APR-C-7
AGAIN AWASH IN THE TROPICAL BIRDSONG OF DAWN IN THE LUSH
GARDEN OF THE ROYAL TARAGARH PALACE,
WE BEGIN A SECOND FULL CLINIC DAY IN OUR MEDICAL CAMP
APRIL 25, 2001
AFTER A FULL SECOND CLINIC DAY IN
THE SCHOOL ROOMS WE HAVE OVERTAKEN AS THE DISPLACED STUDENTS SING AND POSE OF
US,
I MAKE A SOLO STROLL THROUGH THE COUNTRYSIDE FROM THE
GOVERNMENT GUEST HOUSE TOWARD THE SOUND OF THE CHANTING FROM
THE TIBETAN BIR MONASTERY, AND FIND MYSELF INCLUDED IN THE CEREMONIES OF THE
CLAPPING SALUTE OF BUDDHIS DEBATE,
AS THE “ONLY EUROPEAN OUTSIDER” IN THE TEMPLE—
THEREBY MISSING THE MEDITATION SESSUION WITH HEM,
BUT METING A FOURSOME WHO COME TO TALK WITH ME ABOUT
LEOPARD HUNTNG IN THE HILLS NEARBY
As startling as the sound of dawn in the tropical setting of the Taragarh Palace (“The Star Place”), I had not yet got used to it and got up at dawn to audiotape it again. I got out and ran up the mountain as I had before, but this time I had no eager accompanying persons—at least from the beginning through the first part. Jenna had joined Kim and Habeeb on the porch and I had told them about the end point, which was the Kangra Valley overlook with the backdrop of the Dhaulidhar Range spread out in front of us. I took off up the steady incline at a pace they could not match and was alone when I reached the top. I had carried a camera, which I had hoped to use to shoot pictures of all of us on the summit. But, when I had not seen any one coming up the crest of the final hill overlooking the Kangra Valley in one direction, and the dawn rays of the sun gleaming off the Dhaulidhar in front of me, I turned and made the faster easier way back down hill. Whom should I meet after a bit more than a mile, but Habeeb? I asked him if the two women were with him, and he said they were coming up behind hi. Another half mile further, I saw Kim and Jenna who were still on the run, so I turned around and ran with them up toward the hill crest again to show them the “light at the end of the tunnel.” We posed for a self-timer photo while they were jockeying to keep from getting too close to the precipitous edge and get to be part of the Kangra Valley rather than just looking down into it from the high pint of the Dhaulidhar snowcapped backdrop.
We ran back and I directed off toward the Sices exercise ring of the polo ponies. We then returned to the Taragarh Hotel for the morning breakfast after our baths with the hand held shower faucet, and then sat in the splendor of the Taragarh Palace Hotel overlooking the rose gardens and watching the canopy for the long-tailed tropic birds, looking like angels in their snow white plummage and non-aerodynamic flying pattern. I had come through some of the squalor of the average garbage piles on the streets of the average Indian town, although I was fortunate to be ahead of the buses and lorries that would roll by later belching their diesel smoke. From that aroma to the smell of the rose garden, and from the dingy slums to the spectacular Dhaulidhar—these contrasts are the story of India: the wealthiest/the poorest, the most beautiful palaces/the ugliest slums, the most graceful sari-clad women walking down the roads with head loads/the sorriest beggars with their misshapen hands out pushing a filthy baby into you. Yes, this colorful and aromatic noisy pastiche is India.
The motto of the GSD = “Gunner’s Station Depot” is printed on a sign out front across from the “Wildlife Has the Right of Way” sign of the crouching tiger. It reads: “Clean, Green and Fragrant”—quite a slogan for a military base, where esthetics and environmentalism have not typically been the first concerns.
After breakfast we piled into the convoy of Tatas and Mahindras and came into our clinic station through a large crowd of Monks and novitiate students, all in their red robes and sandals, with at least some part of yellow as an undergarment. This is how the Dalai lama is also pictured, since at all times he will have at least some part of his robes colored yellow. There was an ancient “denominational schism” within the Major pathway Buddhism, with the “Yellow Hatted Sect” being the most ancient. In order for the Dalai Lama to lead both parts, the red-robed and the yellow-hatted, he has to be the amalgamator and ecumenical one uniting these factions, and he must have the two colors at all times. (This reminded me of the Argentine “Casa Rosa” = “the Pink House”, analogous to our White House, where the tint is a requirement since it symbolized the merger of two political parties, one colored red and the other white, now united in the colors of the capital headquarters in Buenos Aires just visited two months before.)
I made my way through the crowd of monks and their acolytes and settled into my mud-wattle classroom, with a wooden desk leaning over to the left, and a folding camp stool as my office furniture, and an open window as the source of the room light, and when the wooden shutter was creaked open, the window did double duty as the X-Ray viewbox. As the TCV (“Tibetan Children’s Village” students –it is too long after the seizure of Tibet by China to refer to these students as they were originally “orphans”) posed for pictures with their European guests, partial as they are to blonde foreign women—a rather un-monk-like predilection, I took readings on the site of our clinic.
CLIN is at 32* 02. 21 N, and 76* 41.49 E, which makes it 4.54 mil4es from TARA at 289*, or 25.4 miles from DHAR at 300*, or 241 miles from DELI at 173*, or 7,236 miles from HOME at 338* (which means the straightest shortest path to Derwood is over the top, a bit westward of the north pole.)
As we saw patients, the displaced students had all lined up in the packed dirt of the courtyard, spaced out fingertip to shoulders from each other, and ran through their multilingual prayers and pledges of allegiance—with the stunning snow-capped Dhaulidhar as the backdrop to this performance. From the long queue of waiting patients spinning prayer wheels in the shade of the overhanging porch walkway, the sound of “Omh…..” the sacred syllable of their mantra resonated with its own overtones.
The patients were supposed to be registered in with a slip of paper carried from our “gazebo” camping tent, which was crowded with the clashing colors of red-robed monks and brilliant saris. I saw a monk with an ear infection that had been draining for over a year, which caused him problems when he made a Valsalva maneuver since he could hear air whistling out the perforated drum. This one is headed for mastoiditis and a cholesteatoma, even though we treated him up for this episode with adequate antibiotics. Two young boys were trying to read their Buddhist scriptures, but needed glasses. I saw a woman with classic Tic Dolereaux with an ophthalmic distribution of the trigeminal nerve; she needed Tegritol or even newer treatment of that, but we could give her only what analgesics we had. I saw an older woman with shingles—a good indication that she had never had the EPI (Expanded Program in Immunization). There were a lot of knee pains that presented as complaints for the reasons already mentioned—since Asian “toilets,” are not “knee-friendly.”
There were a couple of patients who were thought to be (and proved to be) hypertensive. To calibrate the rather neat wrist cuff we have which automatically and electronically measures the pulse and pressure, I tested it on me (and then everyone else in the staff, who abruptly became the “worried well” also needing their BP measured!) at 100/68 with a pulse of 48—the kind of BP and pulse that would have someone running for a pressor infusion if it were not taken in a distance endurance runner.
I was asked to do several socio/political consultations, since the District Commissioner came with an entourage to see me. It seems that the Indian government had taken the British Civil Service jobs and titles seriously and made them into even more sacred callings as to “duty”, so there are more colonial relics in the civil service than their may have been positions at the time of the Raj when the subcontinent belonged to the Crown and its Imperiatrix, Victoria. He had a fungus infection of the palmar space of his right hand, and he had been concerned that it persisted despite weeks of treatment. It may well persist despite years of treatment, since some of these deep fungal infections are never cured. He had the hand version of “Madura foot” with the end stage of that refractory ailment often being amputation. I had to encourage him in the prolonged, continuous application of treatment to prevent progression and patience—which is not what he had gone out of his way to consult an American doctor, since we are supposed to be bringing quick cures.
A man presented with no previous known diagnosis or investigation with right neck nodes and a recent left-sided weakness—a stroke from a probable Hodgkin’s lymphoma. He was referred for treatment of the former lymphoma, after a white blood count and platelet count, and management of the CVA, which would probably not improve. This was the first malignancy we had seen that required treatment, but I soon found others, along with a couple which were already known and under some form of inadequate treatment. There is often an allegation of treatment for something that is curable in Western medicine terms, and then the treatment is found to be some form of Ayurvedic herbal concoction. In fact, one of the “translators” that were in scarce supply, so we would occasionally enlist a student who spoke English to remain behind as a translator, was one of the “Ayurvedic physicians” whom I had met on our initial diplomatic social call when we were setting up the schoolroom clinics. He knew less medicine than he did marginal English, and was quite unhelpful. A very thin fellow, he waited until a lull between patients to say that the reason he had come over to volunteer as a translator is to see me about a problem of his own. He had some form of malabsorption and could not keep from losing weight, despite his attempts to try all the Ayurvedic herbal wonders he had espoused in the cosmology he had begun to describe on our opening day. He wanted help, and said that it could only come from some western biomedical intervention since he talked about Ayurvedic treatment “directed at the body, rather than the disease,” but that had not worked with what, for him, had turned into disease.
We had a lunch break in the gazebo tent cover in a field behind the school and compared notes. I had been in the room with Kim and Christi, and had shuttled around to consult with the others who were being helped by a couple of the local Indian doctors, principally Raj Kumar, and periodically they would call on me to see something. If I had seen a patient with an interesting finding, such as a cleft palate, or “rachitic rosary” or scrofula, or toxic hyperthyroidism with lid lag and eye signs, or an unusual rash, I would bring them around to the others, without telling them what it was until they had gone through a list of differential guesses. So, these were our “Clinicopathologic Conferences” as we were on the run. At the lunch break, we could compare notes with what each had seen that I had not circulated around as an interesting finding. Kim could sit in lotus position with Hem and practice her yoga and meditation, and we could exchange information about what supplies were running low. Fortunately, the patient flow dwindled about the same time as the large MAP boxes of supplies was also running down, so in later afternoon, we broke down the clinic until the following day, and half of us went to the TCV and the other half over to the Government Guest house. Maria had announced herself bored and would not be further participating in the waiting around, and had taken one of the vehicles and drivers to carry her back to the Taragarh palace hotel, although she was uncomfortable there as well in her solitary splendor, since she saw colonial repression all around her in the luxury of her quarters.
I had been driven over with a couple of us, including the pediatric team, to the Government Guest house, unaware of the other half of the team having gone over to the TCV hospital, since we were a bit broken up by one of the vehicles being commandeered by the boredom of Maria. I had been sitting in place on the veranda awaiting the other group’s arrival, and fiddling with things like the GPS marking of the Guest house, and making notes to include from the day’s patients, as the sun slanted into twilight over the Guest house gardens. A car drove up, and a drive discharged a somewhat officious woman speaking the correct cadence and clipped English accent that usually means trouble form someone of self-importance.
She, fortunately, approached our pediatrician Carrie, who was also seated on the veranda, making notes as I was. “Are you the group of physicians who are here seeing patients?” Carrie agreed to that statement, and, perhaps, sensing what would be coming did not nod in my direction and I was careful not to notice what I was overhearing.
“Well, I will just have my driver wait for me here, since I have brought a list of the medicines I must have that you will supply to me. You see I break out in pimples at the time of my periods, and I have found the following list to be helpful in controlling this.”
Carrie explained that we did not have the medicine she had requested (rather, demanded) and we did not carry anything that would be useful to her. Well, what about the following?” And she cited a litany of complaints that ranged form trivial to bizarre, all of which would be resolved by the specific free medications; she had been driven all the way over here to collect. Carrie added again that we did not cater to such problems or have such medicines.
“Well, what about ringworm? My maidservant has it so badly and it is so unsightly that I fear I shall have to let her go; what do you have that will fix that?”
Carrie responded very evenly and politely “Not a thing.”
“Well, whatever good are you, then, to me? I shall be obliged to take my list for consultation to some other physician and this entire trip over here will have been wasted. So, just what is it that you have that I can take along with me.” Carrie, again, very evenly responded that she also feared there was nothing we might have that would be useful for her rather unusual list of complaints (mark that trivial.)
She summoned her driver, and stomped off in a huff, declaring that “Well, I never….” Muttering about just how useless these highly touted American medical experts can be. As she got into the car, I had got up to start out on my walk down the road with my camera and leaned over to address the driver: “By all means, if you can, have her maidservant stop by the clinic tomorrow; we may just happen to have something more suitable for her.” He smiled back, obviously having been long suffering for longer than I would be.
I congratulated Carrie on her equanimity, and set out on my sunset walk.
I had got separated from the rest of the group who had gone to the TCV, and found myself waiting with a few of the folk at the Guesthouse. I marked this as GOVT at 31* 57. 01 N, and 76* 46. 49 E or 11.8 miles from TARA at 309*, or 7.71 miles from CLIN at 320* and 32.7 miles from DHAR at 305* I got up from the porch, and walked down a stone path to follow two women in saris carrying enormous loads of straw on their backs, which made them look like giant chocolate ice cream cones with very brilliant red and blue cones from the saris protruding from under the stacks towering over them. I shot a couple of pictures and kept going when I heard an disembodied chant coming from the middle of a large rice paddy spread out in terraced labor-intensive plots along a gurgling stream running down from the snow-covered mountain behind the guest house.
As I walked I encountered two other women coming up the stone pathway under arbors of trees, each carrying a wicker basket, each filled with large rocks. Despite the weight of their loads, they were gracefully bending forward under them coming toward me telling stories to each other that were causing them to giggle. I shot a picture from the hip, but it failed to be a surreptitious photo, since the arbor and the dusk created a flash, and the women were startled, not so much that they had their picture taken, than that it was candid when they were not stiffly posing at their best. So, I made up for that by allowing them to pose, and took another. They walked on giggling even more.
The mantra chant had ceased. Now I had no target to home in on, and walked along seeing only a few gilded spires above the rice paddies. A young monk walked up the pathway toward me, apparently coming under a group of aerial suspension of prayer flags strung out like a big top tent at the circus form a center pole but without the canvas tent—substituted by the fluttering flags. I turned and saw a monastery with the roof gilded by sunset—the two deer with upraised heads around a central disc looking just like the Tibetan imagery I had seen at Tabo and Ki Monasteries and others I had encountered along the Spiti Valley in 1998. As I approached, I saw a large courtyard filled with red-robed monks spaced out at about the positions where they had been apparently seated in lotus position earlier uttering their prayers. They were grouped in pairs, one of them standing, a second seated in lotus position on a small cushion as the standing one would wheel around with one arm and leg outstretched and with a loud slap, lunge toward the seated guru, making a stylized shout. I tape recorded this ritual, and tried to understand what was happening. It seemed that the elder guru was listening to the stylized debate of the yo8unger one standing, who was trying to make a pointed conclusion from the arguments of his “koan” by coming to a slapping punctuation and a shout—essentially, “See? It is proven!” The guru would seem unaffected by the pint which he would ignore, including the karate like lunge at him and the slapping sound of the clapped hands right next to his ear, since the seated one was already on a higher plain and could not be moved, except to point out that there were many more truths yet to be learned before the universe was as transparent as the novitiate was trying to prove.
I took a picture of the milling monks in the courtyard with the gilded roof of the temple behind them in the last rays of the sunset, and the same phenomenon occurred. The flash was triggered, and here I was, sitting under the archway in lotus position (not simply in deference to the others but because I was trying very hard to stretch my spasmed left pyriformis muscle!), having previously been ignored, and now discovered by the flash. Abruptly, a number of the monks wheeled around in their stylized pattern and with the shouting slap directed their outstretched hands at me as they had previously slapped in the direction of their seated gurus. At first I had thought this to be a sign of disapproval, perhaps of a photographic invasion. Then I saw that it was repeated as a deferential salute, and they seemed far more familiar with me than I was with them. I said to them “Tesidili”---the Tibetan greeting as opposed to the “Namaste” I had been using more often that day, a leftover form my Nepali Sherpa greeting. They all chorused the same Tibetan greeting and repeated the stylized salute.
It was now dark, and I figured I would have to get back to the Guest house for dinner—which I could confidently predict would be some form of Dal Bhat. I started up the stone path guided by the gurgles of the stream running along side it, which I could no longer see. I knew if I kept going uphill, I would find the only road in this area, a dirt road on which the Guesthouse is located. I had to feel my way through the dark. I ran into the backside of a couple of stone houses along the path, many of which looked like the houses I had seen in the Kinnaur Valley or along the hilltop roads of “Old Manali”—that is, there were cattle stalls and mangers on the ground floor, with the families living over this source of animal heat on a loft just above them.
I came to the road and tried to figure in which direction I should walk to find the Guesthouse. In this one instance, I guessed right and could see the lights of the GuestHouse up the drive that led to it. There were four shadowy figures of men standing in the drive, and I changed over from “Tessidili” to “Namaste” for the greeting as I passed them. One called out in English, that if I were going in, the group inside was all sequestered in some form of Meditation Instruction Séance and they would be coming out of it in another fifteen minutes to have dinner. I said, “That must be the group I am expected to be in.”
They replied, “We have just come by to meet Dr. Geelhoed, since we are eager to convey regards to him if he is there.”
So, I introduced myself in the dark to this quartet of delegates on the drive while the rest of the meditators continued in their deep breathing and disembodied trance inside. I was trying to do my own special brand of yoga without calling attention to it, which is difficult when it means I am standing in a group of otherwise normal citizens teetering on one leg like a stork, trying to stretch out a painfully spasmed left pyriformis. I explained that I had just been down to the monastery and they gave me its name—the “Bir monastery.” They were a group of people associated with one of the fellows who was a physician, and the others were family or friends, with one of the fellows the security advisor, telling me he had been the security chief for Michael Jackson’s visit to India. I could not be more impressed to be classed in the same company of the Great Michael Jackson, and was wondering what these folks had come to see me about. They wanted to talk about the difference between Indian and American medicine and which I thought to be better? They were puzzled about American health insurance, and wanted to know why anyone should need or use such a policy, since they had no concept that medicine cost money from the consumer of the service.
I later learned that the reason I had been welcomed so warmly and received with such hospitality in the Bir monastery, is that ---these monks were my patients I had just seen that same day! Ah, well, you know, all these red-robed monks look alike!
While waiting for the break up of the meditation session, I asked about the mountainside behind the Guesthouse, and the wildlife here. They quickly told me about the leopards here. Leopards?
Yes, there were quite a number of leopards here at one time, and although fewer now, secondary to one unfortunate event, there are still enough to be spotted running across a road in the headlights by night. One of the men knew a lot about this subject, and we compared notes form my leopard experience in Africa. It turned out that he was active in the unfortunate “event” as he called it and the subsequent “leopard eradication scheme.”
Two of the men were brothers, each named Rana, one of them being Durov, the physician who had led the group to come to see me. The other, Ashmil, had learned that I was interested in the culture of the Tibetan lamas, which is why I had gone down the mountain following the mantra I had heard from Bir monastery. He said he would send me the “totems” by email if I could supply him my email address. I did, and so did he.
Then they told me about the “event”. In 1990 14 children were killed, and their half-eaten bodies were found suspended in trees. The evidence was great that this was the result of a large population of leopards in this district, and form 1990 to 1993, a “leopard eradication scheme was launched, of which Ashmil was a leader and the others were involved form time to time. Durov, the doctor, had to examine the bodies of the deceased and determine what had caused their deaths. He was quite impressed that one woman he saw after the children had been killed, was entirely missing her arm and shoulder, and her body had been found in a tree, when it might have been thought that she could probably outweigh the leopard that killed her. There was evidence of a struggle in which the human side had scored some early rounds, despite the winner being the leopard.
In the course of the three years, by trapping, hunting with dogs, bait and stalking, TWENTY leopards were killed here. I asked if there could have been something wrong with one of the leopards which might have turned rogue, man (or, more accurately, woman and child-killer) citing the evidence of the leopard in Assa, Congo which had cracked a canine and had an enormous dental abscess eroding through the maxillary sinus and into the orbit. “Exactly so!” they said. Durov had autopsied the twentieth leopard killed, and it was found to have a cracked mandible and a large facial abscess that made it too difficult to pick off its normal prey, and it may have taken on a water buffalo instead of the usual deer or monkeys, and got kicked, so it had to turn to easier prey—a rare event. Right after the twentieth, maimed, leopard had been killed, there were no more human attacks, and the “leopard eradication scheme” was discontinued. So, there are still big cats here--even a very rare tiger or two, but plentiful deer and still quite a few leopards, which can live in a balance, since the population of humans is not competing for the same foodstock, most of them being vegetarians, yet without too much enthusiasm for having the herbivore prey species eating up the rice an lentils they are so laboriously planting and tending.
When the meditation session was over and the others emerged, I had my quartet of friends join us for dinner, where they were delighted to talk of US and Indian politics, and make jokes about leaders—here is where we will miss Bill Clinton! They invited me to return and take a hike, and possibly even a hunt (the two brothers own three rifles among them—a rarity in India--) in the hills. I would be delighted to do so, mainly just to SEE and Asian leopard, but I do not have to collect one, especially with a CITES injunction against it making it impossible to return with the pelt. We exchanged addresses and emails and phones and “particulars” and said we will be in contact again in the future. In fact, even before I returned home, and probably while I was still sorting my audiotapes and film rolls from this day’s eventful experiences, the Indian “totems” were on their way toward my email Inbox (see May-B-7) from Ashmil, the chief security agent who had once guarded Michael Jackson, and now was coming to offer services and regards to me. How much more like a Maharajah could I be made to feel?
So, my eventful day began on the run up to the sunrise on the Dhaulidhar, admiring the Sices and their polo ponies at exercise, as well as the tropical birds over the rose garden ant the Taragarh palace at breakfast, extended through a clinic day of a wide variety of patients, and concluded with a mystical serendipitous walk through rice paddies to be saluted by a whole monastery of monks who were my day’s earlier patients, to conclude with stories of Asian big game hunting. Ah, Bliss!