Head in the clouds, feet on the ground. Doctors in Nepal

Head in the clouds, feet on the ground. Doctors in Nepal

Only a hundred meters left. With every step, I feel my heart beating louder in my chest. The air is thin, 18700 feet (5700 meters) above sea level. The view is more than Instagram worthy. At the top, praying flags in different colours flutter in the wind. The mountain ridge is bare and dusty. One sentence from a documentary of David Attenborough keeps repeating itself in my head: “In the mountains, people are only temporary visitors.” My phone has no coverage. Miles around, there is no sign of any living being. So far, the bitter cold and the steep mountain paths have not exhausted me. But once we hear the top is 10 miles further away than we expected, my inflexible mind becomes an obstacle. Dealing with the unexpected is a challenge if you are a product of a well organised society.

What happened before

It was August 2015 when my phone rang. The moment of hesitation was only short. Somebody asked me if I could take one month off to visit one of the most remote areas in Nepal for a medical project. Currently working as a PhD-candidate in a small cubicle at the surgical department in the Academic Medical Centre in Amsterdam, this sounded like a great adventure. Even more after what I had learned from a surgical residency in Zambia a year before.

After crowdfunding some stickers on my backpack, I was on my way to Kathmandu on the first of October. With three other doctors, we were going to visit Upper Dolpo, an area the size of 50000 square miles in the west of Nepal. The founder of this plan was Jan Nikkels (56 years old) — general practitioner, father of four children and the initiator of ‘foundation Zuidwolde’. In his spare time, he is also the president of the local soccer club and one of the driving forces behind a benefit bicycle tour from Tsjernobyl to his hometown Zuidwolde, located in the Netherlands (1100 miles). He promised his wife that Upper Dolpo would be his last big project.

In order to get to know each other, I spent a working day with him in Zuidwolde and visiting patients driving through the Dutch landscape. A few years ago, he refitted his car in order to drive on rapeseed, planted in the area. The building of the general practice uses solar panels and the toilets are flushed with rain water. Jan Nikkels is the example of an idealist who has not turned his back towards society, but who pioneers by example.

Why Nepal?

In 2009, Jan Nikkels visited Upper Dolpo for the first time as a hiker. The roughness and the authenticity of the region struck him instantly. Upper Dolpo lies hidden behind several passes around 19000 feet (5800 meters) and can only be reached by foot or helicopter. The inaccessibility has protected the region from ‘culture pollution’. The majority of the inhabitants of the Dolpo area are Tibetan migrants, practicing ancient Bon-Buddhism: a combination of Buddhism and animism. The yaks are their most precious possessions. They are used to transport salt and other products from the Chinese border to other areas. The isolation and the bare conditions have made the Dolpo people proud and resilient.

 based on numbers from WHO report

based on numbers from WHO report

However, not everything looks rosy, as their remoteness has also excluded them to benefit from modernisation. The average life expectancy is only 46 years and 1 out of 10 women dies during labour. This trip is the third time Jan Nikkels is visiting Upper Dolpo. The main goal so far was to listen. Most of the conversations took place in Tinje, one of the seven villages in Upper Dolpo. After long hours of tea with a nurse, the school director, teachers and a local artist, one important thing became clear to Jan Nikkels. Based on our background of a hectic society, it is easy to romanticize silence and scarcity. A lack of access to health care and education has nothing to do with the maintenance of an authentic culture. At the same time, roads and electricity pose a serious threat to the Bon-Buddhist convents, the traditional crafts such as stone cutting and the original languages. How can you help another human being without imposing your own western ideas of prosperity?

It is almost self-evident to desire running water, good education and a warmer home. And it seems logical that of no one wants a cup of coffee from Starbucks or a Mac Donald’s hamburger. At least, that is what we think. Our own perceptions prelude us from listening without judgement. Who are we to know how people in Upper Dolpo want to live?

Nobody has ever been here, how would they know what we need?
— Chief of the village in Tinje

Local lessons

When Jan Nikkels met Pasang Sherpa, he realised even more that he was ignorant. Although Pasang is originally from a region near the Mount Everest, he is now a permanent guide in the Dolpo area. In the 25 years of experience as a guide, climbing the highest mountain of the world three times, he has learned to bridge the gap between the scope of the westerners and the Nepalese.

He was 15 years old when he saw a guide speaking English. As a porter he realised that by learning that language, he would probably have less blisters on his back. As a true Sherpa, his highest goal in life is very clear. “I am most successful when I can make sure my group travels safely through the Himalaya.” In his own birth village, he has founded a school and a hospital. Currently, he is developing a garbage collection service in his district in Kathmandu. The success of his career depends on the results for the collective, an interesting thought in times of individualism.

 Pasang Sherpa

Pasang Sherpa

Don’t help, just listen

We are sitting at a table with eight local chiefs. A sense of compassion or the obligation to care for these people, seems inappropriate. Big pots of yak tea, a mixture of butter and chai, are poured in small cups of porcelain. One of the chiefs is talking for a long time. I try to understand what he is saying based on his body language. Pasang is our translator. “In Upper Dolpo, we have become accustomed to taking care of ourselves. Nobody ever visits this place. How would they know what we need?” With our guide, the local school director and the nurse we discuss what they would expect from us.

A convent, a hospital post, a sanitary place and a communal room. After a couple of days, we design a draft of the first DAHL-guesthouse (Dialogue, Agriculture, Health, Learning). A building modern in its simplicity: electricity from solar power, good isolation, greenhouses with plastic tarpaulins to grow vegetables. The building will serve both as a community building for the local people and as a guesthouse for trekkers of the Great Himalaya Trail. The revenues will benefit the local people.

The rest of our remaining days in Tinje, we deliver basic medical care. We vaccinate 150 kids against polio and hepatitis and we extract more than 60 rotten teeth. After 10 extractions, the local nurse has got the hand of it. Would it matter that we came here? Maybe. The coming years will tell.

Back to civilisation

After 21 days of walking we arrive back in to civilisation. My dirty body gets a clean shower. My phone retrieves a network. I see the images of endless rowes of desperate refugees, dead bodies in Paris and angry politicians anouncing drastic measures. When my plane lands back in the Netherlands, the country seems filled with stimulants and opinions. Everybody — both political leaders as well as the people standing next retrieving their luggage — seems to know how it should be done. The patience has stayed behind at the snowy peaks. I hope I can build the mountains of wisdom by listening in this hectic world.

Want to know how the project is getting along? Visit www.upperdolpo.nl

Will a robot ever be able to comfort us when we are sick?

Will a robot ever be able to comfort us when we are sick?

Voeten op de grond, hoofd in de wolken. Nepal, NRC Next december 2015

Voeten op de grond, hoofd in de wolken. Nepal, NRC Next december 2015