Encounters with people along the trail in Western Nepal

We come across a middle aged Nepali couple in the Humla District. The
woman has a large goiter on her neck. I wonder whether they were
heading down to Simikot to get some medical attention. I know that
goiters are due to an iodine deficiency. In my pack I have a bottle of
iodine tablets, as a backup for water purification, in case our
Steri-Pen stopped working. Should I offer this woman some iodine
tablets? I have no idea what the proper course of treatment is for
goiters– what form of iodine, what dosage, how frequently, for how
many months. Would it do more harm than good by giving her some iodine
tablets? I don’t know, so I do nothing and we continue on our way.

Another man stops to talk with our guide, Lal Bahadur. He describes an
ailment where some kind of black substance came up from his stomach.
He asks us whether we have any medicine for this. I have no idea what
this might be. I’m pretty sure we don’t have anything to help. We
continue on our way.

A man stops us, complaining of a headache. Do we have any medicine
that would help? I think Julian has some ibuprofin tucked away in his
medical kit. Maybe it would give the man some relief. Maybe not. We
keep walking.

We come across a group of about 20 people working on road
construction. One of them holds out his hand and asks for “money”.
Another chimes in, “money!” With extended hand. A group of three women
step in front of us, blocking our path. “Money!, money!” They shout.

I continue walking forward, between two of the women. One woman grabs
my walking stick and tries to wrest it from my hand. I hang onto it
more tightly and continue walking forward. I glance at one of the
other men in the group, who simply shakes his head, as if to say,
“Just ignore those women.” I continue walking, realizing that I have
become just a bit upset with this incident.

We arrive in Hilsa and wait at the police station for word about the
whereabouts of our passports. A man has been sorting beans on a flat
wicker basket. He picks out two beans, one white and one black and
comes over to talk with us. He indicates that one of his teeth is
black, like the black bean, and it hurts very much. Is there anything
we can do about it?

Probably an abscess; probably a tooth that needs to be extracted.
Julian points out that we have some dental floss with us– perhaps we
could tie it around his abscessed tooth and give it a good yank. Well,
it’s a nice idea, but we say there’s nothing we can do. Sorry.

Encounter with a family in Taulihawa

We’re visiting a family I have known for many years. The nephew of a
friend of mine, about 10 years old, has been complaining of a fever
and constant pain in one of his teeth. He opens his mouth to show me
the tooth, and sure enough it has a brownish color. Definitely
something that calls for a trip to the dentist.

The boy has been told that he will be taken to a dentist soon , but
the trip keeps getting postponed. We suspect that the delay is due to
financial reasons. After a few days, there is less pain and the tooth
seems to be getting better. Is it really healing on its own, or has
the decay advanced to the point where the nerve is dying. I suspect
the latter. Will he be taken to a dentist? I doubt it. The nearest
dentist is a day away.

The boy lives with his mother and grandfather; his father committed
suicide a few years back. The grandfather is financially well off, but
extremely tight with money. Also, he has a long history of being
abusive to his sons. After the death of his first son, the grandfather
built a wall to divide the house into two haves. His one surviving
son, the boy’s uncle and his family have been banished from the
grandfather’s side of the house and the grandfather hasn’t spoken
with them for years.

Obviously there is complicated set of relationships going on here.
Intervening on behalf of the nephew with the toothache could really
set off some sparks. But the fact remains that the boy really does
need to see a dentist.

Just before we leave, I put some cash in an envelope and give it to
the boy’s uncle, explaining that this is to pay for a trip to the
dentist. First, he is hesitant to take it, saying that the grandfather
has money and is able to pay. But after we discuss it a few minutes,
he agrees to take the money and see what can be done.

I have no idea whether this will actually benefit the nephew or not.
But it seems worth the risk.