Nubra Valley Medical work- Day 3

Nubra Valley, Ladakh Medical work

Day 3, 17 July 2018  




Time to work!



Moving out from out last source of wifi.. Chamba Camp Hunder.

From Primary school, to Secondary school, to Junior College, to university, staying in the same hostel next door to each other,
to working in the hospital... and finally today together in Nubra Valley for the same mission!

Here is the VIDEO for Day3

The decision to leave at 6am from Chamba Camp Hunder at 6am was a wise one, factoring in the one and a half hours drive and the possibility of a jam going up to Samstanling Gompa with a huge numbers of devotees jostling for road spaces.

7:15am.

Making several detours courtesy of strict security guards who determined that a small medical team from Singapore carrying boxes of medical supplies should be categorized as foreigners and thus had to make a big round-about route to enter the premises, we came to our designated medical building.

The building and corridor stood just as they did the day before, barren of tables, chairs and curtains. Vicky was smiling. Steady lah, this Vicky. She must have seen enough of it to know things move at snail mail speed around this part.

“We had better quickly set up our medical centre,” said Haw Chou. “Otherwise the patients will start rolling in soon.”

Meanwhile we entertained ourselves taking shots of the many locals who were beginning to gather in huge crowds.

This little table here is my General Practitioner section in this little corner of the world.

Miraculously the tables, chairs, soon appeared as Lama Kendrap and the two young female interpreters arrived.

By 8:20am we were all set and ready to start business.

Jeanette focussing hard at her preparation work.

Vicky the most busy one - because every set of medicine must go through her hands.

开工!

Jeanette declares OPEN FOR BUSINESS!

Felicia Tan and her Urea Breath Test mechanic RK Pandey ready for business.

Us and our interpreters.

The monastery must have advertised our presence as the army soldiers and costumed-ladies were the first to appear. Our registration desk hit the ground running and patient after patient with registration sheets in hands came queuing up and Serene started measuring their blood pressures and pulse rates on the automatic BP machine.

Serene pretending to be busy taking Blood pressures.

My first Ladakhi patient was a senior-looking soldier in his khaki coloured uniform. What an honour!

Me, and my queue of patients all lined up behind. Photo courtesy of Chang Haw Chong.

Our orthopaedic surgeon Chang Haw Chong giving this patient EVERYTHING he has!

With my interpreter Miss Lamo seated behind me I got to work, as I was sure all my fellow compatriots were already. I stole a glance across and saw Haw Chou palpating the shoulder of a patient while Haw Chong examines the knee of an old lady. Felicia and Jasmine were in the privacy of the little room at the back and thus were out of sight. Hanjing was in a corner looking at the face of a lady.

I dragged my focus back to my next patient, another soldier who complained of blurry visions and teary eyes. Moving forward, I found myself inundated by an avalanche of a whole Ladakhi village-worth of ‘blurry-visioned, watery-eyed, painful-eyed, reddish-eyed'. Almost every case that came to the General Practitioner table was an eye case.

Dr Vanessa Ding taking time off her research desk to accompany Serene.

Before the mission I tried to gain a feel by asking around what kind of cases would I possibly see and what kind of load would I expect. Understandably the questions were really difficult to answer because apparently the doctors found that this year’s cases presented with slightly slightly different issues.

I was expecting plenty of cases of gastroenteritis and upper respiratory tract infection but these Ladakhis were a hardy lot. These small little ailments bothered them not, not enough to seek help. They were more concerned about painful, teary eyes and failing visions, all aftermath of years of toiling in the fields under the harsh ultra-violet-laden sun.

Many a case of bad dental caries with severe gingivitis plagued these villagers. And several came up to ask if we could do teeth extractions or teeth fillings.

Perhaps due to the difference in culture, their complaints were somewhat vague. ‘Feeling unease. Feeling weak. Feeling no power. Stomach feeling upset.’ were some of the common words that came from their lips. Symptoms that required either extensive detail blood works and investigations, or a huge dose of highly creative imagination, which in my case, was reluctantly the latter.

“Here zumur? No zumur?” I asked, after learning from my interpreter that zumur meant painful in Ladakhi, as I probed the abdomen of an old lady.

“Zhamsong (how long has it been already)?” Any gastric pain longer than a few weeks, I would, after settling their GP issues, send them over to Felicia For the Urea Breath Test.

The voice of The Dalai Lama giving his teaching came through the loud speaker. I found myself closed off from his words and totally immersed in feeling, palpating, eyeing, auscultating and smiling at each patient with whom I had the honour of examining.

Our ever so energetic Tan Lay Hong escorting patients from one station to another station.

I remembered reading what The Dalai Lama wrote in one of his many books: ‘... a physician must first learn to smile at his patients. No one likes to see a stern-faced physician. But a smiling physician can do much more good for his patients...’

This had become my motto, as much as the Medicine Buddha’s chant my mantra inside my heart, as I worked on each person.

An old lady came and sit down. She couldn’t see clearly for years, especially when she tried doing her sewing work. I took off my reading glasses and put it on for her. Immediately her eyes gleamed and she smiled as the words on the piece of paper became clear.

A 70 year old farmer told me about how his eyesight was failing him especially over the past few years. Looking from afar with the head torch and magnifying with the loop, I found moderate cataracts in both his eyes. My interpreter was very good. She could explain to him that his eyes have turned white inside and since he was still actively working he would definitely benefit from cataract surgery in the local hospital. A referral letter was written.

“Is it expensive to see the government hospital here in Ladakh? Do they get free medical treatment?” I asked my interpreter?

“No, “ came the reply. “They need to pay. But it’s a small amount.”

I looked back at the shabbily-dressed farmer and my genuine thought was how was he able to afford surgery. In retrospect, I doubted if really that many of my those who I referred to the eye surgeons could finally get onto the operating tables.

“Dar, you got to hurry up!” shouted Serene from the BP table. “Your queue is getting longer!”

“DAR!” I shouted back. Of course I will try to quicken my pace. The conventional wisdom was- there could never be ‘Cheap, Good and Fast’. One had to (almost always) choose two out of three. But in my own little cosy corner in this part of the world I was trying to create a fine balance of these three elements. Not one single of these Ladakhis was going to get up from my table without some form of reassurance from this humble GP, even if there was nothing I could do for him or her.

“Doctors, no more Clarythromycin tablets already!” came Vicky shouting across to me. Jiaklat. At least I still had Azithromycin to use.

My eye drops, eye ointments, Cetirizine, Hydroxyzines we’re literally flowing out of the dispensary like huge gushes of Ladakhi waterfalls. And the Tramadol/Paracetamol (ultracet) and Diclofenac were shooting out of the dispensary boxes like arrows propelled by machine guns.

Noon came and went, and then 1:30pm. The Dalai Lama had finished his teachings and had left and the patients started to surge into our medical enclave again. Our boss decided that the medical group had to take a lunch break then come back after 2pm to continue.

Post lunch, the influx was even more pressing and I was thankful that many of my good colleagues were starting to help me see GP cases.

One skinny Ang Moh lady sat down in front of me.  She took me by surprised,

"Hello, you are not from these parts.  Where are you from?" I asked.

"I am from Mexico," this young lady replied. "I am here to listen to the Dalai Lama."

She turned out to have a bad case of pharyngitis.  And knowing that Ang Mohs generally didn't like to take too many medicine, I bargained with her: "Look, you are far away here in this remote place and you have a bad throat infection.  I will promise you not to prescribe too many medicine," she nodded and smiled. "But I just need you to take a three day course of antibiotics, and that's what you should just do and get yourself quickly well," I recommended.

Cases of Upper Respiratory tract infections, laryngitis, some gastroenteritis cases, otitis media, two cases of bronchitis, and many many cases of acute, chronic and acute-on-chronic sinusitis sat across me.

The hard life and the dry, dusty environment with fine dust particles pervading the air, with a huge dash of unfiltered UV rays thrown into the curry pot made those working outdoors - soldiers, farmers, electricians alike - very prone to these allergies. Many eyes cases had papillary swelling on their hyperaemic lower eye lid conjunctivae - classic signs of allergic conjunctivitis.  How I wished I had more varieties of eye drops at my disposal, and more bottles of each type.   Then we could simply dispense the eye drops to them right away here instead of having to get them to buy from the pharmacies... something which deep inside my heart I felt that not many would end up doing for various reasons.

Lay Hong, Gerard, Terence and the volunteers were very efficient, bringing every patient cross borders from one doctor station to another doctor station, in those who required multidisciplinary management.

The left-handed Plastic Surgeon Lee Hanjing dishing out treatment for her patient.

Full support from behind by Terence for Lee Hanjing.

Felicia and Jasmine were so busy themselves in the ladies’ room undressing and dressing the female patients, and doing ultrasounds that Felicia actually deployed RK Pandey to run the Urea Breath tests in the corridor for those suspected of H. pylori infections. There was a moment when Jasmine came behind me...

“Wee How hey I got this patient who has worms infection, but we don’t have any deworming medicine right?”

“Yah hor,” I replied. “Let’s write them a prescription to buy mebendazole from the pharmacies, shall we?”

Our orthopaedic surgeon Lee Haw Chou just waiting for the chance to IA jab another patient.

“Haw Chou!” I called across to the ortho table. “Hey this patient with shoulder pain behind at the traspezius area.. what do you wanna do?”

“Just prescribe Voltaren tds!” came the reply.   Man, these orthopods are all like that one lah.  Short and sharp.

“Wee How!” called out Haw Chong from behind. “Hey I got this case with some acute onset of stomach pain and some wind.. what you wanna give?”

“Let’s add in some domperidone to your ranitidine ba!” I suggested.

“Hey, this woman has been having epigastric pain whenever she ate for the last two years. It’s not a chest pain, can we send her over to Dr Felicia Tan for the Urea Breath Test?” I suggested to my interpreter and they kindly ushered her to Felicia’s side, who I knew must already be overwhelmed.

Hanjing came by: “Hey I got his 2 year old child with abdominal colic but we don’t have any medicine for the colic right?”

“Oh yah hor... we don’t have wor. Bo Bian lah, Hanjing. I guess we just have to make do with the paediatrics paracetamol syrup.”

Very soon between the calling across the tables, Vicky and Shu Xian came running to the treatment sections many times, each time announcing the running out of certain medicine and urging us to strike them off our list. Our medicine supply WAS running low. Dangerously low. We were overwhelmed and the patients, by word of mouth and through the monastery announcement, really made a beeline for our medical side. The shortage was a problem. But it was a happy problem.

Behind me, I kept seeing Haw Chou and Haw Chong giving infra-articulate triamcinolone to knees after knees. And there was even one knee aspiration being done. Man, these Orthopods were doing a great job.

Next to them Roy the God-like Neurosurgeon was trying his best under such conditions to exclude more sinister headache from normal headache.

"You still got hope," offered our Neurosurgeon Roy Koh.

Roy was very candid. Afterwards he said: “In neurosurgery there are only two things we can do- if it’s life-threatening, we just need to operate otherwise they’ll die, if it’s not life threatening they won’t die (yet). Therefore here, if (after I examined and found that) there is nothing else I can do, I just give them some pain relieve.”

That was just so true.

It was fun catching sights and snippets of conversations of my fellow colleagues working on their patients. I have never engaged in such work and this was such an immersion that made it feel more like a person to person interaction rather than work to me personally.

By late afternoon we had to ration our medical dispensing already as we still had another session the next day.

Exercise cut was originally scheduled for 5pm, but I was the culprit holding up everybody, finally finishing just slightly before 6pm.

I asked Shu Xian, our accountant, much later: "Hey Shu Xian, it must be tough for you to have to look through all the medicine names and dispense them!"

Shu Xian replied: "I just slowly learn lor.  Vicky will tell me what name refers to which medicine and she will prepare the medicine and I just write on the label, and then she will do the dispensing."

Still, it was quite a feat for these two ladies - Shu Xian our accountant, and Vicky our nurse, to be handling all by themselves the dispensing of every patient.

A total tally done by Jeanette showed that we saw more than 400 patient on this first day, which was quite a huge number. And we were running desperately short of medicine and Jasmine had to go to a pharmacy some distance away to top up some critical stocks. But no, the pharmacies in Diskit area were nowhere near as well-stocked as those in Leh.

Totally shagged after day one of work... this Lim Wee How.

No chance to meet The Dalai Lama?

Unfortunately due to two main reasons:

the office of HH The Dalai Lama brought forward the dates of his teachings from 17-19 July to 15-17 July at the eleventh hour. Thus we had totally missed our chance of having a private audience with him.

We were so busy working on our patients by the time we finished he had already left.

So we were left with no choice.

“Sorry guys,” announced Felicia. “This time round we really have no chance to meet him already because he is flying of early tomorrow morning on his helicopter to another town. But let’s see what we can do. But it’s a very slim chance lah.”

In my heart I was ready to just continue working as I was tasked to do my work, and everything else was secondary. If it were my karma to meet His Holiness then it would happen.

Dinner back at Wangyal Guesthouse.

Dinner was delicious and our appetites were voracious after a hard day’s work. The power supply kept being cut episodically. And every time the electricity came back again the group would sing me a happy birthday song to me! Hahaha.. these boys and girls were really a cute bunch. And then finally when the electricity came back once more after yet another temporary cut, RK Pandey brought in a huge chocolate birthday cake and everybody sang!

Boy, was I touched! These good people actually ordered a birthday cake from the high class chamba camp in Leh and brought it to Nubra Valley, just specially for me!

I was also specially grateful to the kind gift of a consecrated rosary beads by our kind couple in the team and for the beautifully-worded birthday card from all my nurses.

This, had been a most meaningful and fulfilling day. Meaningful enough for me to say this was one of my best birthdays.

Still, the candle had to be blown after a wish was made and the cake had to be cut.

Taking a long look at the candle, I made my one solitary wish. And blew.

Then Felicia came up to me with her sweet smile and said: “Sorry, I had to hold this back until you make your birthday wish, but, you know.... just to make your birthday wish come true, we ARE going to meet The Dalai Lama himself tomorrow early in the morning before he flies off!”

Felicia’s words were music to my ears and warmth to my heart! I was so overwhelmed I held her arms and blurted:

“But, oh Felicia, how did you know that was my wish?” I couldn’t believe this lovely lady.

“Of course I knew. I just cannot disappoint you, and all of you who are here for the first time, can I?” she must have pulled heaps and heaps of Ladakhi strings to get us that small window of opportunity to meet His Holiness.

With this last piece of news, the day was made perfect, with a capital P. What more could I ask for?

Wake up 4am tomorrow morning and move out 4:30am to drive to Diskit Gompa to wait to meet The Dalai Lama? I’m ready at the drop of a pin!



To continue to the next day's adventure, click: "Day 4 - Meeting the Dalai Lama"

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

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