Buttertea at Sunrise (9 page)

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C H A P T E R S E V E N

Back-breaking

Work

The end of my first week in Mongar is drawing near, and this dark and rainy morning promised to be

slow. Feeling slightly more at ease with my new

routine, I left the hospital for a few minutes to get some of my textbooks from the house. Heavily loaded, I now walk back past the OT. There is a line-up in front of our physio windows. When I left, the hallway was deserted, but now it looks as if someone has opened the floodgates. I observe the queue but cannot recognise any of the faces. Moreover, this crowd is not like the usual onlookers; they seem to be patiently waiting for me, absorbed in their own thoughts.

As I approach, the line divides respectfully to let me through. Perhaps my white lab coat is an unmistakable sign of authority. I smile at the patients and notice that most of them are dressed in Indian clothes, the women in saris and the men in simple shirts and trousers. I wonder if they are workers on the hospital construction site, or else road 66

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workers whom I have seen in little camps all along the road from Thimphu to Mongar.

Pema is already busy taking a history. Since I cannot hear any ‘
ngamla
’ (pain) or ‘
oga
?’ (where?), the words must not be Sharchhopkha, and I assume that Pema is talking in Nepali or Hindi. Not comprehending a word, I sit down to watch. The woman beside Pema speaks in a low, almost inaudible voice, her hands neatly clasped and folded on her lap. Her concern seems urgent and somewhat confidential.

She never looks at me, but after a while, Pema translates.

The patient’s name is Dhan Maya, and she is indeed a road worker at a site about an hour’s walk from here. Her job consists of carrying stones to a spot where others can break them. For the last few weeks, she has been suffering from back pain, and now she can no longer sleep at night.

I look at her referral. It says ‘Chronic lumbar derangement.

For physiotherapy. Kindly assess and treat.’ The signature is a big, bold
B
with a few scribbles behind it. I ask Dhan Maya about her doctor. She says it is Dr. Bikul, the young Indian doctor working in Outpatients.

Pema and I complete the assessment together. Sadly I realise that there is precious little I can do for this lady.

Made of only skin and bones, Dhan Maya’s stature is far too fragile for her heavy labour, and other than somehow altering the gruelling tasks of her day, nothing will alleviate her agony. I discuss her options with Pema. A new job is out of the question. She is here with her family from Bengal, and she and her husband work in order to make some money to send home to his siblings. They are grateful for the work; they have been here for almost seven years.

I ask about decreasing her hours, but I only get a small shake of the head as an answer. I ask if she can take a few more breaks during the day, but again the answer is a no. I ask if it is possible for her to switch her duties with another 67

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woman, but she says that they are all doing similar things, and anyway, she is one of the youngest and strongest.

Can she come here for treatments?

No, it takes too much time out of her work. She only has this morning off.

Physiotherapy is not a profession that counts on quick fixes and easy cures, and I am used to running into problems. However, here in Bhutan, I face new challenges.

At home, I would call her employer and discuss light duties or a change of duties. She could get worker’s compensation or, at the very least, she could get some time off. There would be some way to lessen the constantly aggravating circumstances – but here? What should I tell her? I feel dreadful. I am facing a dead end and I know it.

I am stuck for advice, or a treatment, but somehow it becomes clear that my shy, polite patient is not really expecting any. She is already halfway out the door, and apologetically explains that she has to leave. She needs to get back to work now.

‘We see many workers here,’ Pema sighs, her eyes full of sympathy. ‘You have seen where they live?’

I nod.

‘You will be able to treat them?’

‘I hope so,’ I reply without admitting to my doubts.

The next few patients all have similar complaints. Low back pain, shoulder pain, elbow pain. Every time it becomes disturbingly obvious that the symptoms are caused by the brutal physical nature of their work. They are all labourers.

They all need their jobs. None of them can afford to take time off, and none of them wants to. They walk in with clothes soggy from the rain, tired, dragging their feet, and they leave much the same way – disillusioned, resigned, accepting.

I feel miserable and useless. I wish that we could at least offer them a rest under the heat lamp, something to 68

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comfort them for a short time, but there is no electricity today, and our desired machines are hiding in the damp semi-darkness of the room.

At last, I am confronted with an acute, treatable condition.

Pasang, a young Bhutanese man of 27 hurt his back while lifting a log. I ask him to rest for the day and teach him some exercises. My confidence is boosted, and my spirits rise. Though he is one out of many, at least he can benefit from my being here.

Pema asks why he differs from the other patients we have assessed so far, and we take the time to discuss his condition in more detail. I want this to be a learning experience for Pema. Finally, I send Pasang back to the doctor to ask for a prescription for some anti-inflammatories. Within a few minutes, he returns. The doctor wants to speak to me immediately.

I am not even surprised. All of the outpatient referrals today have come from Dr. Bikul, and this is the first one I have actually been able to treat. Now Dr. Bikul is questioning my methods.

Already this morning during rounds, I had a run in with him over the diagnosis of one of his patients. He thought it was a case of L3 (lumbar vertebrae 3) paraplegia. To me it looked more like an incomplete L4, and I voiced my opinion. We argued for a while over whether it could be caused by a tumour, an autoimmune disorder or a compression fracture. Then he tested me on the nerve supply of the entire lower extremity, all the while waiting for me to foul up. I did not falter. I stood my ground and demonstrated my knowledge. He seemed astonished.

Finally, he admitted that he knew next to nothing about physiotherapy and abruptly turned back to his patient.

Now he probably wants to grill me again. Well, he can wait.

There is another patient outside who has been expecting to see a physio for almost an hour. I will finish here first and 69

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then go. After all, if it is so urgent, why can the good doctor not come here himself? With a sweet smile, I ask Pasang to go back and let Dr. Bikul know that I will come soon.

Half an hour later, Pema and I enter Chamber No. 4

behind a thick, blue curtain. Dr. Bikul looks up from his papers. ‘Please sit,’ he says and directs us to two chairs facing his desk. His attitude is distant, and his arrogant expression gets under my skin. Defensively, I square my shoulders and then look at Pema for reassurance. As always, she is smiling.

‘You wanted to talk to me?’ A little bout of panic wells up in me, but I try not to let it show.

‘Yes.’

The foreboding silence that follows evaporates my earlier courage. I cannot read his expression. Maybe I did do something wrong. Again I look at Pema, but she does not seem perturbed. In my mind, I quickly run through the cases which I have seen this morning. What does he want from me?

His question pulls me out of my thoughts. ‘How do you like Mongar?’ For the first time, a tiny shadow of a smile whisks across his face.

‘Well, I am not sure yet,’ I stutter. Then I quickly add,

‘It seems like a nice place.’ Quietly I scold myself for not displaying more enthusiasm.

‘I am sorry that I sent you so many patients this morning.

I did not know if physiotherapy could do something for them, but I thought you would try.’ He seems almost sincerely apologetic. More relaxed now, I wait for what is to come.

‘Could you explain to me why you gave Pasang those exercises?’

Here is my trap. Again I feel my body stiffening, but then I remember that he is the one who knows nothing about physiotherapy.

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‘From my examination I found that Pasang has a

mechanical low back problem.’ I launch into a long explanation of mechanical back pain, its causes and applicable physiotherapy treatments.

Dr. Bikul listens attentively. At one point, I feel like I am convincing myself, and not him. How do I explain the other mechanical back pain patients to whom we did not teach any exercises? Will he take offence if I talk about the back-breaking working conditions of the labourers? This is only my first week here; better not to stir up any trouble.

Dr. Bikul is still occupied with Pasang and calls him back into the room.

‘Pasang, do you understand the madam’s exercises?’

‘Yes, sir.’

‘Could you show them to me?’ Dr. Bikul points to his examination bed.

‘Yes, sir. Of course, sir.’

Carefully, Pasang climbs onto the bed and demonstrates his homework. Not totally correct, but acceptable, and I say nothing.

Dr. Bikul seems satisfied. ‘Hmm. Good. You do the

exercises like the madam has told you. Come back if you still have pain in ten days.’ He turns to me.

‘Are you finished with Pasang?’

‘Yes,’ I answer.

Dr. Bikul nods at Pasang. ‘OK, Pasang. You can go

home.’

My nerves are settling, and with a new confidence, I eye Dr. Bikul. He is definitely handsome. Young, maybe my age, he has an athletic posture and wide, strong shoulders.

His hair is thick and black, and his dark and smooth features are beautifully underlined by his white lab coat. His eyes are big and expressive, and now they sparkle with a shy smile.

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‘I would like to talk to you more about physiotherapy. It is very interesting.’

‘That would be fine,’ I reply. ‘Any time.’

Our discussion seems to be finished. Pema and I rise to leave. Throughout the entire visit Pema has been quiet, but now she teases him. ‘Doctor, you still have many girls out here waiting for an examination.’ Suddenly, I feel embarrassed and rush to leave the room. Outside, Pema smiles from ear to ear. ‘You really told him about physiotherapy. Isn’t it?’ We both laugh. I have to agree with Pema. We earned our first small victory.

Back in our physio room, I do not feel quite as victorious looking at a neat pile of referrals, which are stacked on my desk.

‘Where did these come from?’ I ask.

‘Inpatients, sister. They are referrals from the wards.’

With a sigh, I look at the diagnoses; an old woman with chronic low back pain; a leprosy patient with an ulcerated foot; more back pain patients.

A young woman, perhaps thirty, enters the physiotherapy room. She comes from a village two days’ walk from Mongar where she heard that a new foreign doctor has arrived. She insists that I have to treat her. At first, I am confused by her lack of a referral, and when I ask her if she has already seen another doctor, she nods. She saw the gynaecologist before, but now she wants to see me. After more prodding, her concern finally becomes obvious. She has come because she wants me to check her IUD, or intra uterine device that is part of her family planning. I am not sure if I should laugh or cry.

Helplessly, Pema explains to her that although I am a

‘doctor’, I am not
that kind
of doctor. Obviously disappointed, the woman asks repeatedly if I might not look at her.

Guiltily I think about her long journey through the rain to the hospital. How quick the news of my arrival has spread 72

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to the villages, and how happy she was at first, thinking that finally a woman would look after her private concerns.

Although this misunderstanding came about through no fault of my own, I cannot help but feel overwhelmed and wonder if I will be able to meet the high expectations of a foreign ‘doctor’.

At the end of the day, we finally arrive at the bottom of the pile of referrals. Tshering Dema, 68-year-old female from Mongar district. Stomach ulcer. Scoliosis. Low back pain.

Pema tells me that I can call any older woman Abi, instead of addressing her by her given name. We agree that I will try to do as much of the talking as possible to practise my Sharchhopkha.

The old abi from Ward B is a delight. The intense sun of high altitudes has wrinkled her face like a prune. A single stained tooth sticks at an odd angle in her mouth and accentuates her glowing smile. While Pema takes a history, Abi mumbles a continuous flow of words, not once ceasing to grin.