Himalayan villages

I will not rush to compile a reflective response to the first two weeks of camps in rural India but would like to offer a narrative thorugh photos and observations of the Himalayan regions visited:

May 24-June 6, we traveled into the rural communities north of Manali for what were advertised as dental and medical endoscopy camp services. Leaving Manali in Kullu Valley, we journeyed up into Lahaul Valley to spend several days in Keylong. Leaving Lahaul Valley for Pangi Valley in the West, we visited the communities of Udaipur, Killar, and Purthi before trekking back past Lahaul Valley to Spiti Valley in the East to serve the cold desert communities of Kaza and Tabo. Traversing the northern region brought us close to Paksitan in the west and China in the east. Tibetan influence was seen throughout the area, as well as blending of Hindu and Buddhist traditions. The elevation ranged from 10,000-15,000 feet and chilly night-time temperatures were those characteristic to mountainous regions. Our team drivers, cooks, and community development director kept the team safe, fed, and warm throughout the two weeks. Visiting foreigners aren’t usually taken on the camp trips, so I was very thankful to have been an exception for the learning and service opportunity.

The morning after my arrival, we gathered for an early 7am departure up the Himalayas towards Lahaul Valley over the snowy Rohtang Pass (13,050 ft elevation). The camps in 6 communities were planned to provide dental and endoscopy services.

Passing Saach Pass (14,500 ft elevation) and several waterways into Pangi Valley we stayed in the community of Killar for two days.

Enjoying two days of collaboration with a dental technician who runs the government hospital’s dental department in the absence of a dentist (mainly does extractions and makes dentures but also tries his hand at endodontics...thus many a pulpectomy was delivered at this site in preparation for local referral).

A monk valiantly tolerates an extraction. It is estimated that in the Spiti Valley 16% of the population are monks (or nuns) associated with Buddhist Monasteries. Their distinct red clothing and constant book-in-hand brings much respect on the roadways to their calling and exile from their native Tibetan Plateau (we would sometimes give the monks rides when en route from one village to another). One of the dental assistants in Kaza wanted to refill the water bottle but forgot to turn off the air pressure, an action which resulted in a loud pop akin to a minor explosion that made our patients jump up and instinctively evacuate the dental clinic as if shell-shocked from times of violence (I don’t know the Tibetan refugee crisis well enough to know how much violence was inflicted on them. The Tibetan longstanding refugee situation makes me wonder if the Syrian refugee crisis will become the next widely accepted exile.

After crossing the Kunzum Pass (15,060 ft elevation) on our jouney back from the Spiti Valley, we stopped for breakfast at a tent diner that receives regional recognition for offering complimentary chai.

The Drilbu Retreat in Tupchiling (Lahaul Valley) is home to a Buddhist Monastery. We had our first lunch there on the way to Keylong and stayed the nights in the huts between a two day journey from the Pangi Valley to the Spiti Valley.

The Buddhist Monastery serves as a summer retreat area for prayer and study to many. Tibetan prayer flags are common in the region. It is believed that the prayers inscribed on the flags are carried by the wind as blessings for the region. People hang these flags on their cars, houses, and especially religious structures.

Keylong is a fairly well-developed village with what looks like a bike shop.

Traditional construction consists of earth and wood, though structures that appear to be under construction often utilize the beautiful rock as beautiful siding.

View from a museum in Keylong.

A wide variety of pharmaceuticals, as in many countries, are readily available without prescription and are sometimes concocted in house.

Dr. Tae Hee, my mentor and closest colleague stays cheerful no matter what!

Woolen products are an art and necessity in the region. Patients are accustomed to removing their shoes in the dental clinic and showcase a variety of styles and colors of warm socks.

Freshly prepared samosas with potato, peas, carrots and masala are available in any market.

I’m not sure if clay or paint was used to coat the building but the colors aged well.

Melting glaciers create streams that trickle down to join the Chanda River, which the road and most settlements in the region stay close to.

Dr. Anjali attended one of the two well-known and renowned Christian Medical Campuses for her BDS training and is completing her service term in the Kaza community. I roomed with her and enjoyed serving alongside this colleague as we related similarities and differences in dental training/practice between India and the USA.

 View of the Pangi Valley from a porch of the satellite clinic of the Lady Willingdon Missions Hospital (our lodging accommodation in Killar). The clear night-scape of stars and sunrise in this remote village is also spectacular.

As we arrived and set up for clinic in the village of Purthi, the school children were just starting their morning prayers and announcements before marching off to their classrooms in rows of classes. Many of the girls were curious and happy to engage with the visiting healthcare team.

Two of our nurses, Amra and Purthi, and I take a walk before dinner. Kunga is native to Kaza in the Spiti Valley and Amra is native to Manali.

As we journeyed through Lahaul Valley into Spiti Valley, we saw a young woman and a baby waiting on the side of the road and gave her a ride. It turns out that she is Kunga’s cousin from the same village where she grew up (towards which we were headed)! She married a man from Lahaul Valley (not so common from someone from the Spiti Valley) and has difficulty visiting her family due to lack of transportation from the area where she lives. Her daughter provided some entertainment as we bumped around on the second day of travel to Kaza.

Between the passes, there are often conglomerations of diners where travelers can stop for a break and some warm chai (as well as purchasing the essentials like woolen warm attire and snacks).

Traditional bread is made much like Latino Pupusas. The wheat-based dough envelops a potato/vegetable mixture and is rolled out before being fried on a pan (eaten with mango pickle or dhal for breakfast or throughout the day). As we rested between passes in a tent diner, it was fun to listen to the woman’s stories of the region and watch her make the bread.

Rest stop before Kunzum Pass.

Kunzum Pass (15,060 ft elevation) is very windy and makes for a spectacular religious center at which to worship (if you’re willing to take your shoes off to enter the temple area in the chilly breeze).

Water shortages and lack of electricity are characteristic and commonplace to Kaza, making life somewhat challenging. Dr. Bishan reports that the population increases yearly while resources become more and more scarce (water and natural resources like wood or the ability to grow food). Suicide rates in the region are also increasing (even as tourism rises and the government struggles to find solutions to resource scarcity). Dr. Bishan recalls the bitterly cold winters in the cold desert but recalls the unique ways communities celebrate family and community by dancing in the snow or celebrating festivals together. These kids, so cheerful and lively on their way back from school, show the hope that remains in the region despite challenges.

It’s a wonder how the remote regions are supplied with petroleum products…one must have to be a very masterful driver to safely deliver large quantities of combustible fuel to people that use it in Spiti Valley.

Prayer wheels and Stupas (as well as Tibetan prayer flags) are characteristic to the Tibetan influence on Hinduism in the region, which has no problem with accepting the Buddha or Dali Lama as religious authorities. We even visited one of the only blended temples in the region that welcomes both Hindus and Buddhists to worship in the traditional Tibetan language.

Prayer wheels can be found throughout the village, including the market of Kaza.

Kids trek to and fro, often lugging large jugs of water from any source that hasn’t been exhausted (the river bed to the left is clearly depleted).

Journeying back to Manali along rocky terrain.

Kitchen at the Lahaul Monastery.

When electricity is not stable, headlight lamps are so helpful!

Downtown Killar

Chaat is a vegetable snack almost like salsa.

Queen Anne's Lace in Udaipur.

Catching up on reading as we prepare to depart for another village.

Many of our patients brought siblings to care for their babies…it is common to see a young girl/boy with a baby strapped with a shawl to their back. Especially those who must work on the land or in construction settings, young children are often tasked with child care from as early as age 5.

Market color

Children are often accompanied by their siblings (not much older than themselves) as parents are likely working or getting treatment as well).

The Eight Stupas in Kaza seem to be placed in the center of a busy road, perhaps encouraging people to use the prayer wheels in passing.

Spiti sunset in Kaza

Taking photos around the Buddhist Monastery in Kaza after clinic.

Several young children accompany their parents to construction sites where men do the heavy lifting/digging and women pound rock with hammers to create pebbles.

Our nurses do a wonderful job of obtaining a brief history and vital signs for each registered patient and direct them to the right department.

Our team members found several four-leaf-clovers and also spotted a moth.

The Eight Stupas in Kaza reach high into the sky.

The schedule for dental treatment in Killar is very structured.

I wonder at what age women adorn the Pangi dress and have the multiple ear piercings made…perhaps at the time of their marriage?

Dressed in typical Pangi attire, this lady from Killar is happy to receive dental care. I have been told that a necklace of a specific type signifies marriage in this region. 

Looking very presentable in his polo and wool, this young man is ready for a dental exam.

Endoscopies and a few biopsies in the medical department. 

Our skilled drivers can overpass cars at a distance of centimeters and can seemingly swim through herds of goats, sheep, yaks, or cattle. I’m not sure if I would develop the courage and tenacity to make such obstacle-coursing a career, though.

A bus station in Killar offers a panoramic view of the mountainside.

Finding refuge under Kunga's shawl when getting caught by a storm on an evening walk.

Old practice to address an issue that I hope is obsolete.

While I attempted to be discrete in taking photos of the landscape and surroundings without bothering the locals, this boy came over and asked “photo?” insisting that I take one of him. These regions are becoming increasingly accustomed to and welcoming to people passing through.

Hospitals seem to be a major supply center for propane gas tanks. In our own hospital van, I spent most of the travel times in the back corner seat with an oxygen tank under me and a propane tank on the roof above me. Especially bumpy terrain made me wonder to  what degree of friction the combustible gases were resistant.

Small structures containing religious paraphernalia are found throughout and between villages, showing how integrated faith is to the daily routines of the communities.

The Lahaul region exhibits a distinct dress that resembles western/European tradition and is said to have remained as remnants of the Moravian missionary influence from ~150 years ago. The cross-like embroidery (often replaced with floral design) certainly suggests so. The Lahaul region has become increasingly developed as education/literacy, tourism, and agricultural industry has increased (all arguably part of the Moravian legacy, namely the introduction of potatoes and perhaps even apples—two of the regions cash crops). This history is heartening testimony to the influence outreach might have beyond the lifespan of the intentional programming. 

A group of mules and donkey's passed our lodging site, eating whatever attracted their interest, including newspapers and other semi or non-edible objects.

Several of the patients posed for us to take in their traditional Pangi Valley dress.

Most post cards of Spiti Valley show this bridge preceding Kunzu Pass. It looks pretty sophisticated for an area that is so sparsely populated but the investment will probably last for many years of travel across. 

Our valiant leader, Dr. Bishan, was the guest of honor when we took tea and lunch at a Buddhist Library in Kunga’s village. Along with the traditional chai, we were served butter tea (salted cream in less strong tea that is characteristic to a region of herdsmen and farmers that need to maintain electrolytes during the day when no lunch break can be taken…I thought sweet cream would suit the drink better). Dr. Bishan served as regional medical director in the Spiti Valley (based in Kaza) for 30 years before joining as Community Development Director for Lady Willingdon Hospital in Manali. His knowledge of the land, people, and history of both seems endless and it is clear that he has a passion for the resiliency of these remote communities. As I read “Mountains Beyond Mountains” about Paul Farmer, I was reminded of Dr. Bishan who has personally visited on foot each village and household throughout his career. I gifted him the book as testament to his evident devotion to the region and in appreciation of the stellar leadership he gave to our camp team throughout the two weeks.

With increasing tourism, specialty items like organic barley coffee are offered for the interest of visitors.

A very ornate Buddhist Monastery and Temple in Kaza.

Lining the perimeter of the roof with straw is said to better insulate the house.

Two nurses, Amra and Bharati (the latter named after the Hindi name for India=Bharart) 

Courtney and Ellie were a great help as support staff in the dental clinic (both on summer vacation from college in the States visiting their parents in Manali).

Last tent diner stop.

Tired but in good spirits as we endure the final afternoon of driving back to Manali.

A part that was known to be worn down finally gave up on us the morning of our journey home. Indian culture offers many consultants for a public event like this. We fortunately had the part along and were back on the road within 45 minutes.

5 hours to traverse the final 17 kilometers to Manali will make even a dentist enjoy cotton candy!

The remaining 2.5 weeks of my time in India after these camps is spent in and around Manali, shadowing in the hospital between the medical and dental departments as well as possibly visiting some boarding schools around the city to offer oral health education/preventive services (a trekking outing or two might also be in store!). Even as I virtually begin to engage in Iowa City to prepare for the start of my residency program at the end of June, I continue to enjoy the opportunity to learn and serve alongside, and develop relationships in another culture.