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Citta Hospital in Humla, Nepal

Dr. Larry Hill

Author: Dr. Larry Hill

I arrived in Kathmandu at ten at night on a flight from Hong Kong. When asked by customs why I was visiting Nepal, I simply replied "trekking”. I didn’t want to have to explain the collection of dental instruments, surgical gloves, boxes of needles and anaesthetic, bottles of antibiotics and pain medications plus two hundred tooth brushes that I was carrying in my two sports bags. I also carried an improvised surgical suction made from a pump designed to pump oil out of boat engines that I had purchased here at the The Harbour Chandler! That would have been difficult to explain with my very limited Nepali.
I wasn’t totally lying; there was a bit of a hike from the airstrip in Simikot up to the hospital where I would spend the next week and a half. Customs accepted my explanation, stamped my visa and I emerged into the frenzy that is Kathmandu. The two days I spent in Kathmandu were in stark contrast to the tranquility of the Humla area close to the Tibet border in Northwest Nepal. To get there, I first flew to Nepalgunj on the border with India. We spent a night there in unbelievable heat and the next morning sat at the airport drinking tea and waiting for the small airplane that was to take us into the mountains. There didn’t seem to be a schedule. In fact there was uncertainty whether we would fly that day. Suddenly, Dr. Llama, who had met and accompanied me from Kathmandu, shouted, "The plane is here, run!” and I was on my way. He would follow on the next flight – if there was one! We left the flat lands around Nepalgunj and climbed up into the mountains. Through the dirty windows of the plane I saw the incredible landscape that is Nepal. Deep valleys with raging rivers and mountain sides with terraced farms everywhere.
We landed in Simikot on a rough landing strip at an elevation of about 10,000 feet. I was asked to present my passport to one of the local policemen and then Jens, a medical student from Germany, introduced himself and escorted me to the hospital. It was a magical moment to find myself hiking the trail to the hospital after months of planning. As I started noticing the plants I was hiking through I asked Jens, "Isn’t this marijuana?” He replied, "Yes, it is one of the most common plants in the Humla area.” We arrived at the hospital, met the staff and I began unpacking my dental supplies. Our "dental camp” was to begin the next day. My new dental operatory was a room in the back of the hospital building.
Rock walls were plastered with mud and the floor was mud as well. All the planks of the beams and flooring for the second floor were a local pine hand sawn by the two small men I had observed hard at work when I arrived. We had solar powered lights thanks to the people of Gabriola Island, but not enough power to run a surgical suction. My improvised pump proved its worth many times. I had brought a battery powered handpiece (drill) which we were able to charge overnight and with it I did a number of fillings for my patients. After setting up the room, we toured the area and prepared for supper in the kitchen building adjacent to the hospital. There, morning and night, the cook prepared dahlbhat (rice, a mixed vegetable curry usually cabbage based and a thin dahl (lentil soup)) all locally grown except for the rice. The cook supplemented this periodically with goat or lamb meat and with dui, a fermented local milk. Most suppers included some beer carried up in a jug from the village.
Simikot village, the capital of the Humla region, is home to about a thousand people. Most people there live a simple existence as subsistence farmers. They own and farm small terraced fields on the mountainsides, sometimes a great walk from their homes. Land is so precious that there is a local custom that rather than break up a farm between sons as they mature and marry, they will all marry one woman. All the brothers become husband to this one woman and the farm remains intact. They grow barley, corn, millet and a number of local grains. In addition, they also grow potatoes, apples, cabbage and carrots along with other root crops. Peppers and tomatoes can be grown in the warmer locations in the area. Malnutrition is common in the winter-time when fresh produce is unattainable. I met a young Australian woman, an engineer, who was there working on designing and building a passive solar greenhouse that could provide fresh vegetables during their cold winter. She was very hopeful that it would work well.
Mornings there brought no sounds of motors; in fact there are no automobiles, motor cycles or even bicycles within hundreds of miles. One could only hear the sound of donkeys braying or the sound of bells on the long horned local cattle turned out to graze the slopes. Every board of wood or beam is hand sawn from logs in forests a day’s hike away, carried up long winding footpaths that connect the distant villages. Because of the great expense of air transport (which is the only way into this area) cement is almost unheard of; homes are constructed with posts and beams filled with rocks in between. This is then covered with mud. Cooking and heating is done with wood stoves which often have poor ventilation. Respiratory complaints were one of the common symptoms which brought people into Citta Hospital. There are forests close by Simikot but they are closed to the populace. People need to hike a days’ journey there and back to forests that are open for firewood collection.
During the dental camp, we had over three hundred people come to the hospital. Of those, we treated about one hundred and thirty. These people came from the area around Simikot and hiked, sometimes for days, to see us. I worked with the three German medical students and with Dr Llama assisting me. Usually one of the students operated my improvised suction pump and the other would assist. The third student would attend medical patients in another room. The students learned how to administer dental freezing and each of them got to extract a tooth. I did a large number of extractions but did place a number of dental fillings too. I found the people of the area had a fair amount of decay that increased with age because of the lack of treatment available. I believe I was the first dentist to ever visit the area.
Our days began at about 9am and we treated our last patient at about 6pm. During the day, we took two breaks of about ten minutes and a forty-five minute lunch. I was able to train the hospital staff in local anaesthetic and extraction techniques and even placing simple fillings. The people of this region are amazingly hard working people who have very little materially. The per capita yearly income for this is area is estimated to be $10.00. Their houses are simple. I can’t imagine living there during the winter when temperatures drop to forty below. Jens (the young German) and I spent some wonderful afternoons hiking in the fields and hillsides, meeting the local people who were harvesting their crops. All the equipment I had carried with me, I left at the hospital and I plan to go back to continue training the staff. If possible, I would like to take several dental students from UBC to be able to provide treatment for more of the people. It was an honour for me to be able to go to this remote area and to help these wonderful people!

Dr. Larry Hill traveled to Nepal as a volunteer dentist in September 2008.

This entry was posted on Saturday, December 27th, 2008 at 3:20 pm and is filed under FEATURE. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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