Daniel sat at his desk-like table in the consultation room that was bright with daylight. A relic of a physiology poster hung on the far wall. Bethany and I were in chairs at his side. The first patient was an elderly monk in his seventies perched on the stool beside the table. He had returned to tell Daniel that the cold was still in his lower abdomen. He had been treated for diverticulitis with antibiotics and was better, all better except for the coldness. We don’t know what that means. It’s common terminology in traditional Tibetan medicine, but

impossible to translate even through the bright English speaking Tibetan monk health care worker who sits across from Daniel.

The elderly monk moved across the room to the metal table with a pillow at one end in a ruffled blue pillowcase and lied down. Daniel was discreet, working beneath the robes and around the thick cotton belts that many monks wear to counteract the “cold” they feel in their abdomens. There seemed to be tenderness over his bladder, so he was sent to the lab for urine tests.

The lab was at the opposite end of the first floor hallway in the H. Poitner Tibetan Medical Clinic of the Sermey Monastery. It was small and efficient. A urine dipstick was used and there was a microscope to examine for cell counts. All seemed to be negative. There was no clear explanation for the elder monk’s complaint.

I asked Daniel if he ever sees urinary retention in the older population. He said that, yes, once he was summoned to the Abbot’s room, to the quarters of the head of the large monastery. Someone had given him an herbal remedy and his bladder outlet had clamped down. The Abbot’s bladder was full to bursting, distended beneath his robes. Daniel had to ride a motorcycle all over searching for a Foley catheter to relieve the man’s pain by providing a conduit for his urine. Next time, there will be a Foley catheter with a sterile kit on the shelf in the clinic. We had brought two.

He was amazed, I think, about the things that we had brought so far through India. So were we. We gave the clinic the microscope, centrifuge, slides, stains, urine dipsticks, sutures, gloves, books and medicines that had been donated by others. In the five suitcases were bandages and other dressings for the many leg ulcers we saw in the clinic that morning. One twenty five year old woman said she was bitten by a snake a year ago. On her left ankle remained a large, four by seven inch ulcerated area that was healing nicely now with pink granulation tissue under the care of the monks who were responsible for her dressing changes. Now they would have new, clean latex gloves, sterile four by fours, Tegaderms – a stock of things to choose from for wound care.

Another Tibetan, lay not monk, came to the clinic for a lower leg laceration. The monks in the treatment room generally do the suturing, not the doctors. Mostly they don’t use anesthetic. The Tibetans don’t expect it and the monks don’t feel comfortable using it even though Daniel urges them to do so. Sometimes, I think, they might be right. The anesthetic requires a needle jab, usually at least two, and it burns as it infiltrates the tissue. For one easy stitch or a few, going without may not be worse than getting the numbing medicine. In our culture, and in the local Indians’, the anesthetic is a psychological must. Obviously, for larger wounds, it is a blessing little utilized by the Tibetans.

Also in the treatment room were two Indian boys, fourteen and fifteen, who looked eight and ten. They were sitting with their mother, soaking four feet deformed from leprosy in basins full of Epsom salts. The oldest boy had it the worst, missing almost half of both feet, the ends uneven stubs, like the eaten fingertips of his right hand. They smiled when they were done with their treatment and replaced their socks and sandals that hid their grotesque appendages. Then they looked like normal smiling boys, just young for their ages. Daniel told us that their mother denies the disease in any other family members. They don’t know how they got it, have no idea. She also says they have not been treated, which Daniel cannot believe. India has a free treatment program available at all the government hospitals. Could it be that no one had provided these two kids with such obvious leprosy derived disfigurement the one month of Dapsone needed to halt its progression? There were no records. There was no one to call and have information faxed. If he treated them again, then they would have to go through another month of medicine and its side effects, maybe for nothing if the disease is gone and only the manifestations of it remain. If he didn’t treat them, the disease could spread, eating away at what remained of their feet and hands. I wondered if the mother just didn’t understand that the disease wasn’t progressing, and if she was hopeful that somewhere someone could help them regenerate what they had lost. The translation from the local Karnat language made things so difficult.

Later we had a complete tour of the two-story clinic building. We saw the registration desk where they keep the patients’ cards, which serve as their basic medical records. The cards cost ten rupees, about twenty cents, on their first visit. After that, the clinic visits are free.

The pharmacy was also on the first floor with the other allopathic health care. Shelves were lined with medicines to be dispensed through the small window at the front. There’s a tiny charge for the pills, like one rupee for an albendazole tablet for worms. If it’s more, and the patients don’t have the means to pay, the medications are dispensed for free.

A German group continues to sponsor the clinic. There is a steady stream of money for the minimal salaries, the medicines and the basic lab supplies. Daniel is told that they are to become self sufficient, but they are a long way from that. They couldn’t operate without donations.

Upstairs sits the traditional Tibetan doctor in her traditional dress of the women of their culture, the chupa. Her husband is also a Tibetan doctor, traditionally trained. They live together in the two-story housing next door provided by the clinic, on the floor below Daniel and his family. She is pleasant and welcomes Catrina over to help her out with her migraine.

In the room next door to hers is a Tibetan pharmacy with shelves full of plastic jars of brown spherical pills of all sizes that look to me like rabbit droppings. They have been shipped from northern India, probably somewhere near the medical school in Dharmasala that I visited last year.