Nubra Valley Medical work - Day 1

Ladakh 01- Nubra Valley medical volunteer work- a totally different experience

Eden Hazard slotted the ball pass England’s goal keeper Pickford and Belgium scored their second goal in the second half of the third and fourth placing match for World Cup 2018.

The whole crowd at Changi Airport terminal three went crazy. With SQ402 departing at 2:35am for New Delhi, we had to watch the second half on the big screen in the airport.

Three weeks ago Lee Haw Chou whatsapped me:

“Hey a team of doctors and nurses are going to Nubra Valley up north of Ladakh for a medical mission. You wanna come?”

It took me half a second to send the reply: “ONZ!”

And here Serene and I found ourselves watching Belgium murder England on this fateful night while waiting for the rest to the team to turn up at Changi airport.

Here is the VIDEO for Day 1

This trip was organized by FEM Surgery. A team of volunteers including Breast Surgeon Dr Felicia Tan, Orthopaedic surgeons Dr Lee Haw Chou and Dr Chang Haw Chong, Obstetrician & Gyanecologist Dr Mohd Jasmine and her sister Veterinarian Dr Mohd May, Plastic surgeon Dr Lee Han Jing, Neurosurgeon Dr Roy Koh, and our important support team- Vicky Tan, Shu Xian, Venessa Ding, Laura, Lay Hong, Terence, and of course Serene.

“Hey Haw Chou, what do we have to do when we set up the medical tent at Nubra valley?” I asked.

“You just put on your stethoscope and start seeing patient lor. Very easy one lah.” he replied non-chalantly.

“We will be swarmed with patients,” said some of the experienced volunteers on the chat thread. “And Dr Lee will be the god because after every jab he gives the patient will be cured,” added Vicky.

“But as a GP what can I do for the patients?” I probed.

“Oh you will be the busiest because every case that the specialist don’t see will be sent to you,” Dr Felicia Tan was very reassuring.

But so, why all way to Nubra Valley?

His Holiness The Dalai Lama will be giving a series of lectures in Nubra Valley and villagers, tens of thousands of them, will come from all around the area to attend his lectures. Our medical tent will be set up just beside the lecture venue to offer medical screening and treatment for whoever need it.

Being a total newbie in this, I was understandably a little kan cheong for I knew not what to expect and what to prepare for.

“What equipment do you all bring? What surgical tools or such?” I asked the various specialists.

The Orthopaedic boys looked at me with a blank look and put up three fingers- syringe for H&L injection, steroid solution, and pain killers. Nothing else.

Our gynae Dr Jasmine brought a portable ultrasound to scan her patients.

“What about medicine ah?” I asked.

“Oh that one don’t worry,” said Vicky. "We will buy from Leh a standard set of medicine and bring over to Nubra valley and then you all can use whatever we have there.”

So that is how it works. For me, I just brought my stethoscope, my aneroid BP set, my pulse oximeter, and my magnifying glasses.

New Delhi

This big city in northern India is modern, has a modern airport that made checking through the immigration via e-visa (applied online a few weeks ago) very straight forward; an efficient baggage conveyor belt system that (thanks to Felicia and Vicky for putting all our luggage on priority business class tags) rolled out our baggage in no time, and interestingly a relatively smooth traffic condition from New Delhi’s international airport to the domestic airport a piece of chapati.

The domestic airport at New Delhi.

Having a quick bite before we depart at gate 31 at 9am for Leh.

Taking a bus to the plane

The domestic Go Airway was a one hour 20 minutes flight to Leh’s Kushok Bakula Rinpoche airport. 8am on 15 July 2018 Sunday morning we found ourselves standing on the grounds of Leh, Ladakh with our luggage quickly loaded up onto our convoy of 4WDs.

Finally arriving at Leh Kushok Bakula Rinpoche Airport.

We had a simple but delicious local Ladakhi Chapati breakfast with sugar and yogurt and chai tea at one of the road side stalls, and another fifteen minutes drive delivered us right to the doorstep of Stok Palace Heritage Hotel.

Leh, Ladakh

Leh is a very interesting town. It’s highly militarized and we can see armed soldiers stationed all over the installations and patrolling the buildings.

I tried taking photos at the airport with my handphone but was stopped by the soldiers from doing so.

“Ladakh is part of the state of Jammu and Ladakh,” explained Neelam (nicknamed Bikky) our guide. “Its people are 90% Buddhists and it’s a peaceful province. But unfortunately where we are standing now in Ladakh was where two major wars have been fought - the India-Pakistan war in 1962 and the India-China war in 1999. And even until today The state of Jammu and Kashmir is still a volatile state because of uncertainty. Every day there are soldiers at the borders being killed. Thus those in the military know that they have to be constantly ready for real operations.” Bikky explained that although he spent most of his early life in military training, and with a strong fine family heritage of military line, he decided ten years ago that the military wasn’t for him and he did a jump to the hospitality industry.

The bridge across the Indus River en route to Stok Palace.

Driving over the Indus River

The rows of small houses and the distinctly Tibetan architectural style of the buildings with the square window frames, the red window sills, the rock-piled fences, and the scattering of stupas, chortens, prayer wheels and a newly erected huge golden statue of Maitreya Buddha next to Stok Palace reminded me very much of Tibet. In fact the old Stok Palace was in a way modelled after a Tibetan palace and was a real palace owned and lived in by the Ladakh King then and has now been converted into a hotel, although still owned by the king of the Namgyal dynasty.

The Stok Palace in the distance.

We drove through the town Centre of Leh and to the outskirts. One thing I noticed about Leh was, the rows of short buildings were scattered much more sparsely across the land as compared with any of the other bigger cities and towns in the Indian continent. The people were also walking at a slightly more leisurely pace. Life here appeared more serene.

Thiksey Monstery from afar

Ladakh is really a mountainous area with barren rocks and mounts jutting out from the peripheries of the town. Some snow-capped peaks dotted the far distance.

The more we looked at the barren mountains the more they reminded us of Upper Mustang in northern Nepal, 30km from the Nepali-Tibetan border. It was the same type of terrain. There was hardly any vegetation on the slopes.

Our convoy finally arriving at Stok Palace Heritage Hotel.

Stok Palace Heritage Hotel

The staff presenting us with a welcoming Kata.

I also have mine.

The two-room villa that Haw Chou, Chin Lee, Serene and I shared at Stok Palace.

Laura and Vanessa went for a small walk around the palace villa ground.

The rooms were huge and lovely.

And the living hall was so beautiful we had coffee and tea and slept on the sofa.

The kitchen was very well-equipped.

How’s the altitude issue at Leh and onwards...?

Leh is at 3500m. Not that high but high enough if we literally flew in and land at that altitude within an hour and a half. Thus we started diamox and really high dose dexamethasone tablets at 4mg three times a day a day ahead.

“Everyone please rest for the next 24 hours. Do not exert yourself and do not take sleeping pills. Drink plenty of water,” announced the broadcast speakers the moment we touched down at Leh’s airport.

Checking everyone’s SAO2, I was glad that most were at 90% and above despite being at 3500m. In my heart I believed the prophylactic super high dose Dexa must have been the reason. This was something new that I learned, for my previous dexa dosages were a conservative 0.5mg BD dose.

“Wah, my oxygen saturation is only 89%?” wondered Vanessa Ding at breakfast. I reassured her it will rise later as she acclimatize, which indeed it eventually did.

“Dar I am feeling a bit breathless and heart palpitation walking to the hotel’s dining hall,” remarked Serene, whose SA02 was around 92-93%. I myself was a tad breathless too walking that short distance to the dining hall.

“When I checked my SAO2 just now, it was ok but I could see that I was tachycardic.” mentioned Hanjing. And it was very prudent of her and Terence to decide to rest for the afternoon because these are all signs that the body is struggling to adapt.

“Just now I was a little tachy, but now I am better,” joked Haw Chong when I asked him how he felt. “But I am still as breathless up here at this altitude as I was when I was down there in Singapore!” I laughed at his self-deprecating remark.

An interesting observation- most of the waiters and the manager of the hotel who I also tested the oxygen saturation on, returned with 98-99% SAO2. You just can’t beat the locals.

“Tomorrow will be an important day,” instructed Bikky over lunch. “We will be travelling by Jeep from 3500m here at Leh to cross the highest motorable pass Kardhungla pass at 5600m before descending to Nubra valley at 3048m. The vehicular trip will take about 6 hours and at the height of 5600m that will be when many will experience AMS. So please rest well today.”

Cellular data, anyone?

Although I purchased a post paid plan from M1 Singapore’s data passport supporting Bharti Airtel that was supposed to work in Leh, I found, to no surprise, that I had totally no signal here as the military has jammed up the signals. Through our trip from Leh to Kardhungla, Diskit, Hunder and Sumur, no amount of cajoling could bring Back the cellular data, it even the GPRS mode, as the Military jamming was so prevalent. Don’t believe what you read on the internet about having to buy a post-paid SIM card for out of the State of Jammu and Kashmir. My M1 data passport WAS a post-paid data plan from outside India. And it was $27 wasted. So much for my M1 data passport. So lesson learned- if coming to Ladakh, forget about cellular data and WiFi. There will be none, except very sporadically some very slow WiFi in certain hotels.

But there was one trick out of this situation. The locals were allowed to purchase SIM cards that gave them cellular data, but only for the locals. So the waiter Vinny very kindly shared his personal hotspot with us so that we may send several important messages back home.

Walking to the dining hall for lunch.

Neelam [nicknamed Bikky] our guide.

The food at lunch was most delicious especially the chicken.

So how about the World Cup final today at 8:30pm Indian time?

That was the $6 million question that had been bugging me since I found out that there was going to be no WiFi and no cellular data in Leh. I thought it would do no harm asking the nice manager and waiter if they are watching the World Cup this evening and to our surprise they were going to. After a short discussion the decided to put up a huge tv and set up the dining hall for all of us to watch the final match tonight! Whadd’ya know! How lucky can we be!

High tea at Chamba Camp hotel

At 4:30pm we left to visit Felicia, Jasmine and May at the ultra luxurious Chamba Camp Resort where they prepared a high tea for the whole group.

The grounds of this luxurious resort was truly oozing with class, and the service and food were top class.

The Lees enjoying the tentage.

Dr Felicia Tan giving us a briefing of our roles and laying down the instructions for everyone.

Hanjing and Terence posing for my phone.

Thiksey monastery as seen from Chamba Camp Resort.

Purchasing medical supplies from Leh Town Central.

It was 6:30pm. We had a dinner ordered back at Stok Palace for 7:15pm followed by the France-Croatia final match at 8:30pm. Intense discussion during the high tea finally pushed the group to decide to go ahead with acquisition of the supplies right after high tea rather than wait till the next day.

Vicky said: “Hmmmm I don’t remember it was any of these pharmacies leh. I remember it was a bigger pharmacy last year.”

But no choice. We just had to tikam-tikam and walked into one of these to try out luck.

Thankfully the vast majority of generic Indian medicine in Leh were cheap except for certain more high class ones. And Vicky and our accountant Shu Xian were good in bargaining with the boss, with help from RK Pandey.

What an adventure. I didn’t know buying medicine from the whole rows of pharmacies opposite SNM Hospital, Leh, could be so exciting. Dr Felicia Tan and Vicky had already prepared a list of medicine to buy and we had a budget. But as all the doctors studied the list each added a few more items to the list and it grew. So by the time we arrived at the pharmacies at about 7:20pm, the list was quite long and Haw Chou, Haw Chong, Felicia, Jasmine started instructing the chemist the quantity of each of the medicine they needed and negotiated for replacement if certain types were not available.

Felicia was very smart.  She found that the Clarithromycin here at this pharmacy was going for too expensive a price - almost S$100 per box.

"Ok, we will go next door and check it out," Felicia decided.  And she went to two more pharmacies next door and came back with the same Clarithromycin at only HALF the price! about S$40+. Such resourcefulness! I was suitably impressed.

It was good because Jasmine, Felicia, Hanjing, Haw Chong, Haw Chou all had their favorite medicine stocked, and I happened to share quite a lot of medicine with these specialists. So with Vicky and Shu Xian keeping a close watch on us from the side we managed to keep within our budget. It took us two hours. But thankfully the pharmacy had a TV set showing the live telecast of the France-Croatia match so the boys and girls managed to witness the first two goals of the match.

Watching the World Cup finals outdoors under the stars around an outdoor fireplace and in nice, cool weather!

I don’t think anyone could ask for a better setting to enjoy the well fought match. The hotel staff went out of their ways to set up a huge tv to play the math outside of the dining hall, and served us dinner as we sat around the fireplace.

In Laura’s own words: “you will never forget the environment and the setting under which you watched the 2018 World Cup final.”

Chang Haw Chong came out from his indoor dining, took a look at the screen and said: “There! France 4 Croatia 2!”

Jeanette wanted to watch the trophy presentation but they had to keep the tv.

In short, sadly for Laura, Vanessa Ding and RK Pandey, Croatia fought hard but was still beaten 4-2 by France.

That night...

I must have had too much Indian food with spices. My gastric acid were acting up and I knew I had started having GERD from the food, perhaps to a small extent compounded by the steroid I was taking. I started my Pantoprazole.

To continue to the next day's adventure, click: "Day 2 - onwards to Nubra Valley!"

To go back to the home summary page, click: "Nubra Valley Medical Volunteer work - a trip of discoveries"