I was sitting in the living room of my new friend Sonam's apartment.  He had invited me to the first birthday party of his daughter (also named Sonam).  It was a small two bedroom apartment, but cozy and comfortable with pink walls, silk curtains hanging in the doorway, a few large oak chairs, but mostly wool carpets for us to relax on.
              He had picked me up after a hike I had taken that morning with two other volunteers.  We had climbed to new Chhokhortse goempa, a center of calm and contemplation overlooking Thimphu valley.  I "talked" with a welcoming beatific monk dressed in orange robes, using my very limited Dzonka, and his very limited English.  "This is my home," he smiled.  "The king's home", he explained pointing up the hillside to another older complex.  Wherever we travel, the king seems to have a home.   He has one near Sonam's apartment building.  To reach the building, we drove down a dirt road that resembled the surface of the moon. It was a hardly a road at all.  His hubcapless light blue Maruti subcompact kept bottoming out.
         "Does the king go down this road?"  I asked.
          "No", he said.  "The king has a paved road.  Over there" he pointed.  "A private road. Just for the king".
           Sonam called me his "Number one guest".  "My parents are so proud of me that I have invited a doctor".  His parents had travelled from the village of Trashigung in Eastern Bhutan where Sonam grew up.  They are farmers.  Sonam's mother died when he was young; his father remarried.  Sonam had to leave school to help support his younger siblings.  His parents spoke the local dialect, sharschop.  They spoke no English and limited Dzonka.  I met them, and his extended family, which seem to grow by the minute as dozens of friends and family arrived.
                While waiting, we had little corn flake snacks, a cucumber dip (flaming hot, of course, with red peppers), sweet dough bits, tea and beer.  While waiting - as always in Bhutan - I met a variety of interesting people. They included a friend of Sonam's, who was working, 3 months out of the year, as a tour company operator.  He said that though he was happy, as were most Bhutanese, there was lots of stress, which he dealt with by taking the rest of the year off to go to India.  And he planned on retiring in his 50's.  "I will work hard now, but after crossing 55 years…. Old, no?"
             When I said I was 59, he acknowledged that on the farms, 59, 70 or 80, even 90, could be young, because of the life they led.   And Sonam's father and step mother did look very young.      Sonam's friend observed, "From here, complexion, we can see.  Happy, no?"
                Also there was the landlord, a body guard and landscaper for the fourth king who had left his wife for an American woman with whom he lived in New Hampshire for 13 years while running a landscaping company, before returning to build apartment buildings, and rejoin his patient wife and family (All he seemed to recall of NH and the US was Mt. Washington "The weather was very bad".)      Then there was a friendly relative, and employee of the health ministry, there with his wife. I sat between them on the floor for a time, as he drank most of a bottle of wine.  But I left when he was leaning so far over onto me that I thought I might end up toppling over to his wife on my other side.      Finally, there was another friend, a politician, recently voted out of office.  Like so many people I have met all over the world, he greatly admired President Obama.  "He is a very very good President!   I look at all his speeches, and I make my speeches just like him!    He is a very good man!..  "  He also appreciated Western religion, though he remained a faithful Buddhist.  "I like Jesus very much!   He was a VERYgood man!"
            Some of these conversations happened after the birthday cake, and explosion of a confetti gun (which scared none of the small children), and finally, after two hours, the serving of food amid much merriment and celebration.  We had no sha (beef),  oak aha (pork fat), and ge ju ( river weed soup).  During the entire evening, a television played in the corner This interested me because I haven't watched TV in a month.  My roommate Ashoff and I live a quiet life.   No TV, no music (except a little from my iPhone when I make dinner) - just the symphony of dieseling cars and
barking dogs at night.
                This being Bhutan, they weren't watching an episode of Breaking Bad.  They were watching a show about the fifth king, Jigme Khesar Namgye Wangchuk.  No commercial interruptions, of course. It was a rerun - his coronation, from 2006. It was in the big soccer stadium in Thimphu. It was a very extravagant affair, with lots of traditional dance - one the king himself performed in - world dignitaries,  and so on.   Friends and families at the party were transfixed.   I found out the next day that this was the sixth anniversary of his ascension to the throne. His father, the fourth king, Jigme Singyei Wangchuck, vigorous at age 51, had stepped down - not wanting to risk dying in office relatively young, as his father and grandfather had.  The fourth member of the Wangchuk dynasty also established a parliamentary democracy, headed by a prime minister - whom I had met that day.
           I had gone to the "Move for Health" annual walk sponsored by the World Health Organization  and the government.  We gathered 15 km from the capital city at 7am.  The goal was to raise awareness of "non communicable diseases" and to raise money for Bhutan's Health Trust fund.  As the the nation advances, it receives less charity from NGO's and so must find other ways to fund vaccinations for example.  (Though Bhutan still depends heavily on donations - whether it be the work of HVO volunteer doctors, Gardasil, or HPV vaccine, donated by Merck and co., and so on).  There were large crowds of excited students in uniform, government workers, and others.
        We mobbed the back of a pick up reaching our hands in the air for caps or T shirts.  "Madame, Madame,  L please.   Madame.  M!"  I got one of the M's.   Dr. K.P  had already given me a cap.
        Then we arranged ourselves in an auditorium, and waited for the prime minister, in front of a stage, empty except for a table with a yellow awning, seats and the chief abbott of Thimphu.  I was seated in the front row with Dr. K.P., the chief representative of Jaico, the Japanese Friendship Association, and Ministry staff.  We stood up and bowed slightly when the ministers, and head of the opposition entered.  I talked with a 50 something retired government employee on my left.  I was wearing my white coat and HVO identification badge.  I explained that just as all the Bhutanese were wearing their uniforms - kho's, I was wearing mine.
           "Doctors are next to gods," he said "The gods heal people but doctors help them".
            I observed the anti smoking posters which I have seen throughout the country.   They featured "smoking man", a collage of a person with one gangrenous foot hanging off, a hole where his left cheek used to be and other grotesque images which would have been banned in the squeamish US.
          "Many of the people, they can't read," the man said.  "You have to scare them".
          Then I talked to the man on my right.  He was an engineer and forester who works in the Agriculture ministry.   He talked about Bhutan as a green nation.
          "The farmers are organic by default, actually" he said.   "Only 3 percent of the farmers use chemicals.   They have found that many of the weed killers imported from India for the rice crop are adulterated; they don't even work."   They would rather farm the old fashioned way.
           "Even though they are less productive," this agriculture expert explained.  The government is trying to help by bringing roads, and mechanized equipment to farms.   And irrigation, especially tricky in Eastern Bhutan where farms are located up steep dry hill sides.   "It's difficult to build waterways up the sides of mountains," he said.   Farms everywhere are sandwiched between mountains, and are usually no more than 30 or 40 hectares.
            "Only 3% of the land in Bhutan is arable" he said.  "We're trying to change that to 8"
            "72 % of the land is forest," he continued, "We are a cachement area.   There is no exportation of lumber.   We are carbon neutral." And Bhutan is one of the ten top regions for biodiversity in the world,  he said.
            As for Bhutan's people, "they are happy, relatively, because of the family structure.
As long as you have a roof over your head and two square meals a day."
            "Two?"  I asked.  "I always thought it was three."
             "Two," he said,   "but three if you are a farmer".
             "People will work for each other without pay.  Only for lunch"   That old fashioned communal way of life.
             We had waited about an hour for the prime minister.  Finally, he arrived, with a flourish.  We rose in respect.   We were served breakfast:  Hot buttered tea and a dish of rice and hot peppers.   We waited for the monk to chant prayers in the style of the Tibetan throat singers, used here, before eating and drinking.    Then we listened to speeches from the ministers and the PM's  --- or they listened, and I daydreamed, since it was all in Dzonka.   I did recognize the frequent mention of "non communicable diseases".   At the conclusion of the ceremony,  Dr. K.P,  said Hello to me and vanished behind the stage.  I went outside and was caught up in a chute leading out to large gate. Escaping the crush of students, I rushed to the front of the parade, where the Prime Minister, a very fit looking man in a charcoal grey kho was leading the procession. His wife was by his side.  They were holding hands.
                  I quickly lost site of the other ministers and, jogging at times to keep up, followed the PM.  There was no body guard.  The others along side and behind him and his wife appeared to be ordinary people, like myself.   Everyone was in high spirits, including the policemen who accompanied us.  They are all much thinner then the police I am used to.   And they don't carry guns. They were directing us to stay to the left, so that traffic, including the ever present large Indian construction trucks festooned with ribbons and colorful sayings meant to bring good luck on Bhutan's treacherous road, could pass, even if only by inches, to our right.     Everyone, including the health minister, Tandin Wangchuk, who I met later, joined in the fun.
      "Left, La, Left!" (La is the expression used universally for sir). " Left!"  People were singing and laughing, even as we had to concentrate to keep up with the fit prime minister.   I ran in from to take a picture.
       Then I noticed a distinguished looking couple.  They were the first caucasians I had seen all day.  I heard the husband, tall, and grey haired tell someone he was 59, turning 60.    "So am I" I said.
We started to talk.  His wife,  Orellana Lincetto is the new World Health Organization representative to Bhutan.  She is a neonatologist.   She spent 5 years in Mozanbique, developing, among other things the protocols the WHO uses worldwide to prevent hypothermia in newborn infants.  After seven years in Geneva in which they were raising children, she had just been sent to her new post here.
      I asked her some questions, including why the WHO continues to suggest ampicillin and gentamicin as first line treatment for pneumonia for hospitalized patients. (The antibiotic ceftriaxone may be given only once a day, is better absorbed by the lungs, and does not run the risk of renal damage). But mostly I listened as she, and her husband talked about their fascinating lives, living around the world.
           After an hour and a half we stopped abruptly.  The prime minister had led such a fast pace, that we were now ahead of schedule, despite the late start.  Things would not be ready for us when we arrived in Thimphu. So the PM, Dr. Lincetto, and other dignitaries sat under a tent drinking more hot butter tea and rice with peppers, while the rest of us waited, for about a half hour.  Then we were off again.
            I met Minister Wangchuk.   I asked his permission to walk with him.   We talked about his name.  He explained that many Bhutanese had taken the surname Wangchuk, but the only people who historically ever had last names were the royal family.  And they have been Wangchucks, with a final "ck".  He, Dr. Lincetto and I discussed healthcare in Bhutan.  Or, I should say, they did.  I listened.  I was well aware of my lower station in this trio.  But Minister Wangchuk did say that he would give his concluding speech at the Clocktower in English as well as Dzonka, so I would know what he was talking about.   At around noon we arrived at the gates to the city of Thimphu.    Burning incense and prayer flags, as well as bottles of tropical fruit juice and hot milk for all, and more snacks around round tables for the dignitaries.
          The final walk to the clock tower was tough.  I had trekked for 14 days over high mountain passes, but I had never walked for over an hour on hot pavement through the urban sprawl which are the environs of Thimphu.  I was getting tired of talking too, even though I met an engineer who told me he was also a philosopher. He had just written a book.  He said that the Bhutanese are relatively happy, but that "all happiness is relative" and not the concern of philosophers like him anyway.  He is more interested in looking below the "inner surfaces" of things.   He could not really explain to me how he had become both an engineer, an author, and philosopher after growing up in a little village in Eastern Bhutan, not even speaking Dzonka, only Sharschop.  Maybe his upbringing was was motivated to him to do all those things.  He was a fast walker, and did not want to wait while I took pictures.
         I walked alone for a while amidst teenage students.  Then, suddenly:
         "Hi, Dr. Dave!"    It was Sonam -appearing out of nowhere.  It was his daughter's first birthday the next day.   And I was invited as his honored guest.    Yes, he would be happy to accept my invitation for dinner as well.  Did we have music, he asked.  He was not a sportsman, but loves to sing and dance -- any kind of music.   I played him samples from my I phone:   Bhutanese music,  Shaggy, Bonny Raitt.   I found myself again longing for my wife Shelly:  We love music, all kinds.  And we love to dance together.
     
        I've learned that the curve of history is viewed as circular, not linear in Bhutanese culture and in other Asian cultures.  So do many of my days seem to be here in this country --- filled with chance, coincidence, and (perhaps) karma. Unexpected and even magical occurrences and happenstance seem to fall from the sky.
        And while the pace of transformation in Thimphu, the adoption of the internet, of Western pop culture and American name brands and food products and consumer items seems to be happening at breakneck speed, some things like the absolute reverence for the royal family seem to be engraved in gold.   How does this affect the society's views towards reform and advance in its health care system?
       At the final ceremony at the clock tower, I rejoined Dr. K.P and Dr. Dowa, a visiting neonatologist from Japan.  We watched and listened as musicians played and sang, traditional music, karaoke style. Minister Wangchuk spoke in English as well as Dzonka as promised.  The theme was again about how non communicable diseases:   hypertension, diabetes, traffic accidents, cancer, and alcoholism and drug use represented the new morbidity and mortality in Bhutan, as they do in the West.   I was to have an unexpected chance to address a couple of these issues two days later.
                But now I found myself nodding off.  I bought a 100Nu "recharge" for my phone,  treated myself to a wonderful haircut and 45 minute head,neck and shoulder massage (all for about $6) and took a nap, before meeting my guide and friend Tsering for diner.