Tuesday, September 11, 2018

   

                       It has been difficult to believe that it has been almost four years already since my time in Bhutan.  And yet I still think of my time there.
         Nearly every day.  It took me two years to get the photo's I took up on the walls of my exam rooms.    But what I lost in procrastination has been made up in effect.  Parents and kids ask, constantly, "Who took these pictures?"
             "Me," I say proudly.
             But they are more than just pretty pictures.   I use them all the time, to help kids through exams, and procedures, as metaphors for problems they may be facing.  In one room, facing the exam table, is a cute little boy in the vaccine clinic, with his mom, looking at the camera with a mixture of curiosity, and perhaps, a little trepidation.  
             I ask my young patients, "What do you think the little boy is waiting for?"
             They often guess "Shots", though there are a variety of other answers, like waiting to eat, for a movie, and so on.   
             Then I ask who the young woman is with him.  
             They often guess it is his mom.  
             If the child needs vaccines, I will say how the vaccine clinic is all there is for kids in Bhutan and many countries of the world without enough doctors for regular checkups, but how important they are.  They aren't so interested in how the vaccines prevent deadly disease as how the shots hurt, so I will point out how the boy stayed calm with the help of his mom.  Their mom or parent or grandparent can do the same. 
               In another room, there is a picture of an archery target with arrows sticking out of it, with archers from the opposing team, in their traditional gho's, waving around the target.  
            First, we will have a guessing game about what is happening.  I'm not sure why, but many kids think they are looking at something like a table cloth instead of a target.   Maybe because the targets in Bhutan are so low to the ground and so small - about the size of dinner plates.   
            If they can't guess, I'll tell them that those are arrows.   I'll say that the opposing archers are shooting from 450 feet away, the length of one and half football fields!  I'll point out the small size of the targets.  If I have time, I'll talk about how archery is the national sport of Bhutan.
How, in the nineteenth century, Bhutanese archers rebuffed the only attempted invasion of their country, by the British, who briefly attempted to extend their empire from India.  The arrows and the Himalayas quickly put an end to that plan.  
             I'll say how the Bhutanese used to be this accurate, somehow, using old fashioned wooden long bows, though they now use American compound bows.  I'll say how these men walk for days, in the mountains from village to village, from tournament to tournament.  There are no roads.
           Finally, I will have the kids guess what the men are doing.  
           "Helping the other guys?" they say, or just "standing around?"
           "No, " I say. "They are hurling insults at the opposing guys and trying to distract them."
           I might point out that in the days of the old long bows, the team guarding the target, would actually try to knock the arrow out of the air with the loose sleeves of their gho's. They wouldn't try that now with American crossbows; but still, standing right next to those little targets, you can imagine what one of the leading causes of injury, and death is in Bhutan!  
           Kitty cornered across from that picture is another, of an archer team whooping it up after a round.  Song and dance are big parts of the sport.  
           These pictures, and stories provide great metaphors:
           1. The amazing things we can achieve with enough focus and practice and discipline (Great for kids with ADD)!
           2.  A nice message about safety.
           3.  The importance of celebration, of dance, and tradition.

          In my big consultation room, I have wonderful photos of children smiling, playing and dancing.   They were mostly taken in the village of Laya - where the Netflix documentary "Happiness" was filmed.  It's a town of several hundred people perched over a hanging valley at 14,000 feet.  There was no electricity nor running water.   The next nearest town was several days walk away.  Yet the kids in the one room school house were smiling when we came in, and all stood up and said, "Hello sir".   
         I played a vigorous game of soccer with a bunch of them on their one mud and rock-strewn field.  The school master played hardest of all.   Needless to say, I was wiped out in no time, though my tough as nails South African fellow trekker did a bit better.  I visited the one general store that had several dozen cheap items for sale, including the local alcoholic beverage, which would knock your socks off.  I saw a young mom with a group of children carrying firewood on her back.   All smiling.    
          They are actually a prosperous village because of the presence of the Cordyceps Sinensis herb, or Yarsagumba, a powerful aphrodisiac and energy enhancer.  It grows on the nose of a caterpillar that buries itself underground.   It only lives up 3300 m in Nepal and Bhutan and Sikkim and has to be found and dug up in the rainy season.   It sells for $1500-$2000 per kg.  Its sale is highly regulated.   It has overtaken yak herding as the chief occupation in these parts. 
       I have a picture in the room of a herd of yaks, taken from the middle.  My guide Tshering and I were hiking down from the village above a valley where the mystical and strange national animal - the takin (which looks like an oversized cow with the head of a moose and the horns of a ram) over winters.  All of sudden, we saw a solitary old woman herding yaks coming down our trail.   
      "Don't move!!" Tshering shouted, when they were suddenly around me.   Yaks are not pleasant animals.   They are the size of bulls with long sharp horns. They are known for their irascibility.  I took some deep breaths, had the forethought to take a few pictures - though not a video, which would have been really cool.  In a minute or two, they were past us, the woman throwing rocks at them to shoo them on their way.
        I have used this story as a metaphor for staying calm in the midst of a tough situation -- great for anxious patients.   I will also point out that their worries may not be as dangerous as being stuck in the middle of a herd of yaks on a steep mountain trail, but they can be just as scary.
      
  
              

Wednesday, August 29, 2018

     As I sit here at this wicker table in a cottage overlapping Nauset Marsh on Cape Cod, it is difficult to believe that this time last year I was taking care of children at the Jigme Wangchuk Dorje National Referral Hospital in Bhutan.  Yet I think about it all the time.
     We love coming here.  The sounds and smells and feel of the ocean are calming and healing.  I can't resist jumping in the waves, any time of year. I always sleep better here than anywhere else.  We feel blessed to be living in a part of the country within a few hours drive of this beautiful national seashore.  We came to relax - to read, to meditate, practice our songs for the jazz choir we've joined, do yoga, do some writing.  My wife brought her water colors to paint..  Yet there is so much to do: kayak in the salt marsh, walk our dogs Jazz and Blue on the ocean or the bay, explore the fresh water ponds, cycle around Coast Guard Beach and up the Cape Cod Rail Trail, that we found little time to just sit around the cottage.
       Bhutan, of course is a land locked kingdom.  It is so far away from the ocean that the fish brought in from the Indian Ocean tastes decidedly old, even though it is salted and preserved.   The kingdom has lots of fresh water but even that is mostly off limits to people.  The high mountain lakes are preserved as sacred ---- stocked with fish, but just to have more fish around, not for fishing.  And though the the Pho (male) Chhu (river) and Mo (female) Chhu in that frame the Punakha Dzong have become river rafting destinations, most rivers, like the one that flows through the capital, Thimphu, are off limits to people.
      No boats.  Few places to swim - even indoors.  A few exceptions like the overheated hotel pool I found, cleaner than the outdoor pool at the big teen center run by the "white monk" with its spittoons along the gutters, but still too cloudy to see more than a few feet.  The manager was going to "get to it" the entire time I lived in the city.  I enjoyed it mostly for its warmth and the reliable heat and water pressure of the shower in the locker room, on those chilly afternoons at 3000 meters elevation.   Bhutan, except for its five star hotels, has no central heating.
       Yet the nation is totally dependent on water.  Hydroelectric power, derived from melting glaciers from the high Himalayas, is its number one industry, it's chief export to India -- the large nation on which it is so dependent.  Trekking in the Himalayas, water was are ever present companion.  Mostly it was in the form of rain.  It was the end of the monsoon season.
        (As I sit writing now, sudden thunderstorms have engulfed us.  Blue is barking at the thunder.
I'm headed to check out Willy's Gym and their indoor pool in Eastham --- hoping that their rules about closing it down during thunderstorms aren't as strict as at our Y back home.)
          "Wow Dave, look at it now,"Shelly says.   Blue is barking constantly now.  The trees are ben double across the marsh. The thunder is almost constant.  Lightning fills the sky.)
        But there were also the many many bridge crossing, fordings in thigh high water (I still remember the guide Topgay carrying 6 foot two inch 240 lb Dan the photographer on one of them).  The trails were muddy, stony and slick.  I still remember when I sprung my back out at the Jolomarhi base camp, on day 2 of the 14 day trek, hopping from stone to stone over stream beds, my pinched nerves screaming with each jump.
         I've learned to ignore pain -- that especially in the case of my back - things will get better. Sitting around makes it worse.  My experience, and the literature backs this up (no pun intended).
We head up a steep trail, looking at gullies on each side.  It begins to rain, lightly.  We see yaks in the distance.  My guide Tshering says "Look out!" as a big Himalayan mastiff guarding a hamlet, begins to bark.  We arrive at a mountain pond, hidden in the mist. Of course, no one can swim here nor fish. There are stories told about children who snuck into the water, and who were never seen nor heard of again.
       Three children approach us.  One is in traditional dress, and two have trousers and oversize yellow galoshes.  One has an umbrella.  They are unsurprisingly, shy, as who wouldn't be as a chillip approaches their isolated outpost.  We smile at each other.  I study the ripples in the pond created by the rain drops as Tshering goes to find a "friendly bush".  (I later learn that he is going for a smoke, a habit that is banned in Bhutan).  I dip my finger in the water, reverently enough so that I hope to have not upset the mountain gods.
        When we turn back down towards our camp, I begin to sing a song, "Hang on Little Tomato", by the group Pink Martini, that my wife sang in our local jazz choir:
          "The sun has left and forgotten me
            It's dark; I cannot see.
            Why does the rain pour down, I'm gonna drown----
             In a sea
             Of deep delusion

             Somebody told me; I don't know who
             Whenever you are sad and blue
             And you're feeling sorta down and left behing
            You just take a look inside you and you'll find

             You gotta hold on, hold on through the night
             Hold on; things will be alright
             Just when it's getting dark, and not a single spark
             Of sing song sunshine from above
              Sending rays of sunny love

            Just hang on, hang on to the vine
            Hang on; things will be divine.
             If you start to cry; look up to the sky
            Something's coming up ahead
            To turn your tears to dew instead

             And so I hold on to this advice
             When things are hard and
                     not so nice!
             You just listen to your heart to hold
                       night through
             Your sunny sunshine will come one day
                            soon - for - you.

    Halfway into the song, the rain tapered off.  I stopped singing.
The rain began again.  I began to sing the song again.  The rain stopped.
Tshering, who had been laughing at me now looked in amazement.  I was amazed as he was
Maybe there are mountain spirits here, who listen to a chillip singing an American pop tune!
      We enjoyed our walk back down to camp.   My back pain was gone.

(This post was begun three years ago, and finished today, on a porch overlooking norther Lake George, NY , after a hiatus from my blog)