What can you say about a country where the ruler, its king, where's a crown with a raven in the middle and skulls around it, to ward off demons, yet has one of the most progressive and innovative economic policies in the world?  Instead of measuring GNP, they measure GNH:  Gross National Happiness.   Which means, among other things, free health care, free education, and preserving 60% of the country in its natural state. 
    What do you say about a kingdom which was completely isolated from the outside world until 50 years ago, without roads, or electricity until 40 years ago, but now has cell phone service which is better than that of the United States?   A developing nation with a median income of $2000 U.S. which has been able to double its average life expectancy in the last 40 years?
     A country which has only seen one war in over a century, one in which the king himself led the troops to oust Indian insurgents in the South, a war which lasted several days only, after which the queen - one of the king's 5 wives - built 108 chortens in a high pass in memory of both the Bhutanese and enemy soldiers killed?
    A nation whose national animal, the takin, looks like a strange mixture of a cow, a horse, and an antelope -- created, according to legend by a mad monk who had defeated an evil woman demon terrorizing the country with his penis?
     About a country whose people are so uniformly kind and generous that my experience of going to a bank and having a teller not only give me directions to the nearest cell phone store, but leave her post, and lead me there, translating from the national language, Dzonka to help me buy the phone, where young guys stopping and  gathering around me in the street, not to rob me, but to politely help me readjust my gho (the complicated traditional dress worn by men) that was coming unravelled as I walked back from the Tsechu (major festival) in Thimphu, are common experiences?
    Such a nation is Bhutan, where I am now serving as a physician through Health Volunteers Overseas in the Jigme Dorje Wangchuk Referral Hospital in the capital, Bhutan.   I had come here on the advice of a very good friend last year, as a tourist with my wife.  This year I undertook a two week trek here, the Laya Gasa trek, which goes over 4 Himalayan passes of 5000 meters, near the Tibetan border.  It's the first half of the Snowman trek, reputed to be one of the most difficult treks in the world.  The difficulty is not only from the altitude, and the ascents and descents.  Unlike Nepal, Bhutan is a country where trekking and tourism have only been developed for the last few decades.  The trails are almost all rough, muddy, wet and slippery, with no amenities along the way. 
        I  started off hiking from Paro to the Johlamari base camp, It is called a "base camp" for this 7000 m. peak, but no one has ever climbed it, because like all the high mountains in Bhutan, it is sacred, and forbidden to climb, as are most of the mountain lakes.   It was raining.  I had pulled my back out , and felt like I could barely move, but forced myself to do a day hike - mostly in the rain - up to a sacred lake anyway, so having done that, it gave me the confidence that I could do anything, I think.  The first high pass we crossed over in rain which turned to snow with near white out conditions, then more rain on the way down. 
          By the fourth day, my clothes, had become wet in the saddle bags, so we stayed in the horseman's home in Chebesa essentially a yak herder's hut, heated by one stove fueled by yak dung. It was a typical traditional village house, with one big living dining room kitchen downstairs with a stove and nothing else except sacks of provisions, and an upstairs for storage and a Buddhist shrine/sanctuary.  The outside was decorated with paintings of manifestations of the Buddha, propitious animals, and large penises. I tried to dry my clothes there but they ended up still damp, and smelling of yak dung, also I got sick from yak milk tea, and sleeping in the shrine upstairs (this was an honor to be able to sleep here, evidently) above the stove below, felt like I was going to asphyxiate because of the smoke/smell.  Tough lodging for an uninitiated chilip! (That's what they call all foreigners here, except for Indians who provide all the manufacturing goods, a large percentage of the soldiers and essentially help run the country.)
          The impressive thing is that this house and every home in the village was built communally.  The main supporting beam in the downstairs, about 6X8 and 20 feet long, was carried by 12 men over two days from another village.  This cooperative approach to life is typical of the Bhutanese, and central to their Buddhist culture.
           The next morning, I  got to see a traditional archery match  where the opposing teams gathered around the target while the other team shot at it from over a hundred yards away, and did little dances and songs after each round was complete.  Archery is the national sport of Bhutan.   It's amazing to see, not only because the ranges are longer than football fields, but the targets are about the size of dinner plates.  The only conflict that came close to a war was when the British tried to invade Bhutan from India, in the nineteenth century.  The Brits gave up quickly, not only because of the daunting topography, but because of the accuracy of the Bhutanese archers with their poison tipped arrows.  The traditional bow is made of bamboo. Traditionally, opposing teams stand very close to the targets, even trying to hit the arrows out of the air as they approach the target.  This practice, and the habit of having more than a few drinks of the potent local liquor, arak, has made archery accidents one of the leading causes of injury and death in the country - especially as powerful American made compound bows have replaced bamboo.
          The  weather did begin to get better after the fourth day, with some clear skies, though it rained, at least a bit, every single day for the fourteen days. Most of the trails were composed of wet slippery rocks, crossing lots of streams. I met some incredible people along the way.  I was traveling for the first 10 days with a group doing the Snowman Trek, led by Beth Whitman, who runs a company, Wandertours, specializing in adventure travel for women; written several books on the subject.
        What about health care in Bhutan?   I was introduced to the health care system as I trekked.     I toured a basic health unit in the village of Ling Shee.  As in most of the developing world, health workers, not doctors or nurse practitioners, care for most of the patients in towns and villages throughout Bhutan.  They get two years of training after high school.  Their prime goal is public health:  They make sure all the kids are immunized (with the vaccines available in Bhutan - they don't have shots against mumps, hemophilus influenza  and pneumoccocus, so they still have those diseases here.   They screen pregnant mothers for risk factors; if they have any, they aren sent to Thimphu to deliver.  They discourage smoking and encourage good hygiene.  They treat diarrhea and dehydrations, with oral solutions, or sometimes with IV's.  They give antibiotics for pneumonia.   They can't do throat cultures, and they don't treat sore throats or ear infections with antibiotics.   There is rheumatic fever in the country.  They keep track of vital statistics.  In this village of 450 people, there were no underweight, nor overweight kids.  
          The latter would be a rare finding in an American town.  An army captain who happened by the yak herder's house asked me for a second opinion about his 6 year old daughter, who was getting hives.  Then he asked me for the best diet for children.   Without hesitation, I said, the traditional Bhutanese diet:  three meals a day, eggs for breakfast, rice, vegetables, rice and lots of vegetables and a little meat for lunch and dinner, fruit for dessert, nothing in between.   Kids drink milk.  When I was here touring for three weeks last year with my wife, my cholesterol dropped by 30.  That was after eating eggs every day. As urbanization increases in the country and more western junk foods filter in, there is a growing problem with diabetes, hypertension, and overweight with adults.  But there are still no McDonald's, Burger KIng, Dunkin Donuts, Pizza Hut, or any chain restaurant or store here.  Hopefully that won't be changing any time soon. 
            There had been four deaths in town in the last three years.  They were all secondary to alcoholism.  That is the number one public health problem in the country.   A close second may be the constant chewing of betel nuts, dressed with lime on a leaf, even by public officials  and physicians.  It not only leads to red teeth, and people spitting everywhere, but to oral and gastric cancers.
             Little actual health care is done in the BHU's.  This one was dark and dingy.  The walls were papered with scary posters showing the effects of smoking and alcohol. The health care worker was doing his wash when we arrived.  But as a public health venture, the BHU seems to be an excellent idea.
             Further along on the trek, I was invited to tea and a game of karimboat (Indian snookers) by a bored and friendly Indian army captain in an outpost by the trail (lots of soldiers in civilian clothes, just hanging out in their posts - I never saw them on patrol or in uniform), got to see caravans of smugglers the soldiers were supposed to stop, their yaks carrying goods from Tibet they smuggle in over 6000 meter passes at midnight(!) - met a 15 year old girl helping lead the yaks, looked like she was 12, though she was married already.

              At last we reached Laya, a traditional beautiful village.  Kids posed for me everywhere.  It's a fairly affluent one, because in the summer yak herders go to the high peaks to collect cordyceps.  The cordyceps is a strange hybrid:  a worm which has a fungus grow out of it's head and poke out of the ground.  They are renown throughout Asia in traditional medicine.  The guide Topgay explained one very important indication.  "It is for this, " he said, moving his index finger from the bent to erect position.  A kilo of cordyceps goes for $24,000, U.S.  That sure beats the $10 a day most horse or yak men are paid for trekking, or the $50 a day guides are paid!  
         I met a group from Canada called Test Your Limits; I felt like I had tested mine!  But they were doing the Snowman Trek.   One guy had had a heart transplant, another  a kidney transplant. They were traveling with their cardiologist and nephrologists.  they had been to the north and south poles as well.    Had a tour, with them, of the local school, checked out the local stores, as my guide flirted with every Layan woman we met.  Lots of jokes about "night hunting".   Then joined the headmaster and a S. African fellow from the Snowman group traveling with me in a game of soccer on a wet muddy rocky field.  Dumb because I hadn't played in over 20 years.  Tweaked my ankle, but taping worked for the rest of the trip (two 7-8 hour muddy rocky slogs mostly downhill to Gasa).   
              I got to see incredible sights of high peaks, forests of azalea, rhododendrons, juniper, spruce, pine and poplar, hear and see birds my guide was good at pointing out.  Overall Tshering (pronounced Ceerin) was a very good guide, but he became jealous of the fact I frequently went to the Snowman group's guide, a big always cheerful guy, named, appropriately Topgay with questions.   "We will see sun today, sir" was his daily weather forecast; he was usually right, even if it meant we were only seeing the sun for about 30 minutes!  We had to wade across two shallow rivers, one with a pretty strong current.  Topgay carried the camera man, who stands 6'3" and must weight 240 lbs, on his back.    

         And all along the way, I was meeting locals who, knowing I was a tourist, and especially  learning I was a doctor, came to me with various ailments, usually wanting American pills, which they think are magical, compared to the basic health units and meds from India. The BHU's certainly haven't put on a damper on this.  Usually I would  just give common sense advice like, to a yak herder woman with a mild wound infection of her hand:  soak it a lot in warm salt water (They all have salt, sometimes obtained illegally from Tibet). The climactic consultation - a bit sad actually- was an encounter I had at the hot springs in Gasa.   
              After arriving in Gasa (much more developed than Laya, though not nearly as charming - they're basically clear cutting mountain sides to try to extend a road to Laya, but it's a Sisyphusian challenge, as every few hundred yards was covered with landslides, with huge boulders and trees ready to come loose at any moment- made traveling on this road, the scariest part of the trip.  Was traveling off and on with a Nepali election officer, who filled me in on a lot of the recent history and politics of the country, but was a bit vague about the ethnic cleansing of Nepalis which happened about twenty-thirty years ago.      But we got to spend a whole day and two nights at the hot springs.   
            A nice relaxing time, with lots of monks and locals and some tourists soaking away stress and aches and pains.  I met an 88 year old monk who was the head guy at the hot springs. He showed me a photo album of him and the royal family of England, who funded the stupa and the rebuilding of the hot springs.   He showed me a picture of him with the king.  He was brought all around the UK by private jet.   But now he had a pain in  his neck from a fall and wanted some pills from me.   He doesn't have his own doctor.   Only the Bhutanese royal family does.   I gave him 7 baby aspirin, and said that this will really work.  The power of positive suggestion.   A psychiatrist, one of two in the country, a fellow HVO physician I have met, says that they used low dose amitryptiline for headaches, "giddiness", depression, with the firm assertion that "this will make you all better"   And it usually does.

                   More, much more on health and happiness in this magical country in future posts:

Below:  Tiger Mountain from the Robluthang camp, elevation 4200 m.,  last stop before Laya.