JUL-B-13

THE TRIP ALONG THE SPECTACULAR INDUS RIVER CANYON,

STOPPING FOR LUNCH AT CHUMATHANG, 13,470 ft,

AND OUR ARRIVAL AT THE LAKESIDE CAMP

TSO MORARI, AT 15,075 ft,

FOR THE TWO DAYS OF CLINIC, CLIMBING,

AND A LAKESIDE MORNING RUN, BEFORE DEPARTURE BACK TO LEH, CONCLUDING LADAKH-03

July 29—August 1, 2003

The Indus River Canyon is stunning, as always. I sat in front and took pictures, again, even those I remembered having taken before, since it is always changing against the infinity of geologic time. On the right side is the Himalayan Range with its Indian Ocean floor sedimentary rock and fossils, and on the left the Ladakhi Range which is melted rock from the tremendous heat released from the collision of the plates, with the Zanskar Range and Karakorum constituting the Asian underbelly that was thrust up. When we got to Kiari military base, the “purple mountain’s majesty” become more than a lyric when the beryllium content is coloring the rock red-purple, with scattered green cuprous compounds. I found marble from limestone compression and other rocks while keeping an eye out for fossil coral, which I would have a better chance of seeing, or course, in the Greater Himalaya Range when I have trekked through the Zanskar Range next weeks.

`Since I had made the great morning run over Leh, I was mellow and resting when we pulled up to stop at Thicksay Gompa, not to tour, but to wait for the arrival of one of our tardy jeeps. Over an hour in the hot sun, finally got me to pull out of the attaché case a sheet of paper to continue correspondence, when we set out again. Our long wait had made us late for lunch which we had by stopping at Chumathang for our box lunches at the “Warm Spring Baths”---evidence of the still-ongoing movement of the crustal plates beneath us in this subduction zone. CHUM is at 13,476 feet and is 33* 21.38N, 78* 19.21 E, 69.8 miles from LEIL at 321* At this elevation and without any unusual activity or exertion, my O2 Saturation is 88% and 88 pulse.

TSO MORARI:

DESTINATION TRAVEL,

FOR OUR FINAL LADAKH-03 MISSION

We crossed the Indus River Bridge at Mahe with our special permit to allow us to enter this restricted area, and passed the village of Karzok along the dusty trails. WE then crawled up the roads out of the highest parts of the Indus River Watershed, to cross a ridge where a special stupa and prayer flags demonstrate the end of the Indus and its origin opf waters. We then enter a high dry basin where waters that run downhill are collected in the basin where evaporation concentrates the salts and leaves them as a rim around the salt lake—which mirrors the snowcapped range beyond them. I had cautioned the passengers in my jeep to be on the lookout for the colonies of golden marmots, once called “gold-digging ants” in legend larger than a mouse but smaller than a dog, which pawed up the earth which turned yellow when they dug under ground. These busy marmots are stationed around the lowest spots where the fresh meltwater of the glaciers far above make a narrow green ribbon through the alpine desert sand. They are very busy at this time of the year getting as fat as possible and laying in I some mown silage to keep them in the early retirement that is forthcoming when they hibernate better even than bears. During that time they give birth in their slumber, like bears, and emerge again with the spring thaw. They are as comical as meerkats to look at when they are startled by the passing jeep and stand up with their staring faces like myopic door guards on the alert.

Tso Morari is the large slat lake, second in size only to Pangong Lake, and it is at 4,400 meters or exactly 15.075 feet. It is 28 km long and 8 km wide, and is denser and saltier than the ocean, inhabited only b y brine shrimp, which is what attracts the nesting birds to the lake, some of them endemic here alone. The distance to Leh from the military base that guards the entrance to the lake is 227 kms. My saturation of O2 at this level upon arrival is 84% with pulse 85. Water boils at 84* here at this nearly three mile elevation. AT reorientation tonight at the campsite, I told each of my team after they had bundled up to get the best protection they could after the sun went down behind the peak over the village, that tonight when they put their head down on the pillow, it will be above all the highest summit peaks in the forty-eight contiguous states of the US. All the vaunted fourteeners of Colorado will be below them, all forty three of them in CO, three of them in CA and one of them in WA. I know many of thee fourteeners very well, since I have expended some energy to stand on top of several of them—such as the single one in WA—Mount Rainier or Tacoma. So, if they expected to do any heroics, to remember that they were three miles up and would need to decrease their expectations by a third. Specifically they were not allowed to wonder off alone in the disputed border zone that got us into trouble last year, despite the warnings repeated to that group. I planed to climb on the second day, but limited to the saddle behind the village, and then to run the third day along the Tso Morari lakeshore. All these plans I carried out, around the clinic set up for the second and third days at Tso Morari with our departure on the fourth.

THE FAUNA OF TSO MORARI:

CAMPSIDE BIRD WATCHING,

BETWEEN CLINIC SESSIONS

I had told the group to be on the lookout for bar-headed geese, a bird with a U-2 wingspan which is the only creature to fly over the Himalayas without a Pratt-Whitney engine and a pressurized cabin. Obligingly, a group of the geese bobbed by in a flotilla, leaving souvenir feathers on the salty marsh shore. There are two kinds of grebes, the horned grebes and a collared grebe, out giving swimming lessons to their chicks, who clamber on the adults’ backs when it gets choppy. There were two different terns; one a sooty tern, and the other that Jim and I decided must be the Caspian tern, almost the size of a big seagull. We looked but did not find the horned larks, an endemic species that I had seen each time before; then I went looking for the little ground nesting birds. Only on the last day did I see a few of the very busy female Desert Wheatears which were busy burrowing a simple nest and moving a row of pebbles to an outside perimeter. I watched as they diligently continued their very elaborate nest building to produce a nest that looked like nothing else but a small hole in the ground, subject to the jeeps riding out to the tents and a pair of horses which were picketed on the salt grass by a couple of nomads later. We saw a lot of white-banded pigeons, and, to Jim’s disappointment, no bone crushing eagles, which he said would make a birder friend green with envy if he came back with one of those spotted. The same thing is being said by the females, who thought it would be nice if I could trot out a snow leopard for their viewing. Only the distant nomadic herders have had close encounters with such an elusive nocturnal beast—or intrepid explorers marooned on a pinnacle in the Himalayas overnight.

THE TWO DAYS OF CLINICS IN TSO MORARI

This time the patients we saw were more interesting than their rather routine diseases. We had nomadic shepherds coming in with the usual knee osteoarthritis, Tb, and eye problems with GERD (Gastro Esophageal Reflux) but the people were very much more interesting. Here would be a seventy year-old Shepherd who had not changed his clothes which were an outer woolen robe over a layer of the most bizarre cast-offs from another world, like a bambi t-shirt and a Beetles sweatshirt, with a French inscribed vest. But always, they would have a small amulet suspended by yarn and a portrait of the Dali Lama and a few jewels—mostly fossil coral beads on a string.

They would also have the marks of moxabustion scars where they had undergone wet cupping with what is essentially a “branding iron.” The physical exam can be conducted like a veterinary medicine review, since “X marks the spot” of their complaint, typically epigastric (GERD), shoulder (supraspinatus tendonitis), knees (osteoarthritis—totally disabling when it involves the know since you perhaps can imagine what an Asian Toilet might look like, if ever they encounter such an up market device.

We saw the usual mix of problems, including a group for the presentation by the students, amoebic abscess and bloody diarrhea from amebiasis, and mycobacterial disease, and several others that were god for the tutorials later. The students were catching on to the drill of the intensive case review and that although they had at first squirmed to know they were tested to and beyond their point of ignorance (“I haven’t had pharmacology or pathology yet!” is not a valid excuse) they also realized that by asking questions beyond the information base they already have, they would learn more than \something they already knew. We would come back to the tents and have tea, and change from the light weight cotton to the heavy duty wool and polypropylene to keep from shivering in the sixty degree temperature drop in this alpine desert after the sun dipped behind the mountain peak I climbed last two years ago. After dinner, we could look up at the edge of the Milky Way disc and see the whole galaxy spread out without the interference of the light pollution seen elsewhere. Orion and the Big Dipper with Cassiopeia in the North, and Scorpio rising in the south would give us an unobstructed view with an occasional shower of meteorites lighting up the sky with action. It was an English watchmaker named Wright who first figured out that we lived eccentrically in a big disc of stars and coined the terms of the edge-on view of the universe seen from planet earth. We have moved around to the far side of planet Earth, and we still have to see anywhere where the stars are so little interfered with than through the thin air at this 3 mile elevation with no competing ground light pollution.

POST CLINICS, CLIMB TO THE VILLAGE OF KORZAK,

AND THEN CLIMB THROUGH THE SADDLE TO THE GLACIAL STREAMS AND SEE YAK HERDER TENTS OF NOMDIC SHEPHERDS AS WE MAKE THE LONG TRANSIT FROM 16,000 FEET

After the last clinic, I grabbed Lee Dutton and Jim Campbell and walked up through the village next to the Gompa on the hillside where we had seen swarms of sheep climbing to their respective grazing areas in the morning. There were shepherds coming in in their nomadic worn costumes selling their fleeces measured by a trip beam balance against the weight of a standard stone. Their skin was rough and tough, but their hands were soft from the continuous lanolin cream they seem to be immersed in.

We went up above the village to the chortens and Mani walls above looking back over the lake. We kept climbing until we passed the saddle where we could go off to the right and re-climb the peak I had summitted two years ago. Jim had never walked so high, so we left the saddle at 16.000 feet and came down the defile to the canyon where the runoff from the glacier was roaring down through the desert, leaving glacier scraped “paving stones” behind in its wake3. I found a piece of fossil coral, to identify this as once a part of the Indian Ocean floor. I also saw other rocks that were limestone and marble, which also confirms of the several ranges of the Himalaya—first the Great Himalaya Range (Indian Ocean bottom), Zanskar Range (which we will be crossing next week and which is in the “rain shadow of the Greater Himalaya Range) and the Ladakhi Range which is essentially molten rock from the tremendous energy generated by the collision of the subcontinent pushing the Asian continent up, some of which is reflected in the Karakorum Range. All through the middle are the results of secondary accretion, of river deposits of the great Indus canyon and glaciers which were at play here for a long time even more than the ice ages from the altitude to which thi9s collision of continents raised them—a process still in progress.

WE cam down to the fast and silted stream and saw a few parachute tents darkened by the fires of the yak dung cooing fires within. I saw mating donkeys and stolid yaks, including my first grey one, with Zoes the cross breed yak bull, cow crosses. I saw a shepherd family trying to get across the stream by wading with the man carrying first his wife on his back, and then returning for the precious fleeces he was carrying to Karzok for the same process of sheep fleece selling. A big wind came up behind us in the wind funnel as we headed back to the Tso Morari down the stream which rose noticeably underfoot as a large sandstorm was kicking up behind us. WE made it back to the tents just in time to get the blow over, and I searched again for the Desert Wheatear and its busy nest building, but not yet taken time to sit in it and lay eggs. What had happened in the interval of rising ground water was a group of the meadow voles popped up above their flooded burrows, and ran around in excited pairs, copulating in front of my camera shamelessly.

The students came to the tent heavily dressed in the expected cold night, and sat waiting me to pour it on in the final didactic presentation s and their tutorials. I said nothing since I had told them earlier that I would let them have the last word on this experience. It started off as a Quaker Meeting, with one after another expressing what this had meant to them. : Lee started off saying he had not expected the high quality of the tutorials and the instruction that would come from the depth of experience of a very seasoned professor, and a few others chimed in, and then a few rather nonsensical “case reports” were presented, largely dealing with the non-[participants and their diarrhea as the reason for their withdrawal.

THE FINAL MORNING COMES WITH THE STRIKING OF CAMP---

AND, WOULD YOU BELIVE, -- A LAKESIDE RUN,

AT 15,175 FEET!

It was a good brisk run, with the tents struck and the bags rolled up. We stopped after the heavy hauling along the lake shore, and we splashed water over our heads for a cleanup before dressing for the long ride back. I had to change vehicles a few times as one or another of our drivers dropped out. But, we got the same view of the spectacular Indus River Gorge on the way out as in, with a return to our Leh Hotel Kangri base, where three more new joiners were awaiting us for the Lingshed trek.

Tomorrow is farewell to the participants of the Ladakh-03, including Lee who will be taking back my Action Packer and film mailers, and will drop the case at Derwood on his way back to Geisinger to arrive in time to participate in a few cases there. I will say goodbye to the Campbells and other participants for whom I have to write evaluations, and also send back notes with a few of them, including to the pathology Professor at UMMC who was one of my instructors and is still giving inspiration to the students at Michigan accord gin to Sophie, my UMMC med student.

This winds down the Ladakh-03 trip, with a good morning run coming up in the dawn tomorrow along with the packing up of the Reeboks and sending them back in the mail with Lee Dutton, a bit of shopping assistance to the Campbells and others, greeting of my GWU three students and a number of other arrivals for Lingshed, and a farewell diner for the Ladakh-03 sendoffs who will be leaving at 6:00 AM back to where they each had originated.

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