Local doctor begins practice in Pakistan

By Dr. Andrew Embick

Karimabad, Hunza, Northern Areas, Pakistan - There isn't a lot in the way of politics, or medicine, in this remote mountain kingdom in the Karakoram, making its way in the space of a century from Stone Age to Information Age.

As for politics, these hardy mountain folks are hardly mainstream as their Islamic sect is Ismaili and their spiritual leader the Aga Khan, based in Geneva, focused on good works like irrigation channels and schools. Their language is Brushaski, or Wakhi in Gojal to the north. Separated from "Pakistan" or "Punjab" to the south as Alaskans are from "Outside" or the "Lower 48,” they still can't understand President Bush's apparent warmongering, though they carefully distinguish between Bush and America per se, which they respect, in some cases have relatives in and may want to immigrate to. Since I myself cannot understand Bush's warmongering, I find a note of sympathy here.

There is a tendency of Pakistanis to read a religious conflict into any disagreement with the Islamic world, which is used to explain our apparent favoritism of Israel over Palestine. To the extent that religion is favored, or "established" in the words of the U.S. Constitution, which forbade it in America, we lose our ability to appear either wise or impartial to the world.

Pakistanis have great sympathy to America for her losses in the Sept. 11, 2001, attacks, and those I've met (a cross-section of a few hundred) have no sympathy for Osama bin Laden, whom they blame (appropriately) for a dramatic loss of tourist trade and revenue, going to near-zero here, in an area whose economic promise was pinned on visitors to the greatest mountains and rivers on earth.

I myself am in Hunza, 18 years after my first visit as an expedition leader for climbing (a spectacular rock tower called Lukpilla Brakk) and kayaking (the Braldu, Indus, Shigar, Shyok and Hunza Rivers, some of the mightiest on earth) for the winter until May, when the apricot trees blossom, barley fields turn green and snow melts on the high peaks.

The incredible industriousness of the Hunzakuts surpasses, as far as I can tell, that of the Egyptians building the pyramids as the oases of terraced fields grow crops only because of a system of irrigation channels bringing glacier-melt water down from the gulches or nallas above the village. Precipitation here, at 8,000 feet elevation, is less than six inches per year. Since this is not a cash-based economy, all the work to build channels literally carved out of the faces of cliffs, running along thin lines of fit-together rocks held to cliff walls mostly by inertia, is volunteer community service.

And such a community it is, cemented by family and ethnic ties (though not genetic, as some folks here appear Celtic, some are likely descended from soldiers of Alexander the Great of Macedon, and some appear to be nephews of Genghis Khan), by time to discuss, by long-term settlement here, and by willingness to work together. Telephones and newspaper appear not to be necessary for this community accomplishment in spirit and works, as both are lacking. Rather, everyone knows everyone, and has time for them while strolling for errands, or waiting and socializing. A warm greeting, a two-handed handshake and perhaps a hug are normal.

The Hunza folks are hardy, not bothered by heat being limited mostly to twigs burning in small stoves at home, electricity being intermittent at best, and telephone out of reach of nearly all. Private vehicles do not exist, and travel is on foot or by clinging to a Suzuki micro-van (as many as 42 people have been counted in, on and around one). My bicycle excites immediate interest, as if it was a Ferrari or Rolls Royce somehow transplanted to rural Alaska.

It's a good thing they're hardy, and willingly or not free of many of the lifestyle faults afflicting Americans. None are even chubby, much less fat. The Aga Khan has counseled against using alcohol, tobacco and hashish, and as an indication of the great respect in which he is held, there is little or no smoking or drug use, though the tradition of stomping on grapes (with clean feet I am assured) to ferment, then distilling a local firewater called "arak" continues. So there is little or no diabetes, hypertension, cholecystitis, cardiovascular disease or emphysema.

What there is, is the collection of infectious diseases which in the U.S. were vanquished decades ago, such as tuberculosis and rheumatic heart disease from untreated strep throats, along with children's illnesses, and all the various injuries which come from working hard, straining muscles and being at risk from falls on truly difficult terrain.

The villages of Hunza, along the Karakoram Highway (a truly terrifying one-lane switchbacked jeep track from Islamabad to the Chinese border 170 kilometers north of here, then to Kashgar in Sinkiang Province), have some basic medical care, provided by the Aga Khan Health Services Foundation. But the most remote village, Shimshal, is 56 kilometers up a trail difficult for even hiking, and navigated just recently after enormous work by the villagers by several jeeps willing to try suspension bridges built for yaks, and river crossings above the bottom of the doors.

I went there, with Ayub, a jeep driver who could transition to flying an F-15 with no problem, and sirdar Atta-Ullah, cook Assan and local guide Anwar. All these folks were needed, as the jeep got stuck up to the tops of the wheels in the Shimshal River. From Shimshal, ibex are seen a little above the village (the village being at 12,000 feet, that means 18,000 feet, much below the tops of the peaks at 24,000 feet).

And after some word was passed by Anwar, a favorite son of the village, and announced by the Muezin as part of his call for prayer, I was mobbed by patients. With no electricity and no heat, we might as well stay outside (in just-above-freezing weather) for the clinic, so we did.

Babies (no diapers here), young girls (bashful and cheerful simultaneously), young boys (tough being an understatement), formal older women wearing embroidered, colorful pinbox hats, and elderly gents erect and proud, flocked to the scene and all at the same time waited their turn, gossiped, laughed at their cousins, friends and neighbors and bounced off with medicine, advice on diet, specific exercises, or, most ominously, that I would return with heart or tuberculosis medicine. Or worst of all, a three-year-old with a congenital dislocated hip, whose treatment in the U.S. would be carried out by a team of expert pediatric orthopedic surgeons at, for example, a Shriners hospital. About 60 were seen in the space of a day and a half.

After the clinic, I was led to the truly sick patients, unable to walk - one with advanced tuberculosis, one with congestive heart failure at age less than 40, and one with truly awful eczema. These people, all young, were at the verge of death, from what we would consider treatable and curable problems.

I'm going to adopt Shimshal as my work for the next four months. I don't know anyone else who would. It will take hiking or biking 56 kilometers (34 miles) up from Passu, north of here on the Karakoram Highway. I'll have Anwar Baig to carry up medicines and translate. He has a Masters in Islamic Studies and a Doctorate in Law, neither of which he is using, and good English. I'll go every two weeks. I'll bring the medicines needed (which are cheap in Pakistan, though providing for an entire village of 2,000 could be difficult).

In the spirit of the Christmas season (Christmas being the same date as the birthday of Jinnah, father of Pakistan) perhaps some Valdezans, Alaskans, Americans would like to contribute to the costs of providing medicines for the villagers of Shimshal. No more appreciative group of people could ever be found. And no lower overhead for a charity can be imagined than zero percent. Donations should be directed to Jeanne Stitzel, Treasurer of Shimshal Medicine Fund, c/o Valdez Medical Clinic, P.O. Box 1829, Valdez 99686.

Embick is a longtime Valdez resident and local physician.

Published by the Valdez Vanguard, January 15, 2003 & posted on this website with their permission