Sunday, July 24, 2005

We Meet a Reincarnate Lama

Sunday dawns bright and sunny - Don is off for the whole day, there is no school (the boys all had school on Saturday morning!), and the weather is gorgeous. We sleep in and then brunch in a leisurely way at one of the hotels, and then we taxi to the trailhead of Tango Monastery (pronounced Tang-goo). Everyone is in gho and kira except Thompson, who feels more comfortable in his khakis and new Bhutan T-shirt. Don has been up to Tango twice before and it's one of his favorite spots near Thimphu. It is a comfortable hike of about an hour on rocky paths thick with fallen leaves, that takes us past similar scenery we saw on the hike to Cheri - trees with moss on them, with ferns growing out of the moss. Dappled sun marks the path and we make quiet headway up the trail, just enjoying a slow hike.

Tango is a very beautiful goemba (temple) - it has a massive curved wall on one side, and lovely flower gardens, and a large meditation retreat building for monks from other parts of Bhutan. We are met at the entrance by a large crowd of monks - we found out later that they had just finished a lengthy meeting with one of the government ministers, so that explains why there were so many of them at the entrance at one time. One of them takes our permit and looks it over and takes it on himself to be our guide. He takes us into the three levels of the tall central tower. Each level is reached by an extremely steep set of stairs (he runs up & down, we take our time, it's as steep as a ladder) and features a cool, high-ceilinged hallway with wide-plank hand-hewn wooden floors that are smooth and cool under our bare feet. Two doors on opposite sides of the hall lead into treasure rooms. Three floors, each with two treasure rooms, so six in all. We respectfully file past some very beautiful statues of seated Buddhas, each of them at least 8 or 10 feet high: in one room, a compassionate Buddha with the most tender expression on his face; in another, three representing Buddhas present, past and future. Some rooms have a thousand gilded small Buddha statues lining the walls in glass cases, each wearing a tiny silk robe. Most have beautiful and detailed wall murals. In one room there are several sacred relics on the altar - smooth dark granite rocks that we are told bear the footprints of Guru Rinpoche and his consort. In addition to the tzichu (the holy water poured into our outstretched right hand in each room), we receive blessings on our heads from a variety of special objects in different locations throughout the monastery: a walking stick of an important lama from the 19th century, a book of scriptures wrapped in silk, a sacred spring of water that our guide, Tendin Tshering, says flows from the heart of the compassionate Buddha statue upstairs.

Tendin Tshering then leads us up the hill outside the walls of the dzong - here and there on the hillside there are small homes and since it is a sunny day (rare this week), nearly everyone has done his washing, and there are red robes draped on the fences, clotheslines and roofs drying in the sun. He brings us to his own home, which is a wooden lean-to up against another building, consisting of two rooms each no larger than 6x8 feet. There is electricity but not running water - so his tiny kitchen has shelves with a one-burner propane stove, an electric rice cooker, but no sink - there is a spigot outside somewhere - and his bedroom has a low couch piled with his bedding which he spreads on the floor at night, some bookcases to hold his scripture texts, one fluorescent tube light, and pieces of silk fabric and sheets stretched tight over the walls with no apparent pattern and tacked tight to cover the walls entirely. It is quite a comfortable room, actually, though I can imagine it is very cold in winter. Several other monks poke in their heads to meet the American family, and someone produces a can of Diet Coke for us to share. I wish suddenly that we had brought some kind of gift to give them.

Here is some Bhutanese serendipity. One of the monks who comes into Tendin Tshering's tiny apartment to greet us, has met Don before in 2002 when he was here in cold February with Thompson and Forrest. They had use of a car to drive to Punakha and back, and on the return trip they stopped and picked up a monk and gave him a ride to the Dochu La pass. This monk remembered them and the boys (including their Bhutanese names), and Don was so surprised and delighted to meet him again. His name is Thubthen Norbu and we made sure to snap some photos to send him later. He also took us to his small two-room quarters in the next building and provided us with refreshments and cookies - and I remembered that we had some American fruit leather in our bag and gave them what we had.

These two monks, after letting us rest a while in their rooms, walked us farther up the mountain to a building where two young reincarnates give public audience on Sundays. Reincarnation is a key belief in Buddhism, and prominent lamas or religious leaders, Bhutanese believe, are often reincarnated and then recognized as reincarnates as very young children. Today we met Gyalsay Chhotu Rinpoche, the reincarnate of this monastery's leader from about 130 years ago. He is now 12, but Don had the chance to meet him in 2000 when he was 7, and we understand that he was recognized and brought to the monastery when he was only 2 or 3. We waited outside his doorway until the monks motioned us in. He does not speak to his guests, but he seemed interested behind his thick glasses when some (American) children his age came in. We respectfully bowed and offered gifts and received a gentle touch on the head from his silk-wrapped bundle of Buddhist scriptures. We met a second reincarnate also giving audience today, who was in his teens.

We took leave of our kind hosts/ new friends and headed down the trail. Partway down we were rewarded with meeting a family of enormous monkeys right in the trees next to the trail. The largest of them was easily twice the size of Jacob, with a tail as thick as a soda can, staring us down from the tree and making monkey-comments to the other nearby members of his family.

Later tonight we spoke with Dr. Gadho about the reincarnate lama. He told us that the boy's parents are ordinary villagers from eastern Bhutan, and that the boy began asking around age 2 to go to the dzong and talked a lot about his monastery, describing things about Tango even though he had never been to Thimphu. They consulted with the head of the dzong there, and eventually brought him to Tango. His health is not good - Dr. Gadho says that he has health problems of an "old person," such as cataracts and spleen problems, and a sensitive digestive system. On meeting such a young lama, one wonders what his childhood is like - does he play, run around, etc? I don't know, but Dr. Gadho who has met him says he is a naturally serious person, holds himself with dignity. When Don met him five years ago, he peered at Don from behind the huge glasses that make his eyes look enormous, and asked his translator to tell him that he knew Don from a previous life. While Don doesn't recall this past life with the same clarity as Gyalsay Chhotu Rinpoche, we certainly respect his role and left with a sense of wonder at the special place that is Tango.

A typical "Tshongkang" or little Thimphu grocery - candy, chips, doma, drinks, crackers, a rack of handkerchiefs hanging from clothespins. This one is the first floor of a home.
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Takins: Here's looking at you, kid.
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Friday, July 22, 2005


Haircut day in Thimphu
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Indian Scissorshands

After the scolding by the headmistress, we wondered if our boys needed a haircut. Well, they needed it anyway, and this was a convenient opportunity to check out the spangled and fascinating barbershop we often pass in the center of town. It's called "Lalon Thakur Saloon" (all barbershops here misspell themselves as saloons) and three barbers from India work constantly with large silver scissors (we mean LARGE) with the speed and accuracy of Edward Scissorshands. Jamtsho warned us about taking our children there, because hair would fly everywhere, but we wanted the local flavor and passed by the ones with posted advertisements for hair products and went to the one where the Indian workers go.

Haircuts cost 30 Nu (75 cents) and take about 3 minutes, but as you can see, with an excellent result. It starts with the BIG scissors and a comb, with a sharp rapid snicking sound, and hair flying everywhere as promised. It even includes the use of a long-handled single-edge razorblade dragged along your neck and around your ears to clean up, and it ends with being powdered with talc in the back of the neck and then whacked smartly with the towel several times, talc clouds rising over the chair.

The boys had haircuts simultaneously in the three chairs by the three different barbers, who talked to each other in Hindi all the while - not a single word of English was exchanged in the entire experience. The room is festooned with mylar garlands in bright colors, posters of hairstyles from the early 1980s with Indian models, and seems busy both day and night with hardly an empty chair, ever.

Jacob in his classroom
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Praying at morning assembly
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School Notes

This week the children have been in school and have regaled us with stories at the end of each day that highlight just how different the educational system is from what we are accustomed to in the US. Mostly this is very good, as the point was to expose them to different experiences, ideas, and expectations. They have learned a lot in one week and have covered some material, particularly in math, that they hadn't seen at home. Given the practical bent of the education, for example, Thompson's 6th-class "maths" for the week have been to calculate simple compound interest and net profit/loss.

On Thursday, each child was offered an iron pill in class by the teacher. Every child takes one, issued by the school, once a week. Schools are also arenas of public health, religious instruction, and indoctrination into national ideals. The sheer number of students in the school is impressive. We estimate at least a thousand in the school between the grades of PP (Pre-Primary) and 8. [Chagangka is one of 31 schools in Thimphu - Kuensel this week says there are 21,000 students in the Thimphu school district.] Class size is 25-30 students per class. I spoke at some length to Madam Karma, Halle's teacher and in her small classroom with barely enough room for her desk and four low square tables there are 24, but she said she often has closer to 40, and one year when they were short on teachers she instructed 63 in that space. Thompson says each room is issued the same amount of chalk, but that his class is running low - the teacher says this is due to the students not taking care of the chalk and that they won't go "begging" to other rooms for more chalk (I guess we know what our parting gift to his teacher will be) - he also describes that one game he plays to amuse himself is tossing his pen up through the holes in the table and catching it.

Discipline is impressive. Shame is a major teaching technique, and I heard the headmistress dress down the entire school body for infractions such as wearing hair too long (boys), failing to be considerate, not giving enough attention to studies, not returning school equipment, not eating a proper breakfast before coming to school, and ignoring other "rules and regulations" by which they are expected to abide. Children are often told how naughty they are, especially boys.
Each of our children has had stories to tell about discipline and shaming in their classrooms - very eye-opening. In Halle's class, the "naughty boy" was hauled before the teacher by his ear. In Jacob's class, children who fidget with pencils are made to stand up and pull their ears. Today he recounted that while the teacher went to the latrine, the class got "restless" and the class captain took initiative and went around "beating everyone with a stick," Jacob included. Jacob felt that since he was talking, he deserved this. Apparently the teacher approved of the class captain's actions. Jacob has been concerned that he hasn't received the same discipline as other children earlier in the week ("Why are they singling me out?") and so he was a little proud of his beating, though clearly uncomfortable with telling us all the details of it. In Forrest's class, he said the teacher told them she wasn't going to issue any beatings, but would take away marks instead if people were naughty. We have heard stories of children having their knuckles rapped for incorrect answers. In Halle's little PP class, she got to sing the "American version" of the alphabet song, which ends "Now I know my ABCs, Next time won't you sing with me." The teacher thought this was charming.... turns out that the final two lines of the one they sing in her class are "Please, Madam, don't beat me/ Now I know my ABC." I'm not making this up. She said she hoped no one in the US would sue them if they heard this version. For Thompson, who continues to have a nose in a book much of the time, his teacher commented approvingly (and in front of everyone) that he likes to read "storybooks," while most of the other boys "only know how to eat and poop."

Jacob's homework one day this week was to make sentences using words given in English dictation, including one that stumped him completely: Diwali (the Hindu Festival of Lights). In a lesson about the seasons which he carefully copied into his notebook, he learned that spring is "when we go to school," summer is "when we get muddy water," in autumn "we go to tsechu in the dzong" (the big annual religious festivals in each dzong district) and in winter "we use bukhari" (the indoor woodstove which is the primary method of home heating). He faithfully copied without a clue what these words meant.

I pick up Halle an hour before the others get out, and she has a couple of standard after-school games to play with the kids who congregate around her: one that involves picking buds and making "stew," and lots of hopscotch. They all know her as Sonam Pelden there, even her teacher. I think every kid in school knows Jacob, though when he told one person his name, something got a little lost in translation and the child repeated, "Chicken?" When we get home, a train of kids (the engine of which is Thinley of course) appear at our house for snacks, drinks, running through our house and amusing themselves with our sets of watercolors and blank paper.

The young boy with the infected tibia
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Surgical Log - Week Four

This has been a pretty challenging week for surgical cases. I will give you just a few of the highlights:

On Monday, I showed up in the operating room and was asked to go into one of the rooms to do the case. It was a man who was already asleep, so I couldn't examine him. His chart had minimal information but it turns out that his hip was dislocated a month and a half previously in a motor vehicle accident. When he was seen initially, X-rays were taken just of his thigh, missing the hip dislocation completely. In general, we like to reduce (i.e. put back in place) hip dislocations within a matter of hours; 6 weeks is certainly less than optimal. It was scarred in place, so I had to make a big open incision to reposition it. His hip socket was completely replaced with scar tissue. Even when I got it back in position, it kept popping out, so I put him in traction after the surgery, and so far everything looks good.

I also treated a young boy with a tibia (shin) fracture where the bone was protruding. He had been treated with a puja (i.e. a religious healing ceremony) only and came in with gross infection. I have also operated on three small children this week with near-amputations of their fingers - fortunately all are doing well so far.

I have been a little disappointed this week at the level of cleanliness in the operating room. We certainly don't have a sterile environment yet and at times it's not even clean. I had hoped that by now (HVO has been sending volunteers here since 1993) we could make more progress in this area. I had to compete with aggressive flies in the wound on most cases I did this week. It's not just the presence of the flies, it's also having to stop and swat them away which is bothersome. We also ran out of surgical gowns and even the surgical drapes a couple days this week, and I did one case in surgical scrubs and gloves but without a sterile gown, with minimal draping. Other examples include seeing a surgical tech washing her muddy feet in the scrub sink, using our only bar of soap for the day. I then had to use that same bar of soap to prepare for my next case. Also I had an anesthesiologist reach into the operative field to reposition the patient.

Today I needed fluoroscopy to pin an open fracture of the hand. The monitor for the fluoroscopy unit could not be moved from another room, so each time I wanted to view an image I had to go out into the hall to see it. My other challenge today was that the two other surgeons both disappeared. As government workers, they are occasionally called away to meetings and take whatever leave is due them, regardless of the surgical or clinic schedule or patient needs. So today, I was responsible for seeing all 70 patients in the outpatient clinic, doing two emergency surgeries, and giving a lecture to 15 physical therapy students on shoulder injuries and treatment. I would be okay with this, except that all three events were happening simultaneously.

No comment needed?
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Wednesday, July 20, 2005


Faces of Bhutan #1: capturing the wonderful expressions in the schoolyard
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Faces of Bhutan #2: on my run this afternoon, these three children were playing in the ditch in the running water, and laughed themselves even sillier when they saw this image on my digital camera.
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Small Mercies and Word Problems

Halle wakes up in the night with extreme gastric distress - vomiting, diarrhea - necessitating a change of sheets, clothing, and a midnight shower. The clothes and sheets must be washed in buckets. How does Ratna do this every day? I wonder as I scrub, soak, and suds things in the bathtub in the middle of the night. I am a bucket-laundry novice and she re-does it for me with patience later in the morning while Don and I are nursing Halle with Sprite, a Thai orange-colored sugar drink called Beeber, and strong American antibiotics - all of which work by the late morning. She stayed home from school today, but will go back tomorrow. By late afternoon she is running around outside as if last night never happened. Likely culprit: I'm guessing the cream filling in an unrefrigerated cream puff from the bakery which she ate yesterday. Or peeing in the bushes at school with no handwashing.

Ratna is in and out being helpful while Halle lies on the couch and watches Animal Planet channel - Ratna works in our home from about 10 until the early afternoon Monday through Saturday. She is employed by the hospital to look after the HVO house. She washes the dishes, the clothes, the floors, shakes the carpets and the tablecloth, hangs the laundry on the line, frets over the job that the sickle-wielding hospital grounds men are doing cutting the grass. She is from southern Bhutan so her accent is a little different - she is married, and divorced, with one son aged 11. She divorced her husband years ago because he took a third wife (she was number 2). Today I asked her how old she was, and was startled to hear that she was only 29. I confess she looks older. She told me that her parents, aunts, uncles, were all dead by 53 and there is no one in her family older than her generation.

While were were sitting, watching Halle drink Beeber and thankfully keep it down, she asks me if I have a dishwashing machine at my home. She asks me what it looks like, and to explain how it works. I give a rough discussion of how my dishwasher works, and she just sighs, and says she has heard of them, but never seen one in this country.

From Forrest's math book: ostensibly a lesson on fractional numbers, but actually quite revealing about daily life in Bhutan, too:

--Thukten covered 2/5 of his journey by road, 3/10 by mule, and the rest on foot. How much of his journey did he cover on foot?

--Rinzin lives 3 and 4/7 km away from the school while Gyeltshen lives 4 and 3/10 km away from the school. Who lives farther from the school and by how much?

--Nima had 6 and 3/4 litres of petrol in his scooter tank in the morning. In the evening he had only 1 2/5 litres of petrol in the tank. How much petrol was used by Nima during the day?

House View #1 - front door, daylilies, hollyhocks, etc. The triple window is in the LR, the high one is the kitchen and the next triple window is Thompson and Forrest's room. Roof is sturdy corrugated tin - loud when the kids toss green apples onto it to roll down, and there are pigeons nesting in the eaves making cloo-cloo sounds in the morning.
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House view #2: front door with its semi-permanent resident dogs on the doorstep (Shadow and Polo), and the day's washing on the lines. Prayer wheel to the right of the door, you spin it when you walk in.
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Halle and friends on the upper schoolyard
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Forrest and friends in his 4th level classroom
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The kids walking "the short way" to school from our house.
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Tuesday, July 19, 2005

School (While On) Vacation

You heard from Thompson's perspective, so we thought we'd add something about the other kids and from what we saw. This was especially meaningful because Halle's first day of school happened here in Bhutan, months before her US school debut. July 18 was the first day back at school for the second term... because the schools are not heated, they don't go in the winter. Instead the school year runs from March to June, exams at the end of June, and then second term from July until sometime as winter approaches. We arrived in Thimphu on the day after exams, and all the schoolchildren have been on 2-week holiday. We decided to place them in school for the start of second term, even though it only means two weeks of instruction, and we signed them up with the headmistress of Thinley's school (to which the June HVO volunteer kids had gone & also the current PT's teenaged boys), Chagangkha School. We purchased uniforms: boys = green gho, white cuffs, navy socks, black shoes. Halle = green kira, red blouse, black jacket, blue socks, black shoes, black hair tie. We outfitted them with blank notebooks and narrow pencilboxes for their pencils, and tiffins - lunchboxes on a strap which contain two round stainless steel tins with lids about the size of tuna cans.

The first day of school Don and I both walked them all the way there - Don arranged to be late to work so he could catch the events of the first day and see the school. The sidewalks during the half-hour (brisk) walk there were full of groups of students of all ages in their uniforms - there are several different schools in this part of Thimphu and the uniforms are all different and the kids looked smartly turned out and adorable. Even the little ones seem to walk to school without adults - there are no crossing guards at the corners - just groups of kids, even tiny ones, independently walking to school.

We were moved and impressed by morning assembly - Don had been to one for Jamtsho's sister a few years ago, so knew that the students lined up and stood at attention when ordered by the school captains, and that house prefects walked along the lines keeping order, and that the entire body placed their palms together as the flag salute and sang the mournful, sweet Bhutanese anthem with heads bowed. It's quite a sight to behold, especially with our children's blond/brown heads bobbing deep in the crowd. One has to be prompt arriving at 8:30 for morning work assignments, and then the bell summons the students and teachers to the assembly at 8:40. Dismissal for Halle is at 2 and for the boys at 3:05, so it's a good long day.

Halle is in "P.P." for Pre-Primary, and both her class and Jacob's are in the oldest building, with very small classrooms, low tables, dim lighting, and tiny plastic chairs. Halle's teacher, Madam Karma, asked me to provide a chair, so I bought one at one of the little hardware stores on the first day and carried it around with me on my errands until I got back up to the school to pick her up. They play outside the building in a large yard mostly remarkable for its dust and lack of vegetation. Halle had a wonderful first day. She was dusty and breathless with excitement when I picked her up. I had been worried that she wouldn't handle the in-floor latrines well, but when I asked her if she had gone to the bathroom during school, she just replied, "Oh, my friends took me, and we peed in the bushes." Imagine that at home; I don't think so! Jacob was instantly taken in by a gang of boys who squire him around with their arms around his shoulders and has had a great time - including his carefully copies Dzongkha lessons. I notice his teacher corrects his capitalization and spelling and doesn't let him get away with poorly formed letters. Excellent.
As for the older boys, their classrooms are spare, crowded, and they sit at narrow desks, two to a desk, on four-legged backless stools. Luckily there are at least two breaks to go outdoors and run around. Their subjects are English, Math, Science, Social Studies, Dzongkha, and Gardening. I love the idea of the last one. Each class has a garden to maintain, and today when I picked up Halle I watched both boys out at work in their respective gardens: learning to use a small hand hoe, plucking weeds by hand, watering the flowers (which for Forrest meant hauling the water from a faraway spigot on the other side of the campus in an old cooking-oil container, along with several other boys who were practicing spitting through their teeth), etc.

In one of Thompson's classes they were assigned to correct the exams that had been taken two weeks before, and the homework was to copy over the exam in one's book with corrected answers. Thinley came over to do homework with Thompson (her schoolgirl crush is a sight to behold) and he made short work of the exam, even though it contained some material he hadn't had yet - some pre-physics concepts like potential energy, and some biology concepts like pregnancy and prenatal health. It turns out this morning that he was the only one in the class who actually had copied over the whole exam for homework, even though some of his answers were a bit creative. For example, the question, "What is contraception?" his answer was "Contraception is a symbiotic connection between an insect and a parasite with mutualistic after effects," showing his parents' lack of discussion with him on this issue - and then turned bright red when we explained the real answer.

One of the things I enjoy about walking the kids to school and picking them up again (besides that it gets me out walking for over an hour each way) is watching the children in their neat little uniforms, playing the simplest of games in the courtyard: double-dutch jump rope, a kind of variation of marbles using pebbles called "ten-stone" popular in Jacob's grade, pickup soccer with rocks for goals, tag - all without any apparent adult supervision. No playground monitors, almost zero equipment, lots of creativity.

Tidbits from Tona's Day

--we have water this morning. Didn't have it yesterday - turn on faucet, nothing. So we used the spigot in the yard (different pipe, apparently, from the one that feeds the house). Got promises from the hospital maintenance people to come check it out. Eventual explanation: the water source had been "locked" farther upstream from us, shutting us out of the feed. Hot showers are a good thing, and so is water in the sink for dishes.

--Kellogg's Mango Corn Flakes. Now why can't we have those in the US? Delicious

--Proof of globalization: the only red apples I can buy here are labeled with stickers from Chile. Chile??!!

--When you order something - pastries at a bakery, say, or momos from a restaurant and you want them "to go," here you say "for packing." They usually pack in tinfoil or a bakery box and then wrap that in newspaper. If you buy an article of clothing, they roll it in a piece of newspaper instead of a bag.

The four kids, outfitted with tiffins and pencil boxes and in their school uniform, setting off on the first day of school.
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Thompson's Account of the First Day of School

My parents will write more, but here's from me:


Today was our first day of school (what, you want me to start with something more interesting??). We woke up early in the morning to pack a tiffin, get on a green gho (kira in Halle's case), and put on knee socks and dress shoes. Then we walked down to the Memorial Chorten where we met the other American family's kids, Cy and Graham, to walk to school. The walk takes 35 minutes.

When we arrived at school, we saw a couple hundred other people with green ghos and kiras. Everyone lined up in rows (row of boys, row of girls, alternating) in the schoolyard, facing the flagpole and got addressed by the headmistress. To all her questions, the entire group of children chorused, "Yes Ma'am." Then they placed their hands together and sang the Bhutanese anthem. I was standing next to Cy and neither of us knew what to do. Then the headmistress introduced someone in charge of a health trust fund, which the school had raised 56,000 Nu for, and he gave a long and boring speech on health care policy while we all stood there in line. My back was aching.

Then I went to my 6th class classroom, VI-D, and was scolded by my teacher for bringing in my tiffin. I was supposed to leave it outside the door. In my tiffin, by the way, was fried rice in one container, and in the other a sandwich and a soggy biscuit. My tiffin is purple and has a picture on it of a country farmhouse. I have many teachers, actually, one for English, one for Dzongkha, one for science, one for social studies, one for math, and one for homeroom. Therefore I was introduced six times to the class. In class, I needed to do a lot of copying into my notebook, mostly of corrected exams from last term: an entire science exam from last term, my own English essay, a social studies exam, a math exam, and I learned how to write my name in Dzongkha, and then I did an English exam. All together I used 34 pages out of my new notebook.
At lunch break, halfway through the day, Cy asked me to sit with him for lunch (even though we had offers to sit with many groups of other people), and then later I switched my place in the room upon request from Thinley's group to the "naughty" boy group (which is what the girls call them, I don't know why). They were very friendly to me and helped me during Dzonkha class. During Dzonkha class, we had an interruption by the head boy of the school, who wanted to come in and talk with me about America. I get the impression he can pop in wherever he wants because he was talking about how he had talked with Jacob for a long time too. He wanted to know about my school in America and what sports it offers. This one competes in basketball, volleyball, and table tennis. After which I went to the Dzongkha teacher (who marveled at my English writing) and she showed me how to write my name in dzonkha (while also marveling over the fact the United States speaks English). She was however, very nice and good at speaking English.

While I'm here, I expect to learn many words in Dzongkha and some of the alphabet (today I learned and practiced the first four: Ka, Kha, Ga, and Nga, which sounds like Nyah). I think it's interesting to go to school during my vacation. In the morning we will have to clean the school before assembly and everyone has an assignment, like emptying trash, sweeping the corridors and school yard, weeding or planting the gardens, cleaning classrooms, etc. Maybe I can sign my papers in Stow with my name in Dzongkha - that would be cool.

Morning assembly at Chagangkha Lower Middle Secondary School, Thimphu - singing the national anthem.
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Monday, July 18, 2005


Schoolboys & new notebooks
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The kids peering in a window where I am shopping in Wangdi - the shop is too small and crowded for them to come in with me.
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Downtown Wangdi
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Wangdi Market
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Wangdi Market Day

If you really want to make an impression as an American in Bhutan, evoke comment, and appear as an exotic exhibit, then shop at the weekend market in the cliff-dwelling town of Wangdi Phodrang. Wangdi is known for having had a fastidious district adminstrator, who insisted on streets being clean and who would turn off the town's electricity if it wasn't kept up properly. The town clings to a high promontory over the river, with the dzong perched on the very end of the promontory, and on Sundays there is a busy outdoor market on the hillside. We spend the middle of the day at the market and wandering the main street with its busy shops. There are children buying empty notebooks for the start of school the next day, red-robed monks out doing the shopping, and lots of taxis clustered in the central square. Down in the market the sellers are as interested in us as we are in their wares. There are the kinds of produce seen in Thimphu, though in less quantity, and some that I have not seen: one dark red bud the size and shape of the first appearance of Audrey II in Little Shop of Horrors turns out to be a banana flower, and they show us how to peel it (sort of like a giant red endive) and pull out the little flowerets inside, remove the stamens, and then cook them into curry. Well, we are having dinner guests later this week, so we must try this and we buy one.

Back up along the main street, we stroll with our children having sudden fits of shyness and clinging to us, slowing us down so that we look like one giant 6-headed amoeba wending its way along Wangdi's shopfronts. We buy a handful of candy from one of the plastic jars sitting outside of nearly every shop, with individually wrapped pieces: Centerfresh mintgum, Milk-n-Nut (a coconut taffy), and Froote (mango hard candy with a prize wrapped around it). When we ask for a restaurant recommendation, two schoolboys proudly march us to the Kuenga Hotel (hotel in the loose sense here, meaning a public eating establishment), and then join us for the meal upon our urging. Don eats lightly of the stewed beef having seen the meat-house at the weekend market up close. One of the boys has had his money to buy school notebook stolen and is worrying about his mother's scolding. We spring the 50 cents for his two notebooks before taking our leave of Wangdi.

Attempting the walk to Chimi Lakhang - action shot of Thompson falling in the mud
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Zangtho Pelri

Our weekend trip over the pass to Punakha and Wangdi Phodrang means an hour of winding mountain road up out of Thimphu, including passing through a police checkpoint, to the Dochu La Pass. This is the only route over the north/south range of moutains that cuts Bhutan from its border with India up to its border with Tibet. At 3140 m (around 10,000) Dochu La is clouded in much of the time, including today, and is festooned with prayer flags. There used to be a single large chorten there, but in honor of the king's victory over the terrorists in Southern Bhutan, the queens have commissioned and built 108 chortens on a rounded hill around which all the traffic must flow. We walk around them a number of times and meet the friendly stray dogs padding around at the pass. Then we begin a 2-hour decent on very twisty, narrow & wet roads. Thompson is prone to carsickness (but, oddly, only in Bhutan) and we tell him not to read in the car, but he ignores us and so (natural consequences) even on the ride up to the pass begins to feel ill. On the way down he turns a faint shade of spring green and sits grimly by the van window, making small adjustments in how open the window is. We have to stop a couple of times to let him walk around. Eventually the Dramamine takes effect and we figure out that he doesn't get sick sitting in the front (less bouncing around). Meanwhile the road is dropping fast through semi-tropical rain forest, with primordial ferns and some banana palms, with considerable moisture and some roadside waterfalls. While walking around outside the car, Passang cautions us against leeches.

We reach a cluster of small towns. Don has told Passang we might like to follow the footpath to Chimi Lakhang, an imposing lakhang way out in the open surrounded by green rice fields and small villages. It doesn't look that far away from the road, but it has been raining a lot and once we get out of the car and literally slide off the path because of the 2-inch deep mud, the walk doesn't look like such a simple matter. As we slowly pick our way across the small paths that separate rice paddies, our feet making smucking sounds, the rain picks up a little, and the lakhang, by some illusion of space, seems to be getting farther and farther away. When we finally reach one tiny village downhill, drenched and with muddy cuffs and shoes, we don't seem to be one whit closer to Chimi. We stand for a while under someone's large eaves, watching villagers walk by with large jugs to fill them with water from the one tap in the center of the town. It rains harder. We abandon the plan of going all the way up to the lakhang, and focus all our energies on getting back up to the van through the mud and rice fields... slow, messy, wet progress through the bright green and the rain. Chimi is known for being a pilgrimage site for women whoh are having trouble getting pregnant. I guess this is an unmistakable sign that we are done having children if we can't even get close to the temple at all.

Passang drives us to our hotel, the Zangtho Pelri near Punakha. "Zangtho Pelri" means the heavenly abode of Guru Rinpoche, and it is set high on a hill overlooking the Punakha Chu, very quiet with only birdsong in the lush green trees and the faraway sound of the river... none of the ambient sounds of our home in Thimphu (dogs, construction noise, trucks, Hindi music). We have two rooms in a cottage set on the cliff with nothing below but cowpaths and rice paddies. After we clean up and change into national dress, we go down into the town for some lunch (momos, red rice, dal, some kind of curry, chowmein + sodas = what is becoming a very typical lunch here for us) in a diner with deep piles of dead flies in the corners of the windowscreens. Then we spend the afternoon at Punakha Dzong - I have already written about that - and then head back to hotel. The kids have heard that there is a swimming pool. If so, it would be one of the few in the entire country. There is supposedly an indoor pool in Thimphu, but I have not seen it yet, and swimming is not a common pastime here - the rivers are too swift and the lakes too few, and the ground not level enough hardly anywhere for such a thing to be built. But Zangtho Pelri has one, and the staff even tells us it is open, but I'm glad we didn't change into swimsuits before looking at it - murky and olive green, with insects roiling up from the depths. Only Jacob is disappointed we can't swim in the pool, and cries about it, but Don tells him he'd have to have antibiotics if he went in.

That night, we went to bed in clean sheets thinking how nice it will be to sleep where it's quiet. But you know, it only takes one large noisy fly and two mosquitoes hovering near one's ear but just out of swatting reach to prevent a good night's sleep, and Halle was in bed with us and kept kneeing me in the kidneys from behind - so maybe Guru Rinpoche rests in peace in Zangtho Pelri, but unfortunately not us.

The only other guest at the hotel was a Dasho, the equivalent of a knight in the government, a very trim and gracious man, with his entourage of drivers and guards. We told the children that Dashos are permitted to carry swords and use them with impunity (which is true), and amazingly this worked to keep the noise level down in the kids room; they feared being beheaded without further discussion if the Dasho's sleep were disturbed. We met him in the morning and he seemed rather mild, but we assured the kids that you never know about these things and it's best to be considerate.

No swimming at Zangtho Pelri: much sadness in the land.
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No swimming at Zangtho Pelri: here's why.
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Sunday, July 17, 2005


Hangen family in national dress in front of Punakha Dzong on the day of cremation of Je Khenpo, 6/16/05
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The three boys making the crossing over to Punakha dzong on the footbridge (shaky, shaky)
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Cremation of a Je Khenpo

Two Sundays ago, we visited the Royal Botanical Garden and walked out a path to its terminus at a large wooden picnic pavilion with a roof. From this vantage point we could see out across a deep green gully. On the far hill was a yellow-roofed lakhang and it was decorated with buntings and banners, which we could see flapping in the breeze even from this great distance. Thinley told us that one of the retired Je Khenpos had died and that his body was lying there in state. She told us that his body had not decayed nor would it, because of his great holiness. The state religion of Bhutan is officially the Drukpa Kagyu lineage of Himalayan Buddhism (according to my Lonely Planet guidebook), and its highest religious leader at any given time is the Je Khenpo who serves for a period of 5 years. This retired Je Khenpo was considered a very holy man, and his body had been lying in state for some time since his death in early June.

On Saturday we took the opportunity to take a weekend trip out of Thimphu, over a high moutain pass and down into a neighboring valley called Punakha - this is the winter home of the National Assembly and the monastic body. We hired the implacable Passang and his comfortable Toyota van to drive us there. This turned out to be a very auspicious weekend to be in Punakha, because the body of the Je Khenpo also made the journey over the high pass and down to Punakha, to be cremated at the dzong there.

We arrived at Punakha dzong, situated at the confluence of two rivers, mid-afternoon. It is not accessible by vehicle, but only by a gently swaying wooden footbridge suspended over the swift-flowing wide Mo Chu River, draped in fluttering prayer flags. Our dzong permits passed inspection and Don had put on his white kabney with some help from Passang, and we were admitted into the courtyard where the ceremony, it seemed, had just concluded. Sweepers with short-handled twig brooms were coming along and sweeping up the wrappers and the dust and leaves. Special ceremonial tents had been constructed in the courtyard, four of them surrounding a central tent with a dzong-like tin roof and turret. Inside this central tent, with red carpeting, flowers, bowls and tables piled high with offerings, and elaborate tormas (butter sculptures), was a central podium shaped with a Tibetan chorten. People were circling this central podium, so we joined the clockwise flow and slowly made our way around the tent, and then around the offerings inside the tent. Two monks were handing out reprinted photographs of the late Je Khenpo, His Holiness Je Nyizer Trulku. We realized as we passed by it, that the "chorten" in the center was in fact the pyre, with a kind of bread-oven opening on one wide blackened with smoke - smoke that was ever-so-slightly still drifting up into the air.

We stayed inside Punakha dzong for about an hour - we were ushered by friendly monks into two of the treasure rooms, where they let us light butter lamps and where we received scented water blessed by the monks in our outstretched hands (touch to mouth, spread on the top of your head...). One of the monks explained that there would be a puja starting at 5 - a collective recitation of prayers, chanting from rows of monks, beating of the tall ceremonial drums with curved red sticks, trumpets, bells, fluttering oboes. We stayed until it started and then when two small novice monks went by us with their arms full of wood we realized that the continuation of the ceremony also meant a continuation of the cremation inside the chorten. Thompson was a little horrified. Maybe the other kids didn't really realize what was going on - in any case, no body could be seen and the chorten wasn't really "body-shaped," so it was all a little mysterious.

The chants rose and fell across the courtyard; rows of people in their best clothing came in to perform ritual bowing: hands pressed together, touched to the top of head, the face, the chest in rapid succession, then kneeling and touching forehead to the ground, rising and repeating, and then took seats under the large tent and began to read the prayers in Dzongkha while the monks kept at their own prayers at a different speed and rhythm. The murmuring of both, punctuated with the unison drumming of some twenty gigantic drums, followed us out across the bridge and out of the spectacular Punakha dzong.

The central tent in the courtyard of Punakha dzong where Je Khenpo was cremated. The table in front is piled with packages of cookies, fruit, bread, other offerings. The chorten-shaped object is the crematorium.
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Ashti Sonam Pelden

Bhutanese parents do not name their children. Instead, they take them to a lama at a lakhang once they are born, and the lama (based on Buddhist astrology, his mood at the time, or some kind of calculation that has to do with birthday - I get different answers from different people about this) gives the child a name. One thing that all my informants agree on is that the parents never dispute the name, or try to influence the decision, and they just accept that this is the child's name, period. There is no family surname in Bhutan and no one changes a name at marriage. Sometimes people receive one name from the lama, sometimes two. And, there are only a limited number of names, which are not gender-specific & can be used interchangeably for first or second names. This is so different from our Western ideas about naming: individuality, uniqueness, expression of family relationship or personality, etc... none of that.

Here are some Bhutanese names: Chimi, Choedden, Dawa, Dorji, Gyeltsen, Jigme, Karma, Kezang, Namgay, Norbu, Om, Passang, Pema, Rindzen, Sangay, Sonam, Tashi, Tenzing, Tshering, Tshewang, Thinley, Tobgay, Zangmo, Wangdi, Ugyen. This does not exhaust the list, but gives an idea of what names are like - pick any two in any order, and you've got a name.

We have had our children named, most of them by Tashi's uncle, a prominent lama - in fact, he was one of four lopens at one time who were the assistants to the Je Khenpo, the highest religious leader in Bhutan, on par with the Tibetan Dalai Lama but certainly not as internationally well known. Uncle Lama named Thompson when he was a baby here in Bhutan in 1993 = Sonam Tobgay. Forrest was named by a lama who was visiting the United States for a Bhutanese textile exhibit in Salem in 1995 = Sonam Tashi. Jacob was named in absentia by Uncle Lama the last time Don was in Bhutan = Sonam Wangdue.

We had hoped to meet Uncle Lama in person on this trip, but he is in meditation for a prolonged period of time, in a small one-person hermitage high up in the mountains somewhere near Thimphu. He does not speak during this time, but can communicate for one hour a day by writing. Tashi's cousin visited him last week, and was kind enough to take up some gifts from us: a white silk kata or ceremonial scarf (traditional gift for the meditating lama who has everything), some tea & jam, and some photos of Don and Halle, and we asked him in a letter if he would please give her a name.

This evening Tashi came to say that his answer had arrived - I suppose with the cousin, but it could also have been by carrier pigeon or flying tiger, the way she said it had "arrived." Halle is Sonam Pelden. Translation: Sonam = merit, luck, positive energy. Pelden = glorious. Fitting? We think so. Ashti is princess, so she we added the title, making her the Ashti Sonam Pelden. She was thrilled with her name, and with the six "lucky" silk threads Uncle Lama sent in an envelope, one for each member of our family to wear around our necks. Such an honor and something that we have looked forward to about this trip for a long time, that she could be named.

We like the name, too, because now it will be so easy to call the children in for their supper of red rice and dal: just yell "Sonam!!" out the door.

Halle ("Sonam Pelden") at Punakha dzong
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Quest for Takin

I asked Tona if she wanted to join me for a run tonight. I don't know why she said no; I'm sure it had nothing to do with being at 7500 feet starting on the side of a mountain with a planned 850-foot climb, nor with running through a town with an estimated 5000 unclaimed dogs (source: Kuensel weekly newspaper 7/16/05)... nor the fact that it was getting dark and we're in the middle of monsoon season with rain always imminent.

My run was pretty much uphill, on winding roads and occasional muddy paths with a goal of reaching Motithang and seeing the legendary takins. We've mentioned takins in a previous blog entry - they are the national animal of Bhutan and a small herd is kept in a preserve above Thimphu city. Forrest wanted to do a school report a couple of years ago in Stow on the takin, but was told by his teacher that takins were mythical beings and he had to choose "a real animal" for his report topic instead. As it gets darker, the dogs become bolder and I turn up the volume on my I-pod... maybe if you don't hear a menacing growl and bark, it doesn't happen, right?

I have been up this path several times before but since I am losing light, I ask a number of people if this is the right way to the takins. People look at me strangely and point in different directions, but I continue on the path that I am quite sure leads to the preserve. Towards the end, I take a path with a couple of log river crossings; the brush is pretty dense here, but at least I recognize that this is definitely the way... it's only when I get to the entrance of the preserve that I see a new, paved road leading straight there.

I don't see the takins at first. I find an old man sitting outside next to a woodfire, unravelling a bag used to carry rice and tying the ends together to make string. He has no teeth, speaks only Dzongkha, and is barefoot. I point in the direction that I think the takins are, but he leads me up to a muddy slope to a point where we can both see the herd. Bhutanese say the takins have the head of a goat on a cow's body - or is it the head of a cow on a goat's body? In the darkness, it could be a head of moose, or bear, and I really don't care. I'm happy to see any funny-looking head on a funny-looking body and get on with my descent back into Thimphu.

I'm expecting mythical knee pain when I wake up tomorrow morning.

HVO guest house living/dining room taken from where you come in the front door.
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Kitchen view 1: Cooking supper (fried rice) in the kitchen. This is my two-burner propane stove, the sink & counter & the one window in the room.
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Kitchen view 2: water filter, bottled water, fridge, dish/food cupboard, and pots&pans, and necessary shopping bag for groceries! (Always bring your own bag...)
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Friday, July 15, 2005


Orthopedic rounds
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This child I saw in clinic is wearing several silk amulet threads to ward off evil spirits.
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Ortho OPD

I start my workdays at 8 am on Tuesdays and Fridays, when I give lectures to the four orthopedic techs. They are quite shy, and overly polite, and speak in very soft voices. We meet in a small room with a single desk. I sit on one side, and they gather around the other side. This month we are tackling anatomy and physical exam - this means actually examining each other's shoulders and knees - which they found challenging at first because of cultural norms! But we are getting through it.

Rounds start at 9, beginning in the female ward, followed by the aseptic ward (i.e. non-infected cases - as these are in the minority, they get their own ward room), and on to the male ward. On earlier trips to Bhutan, I have been the only orthopedist available in the country. But now, our program has grown to the point that we have two trained Bhutanese orthopedic surgeons in Thimphu. This means that I don't need to be a workhorse all the time, but can play the role of consultant and even student, as there are certain types of cases that they have far more experience with than I. In addition to the orthopedic surgeons joining us on rounds are two male orthopedic PAs (physician assistants), who have been trained by the HVO volunteers over the past number of years, the four orthopedic techs, and several physical therapists as well as the ward sisters and brothers (ie nurses and health assistants).

A typical ward room holds between twenty and thirty patients in an open room with no barriers between the beds. Privacy is out. Flies and unusual odors are in. The beds are very old, just slightly better than an army cot, with a very thin mattress. Oftentimes family members of the patient will sleep in the same bed or on the floor nearby. Patients tend to be admitted for lengthy periods of time, since once they go home to the villages they do not tend to return for follow-up.

Health care is entirely free in Bhutan, and as far as I can tell, runs almost entirely on donated supplies and money from the government of India, WHO, Save the Children, UNICEF, and groups from Denmark and Norway. Supplies are very limited and equipment is minimal, but is certainly improving at a steady pace. We have three or four antibiotics to choose from. Surgical patients generally do not receive any pain medicines. It is the norm and patients just accept that surgery hurts.

Rounds take about an hour, and then we head to the Ortho OPD (OutPatient Department) in chamber 16, where dozens of patients are lined up to be seen. We see between 60 and 100 patients a day, generally between the hours of 10 and 2:30. Surprisingly, this seems like a relatively relaxed pace - with no insurance, no pre-approvals, and minimal paperwork and charting. There are also no appointments and people expect to wait the full day. People show up to the hospital to a triage desk downstairs, where they are directed to various chambers. This triage process is imperfect; for example, today I saw a patient with abdominal pain (but also back pain) who probably had a bleeding ulcer, another patient with a kidney infection, and one with a breast mass.

About half the patients speak enough English so that we can communicate directly. For the rest I use an orthopedic tech or PA as a translator. We never know what's going to walk in the door. Today, we had a patient arrive with a traumatic dislocation of his hip that happened over a month ago. Apparently he had X-rays at a district hospital where they visualized all of the leg except for his hip. We will operate on him on Monday. In addition to fractures and postoperative patients, we see a number of burn-related injuries and contractures, as well as numerous cases of osteomyelitis (ie. bone infections), septic arthritis (joint infections), and congenital anomalies (birth defects). We also see ordinary cases of low back pain, tendonitis, and sprains. One of the consequences of free health care is that people in Thimphu are very willing to access it.

On occasion, one or more of us will be pulled out of the OPD by the hospital superintendent to see a VIP patient. Last week, two of us went to wait (!) by the casualty (ER) door for the king's aunt, who we were told was arriving from the Indian border town of Phuntshoeling. We waited for 45 minutes before she arrived, and she only had a minor knee sprain - I was pretty annoyed by this waste of resources while all our other patients waited upstairs, but it was interesting to meet her and her entourage. Briefly, she is half-Russian, half-Scot, but grew up in India, where she met and married the queen mum's brother. Apparently there was a suspected plot to overthrow the king in the 1960s (this would be the present king's father), and this lady and her family were exiled to Nepal for many years.

The Buddhist workday is great! We oftentimes finish around 3pm, which leaves me plenty of time to walk up the hill, take a nap, read, and go for a run prior to dinner.

Ortho male ward at the JWD NR Hospital
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Thursday, July 14, 2005


Putting on the gho: step one
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Sima squaring the hem of Don's gho
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What to Wear in Bhutan: Men

The gho is an ancient Bhutanese garment worn by men and boys. As in some cultures (Scotland, Fiji, others?) the men's garment is a tailored-looking skirt below the waist - which soon looks totally second nature to us. They are very comfortable, warm in winter, and stylish. Don wears gho about half the time to work, and the kids will wear a uniform gho in school. By royal decree, all citizens wear gho and kira when in public and to their places of employment, but they don't always wear them when at home, or running errands; this time around I have seen many more Bhutanese men in western clothing out on the street, and there are many shops selling jeans and T-shirts. Or, to be casual, a man might pull his arms out of the sleeves and tie them around his waist. Nevertheless, for men the gho is as correct a clothing as trousers/dress shirt/tie or a business suit. It is a long robe, with complicated seams, and putting it on is at least a two-person job - and I'm so lousy at helping Don that usually one of the Gadho's household helpers who has a free minute comes over and assists. Underneath it you would wear a T-shirt or short-sleeved shirt and shorts. Then you have either long white cuffs pinned to the inside of the sleeve, or a loose white shirt that is basically just a connected pair of sleeves. To put on the gho, tuck the right front panel into the left, line up the hems, and hold it at the sides. Then fold the extra fabric towards the back, and hoist up the front until it hangs straight at the knee. Fasten the waist with a tightly tucked long woven belt with fringe (the kera), and make sure in the back that the sides are neatly tucked so that they hang vertically. Turn back the sleeves so a nice crisp deep white cuff is showing. The top part of the gho, as it blouses over the kera, makes a pouch/pocket. Finish off with dark or argyle knee socks and dark dress shoes.

If you are going to an official place, like court, or the Parliament, or to a temple, then you need one additional item: a raw silk or linen scarf called a kabney, with very long fringe. This is draped over the shoulders and tied on the left shoulder.

The RIHS graduates in their formal best. Men: gho and kabney, Women: kira, wonju, tego, and rachu.
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What to Wear in Bhutan: Women

What not to wear is easy: no shorts, nothing tight or revealing, and nothing above the ankles if you're over the age of 6. For women, the kira is the traditional dress. It is simply a long rectangle of cloth, usually with horizontal woven patterns, fastened on the shoulders with clasps or pins, and arranged so that there is a deep pleat vertically all the way down the front. Under it is a long-sleeved blouse called the wonju, and the kira is fastened at the waist with a belt similar to the men's but wider and with more embroidery. When correctly worn, one selvedge of the kira will be on the right leg, almost meeting the edge of the pleat. It is such a wide piece of cloth, folded in such a way that there is no possibility of any leg showing even in a stiff wind, and it's quite comfortable to stride in. Over the kira is a boxy silk, linen or brocade jacket called the tego, and the sleeves of the wonju are turned back over the tego to show a deep contrasting cuff. The kira should be worn so that it brushes the ground - shoes are barely visible. Most women wear dress shoes, heeled sandals, etc.

The "new" fashion in kira which is becoming more acceptable is the half-kira, which as its name suggests is just from waist to floor. This is typically worn with a nice tego, even in floral or other bright pattern, and fastened closed with a little brooch or pin.

For formal occasions, the kira are often hand-woven and quite elaborate. One's best tego and wonju will be of beautiful patterned silk, and in place of the men's white kabney is a narrow, tightly woven strip of red cloth called a rachu, usually with gorgeous yellow embroidery.

Women with infants tie them on their backs with a wider rachu that crosses over in front and is knotted with long fringe - I see children up to about age 2 being carried this way. A stroller, of course, would be quite useless here.

The kids and Jamtsho in their gho and kira at the RIHS graduation ceremony 7/13/05
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Women in kira at the national archery tournament in Thimphu
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Wednesday, July 13, 2005


Memorial Chorten, the major Thimphu landmark between HVO Guest House and the town proper.
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Library Card: Anatomy of an Errand

Forrest and I set off from the house at mid-day, with rain threatening. There is a white fog drifting down from the sky visible at the far edge of Thimphu and the lightest drizzle in the air, so we take raincoats. The errand is simple enough: place an order with a tailor for curtains to be installed in our home in America; buy the fabric for said curtains at one of the many local fabric shops and deliver it to the tailor; purchase Forrest a stylish metal pencil-box at a stationary shop I have seen, and finally check out of the public library the second of the Tolkein trilogy which we brought with us and misplaced, so that the boys can continue their reading in sequence. We leave Thompson in charge (nominally) but the housekeeper is also home, and Jamtsho and his two older sisters and an assortment of adults at the Gadho's home, so Halle and Jacob will be kept busy, fed and looked after while Forrest and I walk down into town.

We stroll "the short way" across the weedy field, down the road to Chorten Lam, and down Chorten Lam to the center of town. We have been told there is a tailor shop in the building next to the fabric store. No sign. We go upstairs and ask at a sewing room for tankhas - a man is precisely pressing and seaming the gorgeous brocade around a painted image, but our Dzongkha and his English are equal in their lack, and we do not find a tailor shop there. Asking at several more fabric shops we finally are pointed across the street (Oh! Across the street!), where tucked under a dingy restaurant we find several men at work at the black Singer sewing machines like something out of the 19th century. None of them speak any English, and finally someone is fetched whose English is nearly as limited but who admits to being the tailor. He has tied the sleeves of his gho down around his waist and is wearing a checked short-sleeved shirt and a camouflage vest; his mouth and teeth are a gory russet from doma. Curtains, curtains, I finally make him understand what I am after (it is confusing because I am asking them to sew what here would be used to cover doorways, not windows), and he annotates my drawing with measurements and explanations in Dzongkha, and then he comes with me to the fabric shop back across the street.

There I become a mere appendage to a detailed transaction between himself and the fabric store clerk, a short, thin woman with a faint black mustache. They discuss, bring out the calculator, discuss some more. Don and I had set aside a bolt of fabric days earlier and it is pulled out; coordinating fabric for the panels and "flowers" at the intersections of the panels is selected and they negotiate how much is needed and she flourishes gigantic, fiercely sharp brass scissors to cut the pieces with a staccato zzzp. He and I arrange for the curtains to be picked up on Monday; I receive his price without bargaining (250 Nu per curtain, plus cost of the fabric? Very reasonable, it seems), and then he is off, across the street, with a large bundle of fabric, to make my odd request into a textile reality.

Now I need to pay the fabric shop for what has been carried out by the tailor. They add it up twice, take off some for a volume discount, and come up with a figure that exceeds what I have in cash in my purse. Luckily I have anticipated this and brought three travelers checks to cash at the nearby bank. They will wait for me to cash them and come back, so Forrest and I head to the Foreign Exchange counter at the Bhutan National Bank. I don't understand how this bank works, because every time I go the waiting area is absolutely full of people sitting in bus-station seats, but the foreign exchange counter never has a line. Unfortunately, I realize at the counter that I have grabbed three travelers checks signed by Don, not by myself. Forrest and I roll our eyes at my mistake. There is nothing to do but go back home, get the correct ones, come back, change them, and then pay the fabric store. We walk up to the store to assure them we are still planning to pay, and then hire a taxi to take us home, wait for us while I go inside (where we drop our heavy raincoats, thinking we are done with the rain), and drive us to the bank (ka-ching, 60 Nu), where it is... raining. I change the checks, run to the store, settle my bill there, and then Forrest and I embark on the other parts of the errand, keeping to the edge of the sidewalk under the eaves of the stores to stay somewhat dry.

The sidewalks of Nordzin Lam, Thimphu's main street, gradually run uphill from the lower traffic circle. Due to the change in grade, and to the non-standardization of buildings, there is hardly a stretch of sidewalk a block long that is not interrupted by steps up or down, ramps, open sewer, torn-up/being repaired sections, jutting corners, strange metal rods sticking up for no apparent reason. The sidewalks are flagstone with the spaces between them (sometimes) sealed with cement, and littered with doma splats, crushed bottles, crumpled paper, wrappers, wilted produce, and dogs. The rain does little to wash them clean.

We walk uphill, frequently having to leave the sidewalk and walk in the street, until we reach the stationary shop. Forrest selects a suitable pencil box, and then we go to the King Jigme Dorji Wangchuk National Public Library. It is one reading room in front, a fiction/childrens room with a separate "women's section" entirely for romance novels from India, and two tiny alcoves for the nonfiction and the reference. The books are as shabby and outdated as can be imagined. I fantasize about sending a box of brand-new books as a gift to the library... I wonder if it would arrive or be ripped open in some foreign airport customs office and distributed among the staff. Our entire family passed a quiet hour at the library a few days ago, reading as a break on our walk down from the other end of Nordzin Lam, so we know that the Tolkien is on the shelf. But in order to check it out we must join the library, and we are sent to the membership desk. I purchase a year's membership (oh well) at 550 Nu (this is too steep for most people, I wonder?). For this price I could surely purchase the book, which for all I know is available in "BookWorld" near the clock tower, but it's probably better to support the struggling library enterprise by buying a membership. This entails a form I must fill out, a fancy blue membership record receipt written from a carbon-paper book (all receipt here are done in duplicate books with actual carbon paper in them, which I find fascinating), a separate pink money-received receipt from a separate carbon-paper pad, an entry in a bound logbook carefully recording my name and the amount I have paid, recording all this information in yet another book, and then filling out two card pockets which are what is used to check out the books themselves... we select our books, bring them and the card-pockets up to the desk where the books are stamped with due date and their cards properly filed in my card-pockets, which are then filed in wooden fileboxes. Forrest is impressed with all this detail and with so many things to keep track for the diligent membership clerk.

After all this effort, we are exhausted, and refuel with ginger biscuits, mango juice, and a bottle of Thai-labeled Gatorade; a taxi takes us home (ka-ching, another 30 Nu).

Door panel similar to the ones we are having made as curtains.
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Monday, July 11, 2005


Hangen family with 3 of the 4 ortho techs from left to right, Karma, Sonam Choden, Sonam Jamtsho
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The operating theater of the JWD National Referral Hospital
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Delivering supplies to the OR
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Tonight's Top Ten List

Actual ways to get injured in Bhutan and be seen by the American doctor

10. Backache from carrying heavy loads. Bhutanese are very prone to backaches and this tends to clog up our clinic when we have more important things to see. We do have a number of paraplegics and quadraplegics from spine injuries who stay in the orthopedic ward for a very long time, because there is no place for them to go in their villages.

9. Hit by taxi. Not surprising given the quality of the local driving.

8. Hit by arrow during archery tournament. Targets are 140 meters from the shooting line, and spectators line the entire path of the arrow, leaving only a 10-meter wide corridor. Straight shooting is rewarded with songs. Even a slight error can mean disaster, but this actually does happen to people in the crowd.

7. Gored by ox. Ox and cows frequent the roads and paths, many have long horns. Most are friendly and slow-moving, but...you get the idea.

6. Fell off roof. I don't know why people here have a propensity to imbibe their alcohol while sitting on the roofs here, but it's not uncommon for us to see people after a fall from a roof, and we ask no further questions.

5. Hit by stone. A woman was admitted with a broken upper arm. I asked "what happened," and was told by Sister Wangchoezem, the head nurse, "Hit by stone." "How was she hit by a stone?" I asked. The reply: "A stone hit her arm, sir." "But," I persisted, "how did it happen that the stone hit her arm?" "Oh, she was hit by a stone." I gave up and put a metal rod in her humerus without further clinical information.

4. Fell into open fire during epileptic seizure. I've had three patients so far this month with this scenario. Unfortunately one of them was a small baby who was tied to her mother's back at the time her mother had a seizure; the baby was badly burned on her hand. Today we released burn contractures and made it so she could open her wrist, use her thumb and index finger, and grafted some skin from her groin area to fill in the missing skin.

3. Suprachondylar elbow fracture. At home, I may see only a few of these per year, in children. In Bhutan, we see these every few days. This is a fracture of the end of the humerus bone right above the elbow joint. We manipulate them back into place, and under X-ray guidance pin them in place. On earlier trips to Bhutan we did not have X-ray to help us and probably didn't do a very good job. I don't know why they're so common here, but I have an idea that it may have something to do with both genetics and nutrition.

2. Dawa Transport bus accident. Riding the buses here is very risky. A few times a year, an entire busload of people will go over a cliff. Those who survive have multiple fractures, which creates a backlog of fractures to plate/rod/cast.

1. Fell into Indian toilet. This prize-winning injury happens when people slip while using a squatting floor toilet. Some of these have metal edges which are sharp, and the usual injury is a cut through the Achilles tendon. We see a couple of these a month, and I have seen them on every trip to Bhutan.

A scene from Wel-Come Nite
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WEL * COME * NITE

Just above the hospital is Bhutan's nursing school, the Royal Institute of Health Sciences. Young people come to the RIHS either out of the equivalent of 10th or 12th grades, and go through a 2 or 3 year program to be trained as nurses, hospital techs, emergency medical workers, etc. Four RIHS students who are being trained as ortho techs work with Don and he gives them twice weekly lecture/instruction period prior to rounds in addition to training them on the job in clinic. Although the rest of the public school system just had mid-term exams and is resuming school next week, this is the month that new RIHS students arrive for the start of their program, and we have been invited to attend a talent show put on by the current students to welcome the incoming class.

This proves to be a fascinating glimpse into southeast Asian youth culture even beyond the borders of Bhutan. We arrive after the start of the program, and there are seats left for us on the front row, next to the American HVO physical therapist and her son. The stage of a large pink lecture hall has been decorated with colorful clothing, banners (the big one says Wel-Come Nite), cellophane-wrapped fluorescent lights, and blinking strings of Christmas-type lights. Two students have the responsibility to yank the two large black curtains closed and open between acts, and there is a decent set-up of microphones, speakers, and sound system for the different acts, with one male and one female MC to announce the show.

The first number is called "Dzongkha dance," and proves to be a group number with 6 women in beautiful traditional kira and bright silk blouses performing a type of Bhutanese folk dance called dzong dancing. It is quick-moving, with flowing arms, expressive, with a little shuffling kick-step on every beat, danced to a Bhutanese pop song. Their hands are mesmerizing to watch. The next one is a male solo, a student who sings a crooning song in Dzongkha to the accompaniment of an electric keyboard. He is wearing a gho with bright white cuffs, black knee socks and black dress shoes that are the style here for young people, with extra-long squared-off toes. We hear several solos like this during the evening, some with the keyboardist and some with an acoustic guitar accompaniment. I am interested to see what the next performance is, a "Nepali dance." It turns out to be a well-choreographed dance performance to a Nepali pop tune by a young man in black jeans and Western dress shirt. A "Hindi dance" has no saris in evidence, but two young girls in stylish jeans and T-shirts (no midriff in evidence, of course) taking a Hindi pop song and choreographing a Bollywood-style music video dance - distinguished from Bhutanese dancing by much more shoulder-shaking and some pointing at the audience.

Although the program is mostly Dzongkha dances (groups of women, or men, or in the big finale, 6 of each) and songs, there are enough of these well-received "Nepali" and "Hindi" numbers to suggest that television, films, the internet, and CD sales have blurred some of the cultural borders among young people. The MCs comment on how music is a universal language. After the show, we talk with other guests until someone points out that the remainder of the audience is waiting patiently in thieir seats for us to leave first. The knowledge of etiquette is assumed here and we learn often by trial and error.

The next day is an important day in the Buddhist calendar, the anniversary of the Buddha's first sermon, and one of the ortho techs named Sonam Jamtsho invites us into the RIHS campus to see the prayers being said, to view the inside of the small compound temple, and to eat lunch in the dining hall. While we sit and talk in the dining hall before lunch, 28 students with their ceremonial scarves around their necks sit in two long lines facing each other, on mats, and sing Buddha's sermon (in Dzongkha) with a bell to keep the beat, a tub of incense in the center sending up curving gray ribbons into the air. We see many of the students who performed in the show, and we have an opportunity to learn from Sonam more about the students and where they come from. Surprisingly, everyone I speak to is from eastern Bhutan (the less "civilized" and more rural side, but also the side with easier access to northern India). Western Bhutanese, Sonam explains, aim for higher education programs that will lead to "office jobs," while for eastern Bhutanese farm kids, the RIHS is a significant step up and a great honor. Although they have been taught Dzongkha (i.e. the dialect of western Bhutan) in school, along with English, they have all grown up speaking the eastern dialect called Sharchop, which is linguistically very different from Dzongka, and many of them also know Nepali and Hindi too. Buddhism and youth culture (especially pop music) are the common denominators among the RIHS students.

Lunch is served from a long marble counter onto which are set the huge aluminum pots of today's food. Sonam tells us that the fare is usually red rice, with some kind of accompaniment: Mondays and Thursdays egg, Wednesdays and Fridays meat, and Tuesdays and Saturdays emadatsi (chilis in a cheese sauce). But since today is a special day there is a broader selection: red rice, emadatsi, scrambled egg with chilis, hardboiled eggs rolled in spices, yellow dal soup with potatoes in it, and big baskets of papadam (the crispy Indian "pepper" tortilla that often comes as appetizer in Indian restaurants). No one, including ourselves, uses any silverware. We are asked to go through the line first, and then the rest of the 170 students line up with their own bowls and cups, get their food and go outside to eat it. Outside the door there are four sinks for students to wash up their plates so they can take them back to their dormitory rooms clean. Sonam tells us that one young man each month has responsibility to be "mess captain," and when his month is finished, he nominates a person he thinks will do a better job than himself. That self-deferential and dignified manner is so typical of the Bhutanese, regardless of where they come from, and is something I so enjoy about the people we meet.

The family with Dawa Tshering at Dechhen Phu monastery on the anniversary of Buddha's first sermon
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Dechhenchoeling's main strip
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Dawa Tshering, Assistant Livestock Extension Officer, At Your Service

Some years ago, the visiting American HVO doctors befriended a young man who was about to start a program in Livestock Management. They sent him some money via the June HVO volunteer, and she didn't have time to complete all of the transaction and gave me the remaining banknote along with an explanation that he might call for it sometime during the month. Sure enough, we got a telephone call this week, from a very polite but insistent young man that he would like to come visit. He arrived on a Friday afternoon with packs of banana gum for the children and stayed most of the evening, making polite conversation. He has finished his program and is starting the orientation for his new job, which will be as an Assistant Livestock Extension Officer in the Wangdi area, visiting farmers and helping them with their pasture and livestock development, and helping to staff the veterinary clinic in that area. He wishes he could get a foreign veterinary degree so he could move up in the ranks faster, but meantime, at 23, he makes do with his small stipend. By the time he leaves (with affectionate tight hugs all around for each one of us) he has talked us into going with him on Sunday to a nearby monastery to which we have never been, and then he calls to confirm and re-confirm that appointment no less than 5 times between Friday night and Sunday morning. Plus two emails, each of which reads:

hello to u r family, I am Dawa Tshering to write u. I am writng to check u Id is write or not. I am happy to meet your family. And we will have our track tommarow after lunch. Dawa Tshering Bhutan

Such is the rapidity with which people here can make connections that would seem forward in the US. On Sunday afternoon, then, we set off to hire a cab to drive us to the small town we saw on the way to Cheri, called Dechhenchoeling. Don sits in front with Jacob on his lap, I have Halle on my lap in the back, and Dawa puts Thompson (!) on his lap on the way there. The cab driver puts on a CD of music in Dzongkha. Some have a Beach-Boy beat, but one crooning tune Dawa explains is a song about how life is full of suffering, but that all this will pass. The cab drives us all the way to the monastery on a twisty asphalt road - it is called Dechhen Phu ("Foo") and turns out to be one of the royal monasteries, a very old one that has important associations with the medieval battles with Tibet. It has a tall central tower with tapered walls, painted brick red, and a collection of very colorful chickens wandering its grounds. The attitude is festive because of the auspicious holiday (Buddha's first sermon, and a day off work for most people); picnickers walking on the road and at the monastery dressed in their finest. We have no permit to go inside, so we plan to amuse ourselves with chicken-watching, but Dawa Tshering takes the initiative to ask the head abbot if we may enter and we are allowed to do so, which is a special pleasure.

The rest of the afternoon is spent strolling down from Dechhen Phu to the town, stopping for some refreshments, hailing a cab back to Thimphu and watching the tail end of a soccer (here, football) match on the national stadium field between Royal Army and the Simtokha team on the peanut-shell strewn cement stadium bleachers. By Tuesday Dawa Tshering will be back in his home posting of Wangdi, where we are planning to go for the weekend next week, and so we arrange to meet him next Sunday for more sightseeing. As we are walking through Thimphu Halle doesn't want to hold my hand, or Don's, but "our new friend's."

Sunday, July 10, 2005


The two of us resting on the hike to Cheri in our gho (Don) and kira (Tona).
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Spinning the prayer wheels at Cheri; Thinley is in the back
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Wish Fulfillment

Today we hiked with Thinley to Cheri Monastery, all dressed in kira and gho. Jacob made it very clear that the success of his hike was dependent on seeing a monkey. The trail was quite steep, threading through a deep green forest made mythical by the sound of the rushing river far below, and was covered in slick black leaves and at parts carved its way along the edge of a steep slope. Jacob walked with his eyes glued to the tree cover sure that at any point a monkey would come into view. In fact I heard him singing, "Monkey, monkey... here monkey."

Cheri Goemba is a monastery built in 1620 by Shabdrung, the ruler who is credited with unifying Bhutan. It is reached from Thimphu by a single lane road that passes the palace of the Queen mother and the Royal Bhutan Guards training ground and a small village with buildings made from wood and bark set very close to the road with much social and commercial activity in progress. Women carrying eggs (here purchased in corrugated trays tied with string)... groups standing in knots outside the shops... traffic is slowed by wandering cows... Along the way, outside of the town as the road climbs through hills with high dirt and rock walls, we came up behind a taxi so loaded with parcels (inside, tied on top, you name it) that it couldn't make it up a hill and the passengers (of which there were many) got out to push. At the same time, a gigantic, double-wide dark green Army transport truck came around the corner from the opposite direction and after much negotiation and a little engineering the vehicles were able to pass with a few milimeters of clearance and only one lost headlamp (from the truck).

At the trailhead, we are dropped off riverside. The Thimphu Chu here is full of monster-sized boulders and looks like pure snowmelt. Cheri clings to the top of a steep emerald hill, looking like small white rocks that have been glued to its side. From this vantage point there is no obvious approach by foot. We cross a small wooden covered bridge draped with prayer flags and begin to wind up the trail. We enter a dense forest with trees covered with moss and ferns growing from the branches. We see pack horses with bells on their bridles being led downhill by their owner and strange birds but no monkeys. We hear birds that sound like monkeys, but they prove to be white-throated somethings that look like decorated mockingbirds. One of our hikers is very disappointed as we approach the top. He has heard about a hike I took in this very spot several years ago when I found myself surrounded by monkeys on every side and displaying some aggressive behavior if I moved in any direction. But today it appears they have vanished.

Above a resting spot with a small Tibetan chorten (which Halle insists on circumambulating around 7 times), the trail suddenly emerges from the woods onto the green slope so steep that climbing the last bit is like climbing a ladder. We are rewarded by close-up views of gentle, small brown mountain deer with their two horns laid back like a second pair of ears: adults, and tiny little baby ones, all grazing in the grass with no apparent regard for the steepness of the slope. We end the trail at a gate, appropriately enough, adorned with two stylized deer that announces we have reached Cheri. A frisky blonde puppy greets us enthusiastically.

Being in Bhutan is filled with magical moments (even in the rain)... you can spend an hour on a trail and emerge in front of an ancient monastery that seemed to have no access, that turns out to be filled with red-robed monks and dogs and butter lamps and tea and mountain deer and prayer wheels in a long row so that they can be spun as you go clockwise around the porches... and an 8-year old boy can see the monkeys he has imagined finding there...for looming over us is the monastery, built on several vertical levels, and looming over that is the last bit of mountain with a rock cave in it, and sitting in the cave are monkeys. We catch glimpses of long gray tails in the shadows far above us. Jacob wants to go closer. Apparently the monkeys are as excited to see him as he is to see them, and some of them begin to move from the cave into a nearby tree. It is soon full of monkeys of all ages, including two tiny ones pushing each other around on the top branches. Jacob and I walk to the base of a giant straight pine with hanging moss, and some adult monkeys leap into the tree - now that we are closer we can see that they are very large, as big as baboons with tails. Jacob exults. All the rest of the monastery is anticlimax for him.

Thinley likes Cheri Monastery very much and seems at home on the upper trails as the mountain goats. She takes charge of the children and of any situation... displacing Thompson to his chagrin much of the time... she laughs when I tell the taxi driver that I have brought along my TWO daughters and three sons to visit Cheri. On the trail she is full of conversation and questions. She wants to know if we have a love marriage or an arranged one. I treated a farmer the other day who had been married at 14. It is impossible to imagine Thompson marrying at 14. Thinley says she will never marry. Halle says that when she grows up and lives in Bhutan, that she and Thinley will "hang out together" after work. I ask Halle what she will work at here, and she says, "building houses." We ask Thinley what her job will be, and she does not hesitate to say "teacher." She is a good one for us, always ready with an answer to our many questions, and serving as interpreter and negotiator-of-prices when needed. Her enthusiasm never wanes, even in the long taxi ride back home.

Taxi being pushed uphill to pass the army truck en route to Cheri.
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