Clinics in Sankoo and Panakar

Our first outreach was held at the hospital in Sankoo. Sankoo is about 20 000 people, but it really is a village as there is little infrastructure; just a single street with small open front stores and lots of fields, mostly barley. It is pretty easy to see the gender divisions; men run the businesses, which appear to mean a lot of sitting around, and women work in the fields and carry heavy loads of barley and hay in baskets on their backs.

The Sankoo Hospital, out of which our outreach was based, is fairly new. Dr. Khan had done a good job of getting the word out and organizing rides so many people from remoter areas could get their children to the clinic. Our outreaches were intended for disabled children but attracted a whole variety of ages and health concerns. Our team was divided into three areas. Kids would first be seen by developmental paediatrician Carey Matsuba and would then be sent to our special educator or the occupational/physical therapy team, or both, depending on their needs.

The role of the occupational therapy team was to assess any difficulties that someone might be having performing any range of daily activities. Occupational Therapy is concerned with improving a person’s participation in their daily activities. Since the person may be having difficulty because of physical, cognitive, or mental health reasons, occupational therapy looks at all of those possibilities. We saw lots of kids with cerebral palsy or other developmental concerns and so, interviewing the parents, worked with them to show them how to do stretches in order to prevent contractures or how to position to help with feeding.

A good example of the OT process in action was the young guy and his aunt who cared for him, who came in with the specific goal of improving his ability to use the toilet. It was helpful that they had that clear goal because it made it easy to work with them to figure out ways we could help. He was around twenty, with CP but could walk. He just couldn’t use the toilet. Toilets in India are the type you squat over, which is difficult or impossible to use if you have mobility issues. We were able to do a quick assessment of his physical capabilities, trial a couple of ideas, and sketch out an idea for a bench and handle to go over the pit toilet so he would be able to sit instead of squat. He and his aunt took the sketch off with them to find a carpenter to fabricate it. They were pretty pleased, as were we to have been able to help. However, it did illuminate one of the weaknesses of running a clinic in a hospital. The clinics were designed as a needs assessment, to determine the extent of need for services in the area. That aspect is important but as OTs, we would have been able to offer more if we had been working in his community and actually been able to look at his home environment. Hopefully, that is something that will be able to develop in the future for Kargil.

After that successful clinic, we moved up the valley to the village of Panakar. We had another, one-day clinic scheduled in this remote mountain village. This could be the most beautiful place I have been. The drive follows a rough road from Sankoo into the higher alpine, winding its way along a raging river. The size of everything here is on a huge scale. The volume and speed of the river is intimidating. The smaller mountains that rise up from the river are large by British Columbia standards. Panakar is near the end of this great valley. Just above the town, behind a ridge, sit Nun and Kun, twin summits, which at over 22 000 feet, are the highest summits in the area. When we were flying in from Delhi to Leh, we could only see two peaks jutting above the clouds, which we have since identified as Nun and Kun. They are really beautiful mountains, though it wasn’t until we were heading back to Kargil that we were lucky enough to get a cloudless view of them.

Panakar is also heavily reliant on agriculture, mostly grains and hearty vegetables that can ripen in the short growing season. One of the most interesting aspects of the village is the irrigation system. Channels are built higher up in the mountain streams to divert water. Most of the channels are trenched into the top of dykes and run at a constant grade across and down the hills and through out the town to irrigate all of the fields. There are miles and miles of channels and intricate systems of dams to divert the water from one field to another. When we arrived in the village, the crew of doctors and medical staff who are stationed there took us for a long walk around the village and the fields. It was great to be able to see so much of the area during such a short stay.

In the morning, I was able to scramble up a small hill and get some pictures of the town. It was really beautiful in the morning light. There is not much in the way of modern amenities, other than the cars and satellite dishes. Electricity is only available for a couple of hours in the evening. Things are changing though. Illustrating the convergence of old ways and new technology in this region, on the way up the valley we saw big crews of labourers using hoes and shovels to dig miles of trench by hand. I thought it might be another irrigation system but it turns out the trench is for fiber-optic cable which will eventually bring broadband right up the valley to Panakar.

During the drive back to Kargil, Dr. Khan took us on a bit of a detour to another very small village on the other side of the valley. One of the advantages of travelling with a person who knows the area so intimately is that you get to participate in random, off the beaten path, experiences. While building his home, one of the villagers had unearthed some ancient Buddhist or pre-Buddhist artifacts. We were able to visit these priceless stone carvings, which are propped up in his living room. Dr. Khan, whose father was a historian who wrote several books about the area, is concerned about what will become of these relics and is working to protect them.

By the time we arrived back in Kargil, things had changed. We first noticed something was different when we encountered a grid-locked traffic jam. Turns out the otherwise peaceful Islamic town had changed temporarily into something of a hot-bed of Islamic Fundamentalism. Many people had travelled to Kargil to hear a reputedly controversial Iranian cleric speak. Apparently, this cleric lives in one of the big cities in India and travels around now to deliver speeches and stir people up.

We managed to drive through the heavy traffic until we were blocked by a fist-raising, flag-waving throng. The rally was being held right on the streets in the middle of town so there was no moving further by car. Sitting in the car, you get a trapped feeling, and so we thought it would be better to keep moving away from the crowd. We asked Dr. Neufeld, who was with Doug, Carey, and I in one jeep, if there it was possible to walk from there to the guest house, via a different route. He said there was so we loaded up our own packs and the packs of the other team members and started off on foot. Loaded down with packs, instead of leading us away from the demonstration, Dr. Neufeld led us straight into the packed crowd. With the speakers revving up the crowd over the megaphone and hundreds of fists going up in the air in unison with hundreds of shouts, I was thinking, ‘This is not a good idea’. The whole atmosphere was electric, and I was hoping I didn’t accidentally step on any toes, literally, as we pushed through the crowd. As it was, under the weight of the big packs, we had to bump and squeeze to create a path to get through. Fortunately, we only had to dodge around the outside of the crowd and, as soon as we popped out the other side, we found ourselves in the same bustling, peaceful market area that we had driven through a few days before. Like most other places, the majority of Kargil residents are content to go about their lives peacefully and a minority of residents wants to create change by imposing on others their beliefs. This seems to be what the rally was all about; it seemed large and intimidating when we were stuck in the middle, but was only a small event in the larger scheme of the town.

After a restful night in a comfortable guest house, we spent the morning touring a special education classroom run by the Indian army. With its proximity to, especially Pakistan but also China, there is a great military presence through out the Kashmir-Ladakh region. To help keep the peace, there are several public relations-type initiatives managed by the army. Most kids are driven to school by the army, in buses and even in the backs of military transport trucks. The army also operates classes for special-needs kids on the bases in Kargil and Leh. The class was well equipped and even had a physical therapy space, though the physical therapist who was posted there now worked for the Kargil hospital.

After leaving the army base, we headed north out of Kargil along a road which Dr. Khan described as better than the route we had used to get there a few days before. He was correct. This route is primarily a military road (apparently, you need a pass to travel on it), which travels along the line of control with Pakistan, following mostly the Indus river. It is definitely one of the most spectacular drives you could ever take. Shortly after leaving Kargil, the road climbs up to a high pass at around 14 000 feet in a sea of rock and scree. It then drops down into an impossibly steep, narrow gully that makes its way down the side of a mountain, eventually arriving at the side of the milky Indus river.

The Indus is an interesting river, politically. Its head waters arise in China, it flows through India (and gives the country its name), then into Pakistan, where it is the primary source of water. As it flows along the route we drove, it cuts its way through a steep, high, and narrow gorge. It is an impossible place for a road and yet there is one there. In many sections, the rock is so steep that a road could not be graded so it is cut directly into the rock, creating sort of a three-sided tunnel, with millions of tons of mountain just a few feet above the roof of the car. Along the way, we passed several small villages on both sides of the river. Those on the opposite bank were accessed using rickety bridges or tiny cable-drawn baskets strung above the boiling river.

One of the difficulties with traveling a road intended for military use is the many military check points. Even though it would be impossible to enter or exit the gorge at any point between start and finish, we were required to stop at each one and have our papers and passports checked. At the first, I was singled out by the soldier, which was a bit scary. He wanted to know which one of us was ‘Ross Taylor’. I did a quick panicked scan of my brain, trying to recall if I had any outstanding warrant or the like. As it turns out, I share the same name with a famous cricket player and cricket was the single interest of the soldier (we asked about the World Cup but he didn’t know). At a further check point, we pulled out a camera to show pictures of us with the base commander and that seemed to be a bit of a hit also.

Overall, it was a great trip to Kargil (other than the illness), and after several more hours of driving, we arrived back in Leh, ready to begin clinics here.