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Poverty Medicine in Nepal in 1990

Updated: Jul 6, 2023



I read an article in the Guardian in 2018 that the term Poverty Medicine was coined by a US physician named Raymond Downing in 2001 on his travels through rural East Africa. This is ridiculous because I had declared in my UCLA School of Medicine transcript that I was studying Poverty Medicine in Nepal for a month in April 1990, 11 years before Dr. Downing's travels. This was followed by a month of Tropical Medicine in Thailand before my graduation from medical school that year. I am positive that I did not invent either of these fields of study or their respective terms. So typical of a near-sighted millennial to think that everything was invented after Y2K. Seriously, what does the Guardian think Mother Theresa was doing in India all that time?


Anyway, when you travel outside a school's carefully designed curriculum what you intend to study and what you end up learning are two completely different things. I wanted to study Poverty Medicine and Tropical Medicine in the 1990s because Vietnam had started normalizing relations with the West in those years when I was in medical school and I wanted to be ready to provide some help when my ancestral homeland finally opened up. However, I didn't end up learning that much about poverty medicine in Nepal that month because April was when the Nepal Maoist revolution reached the capital of Kathmandu. Most of the clinics were shut down due to the unrest. The ER had more trauma than illness in the first 2 weeks of April due to clashes between protesters and police. After rounding on the patients in the ward every morning, we'd hung out on the balcony watching the protesters on the streets.



In fact, when my plane landed and I was trying to get a taxi to take me to my host family in central Kathmandu, none of the drivers would take me due to concerns about their safety. The nice man at the airport had to escort me, at the insistence of the Namaste Cultural Exchange people, and he promised the drivers that he can call for help on his walkie-talkie if they were pulled over for some reason. As our taxi was surrounded by demonstrators in the streets of Kathmandu, I pulled out my camera and started taking pictures.





I had known that Nepal was one of the poorest countries on earth at the time and that its medical system was extremely limited. And indeed, the entire month that I was in Kathmandu, there was one young man sitting in a bed in the Cardiology ward waiting for transfer to any hospital in India, yes India, that had the capacity to do a heart valve transplant that was willing to perform the procedure for him for free. His aortic valve had been completely ruined by rheumatic fever so every time his heart beat, most of the blood would backwash immediately back into his left ventricle. His heart had grown so large by the congestion, it was taking over the left side of his chest and he could no longer lie down flat due to the fluids in his lungs. His contractions were so powerful that his head and body would bob back and forth with each heartbeat, rocking the metallic bed. His family visits him some of the time, but all of his days were spent looking at one of the walls in the ward. I wanted to get him a book for him to pass his time but he did not know how to read. So I ended up buying him a comic book of Tin Tin for entertainment. Maybe by the end of his stay there, he could figure out some of the plot by looking at the pictures of the Tintin, Snowy, Captain Haddock, and the Thompson twins.


After a week or so when the unrest settled down, I was able to wander around Kathmandu after hospital rounds and go visit famous sites like the Durbar Square in Patan, which had a surprisingly cool Pie and Tea shop. I remember having a surreal sensation, sitting in the middle of all that old-world architecture eating apple pie, and listening to Tracy Chapman singing about fast cars.



I walked up the Buddhist stupa Swoyambhu Mahachaitya, also known as the Monkey Temple, whose eyes are the unofficial symbol of Kathmandu.



Those similar eyes can also be seen on the pagoda at Baktapur, the older capital which also has a Durbar square of its own. I think much of the Durbar squares did not survive the earthquake of 2015.



There was also the Hindu temple Pashupatinath on the banks of the holy river Bagmati where there were cremations happening all day long. I was told the river Bagmati flows eventually to the Ganges river where all Hindus hope to go. The Ganges is the personification of the Goddess Ganga who purifies the souls and releases them from samsara, the endless cycle of birth and death that we know as reincarnation.



Most days, I'd toured through Katmandu to see the normal life of the city, alone or with a friend I met who came from Singapore.



One weekend I took the tour bus out to Nagarkot, a village about 30 km east of Kathmandu, to stay at a hotel where they wake you up at 4:30 in the morning to watch the sunrise over Mount Everest. You can see it below as a tiny blip on the horizon between 2 small bumps. All these giants of the Anapurna range looked so small from the capital of Nepal. Since it was only about 30 km away, some of us chose to hike back to Kathmandu instead of taking the tour bus. It was a bit of a hike through gentle hills, farmland, and we met some very friendly people.



I usually ate breakfast and dinner with the family that I stayed with, so it was always wonderfully authentic. The lentil soup, meat course, and vegetable dish changed every day. The meat rotates among chicken, lamb, yak, or pork. The lentils were cooked in different curry spices every night. And the vegetables were always tasty, whether fresh, stir-fried, or pickled. The family even took me to a wedding in the neighborhood one night. The smart little girl who was my translator was named Rumi, pictured in 2 of the pictures below.



For lunch and on weekends, I get to sample the fares of any restaurant I happen to pass. The dumplings in Nepal are called momos and originally came from Tibet but have some unusual South Asian spices in the filling. The pizza and the steak served in the tourist areas of Kathmandu are some of the best I've ever had. Probably because the cheese and steak come from buffalos, due to Hindu reverence for the holy cow. But I think there was a sharpness to the tomato sauce that I have never tasted anywhere else, maybe a different variety of tomatoes or maybe being grown in the high altitude of Nepal gave it a distinctly different taste.


After a few weeks, my attending physician urged me to take time off to see the rest of the country. "How often are you going to be in Nepal? You need to travel around and see the country" he advised.

So I booked a trip to Chitwan National Park to see the one-horn rhinoceros which were being hunted for their horn. I traveled through the park on elephants, in canoes, and on cattle wagons, just like my parents in the old days. No protective Jeep rides for us as we hiked on foot through the grassland looking for rhinos. The guide made us climb trees every time a rhino comes near since they are notoriously near-sighted and are liable to charge at anything they think may be a threat.



Then I took a 5-day rafting trip on the Trisuli River and was adopted by 2 English girls and 2 South African blokes since the other half of the group spoke Germans and hung out together.



Afterward, we took the public bus ride to Pokhara. The inside of the bus was crowded and stuffy so we thought it was cooler to ride on the top of the bus with the baggage, literally and figuratively. The ride up the mountain was beautiful, but the ride down the mountain was a scary, crazy, white-knuckle plunge down twisty-turny narrow mountain road at high speed, with no seatbelts or even seats. We were slipping and sliding from one side of the bus to the other, hanging on to anything we could. One of the girls in our group was literally green in the face by the time we got to Pokhara. We came to the conclusion that the new driver who got on at the top of the mountain was a Maoist sympathizer who took one look at all the Western backpackers on the top of the bus and decided to teach them a lesson.


Pokhara was a pretty lakeside town at the base of the most perfectly shaped mountain. I spent a few days there hiking and hanging out with new friends before taking another public bus ride to Lumbini, the birthplace of Prince Sidddhatar Gautama who was to become the Buddha. The Israeli man that I was sitting next to was chewing on hashish the whole time, offering some to me with the pronouncement that Nepali hashish is the best there is. I declined since I had heard the rumor that the very potent Kathmandu hashish was what killed Bruce Lee.


Lumbini in 1990 was not the bustling pilgrimage destination that it is today. There were no other tourists there on the day that I visited. There was a small one-room temple underneath a pagoda tree, another tree standing by the pond, and several brick foundations of buildings that may or may not have been part of the old royal complex where Queen Maya gave birth to Siddhartha Gautama in 566 BCE.



This trip down memory lane was triggered by the finding of an old box of pictures in my closet and the fact that one of my recent subscribers is named Nepali.


As to learning about Poverty Medicine, I need not have worried; when I finally ended up going to Vietnam for my first medical mission in 1994, I had all the experience with Poverty Medicine that I could want. We were shown through the polio and tetanus ward of the hospital in Ho Chi Minh City. The polio ward was usually where people having new polio and post-polio flares were cared for until they recovered enough strength to go home if they do. It was filled with people dragging themselves on the ground because their legs had shrunk or become deformed. In the tetanus ward, they had a pump and 2 water bottles connected by tubes that served as ventilators for people who were going through tetany contractions. The nurses and doctors would push that cart to the bedside of any patients starting contractions to intubate them. After the tetany was done, they would extubate the patient and wheel the cart to the next patient having contractions. They would do this over and over for 1-2 weeks until the patient develop antibodies to fight off tetanus.

We saw so many deformities and pathologies from perfectly preventable illnesses that it brought home how amazing vaccines, modern medicines, and surgeries are and how lucky we were to have been trained and have access to all these miraculous cures that poorer countries just don't have.


Keep counting your blessings because you have so much more in your lives than you realize. Certainly when compared to most people in the world.



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