Saturday 15 October 2011

Tibet Bike Ride – Huge Landscapes and Visible Politics


This piece complements the day by day posts I wrote capturing the challenges and excitements of the trip in real time and reflects on experiencing Tibet. 

“This guide book is reactionary” This was my introduction to the Chinese surveillance of Tibet. We were at Lhasa airport and my books were being inspected by a young Chinese customs officer.  She had noticed my copy of “Seven years in Tibet” by Heinrich Harrer and pronounced this work to be “incorrect history” and then inspected my other books.  I had to suppress my reaction to protest but keeping quiet was vital if I wanted to enter Tibet, I was also curious to see how much English she understood; she clearly understood enough of the political and cultural analysis to confiscate both books.  Fortunately “Annie Matthews”, my father’s memoir about his grandmother was not confiscated so I had something to read, albeit about Yorkshire.  The process of searching was random and arbitrary, other people had brought Kindles loaded with their reading and these were not inspected.   The Chinese colonisation of Tibet is very striking and I saw it across in Tibet in many forms. My airport incident also earned me the nickname Dodgy Di.

The bike ride from Lhasa to Kathmandu is the highest in the world going on the main route across Asia. The journey is 1000km and one has to cross 3 passes above 5000m. I had long wanted to do this route and after Laura’s death decided not to leave this until I retire.  I have also loved the Himalayas since I first travelled in Pakistan in 1975 and have also been intrigued by Tibetan culture and have followed the political situation in Tibet. Deciding to raise money for BIkeAbility also validated the trip, making it more than just a holiday.
I travelled with a group organised by Exodus Travels. There were 17 people in the group, age range 34 -71, eleven men and six women.  I was surprised to find that I was the oldest woman.  Two other people were biking for charities; a woman, A, for the Royal Marsden and a psychiatrist, I, for Mencap.  We had a fantastic Nepal tour leader, Kumar who rode every km of the way and encouraged us all at each stop, at the back was his assistant Ajay (26) Nepali champion mountain biker and it was his first visit to Tibet so he was also photographing all the sights like a new tourist.  Everyone is the group was determined and fortunately we gelled well. The men were competitive, racing ahead to first at the top of the passes.  After a few days I became part of a self selected “slow group” who supported each other up the passes. We biked for 13 day, doing about 100 km a day, one day we did 150 km, much of that riding in a diamond shaped pelton like the racers use and I could feel the drop in wind friction, but also means that one cannot gaze around at the sights, so I did not always bike in the peleton.  We were well looked after and had three cooked meals a day to replace those calories we were burning off, with yak curry for the meat eaters.  Every group holiday has its defining moments, and we had two, a male one and a female one, perhaps ying and yang when  in Tibet  After a few days one of the young men became very frustrated because we were all being driven  part way up a pass and he had been determined to ride every kilometre of the way.  He seethed with frustration and then as we were checking our bikes he punched Kumar, our guide.  A retired headmaster showed old reflexes by immediately pulling the two apart and G then rode off ahead. He was biking with his father who was shocked by his son’s outburst.  It sobered up the other young men who had been grumbling about the pace of the slower cyclists. The women by contrast all went and hugged Kumar. In the evening G apologised to the whole group and the incident helped the group and made the faster ones have time for the slower ones.  On the same day we also had another group event, one of the women had been not been able to climb the first pass and had really struggled with this second one but also inflicted her anxieties on the whole group with non-stop talking! One of the other women, who was a strong cyclist and could have been at the front instead buddied her up the pass and we all formed a welcoming party at the top. The contrasts between male aggression and female altruism were very prominent for me that day.

It was a wonderful way to see Tibet, Lhasa is very beautiful with the mountains feeling close by and the lights clear and sharp. The red and white Potala palace dominates the scene and at night appears to floats above the city, but it has to compete with flashing neon  casino signs. At the summer palace outside Lhasa we saw the pictures of the previous dalai lamas. The photo of the 14th Dalai Lama was tucked away around a corner so that he could not be photographed. It is illegal to have pictures of the Dalai Lama and I did not see any photos of religious leaders.   Shiagatse is a large city with a big monastery and around the monastery runs a pilgrims path of 3km of spinning prayer wheels , from here I looked down on the different parts of the city , the old Tibetan houses were all built around courtyards  with water from street pipes. In the market felt slippers and yak cheese were on sale, the Chinese part was newly built and  concrete and glass shops e selling sunglasses and mobile phones. The villages were very poor, often with no electricity and villagers were busy collecting dung to make winter fuel. In the fields the barley was ripe and deep yellow and being harvested by hand.  Tibetan architecture uses local stone. The houses have striking entrances with double doorways leading to courtyards. The doorways are beautifully decorated with brass and painted metal plates. The windows have black wood frames around them. The hotels were all entered through an archway and had a large courtyard for horse or bikes with small rooms with black window frames above them.  I had been worried that the road would be busy but there were few lorries and almost no private cars. Most Tibetans get around by horse. 
The panoramas are vast with huge bare mountains with the rock strata clearly visible showing ancient geological turmoil.  We also biked around glacial lakes that were a deep blue.  The long climbs up to the passes were tough and the scenery would become bleaker with few plants. The tops of the passes were a mass of colour from prayer flags, perfect for photos. Atop the Rohang pass I could see the mountains stretching away in all directions and I felt that I was in a wonderful airy landscape. We had some fine descents in the afternoons, coming down into a greener landscape with golden barley.  The rivers were also beautiful, grey and flowing fast with glacier water but also reflecting the light. The river down from Everest was especially beautiful with a grey and green landscape and a few yaks grazing in the small valleys. The landscape high up was also like an abstract painting with huge areas of white and snow and rock. We saw plenty of yaks, they occupy the middle altitudes and look cuddly and seem to socialise a little in their small groups. The Tibetans take them up to the top of the passes to be used in photo shots with tourists.

The climb up to Everest was tough and the Chinese Base camp (5200m) is in a valley so one does not have the sense of space that I had from the Rohang pass.  There is a seasonal camp there with brown yak hair tents with central stoves giving out a little heat; we slept in wooden bunks around the edge of the tent. The camp looked like a refugee camp with white Land cruisers carrying Chinese tourists parked everywhere.  Everest was in cloud when we arrived but it cleared in the evening showing its vast beauty.  The Chinese side is austere with stone cairns and an empty ruined monastery and no memorials to past climbers. There was also little life at that altitude, just a few plants and birds, as if nature is reduced down to a minimal life set. Looking at the mountain was humbling.  That night we experienced a grade 3 earthquake there. We felt the tremors and ran out of our tents and could then hear an avalanche but in the dark could not see what collateral damage had been done until morning. All the Chinese tourists fled in their land cruisers during the night. This was a tremor from the earthquake in Sikkim. It was a powerful reminder of mortality.  I felt very tired after reaching Everest, it had been 10 days of biking long distances at altitude, but the group achievement then kept me going for the next 5 days. I remained very well for the whole trip; I had taken stocks of paracetamol for illness and brought it all back! I did not have altitude sickness (25% of the group had it badly) and apart from one episode of food poisoning I had no medical problems.

There was evidence of Chinese colonisation everywhere. The road was in excellent condition all the way to Nepal and when we crossed over into Nepal the condition of the road deteriorated dramatically with landslides, streams and an off road challenge. Chinese troops were very visible in the main sites in Lhasa and then i saw small barracks in many of the towns.  There was also excellent coverage for China mobile right across the country that also disappeared when crossing into Nepal.  On the mountain sides the white stones picking out religious messages have been replaced with Chinese slogans about literacy.

We visited a few monasteries and I found it difficult to tune into Tibetan Buddhism.  It feels a fossilised religion, the monks seemed to be dispensing religious learning and providing nothing for the population but taking large amounts of money from pilgrims. Only in one place, Lhasa did we see monks discussing their teaching and here young monks were engaged in lively disputes in a large garden, each group with a teacher but also a huge range of teaching styles  varying from the acrobatic to the quiet deliberation. I did not feel that the monasteries had done anything to improve the conditions of the people around where they lived. It is noticeable how few religious shrines or symbols there were outside of the few big centres and at the big monasteries there were only small numbers of monks. It seems that the monks have been partly retained for the sake of tourism. Prayer flags only seem to be tolerated at the tops of passes. Our Tibetan guide said that people would worship at home.  I felt an absence of religious freedom in a country where religion is integral to its culture and history.  Seeing the rich monasteries in a very poor society made me understand how the reformation happened in Europe, and feel grateful that it happened.  

I now have more insight into the political and cultural clashes in Tibet which are very challenging.  It is easy to say “Free Tibet” but rather more difficult to see how reconcile communism and theocracy, and democracy is even further off.  The Chinese have invested a lot in Tibet with improved roads and government structures but the Tibetans see this as colonisation.   It was the sixtieth anniversary of the Chinese invasion in July 2011 and Tibet was closed to foreign tourists and The Chinese premier stood in front of the Potalala Palace to say that Tibet would always be part of China. 

In the last couple of days we descended 150 km, biking down a huge canyon that is formed by the Indian subcontinent hitting the Tibetan plateau and the monsoon rains create the deep ravine.  At the top was treeless Tibet, as we descended the trees became larger and more varied and there were huge waterfalls and flowers. When we crossed into Nepal on the Chinese built Friendship Bridge the earth became richer and richer supporting an abundance of crops and vegetation, paddy fields were tucked away on every hillside.  The people were wearing brightly coloured clothes and it was warmer.  Kathmandu felt crowded, vibrant and lively. A fitting place to end a journey of contrasts.   

Doing the ride has given me a sense of achievement.  It was a struggle to climb some of the long passes, especially the climb up to Everest base camp. When I was struggling I thought of my friends and the support from the messages on the web-site. I also reached my target of £5000 for BikeAbility. It was important for me to tie together the challenge of the ride with the prompt that made me do it. The huge austere landscape is beautiful. I was struck by the poverty of Tibetans and the visible Chinese colonisation. It would now be interesting to go to Ladakh where there the locals are ethnic Tibetans but without Chinese colonisation. 

Wednesday 21 September 2011

Wed 21st Sept

Hi from Nepal.
Just had a fantastic ride down from Tibet. Yesterday we traversed a high bleak plateau. Today was a wonderful contrast with a 40 km descent down a valley. This was quite sublime with huge waterfalls crashing down and trees becoming part of the landscape again after treeless Tibet.. It was also uninhabited so I felt I was descending in a secret world. 

We then left China by crossing the friendship bridge and our guides were happy to be home and we lunched on dhal bhat and lassi.  We then had a 40k ride that I thought would be gentle meander past paddy fileds  but the Nepali road is only single track, despite being a maor trade route  and so there were streams, landslides and potholes to negotiate. There was also a vitality in the Nepali villages. 

Tomorrow there should be dawn views of the Himalayas then a gentle ride into Kathmandu.

Tuesday 20 September 2011

Tues 20th

We left ebc in cloud and wondering what damage might have been done to
the road by the earthquake. However all seemed ok. We visited another
monastery, again with very few monks and probably fading away. The
valley down from Everest is huge and bare with just a few signs of plant
life, a minimal plant life set, perhaps?.  We then had a picnic in a
green valley where a herd of yaks grazed and socialised. Then back up to
a high plateau at 4800 with perma snowy peaks above. There were more yak
herds and black nomad tents up here. We had a long off road ride down to
the valley. It is utterly bone shaking to be rock hopping on a bike.
Down in the valley there was a  Marshy area and we spotted a white
vulture and a blck and white crane We stayed in Tangli, a depressed town
full of skinny snarling dogs. Tomorrow is another day of high peaks.

Monday 19 September 2011

Monday 19th Sept


Yesterday was an extraordinary combination of experiencing the awe of
Everest and then the mortality of the mountains. In the morning we all
biked the 4k up to the Everest base camp. On the Chinese side this is
rather severe. With some plaques that one can be photographed beside, a
prayer flag stupa and some names from this year picked out in stones. We
had an orgy of photos including the slow team. But I found myself
thinking about Laura and other people who have died. It is also
surprising that there is no memorial for previous climbers such as
Mallory. Apparently the Nepali side is brimming with memorials.

In the afternoon I chilled out in an almost abandoned monastery. In the
evening we were playing cards in the tent when it suddenly began to
shake. As we went outside we had an avalanche of stones descending.
We were experiencing an earthquake about 4 but because of the dark could
not see how much damage had been done at our site.

We consoled ourselves that this was a small quake but sleeping was not
easy. In the morning we heard that there had been a big quake in Sikkim,
to our south. What a dramatic end to an Everest visit and a reminder of
the power and instability of mountains.

Saturday 17 September 2011

Tibet bike ride Sept 17


I'm sending this post from an almost abandoned monastery just below ebc. Numerous prayer flags flap and there are several flag poles and numerous groups of square red and white columns.  Only a couple of monks tend the place and  I can see old decaying cells.
Yesterday we had a tough ride of 75 k uphill to reach ebc. I was only kept going by the prize of being able to say that I had biked to ebc! I was expecting a french style seasonal  campsite but instead there are about 50 brown yak hair tents, very substantial with sleeping benches along the walls and a central stove for heating and water. I was snug as a bug in my sleeping bag. However the camp looks not unlike a refugee camp because there are land cruisers parked everywhere. Despite years of travelling in Asia I was also surprised to find souvenir vendors both outside and inside the tents. And yes we finally saw mt everest in the evening sun. Huge, dramatic and with interesting ridges.
More about it tomorrow.

Friday 16 September 2011

Tibet bike ride sept 16


Tibet is on Beijing time, despite being 5000k east. So this morning here was still a full moon at 7.30. The other advantage is that the evenings are long so I have walked around the villages where we have been staying looking at the homes and shops.

Today we had another pass, this time 5200 but not such a long climb because we were dropped off half way up. But it was still a 3 hour ride. We had been promised views of Everest but instead there was cloud. But we could still see the Himalayan chain. The descent was through a bare brown landscape with sharp dramatic edges to the rocks. We  stayed the night in a tiny travellers inn with all brightly painted chests filling the where all the women slept on carpets on the beds.

For the group it was a day of aggression and altruism. One of the young men became v frustrated at not biking every km and took it out on the guide. Fortunately in the evening he  aplogised to the guide and the group and we are probably stronger as a result. The altruism came from a fast woman cyclist who buddied the slowest member of the group up because she had not yet managed a pass. We cheered both of them at the top.
Tomorrow we bike up to Everest Base Camp.

Fri 16th Sept


Yesterday was described as the most difficult day with 84k and a 24k climb to a 5220 pass. As we left Lhatse the kids were going to school in their blue uniforms with yellow neck scarves. Off to learn to be model Chinese citizens. 

We biked up a long long valley that was narrow and still shaded but then opened out. I felt as though I should have reached the top but there was another 14 k of climbing. I only reached the top with the help of kendal mint cake and jan garbarekali khan. I was also spurred on by overtaking four young Swedish guys immaculalely equipped who were clearly shocked that a woman in shorts and a jersey could also be on this climb. 

We hoped to see Everest from the top but it was cloudy and cold. We had another fine descent, this time passing yak herds and nomads in black yak hair tents. We stayed in a small village that is the jumping off point for Everest Base Camp. It had a touristy feel - many restaurants and even a massage parlour.
 
Our Tibetan guide Ronsak has taken many tours to Everest but he is not tempted to cycle, he is also very diplomatic politically.
 
There are 17 of us in the group, 6 women, age range 32 - 71yr mainly UK
. 8 people have come with friends, 3 are fundraising (cancer, mencap, bikeability). -it is also quite a competitive group, bristling with meters. I am forming a slow group.

Thursday 15 September 2011

Thur 15th Sept


Yesterday we biked 150 km and climbed a pass of 4100m. It's the longest ride I've ever done, helped by being in a peleton part of the time. There was beautiful early morning light on Shigatse when we left. The countryside then became very dry and treeless, very reminiscent of Afghanistan with low villages and old forts up on ridges. We lunched on a dry river bed and then paused at a road sign saying we were 5000 km from Shanghai. What a potent reminder of China's size. 

We then had a steep, steep climb. At the top I looked out on the bare mountains and felt as though I was on the top of the world. We had a beautiful descent into a greener valley. We stayed the night in a very impoverished town, Lhatse which is famous for its karaoke bars.

The stars of our group are our 2 Nepali guides. Kumar is tiny and is a great encourager. He has a different adjective for each day today was the longest, tomorrow is the most difficult. His assistant OJ is Nepal's mountain biking champion age 23 and this is his first visit to Tibet so he is photographing himself and the group everywhere. He is also tiny and exceptionally fit, he would love to power up the passes but is the back marker so helps the slow ones. Must be like babysitting for him.

Thurs is tough with a 5220 pass to climb.

Wednesday 14 September 2011

Wed 14th Sept


Rest day in Shigatse yesterday. The guide book was very dismissive of the town but I enjoyed being there. It is a town of three parts, the famous monastery, the old Tibetan section and the brash new build of the Chinese section. Pilgrims were prostrating outside the temple and then buying huge bags of butter. The monastery was huge with different chapels, one with a 26 m high Buddha and clearly a very important place for our guide. 

We then followed the pilgrims' route, a 3 mile chain of prayer wheels. In the old town the Tibetan architecture and poverty was reconisable with no electricity or water for the houses built round courtyards. The market was full of felt slippers. The new Chinese part was ultra 21 century with concrete and glass buildings with shops for mobile phones and sunglasses.

The group is gelling and the fast ones are going slower and the slow ones faster.
A major irritation for me was loosing my camera in Shigatse. It had the card with all my photos so far with some nice ones of Tibetan people.  Fortunately I also brought a spare camera.
 
Today we have our longst ride150 km with 2 small 4300 passes.

Tuesday 13 September 2011

Tues 13th Sept


Yesterday was gentle day just 94 km on the flat. We started off with a visit to the monastery where the monks were chanting and then climbed a stupa for great views of the town and mountains. The barley was all being harvested by hand and the reapers sheltered under umbrellas for  lunch. 
The whole area was poor and the only other vehicles were land cruisers with Chinese tourists. As we biked into Shigatse the river was crowded with washerwomen and bathers. Having a rest day here. 

Monday 12 September 2011

Mon 12th Sept


Good day yesterday. We climbed up a long valley to a bleak snowy pass at 5100 where it was even too cold for the yaks. Then traversed alongside another glacial lake with beautiful blues and greens. The bare mountains are like instant geology lessons. Climbed up another 4300 pass where the electrity pylon was decorated with flags. Then a fine ride along a high valley with ripe yellow barley and fortress like houses. 

Spent the night in  gyanste where Younghusband had his stronghold. Now turned into a anti Britsh museum.  Did 104 km yesterday. Slept well. 

Sunday 11 September 2011

Sun 11th Sept


First climb to 4800m was eased by a lift up the pass but was then a steep climb and getting enough air into my lungs was a problem. However my snail approach paid off and I was not the last up! At the top there was a vast collection of colourful prayer flags and tame yaks for photos. Below us was a bright blue glacial lake that we then biked around. We then stayed in a rather sad town where all the official buildings were aggressively Chinese in design.

Saturday 10 September 2011

Sat 10th Sept


65 km along the valley. Beautiful scenery with a fast flowing grey blue river and mountains, autumn just starting with some yellow leaves.  Excellent cooked lunch of rice and veg curry 
(yak for the meateaters) under the trees by the river. We stayed in a village guest house with a courtyard. The village houses had wonderful finely carved doorways with painted wood, metal grilles with gods and double doors with huge door handles. 

First big climb today.

Friday 9 September 2011

Fri 9th Sept - Lhasa day 3


Visited the Dalai Lama's summer palace, a beautiful group of stone buildings set in woodland. inside were murals of Bhuddist and Tibetan history. There was a picture of the 14th Dalai Lama but sited behind a bed so people would not be tempted to photograph it. The palaces  were also colourful with pots of English flowers (dahlias, marigold) which had been put there to spruce the place up because Lhasa has just hosted the national yoghurt festival. In the afternoon we visited a monastery where young monks were debating theology, some with kung-fu like actions. 

I then did last minute shopping of a woolly hat for Everest Base Camp. I think we are all a little nervous about the biking and the altitude.

Fri 9th Sept - Leaving Lhasa


Leaving under clear blue sky after stretching exercises and testing our bikes. Shaistse in 4 days... 

Thursday 8 September 2011

Thur 8th Sept - Hi from Lhasa


Lhasa is a beautiful city, low stone houses and surrounded by mountains. These are treeless and some have a green hue from the summer grass. 

Yesterday saw too many chapels and gold covered dalai lama tombs in potala palace. Dark and oppressive despite the butterlamps. The monks interpret the religion for the people.  Made me glad of martin luther and cromwell. 

Short bike ride this afternoon. 

Wednesday 7 September 2011

Wed 7th Sept - Hi from Lhasa


Good ride in Kathmandu, mostly nice group, one woman who is very self centred.

Now in Lhasa, mild chest tightness only and fine today. Tibetan landscape amazing.

Friday 5 August 2011

Ethiopia Highlands, Summer 2011

Letter from Ethiopia: Highlands , Homes and Churches
I was in Ethiopia for a week in July 2011- almost 17 years since my first visit in Nov 1994. The government which overthrew the revolutionary Derg regime has just celebrated 20 years in power with huge roadside posters in Addis.  Living standards have visibly improved.  Democracy is not yet well developed in Ethiopia, the opposition fared badly in last year’s elections. I wondered whether this was because the governing regime is protecting its power but people said that the opposition was very feeble and had offered few new ideas and deserved the rejection that they received at the polls.
I was there to visit my research fellow S and monitor progress on a trial of ciclosporin that we have been trying to set up for the last 3 years. Ethiopian bureaucracy is slow and obdurate; S has had the patience of a saint to negotiate it. We had been waiting for the drugs to arrive from India for months. Finally they arrived a few days before me. But although they had arrived they were then untraceable at the airport. It took endless phone calls to track down the container with our drug consignment. Then we had to negotiate Customs, finally we were presented with a bill for storage costs for the time that the container had been “lost”. Since the container people still had the drugs we didn’t have much choice over paying.  I followed S taking the calls. Her fluent Amharic enables her to negotiate with Ethiopian skill.
S is a quarter Ethiopian , quarter Italian and half German and she seems to be blessed with the strengths of each nationality. She is phenomenally well organised, just the person to be running a trial, she has the warmth of Italians welcoming one with food and love and she has the determination and nationalism of an Ethiopian. She is married to G, an engineer who is half Ethiopian, half Italian who is based in Kenya building roads and bridges.  S has set up a household of three servants and a baby in a quiet, residential part of Addis.   Baby L is 10 months old and is the happiest baby I’ve ever seen. He crawl s around contentedly gazing at the world with his big Ethiopian brown eyes. He has fair skin and so his eyes are very noticeable, he looks like one of the Ethiopian icons. There are three servants, a twenty two year old nanny looks after L devotedly, and she hopes that her next job will be in The Gulf. Now she is too young- Ethiopia does not allow women to go and work in The Gulf until they are over twenty five, in an attempt to protect them. The cook is older, more serious and lost her husband years ago. She has a very bright son who although he comes from a poor background has done well in school and is just about to sit the entrance exams for Addis University.  She makes lovely food, highly spiced Ethiopian dishes alternating with Italian pastas and all accompanied by beautiful salads topped with concentric circles of chopped veggies that I was reluctant to disturb by eating. She is a diligent woman who works to high standards and I suspect that her son also her ability to work successfully. The cleaner is poor woman, with a cross tattooed on her face; she has epilepsy and only just manages in the household as a rather hopeless cleaner. S took her in out of kindness a few years ago and she is now part of the household but she has trying bouts of extreme religiosity and superstition.  I could see that the other two women were looking out for her; ameliorating her  outbursts. 
No sooner had I arrived in Addis than S took me away for a night to Debre Libanos, the site of an ancient monastery.  The highlands were beautiful with green grass everywhere, above were clouds and shafts of sunlight broke through into the rural scene.  There were clusters of huts for each family and clumps of eucalyptus trees.  There small herds of cows were tended by black blanketed herdsmen.  The lodge at Debre Libanos is perched on the edge of a deep natural gorge The ground just falls away from one for hundreds of feet  with a few little shoulders of land left were small fields have been created. Deep down in the valley a river flowed and there were small villages across the valley. I felt as though I was on the edge of the world.  We slept in stone floored mud huts, cold at night. In the morning I smelt the rosemary that was growing in the cracks between the stones on the terrace and watched gelada baboons roam through the scrub and small bushes below us. Eagles and vultures soared on the thermals waiting for breakfast.  Last a huge solitary eagle soared, perhaps one of the lammergeyer eagles found in Ethiopia who break open bones by dropping them on the rocks.  The monastery at Debre Libanos is famous and if one dies there one goes straight to heaven, so the monks have exploited this by selling exclusive sites in the cemetery, family plots for £ 2000. So donors believe they have a fast track ticket for the future and the monastery finances are boosted, surely a win/win! The monastery has about 300 monks saying prayers around the clock. We were shown around by a tall handsome blue robed monk who was very keen to tell us all the details of the saints there. Inside a few people prayed before the effigies.  Unusually for Ethiopia the church has modern stained glass and has very attractive scenes from the Old Testament, Jonah perching on a huge toothed whale mouth. Outside the church the beggars line the road for about a mile, all hoping for some alms from the visitors. We also had a request from home women to bring some holy water back to Addis for them. Holy water is very popular in Ethiopia; all the patients try holy water as the first remedy for any illness. We also bought some holy charcoal; if one cannot carry water then crumbling the charcoal into water later on will make it holy. Travel friendly holy water. I was struck by the contrast between the richness of the church and the poverty of both the beggars and the surrounding town.  The church did not appear to feel responsible for their neighbours. We had more church encounters back in Addis. L’s devout grandparents have insisted that he take his first communion, which happens at eight months of age. Now the poor chap has to take another five communions in the next x months because e it is especially important that children who are sin free take communion. He also had to take communion on his saint’s day and was taken off by his nanny and grandfather to the church, initially he was supposed to be fasting but this was relaxed after S protested. I was also glad that the communion on his saint’s day was also going to protect his against leprosy- who could deny him that particular benefit.
ALERT hospital was taken into the government service from NGOs several years ago and went through a ghastly period of restructuring when many people left, partly because their salaries were savagely cut. The hospital has now stabilised again and seems to have better interactions with the Addis University dermatologists. New buildings have also sprung up but it was heartbreaking to walk through the dermatology out-patients, packed with people waiting for a diagnosis. The leprosy clinic is now in a separate hut away from the main out-patients. The advantage of the separation is that the doctors have a lot more time to talk to the patients. There are two young Ethiopian dermatologists working there, Dr X and Dr Y. Dr X is full bearded and is touched by the plight of the leprosy patients. He has also travelled down to South Africa and was amazed by the wealth he saw there. Dr Y is a debonair young man wearing a suit and elegant tie. Both of them finished their dermatology post grad training in Addis. The trio seem to work together well and I hope they will form a leprosy nucleus. And the trial? Well it is certainly well prepared, S and I picked up the proformas that had been printed locally and were just being bound into booklets. She walked me around the hospital so that I met everyone who was involved in the trial and I saw them in their natural habitats, the pharmacist in his drug store, the biochemist in the lab. The next day everyone contributed to a presentation about the drug trial. So now all we need are willing patients.
It was a fine visit to Addis, staying with S opened up many aspects of Ethiopian life to me as well as being fun and nourishing.

Friday 15 April 2011

Korea travels, Spring 2011


Beauty- natural or acquired?

During twelve days in Korea I experienced some amazing contrasts between the commercial strength of the beauty industry and the remoteness of the old leprosy colonies on remote peninsulas in the far South.


The World Congress of Dermatology was held in a 21st century conference building and was impeccably organised with teams of polite Korean students keen to help and every detail of the conference planned , from daily conference newspapers for the 9.000 attendees to giving us prepaid travel cards for the metro. Dermatology conferences have been completely hijacked by the beauty industry and the L’Oreal stand dominated the exhibition hall advertising attainment of beauty, there were two floors of exhibits 95% of which were stands advertising botox injections or laser treatments to magic away aging skin. Vast photos of Asian women with impossibly flawless spot free skin hung over the stands, all advertising an unattainable ideal. Delegates flocked to the sessions on cosmetic dermatology but just a few brave souls came to the 8 am leprosy and leishmania sessions where we discussed real skin problems. From the advertising and sponsorship one would have no idea that skin disease is unpleasant and that treating itch is the daily challenge of dermatologists. I also had my skin assessed by a computer programme that mapped out wrinkles, spots and blemishes. One could see a vision of one’s younger skin, so I was contrary and asked to see my older skin, so that I can prepare for those deep wrinkles The girl running the programme must have liked my approach because she then reassured me that I did not need treatment when of course she should have been emphasising how much improvement I could gain from botox. I also learnt that one cannot smile if one has had repeated botox injections and so the botox recipients have to relearn smiling. One of my colleagues Terence Ryan is fighting a rearguard action against cosmetic dermatology and is promoting the concept of community dermatology, so that the focus on skin disease or poor people is not completely lost. He shared the leprosy platform but should have been somewhere with higher visibility. The other pleasure was meeting leprosy friends from India, Brazil and Sri Lanka.


I then flew south to visit two leprosaria. The first leprosarium I visited was a former mission-run hospital located on a rocky tree-covered peninsula. It had been founded by missionaries in 1926 when Korean leprosy patients were cast out of society and stoned if they were on the roads. The missionaries were the only people who would care for them. The hospital has now evolved into a modern orthopaedic and dermatology hospital. There was also an excellent museum created around pictures of patients and missionaries. The different phases of leprosy treatment were well shown, from shelter through early drug treatments, to rehabilitation. The old missionaries were also remembered with statues and a Korean carved stone memorial. About 70 very old patients still live in the hospital and are e cared for in an old people’s home. I looked in on one old lady with severe deformities. She was lying on her tatami mat with a bowl of cherries nearby and light was flooding in through the window, a peaceful scene. The hospital was run by a very energetic surgeon who took me and some other visitors out on a walk in the evening. We walked though a huge flat reed bed and up a small mountain with an observatory atop it. Cranes and herons flew around the reeds and crabs scrabbling around in the mud. There were beautiful views and also notices telling one precisely where to take the best photos. In the evening after a Chinese meal at which all the docs had been very deferential to their boss, I was driven back to the hospital by a young doctor doing his national service who poured out his woes to me about his remote posting and how he could not travel overseas because of his service status. So he was a typical conscript in hating his posting, even though it had interesting possibilities for research. The next day Ii travelled to the government hospital on an island. As I was waiting in a car park a hospital bus pulled up and I thought this was my transfer but instead 12 staff got out to welcome me. We then went to a restaurant and sat on the floor and had a Korean feast with a least 12 different types of fish to be picked at with chopsticks. I was then driven over the hospital by a local dermatologist in his Mercedes. I had been expecting a dingy building but instead found a new modern hospital with a high airy atrium and art pieces in the lobby. They had made a large sign saying “Welcome to Dr Lockwood and her special lecture on leprosy”. I then talked about leprosy on London. The director was passionate about providing a good service to the remaining leprosy patients in Korea. There are about 20 000 patients altogether in Korea but now only 20 new patients per year. I was then taken around the island where there were villages that ex-patients had settled in. There was also a small prison for misbehaving patients. The most poignant remnant was a mortuary, preserved with an autopsy table still inside and a notice saying that here patients had autopsies without consent and married patients were sterilised. It was like seeing something from Nazi Germany and was a very forceful reminder of the human rights abuses that leprosy patients have suffered. In the mission hospital I had met some anthropology students from Seoul who were interviewing patients about their past injustices. Patients had been forcibly relocated and also had to work as forced labour. All occurred mainly during the Japanese colonization from 1920-1945. The Korean government has acknowledged the damage done to former patents and when the president came to open the new hospital he apologised to the old patients. I had known of the abuses that leprosy patients had suffered in Japan but I had not realised that this also occurred in Korea. I was very touched by seeing the mortuary and although it is historical there is still much to do to demystify and moralise leprosy.


I was also a regular tourist and was bussed out to the Demilitarised Zone about 50 km from Seoul. It was a murky day so I barely saw over the barbed wire to an N Korean exhibition village that is close to the border but no inhabitants. . We were also taken deep underground to one of three tunnels that the South Koreans found were being burrowed towards the border. These were discovered in the 1970s and 80s and the S Koreans claimed that 60.00 soldiers could pass through the tunnel in 6 hours. I’m not sure that the North Koreans have the ability or the energy to attack the south now. Being in Korea I could feel how far apart the two countries are and how suspicious the South Koreans are. An N. Korean collapse like the collapse of E Germany in 1989 seems very unlikely. It is a very surreal place to be, especially as the DMZ is now a haven for wild life because it has had 40 years of complete wilderness.


Koreans work insanely hard, one sees school students on the street at 10pm, having just finished their post-school academy work and heading home for home work. Their fathers will also have worked 10pm and will be eating with their work colleagues before returning home to sleep and then starting again. I spent a day with Heyjon, a Korean scientist who had done a PhD at LSHTM and she confirmed that she only eats with her husband at the weekend. Suicide is the biggest medical problem facing Korea ; this happens at all ages, school kids, young people, middle aged people because they are all under huge pressure to achieve good grades or earn good salaries. When a celebrity commits suicide then people agree that something should be done but then nothing happens. I guess it requires such a deep change that it is too difficult to contemplate. Most families have one child only by choice and I can understand the huge pressures that are then put on these children and how resentments can develop.


Seoul feels like a huge American city with endless blocks of high rises and four lane highways criss-crossing the city, but when one explores it the individual districts are interesting and have their own flavour. I stayed in the Yonsei university guest house and that district was very lively at night with cafes and bars. Yonsei university was founded in the 1980’s and has an Ivy league feel with ivy clad 19th century buildings, but has continued building since then and has a beautiful outdoor Greek style auditorium to seat 3000 spectators. The women’s’ university was also as old and had an amazing piece of modern architecture that looked like a deep canyon cut out of the hill with glass sides. As I explored it I found that classrooms had been set into hill behind the glass. New graduates in miniskirts and high heels were posing with their friends for graduation photos. The straplines of the two made an interesting comparison, Yonsei was “First and Best”, the women’s, “Where Change begins” In the Bukkon area old Korean house built around courtyards with blue tiled roofs had been preserved and are now used by artists. There is also a very vibrant modern art and photography scene in Seoul and I wandered around small studios with interesting installations and maxed out on contemporary art. This was such a contrast to the public sector and corporate scene that I wonder whether Korea’s artists are doing a collective dissent for the nation. Certainly in other spheres dissent is not encouraged.


I also met a young English architect who has worked on the renovation plans for my house in Islington and is now doing a project in Seoul designing student accommodation. We spent a day biking around central Seoul and then an evening walking around the downtown area. She was both excited by being there and to be doing a project that she would not have done at home, but she also found the working conditions difficult. The long hours were killing her and she was surprised to find that there is little team work in Korean offices so people do not share information about the projects they are working on or help people with ways of improving computer programmes.


So my trip to Korea was full of contrasts, first the contrast between beauty and real world dermatology, then being in the leprosy hospital and feeling that I was touching a very recent past which involved exiling leprosy patients and abusing them. Then meeting Korean people and getting a glimpse into their work –oriented and dissent-averse society. But also being able to enjoy the sculpture and art in public spaces.