Buttertea at Sunrise (7 page)

And now, in the rain, he will get wet. And who will look after him all day? I cannot take him back in the middle of the day.’

Now I feel guilty for my thoughtlessness, but Pema smiles at me. ‘I think now you are here, we will make many changes in physiotherapy. It will be good. So long I was asking for two rooms. Now you are here, and already we are getting an exercise room. That will be very good for patients, isn’t it?’

A couple of nurses stick their heads through the door and exchange a few words with Pema in a foreign tongue.

‘Welcome sister!’ they greet me and immediately the now familiar question follows: ‘How do you like Mongar?’

I smile and nod, still searching for an appropriate answer.

‘Please come for tea, sister,’ they invite, and in leaving call a few more words to Pema. Grateful for Pema’s fluent English, I turn to my new assistant and ally.

‘How many languages do you speak?’

‘Sharchhopkha, Dzongkha, Nepali and Hindi. At home with my parents, I speak Sharchhopkha. Most of our patients also speak Sharchhopkha. I will teach you. And we 51

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will go to see my parents in Bargompa. You will like it there.

It is like real village. But you must speak Sharchhopkha.

You know “
Kuzuzang po la
”, isn’t it?

‘Ku zoo zang poo la!’ I repeat and we both laugh.

Together we continue the survey of our room. The

cupboard resists all attempts at opening until we fiercely bang against the sliding door. Once open, we are greeted by a wild mess of blankets, corset-shaped elastic back supports, various slings, a tub with black grease, a new white bed sheet, another supposedly temperamental ultrasound machine, a box with all kinds of screws, toothpicks, clasps, spare parts for machines that are long gone, and a pile of telltale mouse droppings. Most of the supplies look ancient and must date back to a time when Mongar Hospital was established and then run for twenty odd years by the Norwegian leprosy mission.

Pema explains that a few years ago the mission left, and Mongar Hospital was turned into a general hospital managed by the Bhutanese government. In January of this year, it was officially upgraded to become the Referral Hospital for Eastern Bhutan.

We examine a decrepit exercise bicycle and a pair of crutches with missing rubber tips.

‘We have many more crutches, but I cannot use them.

They are in storage room. When the mission goes, they leave us all crutches.’ Pema points in the direction of a building above my classroom. She then proudly shows me her collection of bandages that have been given to her by the operating nurses. ‘I keep them here, just in case,’ she explains.

Our tour ends with a close inspection of the appointment book in which she records who the patient is, whether he was an in or outpatient, and what the diagnosis and treatment were. Overall, her records are meticulous and I am well satisfied.

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One thing that begins to bother me immediately is the number of spectators that soon assemble in front of the physiotherapy rooms. Judging from the number of faces staring through the open windows into our physio room, I must be a rare species of
Homo sapiens
. Feeling none too self-conscious, patients and visitors who are on their walkabouts of the courtyard stop and gawk at me intently.

Every inch of me is scrutinised. They study my blond hair, my pale skin, my skirt, my shoes, my gestures, my speech. They nod in my direction, or point at something.

A few talk to Pema, others just silently stare. I would not be surprised if someone said that they were counting my breaths per minute.

Clusters of schoolgirls whisper and giggle, turning away shyly if I return their gaze. Occasionally, I hear the word

‘
phillingpa
’ (foreigner) and ‘doctor’. Pema takes pity on me and asks them to leave. Still giggling they retreat, only to be replaced minutes later by another group of curious spectators.

After a couple of hours, I crave anonymity. I want to have black hair and dark skin. I promise myself that from now on I will wear only kiras. I will learn Sharchhopkha and I will fit in. Soon. Nevertheless, for now, I want to shut the doors and windows, and I want the patients in the hallway to stop staring. With much difficulty, I continue smiling.

At the end of the day, the room has received a facelift.

All surplus furniture and equipment are shoved into the hallway for removal, and the exercise room shines with a fresh coat of paint. The floor is swept and mopped, the dirt having been effectively wiped from one corner into a new one.

The windows remain open; I try not to notice the peering faces. By three o’clock I am exhausted. Pema, in a hurry to get back to Nima, leaves me to close up the department.

The crowds in the hallway have not yet dwindled and, 53

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without Pema, I feel stripped of all self-confidence and fully conscious of my every move. Like a model on the runway, I slowly tiptoe home.

The next morning, when the monsoon rain pelts down in heavy downpours, and Pema again fails to arrive at nine o’clock, I join the doctors on their morning rounds. Dr.

Lhendup, a general doctor in charge mostly of outpatients, seems like a jolly fellow. He looks sincere and is full of conversation. Reviewing the patient’s chart, he wrinkles his forehead in concentration and then talks rapidly in Sharchhopkha.

Dr. Kalita, the orthopaedic surgeon, is a newcomer to Mongar, having been transferred here shortly before I arrived. Originally from the state of Assam in India, he completed his medical education in Scotland, and is now one of the leading orthopaedic surgeons in Bhutan.

Dr. Shetri, the dentist, is a short energetic man. His mastery of the local language seems to be in its infancy, but while constantly cracking jokes, he tries his best to communicate with his own mixture of Nepali, Dzongkha and Sharchhopkha. Surprisingly, he also takes a very active role in the diagnosis and evaluation of the patients.

Obviously, his medical knowledge is not limited to teeth alone.

The DMO is an eye specialist and, when not called away by administrative duties, joins our little team off and on.

Dr. Bikul, a young Indian general doctor, seems

preoccupied with his cases and keeps disappearing to his outpatient chamber.

I am told that there is also a medical specialist, Dr.

Pradhan, and a gynaecologist from Cameroon, Dr. Robert, both of whom are on leave at present.

The matron of the hospital, a short, compact woman with a determined attitude, pushes a little yellow cart containing 54

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all of the patient charts through the wards. There are other nurses as well, all dressed in white kiras with little caps on their heads. They take off bandages, comment on the patients’ condition and get the necessary charts ready.

One round of the hospital includes five main wards and a few private or semi-private cabins. Ward A and B are for females and children, C and D for males, and there is a separate ward for active TB and leprosy. In total there must be about sixty beds, give or take a few; overflow patients are bedded on mattresses on the floor as needed.

Quietly, I follow the little procession of doctors as they make their way through the wards. Most of the diseases presented here are unknown to me, and I am unsure of the patient’s source of suffering. In addition, none of the patients are addressed in English, and my grasp of the local language is far too sparse to understand anything. Yesterday I learned that
lekpu
means good or better;
mangi
or
mala
are forms of no;
phaiga
, at your home; and
pholang
means abdomen, a word I hear frequently used. It seems that a large number of patients suffer from some sort of stomach trouble. On the charts, I read other foreign sounding diagnoses: osteomyelitis, viral encephalitis, chronic malaria, typhoid, abdominal tuberculosis, leprotic ulcers, grade three malnourished… I have entered a world of medicine unknown to me.

In the wards, I have difficulty separating patients from attending family members. More often than not, two or three people sit on one bed. Like their attendants, patients are dressed in everyday clothes. There is no sign of pyjamas or hospital gowns.

The thick hair of both men and women is short, at times spiky, dust and oil turning into a natural hairspray. Everyone wears a certain amount of grease and grime. Many lips and teeth look as if they were bleeding, permanently stained by the juices of betelnuts mixed with lime. Clothes are 55

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smudged and tied carelessly, often well worn to the point where the material is hanging on by merely a few thin threads. By far the most remarkable attribute is the patients’

feet. Disproportionate to their short stature, their feet are huge, with round stubby toes and unkempt nails. The soles are covered by a thick layer of dirt which has grown deep into the chaps and cracks of a lifetime of barefoot walking.

The general lack of cleanliness has rubbed off onto the surroundings. The blue hospital sheets are stained, and often a kira is used instead of a blanket. The yellow and white walls are spotted with mud and mildew, and the windows are faintly tinted by a covering of dust. Despite the screens, thousands of flies populate the hospital, crawling over beds, people and food. Although I had mentally prepared myself for a certain lack of hygiene, what I see worries me deeply.

Garbage litters the corners, and patients readily dispose of bloodied bandages, plastic bags or food scraps under the beds. I think of the flies crawling over everything and then looking for a hatching place for their eggs. As we continue along the rows of beds, my stomach twists into a tight knot, and my knees begin to wobble. Shocked, I try hard not to avert my eyes.

Privacy is not a concept practised or valued, and the metre of space between beds is hardly enough to keep neighbours from actively observing every detail of an examination.

Many patients wear a look of dull surrender, a blank stare that seems to reach beyond the hospital walls, yearning for the world outside in the hills. Yet it is not an expression of suffering, but rather of resignation or disbelief. There is no questioning and often no response. What goes on inside their minds is hidden to me.

How would I feel if I had to lie in one these beds, lined up in a row, no curtains and no dividers? What would it be like? A nightmare, no doubt. Everyone in his or her street clothes, looking dirty and smelling accordingly. As we 56

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continue our rounds, I feel a mixture of pity, sadness and anger. The patients’ obvious lack of education and often innocent ignorance tug at my heartstrings.

A few people are introduced to me as my patients. A girl with a severe burn scar and a damaged knee is disabled and confined to her bed. An old man who is in the hospital for the treatment of his eye infection, complains of a painful, stiff shoulder. A boy in a coma with malarial encephalitis has been paralysed for several days. An old diabetic woman who has recently undergone a below-the-knee amputation for a gangrenous leg needs to get out of bed.

I try to smile at everyone, although my rebelling gut has sucked out my confidence. How will I ever treat these patients in our little two-room department with the fancy title ‘Physiotherapy’? I look at the faces and see only tragedy.

I reach out to greet a patient and meet the eyes of accepted suffering. The poverty, the dirt and the diseases overwhelm me. My heart cries, and my boldness plummets. If I can help any of these patients even a little bit, it will be a small miracle.

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Lhamo

At first, I see only a small, wrinkled face with a lovely smile peeking around the corner. My desk in the

physiotherapy room is set back beside the door

frame, and so the next thing I can see from this vantage point is a pair of thin, bony legs floating a few inches above the ground. Then the figure of a tiny lady, and lastly Lhamo who is being carried piggy-back into the treatment room.

Baffled, I stare at the surprising appearance of mother and daughter. Though Lhamo is as thin as a beanstalk, she dwarfs her mother who stands at no more than four and a bit feet tall. At thirteen, Lhamo’s shoulders are several inches wider than the ones carrying her. It seems impossible that the petite lady does not buckle underneath her heavy load.

Yet there she stands, steadily balancing Lhamo on her back.

She even manages to untangle one of her arms to point at the bed beside me.

I snap out of my stupor and quickly pilot them inside the room. We manoeuvre Lhamo onto the bed, and there she stays lying in a fetal position, nervously staring at me. I try to make her feel comfortable by talking to her in English 58

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