Due to lack of equipment and resources, many conditions simply cannot be diagnosed properly in Bhutan, and for complicated diagnoses or treatments, patients are sent to India. However, the costs for the Bhutanese government for each referred patient are huge, and the waiting list for outside referrals is long. And yet for Pema, Vellore signifies her only real hope. So far, no one in Bhutan has been able to make a diagnosis for her baby. Myself, I am confused by the little boy’s signs and symptoms which, if nothing else, point towards cerebral palsy.
‘We only live for him now,’ Pema says with a sigh. In a sudden impulse, I reach out and put my hand lightly on her shoulder. The young mother looks at me and tries to smile, but her dark, sad eyes betray her. I stroke the soft curls on Nima’s small head, and the boy rewards me with a 80
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O M M A N I P A D M E H U M
little gurgle. Unnoticed by Pema, he has managed to again free his hand which is promptly on the way to his lips.
Then he turns his head and I think I see happy recognition on his face. I follow his glance to the door.
‘Good afternoon, ladies.’ Pema’s husband enters with a box of sweets from the bakery. He offers me a tired smile, then reaches down to cuddle his son who squeaks in delight. ‘I thought you might be hungry.’ Turning to Pema he asks: ‘What did Dr. Pradhan say?’ For a while the two parents discuss quietly.
‘You’re not working today?’ I ask Karma.
‘I took the afternoon holiday so I can take Nima home.’
His answer is slow and drawn out with the slur of fatigue.
‘Nima didn’t sleep well last night,’ he apologises, and I can guess that none of them did.
‘Why don’t you go home, too?’ I say to Pema and point at the powerless bulbs. ‘I am sure we won’t get many more patients.’ For a moment I wonder if I am overstepping the boundaries of my authority, but then reassure myself that no one will notice anyway.
‘You will be OK by yourself?’ Pema asks, then gets up quickly, perhaps afraid I might change my mind.
‘Of course,’ I lie with fake confidence, searching for one more rationalisation for Pema’s early departure. ‘We always advise our patients to take some rest, don’t we? And I think that is what Nima and you need most right now, too.’
And it is true, after all. Perhaps there is not much we can offer here in our little physiotherapy department, but at least I can put a small part of my western training to use.
81
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C H A P T E R N I N E
Choden
I noticed Choden a few days ago during rounds when Dr. Shetri explained that she was a case of transverse myelitis, admitted to the hospital for a urinary tract infection caused by her catheter. A little unclear about this diagnosis, I had asked further, and the doctor explained that transverse myelitis is a viral disease, attacking the spinal cord and leading to neurological deficits. The disease left Choden partially paralysed from the waist down, and for about four years she has not walked or stood. When I watched Choden that day, I noticed that the muscles of both of her legs seemed to violently contract in frequent spasms, leaving her curled up on the bed, helplessly writhing in pain. When I enquired as to whether she was receiving any treatment for her legs, the answer was no. She was only here to fix the urinary tract infection.
No one seemed to think that Choden was a candidate for physiotherapy treatments – except for me. I wanted to give it a try. I asked permission to work with Choden, and reluctantly the doctors wrote out a physiotherapy referral.
82
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C H O D E N
The apparent hesitancy with which I
‘We only live for him now,’ Pema says with a sigh. In a sudden impulse, I reach out and put my hand lightly on her shoulder. The young mother looks at me and tries to smile, but her dark, sad eyes betray her. I stroke the soft curls on Nima’s small head, and the boy rewards me with a 80
Buttertea at Sunrise_PROOF.indd 80
Buttertea at Sunrise_PROOF.indd 80
13/01/2006 14:59:12
13/01/2006 14:59:12
O M M A N I P A D M E H U M
little gurgle. Unnoticed by Pema, he has managed to again free his hand which is promptly on the way to his lips.
Then he turns his head and I think I see happy recognition on his face. I follow his glance to the door.
‘Good afternoon, ladies.’ Pema’s husband enters with a box of sweets from the bakery. He offers me a tired smile, then reaches down to cuddle his son who squeaks in delight. ‘I thought you might be hungry.’ Turning to Pema he asks: ‘What did Dr. Pradhan say?’ For a while the two parents discuss quietly.
‘You’re not working today?’ I ask Karma.
‘I took the afternoon holiday so I can take Nima home.’
His answer is slow and drawn out with the slur of fatigue.
‘Nima didn’t sleep well last night,’ he apologises, and I can guess that none of them did.
‘Why don’t you go home, too?’ I say to Pema and point at the powerless bulbs. ‘I am sure we won’t get many more patients.’ For a moment I wonder if I am overstepping the boundaries of my authority, but then reassure myself that no one will notice anyway.
‘You will be OK by yourself?’ Pema asks, then gets up quickly, perhaps afraid I might change my mind.
‘Of course,’ I lie with fake confidence, searching for one more rationalisation for Pema’s early departure. ‘We always advise our patients to take some rest, don’t we? And I think that is what Nima and you need most right now, too.’
And it is true, after all. Perhaps there is not much we can offer here in our little physiotherapy department, but at least I can put a small part of my western training to use.
81
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Buttertea at Sunrise_PROOF.indd 81
13/01/2006 14:59:12
13/01/2006 14:59:12
C H A P T E R N I N E
Choden
I noticed Choden a few days ago during rounds when Dr. Shetri explained that she was a case of transverse myelitis, admitted to the hospital for a urinary tract infection caused by her catheter. A little unclear about this diagnosis, I had asked further, and the doctor explained that transverse myelitis is a viral disease, attacking the spinal cord and leading to neurological deficits. The disease left Choden partially paralysed from the waist down, and for about four years she has not walked or stood. When I watched Choden that day, I noticed that the muscles of both of her legs seemed to violently contract in frequent spasms, leaving her curled up on the bed, helplessly writhing in pain. When I enquired as to whether she was receiving any treatment for her legs, the answer was no. She was only here to fix the urinary tract infection.
No one seemed to think that Choden was a candidate for physiotherapy treatments – except for me. I wanted to give it a try. I asked permission to work with Choden, and reluctantly the doctors wrote out a physiotherapy referral.
82
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Buttertea at Sunrise_PROOF.indd 82
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13/01/2006 14:59:12
C H O D E N
The apparent hesitancy with which I
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