by Britta Das
In any case, today Choden is coming to physiotherapy, accompanied by her mother and her little five-year-old daughter, Yeshey. Choden is a very pretty young woman of twenty-six, with large brown eyes and a full head of short black hair. She smiles readily, and her expression is one of intelligence and understanding. Self-confident and remarkably agile, Choden has learned to manipulate her legs in such a way that she can get around by supporting her body weight on her extremely muscular arms and pivoting her hips to the side. This method allows her to at least move from the bed to a chair or, if needed, to the ground.
Transverse myelitis struck her a few years ago. Again, the number of years varies between different versions of the story, but it seems clear that the onset occurred after her daughter’s birth. Since then, she has gone from being completely paralyzed below the waist to her present status of experiencing painful lower extremity spasms. She says that her catheter is the main problem. She has only one and, in her village, it is difficult to keep it clean. Over the past few years, she has been in the hospital several times for urinary tract infections.
Curious, Yeshey, the little daughter, looks at me. She appears intrigued by my blond hair and pale skin but remains quietly standing beside Choden’s wheelchair. Like a tiny guardian, she assesses my trustworthiness.
“Do you want to sit on the bed with your mom?” I ask. Yeshey nods seriously. She does not intend to leave her mother for even one minute.
I ask Pema to translate our assessment plan to the three women. Choden’s mother asks a few questions, but Choden remains quiet. Smiling, she pulls her daughter closer, and although Yeshey must not understand all that is being said, she visibly relaxes.
Pema turns to me with a frown. “It would be better to be in Thimphu.”
“Why is that?” I ask.
“Thimphu has more equipment and better room. It is much easier to work there.”
“I don’t think it’ll make much difference for the assessment,” I counter.
“Still, it is better to work in Thimphu.”
“Well, let’s see what we can do here. We should be okay.”
Pema’s sudden appraisal of our primitive conditions in Mongar astonishes me. Could it be that Choden reminds Pema of her son, and now Pema is wondering if Nima could get a better treatment in the capital? I resolve to encourage my faithful assistant to bring Nima to our physio room. Maybe if we see some success with Choden, Pema will feel more confident in my treatments and let me try with Nima.
I look from Pema to Choden and am struck by the same quiet determination that these two young women share. But for once I am grateful that my patient does not speak English.
“Please don’t discourage Choden before we have even started,” I plead with Pema.
My usually diligent assistant shrugs her shoulders but affirms once more, “Thimphu has better facility.” Then she starts the physical assessment.
After several attempts at moving Choden’s legs to evaluate her range of motion, Pema has to abort her efforts. The more she tries to push, the more Choden’s legs go into spasm. Once triggered, the strong involuntary muscle contractions grip Choden’s legs like a vice, pushing them into a pointed-toe, straight-leg position, or pulling them into a tight crouch. The harder Choden concentrates herself, the more her muscles play havoc. Nothing can be done but to wait for them to relax in their own time. Eventually, when the tension slackens, Choden is able to put her legs into a reasonable position through stiff, jerky kicks.
Still, she is eager to keep trying, and after a short rest we again attempt a meaningful movement, this time more slowly. Initially, it looks as if we could succeed. Then, completely unexpectedly, I feel Choden’s legs tighten, and before I can react she has kicked me against the wall. My hip bangs against the iron bar of the suspension frame, and loud rattling echoes through the room. Embarrassed, Choden apologizes, and I can see that she is now ready to give up. Through Pema I try to reassure her, try to tell her that it does not matter at all. How can I make her understand that I am the one who feels silly? I should have been prepared. I promise myself to watch out the next time.
In full concentration, we continue for another twenty minutes. Finally, we find a solution. Bending Choden’s knees to ninety degrees and pushing the soles of her feet with an even pressure onto the bed seems to interrupt the constant waves of spasm. Choden smiles through her exhaustion. Perspiration has plastered her hair against her forehead, and little rivulets of sweat are running down her cheeks.
Choden’s mother disappears to fetch a glass of water. Yeshey climbs onto the bed and lays her head on Choden’s stomach. Tenderly, the two whisper to each other. Then Choden laughs and brushes a curl off Yeshey’s forehead. I am touched as I watch the closeness and confidence between mother and daughter, and ponder the stormy weather that must have strengthened this trusting bond.
Just like Lhamo, Choden and her family live in a small village far away from Mongar. A trip to the hospital is like a voyage to a different continent. At home, her parents and her husband run the farm and Choden is left to herself for most of the day. She gets around the house by sliding along the floor, pulling herself with the help of her arms. Still, her happy spirits do not seem to suffer. Now she is joking with Yeshey, and together they tackle her transfer to the wheelchair.
Encouraged by our modest success, I plan my treatment strategy. I want to help Choden to walk. Her body is strong, and she is a determined woman. Somehow we will make it; we will find a way. I ask Choden to come back tomorrow morning, first thing before rounds, so that we can divide the treatment into two shorter sessions. Upon my arrival in Mongar, the DMO had inquired if I needed anything else, and now I know what is missing: a set of parallel bars! We need a solid grip for each hand to help Choden stand up, and a narrow walkway to prevent a fall. There is enough space along the far wall of the exercise room to accommodate a bar of ten-step length. Just long enough. And we need a mirror. Choden has to see herself stand; she has to see that it is possible.
I explain my ideas to Pema. “Do you think we could find a really tall mirror?”
“Why not!” Pema answers enthusiastically. All signs of her previous wariness have vanished. “You should speak to ADM.”
Shortly thereafter, I discuss my plan with the hospital’s administration, and the ADM sends Arup, man of all trades, to assess the situation. We agree that for the parallel bars we will use a couple of old pipes and make a base out of wooden boards. Immediately, Arup asks me for an exact drawing of what I have in mind. Perhaps my enthusiasm is contagious.
Two more “general mechanics,” Dendrup the electrician and Tenzin the assistant, join our little group, and like a team of engineers we survey the building site.
“If the base is too long, it will not fit around the corner here,” Pema cautions, pointing at the hallway that leads to the TB ward.
We study everyone’s palm size and estimate the required circumference of the pipes needed. Then we discuss stability problems. I show them how ideally we would need the bars to be able to move up and down to accommodate patients of various heights. Arup answers my every suggestion with a return confirmation, “You would like it like this . . . isn’t it?” followed by an encouraging little sideways shake of the head. “Yes, yes, I think that is possible, okay, okay!”
Arup is eager and seems quite knowledgeable. Pema is ready with critical comments, and Dendrup and Tenzin nod obligingly. I have every reason to put full trust in our mission.
In the afternoon, I am standing with Arup and Dendrup in the laundry-drying hut, a simple covered wood structure held up by a few posts. There is a fireplace at one end, and wire clotheslines run parallel throughout the length of the shed. The hut seems to double as a storage room, and below the drying sheets and pillowcases there are piles of wood scraps, old doors, dented, rusty night tables, and broken windows consigned for . . . I don’t know what.
Though all sides of the hut are open for a breeze to circulate, the air smells stale
and musty. An old woman, probably a relative of one of the patients, is cooking something over the fire and smoke creeps through the mist to settle on the freshly washed sheets. Arup and I are discussing the engineering principles of building parallel bars, and I watch as Dendrup hammers the four corner supports into place.
I am flabbergasted by the speed of the whole operation. In my experience, the hurried, fretful West and most of nonchalant, unruffled southern Asia run on a different perception of “on time.” Bhutan is no exception. Usually things promised for tomorrow arrive the day after, if you are lucky. So far, I have learned that patience is probably the one survival technique that I will have to perfect. Yet here I am watching the makings of my parallel bars, less than a day after the idea was conceived. It is a miracle.
Another miracle blesses that wondrous afternoon. The rain stops! As if someone in the heavens was grabbing chunks of the white fluffy stuff and flinging it into space, the clouds break up. Torn to this side, then to that, the fog loses its grip on the ground and evaporates in one slow huff. Warm yellow sunrays flood through the patches of blue sky and burn away the remaining shadows. Steam starts to rise from the earth, as water droplets on trees, bushes, and grass turn into vapour.
Around me, an entire spectrum of green explodes in the sunset. Out of the mist, the mountains rise to meet the sky. They are beautiful, gentle mountains, softly curved and cushioned by jungles of dense green foliage. Valleys carve themselves through the ranges, zigzagging between the slopes only to lose themselves behind the next corner.
In front of the hospital, in a little courtyard half enclosed by the infectious disease wing and the operating room, a small crowd of attendants and patients gathers to enjoy the glorious evening. Women chat quietly, their fingers all the while busily finishing off a piece of weaving, spinning some wool, or picking lice out of someone’s hair. A group of men sits off to one side, absorbed in a game of cards. In a large depression in the ground where the new hospital construction is planned but has not yet begun, children play on a pile of sand. Some are engaged in a game of hide and seek; others are strapped with a saggy piece of elastic that is the instrument of a lively jumping contest. A few boys noisily play football.
Choden’s wheelchair has been pushed up the ramp to allow her to watch some of the activities, and Lhamo’s mother wheels her daughter over to the grass. Timidly, Yeshey and another little girl in a tattered kira begin a game of catch with Lhamo. For the first time, I hear laughter that is loud and free. Unconstrained and relaxed, the afternoon is marked with happy songs and games. Only when the sun sinks behind the mountains and the cook announces the arrival of dinner does the little community slowly move back inside the walls of the hospital.
The art of weaving is an important part of Bhutanese life.
10
compassion for little things
In the third week of June, blessed with a full day of beautiful sunshine amid the dark days of the summer monsoon, I move my bed and buckets into my newly assigned two-room quarters below the hospital. My spirits soar. In no time, my cheerless classroom abode is forgotten. Although the neighbourhood of construction sites has tripled from there to here since I arrived in Mongar, if I can ignore the noise, the view is superb. Before my doorstep, a steep valley drops out of sight, climbing up the opposite side on the southern slopes of Chhali Mountain.
My set of rooms is one of four identical apartments in a cement building that skirts the lower hospital campus, and if it were not for the construction noise around me, I could make-believe that this is indeed my palace at the end of the world. My neighbours are friendly even if not overly eager to become acquainted. Only the OT nurse Sister Chandra to my left is happy to exchange a smile and chat. The inhabitants of the two units above me prefer to share only our vista.
In front of my entrance door, there is a little overhang of the stairs leading to the upper units. I quickly designate it as my own laundry-drying room. On the first Sunday morning after my arrival, my small could-be porch is promptly christened by a chicken, which very unceremoniously blesses my doorstep with a couple of squishy droppings. Apparently satisfied, it then proceeds to stick its head through my door, inspecting my all-purpose living room/bedroom. I never find out whether my decorations meet approval because a rooster comes speeding around the corner, and the two take off in a feather-flying cackle.
Then the telephone rings. A real phone, my own telephone, in my own apartment! It is not any old telephone either. For the last five years, Mongar has been connected to the outside world via satellite, a luxury beyond measure. I am reminded again that when new technology arrives in Bhutan, it is often accepted only in its most useful and sophisticated form. In eager anticipation, I pick up the receiver and find that the line is clear and static free. But I cannot recognize the voice at the other end.
“This is Dr. Bikul,” the voice repeats.
Yes, of course, the skeptical doctor. Why is he calling me on a Sunday morning?
“Do you want to play badminton with us? All the doctors are going to play a game at about ten o’clock.”
Me, play badminton? Help! I have not held a racquet since high school. I am not convinced that this is the time to start delving into a game against all of the respected high society of Mongar Hospital.
“Well, I don’t have a racquet,” I answer.
“That’s okay, you can borrow one from somebody else,” the doctor insists enthusiastically.
I try to think of another excuse, but my mind is blank. My reply sounds hollow and lame even in my own ears. “Thank you, but maybe not today. I might come up later and watch.”
Dr. Bikul does not seem satisfied with my answer and hangs up after a disgruntled “Okay. Bye.” I feel guilty for turning down his first social invitation. Nonetheless, I am off the hook for today.
By noon, a little stab of loneliness shames me into watching at least one game. Fully expecting the inevitable stares and hushed snickering at my appearance, I climb the path to the main campus and head towards the hospital. To my relief, I meet no one.
On a small cement island amid the staff quarters, a men’s double is under way. ADM and DMO are facing Dr. Bikul and Karma, Pema’s husband. The game is fast and cutthroat. No laughter breaks the tension. Though I assume that they are enjoying themselves, the players look as if they are fighting a war. Clenched teeth, eyes pinched into a narrow squint, they attack the bird. A fumble of the shuttlecock is greeted with a loud groan by the teammate and a triumphant cry by the opposition.
I linger for a few minutes, and then continue along the road leading through the hospital campus. The Class A quarters surround a grassy patch with a few trees and an old volleyball court. Dr. Shetri, Dr. Kalita, Dr. Bikul, and Dr. Robert each have separate houses with little gardens and a spectacular view over the valley. The DMO, ADM, and matron have flat bungalow versions of Class A, located in the heart of the campus. Around and to the sides lie Class B and C quarters for nurses, lab technicians, and other support staff.
I know that there is an acute housing shortage. All of the present construction is for new staff quarters. However, the space is limited and old quarters had to be demolished in order to build new ones, leaving many employees without a home. They had to move into the town itself; however, there too, everything is occupied. A place like Mongar does not see a lot of change, and an influx of new bodies simply cannot be accommodated.
On completing one loop of the hospital road, I end up back at the badminton court. The game is over, and the ADM and Karma are dismantling the net. Dr. Bikul saunters over to join me. Immediately, my nagging guilt returns, and I smile.
He seems to have something on his mind, but not the words to say it. Shifting nervously from one leg to the other, he looks at me, then at his racquet, then again at me. “Do you want to have dinner at the guesthouse tonight?” he finally asks.
Dinner? I can hardly believe my ears. Yes! Of course! A dinner that has been cooked by someone else. A real dinner, not
like my brew last night. I think of my rice, which turned into a pot of porridge-like gunk, and the green beans that were tasteless too, not forgiving the lack of spices or sauces. For far too many days, I have been living off potatoes and bread. Honey and peanut butter are already coming out of my ears.
Does he know that I am a lousy cook, or is this a social invitation? Well, one way or the other, dinner means a full stomach to sleep on. Trying not to sound too eager, I quietly accept the offer.
The Sunday turns into a hot, muggy day, the kind that leaves you gasping for air, dreaming of fresh lemonade and ice cream. We start our climb from the hospital at five o’clock. The evening is warm and cloudy. Finally, the day’s heavy humidity has ceased to throttle our energy, and the agonizing heat has cooled to a pleasant mild summer’s night.
Dr. Bikul marches slightly ahead with short, purposeful steps, and I do my best to keep up. By some unspoken law, we walk in silence until we reach the bazaar. Then, among the hubbub of Indian labourers, villagers, and young men drinking and noisily playing carom, a game similar to pool, we slide into a serious conversation. Dr. Bikul is now eager to talk.
“I like Canada. It is a good country. Canadians do a lot for the environment. They are an international leader in environmental protection.”
“Hmm.” I answer with a vague confirmation.
Dr. Bikul continues, “I like especially the Hudson’s Bay Company. I have heard that they do a lot to protect the forests in Canada.”
This time I have to interrupt. I am not sure that he really means the same Hudson’s Bay Company that I am thinking of. “Did you also know that the Company was originally based on fur trade? That is not an entirely environmentally friendly business,” I say.
