The longer we’re here and the more we get integrated into this community, the more we are making connections with other people, groups and resources who share our goal of providing basic medical care to those who would not otherwise be able to get it. Just as in the West, there’s various reasons for this, from ignorance of the (limited) existing systems to being refugees to being too poor to afford even the very cheapest medicines. Some people, particularly those newly escaped from Tibet, have emotional and psychological traumas that complicate their physical issues. Others live in such isolation in remotive villages that just getting to our little town of Rewalsar is a monumental occasion - there’s no way they are going to find their way to a government-funded hospital or clinic in a “big city” like Mandi.
Both the Himachali government and the offices of H.H. the Dalai Lama recognize this problem to some extent. That’s the positive news. On the downside, like bureaucracies everywhere, there is a limitation on both what they can do as well as how they choose to act on their awareness. In addition, there are individual medical providers, like Dr. Vanayak, the eye surgeon, who choose to use a portion of their skills are resources without recompense to help people who otherwise would fall through the cracks. There is Dr. Malhotra in Mandi, part of a highly trained team of oral and cosmetic surgeons who have agreed to donate cleft palate reconstruction for babies and children of poor families. Slowly, but surely, we are developing a network of like-minded people who care that vital services be available to everyone, whether rural farmers, refugees or tribespeople down from the high mountain places. People such as our neighbor, Ankush, who turns out to be a skillful emergency medic, one young enough to cheerfully get out of bed at midnight and put stitches in a kid’s head. Ankush’s family run a small pharmacy in town and he has also helped us get the most of every dollar the Emergency Fund spends on the medicines and supplies they can get. His willingness to put people above profit has expanded the number of people we can help with your donations!
Another way we have been able to expand outreach and effectiveness has been working with the little “clinic” set up by the Tibetan Government in exile. A space has been donated by one of the monasteries in town.
The resources are stretched verrrry thin, but there is a doctor who comes (or tries to - his territory is pretty huge) for one day a month. The rest of the time, the clinic is staffed by Chokyi Lhamo, a Tibetan woman who has been taught some basic nursing skills - she can take a person’s temperature and blood pressure, explain contraception and simple hygiene, bandage a minor wound and - most important - recognize when something is potentially serious and refer the individual to further care. Mostly she oversees the dispensation of the clinic’s dismally limited supply of simple medicines: Tylenol, Ibuprophen, some cough medicines and decongestants, pills for nausea, antacids for gastric reflux and a handful of asthma inhalers. These are frequently used up by mid month, particularly in the winter when the elderly have greater aches and pains and everyone catches cold, pneumonia or things even more dire. Chokyi Lhamo also checks on people known to be sick and the elderly who have trouble getting around - a great help in a town with many of these.
We’re well aware that the doctor assigned to the clinic is stretched too thin. Like the government he serves, he has a lot of responsibility and not enough resources or time. Just getting from one settlement to another in these mountains is a day’s hard journey. Whatever supplies he might need, he must bring with him since the clinic is most minimally equipped: a blood pressure cuff, a stethoscope, thermometer and maybe a handful of vinyl exam gloves. There’s a room the size of a closet with a cot for doing examinations and a front office with desk, shelves and chairs. I’ve seen inner city schools with more supplies in their first aid kit than these people have to work with on a regular basis. And they are truly doing their best with it, they are helping the refugees, both the new and those who have been here awhile, to the extent possible with limited resources. Still, people were making the trek up the hill to our house several times a week to ask for medical assistance, advice, treatment. A lot of what people here need - and can’t afford -are services or medicines the clinic doesn’t have - and can’t afford.
We’re still here and people are still making that trek. But it’s not an easy track for an old or sick person and many of the Tibetans don’t know or trust or can’t afford the few rupees for the public bus that will trundle them up the mountain several times a day. It got so that, every time Lena went down to town for something - to see a friend, to buy vegetables or have a cup of tea, she ended up surrounded by people who wanted her to come and take a look at their bedridden mom or check the swollen place on their neck or advise them what medicine was needed for arthritis. People who were too shy to come up here and people whose ailments wouldn’t let them come, wouldn’t let them climb our steep stairs. Almost all houses here in India have awful, steep stairs. She’d end up doctoring at the side of the road or in a tea shop. It’s really hard to do a physical examination or check someone’s blood pressure in a tea shop. And she wouldn’t have her equipment with her because she was expecting to buy some bananas and a bunch of cilantro and come right home on the next bus. So she’d take them down to the clinic building which is more or less at street level and at the back end of town. There she already knew Chokyi Lhamo and could use their blood pressure cuff, buy the person the meds they needed and ask Chokyi to look in on them in a couple of days. Well…
So now she spends one scheduled day a week at the clinic seeing people whose conditions are beyond Chokyi’s basic ability to hand out headache remedies and cold pills and who can’t or won’t wait for the day a month when they might get to see the visiting doctor.
Truly serious cases get home follow up or end up in our back bedroom/dispensary during the week or get sent to the hospital in Mandi for the kinds of testing and treatment that is beyond our means in this town. We still see whoever turns up at the door, which is quite a few people in addition to the Tibetans who go to the clinic building. Ankush is terrific backup and will go out at night if necessary on his motorscooter. The network of resources in the larger towns around here keeps expanding for those times when an emergency ultrasound exam is needed or the broken leg needs more than a simple x-ray.
We’re not the only ones trying to pull resources together. Our friend Harish has started an NGO (non-profit organization) to help get assistance for the more severely disabled - mostly children.
Last year they were able to distribute a number of little red wheelchairs to crippled kids. They have the equipment and the training in their office (a former weaving loft above the blacksmith’s shop) to do basic hearing tests and connections to refer people on for further testing and hearing aids if necessary. We recently arranged for Harish to test one of our elderly Tibetan patient’s hearing. It was really good not to have to try to drive the somewhat unsteady old fellow through the mountains to Sundernagar as we’d feared would be necessary.
What our patient didn’t tell us is that he already has a hearing aid, prescribed for him years ago in Dharmsala and which works just fine (when it has batteries in it.) He was hoping, in the way the old and innocent sometimes do, that we could somehow take him in for an operation to get (and this is pretty much a quote) his ears replaced with ones that worked since “they” can do so much these days! No matter how carefully we ask questions, people still manage to surprise us sometimes! This is a backwater in a lot of ways. That’s what makes it so interesting. Where else can you look out of the clinic door and see a few sheep following what appears to be a bush with legs heading up the street past you?
Or have to detour because the walkway to your house is clogged with a herd of goats heading to winter pasture:
Now someone in the government of Himachal Pradesh, the state we are in, is at least peripherally aware that a huge number of its citizens live in isolated farming villages in the mountains, far from access to health care of any sort. They also know it’s fairly impossible to bring health care providers to each and every tiny community and hamlet - even more than the Tibetan clinic, the result is a system that would be spread too thin for effectiveness. So they are trying to create opportunities for as many people to go TO the health care providers by allocating funding for events - medical “fairs” or “camps” where a large number of medical services - physical exams, basic lab tests, chest x-rays, dental exams, eye and ear testing, blood pressure readings, women’s health and contraceptive information and services, come together in one place for several days and people can come from all over the district and get their problems looked at, their kids immunized, their medicines adjusted, their teeth filled, all these quality of life services, free and under one roof. We’d been talking with our eye surgeon friend about doing such an event specifically for eye care when the call went out for interested providers and NGOs that would be willing to do the work of putting it all together.
So Lena called Harish and Harish called his circle of providers and our circle of providers, including the oral surgeons, dentists, optometrists and opthalmologists and his NGO is sponsoring the application for funding for one of these “camps.” It doesn’t take the place of any of the services being provided by the clinic or Ankush or the Emergency Fund. This isn’t a day-to-day healthcare or emergency care situation. It won’t even take place all that near to here, just in the same governmental district. But it will reach the villages where no doctor ever goes. It will get kids seen who might have been written off as stupid when in reality they’re deaf or have poor vision. It’s going to get some people on necessary blood pressure medication, prevent some unwanted pregnancies, save some people a lot of pain and grief. Hopefully, it will help prevent some emergencies we’d otherwise have seen later on. This can only be a good thing. And it’s really wonderful knowing that we’ve helped connect people up so it can happen, that we’ve been able to work together and meet some of these terrific doctors and medics and administrators who genuinely care about helping people - because of the Emergency Fund and the many people who have contributed to it over the past two years. All those gifts are part of an unbroken circle of connections that just keeps growing and doing more and more good in this world. I’m amazed and awed and very, very grateful.
A last comment to another blog post that isn’t what I’d sat down expecting to write: What we really need to add to the circle is some mental health expertise: PTSD, abuse, adolescent issues including anorexia, grief counseling, culture shock, knowledge of psychopharmaceutical treatments. There is nobody locally qualified in these areas; we’ve looked. Anybody out there want to volunteer by phone?
) you like. Nag me if you need to. There is so much wonder and beauty here to share, I promise not to be selfish and keep it all for myself in 2010.
