I had a sorrow I could not shake. It tailed me, waited for me around corners and whispered from the shadows. Sometimes it seemed to jump into my path. Because of it, I resolved to go for a walk. A long one. Although hardly young, I elected to go to the back side of the Himalaya, near the edge of the Tibetan plateau. I would go walking with doctors, nurses, and Buddhist clerics to deliver health care in a land where trained clinicians rarely go. I hoped to absorb the medicos’ approach to caring for people even when the care could not cure, even when routine ailments, for want of laboratories, scanners, and operating rooms, resisted their powers. Perhaps their dilemma might teach me about my own. The planetary disasters now in constant view—extinction, climate change, and the ills arising from them—also resist cure, yet they demand much care. My delight in the beauty of the world now coexists with grief at its destruction. These emotions are like cellmates who cannot get along. They dwell in my head and my heart, and their argument creates a moral ache that sometimes sours the taste of life.
And so in September 2016 I packed my clothes, hat to boots. And also my gear: collapsible bucket (for washing clothes), pens that write upside down (for making notes while in a sleeping bag), headlamp, batteries, tent cord, and so forth. We would be a community in motion, employing scores of mules and horses, guides, camp tenders, and muleteers to transport our gear and ourselves along the precipitous trails of a land identified with Nepal only in modern times and for previous ages part of a shifting assemblage of theocracies and kingdoms.
We were headed for Upper Dolpo, which is “upper” by reason of both remoteness and altitude, most of it rising 12,000 feet or more above sea level, with many summits higher than 20,000 feet and crucial passes, which we must cross, touching 17,000. A quart of air at such a height contains roughly half the oxygen it has at sea level.
Dolpo lies in northwest Nepal, bordered on the northeast by the Tibetan Autonomous Region, a subdivision of China. (China began its forceful “liberation” of a more truly autonomous Tibet in 1950; the Dalai Lama fled to India in 1959.) The Himalaya’s tallest mountains shield Dolpo from the monsoons of the Indian subcontinent, rendering it a high, cold desert, where success in the brief growing season requires irrigation from mountain streams.
Dolpo’s communities are delicately poised between sufficiency and want, between satisfied stomachs and empty ones. The Dolpo-pa, its people, are few, widely scattered, and (in Upper Dolpo) ethnically Tibetan. It is easy to think of them as shut off from the rest of humankind and suspended in time, but they too have felt the winds of geopolitical turmoil, and they too hear the siren song of the market-driven world that surrounds them. They also feel the slow tumult of climate change: melting glaciers, floods, droughts, and ill-timed rains. Where better, I thought, to witness the beauty of the world and also its decline? If proof were needed of the predicament of the Dolpo-pa, the 2021 calving of the Nanda Devi glacier, 200 miles to the west in Himalayan India, should provide it. The ice collapse burst a dam, with more than 200 persons killed or missing.
At the beginning of our journey, I had no idea how much the Dolpo-pa had to teach a questing Westerner like me. Still less did I suspect that part of their lesson might be delivered through the strangest of means and the oddest practice of our clinic: the washing of feet.
Village of Tokyu, September 28, 2016
Days ago, the leader of our expedition, Roshi Joan Halifax, told me, “My secret plan is to help these Western doctors change their focus from cure to care.” The plan may be working.
Michael Lobatz, who recently stepped down from heading the prosperous clinic he founded decades ago in San Diego, has a practice many other doctors would envy. He does things his way, with great success, seeing only the patients whose cases interest him. Not least, he charges plenty, and “they pay in cash.” But our first Dolpo clinic rocked him: “The poverty hit me like a fist. I’ve never seen anything like it.” That kind of jolt will soften a person, and I sense it is having an effect on Michael, as well as others, including me.
Now Michael and the rest of us are preparing to meet a second surge of ailing and aching people. The prospective patients of today’s clinic began to gather after sunrise in front of the gompa, a centuries-old temple, built like a fortress, that broods above the riverside fields.
Here in Tokyu, two noisy creeks converge to water the long Dho Tarap valley. An app on my phone gives our altitude as 13,829 feet. Tokyu is the highest village in Dolpo and one of the highest permanent human settlements in the world. Unfortunately for village farmers, we have come at an inconvenient time. The barley harvest has reached its culmination. Two weeks ago, maybe more, every available man, woman, and child strode into Tokyu’s waves of grain armed with sickles to cut the stalks. Stooped over, they crept through the fields hacking the stems a fistful at a time. This was backbreaking labor, as is the local digging of potatoes, which is accomplished with a short-handled hoe. The scythe and the long-handled hoe, if they are known, must be unavailable or unsatisfactory.
After cutting, the harvesters gathered the barley into sheaves, binding each sheaf with a stem of barley tied in a soft knot. They bunched and stacked the sheaves a dozen at a time and set them on end, grain downward, leaning against each other to dry. The brushy pyramids now fill the fields, a yard or two apart, hundreds of them, no, thousands, repeated in every rock-walled plot on both sides of the river. From a distance, they appear to enlace the valley in a web of dotted lines.
At first light, the rock walls and the stacks of barley sheaves cast long shadows, the barley tan and the rock walls rusty red where the early light slants into them. Narrow lanes follow the roll of the land, snaking between the walls. At the end of each lane squats a low dark house, with a curl of smoke rising from its roof.
Suddenly, I see mounds of barley moving. Two great bundles, nearly as big as hayricks, inch up a lane by the river. They seem self-propelled until, with binoculars, I make out a pair of legs at the bottom of each. The bodies belonging to the legs disappear within the bushy loads. Now I see that a man is in front, hands at his shoulders gripping a strap that holds a sagging mass of barley sheaves, and behind him comes a woman equally burdened. I follow their progress to a large walled pen behind a mud-plastered house.
“Tashi delek,” I say when I reach the wall of the pen. They have deposited their loads and released the carry straps so that the sheaves spill down. “Tashi delek,” they answer, a little out of breath.
Tashi delek—a common greeting of blessing and good wishes—is as much Tibetan as I can say, after which, with no other words in common, we exchange slightly embarrassed smiles. They rest no more than a minute, then draw a blue tarp over the mound of sheaves, coil their straps, and set out again for the fields.
Our clinic is inconvenient because we have appeared at a time when several hours taken from the field to see a doctor, let alone the better part of a day if one travels from a distance, entails risk as well as lost time. The anxious weeks of drying have gone well, but now clouds have begun to gather, and it is imperative to get the barley out of the fields and under cover. Not all the farmers are so poor that they haul their harvest on their backs. Some load the grain on horses, some on yaks, and as the sun continues its climb, the fields and lanes quicken with the movement of people and animals.
Soon all of Tokyu is aquiver. Cumulative tons of grain trundle down the lanes, drawn by people and beasts, and no growl of engines fractures the day. Barley is the staff of high-altitude life. Its roasted flour, called tsampa, constitutes the entirety of many, if not most, Dolpo meals, prepared as a gruel and flavored with a pinch of salt and a dollop of yak butter or mustard oil. The villagers downstream in Dho, in the neighboring village of Tarap, and in all the hamlets of the valley labor with the equal urgency to collect their barley and reap the final benefit of the farming year. Even so, more than 200 of their neighbors have made their way to see the medicos at the clinic of the “round-eyes,” as Roshi jokingly calls us.
They queue at the triage table where Prem Dorchi Lama, who directs our day-to-day operations, aided by Julie, a nurse from California, writes a number on the patient’s hand with black marker and assigns him or (more often) her to an examination tent—women’s health and pediatrics, general medicine, acupuncture and bodywork—or to Amchi Lhundup, a traditional Himalayan healer, or Dr. Sonam, a Nepali M.D., who work at small tables in a recess of the dim gompa, or to the cardiology and neurology specialists, Ranjit and Michael, who started in the gompa but moved outside in search of warmth and light.
Acupuncture patients, scores of them, go first to the foot-washing station, a scene of awkward hilarity. The commonest complaint heard in the clinic entails pain in the hip or knee, ailments honestly earned in a lifetime of carrying heavy loads up and down steep slopes. For treatment, shoes and socks must come off, and on warm days in previous clinics, the smell of unwashed feet corrupted the air of the acupuncture tent and made working there intolerable. On cold days, with the tent flaps closed, it was worse. Moreover, the sites of needle insertion need to be clean. These factors mandate the preparatory washing of feet and produce a tableau especially pleasing to Roshi, with its biblical overtones and cultural comedy. Men from our group perform the service, and the patients of the clinic, mostly women, receive it. The sight is arresting: rich Western men (rich by definition, having traveled halfway around the world) kneel at the feet of Tibetan peasant women. The resulting surprise, embarrassment, and incidental tickling make the foot-washing station a node of laughter and bonhomie within the diligent urgency of the clinic.
Runners shuttle patients to and from their proper destinations. They also hurry in and out of the gompa fetching prescriptions from Rigdzin, whose pharmacy occupies a particularly frigid alcove just inside the entry. In the first hours of the clinic, I was such a runner, but as the day wore on, Jigme, Pau, and other senior guides joined the ranks of the runners and left me free to enjoy the spectacle.
A hundred people huddle by the triage table before the gompa doors, the line spilling to a terrace below. Old women squat in groups of four and five, no space between them. Compared with our previous clinic in Ringmo, a portal to Upper Dolpo, the faces of the crowd show less of the Aryan heritage of lowland Nepal and more of the features of Tibet and its Mongol roots. The garb is different too. Nearly all the women wear the chuba, a wraparound dress of purple-brown broadcloth, covered by the usual figure-concealing apron. The men, in similar garments, have rolled down the tops and tied them at the waist, sometimes going naked above, and the children are in jumpers and quilted pants. A smoky odor rises from the crowd, which has pressed past the triage station and into the little courtyard beside the gompa. The shouts of children and the snap of prayer flags in the wind punctuate the murmurs of the throng.
Two policemen in stiff camo uniforms have climbed a wall to survey the goings-on, swagger sticks under their arms, disdain in their eyes. Lowland Nepalis, they give the impression of having frowned continuously since birth. A mob of choughs swirls overhead. They are little crows as black as tar. From long experience, they watch the crowd expectantly. Activity at the gompa usually signifies a religious ceremony, with offerings of yak butter and tsampa set out where the birds can eventually pillage them. They swoop low, cruising the throng, but detect no feast. Gradually they lose interest and coast away.
A drunk wanders in. He is aged, disheveled, and perhaps doddering as well as soused, and one of the grim policemen drives him off. When the old man staggers back, the cops look away, the better to preserve their dignity, and Jigme briefly leaves his post by the triage table to escort him beyond the courtyard. But soon the old man returns, tottering dangerously past tent stays and random plastic chairs. A girl of perhaps six, no more than a yard in height, takes charge. She barks at him sharply and turns him around, pushing on his hips. Scolding nonstop, she harries him off. This time he does not return.
At our morning circle, Roshi had said to the clinicians, “Use this as a generative moment in your practice of medicine.” She acknowledged that not much would be normal, especially for the Westerners. Diagnosis always involves uncertainty, but here the ambiguities of translation compound it, and culture compounds the ambiguity even more. If, say, “dizzy” is indeed a correct translation of what the patient said, what does “dizzy” connote in Dolpo—is it a specific loss of balance or a general feeling of malaise? Or is it something altogether different? And what if “dizzy” should have been translated as “nauseated” in the first place? Time can be puzzling, too. When your patients—virtually all of them—say that the onset of their ailments was “years ago,” does that truly mean years, or might it be months? Can everything be of such long duration?
You grope for answers. The tools at your disposal include a stethoscope and three blood-pressure cuffs shared among the practitioners, only one of which seems to be reliable. You cannot order an X-ray, a scan, or bloodwork. You interview the patient, aided by an interpreter. You perform the physical exam, resorting to touch, feeling the pulse, absorbing the look of the eyes and ears, the throat and skin; you palpate the abdomen and percuss the chest. This is part of what you came for, a return to medical basics.
As the means of diagnosis are limited, so are the treatments. There are no return visits, no follow-up. Your pharmacy has limited supplies, although at our meeting this morning Charlie McDonald, our medical director, urged that no one think in terms of shortage: “Treat what you need to treat. Don’t hold back.” And Dr. Sonam cautioned that in Chinese and Tibetan medicine the patient expects to take a handful of pills all at once, a practice that may suit the use of herbal compounds but becomes dangerous with Western meds. Think of an entire course of antibiotics concentrated into one big gulp. The result could be horrific. So, he said, short courses are best, but don’t forget to emphasize finishing the course even when the patient feels better.
With pain meds, Charlie suggested, tell your patients, take one or two pills on a bad day and save the others for the next bad day. Be really clear about dosage. And when in doubt, trust your instincts. Also, take a break when you need one. Roshi Halifax closed with her medical mantra: “care over cure,” which implicitly admits that not much is going to get fixed, that you do what you can while you can, and you do it through making a connection: “warm hand to warm hand.” She closed with another, oft-repeated admonition: “strong back, soft front.” The phrase encapsulates the ethic of the expedition, and not just of its medical practice: everyone is on call, at all times, to deal with whatever develops. You try to keep yourself ready to handle the hard stuff, but not by shutting it out. You let it in, along with the people entangled in it. You face up to things with calm compassion, and you act. The meaning of the phrase sharpens when you think of its opposite: “strong front, soft back,” which describes going through the world armored against criticism and connection, chronically scrambling to conceal vulnerabilities, putting on a show to shield the lack of substance behind one’s bluster. We’ve seen leaders like that, adept at hoodwinking the gullible, but while such falsity may succeed in the domain of social media and retail politics, it is useless on the loneliest side of the Himalaya, amid the rockscapes of Dolpo.
Tonio Verzone and Pete Hamill wash the feet of clinic patients in Ringmo, Dolpo District, Nepal, September 2016. (William deBuys)
Village of Tinje, October 3, 2016
The key to foot washing is to be personal, but not too personal. You are present, also detached. The encrusted toe before you is not your toe; it is hardly like your toe. So you go easy on the projections. Still, it is a human toe, connected to a human person, and it deserves a gentle touch, almost a caress, no matter if it belongs to a wizened man who smells of whiskey or a crone with one crooked tooth.
I am working next to Pete Hamill, a burly lawyer from Hawaii and former college running back. Pete has been washing feet since our first clinic in Ringmo. He is efficient but unhurried, beginning with a quick rinse of warm water, if we have it, but more often cold because we don’t. Then he scrubs the foot with a soft yellow sponge that quickly turns gray. One hand holds the foot in an enveloping grip, while the other whisks along with the sponge. The woman who belongs to the foot looks away, at no one, but her foot is relaxed. She lets him have it. He puts it down on a clean white cobble and tenderly picks up the other. He rinses and scrubs. Next comes a light application of soap, one of the expedition’s most precious commodities. Rigdzin is certain that a bag of soap was packed in one of the clinic duffels, but no amount of searching has turned it up. Perhaps it was sent to the hospital in Dunai along with an errant stash of antibiotics. Mercifully, someone—I think it was Donna—has contributed a mini bar of hotel soap from her personal kit. We use it sparingly, for it may have to last through hundreds of feet. Pete and I wear latex gloves, which are almost as scarce and prized as soap, and we guard against tearing them on a toenail, a likely enough outcome given that few, if any, of the toenails of Tinje have been trimmed, possibly ever. Some have bladelike edges and ice-pick points. So we are careful. Especially when lubricated by a few suds, the latex gloves glide easily over the feet of our clients, producing giggles in some and stupefaction in others.
We kneel among the cobbles of a sandbar where the clinic tents are pitched, with our clients seated on stools before us. Others waiting their turn watch us closely. Because the wind blows hard, we weight down everything with cobbles—the basin holding clean sponges, the rags for drying feet, and the cushions we kneel on, from which we rise periodically to stretch our backs.
Tinje is made of cobbles. The village lies at the confluence of rivers, one of which gathers its headwaters at the Chinese border. The land in every direction is glacier cut, and in ages past, enormous quantities of rock washed down from the heights, smoothing to cobbles in their violent descent. Over centuries the people of Tinje have gathered the bright stones and piled them in serpentine walls to enclose hundreds of small terraces, no two shaped alike and each scalloped into the next. The terraces ladder up the slope from riverside to village. Some of their walls stand above the earth, while others, half buried, only hold back the ground from spilling downward.
The terraces are gardens for barley, potatoes, and buckwheat. Few are large enough to be called fields. Building the walls that separate them was an act of removal more than enclosure. The point was to get the cobbles to the side so that a semblance of soil might be retained and plowed. The walls hold no animals in or out. Yesterday at dusk we watched a thousand village sheep and goats swarm up the terraces and over the walls on their way to nighttime quarters. Even the village yaks, which number in the hundreds, clambered freely through the labyrinth.
Pete and I are acquainted with the dung-seasoned soil of Tinje. It coats every foot like an earthen sock. Wetted, it becomes a pigment you might paint with. With every touch my gloves blacken. I try to hide this fact from my client, keeping my hands low and out of sight as I reach into a second basin for a rinse. I am not sure why I do this. Perhaps I fear that the filth on my gloves will embarrass the owner of the feet I am washing. Or perhaps it is only I who am embarrassed by the notion that there is anything wrong with chronic grime. Feet are feet, and dirt is dirt. And the dirt, including the pungent cultures breeding within it, must be removed.
I wash the feet of a man whose weathered face glows like polished mahogany but whose feet, relieved of their coating, are as pallid as mine. I wash the feet of an old woman who says the bulbous swelling on her ankle is not tender but who winces when I touch it. Clients come and go. I grow certain that none have had their feet handled, let alone gently, by another person since infancy. I observe and remove what I take to be sloughed skin along with the grime. The breeze is ever restless, yet the odor here is overripe and air-deprived. As the day wears on, a scent of decay attaches to both Pete and me. In contrast to the mountain wind, which speaks of vast, eternal solitudes, this work imparts a stifling reminder of mortality.
The place where we wash feet is a kind of theater. Friends watch friends get their feet washed, and then the friends take their turn. Oddly, the women stick out their tongues when I take their bare feet in my hands. The author of the pocket language guide I carry (which, at least for me, is less than useless) writes that the tongue-sticking-out gesture is meant to say, “See? I have nothing in my mouth. I speak the truth!” But I have asked around, and no one corroborates this notion. The sticking out of tongues seems instead to express embarrassment mixed with delight: “See how crazy these round-eyes are? And it tickles!”
This is our second day of foot washing at Tinje, and I have lost track of the rest of the clinic. I hear scraps of reports: a pebble has been removed from the ear of a boy; 50 ccs of fluid were drained from a thyroid abscess; a thumb got splinted; a walking cane was “prescribed” for a man with cerebral palsy. We are running low on ibuprofen because everyone aches. We are in a world of pain, and at least half the patients receive acupuncture before seeing other clinicians. Which means they come first to Pete and me.
In much of Asia, feet are considered impure. They live on the ground, in the dust of the field, in the shit of the sheep pen, in spring mud and city filth. Perhaps you have been sitting a long time on someone’s floor and want to stretch your legs, or you have an aching knee and want to put your foot up, but you must hold back. It is considered exceedingly impolite to expose the soles of your shoes or the bottoms of your bare feet toward another person. Yet here in farthest Dolpo we touch the feet of people who rarely or never wash them. As they live in one of Earth’s coldest human habitats, they do not squander the warmth of their bodies by rinsing in ice-melt streams. Still less do they burn precious fuel to heat water for inessential bathing. They work ankle-deep in dust and mud, and because nowadays the traditional, handmade Tibetan boot is saved for ceremonial occasions, their footwear consists of low-cut Chinese sneakers. How crazy we Westerners are to care about feet. How crazy this convergence between the feet of Tinje and the kneeling, white washermen!
A sustained gust sends the tents straining against their stays, walls shuddering. Loose things clatter downwind. A commotion erupts some distance behind me. People run and shout. Something important must have blown into the river. Pete and I stay at our tasks. As the hubbub continues, I feel the foot in my hands change. I cannot explain it, but I sense that the person who belongs to the foot is staring at me. I look up. She is a woman of middle age, handsome and collected in her gaze. Her eyes peer into mine warmly and thoughtfully, with no trace of shyness. It is as though I am a puzzle she might decipher. Her regard holds me. Either of us could disarm the moment with a grin and a laugh, but she doesn’t, and so neither do I. I hold her soapy foot in both my hands and admire her broad, flat cheekbones, her straight black hair, and the nose ring in her septum. For long seconds she allows me into the centers of her dark eyes, where I encounter a steady, unblinking calm. I am not used to such undefended intimacy, but in this moment it feels right. We wonder at each other. Her foot is relaxed and warm. She does not flinch. The moment lengthens into two long beats, into three. The thought seems to come from her foot into my hands that in a different world we might have known each other, might have shared a laugh, a grief, an understanding. A closeness. Then a woman returning from the excitement by the river calls to her in the tone of a joke. The woman whose foot I am holding quips a reply and, looking again at me, sticks out a pink tongue. Hah! How crazy! Her grin is broad, her eyes alight. And she lets me see the light.
That night in my tent, I replay the moment in my mind. I see the woman, calm and strong. I feel her inquiry. And her warmth. I marvel at the gulf of difference between us and at the fleeting instant that seemed to bridge it. I see the woman even now, as I write this.
Weeks later we learn that word of the foot washing reached Dolpo Tulku Rinpoche, the highest lama of the region, who, although absent, is a guiding spirit of our expedition. The title tulku indicates that he, like the Dalai Lama, is considered the reincarnation of previous lamas of his line. People throughout the district revere him. Eventually Dolpo Rinpoche confided to Roshi that our strange practice of foot washing had an impact on the people who came to our clinics. It convinced them that we were unlike other Westerners. He said it showed that we were trustworthy. Like his compatriots, he considered the foot washing an exceedingly curious thing for us to have done, but also like them, he approved.
When it is time to harvest barley, the staff of high-altitude life, the entire village participates, gathering it into sheaves. (Hemis/Alamy)
Village of Saldang, October 7, 2016
Let us now praise feet and all their parts—the curve of the arch, the stoic heel, the pliant toes. To bear witness to feet is to appreciate the sublimity of evolution, for the foot is the result as well as the agent of our election to stand and walk. And to walk and walk. The footprint, laid down in savanna dust, was our first signature on the surface of Earth, and in time we pressed it into Arctic snow and tropic mud, on mountain, forest, desert, and steppe, from ocean to ocean, and even on the moon.
The feet of Saldang now march to our clinic. We have set up within the grounds of the village school, where tuition is 50 kilos (110 pounds) of dry dung for the year. The school is the work of Western humanitarians, and the good they have done is real. Because of a similar school in Dho, our fellow clinician Tsering Wangmo studies nursing in Kathmandu instead of herding goats on barren hills.
Again we rinse, soap, and scrub. Again we encounter the gnarled toenails, the pungent grime, and the tongues stuck out in shy hilarity. We are a merry group. Our clients chatter freely and incomprehensibly to us, and the feeling is one of casual, if surreal, friendship. Pete and I are mostly silent. The work requires concentration, and the waiting line is long.
Dolpo, it happens, is a literary terrain. Our expedition has plied many of the trails that Peter Matthiessen and biologist George Schaller traveled in 1973. Matthiessen recounted their journey in The Snow Leopard, a marvel of its kind. Of Saldang, he wrote,
In such barrenness, the neat aspect of houses, walls, and fields speaks for the strong spirit of these villagers, who constructed spears to drive off bandits, and can dance so merrily when their food is almost gone. … One day human beings will despair of grinding out subsistence on high cold plateaus, and the last of an old Tibetan culture will blow away among the stones and ruins.
Saldang is not gone yet. It still clings to its steep, bare slopes. No bounty or excess cushions life here. The dogs I have seen in Upper Dolpo I can count on one hand. I have heard one rooster and spotted two cats in three weeks. There are no pigs, which cannot tolerate the cold, nor any other mammal above a rodent that might subsist on what humans discard. Surplus does not exist. Buckwheat, barley, mustard, potatoes, and little else will grow at this altitude, where summer prepares to depart as soon as it arrives.
A single willow survives in a corner of the school grounds. It is only a whip of a tree, but for weeks I have seen no plant half as tall. The children go to it when classes are done. They like to taste the sap, which is sweet. Perhaps it is the sweetest thing in their world. Bees, honey, and all but a few beleaguered fruit trees are impossible in this attic of the planet. Perhaps the willow sap also confers a mild analgesia. Salicin, found in willow bark, is a precursor chemical of salicylic acid, which in the laboratory evolved into aspirin. Alas, there is precious little aspirin in Dolpo, or any other painkiller, save for barley beer, the local moonshine called rokshi, and the rare, coveted bottle of Chinese vodka.
One might expect the people living under such grim circumstances to be sour, but we have met only courtesy and willing smiles. Adults, of course, wear many masks, but not children. Even the scruffiest among them possess a cheerful, impish vivacity. One small mob of tykes caught sight of Pete, Becky, and me strolling down a lane. In a frenzy they shouted namaste again and again, across 200 meters of field and wall. Their joyful yelling continued for as long as we remained in view.
Our camp sprawls amid the ruins of good intentions. I hung clothes to dry on the lower struts of a defunct cell-phone tower, the relic of a failed attempt to bring modern communications to rural Nepal. Near it stands a windmill for generating electricity, built by a Western NGO, but the generator has failed, Saldang’s talcum-fine dust having clogged its bearings. In the same complex as the lovely school, we encountered the locked doors of a medical clinic, its resident nurse apparently having gone on extended holiday. No one can say if she is expected to return.
Our clinic briefly fills a void, but we cannot know whether the difference we make will last. The care we deliver is mainly palliative, the relief temporary. The toothbrushes we hand out have value, as do the solar-charged lights, corrective lenses, and sunglasses, the last of which we gave away today. Occasionally we make someone well, or even save a life, as may have been the case with a young woman in Tinje, pregnant with her first child, whose severe urinary tract infection was tamed by antibiotics.
Harder to measure is inspiration. All the clinicians, Nepali and American alike, feel that the work they do under these wind-whipped conditions shifts their perspective, and this is also true for supernumeraries like myself: we bear witness, we try to act with compassion, we don’t know what consequences may ensue, but our not knowing would make a poor justification for not acting.
And then comes surprise, which attended the case of nine-year-old Pema Nurbu. His parents brought him to the Saldang clinic because his headaches never ceased. His eyes also twitched strangely—a nystagmus, in medical terms. Michael Lobatz, the neurologist, feared a brain tumor. Long conferences among the parents, Lobatz, Roshi, Sonam, and others followed. The boy and his father would travel to Kathmandu. Roshi would guarantee the costs. Sonam would make arrangements. The boy would have a brain scan. Lobatz was prepared, if surgery was called for, to link the family to expert colleagues in India.
No one could have foreseen the outcome. Happily, no tumor was detected, and the nystagmus proved to be congenital. The scan, however, revealed a severe sinus infection, clearly the cause of the headaches, which subsequently eased under treatment by Dr. Sonam. The boy stayed in Kathmandu. He had been a poor student in Saldang, unable to study, but now, relieved of headache, he excelled. The following year the clinic returned to Dolpo but got no nearer Saldang than the Dho Tarap valley. No matter. Pema Nurbu’s parents walked all the way from Saldang to Dho, a roundtrip of at least 80 kilometers. They wanted to see Lobatz, Roshi, and the others. Their purpose was not complicated. It was simply to say thank you.
The gratitude of the Dolpo-pa amazed our clinicians. So did the fortitude. Said one of our doctors, “They come in with joint pain, a blown-out knee, GI distress, a horrible rash, whatever, and maybe we can’t help them. ‘Sorry,’ we say. ‘Wish we could do something for you.’ And they get up and smile. They say, ‘That’s fine. Thanks anyway.’ And off they go, as cheerfully as they came in. Patients back in my clinic [in Colorado] are so different. Whatever hurts them becomes so much bigger a thing. And we give them meds for blood pressure or pain, but they really seem to want us to fix something bigger than that, something we don’t have meds for. They want us to fix the pain that is in their minds or in their souls. My Nepali patients have lots of problems, but not that one.”
At Saldang, we were somewhat more than halfway through our journey. The sorrow that I hoped to escape still dogged me, but it was at my heels, not in my way. I prayed that the stoicism of the villagers was rubbing off, at least a little, and that the spaciousness of the land had begun to seep into me. We had many miles to go and the highest pass yet to cross, but slowly I began to sense that something in me was changing. Day by day, the trail felt more like home. In time I understood: now, as I approached the end of my seventh decade, I was finally learning the proper use of my feet. I was learning how to walk.
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