Buttertea at Sunrise (11 page)

His answer is slow and drawn out with the slur of fatigue.

‘Nima didn’t sleep well last night,’ he apologises, and I can guess that none of them did.

‘Why don’t you go home, too?’ I say to Pema and point at the powerless bulbs. ‘I am sure we won’t get many more patients.’ For a moment I wonder if I am overstepping the boundaries of my authority, but then reassure myself that no one will notice anyway.

‘You will be OK by yourself?’ Pema asks, then gets up quickly, perhaps afraid I might change my mind.

‘Of course,’ I lie with fake confidence, searching for one more rationalisation for Pema’s early departure. ‘We always advise our patients to take some rest, don’t we? And I think that is what Nima and you need most right now, too.’

And it is true, after all. Perhaps there is not much we can offer here in our little physiotherapy department, but at least I can put a small part of my western training to use.

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Choden

I noticed Choden a few days ago during rounds when Dr. Shetri explained that she was a case of transverse myelitis, admitted to the hospital for a urinary tract infection caused by her catheter. A little unclear about this diagnosis, I had asked further, and the doctor explained that transverse myelitis is a viral disease, attacking the spinal cord and leading to neurological deficits. The disease left Choden partially paralysed from the waist down, and for about four years she has not walked or stood. When I watched Choden that day, I noticed that the muscles of both of her legs seemed to violently contract in frequent spasms, leaving her curled up on the bed, helplessly writhing in pain. When I enquired as to whether she was receiving any treatment for her legs, the answer was no. She was only here to fix the urinary tract infection.

No one seemed to think that Choden was a candidate for physiotherapy treatments – except for me. I wanted to give it a try. I asked permission to work with Choden, and reluctantly the doctors wrote out a physiotherapy referral.

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The apparent hesitancy with which I am granted a trial period of treatment irks me a little. I am puzzled by the doctors’ attitude towards my role at the hospital. Although I am seemingly welcomed as part of the staff, there is an unspoken underlying resentment whenever I suggest

something different from what has already been prescribed.

At times, I wonder if it is all in my imagination; perhaps I am a little paranoid and hear criticism where none is meant. Yet I cannot shake the miserable impression that I am treading on somebody’s toes.

In any case, today Choden is coming to physiotherapy, accompanied by her mother and her little five-year-old daughter, Yeshey. Choden is a very pretty young woman of twenty-six, with large brown eyes and a full head of shortcut black hair. She smiles readily, and her expression is one of intelligence and understanding. Self-confident and remarkably agile, Choden has learned to manipulate her legs in such a way that she can get around by supporting her bodyweight on her extremely muscular arms and

pivoting her hips to the side. This method allows her to at least move from the bed to a chair or, if needed, to the ground.

Transverse myelitis struck her a few years ago. Again, the number of years varies between different versions of the story, but it seems clear that the onset occurred after her daughter’s birth. Since then, she has gone from being completely paralysed below the waist to her present status of painful lower extremity spasms. She says that her catheter is the main problem. She only has one and, in her village, it is difficult to keep it clean. Over the past few years, she has been in the hospital several times for urinary tract infections.

Curious, Yeshey, the little daughter, looks at me. She appears intrigued by my blond hair and pale skin, but 83

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remains quietly standing beside Choden’s wheelchair. Like a tiny guardian, she assesses my trustworthiness.

‘Do you want to sit on the bed with your mom?’ I ask.

Yeshey nods seriously. She does not intend to leave her mother for even one minute.

I ask Pema to translate our assessment plan to the three women. Choden’s mother asks a few questions, but Choden remains quiet. Smiling, she pulls her daughter closer, and although Yeshey must not understand all that is being said, she visibly relaxes.

Pema turns to me with a frown. ‘It would be better to be in Thimphu.’

‘Why is that?’ I ask.

‘Thimphu has more equipment and better room. It is much easier to work there.’

‘I don’t think it’ll make much difference for the

assessment,’ I counter.

‘Still, it is better to work in Thimphu.’

‘Well, let’s see what we can do here. We should be OK.’

Pema’s sudden appraisal of our primitive conditions in Mongar astonishes me. Could it be that Choden reminds Pema of her son, and now Pema is wondering if Nima could get a better treatment in the capital? I resolve to encourage my faithful assistant to bring Nima to our physio room.

Maybe if we see some success with Choden, Pema will feel more confident in my treatments and let me try with Nima.

I look from Pema to Choden and am struck by the same quiet determination which both of these two young women share. But for once I am grateful that my patient does not speak English.

‘Please don’t discourage Choden before we have even started,’ I plead with Pema.

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My usually diligent assistant shrugs her shoulders but affirms once more, ‘Thimphu has better facility.’ Then she starts the physical assessment.

After several attempts at moving Choden’s legs to

evaluate her range of motion, Pema has to abort her efforts.

The more she tries to push, the more Choden’s legs go into spasm. Once triggered, the strong involuntary muscle contractions grip Choden’s legs like a vice, pushing them into a pointed-toe, straight-leg position, or pulling them into a tight crouch. The harder Choden concentrates herself, the more her muscles play havoc. Nothing can be done but to wait for them to relax in their own time.

Eventually when the tension slackens, Choden is able to put her legs into a reasonable position through stiff, jerky kicks.

Still, Choden is eager to keep trying, and after a short rest, we again attempt a meaningful movement, this time more slowly. Initially, it looks as if we could succeed. Then, completely unexpectedly, I feel Choden’s legs tighten, and before I can react she has kicked me against the wall. My hip bangs against the iron bar of the suspension frame, and loud rattling echoes through the room. Embarrassed, Choden apologises, and I can see that she is now ready to give up.

Through Pema I try to reassure her, try to tell her that it does not matter at all. How can I make her understand that I am the one who feels silly? I should have been prepared.

I promise myself to watch out the next time.

In full concentration, we continue for another twenty minutes. Finally, we find a solution. Bending Choden’s knees to 90 degrees and pushing the soles of her feet with an even pressure onto the bed seems to interrupt the constant waves of spasm. Choden smiles through her exhaustion.

Perspiration has plastered her hair against her forehead, and little rivulets of sweat are running down her cheeks.

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Choden’s mother disappears to fetch a glass of water.

Yeshey climbs onto the bed and lays her head on Choden’s stomach. Tenderly, the two whisper to each other. Then Choden laughs and brushes a curl off Yeshey’s forehead.

I am touched as I watch the closeness and confidence between mother and daughter, and ponder the stormy weather that must have strengthened this trusting bond.

Just like Lhamo, Choden and her family live in a small village far away from Mongar. A trip to the hospital is like a voyage to a different continent. At home, her parents and her husband run the farm and Choden is left to herself for most of the day. She gets around the house by sliding along the floor, pulling herself with the help of her arms. Still, her happy spirits do not seem to suffer. Now she is joking with Yeshey, and together they tackle her transfer to the wheelchair.

Encouraged by our modest success, I plan my treatment strategy. I want to help Choden to walk. Her body is strong, and she is a determined woman. Somehow we will make it; we will find a way. I ask Choden to come back tomorrow morning, first thing before rounds, so that we can divide the treatment into two shorter sessions. Upon my arrival in Mongar, the DMO had enquired if I needed anything else, and now I know what is missing: a set of parallel bars! We need a solid grip for each hand to help Choden stand up, and a narrow walkway to prevent a fall. There is enough space along the far wall of the exercise room to accommodate a bar of ten-step length. Just long enough.

And we need a mirror. Choden has to see herself stand; she has to see that it is possible.

I explain my ideas to Pema. ‘Do you think we could find a really tall mirror?’

‘Why not!’ Pema answers enthusiastically. All signs of her previous wariness have vanished.

‘You should speak to ADM.’

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Shortly thereafter, I discuss my plan with the hospital’s administration, and the ADM sends Arup, man of all trades, to assess the situation. We agree that for the parallel bars we will use a couple of old pipes and make a base out of wooden boards. Immediately, Arup asks me for an exact drawing of what I have in mind. Perhaps my enthusiasm is contagious.

Two more ‘general mechanics’, Dendrup the electrician and Tenzin the assistant, join our little group, and like a team of engineers we survey the building site.

‘If the base is too long, it will not fit around the corner here,’ Pema cautions, pointing at the hallway that leads to the TB ward.

We study everyone’s palm size and estimate the required circumference of the pipes needed. Then we discuss stability problems. I show them how ideally we would need the bars to be able to move up and down to accommodate different sized patients. Arup answers my every suggestion with a return confirmation, ‘You would like it like this…

isn’t it?’ followed by an encouraging little sideways shake of the head, ‘yes, yes, I think that is possible, OK, OK!’

Arup is eager and seems quite knowledgeable. Pema is ready with critical comments, and Dendrup and Tenzin nod obligingly. I have every reason to put full trust in our mission.

In the afternoon, I am standing with Arup and Dendrup in the laundry-drying hut, a simple covered wood structure held up by a few posts. There is a fireplace at one end, and wire clothes lines run parallel throughout the length of the shed. The hut seems to double as a storage room, and below the drying sheets and pillowcases, there are piles of wood scraps, old doors, dented, rusty night tables and broken windows consigned for… I don’t know what.

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Though all sides of the hut are open for a breeze to circulate, the air smells stale and musty. An old woman, probably a relative of one of the patients, is cooking something over the fire and smoke creeps through the mist to settle on the freshly washed sheets. Arup and I are discussing the engineering principles of building parallel bars, and I watch as Dendrup hammers the four corner supports into place.

I am flabbergasted by the speed of the whole operation.

In my experience, the hurried, fretful West and most of nonchalant, unruffled southern Asia run on a different perception of ‘on time’. Bhutan is no exception. Usually things promised for tomorrow arrive the day after, if you are lucky. So far, I have learned that patience is probably the one survival technique, which I will have to perfect.

Yet here I am watching the makings of my parallel bars, less than a day after the idea was conceived. It is a miracle.

Another miracle blesses that wondrous afternoon. The rain stops! As if someone in the heavens was grabbing chunks of the white fluffy stuff and flinging it into space, the clouds break up. Torn to this side, then to that, the fog loses its grip on the ground, and evaporates in one slow huff. Warm yellow sunrays flood through the patches of blue sky and burn away the remaining shadows. Steam starts to rise from the earth, as water droplets on trees, bushes, and grass turn into vapour.

Around me, an entire spectrum of green explodes in the sunset. Out of the mist, the mountains rise to meet the sky. They are beautiful, gentle mountains, softly curved and cushioned by jungles of dense green foliage. Valleys carve themselves through the ranges, zigzagging between the slopes only to lose themselves behind the next corner.

In front of the hospital, in a little courtyard half enclosed by the infectious disease wing and the operating room, a 88

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