office ; First pediatric patient ; PSA's ; Sr. Goma explains hospital family planning incentives ; Poster encouraging women to give birth at the hospital ; Sr. Goma explains the cash bonus given to women who come to the hospital for childbirth ; The supply cabinet for the maternity ward ; the maternity ward ; Pharmacy armoire for the hospital with prescription pads atop
On this first day here we sat with Karna, who works here. He also works in a small clinic in his tiny village of Thini in addition to this hospital; he will come here also in the case of an emergency. I am not certain of their procedure for emergencies, but the head doctor, nurses, and some of the pharm techs live in houses and dorms on the grounds (there are also brand new nurses' quarters here, recently built by the government.) The hospital also has a visiting doctor for 2 years, a young Nepalese man who will serve here as the government gave him a med school scholarship—he is essentially the Joel Fleischman of Northern Exposure of Mustang. Dr. Rupesh, from Kathmandu and working with WOF here and a relative of Subarna, told us that keeping doctors at the hospital is difficult, that once any local people go to med school and are in Kathmandu for long, they aren't very enticed to live and practice out in the remote regions. It's understandable. Sr. Goma is not herself from this area—she came here about 30 years ago and ended up staying, marrying a local, and raising 3 children who still live here today. She is an energetic, serious yet lighthearted woman, who has been manning this ward for ages but was enthused about working with Dr. Drinkwine and Theresa. There were differences in opinion between them on diagnoses, but she seemed receptive to the experience. This seemed especially true when she convinced the hospital administrator/head doctor to extend the clinic days for the OBGYN arm of the hospital with Dr. Margaret and Theresa beyond the allotted 3 days time, mandated by the government. Sr. Goma is very proud of the hospital and obviously puts much love into her labor.
L to R: Steve and the Happy Condom Man ; Karna in the Pharmacy ; Dr. Rupresh seeing a patient ; Two of the Pharmacy staffAs far as I could tell it was difficult/prohibitive for many in these areas of Mustang and outside to even travel as far as Pokhara for more involved care, both for the cost and the time away from field work, and that many ailments are 'lived with' for this reason. We experienced this first-hand when we had to take the bus from Jomsom to Pokhara when planes weren't flying at our time of departure from the region, and it became quite palpable why people don't and can't just up and travel by bus for 9 or more hours uncomfortably and, for them, expensively when they might need extra care. Though the clinics we ran were supremely busy and crowded, we did hear that there were also many that didn't come due to the demands of work. The harvest was winding down, and there were many people still to be seen in the fields, reaping the season's finales.
Dr. Rupesh sees as many patients as he can on that first day, though we know many more patients will be coming tomorrow when the other doctors are expected to arrive. We hadn't received most of our stock of medicines so most people were treated from a pool of about 5 kinds bought by the mission.
In the evening, Dr. Rupesh and Mary Ann went on an impromptu trek across the river to spread the word of available care this week at the hospital, and one of the pharmacy techs, Karna, did the same in his village of Thini (Note: when I ask him, he claims Thini to be about 20 minutes away by foot; when we later in the week take the trek to his village it takes us over an hour in the daylight. This is a commute he does to and from work—institutionally every day but Saturday, the one non-work or school day in Nepal. I know that there was no night he left the hospital before dark, and I again make a mental note to remember this the next time I have any self-absorbed/spoiled complaints about my own home-to-work commute.)
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