A Balcony in Nepal: Glimpses of a Himalayan Village

Medical humanities, an established concept in the Western world, is still in its infancy in developing countries such as Nepal. Art and literature used for teaching and learning medical humanities is mostly from Western countries and reflects a Western perspective. Sally Olds and Margaret Roche have visited Nepal many times and ‘‘adopted’’ Badel, a remote village in Khotang district, eastern Nepal. During their visits they used to stay in the house of their guide, Buddi. Their abode was the balcony on the first floor and they had a splendid view of the surrounding hills across the river. This probably accounts for the book’s title. The book is divided into five parts: the first part, dealing with the period before the authors went to Badel, and the remaining parts, dealing with their many visits over a period of about 10 years. The authors were accepted by the villagers as relations. The views, observations and perceptions of the Western ‘‘grandmothers’’ (a writer and a painter) are acute and astute. Like many visitors, the authors fell in love with Nepal; the beautiful scenery, the majestic Himalayas and the smiling people. The book contrasts the simple life of Badel with the complex and complicated life of the West. Innocence and simplicity have disappeared or is disappearing from most of Nepal. The book can be used to introduce a number of concepts in medical humanities to both Western and South Asian students. Living in the moment, Zen and letting go, attachment and possessions are recurring themes. Stress, tension and harried life styles are responsible for the rise of ‘‘lifestyle’’ diseases; the simple, unhurried, ‘‘doing one thing at a time’’ lifestyle of the villagers of Badel is definitely healthier. The authors comment on the remarkable cheerfulness and sweetness of the Nepalese people and their friendliness and joy in the face of poverty and adversity. This remains true despite the bitter conflict and increasing violence and disparities. A positive attitude towards life and living (and not material wealth and possessions) are important for happiness. Lacking modern, allopathic medical care, people in remote villages depend on complementary and alternative medicine (CAM) during illness. In Nepal and many developing nations, CAM was the original system of treatment, on which allopathic medicine was superimposed. CAM is closer to traditional beliefs and takes a more holistic view of the individual, as is stressed in the book. CAM is becoming increasingly common in the West, and ‘‘integrative medicine’’ is also gaining ground. The second chapter deals with ‘‘letting go’’. Frustrations, trials and tribulations are a part of daily life; often things do not go according to plan. Accepting such problems and not being emotionally worked up about events that we cannot control may be a recipe for a healthier and happier life. The book often talks about the foot trails of Nepal, which are narrow, winding and difficult. They demand the full, undivided concentration of the walker. The authors have titled a chapter ‘‘On the trail: Don’t look down, Don’t look up’’. One of the maxims of trekking in Nepal is ‘‘Trek while you trek and look while you look.’’ Doing the two together can lead to disaster! Shamans (nearly all are men) are an easily available source of medical and psychological support in villages. Their remedies work because of people’s belief in them. Placebo effect and mind–body medicine are becoming increasingly recognised and accepted in the West. Mind, family, community and society (important for health and wellbeing) are recurrent and important themes in medical humanities. Shamanic ceremonies have been explored in detail, and other states of consciousness and alternative perspectives can also be issues in medical humanities. Change is coming to Nepal and the younger generation are more sceptical about shamans and faith healing than their parents. The attitude of the villagers towards Western medicine ranges from non-acceptance to complete belief and expectation of miracle cures. The villagers have close family and community ties and the whole village is like an extended family. This offers support systems during sickness and health that have long vanished from industrial societies. The grandmothers are not fluent in Nepali and must converse with the locals, especially women, through an interpreter. They highlight the importance of speaking in a common language to actually converse with a person. Nepal is a patriarchal society, and most decisions about family and health matters are taken by the male head of the household. This has had a deleterious effect on women’s health and issues. The authors return to this theme repeatedly. Women in traditional societies are expected to follow a set pattern of dress and behaviour, and deviations are looked on with disfavour. Traditional women wear more jewellery and dress more modestly than non-traditional ones. The authors, as visitors from another culture, were not expected to follow these rules, but their differences in dressing and behaviour created occasional confusion. Gender roles and the impact of gender on sickness and health behaviour are also topics for exploration. The authors had paid for surgery to repair the cleft lips of two children, Kumari and Om, and they highlight the changes the surgery had brought about in the children’s lives. The authors describe the disciplined behaviour of Nepalese children and contrast it with the often violent behaviour of American children. They explain the difference by saying that children in Nepal are always being held and minded by someone (often an older sibling) and do not have to fight for attention. Is this true, or is it an oversimplification of a complex phenomenon? Unfortunately, with increasing urbanisation, migration and conflict, the situation is changing even in Nepal. The simple lifestyle, lack of many modern conveniences, absence of processed foods, minimal use of sugar, clean air and absence of pollution ensure that people retain their bodily functions even at an advanced age. The authors have given the example of squatting, which Westerners find difficult but Easterners do quite comfortably. Western civilisation has brought a number of benefits to mankind but has also brought disadvantages. I often trek in the Himalayas and enjoy the simple lifestyle and absence of noise and pollution. I wonder whether the internal combustion engine is an unmixed blessing. How to simplify ‘‘modern’’ lives, retaining the benefits of the industrial revolution and discarding the disadvantages, can be a theme of the humanities and is repeatedly discussed in the book. The authors ‘‘interview’’ the midwife of the village, Sabut Maya Rai. The midwife lacks many things which modern obstetricians take for granted. She is, however, well aware of her limitations and sees her role more as a helper of nature. Women in traditional societies are more active during pregnancy and experience easier childbirth than affluent women. However, complicated deliveries and infections during the first days of life exert a significant toll on both mother and baby. Lack of medical care can be frightening for visitors to remote villages, and the authors look at this phenomenon in detail. The beliefs of the community regarding death and migration of the soul to the heaven place after crossing the river are also important topics for medical humanities. Death, preparation for death and the afterlife are increasingly becoming the doctor’s province. The authors learn about the ‘‘Rai way’’ (Rais are an ethnic group whose homeland is the hills of eastern Nepal) of life lived according to ancient rhythms in a spirit of cooperation and friendship. Wife beating and violence against women do occur in Badel, and the authors call it ‘‘the dark side of paradise’’. Anger (rage) in Nepal is repressed and occasionally erupts cataclysmically. The violent 10-year conflict could have been an expression of that rage. The lack of medical care in the village, the long journey to the health post, the cost of treatment and problems with availability of medicines are a recurrent theme throughout the book. These are also important issues for medical humanities. PostScript