by Ed Jackson
Our car turned off the main road and, as we bounced along the dirt track, I couldn’t help but peer up at the surrounding canopy. Vines and creepers circled their way around the tree trunks, linking the foliage together for the monkeys to climb across. Thick bushes covered the ground, impassable outside of the trails, and hiding the animals of the jungle. I felt as though as I was being driven towards the gates of Jurassic Park.
When the cars pulled up, I got out of ours as quickly as I could – I was eager to hear about their vision for the spinal unit. Fourteen of us stood in the clearing where the trees had already been felled. Wood chips were scattered on the ground, which gave me an idea of the size of the hospital. Up above, the calls of unfamiliar birds and animals balanced our own chatter below.
‘It will be an eighteen-bed hospital,’ the translator informed us.
‘How much will that cost to build?’ I asked, trying to tot up possible numbers in my head.
‘We think it will be £250,000.’
I couldn’t believe it. With that sort of money, you could build a house in the UK but never something that could transform the lives of eighteen people and their families.
As we talked, I was taken down to the river that acted as a natural border to the national park. Although the site was only fifty metres from the main road, it felt like I was miles away from the bustling streets that had led us here. Staring up at the dappled light that filtered its way through the lush green leaves above, I thought back to my time in Horatio’s Garden at Salisbury Spinal Unit and how that outside space had aided my recovery. I was therefore pleased to hear that architects for the spinal unit in Chitwan planned on leaving as much of the natural habitat intact as they could while creating an outside space for the patients. After you’ve been lying on a bed inside for weeks or even months, feeling the sun on your face or breathing fresh air can be such a positive, life-affirming experience.
We explored every part of the site and then went for a meal at a nearby hotel where stories were exchanged and tentative plans were drawn. Before I knew it, jet lag had set in. Lois and I made our way to our hotel room and the most inviting-looking bed I had seen for a long time. I closed my eyes with a vision of what I thought the new spinal unit could be. And what an exciting vision it was.
One of my favourite things about this part of the world is that it’s socially acceptable to eat curry for breakfast. Chuck a few eggs on top and I was set for the day.
We had been invited to meet the local mayor. This confirmed our suspicions that everyone had mistaken us to be far more important than we actually were. That morning, Lois and I had put on the best clothes our backpacks could provide and I had even ironed my T-shirt. When we arrived at the council buildings, we were whisked from the waiting room into the mayor’s office. Giant Nepali flags and pictures of the Himalayas adorned the walls, leaving us in no doubt that we were in the right place.
From behind a large desk emerged Mayor Dahal, a petite woman who was not much older than me but who had the presence of a lioness. Fortunately, a few of the spinal unit doctors had come along to introduce us and help translate. We were invited to sit and I began to explain how excited I was about the project and what I hoped would come from it. Mayor Dahal listened patiently and when she spoke it was with a wisdom that surpassed her years. It soon became very clear why she was in her post.
As the mayor listened intently, she nodded and smiled at me graciously. I’m not entirely sure if the doctor who was acting as my interpreter was deliberately adjusting the translation of my drivel in a way to please the mayor, but the amount of nodding and smiling I was receiving was reassuring.
The reason I had been invited to speak with the mayor was to thank her for donating the land for the spinal unit. Funding for any type of rehabilitation in Nepal is almost non-existent as the limited funds are funnelled into maternity services. And rightfully so. The infant mortality rate is as high as 50 per cent in some regions of Nepal. Rehabilitation always falls behind acute care in all countries; we are just lucky that in the UK we have the NHS to provide a basic level. Without a well-funded national health system, next to nothing filters through to rehab and this results in an area that is in desperate need of support. With that in mind, we were incredibly grateful that Mayor Dahal had arranged for the land to be donated.
All too soon our hour was up. With a final namaste, Lois and I left the room. I was all fired up; it really felt like we could make a difference.
At the entrance to Chitwan’s current spinal unit, I was met by a big lad in a wheelchair. Through the translator we introduced ourselves and I found out that he was a former patient who regularly visited the hospital to provide support and counselling. We got chatting and he told me that he had been left paraplegic after a serious traffic accident.
‘How did you injure your spine?’ he asked.
‘Well … ah … I dived into the shallow end of a swimming pool. I thought it was deeper than it was. There was a really pretty waterfall that made the surface of the pool gently ripple …’
As I kept on talking, I could feel my man points were reducing in his head. It wasn’t the first time that I’d wished that if I had to suffer a spinal injury then at least I could have done it in some daring escape, possibly involving a motorbike chase and an extended free-fall parachute jump. But I suppose we all have to work with what we’ve got.
The fact that there appeared to be regular accidents over there that would rarely happen in the UK had not been lost on me. The Nepali people had more natural disasters to contend with than we did back home. The sad truth was that most people died from their injuries, especially up in the mountains, as they wouldn’t be able to get to hospital in time to have the lifesaving surgery they needed.
Taking in the dilapidated frontage of the spinal injury hospital, I noticed how most of the windows were caged or covered. It looked more like a prison than a place of rehabilitation. We went into the building and stopped in a small room made entirely from bare concrete with a single rusty fan slowly turning in the corner.
I ducked my head to enter the room and was met with a huge grin from a young man lying on the wrought-iron bed. Pressing my palms together, I made my namaste, which was always as satisfying to give as receive.
The room was dark and stiflingly hot; chinks of light from the shuttered window cast long shadows on the floor and the air smelt stale. I looked around for any hint of items that had been brought in to brighten it up, but there was nothing that I could see. The paint was peeling from the walls and the concrete floor was bare. The idea of spending days here, never mind months, left me cold.
With the help of the translator, I pieced together the patient’s story. As he told it to me, he was smiling; there was not a trace of self-pity in his demeanour. Like a lot of the Nepali people, he viewed his accident as his fate and therefore something that just had to be accepted. All the time his wife busied herself folding his clothes. She did not speak except to greet me with a forced smile that didn’t quite reach her eyes. Later, I began to understand why his wife was hurting, why she was angry with what had happened to them.
Many spinal units in Nepal are so woefully underfunded that they cannot provide nursing care, so family members have to stay with each of the patients. Specialised spinal units are few and far between in Nepal. As wives are expected to care for their husbands for the rest of their lives they often have to leave their children behind, never knowing when they will see them again, in order to keep their hospital places. Without a change in their circumstances, they often effectively lose their children.
As we were leaving the room, one of the doctors turned to me. ‘It is very common that the patients and their families have to make these impossible decisions. I’m sure that you can understand that life in a wheelchair is not easy here. It is very hilly, and the road surface is very uneven.’
I nodded. I had been struggling to walk here. To say that Nepal was hilly was the understatement of the century.
> ‘And then there is the problem of jobs,’ the doctor continued. ‘Most of the work available is hard manual labour, which people in a wheelchair would not be able to do. There are no welfare payments for disabled people so the truth is that, in very poor rural areas, the injured can often be pushed out of the family home as they cannot afford another mouth to feed.’
‘So, where do you discharge them to?’
‘We try to train the family member who comes with them in physio and also about the physiological side of the injury so they can help with their rehabilitation. We hope this will help them return to their homes and that having a family member who understands their injury will help persuade the extended family that they can still have a future. In the new hospital, we hope to have the resources not only to aid their rehabilitation but to train, educate and help the patient find work. This will help not only them, but their families as well.’
‘So, people won’t lose their children?’
The doctor nodded. ‘As you know, these injuries do not only affect the injured. The repercussions are immeasurable.’
As I mulled over what the doctor had told me, I followed him into the physio room. I tried to pay attention as he showed me their equipment. There was a TENS machine that looked as if it would have been used to start a car battery back in the Seventies, a standing frame and a tilt table that were both worn from repeated use. And that was it. That was the sum total of the rehabilitation equipment the hospital had. Three items that would have been written off thirty years ago back home. Don’t get me wrong, the staff were amazing and doing everything they could with what little they had; there was no complacency here – just an utter lack of resources.
If only they could have the medical care I had back home …
For the rest of the day I was quiet. I couldn’t take it in. It was hard enough for me to stay positive in the comparative luxury of the hospitals I had stayed in, let alone out here. Yet the patients and staff did what they could to stay sunny and bright. There was no complaining from them. They just got on and did what they could with what little they had.
It was a sobering visit and had given me a lot to think about.
With the official part of our trip over, Lois and I travelled up to the Himalayas. I couldn’t make a trip to Nepal and leave without visiting some of its mountainside villages. There would be no actual mountain climbing for me but I had been reassured by our taxi driver that there would be some excellent views to soak up.
Lois and I both clung to our seats as our taxi tore up the mountainside road. Buses and trucks ploughed down towards us, honking their horns impatiently as they overtook each other on corners. I was constantly alert to the drop only a couple of feet from the tyres of our taxi that would plummet us hundreds of feet below. Seat belts didn’t seem to make much of a feature here, so I gripped onto the driver’s headrest and tried not to look down.
Our starting point was Nayapul, a small village that is an entry point to the Annapurna region. Hikers, climbers and kayakers milled around in clusters as our taxi drove past them to the drop-off point. Some were preparing for the adventures ahead; others were clearly returning from the wilderness. I soon found out that their state of disarray and their general aroma was a key indicator of which direction they were travelling.
Stepping out of the car, the first thing that hit me was the heat. It was overwhelming. If, like me, you had assumed the Himalayas were cold, you would only be half right. The largest mountain range on Earth is not actually that far from the equator, so the ice and snow you see is the result of altitude. Where I was, in the foothills of the mountain slopes, the temperature was above thirty degrees and very humid.
Pleased to be back on solid ground, we made our way to the Nepali man who was holding a sign with my name on it.
‘I am Bigraj,’ he said, shaking our hands and smiling shyly at us.
We introduced ourselves and in a few minutes we were off, this time on foot. We followed Bigraj as he led us away from the busy hut where the tourists met their guides. Soon we were on a road that doubled as a dirt track that wound its way above the green valley below. Every so often we would have to cross a precarious wooden rope bridge that hung over the water streaming below. If my leg went into spasm, I knew that I could easily be sent tumbling into the rushing water.
Trying to take my mind off whether the swinging bridge could take my weight, I decided to ask Bigraj if he had grown up around here.
‘Much higher up,’ he responded, as he expertly crossed the bridge in a few short strides. ‘From age four or five, like many in Nepal, I had to climb stone steps to go to school. I climb for an hour each day. I will take you to stone staircases soon. The best views up high.’
‘So how did you become a guide?’ Lois asked from up ahead.
‘When I was fourteen I work as porter, carrying the bags of tourists while guides showed the way. I was interested in the languages. I managed to learn English by talking to visitors. Nine years later, I was promoted to guide. I have been walking these mountains for nearly thirty years now, so I have much to show everyone.’
Listening to Bigraj helped calm my nerves as I made my way slowly to the other side of the bridge.
After a couple of hours of clambering up the valley, we stopped off in a little homestay/restaurant for lunch. All of these small mountain villages seem to be run by the same character, a smiling yet authoritative older woman who I shall just call Grandma. As you can imagine, all of the locals are incredibly fit with hardly an ounce of fat between them … well, most of them. Grandma is undoubtedly top of the food chain. Whilst the others work the fields or carry huge loads thousands of vertical metres, Grandma is in the kitchen cooking up a storm to feed them all. She may have been taking liberties with the portioning, but it seemed like a fair deal – the whole place would collapse without her. And, like all grandmas around the world, her food was always delicious.
We sat down at the side of Grandma’s house and Bigraj told us the food options.
‘What do you think we should order?’ I asked.
‘Dahl Bat,’ he responded. ‘You should order it at all the homestays. You will see why.’
Dahl Bat is a local dish that’s a combination or rice, lentils and pickles and, if you were lucky, a bit of meat on the side. Following Bigraj’s advice, Lois and I promptly ordered the Dahl Bat.
As we waited, I noticed another tourist couple wander in who ordered one of the other dishes on the menu. Grandma rolled her eyes in response. When we had finished up our delicious Dahl Bat, Grandma bustled over and politely offered us seconds while pointedly ignoring the other couple when they had cleared their plates. There were no seconds for them as they’d gone off-piste. Bigraj was a wise man.
After we had finished refuelling, we thanked Grandma, crossed the road, and set off up a stone staircase that literally disappeared into the clouds. All of the villages up here are linked by stone staircases and beautiful ones at that. Hand-chiselled, narrow flags of stone were laid three deep to create each step. They had been produced by many hands and the amount of work that had gone into them was awe-inspiring but completely necessary – the villages had to be accessible in all seasons and because of the acute gradient, pathways would either be too steep or not wide enough.
As I began climbing each step, I realised that I might have taken on a bit more than I’d been prepared for. The uneven nature of the stone steps meant that every placement of my foot required some consideration and I was grateful to have my walking poles with me to take some of the strain.
Step by step, I worked my way up the mountainside, concentrating on each movement. One misplaced foot or pole could bring nasty consequences and, considering the isolation of the villages, it wasn’t the best place to be injured. After half an hour of this, the strain began to build. I really struggle with lifting my left leg vertically, but it’s much easier for me on a pathway as I can swing my leg upwards. I therefore have real issues with stairs and I hadn’t reali
sed that we were expected to climb them for the next five hours. My right side has to work twice as hard as my weaker left side so my heart rate was sitting at between 160-175bpm for five hours. To put this into context, the average person’s heart rate during a marathon is 160bpm over four hours. There are large parts of these physical challenges that I hate – the pain, the frustration and the negative thoughts. But the rewards are always worth it … and, as we climbed higher, I knew this time was no exception.
After a few hours of strenuous sweating and soul searching, the path flattened as we neared the village where we would be staying for the night. There was still a sheer drop to my left but the village was only fifty metres away and I could almost smell the Dahl Bat. Staring up ahead, I wasn’t concentrating on where I was placing my walking pole and I missed the pathway. All my weight went to rest on thin air and I tipped over the side of the mountain path.
I swivelled around and made a grab for the ledge but missed.
As I fell, all I could think was, Oh no, not again. You absolute idiot.
With a crash, I landed in a bush six feet below. That bush literally saved my life. If I ever return to the area, I’m going to head back up there and buy it a beer.
Lois shouted out and, in a few moments, both her and Bigraj’s worried faces popped over the side of the walkway. I lay on my back, staring up at them. Glancing down at my legs, I noticed a bamboo stick poking into my right calf. Panic flooded through me as I had no sensation there so it could have easily pierced my leg by several inches and I wouldn’t have been able to feel it. Touching my calf, I was relieved to realise that the bamboo was blunt and would only cause a bruise.
Bigraj hopped over the side to help me as I wriggled my way off the bush. I couldn’t help but laugh, probably in relief that I hadn’t injured myself, but Lois hadn’t found it so funny; for the rest of the walk up to the village, she pointedly ignored me.