JUL-B-10
AT TSO MORARI IN THE RESTRICTED AREA OF
KARZOK, LADAKH, AND OUR RETURN ALONG THE INDUS RIVER
July 27—29, 2002
This is my third trip up the Indus River and into the restricted area of the Ladakhi “Kingdom in the Clouds” to the Lake, Tso Morari. This salt lake is at 15,100 feet at the level of the lake, settled into a basin with surrounding peaks with snow line at 18,000 feet, which runs down at three inlet streams of fresh water. The one of these streams is diverted through a very clever system of channeled irrigation ditches into small cultivated plots below a summer village named Tso Morari as well, about five hundred feet up higher than the lake itself. This would make Tso Morari the highest village on earth, even higher than the village of Kibber in the Spiti Valley which claims that title, but for the fact that the villagers have to leave in winter, which is much, if not most, of the year. Nonetheless, when they are here during the brief growing season, the village inhabitants of Tso Morari have the proud boast that they are tilling the highest cultivated fields on earth. This was the claim made for them by the BBC India division, which had the only permit before my original one to enter this restricted area. The TV documentary, which I have and which I showed a number of people who were potential joiners on this trip each time I have done it, is called “The Kingdom in the Clouds.” Narrated by George Page, it claims also to have some of the rarest wildlife TV footage ever shot, and that is of the snow leopard dragging a yak calf back from its kill.
The three known (to me) freshmeltwater streams entering the lake from the rim of 20,000 foot peaks all around, are not matched by any outflow streams, so that the lake is a big solar panel evaporating water and concentrating the dissolved minerals that run down to it as it erodes what once was the bottom of the Indian Ocean before the subcontinent rammed up under Asia and this salt has steadily concentrated in the long interval since the upheaval, so Tso Morari is saltier than the ocean, and no offish live here. But, like Lake Mono in California’s Eastern Sierras, there are huge numbers of brine shrimp in the water, and I can see a score of them in a very small space at the small cupful of water along the salt encrusted shore. So, this is the attraction for a number of birds that visit and a few of theme that are found nowhere else.
ALONG LAKE TSO MORARI’S SALTY SHORE
These endemic speices include the “horned lark” which is along the salt grass shore of the lake, and nests right on the ground with almost no cover or effort in nest-building. I found a nest, with a few downy feathers in it as a small scooped out area in the sand. Then I found what I was looking for, a shallow saucer-like depression and two speckled tan-brown eggs. It was only a matter of time before we found the third evidence, a shallow depression, guarded only by a few blades of grass (before we moved rocks to either side of it) with four down little newly hatched chicks who were cuddled together, wiggling being their only sign of life, until I would pass my hand over the nest, and the more aggressive of the topside little birds would rear up an unsteady neck and a huge gaping mouth, clamoring and peeping for a food handout. How these tiny birds stay warm enough in the cold morning and long night, I could not figure out, since I did not see the parent bird covering them as I suspect they must overnight, or perhaps they were just off food gathering to supply their brood. But, I had photographed the horned lark in other parts of the sandy patches near those highest cultivated patches of irrigated cropland on earth, and they did seem reluctant to fly away far, despite the fact that I looked, but did not find, other nests where they were hanging close to their territory.
Bar-headed geese are another endemic species but they migrate—and how! They are on e of the few birds to fly over the Himalayas, all the way up into the jet stream! They have a large wingspan looking like a U-2 with feathers. This is the time of year according to that “Kingdom in the Clouds” TV tape which I have not seen for a couple of years since I last loaned it out, when they come to the island in Lake Tso Morari to court in their lifelong marital arrangements and to build a nest and hatch out their chicks. This happens in the island, and with a few other birds also nesting on the island, it gives a chance to compare their different ways of nest building and chick rearing. I am always following the bar-headed geese around the lake shore since they post sentries when they are on land, where they would rather be when there is a chop on the lake surface that makes it difficult for newly hatched chicks to float along; but when I approach, they elders crane their necks and push all the chicks into a formation and waddle off to the lake and get just far enough off shore to be out of reach, but not farther than the telephoto can pull them in.
The other two birds that nest on the lake’s islands are the black-necked grebe, and the crested grebe. I saw the first when we came around the lake toward our campsite, but tired to take a photo which was not understood by our driver, who at that time was Sunil, who was out of it, having vomited and was drowsy on the ride up. Some of the other naïve travelers think nothing of calling a halt to take a picture of a sign posted along the road, and that stops the entire convoy. That is the purpose of faster film speed, one does not need to stop the parade in order to get shots that are much more natural than the contrived posed shots. But, since I never call a halt to take a picture, we bounced by the crested grebes scurrying along on the surface and trying to gather their chicks to raft them along on their backsides, and no photo was taken.
But, I had a long solitary walk along the lakeshore when I arrived, and that was a very good time for observations from moving slowly along the shore and gathering up a few bar-headed geese feathers along the way. I saw the black-necked grebes floating along the surface and heard an occasional plaintive cry come from one of the other of the two adults, against a beautifully backlit mountain backdrop behind the lake. Then I heard the peeping sound of the baby grebes that seemed to be out for a swimming lesson. One of the adult grebes would circle around and disappear as it dove under water. When it came up, the peeping noises would have stopped. As I watched this repeated several times, I realized that the grebes would swim away from a small struggling group of little chicks that were bobbing in the three-inch ripples. When they panicked and would peep their alarm at not seeing the adults and not knowing where they were going in this vast salt sea, one of the adults would dive and come up under them, and the little chicks would clamber on board the parent’s back and get rafted along with the bigger bird. I could just see through the telephoto the small heads of the baby birds as they peered out from under the folded wings over the adult birds back before they ducked back in to the “below decks” position.
The one emblematic bird of the Tso Morari region that I looked for on this—as well as each previous season—is the black-necked crane. This is the bird that is rare and is found here as no where else, so that the WWF and other organizations have been supporting making this a wildlife refuge—even the army cannot bring helicopters in to this area to avoid the disturbance such would cause. I looked---but did not see—the black-necked crane, except on the posters in Leh and elsewhere announcing the special nature of the wildlife of Ladakh.
The second most beautiful duck in the world—in my opinion—is the Brahmini duck. It is present here and is found in early morning around the lake edges, where I saw it at a distance. It is often the ornamental duck in domestic collections and a bit bigger than the one that I think is the most beautiful duck in the world. My choice is the wood duck drake. It is a common resident of the areas around may house in Maryland, and it is for that reason that I have the new Derwood mailbox emblematized with the wood duck drake---“We are the odd ducks that live in the woods.” The wood duck makes its first exploration of the universe by sticking its head out of the hollow log that the parents have constructed their nest in over water. The little duckling leans way out to see what the world and its environment are like, when it topples too far and splashes down into the water for its first swim. It is thereafter on its own way trip never to return to the warm log hollow of its nest again. It is a harbinger of spring around the streams and rivers I run by in late March, and it is also the nostalgic signal that fall is fading fast when it gathers in flocks and peals off to fly south. Remember that one of the Geelhoeds—Donald—was universally known as “The Duck.” That is because when he was one going on two years old (precisely the same age that his daughter Kacie Elizabeth is this week) in Nigeria, all the kids had heard of only one other Donald, and that is a duck. So, even his badge number and call signal is now the Duck.
The new Derwood mailbox is that of the wood duck drakes that live in the deep woods, and make excursions far out into the world from that comfortable log nest in the forest along the streams. The Brahmini duck drake here at Tso Morari is far above any timberline, and is trying to do an imitation of its more beautiful native of the Maryland woods.
We were camped lakeside in this high dry basin of the Tibetan Plateau, with the salt waters of the Tso Morari, and the meltwater streams from the snowline at 18,000 feet, 2,000 feet above us, are the only waters in this arid atmosphere. Without the waters surrounding us here—as I learned from the comparatively modulated weather of Michigan with all its rivers and streams and tucked in among the Great Lakes, the temperature swings are extreme. It is baking sun-burning hot by day when the sun is over head or just before it ducks behind a rimming mountain. At that point, one had better scramble for all the down and wind-proofing one can find, or get down inside the sleeping bag liner and under the down and feathers maximum cold sleeping bag. We had a fire from the firewood we had purchased in Leh to carry up on the roof racks of one of the jeeps, since we are far from timberline, and would probably have had to spend a long time scavenging for dung to build a fire. After dinner, when the wind was whipping through and the Godfather beer was past around the fireside around those huddled and wrapped up, the group was still obsessed with the whining Indian music that they insisted be played at the top of any one’s hearing painful threshold to learn the stylized minimalism of the Indian dances. This meant all the batteries and Discman action was impressed into service for the compulsively social set, who are always present at party time but have a much more difficult time finding their way to the clinic when the heavy lifting of the clinical work had to be done. I retired to my single LL Bean tent and into my sleeping bag for surprisingly comfortable nights while the wind whipped overhead and the temperature plummeted. AT sunrise, I could see the lake and the birds on it through my open tent flap, and within an hour, the sun was making the tent space uncomfortably warm. It was time for breakfast and a start up of the clinics.
The book of the registration of patients seen in this health care facility showed that I was the last physician here, and the last patients logged in were those seen by our team last year. The number for that one and a half day clinic was 254, although after the half of the team who could not stand the isolation had commandeered two jeeps and gone back to Leh to shop had left, I saw a number of nomadic people alone, who had begun walking about the time that we had started the clinic and arrived after most of the team had disappeared. That was the most efficient time of patient management, since we saw about forty patients in 45 minutes, before I went up the mountain to climb—with the permission and notification of the local army force—to the peak over the lake.
On our opening day, we saw 168 patients. We had separated the team into five stations and I tried to cover the field in seeing all of them. As my pet peeve was on the first mission of someone coming to seize the ballpoint pen of someone taking a history, totally shutting done the station for lack of the simplest parts of the gear, the single most common theft this time was of the translator that I had shuttled around three stations while the other two had one translator. Since the other stations preferred Abdul, our cook and the simplest and most rapid of the Ladakhi translators, they would come to steal him and tell him to stay with them at their single station, closing down all three of the stations I was covering without anyone at all to translate. When I pointed out that Abdul was to remain where he could do the most good for all three stations, I was told: “OK we will flip you for him; now, that is an offer you cannot possibly refuse!” I thought this is rather typical of the audacious insubordination that I find common among such junior clinicians whose world has been made rather easy for them, so I replied, “I certainly can, and just did!” If I moved to a station where Abdul did not happen to be at the time I was checking someone else’s patient, I would invariably find him absconded by one of the other teams yet again, so they do not take the loss of anything that they would really rather have lightly!
We saw the same variety of GERD, arthritis, TB, skin rashes and conjunctivitis that we had seen in the previous clinics. The dental student Jake pulled a few teeth, and I had helped him with a couple along with the local health care worker who rides a circuit and was going back to Leh with us. We kept a good flow of patients going, but when the box of toys and clothes was opened, we saw a whole bunch of kids who came in a rush, who had recycled several times each time with a new and specious complaint to have another go at the toy box. For Buddhist kids, who have been taught that all suffering comes from desires, and the way to overcome suffering is to master desires that are put behind oneself, they certainly did unlearn this avarice in a hurry when they would see Ranger Woody, or Happy Meal toys inside the big plastic box. The filthy rags in which they are wrapped would be startling when replaced by a clean white shirt—but the shirt got to looking a lot like them very shortly.
We had a very good session of their case presentations and also a series of didactic lectures on altitude sickness, blunt and penetrating trauma, and parasitic worms in tropical medicine, combined with a mycobacteria talk, so that they would go back with some information about leprosy. We saw about half of the residents of this area, since there are about 100 Indian Army based here (we got to see a few of them rather intensively later) and there are about 75 residents of the Gompa and supporting village houses, and then about the same number of nomadic shepherds scattered over the far mountainsides. In the mornings, it is fascinating to watch the sheep going up the mountain in a rectangle that looks like the moving pattern of the US flag dragged behind a skywriter aircraft. There are typically about three contingents of about 100 sheep each in formation as they go up and over the crest of the mountain in search of the basins to be grazed, with the punctuation marks below or beside them representing the shepherds who are dressed in the rags and home made felt boots that are almost the same color as the mountain since they carry quite a bit of the mountain with them.
FROM AN
UNUTHORIZED CLIMB
When I had taken my lake shore walk, a couple of our group had looked up at the snow capped peaks behind camp and the little village and said in no uncertain terms,” That will take about three hours tops to get up there and back again.” I replied, “How about a day and a half, at minimum, which id longer than you will be here in total.” “No way!” So, as I was walking, another three decided to run up to the top and back. They came back late, having made it less than a third of the way, and were still not convinced that they could not make it to the top with an early enough start, so they decided that three of them would take off at 5:00 AM in time to be back for breakfast and over to the clinics at 8:30 AM. The same warning was issued to them, about time and distance and unauthorized climb into sensitive border space. “No way!”
Three of them left at 5:00 AM. One of them returned about mid-clinic, saying she had to leave since she could not go further, and had almost reached the snowline, as the other two went for the snow and presumably the top. We finished the clinics and had packed up the camp and had lunch while they staggered in about 1:00 PM. They had not made it to the top, and had barely made it to the snowline. And, they had set in motion a chain of events that would have us all jailed if it were not for a lot of back-peddling, apologizing and “never-againing” on the part of Hem, Ravi and me.
Fortunately, we had treated the base commandant, and several of his men who had repeatedly told me how grateful they were for our being here, and for our services not only to the people of Tso Morari, but to the army folk posted here so remote from any kind on help. The new Base Commander had come over as a courtesy call to meet me and to introduce his wife who, with his son, was a transient visitor. So, we were relatively well connected before the incident of the missing hikers.
Now, along with a guard toting a machine gun came the same camp commandant who had been treated the previous day, furiously angry. They had sent four teams of two men each to intercept or find the missing climbers. If they stumbled across the Chinese observation posts and were kidnapped or were injured falling into a crevasse in this no-man’s land, they would each get the sack for having unauthorized climbers above 15,000 feet. The climbers, despite their extensive warnings had gone off AWOL into the LOC, and were wandering in a free-fire zone where orders are to shoot on sight. The commandant retold the litany of the tensions with Pakistan and China, and how it would look for him to have the American guests –the “doctors” (everyone around uses that term somewhat loosely when applied to medical school freshmen) were the ones who were making such stupid mistakes. So, I stood quietly mumbling apologies as Ravi was told that he and Hem could be kept hostage while reports were field down to Delhi and back, etc. My prediction? I will repeat the warning each time; and each time, first world medical students who are used to having things their way will do it all again.
AFTER THIS
INAUSPICIOUS SEND-OFF,
WE TRAVEL THE LONG
RETURN ROUTE DOWN THE INDUS RIVER VALLEY TO RETURN TO LEH
I rode up front in the only jeep which did not have a tape player. That would have been my choice, but Ravi had told me to put my stuff in the front seat of his jeep so that we could discuss a few personnel problems and the pals for the forthcoming Lingshed trek and people who are trying to get either in or out of it. So, I put all my stuff in the front seat of Ravi’s jeep, and after I had packed up the camp and struck the tent, I went to clinic. Can you believe, not only did the junior “girls” rebel at even the possibility of riding in a jeep without a sound system where they could play their favorite tapes and gyrate to the hand motions and other Indian “Bollywood” fantasy music, but Ravi caved in to the pressure! I would not have allowed this but for the fact that I preferred the Jeep in which I could think of the passing scenery of the mightiest mountains on earth rather than Hindi shrieking oscillating with Bob Dylan tunes, and packed up in the rented red Mahindra. Our driver has a fully formed complete accessory thumb on his right hand, and I wanted to take a picture of it. His name translates to “Strong Lion” so after pointing that out to him he agreed to have his hands photographed. Unfortunately, the stop we had made was in the TCP “Traffic Check Point” in a military base, so we had to wait until the next stopping point when the sun had already gone behind the canyon rims. We drove along the Indus River as we stopped at TCP-Mahe, where the permit must be examined and we must account for our passengers.
A mini-mob scene resulted, since “the doctors” had arrived, and on top of their jeeps was an unlimited supply of free medicine. So, every one lined up for roadside consultations and treatment—the worst of “Medical Tourism on the Fly.” Out came the blood pressure cuff, and the army commander of the checkpoint was found to have a BP of 140/80. I would have said this is normal and let’s be on our way. But, the next I knew, Hem was standing on top of the jeep, tearing away the plastic tarp over the medicine boxes in search of an antihypertensive that Fern had prescribed for this normal BP which we would just drop as medicine and continue on our way with no further checks or follow-up. This is precisely the kind of nasty “Medical Tourism” about which others have been faulted by the group at the HRA in Nepal and had written up in the British Medical Journal to which I contributed an editorial—and may be in chapter three of the thesis outline if ever I can get to a lace where both the computer and electric supply are reliable!
Next came a woman with a bug in her ear, and others with GERD from the problems that army guys get into from sitting in a remote post with nothing but free booze on hand. I interdicted all but a bundle of antacid, and we were trying to get into the jeeps to be on our way, when the disappointed army checkpoint commander named Singh came over to me, with no antihypertensive medicines in hand as he was expecting for the hypertension he does not even have, and said to me “Your compass, Sir!” He had seen me checking the mark of the TCP-Mahe on the GPS on our way in, and this superior technology fascinated him, so, if he was not going to get free unnecessary medicines from this traveling group of doctors, well, a little bit of hand-held high tech would do. It was just like the kids in their feeding frenzy in Tso Morari when the box of toys and Happy Meal handouts had been opened---American materialism “One”, Buddhist freedom from desires, “Zero.” We have worked an immediate change in the cultural environment, and not necessarily for the better.
We whisked
the convoy on its way, and as I rode along I spotted chukar partridge, one with
a whole brood of chicks. These are a
favorite American exotic game bird import, and here they are in their native
element, with a breathtaking background around their precarious cliff-side
perches. So, the trip to Tso Morari has
once again taken place, beginning and ending with the birds, with a number of
people helped in the middle, which usually results in some feeding frenzy for
further things that probably will not help but definitely contribute to the
first-world status of the recipients of freebies. And, still another set of infractions of clear-cut rules were
enacted by those who are convinced that they are remote beyond rules, and they
can either practice unrestricted medicine, deliver babies when they had never
seen a delivery, operate without the regulations of quality restrictions to
those who are capable, or go for an AWOL hike into an international free-fire
zone, since they are, after all, doing good, so, therefore, we can do
no wrong!
Even this remote part (or, especially, this very isolated part) of the third world is a wide open laboratory for thesis material in “Treating Others.”