I am confused with time. I have to remind myself what day it is.
I had been to Zanskar for a camp. It was like entering through a portal in the mountains into a whole new world. The road from Darcha to Padum has been laid like a ribbon of steel, winding snake-like through massive mountains, shining black and beckoning as we negotiate those high mountain passes. Your breath catches—not just with the view, but with the need to breathe, which is normally such an involuntary process, as you climb to 16,700 feet above sea level.
The sky is a brilliant azure blue by day, burning your skin, and at night it is golden-flecked with purple. The wind blows through you, cold and incisive.
We camped the first night at Khargya in a tent that was comfortable enough, but cold. A brilliant idea involving solar power allowed us to get hot water from a machine that had to be fed an equal amount of cold water. Dr Bishan recalled the quote attributed to PM Modi, who was reported to have promised farmers in Gujarat a machine that would spit out gold at the other end if you put potatoes in at the other.
We left the next day after paratha for the camp at Khargya, which was held in a community centre that was well made, clean, supplied and obviously well used. They had a monitor, an oxygen cylinder and a pharmacy with a reasonable stock of medicines.
There were not many patients, as most had gone to work on the roads with the BRO. They are enlisted in the BRO and are employed in road construction, contract work they have been doing all summer. It apparently pays well, and the work is not heavy, though it is onerous to have to go every day and spend the whole day on the road. The grapevine says the gossip line grows with this employment. There is no electricity here other than solar, and the telephone network does not work. So the road crew may serve as their main means of networking—a viable alternative to JioFiber.
I felt myself nodding off and my head hurt. Patients trickled in during the afternoon after a delicious lunch of pulao, which had been brought to us by our team.
Most people here have dental needs. Their upper teeth have all but disappeared from eating dried meat through the winters, and nearly everyone had at least one tooth that hurt. Dental hygiene was almost non-existent. Joint pains and eye problems were the other prevalent complaints.We saw only fifty patients in Khargya that day.
We loaded up and travelled to Padum. Arriving at about seven-thirty in the evening, we were grateful for beds, hot water and heat at the Sai Shanti Hotel. We filled the rooms on the ground floor and had the kitchen to ourselves, which was extremely comfortable.
I felt tired. However, I did manage to make it to the clinic in Phey.
They had the clinic in the community centre. The local Soma-Rigpa amchis were also there distributing their medicines, so none of the villagers had gone to the fields—which would have otherwise been their priority, since winter was nearly upon them and their fields were ready for harvest. The harvest and grass-cutting are an uncompromisable necessity here, as people hurry to get all the work done before the harsh winter clothes the place in its coat of impenetrable snow. This is for them, a matter of survival. The best time for a camp here would be early June or July.
Because of the event, we saw many more patients, of all ages. Most were middle-aged, with problems similar to those we had seen in Khargya. There are hardly any diabetics. There are a few hypertensives, who have already been supplied with medicines.
I saw a nonagenarian who had an enviable bone structure at his advanced age. Elderly ladies also seemed to live well into their eighties. There was hardly anyone who was really sick or ill. I suppose those who are not healthy would simply die in this harsh environment.
Their children are precious and communal property, with hats that accentuate wide eyes, robed in traditional dresses that make them look like little lama dolls.
They ladies served us with snacks, a continuous flow of butter tea, lunch and biscuits. They were incredibly grateful for the pickings of medicines we handed out, mainly for joint pains, eye pruritus and gastritis.
The ultrasound machine was the greatest draw, and so was the laboratory. However, both services competed for power from a tiny generator that grunted, gasped and soon died. Not to be deterred, the local sarpanch, Sonam, engineered a power swap from the mainline cable and had both services chugging away after lunch, allowing us to complete the work by five in the evening.
The camp for the day was in Stongde, which was on the road to Leh, again a village with a population of about 900.
The community centre here had a heating system with panels on the wall and an inverter supply capable of alternating between AC and DC. Solar panels provided hot water for washing. The rooms were neat and clean, though the caretakers, both Muslim, complained of the constant battle with the fine dust that pervaded the region in the afternoons. I did not find dust in the centre—a tribute to their industry.
Ruksana was the nurse who had been here for some time and knew all the details about the local health demographics, including the number of expectant mothers and hypertensives.
There was a monastery situated high up on the mountain, and we received monks from there, some of whom were eighty years old but could outrun us on their walk up to their rooms. We did not even want to attempt the climb in our condition.
The pattern of disease here was similar, though I did see an eighty-two-year-old lady with a probable fungating pleomorphic adenocarcinoma on the left side. She had already been seen in Padum and Leh, with no permanent solution. She had ECG changes and was hypertensive and anaemic, so I was reluctant to accept the challenge of taking it out—which I would have done had she come to me a little earlier.
The highlight of the camp, which made the whole process so satisfactory for everyone, was the presence of Tenzin, our translator. She was from this area, and the locals knew her. She acted as our interpreter, and that made such a huge difference to the whole process.
This is a lesson to be learnt for future camps.It is the icing on the cake for everyone, as all leave satisfied with the communication, certain that no gaps exist in understanding one another.
Each place rewarded us with khatas, draped ceremoniously around our necks—expressions of regard and gratitude from their simple hearts.
We had lunch in a local house, seated on mats on the floor and served pulao and stabo from a modular kitchen in that traditional house, which still had a local toilet, kept neat and clean in a distant corner.
It was eye-opening to see the modern and the traditional brought together in this construct, a testament to adaptation to their needs.Traditional toilets work so much more efficiently here through the harsh winter, when temperatures plunge to minus forty degrees Celsius and everything freezes. There is no possibility of considering a sewerage or plumbing system which would invariably freeze and clog. The offal then provides manure for the field for the next year as it self-composts.
Towards the tail end of the clinic, I went with Tenzin to see the local civil hospital in Padum.
The last time we had visited was in 2007, when we had arrived by motorbike for a camp at this hospital. At the time it was like any other civil hospital: a building with some rudimentary supplies. They did not have basic medicines like ampicillin or IV fluids.
Dr Tenzin, the doctor posted there, requested some of our supplies, which we left with him happily, as we learnt that they were being discriminated against by the district headquarters in Kargil for being Buddhist. Kargil was a Muslim stronghold, and the administration there, we were told, preferred to sell the supplies rather than send them to Padum. We learnt that the good doctor Tenzin had passed away two years ago.
Zanskar became part of the Union Territory of Ladakh in 2019, which liberated them from this discrimination, funneled funds into the area and permitted them to develop.
As I was walked around the hospital by Dr Angmo, an anaesthetist who had been in charge for the past seven years, I witnessed the magical transformation of the place into a clean, well-equipped and furnished hospital that permitted them to function very well.
They had central diesel heating and electrical panels on the walls for heating, a borewell, adequate generator backup, separate wards with piped oxygen fed from a PSA plant, an excellent OT with Meditech light pendants, a Penlon workstation, an electrically powered table and a BPL C-arm.
They had converted their second OT into an ICU equipped with Nihon Kohden monitors and two Hamilton C1 ventilators—the same brand we use in our ICU.
They had a horizontal autoclave and separate changing rooms for male and female staff, with toilets attached. They had a waste-disposal system with a shredder and deep-burial pits which fulfilled their purposes quite adequately.
Everything was spick and span and in working order.
She took me to her laboratory, equipped with fully automatic machines for all basic biochemistry and a safe negative-pressure chamber for tuberculosis and CBNAAT.
The standards were indeed impressive, probably the best I have ever seen in all these years and in all the locations I have visited.
Her one despair was that she did not have specialist personnel to use all these machines. I think this is a longstanding debt that no one has paid as yet.
I am hopeful of bringing in a surgical camp to this location next year.
The burden of surgical disease here is not much. It comprises mostly cholelithiasis, and perhaps some hysterectomies and minor surgeries, judging from the pathology we have been seeing in the villages.
Currently, people have to travel to SN Norbu Hospital in Leh, which is equipped with specialists and even boasts a cardiac laboratory. The journey, however, is arduous, since it is about 300 kilometres away.
And so here I am now, at two in the morning, typing away on my keyboard after a fitful night’s sleep. I have returned through that portal from that magic world which now is only six hours away but always welcomes its visitors with unimaginable vistas where the air is clean but always blows with the threat of altitude sickness.
