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as soothingly as I can. My efforts are rewarded with a shy, uncomprehending smile.

A few moments later, Pema enters and tells me that she has called Lhamo for treatment. Confused, I ask if they do not have a wheelchair. Pema explains that Lhamo’s mother is used to carrying her daughter, and it really is no problem.

‘Of course this is a problem,’ I think, but for now I keep my thoughts to myself and take out an assessment sheet.

Pema pulls up a stool beside me. The main goal of

my stay in Mongar is to teach Pema as many of my

physiotherapy skills as possible. Through her training as an assistant, she already has some basic knowledge of anatomy as well as physiology, but her treatments are solely based on a cookbook approach of using a diagnosis made by the doctors as her prescription. During my year in Mongar, I will try to help her become more independent in assessing and treating patients. For the first week, we have agreed that she will act as a translator and watch what I do.

My pen and paper poised, I am ready to take Lhamo’s history. Lhamo’s mother, however, is not. In an

uninterrupted torrent of words, she talks to Pema in Sharchhopkha. When she finally finishes, I ask Pema the meaning of her outburst.

‘She wants to know will Lhamo walk again.’

A little exasperated, I ask what else she said.

‘Nothing,’ Pema replies and turns back to Lhamo.

Over the better part of an hour, we patch together Lhamo’s history. Lhamo’s family comes from the district of Trashi Yangtse, from a small village two days’ walk from the main road. Like most villagers, her family has lived on the same farm for generations and produces a small crop on a bit of land. Lhamo herself has never attended school.

According to her mother, five or six years ago Lhamo fell over a pot of boiling water and burned the back of her left leg. It healed, but since then, she has had a severe scar from 59

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the buttock right down to below her knee. One year ago, a knife injury damaged her right knee, and now it is stuck in its present position and hurts.

The details and dates of this story vary from what the nurses had told me, and on further repeated questioning of Lhamo’s mother, the injuries now range anywhere from eight years ago for the left leg, and three years to a few months back for the right. It seems pointless to harp on a detail that obviously does not hold priority in their lives, and we move on, marking the category ‘Time of onset of injury’ with a big question mark.

What does become apparent, though, is that this second injury has caused much hardship for Lhamo and her family.

Since the trauma, Lhamo has not stood or walked. Confined to her bed all day, Lhamo is carried outside by her mother only to urinate or defecate, or at the odd time, to have a wash.

They have tried several ‘treatments’. The village lama has come to hold many a religious ceremony called a puja. Her family has prayed and made offerings for a quick recovery.

No result. They brought her to the hospital, and the surgeon at the time tried to lengthen her burn scar to allow the leg to extend completely, thereby making weightbearing possible. No help. Different doctors subsequently tried the same operation. Unfortunately, the resulting fibrosis and immobility in bed only made her stiffer and, in the end, the leg seemed the same. A team of Australian plastic surgeons came for a visit, but they too shook their heads in regret.

There was nothing to be done.

Between every bit of revealed information, Lhamo’s mother asks me if I can fix her daughter. Gently, I tell her that I will try my best. Mom is not satisfied. In her eyes I am a foreign doctor, therefore ordained with a lot of knowledge and ability. I have to cure her daughter.

I ask Pema to coax some answers out of Lhamo, but the girl only stares at us. Her look is frightened and distrustful.

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Without touching her, I again start speaking to her in English, and Pema translates. I explain that I only want to have a look, that I will not hurt her, that her Mom will stay right beside her the entire time, and that she can tell me where she has pain. Ever so slowly, Lhamo relaxes. Still suspicious, she watches my every move, but at least her distrustful attitude slackens.

A few spectators have gathered in the hallway and this time, determined to get some privacy, I shut the windows and door tightly. Then I ask Lhamo to remove her skirt, a simple flowered petticoat, which she wears instead of her kira. Lhamo refuses. I try to explain that I have to look at her whole leg – but she is immoveable. Tentatively, I lift the flimsy garment a few inches, and Lhamo starts wincing like a baby. I realise the problem immediately. Lhamo has no underwear.

Somehow we manage to tuck her skirt between her legs to cover her embarrassment and still allow me a better look.

The back of her right leg is horribly deformed. A long, deep and tight burn scar covers the rear of the knee and stretches in ropelike bands all the way up to her buttock. Though not painful, it resists all movement trying to straighten it beyond a 75-degree bend. The right foot hangs on the ankle like a useless appendage. All muscles have been wasted from years of disuse, and her sole is turned in, resembling what is medically termed a clubfoot. Although she is tense and tries to resist my moving her leg, Lhamo is far too weak to put up a real fight. Instead, she continues whining and whimpering, yet whenever I ask if there is pain, she shakes her head.

Her other knee is obviously very tender. The moment I touch it, Lhamo starts screaming. After several attempts, I have to give up. I assume, from what I observe, that there is maybe a 5-degree freedom of movement, if any. We ask Lhamo’s mother if the knee has always been this stiff, and she confirms. Has it always been this painful? She nods.

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Neither her mother nor Lhamo have told me about any other injuries, but in her chart I see a note about dressing a bed sore, so I continue my examination. I find not one but two deep, puss-filled sores, one over her tailbone, and one over her left seat bone which explains why Lhamo does not want to sit. Thin cotton bandages have been taped over the wounds, but with moving about, they have slipped, and now the tape is partly stuck to the bleeding flesh. The wounds are oozing, and Lhamo’s skirt is damp. Appalled, I ask her mother when these wounds were last cleaned.

‘Yesterday.’

‘Why not today?’ I ask, wondering who is responsible for this needless neglect.

‘Always, they are only done every two days,’ Pema

answers.

I am shocked. ‘Do they always look like this?’

The answer is yes. From Pema’s translation, I learn that it is difficult for Lhamo to use the toilet, and that the bandages always get wet from washing her buttock after passing stool. Still Lhamo’s mother thinks that they are slowly getting better.

Lhamo is quietly whining to herself, and when I turn to ask her to sit up, she throws a temper tantrum and screeches in a high pitched voice. Her mother chides her sternly, but Lhamo continues her lamenting. Pain and an overwhelming terror are clearly written on the girl’s face. I understand that for today it is enough and ask her mother to take Lhamo back to the ward. Relieved, the tiny mother picks up her daughter and carefully carries her out of the physiotherapy room.

I feel guilty. Did I push Lhamo too hard? Desperate to focus on something positive, Pema and I discuss the availability of wheelchairs. There are three new ones in the hospital, one of which belongs to physiotherapy and two to the wards. Unfortunately, the physiotherapy chair 62

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always disappears. I ask Pema to go and look for it, and she dutifully sets off on her mission. Minutes later she returns with a foldable, soft plastic-seated wheelchair, and I sigh in relief. At least one thing we can offer to Lhamo immediately.

A quick check of the chair reveals that the brakes are useless, overstretched and barely able to touch the wheels.

For the umpteenth time since my arrival in Bhutan, I pull out my Swiss Army knife and start repairing. Luckily, the problem is easy to fix, and I take the chair for a test ride.

Although I generally find the faces of the people here very hard to read, as I wheel myself past the windows of the operating theatre’s prep room the nurses’ astonishment is obvious.

‘Sister Britta! Where are you going?’ Sister Rupali, a plump, jovial nurse sticks her head out the window and calls after me. In the hospital, I have been demoted from doctor to sister.

‘Just testing out the chair!’ I reply and grin.

‘Sister, will you come for tea? Please come and join us for tea. Sister Pema is always coming for tea!’

I have wondered when and if we get a lunch break, and the offer is tempting.

‘Thank you. I would like that.’

The window of the OT prep room closes again, and I steer back to my treatment room.

Over a hot cup of sweet tea, perfectly spiced with ground cardamom and cloves, and a couple of sugary cookies, I voice my worry about Lhamo’s wound dressing.

‘Do you think it could be done more regularly?’

‘Lhamo is nice girl, isn’t it,’ Sister Chandra replies. ‘It is good that you can help her now.’

Sister Rupali agrees but also dodges the issue of wound dressing.

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‘You have to talk to Matron about that, sister. Here in the OT, we only prepare the dressing sets. You see,’ Sister Rupali points to the steaming autoclave, ‘it is so difficult.

No electricity and it is always broken, isn’t it, sister?’ This time she turns to the other OT nurses for confirmation.

Everyone at the table nods seriously. ‘Every day we make dressing kits, we are always busy. But this machine is never working.’ Rupali condemns the whistling autoclave with another stare. Then abruptly she changes the topic to yesterday’s operation.

Most of the nurses at Mongar Hospital seem to come from Southern Bhutan, and among themselves, they

generally speak Nepali. Initially, I guess that the discussion centres on an emergency caesarian section, but then I get lost in the foreign language and cannot follow another word. Surrounded by eagerly chatting nurses, I am left sipping on my tea, wondering how long it will take me to understand at least enough of my colleagues’ language to participate in their daily gossip.

After my interlude in the OT’s prep room, Pema and I take the prized wheelchair to the ward. It is time to teach Lhamo that from now on, at least while she is in the hospital, there will be an alternative mode of transportation to her mother’s back.

We find both Lhamo and her mother on the bed sharing lunch. Excited talking erupts at our arrival, and the half-empty plate of food is left on the blanket. While I push the wheelchair over to the bed, I take a look at the hospital ration. Rice, some sort of potato curry and a cup of dal compose the lunchtime feast. Earlier I saw how the cook dished it out from a couple of huge buckets in the courtyard, but now I am somehow surprised to see it here, heaped on a plate. It looks better than I had anticipated.

Lhamo eyes the wheelchair with a worried face. All new commodities cannot be trusted, and the unknown 64

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technology seems to intimidate my young patient. The little chattery mother, however, is quick to realise the advantages of mechanical wheels. With a beaming smile, she proudly assesses the chair.

Still looking more than sceptical, Lhamo eventually lets herself be convinced to give it a try. To avoid further complications, I decide to neglect the proper rules of a transfer for the moment and lift Lhamo off the bed. Mistake!

Within fractions of a second, her long skinny fingers dig into my neck, and she lets out a terrified squeal. Like a monkey, she hangs on for dear life, refusing to let go of my neck. I can hear Pema talking and even the neighbouring patients giving good advice, but only the warning voice of her mother makes Lhamo relax her grip. Slowly we lower her onto the chair, and she sits awkwardly and stares at me. Determined, her mother takes the steering and starts wheeling Lhamo around the ward.

When she finally comprehends the great potential of her newfound freedom, Lhamo’s face brightens into a lovely smile. Carefully she leans over the sides, testing the arm rests with a tentative pressure and playing with the foot supports.

‘
Yalama!
’ she calls out in excitement, and an old woman in the bed beside her starts cheering.

Now eagerly jabbering with her mother, Lhamo propels the wheels forward a few feet, then she claps her hands and turns around to look at us. Her face is radiant with joy.

In her eyes shimmer hope and excitement, and childish pleasure in the little perks that must come along so rarely.

As if waiting for this moment for many months, Lhamo’s laughter breaks through her wall of suffering. No longer confined to her bed, on the plastic seat of an overstretched wheelchair, Lhamo has found a new independence. And for the first time since my arrival in Mongar, I know that I made the right choice in coming here.