Buttertea at Sunrise (10 page)

My turn arrives to start the physical assessment.

Immediately, Abi peels herself out of her kira and before I have a chance to protest, she is lying on the bed, stretching a pair of incredibly large (and even more notable, incredibly dirty) feet towards me. Awkwardly I clarify to her that she needs to be upright. Abi gives me a toothless smile, points at her back – and continues to lie on the bed. When I finally convince her to stand, she busies herself putting her kira back on. With much difficulty I get her to stay undressed long enough for me to throw a glance at her back.

Her trunk is deeply rutted just above the hips, perhaps from continuously wearing a kira belt much too tightly.

That, combined with extremely heavy fieldwork and years of carrying the children and later grandchildren on her back, is enough to cause pain in even the strongest of spines.

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Abi’s vertebrae are oddly twisted and turned, making the diagnosis of scoliosis almost an understatement. I ask her to do a few movements. Abi just smiles.

While I am contemplating my helplessness in resolving her pain, the lights come on, indicating a functioning electricity supply. Like a flash, Abi is back on the bed, looking at me with great expectations. I switch on the infrared lamp, which has become an object of great desire, and Abi mumbles happily. Within a minute or two, she is fast asleep. Unfortunately (but not surprisingly) only ten minutes later the lights go off again. I tell Abi ‘No lights, no machine!’, so again she smiles, dons her kira and, in leaving, insists on squeezing a bunch of walnuts into my hand.

‘
Kadinche la
,’ she thanks me. Slowly, bent over, diminished to maybe three-quarters of her real size, she limps out of the room and waves goodbye. I noticed on her referral that she was discharged from the hospital today, and I am sure that I will not see her again. She is probably already on the way home to her village, back to the fields and a myriad of chores.

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Om Mani Padme

Hum

Don’t move.’ Pema rushes towards me and quickly

pinches the front of my lab coat between her fingers.

‘I got him!’ She inspects her catch, focusing on her fingertips. ‘They really like you.’

Throwing my hands in the air, I have to grin. Yes, the fleas seem to thrive on me. Since my arrival two weeks ago, every day in the hospital is flea-collection-day, and I am the designated collector. No one else seems to have a problem with those awful, tiny blood-sucking beasts. I have asked several doctors what I can do, but they just give me a puzzled look and tell me to change my clothes after I get home. ‘Of course I change my clothes!’ I think, but what good does it do when I simply refresh my flea supply the next day as soon as I touch a patient. Sometimes I can see them jumping over, other times I just feel that annoying itch somewhere inside my shirt. And they always head for my underwear! Like a rash caused by cheap laundry 75

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detergent, I have semi-permanent red dots all along the elastic of my panties and the outline of my bra. Hats off to mosquitoes and blackflies, but they are nothing compared to fleas. I have spent a few sleepless nights already, trying not to scratch, trying to ignore the unbelievable itch. No chance. By now, my skin is overly sensitive and bleeding in some areas.

Pema is full of sympathy. ‘They are terrible. Nima gets many bites all the time. I don’t know, they never bother me or Chimmi. Maybe it’s because we have darker skin.’

Her concern for me is genuine, but she has no solutions either.

We return to our previous discussion. Pema is studying the anatomy of the shoulder, and possible causes of pain in that joint. Mongar is turning out to be typical of any physiotherapy referral pattern: syndromes come and go in spurts. You might not see a single shoulder patient for months, and then within a day, there are four patients with similar symptoms. Yesterday, we were flooded with chronic shoulder pains.

Pema wrinkles her forehead in concentration. ‘What are rotator cuffs?’

‘They are the supporting muscles of the shoulder, the little ones inside. These ones,’ I point to the picture in the book.

‘How we can treat them?’ Pema is eager to get to the interesting stuff.

I try to be as unspecific as possible, to encourage her to think on her own.

‘Well, how do you treat other inflammations of tendons?’

I ask instead of replying.

A ‘
Jang oma exercise pincha mo?
’ interrupts our studies.

‘Should I do my exercises now?’ An old, leathery face twinkles its remaining teeth at us. I laugh. This meme (a 76

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Sharchhop title for old men) is another one of my favourite characters.

‘
Nan odo, Meme!
’ I reply. ‘Come in, come in.’

Meme shuffles through the door, pulls his gho off his shoulders, and heads straight for the stool beside the heat lamp.

‘
Mangi, Meme,
’ No, not now! I try to explain that there is no electricity, and therefore no heat lamp. Pema doubles over in laughter at my attempt at speaking and signing Sharchhopkha, and then translates in a few short words.

Meme looks disappointed that his idea of exercising is not available today. I point towards the pulley system in the doorframe.

‘
Nan exercise pi. Nado
?’ You exercise now, OK?

A reluctant ‘
Dikpe, dikpe,
’ is the answer. OK, OK.

I watch Meme as he gets ready. His legs are bowed from years of hard work in the mountains. His trunk is thin and fallen in, every rib is showing, and his collarbones stick out like two thin shelves. He wears a farmer’s tan on his lower arms, and the rest of his body, except for his feet, is rather pale. His hair is grey but still thick. A wispy moustache and an equally thin goatee underline his marked cheek bones, and permanent laughter lines are etched deeply into his face.

Meme scrunches up his already squinting eyes. Skeptically he inspects the pulley and draws the string tentatively. It moves. Surprised, he pulls some more. Look at that, it works. Meme turns to me triumphantly. His face smiles with a thousand wrinkles, a thousand proofs of a long and happy life. He starts joking with us and clowns around with the rope. His efforts cannot exactly be described as exercise, but they serve their purpose. At that moment, the light bulb springs to life again. In an instant, Meme drops his preoccupation with the rope and sprints towards the heat lamp. Lights mean electricity, electricity means 77

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taking a rest under the comforting heat of the infrared rays.

Meme’s life is indeed blessed.

Soon, another old man pulls up a stool beside the heat lamp. He brings with him his tattered physiotherapy referral, a prayer wheel and his rosary. While he patiently waits his turn for treatment, the two pearl-sized globules hanging from the handheld prayer wheel make round after round, swishing and pulling the cylindrical drum on the top, as he slowly rotates his wrist in a clockwise direction.

The other hand is busy with the rosary, his thumb steadily counting and moving the beads. He mumbles something under his breath, but I cannot understand the words, so I ask Pema.

‘He is saying “
Om mani padme hum
”,’ she explains.

Om mani padme hum
? Is that a prayer, or is he hypnotising his pain away by repeating the same words over and over?

I ask what it means.

In response, the old man murmurs his words loud enough for me to hear. ‘
O manee peme hu, O manee peme hu, O manee
peme hu, O manee peme hu
…’ the same syllables are repeated over and over, slightly slurred, and each time a rosary is moved and the prayer wheel completes a few turns. I ask for the meaning, and find myself pleasantly surprised that this praying meme has an answer for me. Generally I have noticed that the Bhutanese are extremely religious and follow their rituals diligently; however, few are able or willing to explain the deeper meaning. This meme is obviously well learned and well spoken because he seems to have many things to say. With much difficulty and many long pieces of explanation, Pema translates for me.

From what I understand, ‘
Om mani padme hum
’ is a mantra, a prayer which, through its devout repetition, brings one closer to a desired outcome. There are many mantras in existence, but in Bhutan ‘
Om mani padme hum
’ is the most common one. Literally translated it means ‘Hail oh jewel 78

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in a lotus’.
Mani
means jewel,
padma
means lotus,
om
is the sound of the beginning of all things, and
hum
is the end; om together with hum represents the universe.

It is believed that with each turn of the wheel, merit is accumulated. Each time the mantra is murmured, it is added to the many prayers out there, thereby increasing the likelihood of the enlightenment of all beings. The act of reciting the mantra gains merit for a spiritual path that will lead closer to enlightenment.

Having exhausted Pema’s translation vocabulary, the old man turns, closes his eyes and presumably continues murmuring for the enlightenment of all beings.

The news of the heat lamp has caught on, and soon we have a queue of eager patients waiting for a blissful holiday at physiotherapy. Unfortunately, the power surge is short-lived, and a little later, we again sit in the semi-darkness of the room. Our patients disappear.

When at noon the power still has not returned, Pema rushes home to bring Nima back to the hospital. The little boy’s cough has worsened, and Dr. Pradhan, the medical specialist, has promised to have a look at him. Pema seems relieved but nervous when she returns to the physio room with Nima on her arm.

‘He thinks it’s only a cough. I get cough medicine for Nima.’

I have noticed that Pema puts great trust in Dr. Pradhan.

‘What does Dr. Pradhan think of Nima not crawling?’ I ask carefully.

Pema twirls one of Nima’s fine black curls around her finger and the little boy begins to giggle. She then gently picks him up and supports him in a standing position on the floor. Nima wobbles and sways, but keeps his shining eyes fixed on his mother.

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‘Perhaps he got injury to the head. Or maybe it happened during birth.’ Nima continues to giggle until a bout of coughing rattles his little body and Pema hugs him tightly.

‘But I think he was fine in the beginning.’

Determined, Nima frees one of his hands from Pema’s embrace and raises his fingers to his lips. His expression becomes distant, almost thoughtful, while in slow, steady circles, his index finger caresses his lips.

‘Don’t!’ Pema gently scolds her son, then turns to me. ‘I am not sure that he can hear me, you know. Sometimes he smiles when we talk to him, but we just don’t know if he hears us. I want to take him to Vellore. Dr. Pradhan also thinks that only in Vellore they can give good diagnosis.’

For the first time since we met, I can see a tear rolling down Pema’s cheek. It leaves a little dark mark on the front of Nima’s sleeve.

I nod and turn to the papers on my desk to give Pema some privacy. From Dr. Pradhan I have learned that Vellore in Tamil Nadu is one of India’s foremost diagnostic and research hospitals. Due to lack of equipment and resources, many conditions simply cannot be diagnosed properly in Bhutan, and for complicated diagnoses or treatments, patients are sent to India. However, the costs for the Bhutanese government for each referred patient are huge, and the waiting list for outside referrals is long. And yet for Pema, Vellore signifies her only real hope. So far, no one in Bhutan has been able to make a diagnosis for her baby. Myself, I am confused by the little boy’s signs and symptoms which, if nothing else, point towards cerebral palsy.

‘We only live for him now,’ Pema says with a sigh. In a sudden impulse, I reach out and put my hand lightly on her shoulder. The young mother looks at me and tries to smile, but her dark, sad eyes betray her. I stroke the soft curls on Nima’s small head, and the boy rewards me with a 80

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little gurgle. Unnoticed by Pema, he has managed to again free his hand which is promptly on the way to his lips.

Then he turns his head and I think I see happy recognition on his face. I follow his glance to the door.

‘Good afternoon, ladies.’ Pema’s husband enters with a box of sweets from the bakery. He offers me a tired smile, then reaches down to cuddle his son who squeaks in delight. ‘I thought you might be hungry.’ Turning to Pema he asks: ‘What did Dr. Pradhan say?’ For a while the two parents discuss quietly.

‘You’re not working today?’ I ask Karma.

‘I took the afternoon holiday so I can take Nima home.’