A Search for Clarity in the Valley

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“These Himalayas are proof that God is real and that he loves us,” a delightful Canadian woman told us while we were nearly fed up with the rough trail on our way to the Tsum Valley.

The Tsum is located on the northern side of Gorkha district in Nepal, neighboring Tibet. It is a valley carved out by the Shear River flowing down from the gorge between Ganesh Himal (7,406 m) and Shringi Himal (7,186 m) with the sacred Buddha Himal (6,692 m) towering over across. The word Tsum appears to be derived from a Tibetan word ‘Tsombo’, which translates to 'clear'. For our purposes, this word represented the reason a few key doctors and nurses chose to embark on the month-long medical mission trip: yes, to clear up the ailments and diseases of the Tsumbas, but also to clear the confusing emotions leftover from losing a loved one.

We were a group of 16 medical professionals on a trip of fact-finding, capacity building and treatment for the villagers who call the valley home. The organizer, a nurse from Minnesota, had recently lost her daughter to suicide, a story which had attracted a few other volunteers who wanted to mend their own hearts while mending others' wounds. For the rest of us, we found ourselves empathizing with their losses as we walked in the shadows of the Himalayas over the one-year anniversary of the Gorkha earthquake.

We started out on the Manaslu circuit where there are many tourists - young and old - walking forward, climbing upward and breathing heavily through their enduring smiles. We wondered why these fair-complexioned people from other parts of the planet flocked here to embark on a trek in which a misstep might determine life or death, how a group accustomed to the daily luxuries of running hot water and pillow-top mattresses could rediscover happiness through roughing it in the mountains. They quickly became nostalgic for simpler times and idealized the homes with a view of the snow-capped giants. It was all but a palaver for a Himalayan native like me. Sure, these mountains may captivate, but one can't ignore the problems that accompany life in the mountains. It can take a week of walking or—in many cases—even longer to reach one’s home. But in the eyes of foreigners, a week without engine-equipped vehicles can have a profound impact on one's peace of mind. Some say that the experience can change what the word peace means to a person, taking it from an illusory term to a flood of the senses.

A minibus travelling from Kathmandu stopped in Arughat at 5 pm on the 4th of April and unloaded our dizzy and carsick group at the guesthouse front gate. Mr. Tanzin Lama, our spry young trekking guide, assigned each volunteer a bed in shared rooms and set a time for dinner. The non-vegetarians enjoyed the last meat-based meal before we entered the 'no-kill' zone of the Tsum Valley, a region that has honored an oath of nonviolence since 1921 when it is said that the honorable Lama Serap Dorje requested the villagers to do so. The villagers have renewed the oath time and time again; 2010 was the last occasion, done so through a Syakya (nonviolence) Festival. Being part of the Manaslu Conservation Area, there are also stringent rules against bonfires, hunting wild game and taking honey from natural beehives. It seemed that we were on our way to explore a culture closer to pure Tibetan Buddhist ideals than what is found in most other regions on earth.

The 5th of April began with a three-hour warm-up hike along the motorable road to Arkhetand, then to Sotikhola where we stopped for lunch. The afternoon unfolded the real trail full of bumps and stones, and yes, the mules’ poo and fragrant piss. Having never trekked before, I didn't imagine my olfactory system would eventually grow so accustomed to that heavy aroma. Days later, mule’s poo became what we searched for lest we got derailed from the usual course of the trail.

The first day of trek we barely made it to our accommodations in Lhapubesi before sun was down. Lhapu is perched up high in the mountain and is constantly hit by gentle breeze. A large, barren and vertically land-slipped hill stares at you from across the deep-seated river, and being early April, we could see green saplings of maize growing up and down the path. Profound gratitude sunk in when the foreigners realized every man-made object in sight was at some point carried in by donkey, mule, man, woman or child on the same ragged trail we had walked on. Every sip of beer and every flush of the porcelain western toilet was given a moment of appreciative pause. We slept knowing whatever was beyond that point would feel just as special. 

Continuing on the next day, two hours before reaching Machhikhola, we encountered a man carrying an older gentleman in the traditional bamboo doko. Oblivious of the mission we were on, they—the wounded man's wife and neighbor –kept working their way down the pebble-strewn beach. When asked, they reluctantly told us that the old man had broken his right leg and that they had been carrying him to the nearest hospital, a four-day journey. The faces from the western world looked completely perplexed when I told them that this multi-purpose basket has long been the ambulance of hilly Nepal. The elderly man was then put down, and a family physician from Australia confirmed with a portable ultrasound device that he had sprained his right leg. With the help of other team members and a bit of ready-to-use plaster of Paris, his leg was fixed at the banks of the Kali Gandaki River.

Machhikhola is a pleasant place with a stream of clean water running adjacent to the town. There is no electricity outside of small solar powered batteries, so those who like a cold beer can instead cool their bottles in the flowing water. A few members of our group did just that while also sinking their trail-weary feet into the river. Others who opted out for the naturally chilled Carlsberg practiced yoga on the sandy and stony beach, an end of the day routine many looked forward to.

The next day we reached a main attraction of the route: a hot spring. The natural hot water that splashes down the massive rocks not only tingles your skin- it nearly burns it. Nevertheless, hiking every day can leave the body exhausted, not to mention slightly emaciated, and a hot water bath can relieve the body, wash away all the layers of perspiration and leave you with a fresh frigidity afterwards. Many locals walk for days to reach the hot spring as they believe even a single bath can eliminate all their skin diseases of present and future. 

Jagat is always the next destination to stop overnight. It is an extensively clean town, abounded with heedfully laid stones along the pathways. By the time we reached Lokpa, which is the starting point of the Lower Tsum, we had already climbed 2,000 meters in altitude. Landslides, leaving scars of makeshift renovation, intermittently devastated the path: rocks covering holes on suspension bridges and timber felled to cross smaller streams. If the earth was to quake while we walked in the valley, it's uncertain we all would've made it out alive. Steep rocky cliffs towered over at the brink of collapse. In many places along the trail, we would've been hard-pressed to find protection should the crags be slightly shaken. 

The gushing river, which in the beginning inspired fear and awe, became monotonous as we followed it up the track. Occasional glimpses of grazing goats and yak, trains of load-bearing mules and donkeys and their yipping herders, along with the mischief of monkeys, refueled our verve, but most of all, it was our curiosity to reach higher and more remote villages which gave us the energy to continue and the attitude to enjoy it. In fear of twisting ankles out of distraction, many decided not to talk with anyone else in order to concentrate on their footing. We Nepalis were born and raised as fearless runners, not mere walkers along rugged trails, and the silence was uncomfortable.

The further up the trail we went, the higher the price of goods rose. A water bottle normally costing 20 NRS increased by ten rupees at each next settlement. The mules carried in everything stocked on the shelves of the small shops, thus adding to the cost. The team instead had different techniques for water purification in order to drink locally available tap water; a few used chemical pills, others chose a Sawyer filtration system, and still others used small but powerful UV-lights. Even with the precautions, each of the foreigners was caught with at least one form of ailment along the journey. Some felt proud to say it was due to altitude, that their stomachs were as strong as the locals, but acclimatization, in most cases, does not cause diarrhea. The accidental intake of impure water or foodstuff might have been the culprit, but who knows when there are highly disease-prone subjects involved?

Soon we reached Chumling where we were to conduct a four-day comprehensive camp for the villagers of the Lower Tsum. Gopal Dai, the village leader and a hard working man, had the one-and-only hotel in Chumling. Any group trekking through the Tsum must stay a night at his house- or else tent up in the jungle (but more likely in his large front yard). When we arrived he was setting up three large tents in that yard for our makeshift clinic.  

All the participants underwent a detailed health evaluation along with deworming, vitals and visual acuity examinations. We also conducted educational sessions regarding alcohol and tobacco, family planning and nutrition. Our team found that most people in the Lower Tsum are illiterate and living almost self-sufficient lives gathering wood for their stoves, herding ox and yak, and farming potatoes, corn and other grains. Some families depend partially upon the income of young people who were often porters or guides in the trekking business or working jobs in the cities or abroad. A few individuals understood Nepali, otherwise we had to depend on our team of translators to communicate with them in Tibetan or the Tsum's own local dialect. Hygiene did not seem to be a priority for the people of lower Tsum. Dirt was caked onto skin with swarms of flies clouding around their shoes. Many people openly shared with us that they bathe just two or three times a year. I would characterize the smell of most villagers as slightly milky, most likely due to the yak butter used in their hair. Females were clad in the traditional woolen Tibetan dress, which also went months without a wash. 

Dhido (a typical Nepali cuisine prepared with water and any type of flour including barley, wheat or corn) was the staple diet. Corn is the major crop, but many patients complained that rats usually take almost half of the stored harvest. Being a "no kill" valley, the people have little they can do about the pests aside from keeping cats around. Monkeys also dipped into reserves and for this reason, most households kept a dog to chase them away. 

From young children to the elderly, strong and healthy to the sick, alcohol consumption was found to be highly prevalent. There were a few patients who showed up to the camp intoxicated with their homemade spirits, which they claim to have a number of health properties. Though the doctors made alcohol education and intervention one of the top priorities, one couldn't help but feel that the efforts were a bit hypocritical at the end of each day when most indulged in a post-work libation. 

The houses in the Tsum are made by piling stones carried from the hills using no mortar to hold them together. According to some sources, the earthquake a year back destroyed 90% of the houses in the valley; however most of the houses that have been rebuilt were done so in exactly the same way. Houses are traditionally roofed with layered flat stones, but more and more families are choosing tin-sheets, which are safer but villagers lament as being less picturesque.

After four days of the health camp in Chumling, we headed up and up to the village of Chhekampar sitting at 3000 meters. Our guides informed us that the steep slopes towering beside the usual trail were, in one section, still slipping with pebbles and that we would have to reroute towards Ripchet and cut up through the dense forest on an old and mostly unused path. Each of us carried a pack lunch that was doled out by Gopal Dai in the morning, as there were no stops in between Riphet and our destination. A flatter clearing on the forest floor served as a dining hall around 1 pm. Our spirits were still high, but after eating, our detour sent us careening uphill through the coniferous trees on an endlessly precipitous trail. The bluebell flowers of the verdant floor and a variety of rhododendrons in full bloom diversified our climb, but hours past with no hillcrest in sight, taking group morale to an all-time low.

Many members of the team suffered nausea from the increase in altitude, which slowed down the pack. It had seemed at times that we weren't going to make it before sun down. Our guides from the area, and even one Nepali doctor, sped things up by descending back down the hill to help carry the others' daypacks. We worked together as a unit: sharing food, water, anti-nausea medication and of course, encouraging words. "Only your own legs will carry you," said my fellow Nepali optometrist to one the weary foreign volunteers. Later I was told that ironically, those words carried her through the trek. 

Over the forested mountain of a hill, we encountered traces of stone sheds from nomadic groups of times past before descending back down to cross the river. The canopy cleared and we spotted the head cook of our team, who had already reached Chhekampar by taking the more dangerous alternative route. He had in his hand a thermos of hot Nepali tea to fuel us for the final climb. It was at this time, 10 hours after we'd left Chumling. Once in the comfort of the newly renovated guesthouse, the group fought exhaustion with the astonishment of our physical accomplishments and we celebrated with a round of raksi, a traditional distilled spirit.

Chhekampar was an idyllic-looking village. It's located on a wide flat stretch of land, which sits atop a cliff nestled in the mountains. A stream flows from the melting glaciers through the town to join with the river below. The wheat and grass saplings sprawled out uniformly and imparted prosperous green scenery for our curious eyes. This town marks the starting point of the Upper Tsum, and although it is closer to Tibet than the Lower Tsum, we found that more villagers could speak Nepali. The town was almost completely rebuilt from the earthquake and the people were also strikingly cleaner. The disparity between the Upper and Lower valleys may have developed for a number of reasons, but most obvious to us was the wealth of flat, fertile, and therefore, easily cultivatable land in the Upper Tsum. The climate was also considerably cooler, meaning they needed to store food over the winter months, while people in the Lower Tsum are, to some extent, eating field-to-mouth. 

The next day, just over an hour's walk was all that was necessary to reach our second health camp location and home for the next 7 days: Lama Gaun, or the 'village of Lamas'. The way to Lama Gaun was replete with enthralling panoramas of snow-capped mountains. Midway through our leisurely flat stroll, a group of our translators came out from behind the sunshine yellow shrubs and stone mani walls to welcome us to the Upper Tsum. One young woman wore the traditional woolen dress her mother had woven for her. Her outfit was decorated with with a silver spoon -handed down through generations- dangling from her belt. Each translator carried bunches of pink rhododendrons and white blessing scarves (khata) to offer our group. We toasted with raksi and tea to wash down homemade and store bought biscuits, and we filled our cameras with group photos, yoga poses and the mountain views. 

In Lama Gaun, we worked out of the Compassion Health Center, a primary health care center with basic amenities that was recently established by Lama Gaun's head spiritual lama and his two brothers. Over the six days camping out at the clinic, the lama did all he could to make us feel welcomed and comfortable. He was ecstatic at the care we were providing his community, especially the acupuncture that was evidently the talk of the town. At the end of a total of 10 days treating patients and documenting records in the Lower and Upper Tsum, we had seen just over 600 patients. Having done many health camps around Nepal, this is not an impressively large number, but I will say that each patient received better comprehensive care than most other medical missions can boast. 

A small monastery called Mu Gumba perched at 3,700 meters is the ultimate destination of the Tsum Valley trekking trail and my last excursion before flying out of the valley in the supply helicopter. The six of us fitting in the chopper lamented leaving early even though all that was left for the others to do was to walk out of the valley the same way we came. On the way back from our day hike to Mu Gumpa, a friend and I stopped to pay respects at the Milarepa cave. This is the very cave where Boudha guru Milarepa meditated until enlightenment. We stared at his footprints imprinted inside the grotto and wondered if there really is something clarifying about the Tsum. Maybe the humility felt amongst the beauty and power of the mountains is what brings us closer to accepting death; it is the feeling that if we were to die from slipping off the path or being buried by a landslide, our bodies would become part of that land, so striking and seemingly divine. Thinking back to the doctors who had come to the Himalayas to heal others while resolving their depression from loss, I say with certainty that we completed our mission. 






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