Departure

This entry is written in the waiting area of the Paro Airport.  I’m on my way home.

The last few days here have been most enjoyable. I already wrote about my lovely meal with Damcho and her family. The day after, Christmas Day, I had a nice walk around Thimphu, taking pictures of day to day life.  Sunday I walked to the radio tower and then to a monastery; I’ve already written about that.  I had an interesting incident in that I met two utterly sweet teenage girls who started chatting with me (all the kids love to practice their English) and when they found out I was an American doc, wanted their picture taken with me. So, their dad took a picture of these two kids resting their heads on my shoulders. My error was in not asking him to use my camera to take a picture as well.

Sunday was also Boxing Day, and I was invited to the home of some Christian Indian contract nurses. I had a delicious authentic Indian meal and found myself trying to explain Judaism, to some degree, to folks for whom I was probably the first Jew they met. I was asked if I was baptized, and said no. They were really surprised. I explained about circumcision, and a light went off—“Ah! Like the Muslims!” I said yes, but actually the Muslims are like the Jews, not the other way around. Incomprehension again. Oh, well. Anyway, it was a blast to spend time with these nice people.

Monday I went out to dinner with “Mr. Pete” and his family. Pete Cueva is a great guy, retired nurse anesthetist who has been volunteering here as well. He had been joined by his wife and daughter who are utter delights. I had been given a bottle of champagne by my jaw abscess patient for my help, and I had the Cuevas, “Dr. Trish”, and the Smiths over for the champagne after dinner. Dr. Trish is Trish Shands, an orthopod from Alaska—great lady, great doc, apparently also a great drummer but I know that only by reputation. The Smiths are Sue and Dave—Sue is a PT and they have been here for four months. Sue has been my partner in crime in getting physical therapy started in the ICU. Also wonderful people. We talked way past bedtime, but the other HVO volunteers have been a major positive in the experience.

Tuesday, my nurses and two of the docs I worked with gave me a going away party. Again, great home cooked Bhutanese food. I was given a Bhutanese tie and a Buddhist embroidery of the elephant, monkey, rabbit, and bird that symbolizes cooperation and harmony. What a nice remembrance.

Wednesday, we had a last meal at M-K’s, a restaurant run by a Bhutanese Hindu catering to Japanese tourists and expats who serve wonderful Bhutanese and Indian food. Go figure, but we had wonderful thick noodle soups, fried momos, and potato filled parathas.

And here I am in the Paro airport. A number of people, nurses and the other HVO volunteers, as well as the Bhutanese docs say that I made a genuine difference. I don’t know if they are just being polite, or that maybe I started something. More on that later, after I have some time for reflection.

The only bad thing is my final couple of days in the ICU. My tetanus patient died, my arrow patient got worse, and we had two sepsis deaths within 24 hours in addition to the tetanus patient. Again, I need to reflect on this before I comment.

More later, maybe in a week or so.

A Final Walk Around Thimphu

The title is not exactly accurate. This post is primarily to show some pictures of Thimphu's monastic architecture, primarily the Thimphu dzong. It is huge, and is the seat of government. I visited it with Kajal while she was still here, and never posted the photos. Later, like the 26th of December, I did take a good long walk up in the hills and got some good photos of the dzong from elevation. While up on the trails, I visited another monastery and at one point was literally engulfed in a sea of prayer flags.

Here are some shots of the dzong:

When I walked to the Sangyegang radio tower, as it is called, I didn't realize that there were prayer flags all over. The wind was blowing, and it was just beautiful:

I walked from the radio tower through a pine forest to the Wangduetse Gompa, a monastery, where I made the usual donation, was blessed by the monk, and went inside and saw the Buddha:

A nice walk, just the right amount of exertion, met some lovely people along the way. A nice day.

The National Sport

All right, all right, this is a teaser-- those of you who know me well know I don't give a hoot about sports. However, archery is the national sport of Bhutan. It's quite different from archery in the US. The distances between the archer and target are quite long, and the wooden target is quite small. There are two targets at the correct distance. One team of archers stands at one target, firing at the other target while the other team observes at the second target, presumably safely out of the way.

Life is not perfect. These are powerful bows, and bows and arrows don't  have a safety, and we occasionally end up with a CT scan like this:

 

Because this is a low velocity penetrating injury, there is no tissue shearing shock wave as there is with a bullet or piece of shrapnel.  Brain damage is surprisingly limited, with a conscious, hemiparetic patient who has a pretty good chance of recovering a lot of function. His main risk is brain infection at this point. I'm sorry I won't be here to see what happens.

We continue to have problems with overwhelming sepsis. If/when I come back this will need some work. We've have now lost two relatively young people in 3 days. Very frustrating and sad. I'm not even sure what the problem is.

We have had a nice turn of events with introducing physical therapy to our long term patients. This is a really nice, low-tech intervention that may really reap some rewards:

Our PT team at work!!

I think that about wraps up this installment.  Still to come:  that final walk around Thimphu, and some final thoughts and farewells.

La Vie Quotidienne

That's from high school French. One of the great French writers, I forget who, used to write of La Vie Quotidienne, which is daily life. I've gone around and snapped some pictures of some of the places and things that might show what is was to live here, rather than visit here, as an ex-pat.

So, first the apartment:

Living Room. Spend most of our time here.

Hall/Dining room. Used mostly as a hall.

Kitchen. More below.

 The bathroom has been a source of interest for many of my followers.  Well at the risk of being a bit too explicit, let's go over this... The squat toilet is pretty easy to get used to. It is smellier than a western toilet, because your business sort of lands there and just sits. However, it is extremely hygienic, particularly if you are in a public place. Your private parts simply don't touch anything, only your feet on those two white tiles that basically are there to show you where to position yourself. The position, after minimal adaptation, is quite natural and comfortable. The key is to carry toilet paper so you don't have to go the next step, which is washing yourself rather than using toilet paper. When you are done, you simply flush, and while the water is sluicing through, you use the scrub brush (that blue thing under the tank) to clean up any skid marks. No muss, no fuss, honest.

 The shower is a bit odd. As you can see, there is no stall, and the curtain was an HVO improvement. You also can see four spigots. The two middle are for hot and cold. Turn on the top one to have water come out the shower, turn the lower one to have water come out the tap.  Put your clothes, and anything else you want to keep dry, as far away from the shower head as possible. Mix the water very, very carefully because hot is hot enough to brew tea.  When done, dry up, get into  your clothes, and then squeegee the floor. The drain is the hole in the floor, which is actually connected to a drain pipe; it's just that it is a hole in the floor.

 Bedroom is quite pleasant. Beds are hard in Asia! Heat is from an electric portable radiator, barely visible on the far side of the bed.

 More on the kitchen and cooking for myself. Appliances and staples:

Water purifier. Put tap water in the top container and drink out of the bottom.

Two burner stove. LPG tank under the counter.

Electric kettle (water boiler) on the left, rice cooker/steamer in the middle, and fridge on the right.

 Here are some of  the things we kept around the kitchen:

Cheese. The white spheres are the cheese from which the "datse" dishes are made. The square chunk is Bumthang Gruyere. Very yummy.

Snacks: Fried dough at ten o'clock, crisped rice at one o'clock, and an "orange" (it tastes and peels like a tangerine) at six o'clock.

Cookies and milk (Hint, the milk package has a cow on it. Doesn't need refrigeration til you open the package)

Tea

Paneer (Indian Cheese)

Various condiments.

The sidewalks are very broken up. I actually fell and got a nice scrape and hematoma on my forehead, which has now drained into my orbital regions giving me two black eyes, and killed a pair of pants. Fortunately no major damage. Despite that, walking around here is great fun.
  
When you go out, this is how you lock your door:

The city is, in a bizarre way, quite pedestrian friendly. There are shortcuts everywhere, and crossing someone else' property to shortcut is considered appropriate. This is a shortcut we used almost daily to get to the downtown:

Dogs are everywhere:

Laundry is everywhere:

 The main street is crowded and busy, but pleasantly so. There used to be a stop light at the site of the traffic policeman; it was so unpopular that the traffic policeman was returned to his kiosk:

 

 Shops sell almost anything and everything. Here's a smattering:

Bhutan Telecom. This is where you pay your Internet  bill....

In person, in cash.

I went vegetarian here. The butcher shops freaked me out.

Produce was gorgeous.

Weavings and fabrics for the tourist trade

Tires, straightforward enough. However, look at the sign on the door!

Fabrics for making kiras and gohs, the female and male national costumes respectively.

An everything under the sun shop

An almost everything under the sun shop.

So that's life in Thimphu.  Maybe one more medical posting if things get interesting, and some pictures from a couple of long walks around Thimphu, including the Thimphu dzong.

Food, or why there aren't Bhutanese restaurants in the U.S.

Let me say at the outset that I have by and large enjoyed eating here. Food has been wholesome, I haven't gotten sick, and once the taste is acquired, is fairly enjoyable. On the other hand, once a week I go for pizza, or Thai, or Indian.

Bhutanese cuisine is a mix of Tibetan, native Bhutanese, and Indian. reflecting the geographic and ethnic makeup of the country. Many dishes here are quite hot. The main condiment is a crushed red pepper sauce:

 The national dish is ema datse, which is chilies eaten as a vegetable, smothered in a cheese sauce.  This is not disgusting, and is an easily acquired taste. The chilies are not Scotch Bonnet grade, more like jalapeno's or a little less spicy. No other condiments, save for some salt and some garlic. When done properly,  you can taste the flavor of the chilies as well as their hotness.




 The "datse" suffix can be applied to most anything. Another common dish is kewa datse, potatoes and chilies in cheese sauce.

Quite delicious, actually. There is mushroom datse, green bean datse, pretty much anything. When I was at Damcho's house, the ema datse had some dried beef in it (dried beef is more popular than fresh. Sort of like beef jerky without any salt or spices. Again, not bad at all once you get used to it.)

Rice is another staple. The Bhutanese like both standard white rice as well as red rice, a local specialty that tastes very much like brown rice but cooks much more easily:




 Subtly flavored white rice is also served regularly:





 Chopped leafy vegetables sauteed are also pretty common:



 I didn't have any chicken at the meal I photographed, but typically it's just hacked into pieces without filleting, and cooked in a variety of sauces.

Eggs are used extensively, because they are inexpensive, in good supply, and are considered by some to be vegetarian fare. I don't know the name of this dish:



Meat is a little strange. Pork is very much enjoyed. Typically is a bacon type cut, with the rind and fat attached, and some meat as well. Eating fat in this climate makes sense, and given that people burn lots and lots of calories staying warm and working, perhaps it can be forgiven. I'm not sure the picture shows the pork well. The round slices are a kind of root, looking something like daikon. Mild, tasty. The pork dish was actually quite good:






 This beef dish below is probably of some Tibetan influence, guessing this because of the noodles. Spicy. Even though this was a high end tourist restaurant, the beef is stringy and full of gristle. Quite tasty:

 I didn't include pictures of thukpa, a delicious Tibetan noodle soup, or momos, dumplings that are filled with cheese or beef. They are a wonderful snack, eaten with hot sauce.  I'll definitely get a picture and update this entry.  Indian items such as nan (bread), roti (bread), samosas (fried pastry filled with potato or vegetables), pakoras (vegetable fritters), curries, Indian cheese (paneer), biryanis (rice dishes), dahl (lentils) and Indian style prepared cauliflower and spinach  are also commonly on the menu.

Even though the Bhutanese cuisine is tasty, it is a little repetitive and takes some getting used to. I wasn't kidding about the U.S. restaurants. The majority of patrons would come in once, try the menu, and not come back because it was so heavy and so unusual. Given some time and no other options, I've grown to enjoy it.

I'm getting hungry. Time to go out for lunch!!

Back from lunch. Here are the momos:

Yum!  Momos in the middle, chili sauce at top, and sweet milk tea to the left. 

 What a great meal.