Wednesday, November 25, 2015         


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Top of the world provides vantage of way forward

By Ira Zunin


The top of the world seems a different world altogether. This week my son and I returned from the Himalayas where we provided medical services for seven days in the Nepalese village of Sama. To get there we had to take a kerosene-fueled helicopter from Katmandu.

The people of Sama contend with contaminated well water when the streams are low, and inadequate food supplies much of the year. They live without access to health care as we know it and must trek for six days to reach the nearest road.

Tuberculosis, emphysema and chronic bronchitis run rampant as a result of the dung fires in their stone houses without chimneys, tight living quarters and cigarette smoking. The contaminated water leaves many of the villagers with dysentery, parasites and, at times, typhoid.

Only recently, Phase Nepal, a local nonprofit group, stationed a 19-year-old nurse with a high school education and eighteen months of training in the village.

The people of Sama spend most of their days chopping wood and carrying water along steep mountain paths. Even in their mid-20s, many struggle with arthritis from worn-out knees and necks that have for years supported the heavy baskets used for transport.

Because of the sparse foliage at 13,000 to 15,000 feet, the villagers must journey far from their living quarters each day to graze their animals. After a short growing season, villagers recently harvested their barley crop, and the dead of winter is fast approaching. The opportunity to eat vegetables is rare, and fruits are considered medicine. Vitamin deficiencies are common.

While there we treated everyone we could, some in a makeshift clinic, others in their homes.

Amazingly, despite gripping illness, the bright smiles on so many faces reflect the resilient human capacity for joy under difficult circumstances. No doubt, it relates to the fact that their ancient culture is intact and unbroken, something that cannot be said for their Tibetan cousins, a half-day's walk away, on the other side of the Chinese border. In comparison, the things we complain about here at home seem so manini and the typical focus on money fades in this remote region.

In short order I realized that several key elements would enable this community to become a Himalayan model for sustainable living:

» Screen and treat the village for tuberculosis.

» Fund periodic medical missions to manage medical and dental needs, and cataracts.

» Work with the religious leadership, village chief and school headmaster to initiate a campaign to address alcohol abuse, smoking cessation and the need for chimneys.

» Extend the primary school to serve to provide secondary school education and send selected children to Katmandu for Western and Tibetan medical training on the proviso that they return to serve their community.

» Take steps to empower and perpetuate indigenous Tibetan medical care to be delivered in collaboration with Western medical services. This will reinforce the cultural fabric and be cost-efficient.

» Import simple materials to set up greenhouses for each family to grow vegetables and fruits and thereby eliminate most vitamin deficiencies.

» Install a solar-powered water filter adjacent to the clinic and enlist the headmaster to place children and their families on a bathing schedule during which time they would receive needed health care. Identify a water manager who would report to a board. The filtered water could be sold to trekkers and generate revenues for system maintenance and village needs.

All this is well within reach, even at the top of the world. With the commitment of the Nepalese government and financial support from those who care, both in Nepal and in the U.S., Sama can become a village with a future.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to

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