APR-C-5
DRAMATIS PERSONNAE
OF OUR DHARAMSALA MEDICAL MISSION
AS WE SET UP SHOP IN THE DALAI LAMA’S SUMMER PALACE
APRIL 23, 2001
WE AWAKEN IN MC LEOD GUNJ, DHARAMASALA,
IN HIS HOLINESS’S CITY
TO HEAR THE MORNING PRAYERS
AND WIND UP AFTER A LONG AND WINDING ROAD BY TATA
IN THE ROYAL TARAGARH PALACE
BROUGHT TO FULL STRENGTH BY THE JOINING OF OUR ONE STRAGGLER
FOR STARTERS, OUR MEDICAL TEAM FOR THE MISSION TO DHARAMSALA
THE NORTH AMERICAN STAFF:
We can begin with the volunteer medical staff, from the US and one from Canada.
Glenn W. Geelhoed—‘Nuff Said
Jenna Beart 12’30/’72
29 Castleton @2
Jamaica Plain, MA 02130
310/489-8461 (mobile)
Jenna is the daughter of a colleague of mine, whose roots re-trace her father’s steps as a career employee of Mayo Clinic, where he went to Rochester, MN originally as a transplant surgeon, at about the same era as they had recruited me, for the same function. He switched to colorectal surgery, and later was moved by the Clinic to Scottsdale when they opened a branch there and in Florida. Jenna, therefore was brought up in Minnesota and Arizona, and then attended UCLA, where she graduated last year from medical school and matched in medicine at UCSF, broke her contract and did NOT take her prestigious internship there, because she had got a Wharton School MBA and started a business—an Internet based diabetic counseling service, with a boyfriend, with whom she subsequently broke up. She is back on the medicine-matching track now, and has matched—of all places—at the Brigham—so she would be my closest kindred spirit, and has the best future of our group!
More importantly, Jenna has DONE things. She lived in Europe for a while and decided, for example, that she would run the Copenhagen Marathon—and did. This is not a small thing, since Jenna was diagnosed at age 16 with Type I diabetes mellitus. She is on an insulin pump and checks her blood sugars about eight times a day. This will all sound uncanny in its coincidence, when I tell you about another of our star performers—Mike Eifling.
Jenna joined us late, since she was bumped from the flight that should have brought her with us, so our driver Santosh went back to pick her up a day late after she had spent a day in New York, since she traveled KLM/NW through Amsterdam, and was bumped as a frequent flyer miles traveler. She is adventuresome, confidant, and a real trooper. She needed to leave a day early to move into a new house on which she was closing in Boston on the other side of the country from her Southern California base. She knows a lot about electronic business, and helped me at one point send the one of two emails messages I was finally able to get out of Dharamsala. Jenna is a one of the bright reasons this was a good trip.
Michael Eifling 3/27/’71
2243 S. Oakland Way
Aurora, CO 80014
729/748-0742
Can you believe it? Michael comes from CU at Denver Colorado, and just completed a rotation at the DHHA with my friends Gene Moore, Reg Franciose, and specifically Eric Sarin, who was exactly in his position when he took this trip three years ago-one of the reasons Michael is talked into being here. But, more amazingly, Michael is a juvenile diabetic, and is on an insulin pump! The coincidence of two such individuals on the same adventure trip, and—as Michael says, “hearing her ‘talk the talk’” is a coincidence enough, but they are both closing on a house, both entering a medicine residency next month (Michael staying at CU) and each have overcome the limitations of regular checks on their “karma meters”.
On the application blank that asks if there are any physical limitations that would prevent you from performing your expected duties, Michael had not written in diabetes, since, as he said, “It does not limit me from doing what I am supposed to do.” In an email from his wife, he found out that he will be getting an award as the outstanding senior medical student going in to medicine, adding that the woman who got it last year is an awesome resident currently at the Brigham.
Michael said to me that he had married a woman ten years older than he, who had two teen-age children and that she was recently diagnosed with MS. I said I was in the opposite experimental position, and when we compared notes, his wife Amy is exactly the same age as Virginia. Michael is a photography buff, and is my roommate for our limited time in Delhi. I will try to work out a visit in the next month’s travels through Denver, so we can compare photos from this and other trips.
Kim Riehle
703 Bellevue Ave. E 42
Seattle, WA 98105
Kim is a lanky blonde from Iowa, living the last four years with a computer fellow named Andy, who is finishing at Emory in Atlanta and then will start a surgery residency in University of Washington. She is a vegetarian, and did yoga through college, and was into meditation exercises with Hem, as well as stretching exercises and a bit of running. She had interviewed at Colorado, and told me of her long and frank discussion with Alden Harken when she interviewed there, and he had told her of the good and bad features of the program, including the disruption of the transition of the entire University medical school program to Fitzsimmons Army Base in the next years, which he was not too sanguine about.
She is a Dutch ancestry Iowan awaiting the transition into a new life as a surgery intern, and is doing precisely what I did at exactly the same career stage, in a foreign fellowship in her senior year before returning to “her man” Andy, whose parents are Mennonite. Of course, I would identify with her and the excitement she has at graduation and the transition to a new life, not too different from mine in career pattern, although in a very different era. I worked quite closely with her in each of the clinics, making some sense, since we were the surgical team, even doing a couple of things like aspiration of a breast cyst—a good outpatient procedure to know. She will be a good surgical intern.
Elizabeth Parsons 6/12/’73
910 Constitutions # 815
Durham, NC 27705
919/382-971
Elizabeth is a sweet and spunky freshman in Duke in between the quarters that will start her sophomore year. She was teamed with Carrie Starkie, so she learned a lot of pediatrics, which she says she now really likes. I helped her in a couple of markets so that she thinks her Christmas presents are resolved into the future.
Carrie Starkie MD 7/26/’70
4055 Mineral Springs Lane #203
Glenn Allen VA 23060
804/935-1873
Carrie is a big asset since she is the most senior of the others and as a senior pediatrics resident, she is the first pediatrician we have had on such trips as this and therefore a real bonus. She is finishing her residency at MCV Richmond, and is building a house in the new job she will be joining in a group practice in Piedmont Primary Care in Warrenton Virginia. I met her husband Tony in Dulles when she and I were the only fellow travelers to bump into each other; he is an Alaskan fishing guide during the summer, and does computer web site things during the rest of the year.
Carrie is the strongest clinician of the team and is a very good pediatrician, so that I would stop in to see what was happening in her room with Elizabeth, largely to learn what she was seeing, rather than to supervise what she was doing well already.
Jen Reedy 4/15/’78
4800 University Drive Apt. 12K
Durham, NC 27707
919/417-8732
Jen is a classmate of Elizabeth, and is perhaps the most junior of our group in clinical skills, and seemed a bit intimidated about what she had got herself into. She was quite quiet, and seemed to have a negative reaction to me, when others would ask me about previous experience in such trips, including some questions about running or climbing adventures, she figured the responses were bragging, and seemed turned off by any athletic endurance discussions. She avoided me and stuck to a primary care Indian physician, a gentle young fellow named Raj Kapur. I was puzzled at first, and teased her a little, as I would all of the others, until I realized this did not work.
Only later did I realize that she had a handicap that she was very reluctant to talk about with anyone. She seemed to have difficulty walking, especially up steps and particularly without shoes, which is a requirement for us to be barefoot in temples. When others had asked, like Michael, she dismissed it with “I have weak joints.” But she had several falls and scrapes, and when I saw her on the trails and with Carrie helping her across the courtyard steps, I realized that she had a neurologic gait, not any sore muscle or orthopedic problem. Carrie finally found out what she has---Charcot-Marie-Tooth Syndrome, a progressive neurologic degenerative inherited disorder, and this may explain her rather distant relationship to the runners and, at least in part, to me. The others with any handicap—myself included, if you want to include periods of severe pyriformis muscle spasm—were open and supportive about it—witness our many discussions about diabetes and pumps. But, Jen was secretive and did not want to get into the discussion of this or some of the other features of medicine and life in India. She was particularly upset about my proctoring Kim—who besides being a Dutch lanky blonde, is going into a surgical internship next month—a bond more like a foxhole relationship than the otherwise younger daughter of whom I would be very proud relationship—we all posted our birth dates for the horoscope and astrology, and everyone there was aware that each was younger than my younger son.
Habeeb Sadeghi DO
41 Schermer Thorn St. Apt #145
Brooklyn, NY 11201
Habeeb is a Farsi Pasha charmer, going into anesthesia residency in Brooklyn, having come from Iranian immigrant parents and going to osteopathy school in Southern California. Everywhere we went he had a string of miscellaneous girls calling or trying to make contact, some of whom he had brought over for dinner when we were in the hotel. He left two days before our clinics were finished, going out with the mysterious Maria, and had gone off for a trek alone—but, he is never alone for long, since he picked up two Mexican women who had joined him on the trek.
Christa Ng
84 Mt Aberdeen Manor SE
Calgary, Alberta
TZ 7 3 N8
403/282-9350
Christa is a Canadian (Eh?) from Calgary born of Hong Kong born parents. She is a serous medical student and also has a “honey” as she described him with a couple of teenage kids. Of the two students I covered most closely, I began and continued with Kim, who did well, so I shifted to be doing more with Christa, who worked hard on her history taking and clinical skills. As in many of the UK/Canadian schools, the physical diagnosis skills were more apparent than they were in the American medical students. She stayed on for two more weeks in an arrangement setup in a clinic in the new medical school organized in Himachal at Dharamsala, and we met her preceptors with her. I filled out the evaluation from she requires for an accreditable experience, and she had done a good job.
Maria
Just who is this woman Maria? I had no idea she was joining us, and she appeared two days early fretting in the Jukasso Inn in Delhi. She is a 69 year-old Spanish speaking woman with white hair which she always obscured with a turban or floppy hat and sunglasses “so they cannot see my white hairs.” She was born somewhere she had refused to say—my guess would be Cuba. She had pestered Ravi to come on this trip, and allegedly was a retired nurse. Ravi had some misgivings, but agreed after she said what every one of the inappropriate choices for inclusion has always said “Oh, I won’t be any trouble; I will just sit by quietly and watch the team work without interfering—just don’t worry about me!”
She was nothing but trouble. Her being here with our group was a mistake, since not only did she soak up a lot of time, attention and resources, but also she contributed nothing and noticeably sapped some of the enthusiasm of the working group. Special arrangements had to be made for her at several points. Her tickets were rearranged, and then changed again when she changed her mind. She obviously was not going to be trekking with us, and she would insist that she was “bored and fretting, sitting in this intolerable heart” and demand a car and driver to take her back to the hotel.
She was bored one day, and insisted she be taken back to Dharamsala, to do what or see who knows what was not apparent. No matter that the Dharamsala trip is four hours one way over tough roads. Ravi even offered to have her stay there and return the next day while keeping her VERY special room in the Taragarh Place Hotel. No, she would go both back and forth, she insisted, taking the Tata and derive Santosh, our best and safest driver, for eight hours of driving separated by nothing visited while she did arrive in Dharamsala to return exhausted.
Her “special arrangements” in her accommodations included a “single room” in the Maharajah’s suite in the Taragarh Palace Hotel—sumptuously fitted with crystal chandeliers and fireplaces. At first it was almost to her liking, then she sulked again, since she said it reminded her of what the British had done to the Indians—no matter that this was the royal Maharajah’s Queen’s family oppressing their functionaries here. She was also against any abuse of the Indian population reflecting a concern about her own mysterious ancestral background—but that did not keep her from calling driver Raj “Baby”—no matter that he had two babies of his own.
I was in the Tata’s front (left) passenger seat as Santosh was driving up a hill, when he swerved into a zig zag pattern. From the back seat, Maria leaned forward and demanded of me: “What on earth is wrong with him? Make him stop doing that!” Now, I do not address our safest and most competent Indian driver who makes his living knowing how to get around potholes and how to switchback in traffic, and tell him that someone visiting India for the first time wishes to change his driving habits for her convenience, so I just looked at Santosh and smiled.
After fretting her way along with continuing demands for special consideration while the team was working, she was shipped out early along with Habeeb, and things seemed much less complicated when she was gone
INDIA STAFF:
Ravi Singh
Ravi is the president/owner and worrier of Himalayan Spirit and organizes but does not attend the tourist treks, but accompanies most all of the Himalayan Health Exchange missions, the non-profit part of the business. He also drove a Mahinda Bolero over from his enlarging base in Simla, although he lives in Atlanta most of the year with his wife Carolyn and daughter. He was married (second wife—the divorced one living near Simla) just around the first trip I had made as the medical leader of the Himachal mission to the Kinnaur Valley and Spiti Valley in 1998, and it was during the 1999 mission to Nepal that his daughter was born. Ravi was with us from our meeting him in McLeod Gunj Dharamsala at the Hotel Baghsu to our departure at the Chandigarh train station, and every other step along the way we were well attended by Hem, who is the best of gentle and attentive guides, besides being our meditation instructor.
Raju Kanwer
Raju is Ravi’s long-term friend and partner in Simla, and used up the two weeks vacation from his regular job to attend us and even help with the translation in the clinics, as well as pack up our tents, etc, as he had done when I first went trekking in the Vayas Kundh. Raju and I toasted his brother Baldev’s marriage to a stewardess; on the evening it was happening, no other disapproving family members in attendance. There will be a later party in Simla, and I am invited to go home with him at some future visit to meet his father and others of the family. Last January, his father underwent coronary bypass surgery for which they had requested a letter from me, figuring that a signature from a US professor would increase the attention his father received. That part went well, but he had subsequently been re-hospitalized for what sounded exactly like DVT and PE, which I was asked to write up in descriptive form. I did, but I will also carry my reprint on this subject when I come back to do the Ladakh trip in July.
Anuj
Anuj is the faithful workhorse, all-purpose “utility man” of our trip, and has been on each of the trips I have been on and will be in the next several this year. He was wearing my running shoes, which I had left for him last time, which he said enabled him to run faster and jump higher—it seemed to be true, since he was up the mountain first.
Santosh
The best of our drivers is a quiet fellow, but when we came down the mountain at Billing, and we got our chorus exercised in “Dona Nobis Pacem”, he was part of the chorus, and would snap his fingers in the air alternating with grasping the wheel as we swerved around through the rhododendron forest.
Raju
“Raj” was called “Baby” after Maria first tagged him with that name, and he looks like a James Dean with a vehicle that needs to get a bit more rugged, and then he will be a standard fixture on each of our excursion, particularly Ladakh, where we now have over twenty participants registered—some of whom may be ill-suited to such a rigorous trek and may need winnowing (and as many wait-listed) who will need carriage in our convoy of Tatas.
Hem Thakur
Apple house
New Land Estate
Near Timber House
Shimla, 171001 HP India
91-172-222797
Hem is wonderful. He is of unfailing good cheer and serenity, doing everything from paying bills, arranging taxis or rickshaws and getting everybody in and out of trains, planes and hotels. He doubles as our vegetarian cuisine consultant, and meditation guru and oriental religion instructor. He is the best feature of each of the excursions I have made. It was his birthday on the morning he sent us off, and I made him a present of the only “Out of Assa” books I had carried.
Raj Kumar
C/o chhailsingh
VPO- Mushinhpur Tahr-mulherian district
Hashiarpur, HP India
W) 01894-68558
H) 01993-47813
Raj is a local GP who has graduated from medical school, but has had no residency, and is taking this station as a remote rural fulfillment of an obligation, as all Indian graduates are required to do. He has a small clinic aobu100 meters from the government Guest House in which we had dinners at Dharamsala. He was the “attending physician coverage” for several of the students, particularly the most junior, and they had a lot of time to talk with him, which I tried not to disturb. He made reference to Michael about a pivotal transition experience he himself had had a few years ago, and when Michael asked what that was, he said “It is better that you not know so that you will have a chance to get to know me better.”
He was a gentle fellow and a real asset to the team, unlike a lot of the official Indian physicians who come to associate for he sake of bringing by one of their prestige patients, or getting some inflation of their standing by associating with a team of American doctors. It will be even better to have the medical school at Dharamsala, which is so new as to have only one class level started in it, but this would be a good affiliation for the “Health Exchange.”
WE AWAKEN IN MC LEOD GUNJ, DHARAMASALA,
IN HIS HOLINESS’S CITY
TO HEAR THE MORNING PRAYERS
AND WIND UP AFTER A LONG AND WINDING ROAD BY TATA
IN THE ROYAL TARAGARH PALACE
BROUGHT TO FULL STRENGTH BY THE JOINING OF OUR ONE STRAGGLER
The pre-dawn awakening in the “hill station: of McLeod Gunj, Dharamsala brought a succession of birdsong like that heard in Delhi, with a few more chirps from unfamiliar species. I had seen the spectacular green parrot like bids I was calling “lorikeets” based on their similarities with the birds I had seen in Australia. I walked out into the garden, and wanted to get started down the hill toward the temple where their would be the prayers of the monks and followers of his Holiness who was in residence at this time. Mike Eifling joined me with cameras and my tape recorder, as we strolled down the holy hill. I did not know where I was going, but I followed a monk who was twirling his prayer wheel, and figured I would go to the same place and be there about sunrise. I was, but there were no people congregating where all the prayer flags were strung along the chortens and over the stupas. I figured to keep on following, which had me going uphill to keep the sacred objects on my right hand side. I followed one man who was clapping two boards together in front of him and prostrating himself every other step—a slow way to climb a mountain but great ascetism. When we came to the same point at which we were originally on the path way down the mountain, we realized that we, too, had made a complete circle, and kept on going to the temple where we had seen the prayer flags and ceremonial burnings of evergreen bushes. A monk came forward and asked the nearly universal question in the universal language, English, “What country do you come from?” When we said “America”, he added “Very good—please join us at the prayers.”
There was circle of folk in front of the stupas, including the monk who had invited us and a small boy who could not resist the temptation to peer around the robes of the elders to stare up at me with big round eyes. He was the source of a good deal of film shot by me during the prayer chanting and prayer wheel spinning that followed. I taped about as much of the ceremony as any tape listener should be able to stand, as the blaring and hypnotic clanging continued. We walked back up hill keeping the holy items and mani walls on our right. I tried to get back in time to work a bit on the computerized recording of our arrival and send it back from a cyber café as an email attachment. The attachment did not attach, and the address disc I had made up did not work until it was redone with semicolons replacing commas in separating the addresses, and also it could not take more than a few of them if they were batched in fewer numbers. Fortunately, I had stopped in with two people who knew how to manipulate this system, and they made it possible for me to cut and paste with a “rig click” use of the mouse, and I could get at least the brief one sentience message “I have arrived in Dharamsala” sent out.
We walked around McLeod Gunj (named after two British Army officers who had established this area as a “Hill Station”) and then had lunch as a group, all assembled but for Jenna Beart, for whom Santosh had been dispatched to collect her at Chandigarh. We then drove for a while to get around the steep mountains around the Kangra Valley up against this Dhaulidhar (“White Range”) to arrive at the Norbulingko Institute—the summer palace, of the Dalai Lama and the place where we will be checked into to stay later after our clinics. WE saw the cool fountains and replica temples of the ones left behind in Tibet (and now, doubtless, destroyed by the Chinese occupation) and were eager to get back here to see it at some time without a rush. The name means “Jewel Garden”(Fountain”), apparently a reminder of the more elaborate ones left behind in Tibet. There is an associated charity here called TCV “Tibetan Children’s Village” that is set up under international donor aid, to help what pass for orphans, but it is unlikely there would be too many of them emerging now, some had century after the evacuation of the refugees from Tibet at the time of the 50”s Chinese takeover.
We continued in a long, hot, drowsy drive, around tough roads, until we drove into a paradise of gardens and a palace to check into. We had arrived at our distinctly non-primitive accommodations of the Taragarh Palace Hotel—the former Maharini of this area had the queen’s side of the royal Maharajah’s palaces well-laid out for her with pools, rose gardens, pea fowl, and the usual requirement of polo ponies, tennis courts and sporting life photos on the wall—one of the Maharajahs was standing over four dead tigers, while others showed a “shoot” of six hours with a bag of several hundred geese and ducks, a few barking deer, and a miscellaneous mixed bag. “Pity we lost Inja! Quite!”
Two Bengal tiger skins from the surrounding hills are on the wall—bagged in the fifties, and a few stoats, boars, deer and a variety of birds fell to the Royal Highnesses in brief outings with their four bores. Pity.
I was put up in the attic, which had been revised to hold twin beds with an off site bathroom. But the members of the team had each got a luxurious accommodation named after some member of the royal family—except for the mysterious Maria. She took to he suite, and we all could peak at the interior, but she was later heard to be agitating to be moved, since she was suffering from post-colonialism. But, hot water facilities are able to make for a certain historical forgiveness, and she remained, but had a new focus of discontent to express.
We drove over hill and dale, giving me a good idea as to the sites of the running routes I planned for the morning. WE got to a small school with a facility in font of the larger TCV facility of the Tibetan Children’s Village. We were lined up for the compulsory tea and welcome ceremony, which is the diplomatic function that begins each such site familiarization. I was introduced to several district medical officers, and asked questions. It soon became apparent that the physicians I was talking to were not, as they say “allopathic physicians” but were Ayurvedic practitioners. As they described it, drugs are directed at the disease, but they work on Ayurvedic herbs in nourishing the body. I had only asked in order to avoid having our pharmacy of new drugs interfere or substitute for their usual treatment patterns, and said that we anted to help support and not substitute for the medicine that was always available here and would be when we are gone. They launched into a story of the great beginnings when Lord Brahma brought forth life and the herbal cures of diseases specific to peoples living in different areas. In fact, it turns out, that the population of people is specific for an area and the curs for them must also come from the same area or it will not work. So much for upward mobility. I kept insisting that I was interested in what they had to teach us, but did not want to represent that we were here to substitute for them or change the part tern of how people usually got their care. The medicines we would leave behind were free and would be donate to them to use as we could help them appreciate as they were teaching us about their patterns of practice.
They were still telling me about four fluids and four organs—the liver, fever/metabolism, and there are 80 diseases located in the liver, 40 in the blood and 20 in the digestive tract for a total of 140 diseases, for which the appropriate alignment of astrology was a way one could predict the cures. It sounded like we could split the difference with them---we would try to deal with acute diseases and leave the chronic diseases to them. We were not going to spend too much more of the patience of the number of people who were all crammed into the greeting room going thought cosmology 101 as an Intro to medicine, so we adjourned to look over the crumbling bare rooms we will use as clinic rooms for about five teams to examine patients depending on how many translators we could engage to have them help support each clinician. A young lady named Althea would be our dispensing pharmacist, and she and Hem would be getting together later for different purposes. I thought of a rather cogent question that would need answering to fit Ayurvedic medicine into the pattern of treatment we were discussing—but was afraid to ask it lest it derail our working arrangement: If Ayurvedic medicine is that which uses herbs from specific areas to treat patients from the same specific area, how will we be treating Tibetan refugees under such a system they had proposed? Right, better not to know, and use up our stock of Allopathic medicines first.
On return to the elegant Maharajah’s Taragarh Palace Hotel, I met Jenna Beart, as she had been delivered by Santosh, with whom she could not exchange many words, but he did fetch and deliver her efficiently. I learned a bit more about Jenna, besides the opening information that both she and Michael emoted over—that both of them are insulin pump diabetics!
As we toured the old place and current hotel, we saw portraits of the previous residents, several of whom looked like Hapsburgs with their prominent jaws, and all of them bejeweled and pampered by a staff in waiting. We had dinner, and even ended in ice cream—after a prior warning that we should not eat dairy products—, which Michael said would have his pump “smoking”. We compared notes about the interesting little Briticisms or Indian interpretations of English that caught our eyes. I liked the notice of a phone facility in a drug shop, notified by a sign labeled “STD—CHEMIST” That is what I considered “one stop shopping.”
It is time to get to work, and to wait until our clinics are done before continuing our tourist mode—and it seems we have the team ready---particularly Carrie, Michael, Jenna and Kim who will be the backbone of our operation. I am already planning the early morning run under the canopy of the bird-filled trees with a large foreground filled with tea plantations and the Dhaulidhar as a backdrop.