* Tibetan Marches, Hart-Davis, 1955
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Refuge in Dharamsala
30 JULY 1963
I got off to a gruesome start this morning. When we arrived at the Dispensary at 5.30 a.m. my first job was to put two children, who had died during the night, into the cardboard boxes which serve here as coffins. They were both four-year-olds but malnutrition had left them as small as an average two-year-old; it’s quite impossible to cure such miserable scraps once they get measles, bronchitis or dysentery. To make matters worse there is no possibility of notifying their parents, though the majority of the children have at least one parent living; so one often finds a mother or father wandering around the compound searching for their child, who has died perhaps several months ago, clutching the pathetic little bag of cheap sweets that was to have been the reunion present. Most of the parents are working on the roads in the Chumba or Kulu valleys, and they save up until they can pay the bus fare to Dharamsala and provide a few ‘extras’ for their children.
The Tibetans’ religion says that the dead must be given to one of the four elements – earth, fire, water or air. In Tibet the custom was to dismember corpses on a ‘cemetery’ hilltop, where birds ate them in a few hours, bones and all. This was considered giving the dead to the air and the custom obviously arose because in Tibet the earth is frozen hard for most of the year, wood is too scarce a fuel to be used on funeral-pyres and indiscriminately throwing bodies into rivers is unwise. But now, in India, Tibetans are cremated like Hindus.
This is our daily timetable, as devised by Juliet. Of course various adaptations have to be made to meet emergencies.
5.15 a.m. Rise, wash and dress. Walk to the Dispensary.
5.30 a.m. Take temperatures, distribute cough-mixtures, vitamin pills and calcium and iron tablets. Treat very bad cases of trachoma and conjunctivitis.
7.30 a.m. Breakfast while listening to All-India Radio News in English on Juliet’s transistor.
8 a.m. Bath the worst scabies cases in permanganate of potash and rub them all over with sulphur ointment. Clean out infected ears and treat them with Terramycin drops. Give percussion treatment to pneumonia and severe bronchitis cases. Massage rickets cases with shark liver oil.
12.30 p.m. Lunch, for which Oliver joins us at the bungalow.
1.45 p.m. Paint lesser scabies with mercurochrome and check all children to see if any urgently need Oliver’s attention. (Just needing it is not enough; in these circumstances a child has to be very ill to qualify for the Dispensary.)
4.15 p.m. Tea and biscuits in the bungalow.
4.30 p.m. As during the two hours before breakfast.
6.30 p.m. Cold bath in tin tub, with lots of Dettol in the water to kill any scabies mites acquired during the day.
7 p.m. Supper, for which Oliver joins us.
8 p.m. Writing letters, diary and articles.
11.30 p.m. Bed on the floor in the corner.
I must confess that tonight, after my first day in the camp, I’m feeling as depressed as anyone could be among these jolly Tibetans. It seems to me mathematically impossible that four Europeans, assisted by a handful of overworked, untrained ayahs, could ever make any significant impression on such a mass of misery.
This evening’s sunset was most spectacular. After a very wet thunder-stormy day the rain ceased for about an hour and the valley below us was hidden by an expanse of silver cloud. Suddenly the sky became a frenzied conflagration of orange, violet, red and lemon, and in the near distance a solid-looking black cloud wrapped itself round the dark rock of the jutting mountainside until you couldn’t see which was which. In fact so curious were the cloud formations that the whole western sky looked as if it were full of buildings, floating in space.
The weather here suits me – it’s just like a warm, wet Irish July – but the humidity complicates our work beyond endurance. There is no way of drying clothes, so the children’s garments are either filthy, which leads to more scabies, etc., or damp, which leads to more bronchitis, etc. And of course a humid climate is in itself unhealthy for Tibetans, even if they are living under the best conditions.
This afternoon Mrs Tsiring Dolma, His Holiness’s elder sister and the Principal of the Nursery, came down from her office at the Upper Nursery to ‘vet’ me. She speaks no English but was accompanied by her two henchwomen, Dela and Diki, who were educated in a Darjeeling Convent School and speak perfect English. Mrs Tsiring Dolma welcomed me most cordially and was very sweet and charming and apparently deeply concerned about my comfort while in the camp; she was effusive in her expressions of sympathy for the children and of gratitude to all Western helpers. Obviously she is enjoyably aware of being the Dalai Lama’s sister, yet she seems unsure of herself in dealing with foreigners. I noticed that she wears dark spectacles, which effectively disguise all her reactions. Perhaps she finds this convenient at times.
3 AUGUST
This morning five-year-old Dolma, a most attractive child, died in Juliet’s arms while being taken to hospital in His Holiness’s jeep. She had been fed through a nasal tube for the past week and we had all longed to save her, as she didn’t suffer from that hopeless degree of malnutrition which means that there is no chance of normal health in maturity. But when we saw Juliet returning down the path to the Dispensary, soon after she had left carrying the little blanketed figure, we knew that Dolma was gone.
Poor Oliver was nearly in tears and quite convinced that somehow it was all his fault; he has not yet come to accept the death of a patient as one of the occupational hazards of his profession. Dolma was the fourth child to die within five days so at teatime a post-mortem was decided on lest some undiagnosed infection should have invaded the camp. Oliver assured me that he and Juliet could easily cope without me, but I’m afraid that his consideration was wasted as I’ve always wanted to witness a PM and had no intention of missing this opportunity.
After supper we set to, having forbidden any Tibetan to enter the Dispensary, hung a blanket over the window, spread countless newspapers on the table and drenched the room in undiluted Dettol. The whole thing was extremely dangerous for Oliver; without adequate gloves or instruments the slightest nick in his hand could have proved fatal. In spite of my fondness for the child I was fascinated by the operation; somehow one doesn’t connect the corpse that’s being cut up with the human being one liked. After three hours’ hard work every organ had been removed and dissected, but the examination merely confirmed that Dolma had pneumonia in both lungs, an enlarged liver and intestines crammed with huge worms – which were still alive. It’s astonishing how much a body can contain: when everything was out in a big basin one could hardly believe that it had all fitted into the little space available. Oliver was very scrupulous about replacing every organ in its exact position, after I had baled bowlfuls of blood out of the torso, and then he sewed up the body as neatly as though after an operation. When we had replaced it in its little cardboard coffin he completed the ceremony by reading a short prayer for the dead from his German prayer-book.
4 AUGUST
It’s Sunday today so we have a free afternoon and I can write a longer entry. Really these Tiblets are most remarkable – I doubt if 600 children of any other breed could be so easily managed. Indeed it would be impossible to treat their complaints even as effectively as we do were it not for their extraordinary obedience and conspicuously high average rate of intelligence – even the tiniest tots respond to signlanguage. On my first morning at the Dispensary Juliet decided that we should administer cough-mixture regularly, so I went out to confront the multitude, bearing a huge flagon of mixture and a spoon. Not very hopefully I coughed exaggeratedly myself, pretended to drink from the spoon and indicated the spot on the veranda where I wanted all ‘coughers’ to queue. My astonishment was considerable when, within two minutes, all concerned were lined up for their dose, beaming at me with that irresistible blend of spontaneous affection and trust so characteristic of small Tibetan children.
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bsp; Of course the language problem is a nuisance at times as none of the children even speak Hindi, which Juliet would be able to understand. Neither she nor I hope to learn more than a few basic medical phrases in Tibetan, but Oliver, with his Swiss gift of tongues, is making rapid progress and should soon have a good working knowledge of his patients’ language. I envy him this facility, as it will enable him to get closer to the Tibetans than most Europeans do; already his sensitivity to their point of view has won him the affection and confidence of both adults and children.
There are two hamlets of tumble-down shacks near here – Forsythe Bazaar and Macleod Ganj – which have been taken over fairly recently by the refugees. Hitherto these adults have been wary of Western medicine, preferring their own ‘amchis’, who use a combination of herbal lore and quasi-religious charms – but now the sick from both hamlets are coming to the Dispensary in increasing numbers during ‘out-patient’ hours. Perhaps this is partly because Oliver sincerely respects their religious beliefs and also studies the old herbalist medicine; he believes in using simple local remedies when possible, rather than in concentrating on exorbitantly expensive drugs from abroad.
To return to the Distinguishing Marks of Tiblets. Their consideration for and politeness to each other positively makes me feel I’ve moved to another planet. I haven’t yet seen them quarrelling over anything – a most striking example of how deeply the Buddhist doctrine of non-violence has influenced the race. Not that Tibetans are incapable of quarrelling; many of them, especially the Khambas, have very hot tempers, and when drunk on chang or arak (their beer and spirits) they quite happily resort to fisticuffs. But fundamentally they are neither aggressive nor vindictive and their quarrels are always short-lived. In Simla I watched a practice soccer match between some of the boys at Chota Simla School and there wasn’t one deliberate foul in the whole sixty minutes. Moreover, if a boy accidentally fouled he stopped playing immediately and apologised to his opponent. Incidentally, Tibetans seem to be wonderful natural footballers, though the idea of organised team sports is foreign to them, and this school recently beat five others to win the regional championship.
But the most endearing of all the Tiblets’ unusual traits is their generosity, which seems particularly impressive when one remembers how very little they have to be generous with. If a parent brings buns or sweets the lucky child will often divide them up and hand them round to those near by – without any prompting from anybody. Similarly, when I go on my rounds in the Dispensary with special foods for certain cases, the privileged patient will take a few mouthfuls and then point to those whom he considers are being unfairly neglected. It’s indescribably touching to see a worried five-year-old sitting up in bed looking from his mug of savoury soup to the mugs of soggy rice given to the others and emphatically indicating his disapproval of this injustice, before finishing his meal with an obviously guilty conscience. Unfortunately I can’t explain that food suitable for one case would kill another, so even those who can feed themselves have to be supervised at meal-times or the sharing of sieved spinach with dysentery cases might have fatal results. Some Tibetan children have already been sent to Europe and others are to follow soon. I dread to think of the effect our civilisation will have on them.
Most Tiblets don’t seem to form any special friendships: they play or chat together indiscriminately. Europeans often remark on their lack of playfulness, in our sense of the word, and attribute it to malnutrition. Obviously there is an element of physical lethargy involved, but I feel that some visitors to refugee camps over-stress this and misinterpret it as a symptom of misery, forgetting that Tiblets are not as restless as Western children and can be perfectly happy sitting immobile for hours on end, talking to each other quietly but animatedly. Yesterday provided a good example of the inherent self-discipline of these youngsters. Before lunch I captured Sonam Dorje, aged about six, and laid him on a bed in position for percussion treatment. Then Oliver called me to help fix a drip on an emergency case so I abandoned Sonam Dorje, taking it for granted that he’d amuse himself until my return – but when I came back three-quarters of an hour later he was still lying exactly as I’d placed him, wide awake yet quite content to await developments for as long as might be necessary. And he is certainly suffering from no lack of energy, because when I’d finished tapping him he romped off and was soon to be seen aiming stones at a target rock down the mountainside.
All the children have names, except one chubby two-year-old who was found a year ago beside the body of his dead mother in Kalimpong. (I have now christened him ‘Ming Mindu’ – ‘The Nameless One’!) However, there are no family names in Tibet, apart from the nobility, and the range of Tibetan names – which are often common to both sexes – is strictly limited, so each child has a number written on a piece of cloth which is hung round its neck. Many Tiblets also wear as ‘necklaces’ a picture of His Holiness and a piece of red cloth blessed by a High Lama and guaranteed to protect them from evil.
The chief complaints here are bronchitis, pneumonia, TB, whooping-cough, chickenpox, measles, mumps, amoebic and bacillary dysentery, round-, hook-, tape-and wireworms, scabies, septic headsores from lice, septic bed-bug bites, boils, abscesses of incredible sizes, rickets, bleeding gums, weak hearts, asthma, conjunctivitis, trachoma and otitis media. The majority suffer from calcium and vitamin C deficiency and a heart-breaking number, no matter what is done for them now, will probably be partially blind or deaf, or both, in maturity. I was quite relieved by the deaths of three out of the four who went this week: it was obvious that they would have died young anyway, after a few more years of suffering. Worms are the main immediate cause of death. Juliet tells me that soon after she arrived she witnessed the unforgettably horrible sight of a fourteen-inch-long worm coming out of a year-old baby’s mouth. Naturally enough the child was choked to death. In extreme cases the worms sometimes infest even the brain. Scabies, which we tend to think of as a mildly annoying skin disease, is almost equally serious under these conditions of malnutrition, overcrowding and dirt. Many of the children are so covered with festering, open sores that you couldn’t find room for a sixpence on a clear bit of skin. And when put to bed – six children lie across each bed – the heat so aggravates the itch and pain that they often lie awake whimpering quietly for hours. The only effective answer to scabies is cleanliness, but until the monsoon is over we are helpless to do anything about this. We can only try to keep the suppurating sores under some sort of control, and here again, if the Tiblets weren’t so co-operative our task would be almost impossible.
Each afternoon when Juliet, Kesang and I go out onto our bungalow veranda we find five queues – one from each room – awaiting us in charge of their respective ayahs. We are then joined by two of the Dispensary ayahs, and for the next three hours there isn’t time to raise one’s eyes from the succession of naked little bodies. The children take off their filthy dress or shirt and trousers, just before their turn comes, and many of them have to be painted all over with mercurochrome. Others are infected only in certain places and it’s pathetic to see tiny tots of three or four helpfully and solemnly indicating their sore patches, from the tops of their shaven heads to between their toes. It’s even more pathetic to see some of them comparing scabies, as our children might compare stamp collections, while they wait in the queue. But then, they don’t know what good health feels like, so perhaps their suffering is not as ghastly as we imagine. Sometimes, during my first couple of days, I didn’t notice all the infected areas and if the child concerned failed to put me right the next one would very quickly point out that a place behind this ear or under that arm was being forgotten. Often one comes on a boil or an abscess that needs squeezing out and then a little crowd collects around the sufferer, stroking his back or patting his head to help him through the ordeal. I wish I could show more sympathy to each child during this whole performance, but when dealing with such numbers it’s difficult to treat them as individuals. Yet already I’m afraid I have a fa
vourite – which is deplorably unethical of me!
Lunchtime today provided a little light relief. Spinach was one of the vegetables, and the last meal Dolma had before her death consisted entirely of spinach – a fact which became very obvious during last night’s post-mortem. Accordingly, when the lid came off the vegetable-dish both Oliver and Juliet paled perceptibly, and I – the non-medical member of the party – had three helpings.
Which brings me to the subject of food. Our diet here is about 80% Tibetan – very nice too. All meals come from the camp kitchen, and though the ingredients are local the methods of cooking are not. For breakfast we have an almost European meal of cornflakes bought by Juliet in Lower Dharamsala, processed cheddar cheese donated to the camp by the American Government, hard-boiled eggs and moo-moo – which is steamed, grey-brown Tibetan bread, served in the shape of little dumplings. The lunch and dinner menus are very varied – potatoes (a favourite vegetable in Tibet) cooked in many strange and palatable ways, ordinary vegetables like carrots, cabbage, peas and egg-plant, noodles with unidentifiable little things chopped through them, vegetable salads mysteriously concocted, marvellous goat’s meat fritters, curious objects like sour-milk pancakes which I absolutely adore, rice pilaus and savoury dumplings made like swiss rolls filled with meat and onions and unknown herbs. Soup is served, in Tibetan fashion, at the end of the meal and no puddings are provided. But Chumba bakes several different types of delicious bread, on which we spread tinned jam or the excellent local honey. The Tibetans don’t normally use curries, I’m thankful to say, and on the whole their food is much more European than anything I’ve tasted since leaving Bulgaria.
Tibetan Foothold Page 4