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Howdy folks!

I returned home safely last Saturday evening after a grueling 38 hours of transit and have spent the week trying to return my equilibrium to normal. My first order of buisness upon returning home was devouring a Great Dane burger and bock beer!

My last week in Dehradun was a short one, very similar to my previous week in Dehradun and busy with return-home planning so I won't write much about it. I aim to write one more post about the herbal/homeopathic medicine I experienced but for all intents and purposes this is me signing off!

I've updated my Flickr account with all the photos: http://www.flickr.com/photos/timkufahl/

I am very happy to be home and grateful to have stayed safe and healthy during my travels. Thank you all for following along with my story and being part of this amazing experience. Your support while I was abroad is greatly appreciated. 

Cheers friends!

Journey to the Himalayas

Wow - where to even begin? My trip east to the Indo-Tibetan border Himalayas was about as epic as I'd want it to be.

I'll start with the bus ride to Joshimath, the site where my travel team is picking me up. The distance from Dehradun to Joshimath is 289 km (180 miles), roughly the same distance from Milwaukee to Green Bay - a trip that takes two hours at home. In India and in the foothills of the Himalayas, however, this distance takes an estimated 10.5 hours to traverse. The bus left Dehradun at 7pm and slowly crept through the foothills for the first few hours. Once we were past Rishikesh, the ride got REAL. The road went from being hugged comfortably between hills to being perched hazardously alongside a canyon, following the Ganges River north to it's life source glaciers. The scenery was outstanding but commonly overshadowed by the harrowing traffic and the adventurous lead foot of our friendly bus driver. During the drive there were a number of people with their heads completely out the window and I naively thought that this was passengers taking in scenes. Until I heard the lady across the aisle from me wrenching with her head out the window did I realize that folks were in fact vomiting off the side of the bus. The bus even had to completely stop several times for passengers who were standing and did not have the luxury of window access.

Here's a little taste of the bus ride :-) 

The trip was truly gorgeous. The road along the canyon slowly increased in altitude and the cliff's (ranges between 500 and 3000 ft.) as we passed numerous small villages built into the sides of the mountains and the Ganges River became increasingly turquoise.

The Ganges just north of Rishikesh.

One of the many villages we passed during the bus route.

The canyon grows.

And grows...

Lunch along the way :-) Can't believe I made it this long without posting a food picture.

Pack took a nasty beating riding on top of the bus.

Joshimath

I arrived in Joshimath at around dusk and had to wait a bit for my guides to arrive from Auli. By the time they arrived and ran a few errands it was dark during the drive to Auli where our lodge/camp was. I was completely exhausted after the day's travel so went to bed pretty early after dinner. Slept soundly in cool, 30 degree mountain air and awoke to birds chirping. When I walked out of my windowless room and into the entirely glass-cased dining/living room of the lodge the view was breath taking!

Pretty awesome view huh? The lodge was very comfortable and the air was still spring cool.

Auli is on the northwest side of the Nanda Devi National Park and Bio-Reserve. The group I planned my trip with is an upstart organization called Mountain Shepherds and their aim is to promote eco-tourism. They employ local villagers as guides and attempt to give back to the local villages and promote green initiatives within the Bio-Reserve. I learned while I was there that Nanda Devi National Park is actually very difficult to get into because the government patrols entrance very strictly since the 80's when groups of trekkers and climbers would basically pillage the area and leave waste throughout. In fact, the inner sanctuary of Nanda Devi NP - and access to Nanda Devi summit via the 8,000 foot canyon glaciers surrounding the Rishiganga River - has inaccessible since 1982. Numerous attempts at the summit have been attempted via different routes to no avail, making this Nanda Devi a notoriously elusive mountain. The only groups who have been granted access to the inner sanctuary in the last 30 years have been to a few government scientific groups who monitor the progression of the conservation initiatives. We were able to hike the outer sanctuary of the park but had to stop at a government check-point building and obtain a permit before every hike we did and the guides said there were strict punishments if we did not adhere to the regulations.

When I was planning the trip to the Himalayas I knew that going up to 10,000 ft was a risk because it is still early in the trekking season and snow at this altitude. I had hoped to do an overnight backpacking trip but figured if there was too much snow it would still be great just to be in the high mountain sand I could do day-hikes from the lodge as an alternative to backpacking. Well, there was in fact too much snow (again, the park is strictly regulated by the government) and day-hikes were the only possibility. In the end this option was a great one. It was nice to sit around with the guides who were local villagers but knew great English. There was also a German student at the lodge who was studying management and eco-tourism. We basically explored the area, hiking 4-6 hours per day, and spent the rest of the time reading, eating, and listening to music.

Here's a few shots from our hikes:

Mountain Shepherd Lodge - Nanda Devi Bio-reserve and National Park; Auli, India

Sweet look-out tower. My guide wouldn't let me go up.

Nandu, my excellent guide.

Prayer flag

View through the forest.

There were a number of mountain streams flowing through the woods.

Failed summit attempt ;-)

Another shot of the lodge. Probably the best photo I have that captures the true massiveness of the Himalayas and how steeply they come to a peak. It's breathtaking!

Tea at 10,000 ft.

Home

Mountain Flora

Hindu Temple en route to Garson Top.

A little bit of forest hiking before reaching the tree line.

Sky for miles!

Myself and Nandu

Trudging along.

Classic rock figurine

Picnic lunch. Nandu ate an entire sleeve of butter biscuits.

The epic Nanda Devi herself!
At 25,643 ft. she is >5,000 ft taller than any peak in North America but only the 23rd tallest peak in the Himalayas/Karakoram! Whoa!

Nanda Devi

The bus ride home took 14 hours - roughly 13 miles per hour - and involved numerous stops for construction, traffic, and mechanical/engine repairs. Suffice it to say I learned a lot about patience, personal space, hygiene, and hunger during this hellatiously* long day.

Oh and speaking of hellatiously* long days, in a few hours I begin my 38 hour journey home. Wish me luck.



* = probably not a word.

Week 3: Mussoorie

Howdy once again friends:

My remaining days have been action-packed here in India with a lot of traveling. After Rishikesh I headed back into the upper foothills to Mussoorie for a short work week with some great folks. As I mentioned earlier, Mussoorie is a touristy "hill station" but on the backside of the hill from the tourists and busy malls and markets there is a peaceful little community called Landour, which is where the hospital is located.

Landour Community Hospital (difficult to get a proper photo b/c it's on a steep incline)

My digs at Landour was a converted hospital room just across from the OR, which meant I got to see all the late night emergent operations :-)

Landour Community Hospital was built 75 years ago by British missionaries so the architecture of the hospital has a colonial charm including wood-framed windows and an epic hardwood staircase in the center of the three story building. The hospital is affiliated with Emmanuel Hospital Alliance, which is an organization who's mission involves fixing and rebuilding a lot of the old, run-down missionary hospitals throughout India. The hospital serves the town of Mussoorie-Landour as well as the surrounding village communities.

The hospital runs on the German system of health care and involves "smart cards" - actual cards that patients carry with them - so that patients under a certain level of poverty and pregnant women get free care and the remaining patients pay fixed rates. I had a look at the price list of services and most labs were between 50 and 100 rupees ($1.00 - $2.50). An echo-cardiogram costs 1500 rupees ($30). It's easy for myself and westerners to look at these prices and believe that everyone in India should be able to afford these prices but you must keep in mind that an entire family could live comfortably for months on 1500 rupees. Most meals in India are under 50 rupees (you can eat VERY well for 50 rupees, or 1 dollar); in fact, with some clever financial maneuvering you could very well feed an entire family for 50 rupees.

The hospital staff is diverse and includes Indians, Americans, and New Zealanders so it was really great to work with physicians with experience in the western world as well as India (and also to have some conversations in English and talk about March Madness). There is a general surgeon (Dr. Uttam), a pediatrician (Dr. Jakob), a general practitioner (Dr. Joe Weaver), a Ob/Gyn (Dr. Sima Weaver), and an orthopedic surgeon (Dr. Alex). There were even a few other medical students: Natalie, a PGY1 from Memphis and Eddy and MS3 from Leeds, UK. The professional and collegial atmosphere at Landour is incredible and it is clear that physician and staff satisfaction and quality of life is very high. The physicians are recruited by Catholic Charities so that all physicians are Catholic and the nursing staff are all nuns. Each day begins with a short prayer mass at 8:00am. Then all the physicians round at the same time so that if problems or questions arise there is instant consultation between physicians ans nursing staff.

The hospital census and clinic was a little slow during my few short days at Landour but I was able to scrub into and experience a few surgeries, including several cesarean sections, lateral sphincterotomies, and some really cool orthopedic cases. I was amazed at the technology in the ORs of Landour, including orthoscopic arthoplasty (ACL repair done with minimally invasive techniques and video scopes). The techniques were identical to what I saw on my surgery rotations in America with the exception of higher technology like optic fiber wiring and high definition screens.

Dr. Alex and his colleague repair an ACL.

Minimally invasive.

The hospital and clinical experience at Landour was excellent but the true highlight of the week was the nature and peacefulness of the hills behind the hospital. The network of trails and viewpoints from above the hospital were unreal! It was like a whole new world: there were maintained trails, garbage cans with inspirational green quotes, and - get this - "no honking" signs! Whaaat!? I learned that these changes are due to the fact that there is a world-famous boarding school - Woodstock School - also nestled in the hill by the hospital and that the international staff at the school have made this green sanctuary their own over the past 50 years. I was told that from the highest point of the hills (appx 7,000 ft) there are great views of the Garwhal Himalayas on clear days. I awoke every morning at 5:30 am in hopes that the sky would be clear but had no such luck but I did capture some pretty great shots none the less.

I had to depart Landour a bit early to start my trip east into the high Himalayas. Will write another post soon detailing that trip - hope everyone is doing well back home - I'm getting excited to return :-)

Indeed.

Trails above Landour

7000 ft. sub alpine forest

My hiking partner Natalie. It was great having some American companionship.

Mussoorie-Landour by dawn.

Sunrise through the forest.

Didn't get to see snow-peaked mountain tops but this made up for it! 

Rishikesh

Hello!

Had a great celebratory getaway in Rishikesh this weekend! Rishikesh - also known at The Gateway to the Himalayas and The World Capital of Yoga - is about 1.5 hours drive from Dehradun so I left on Saturday morning. It was great to get out of the city and I was really hoping to find some peace and quiet - and the yoga capital of the world seemed like a good place for it ;-)

Rishikesh is a beautiful city along the Ganges River built into the foothills of the Himalayas. The Ganges River basically weaves through in an 'S' formation and there are two huge bridges that span the Ganges. To truly appreciate the city it helps to be familiar with ancient Hindu literature and I'm glad I heeded the recommendation to read The Ramayana before arriving in India. The epic states that Rama (the god Vishnu, incarnate, and probably the most identifiable and popular Hindu figure) spent time here for penance after destroying the demon Ravana and burning his kingdom of Sri Lanka to the ground after Ravana stole his wife, Sita (not cool Ravana...). Anyway, Rama spent his penance here and his brother Lakshmana came to visit and crossed the river using a jute rope bridge. Thus, the two bridges in Rishikesh are named after the brothers, Rama and Lakshmana (Ram Juhla and Lakshma Juhla) and Lakshma Juhla still today is a "swaying bridge" to commemorate the use of the jute rope bridge that Lakshmana used. Phew, that was exhausting....

As soon as I got into Rishikesh and I was walking to my hotel I stopped by the Ganges to rest and a native Yogi came by and blessed me, painted my forehead, wrapped a bracelet around my wrist, and gave me a marigold flower to send down the Ganges :-)

Ram Juhla in the background. 

The city is truly beautiful. There are flowers, yoga temples, statues, and parks all over. It felt great to sit in peace and quiet. The streets are filled with folks clad in cotton and hemp: native Yogis, transplant expatriates, and tourists - all in search of their Samadhi. Dialogues were ripe with terms and phrases like, "consciousness," "in tune with the universe," and of course "Hare Krishna." It was great to meet and share a few meals with some other tourists and have conversations in English.

After wandering the city during the day, I set out just before dusk to check out the Ganga Aarti - an ancient Hindu ritual of worship (in this case, the Ganges River) - that takes place every night in Rishikesh. It was a fantastic spectacle. There was a very large group of people on the huge ghats by the river all encircling a group of monks who led the worship. Then the ceremony broke into song and dance as the Aarti Lamps were lit and passed around. Worshipers were taking the heat from the lamps and spreading it onto their body and heads to worship the Ganges. All the while people were lighting candles and incense on small boats with flowers on them and sending them down the river. I have an excellent video of the ceremony but here are some photos:

Ceremony Site. Rama seated at the throne. 

Passing the Aarti Lamps through the crown toward the Ganges

Nico sending his worship to the Ganges. 

It was awesome to see and be a part of this ancient ceremony. It was an intense atmosphere. The Ganges River has been a life source for the people of this land for thousands of years and the importance of the river was undeniable during Ganges Aarti Ceremony. 

Sunday I hiked up the hills to a temple and got some great panoramic photos of the city. Then I walked the streets, did some shopping, ate some food, and snapped a few more pictures. Enjoy!

 Rama

 Markets of Rishikesh. 

 

  Mmmmm. 

 Ram Juhla by night. 

 Sharing some snacks. 

Ganges.

View from Lakshma Juhla 

Lakshma Juhla. And 1,000 people on a swaying bridge :-)

 Taking in the views...

Lakshma Juhla