Feeling Perplexed

Policies, Parties and People

Yesterday, Lois and I went to a local hustings for NW Coventry. We came away feeling even more perplexed and unsure who to vote for; we were disappointed with the overall quality of candidates being put forward by the parties.

So, while we were wavering between a Green or a Labour vote, we are now even more uncertain, and pondering whether to base our votes on the policies, the parties or the people that we would like to see go through.

The only two certainties seem to be that we won’t be voting (on the basis of the policies, parties or principles) for the Conservative or Brexit Party candidates.

Our main options then are:

  1. Vote Green – recognising that this is the party whose policies most align with our priorities; who, while they cannot hope to achieve anything more than an increased share of the overall vote, and maybe a few more MPs to support Caroline Lucas, are the Party of the future, and the only party to consistently take the environment and social justice seriously. The local candidate, Stephen Gray, seems keen and committed, but lacks experience and seems more suited for a role as a city councillor than a member of parliament. While our Green vote might make a statement, it is unlikely to count in any way in a Labour-Tory competition in NW Coventry.
  2. Vote Labour – while we are members of the Green Party, it is the Labour Party under Jeremy Corbyn’s leadership that we feel holds out the greatest hope for our country at this time. Reviewing their policies, almost all of these align with our own priorities, although several don’t go far enough. It may be that our Labour vote will help consolidate a Labour win in NW Coventry, and along with that an overall Labour majority. The local candidate, Taiwo Owatemi, is a woman from an ethnic minority and a health sector worker. However, she is not a Coventry resident, and came across poorly in the hustings, so it feels that she just isn’t ready to be an MP yet.
  3. Vote Liberal Democrat – the local candidate, Greg Judge, came across as the most confident and competent of the candidates – and someone whom I believe we could trust to represent our constituency in Parliament. While we agree with many of the Lib Dem policies, there are others which seem to go against our principles, and those that are aligned generally don’t go far enough. In particular, we think their policy of revoking article 50 without a second referendum is misguided and won’t help heal the divisions that have arisen in our country. And, so far, we have failed to be inspired by Jo Swinson’s leadership.

So there we are. Do we vote on the basis of our Principles, the Party we would most like to see in government, or the Person whom we would most like to see represent our constituency in the next parliament?

We are open to any thoughts, comments, persuasion…

Working out how to vote: Establishing my priorities

  

It is now less than three weeks to the general election and I find myself increasingly exercised over how to vote.

It seems to me that we face a stark choice as a nation:

  • On the one hand the prospect of many more years of a Conservative government, with the danger that this will prolong the damage caused to our public services, further increase the widening inequalities in our country, and fail to tackle the issues of housing, poverty and the environment; and all this under the leadership of Boris Johnson – a prime minister who has shown himself to be dishonest, and disrespectful to women, ethnic minorities, disabled people and those of different sexualities; a leader who will push through his personal vision of Brexit, ignoring the concerns raised by politicians and specialists of all parties and persuasions, and refusing to take it back to the people.
  • On the other hand we could see a Labour government, with a manifesto which (while I don’t agree with all that is in it) offers hope for promoting environmental care, building up our public services, reversing the growing inequalities, and lifting people out of poverty; under the leadership of Jeremy Corbyn who seems to me to be a man of principle and integrity, who has consistently stood up for justice, equity and human rights, who respects and listens to people, and who, by taking a neutral stance and offering a second referendum with a clear deal on the table, is showing that he is genuinely listening to and respecting the will of the people of this country.

I recognise that many will have a very different (and no doubt equally valid) view of those two options; also that whichever of those two comes to pass, a lot will depend on the role of the other political parties in forming a coalition, or in supporting, opposing or moderating the policies of the ruling party. For me, the main choice seems to be between voting Green with the long view in mind or voting Labour to counter the immediate risk of a Johnson-led Tory government or – worse still – a Johnson-Farage coalition.

I read a rather disturbing editorial in the Times last week which basically suggested that most people vote, not on the principles they believe in, or on the basis of any manifestos, but rather in line with what they perceive their social circle will vote.

That troubles me, and just because most of my friends, most of my colleagues, and most of the people I spend my time with voted remain and are firmly left of centre on the political spectrum[1], I want to be able to listen to all sides, to think critically about what the different parties are promising, and to base my vote on the values and priorities I truly believe in.

So what are my priorities?

Lois and I have been giving this some thought over the past weeks, and here is our starter:

  • Addressing the deep social and economic inequalities in our society, and reversing the widening gap between rich and poor;
  • Caring for our environment and taking meaningful steps towards reversing the damage we are doing to our planet;
  • Providing affordable, suitable housing for all and taking immediate steps to tackle homelessness and food poverty;
  • Reinvesting in our National Health Service and valuing and supporting all public sector workers;
  • Putting children’s rights, their health and their welfare at the centre of all policies;
  • Rethinking our defence and international policies to promote peace, justice and human rights, and to curb the power of the arms industry;
  • Reforming our electoral system so it more genuinely reflects our society and works for the good of all.

As I continue to read through the party manifestos and listen to the news and what people are sharing on Facebook and elsewhere, that is what I will be trying to judge it all against. At the moment I genuinely am undecided what way I will vote, so it would be really good to hear from others what your priorities are, and how you feel any of the parties match up against them.


[1] Yesterday, Lois and I spent a thoroughly enjoyable evening with some friends who had all voted to leave the EU, were somewhat right of centre politically, and were deeply engaged, well-informed and highly thoughtful. It was an inspiring and refreshing evening.

A Children’s Rights Act? Are our politicians serious about building a society where every child matters?

A letter to The Times

from Article 39, The Association of Child Protection Professionals and over 70 other signatories

 

Today is the thirtieth anniversary of the United Nations Convention on the Rights of the Child, which the UK ratified in 1991. This treaty grants every child the right to an adequate standard of living, the best possible health, to inclusive education which nurtures their talents and personality, and to protection from all forms of violence and exploitation.

It cherishes child-parent relationships and entitles parents to positive support from the state. Special protection and assistance is granted to those children unable to live with their families. Compassion, dignity and humanity are extended to all children, including those caught up in our immigration and criminal justice systems. The treaty’s general principles entitle children to be heard and taken seriously, to develop their full human potential and to enjoy all of their rights without any form of discrimination. Governments and public authorities are meant to treat children’s best interests as a primary consideration in all actions concerning them.

Earlier this month we published a document setting out 30 general election pledges. Our first call to political parties is to commit to incorporating the Convention on the Rights of the Child into UK law. If we are serious about building a society where every child is respected and can thrive, then let’s show we mean it with a Children’s Rights Act.

 

Are our politicians serious about children?

The election manifestos are all being published; the leaders of the political parties are actively campaigning and appearing on TV. Let’s hold them to account on their attitudes to children – will any of the parties truly show they are serious about building a society where every child is respected and can thrive?

Austerity, income inequality, and the unprecedented rise in infant mortality for the poorest in our society

Changes in infant mortality

For the past twenty years I have been researching child mortality both in our country and overseas. One of the most encouraging aspects of this has been the steady decrease in child deaths over this period and for many decades before throughout the world. There have been some particularly positive achievements in this, with deaths from cancer, external causes and violent deaths in children all falling by more than 50% in England and Wales since the 1970s, while Sudden Infant Death Syndrome (SIDS) fell by over 80% (Sidebotham, Fraser, Fleming, Ward-Platt, & Hain, 2014). Globally, under five mortality rates have fallen by more than 50% since 1990 (Unicef, 2019).

Sadly, though, those huge achievements have not been maintained, and a recent paper in the British Medical Journal has shown that, for those in the most deprived areas of our country, infant mortality has actually been rising since 2013 (Taylor-Robinson et al., 2019). The gap between the most wealthy and the most deprived, having been reducing for many years, has now started to increase. While there are some limitations in their research, the overall pattern seems very clear. In this graph from that paper, infant mortality in the most deprived local authorities is in pink at the top of the graph, with the least deprived in brown at the bottom.

Changes in infant mortality rates by local authority deprivation quintile (Taylor-Robinson et al.., 2019)

 

Politics, Poverty and Austerity

In the run up to a general election, with all the political posturing going on, it is hard not to conclude that this reversal in infant mortality is linked to a combination of poverty and austerity, with increasing wealth inequalities, reductions in welfare benefits for families with children, and real-terms cuts to the NHS, local authority children’s services, social care and public health budgets. It is notable that throughout the Labour administration from 1997 to 2010, infant mortality fell, particularly in the most deprived areas of the country. The reversal in this trend seemed to kick in just a few years after the change of government.

It seems to me that we need a clear change in policy (and not just electioneering promises) if we are going to see a reversal of this recent trend and a change in the life-chances of those who are most disadvantaged in our society. Perhaps we should be judging our political parties, not so much on what they promise to do, but on their actual track record in tackling poverty and inequalities, ill-health and child mortality.

 

In the context of increasing health inequalities in England, policies that reduce poverty and social  inequalities and investing in child health and social care are likely to reduce the occurrence of infant  mortality and that of many other adverse child health outcomes.  – Taylor-Robinson et al., 2019

 

 

Sidebotham, P., Fraser, J., Fleming, P., Ward-Platt, M., & Hain, R. (2014). Patterns of child death in England and Wales. Lancet, 384(9946), 904-914. doi:10.1016/S0140-6736(13)61090-9

Taylor-Robinson, D., Lai, E. T. C., Wickham, S., Rose, T., Norman, P., Bambra, C., . . . Barr, B. (2019). Assessing the impact of rising child poverty on the unprecedented rise in infant mortality in England, 2000-2017: time trend analysis. BMJ Open, 9(10), e029424. doi:10.1136/bmjopen-2019-029424

 

Beautiful Valleys and Broken Dreams

Travels in Himachal Pradesh VI: Beautiful Valleys and Broken Dreams

 

The final day of our trip we awoke to a totally different vista. Having left the barrenness of the Spiti Valley as night fell, we were now treated to the lush, green slopes of the Sutlej valley. Trees – pine trees, eucalyptus, rhododendrons, splashes of bougainvillea lined every hillside, reaching up as far as we could see. For the whole of the past week we had travelled at over 3,000m – mostly above the height of Mt Cook, and more than twice that of Ben Nevis. The mountains around us had risen to well over 6,000m. And now, here we were, back in the land of ordinary mortals, less than 1,000m above sea level.

And still surrounded by beauty, though now of a different, more gentle, comforting kind.

Sutlej Valley

As with the previous evening, we feasted on a sumptuous breakfast at Star’s restaurant, presided over by the ever-smiling Star herself. Star, from North East India, and another friend of Laji and Sheila, seemed to reflect the mood of this new valley: her easy-going, flowing manner contrasted with the austere and more reserved nature of the Spiti locals we had met.

Setting off from Jhakri, we drove a bit further down the Sutlej valley, past more hydro-electric plants and wandering towns, before crossing the river and heading up towards the Jalori Pass – a climb of over 2,000m. As with our climb to Rhotang Pass a week ago, the road switch-backed up and up, this time, though, through swathes of dense forest. There was far less traffic on this road, and mostly, the driving was easy. At every town and village, though, all traffic ground to a halt, as buses, cars, motorbikes and vans in both directions jostled for space in the tiny streets, already crammed with pedestrians, wandering cows, flocks of sheep and goats coming down from the mountains for their winter lodgings, and shop fronts spilling out into the already constricted roadways. As with so much of India, the general philosophy of driving seemed to be to nudge yourself as far forward as you can, make as much noise as you can, and hope that eventually someone or something will give way to create a gap through which you can squeeze. Somehow, miraculously, it eventually worked, though we were often left wondering if there might not be an easier way of achieving the same goal.

Waiting for the goats

We paused for a leg stretch at the crest of the pass (3223m) and gazed in wonder at the view before us, up towards the Kullu Valley, and, far in the distance, the mountains on either side of Rohtang Pass. Above us, two eagles soared on the thermals, enjoying a freedom of which we could only dream.

We dropped down the other side to the tiny village of Jhibi, where we stopped for some lunch at a small hospital which Laji and Sheila had established in the 1990s, and Lois’ niece, Kaaren, and her husband, Jeph, had spent some time here as resident doctors while their children were small. It is hard to envision a more picturesque setting in which to practice medicine: a remote mountain village, surrounded by wooded hillsides; plenty of forest trails to hidden waterfalls and lakes; steep climbs to mountain ridges with panoramic views; and the clinic itself nestling beside a tumbling, clear mountain river.

Jhibi Clinic

When Laji first started coming to Jhibi from Manali, he would set up a road-side clinic on a sheet of tarpaulin. Villagers would trek from all over the valley to consult him, and his clinics would last long into the evening, continuing by candlelight, before driving 3-hours back to Manali after a long, long day. After several months of treating basic illnesses in this way, a local shop-owner offered him a small room at the back of his shop, where Laji continued to come regularly for his day-long clinics. Eventually, he was able to purchase a small plot of land beside the river, and designed and built the clinic, with a consulting room, pharmacy, operating theatre, x-ray room, dental surgery, and two wards, along with offices and accommodation upstairs.

The clinic served the people of this valley for many years, offering a much-needed alternative to the arduous and expensive journey to Kullu or beyond. However, as with so much that we had seen, what was lacking was other doctors to carry on the vision. Now in his late 60’s and still going strong, Laji continues to work tirelessly in Manali and the Spiti Valley, but just cannot sustain clinics in every place where he has gone. So, apart from a small team of nurses offering basic healthcare and health education, the clinic lies empty, its ancient operating theatre and x-ray room a sad reminder of what could have been.

I wondered what to make of these broken dreams. Was it all misguided enthusiasm? An over-ambitious passion to bring hope and healing to those for whom it might otherwise be unattainable? Was it a failure? Or was it just a vision that had its time? A practical response to human need that brought a glimmer of light to some people? Perhaps, for those people, it was more than a broken dream, but a step towards healing and wholeness; a touch of compassion in an otherwise harsh existence; an offering of beauty in the brokenness of our world.

And so, still pondering on beauty and brokenness, we left Jhibi, for our final stretch down to the Kullu Valley and so to Manali, and the Aadisha Retreat House.

Aadisha

The world’s most treacherous road

Travels in Himachal Pradesh V: The world’s most treacherous road

The world’s most treacherous road?

From Kaza the Spiti river winds for miles Eastwards towards Tibet through steep narrow gorges, interspersed with all too brief openings of wider, fertile valleys. This sixth day of our trip was to be one of the longest, most challenging and most inspiring.

Above us, the rocky mountains towered unbelievably high, stretching up to the clear blue skies. Huge scree slopes with impossible paths traced across them alternated with enormous rocky outcrops. It was as though nature itself was challenging humankind to defy it. These mountains that had taken millennia to form, thrust up from the very foundations of the earth.

And humans had risen to the challenge.

Our road tracked along the side of the river: sometimes cutting through hard rocks close to the river bed itself, at other times, rising high above it in multiple bends to overcome the sheer rock faces rising above the raging torrents.

A steep climb in the Spiti Valley

After a stop for breakfast and a visit to the home of a student from the school Laji and Sheila had established in Manali, now a primary teacher in a small school in Tabo, we carried on Eastwards to the checkpoint at Sumdo. Here, the river turned south, skirting the Tibetan border and continuing down through ever more challenging gorges.

Signs along the side of the road proudly proclaimed this to be ‘the world’s most treacherous road’. And, to complement, this, the Border Roads Organisation (BRO) had commissioned a series of road safety signs, all bearing the signature Deepak. Whoever Deepak is, he clearly loves playing with words, so we were treated to a host of amusing philosophical musings, puns and rhymes:

‘Always Alert, Avoid Accidents’  

‘After whisky, driving risky’

‘A cat has nine lives, you only have one’

‘Stay alert, accidents hurt’

 

Once again, we had to marvel at the skill of our driver, and that of the countless other tourist vans, army vehicles, trucks and buses, as they made their way along this awesome highway. The BRO is working hard on a highway improvement scheme, gradually transforming this unsurfaced, single track road into a wide two-lane highway. But most of it remains single track (without passing places), and much either untarmacked or undergoing grading and surfacing. The most unbelievable incidents came when two vehicles met on one of these stretches. It is amazing just how narrow a road two large trucks can pass on, particularly where there is no clear edge to the road, a sheer cliff rising above you (and often overhanging above you) on one side, and an equally sheer cliff dropping down to the tumbling river far below. It is a wonder there aren’t more tragedies along these roads.

There seem to be three main occupations in the Spiti Valley: growing fruit and vegetables for export (the cool, high altitudes particularly favouring apples and peas, which are shipped out each season in trucks piled high with boxes of produce); the tourist industry, with all the restaurants, hotels and home-stays, tour experiences, and building works to support it; and road maintenance.

The skill of the engineers building and maintaining the roads is quite phenomenal. Each winter, the harsh temperature (dropping to -30°C or less), snows and rock falls wreak their havoc on the existing roads, so from April to October, there is a constant programme of clearing, regrading and surfacing, let alone any upgrading of the main routes. In places, the roadway has been literally chiselled out of a sheer, unforgiving rock face. In others, the challenge is to create a secure surface on the loose shingle of a scree slope.

Part way down the South-flowing route, we were held up for an hour as a huge digger worked to clear a rockfall that had completely blocked the road. We concluded this was a planned part of the upgrading programme, as there were workmen above the road at this point, painstakingly drilling dynamite holes in the solid rock. So much of this treacherous work is done by hand, with ancient pneumatic drills, hammers and stone chisels, all wielded on the sides of these precipitous rocks and with a minimum of safety equipment.

All in a day’s work: a bit of road maintenance

After another police checkpoint, the Spiti river joined the Sutlej river flowing through from Tibet and turned West into the region of Kinnaur. As darkness fell, the landscape gradually transformed, becoming increasingly green as we once more came out of the rain shadow of the lesser Himalayas. The road, too, became easier, with more and more of it paved, mostly wider, and with clear, marked sides. The remote, barren landscape was being replaced by signs of industry and commerce, huge hydro-electric projects, and sprawling towns spreading up the mountain sides, their myriad of lights shining out in the darkness.

 

White elephants in Kaza

Travels in Himachal Pradesh IV: White elephants in Kaza

The glorious colours of Mane

In contrast to his softly-spoken wife Sheila, Laji is like a modern-day itinerant rabbi or sadhu. And we his travelling disciples. There was nothing he loved more than discussing his thoughts and musings as we wandered among the fields of those Himalayan villages, or sat in the evening round the warming tandoor. Laji had a deep love for the people of these valleys, for their way of life, and for the surrounding beauty and awesome majesty of nature. He could draw deep philosophical and theological truths from observing a pair of oxen breaking up the clods of earth, or a shepherd bringing his flock of sheep down from the mountain heights.

As a follower of Jesus, Laji had his questions – deep, challenging dilemmas heightened by the powerful, demanding landscape. He loved to serve others – whether through an impromptu medical consultation, or by entertaining a group of village children; and he was clearly loved by the people he has served. Over the years he and his wife Sheila have established clinics, small hospitals and school rooms, and led teams of doctors and nurses in providing health services to these remote areas. And yet, he longed to bring more to these people. He saw the impact of drink and gambling on the men of these valleys – men who struggled to cope with the harshness of their lives and the long, cold winter days with nothing to do. He saw the fear etched into people’s hard-lined faces; the resignation brought by an ultimate belief in dharma and an individual’s lack of capacity to change the way things are. He saw the corruption and greed that limited progress and ignored the most vulnerable in these societies.

And yet, he knew that our typical Western, or even Indian, Christianity had little of meaning to offer to these people, and so often came tainted with all the trappings of Western consumerism. To seek to impose his beliefs on others would be both meaningless and arrogant, showing little respect for their own deep beliefs and way of life. So he longed for an authentic faith which he could share; one which would respect the spirituality and traditions of these people; one which would affirm their unity with nature and their commitment to peace; one which could offer genuine hope in the face of their fear and resignation, tangible grace in the midst of the harsh realities of their lives, and practical love for each individual, no matter what their lot in life.

As we spent time in the Spiti Valley, I, too, could share something of Laji’s hopes and dilemmas. The sheer magnitude of the mountains around induced a sense of humility and respect. Any concept of a creator had to be so much greater than my own, limited understanding of who or what that creator might be.

Looking down to Mane from the ridge above

On our second morning in Mane, I took an early walk up through the village and the poplar groves above, then on up the slopes behind. My path took me up to a shoulder of the ridge from where I was treated to another stunning view up a small hidden valley beyond – once more with golden groves of trees and terraced fields nestling among the tumbling boulders and scree of the higher mountains. Later in the day, I would look back from across the valley and realise just how miniscule my walk had been – the shoulder I had climbed completely dwarfed by the gargantuan mountains above.

Looking back towards Mane – the ridge I’d climbed can just be seen above the yellow of the poplar groves towards the bottom left

We were heading back to Kaza where we needed to pick up fresh passes for the road south. But Laji took us via the monastery of Dhankar – a classic Tibetan monastery clinging desperately to a rocky outcrop. While Sheila, Laji and the driver remained at the monastery, relaxing in the café, Lois, Amanda, Juan and I enjoyed a strenuous climb to Dhankar lake. This beautiful lake, at over 4,000m and surrounded by Himalayan peaks was a highlight of the trip. A haven of peace and stillness with just a gentle breeze rippling over the turquoise waters, and fluttering the prayer flags on the adjacent stupa. We were surprised to see two cormorants sitting on the bank on the far side of the lake, then even more surprised to find several large shoals of carp shimmering in the warm, muddy shallows.

Dhankar Lake

As we set out from Dhankar, we spotted a number of women pursuing a pilgrimage of penance up the road to the higher monastery. Each one would stand, kneel and then lie down on the road, stretching out her hands before her and placing a stone at their extremity. She would then stand again, move forward to where the stone was placed, pick it up and start over again. Thus, slowly, each woman would inch up towards the monastery and the goal of her pilgrimage. Perhaps, I thought, I have something to learn about commitment and devotion to my own faith.

Dhankar Monastery

From Dhankar, another winding mountain road brought us back to the life and bustle of Kaza. Here, Laji and Sheila had built a small hospital and school room some years ago. The clinic still operated intermittently, and the pre-school more regularly, but there weren’t the people to keep it going the way Laji had originally hoped. It was a pattern we were to see elsewhere on this trip. Even more troubling here in Kaza though was the Community Centre in which we stayed. This had been built in 2015 as part of the inspiring Spiti Valley Project. Championed by a charismatic English woman, Joan Pollock, the project has brought healthcare, education and community developments to many throughout the Spiti Valley. The Kaza community centre was one such project, inspiring in its ecological design and vision for the community. However, four years on from its grand opening, the centre came across as unused – a pristine white elephant that has failed to fulfil its objectives. A craft room, dining room, meeting room and library lie empty and unused by the community. The John Lewis towels and bedding in our rooms seemed bizarrely out of place, and we wondered how they fitted with an emphasis on empowering and encouraging the local people. Was this just another example of something good and well-intentioned that had failed to engage effectively with the very people it was provided for?

One striking feature of Indian life is their capacity for leaving everything seemingly half finished. All over Kaza, as elsewhere on this trip, there were buildings going up, a rush responding to the continued influx of tourists and their love for ‘homestays’. But it was often difficult to tell which buildings were newly constructed, which were still being built and which had been built some time ago, but left with protruding iron rods or concrete pillars. Perhaps, though, looking at it through another lens, it is us Westerners, with our fixation on having making everything neat and tidy – on having to have everything resolved and tied up – who are the foolish ones. Why spend thousands of pounds finishing off your house, then spend thousands more to take off the roof, insert reinforcement beams and add a dormer when you decide you want to expand? Surely it is far better just to leave it ready to add to once you can afford to do so? And perhaps the same is true of our philosophies, science and religion: we do so love to have everything explained, neatly packaged and complete. Perhaps we in the West could learn something from our Indian brothers and sisters about leaving things unresolved, mysterious and open-ended.

And then there was the row of western toilets Lois and I came across as we wandered across the fields from Kaza. Someone had obviously decided to build a tourist camp on the plateau above the river. They had got as far as putting in the plumbing and the toilet bowls, but clearly run out of money or drive, so they sat, each on a concrete plinth, beneath the wide, blue sky, ready for another season, another day…

A row of white elephants?

As with Laji’s musings on what his Christianity could possibly bring to these people, so, too, with a more secular community development project. While both may bring some benefit to individuals (and, perhaps, even great benefit to a great many people), real, lasting change cannot rely on individual charismatic personalities; it has to start with the people, with listening; with walking the long, hard road with them; with breaking out of our own preconceptions of what is good or right for others.

Saints with human faces

Travels in Himachal Pradesh III: Saints with human faces

 

One of the benefits of growing up in Hong Kong, having worked in Cambodia, and my long association with the Mission Servants to Asia’s Urban Poor, is the number of inspiring people I have been privileged to know: modern-day saints who have given of themselves in the service of others.

Sheila and Laji

Sheila and Laji are two such people. Both from South India, they met and married at medical school in Ludhiana. Shortly after qualifying, they moved to Manali to fill a gap left by the departure of the resident physician at the local mission hospital. That was forty years ago. Laji – an energetic and engaging character – recounts how they had a six-month handover during which he was taught to do everything – general medicine, infectious diseases, surgery, anaesthesia, orthopaedics, gynaecology. As the sole resident doctors and with no tertiary hospital to refer to, they just had to cope with whatever came their way. For many of their patients – some of whom had trekked for days on foot or donkey back to reach them – they knew that, no matter how unqualified they felt, if they did nothing, the patient would die.

And so they stayed on in this remote part of Northern India, learning on the job, making do with whatever limited resources they had, and trusting that somehow their efforts would make a difference to at least some of those who came to them.

As we travelled through the Spiti Valley, it soon became clear just how much of a difference they have made to so many people’s lives. Everywhere we went, people would come up and greet them warmly and Laji would tell us how they had helped them: ‘I treated that woman’s brother for meningitis’ or ‘this person was brought to us as a child with intestinal obstruction’. For some, the outcomes had been less favourable: adults with cancers for which no treatment was available; those with advanced tuberculosis which had spread throughout their bodies; or alcohol-related liver disease. Or the woman who had trekked three days across the snow-covered passes to Manali, carrying her child wrapped warmly on her back, only to find that the child had died on the way.

Our landlady in Mane, was one of the more fortunate ones. Laji had first met this wonderful couple when he had come trekking in the Spiti Valley. J had been his guide and, at the end of the trek, had asked Laji if he could take a look at his wife, S, who was unwell. Laji had diagnosed peritonitis with advanced shock, but with no medical equipment to hand felt very pessimistic about the outcome.

At that time, Mane had no road or bridge connecting it to the outside world. So they had set out along a narrow track up the valley, S on donkey back. Several kilometres up there was a cable basket crossing to the road on the other side. There they were able to flag down a passing truck to Kaza where Laji was able to beg some IV fluids to mitigate some of the effects of shock. They then hired a jeep to take them the arduous 200km journey over the Kunzum and Rohtang passes to Manali.

Remarkably, S survived, though left infertile as a result. She and her husband were wonderful hosts during our two days in Mane.

For me, those two days were really the highlight of the trip. Mane is a beautiful village, nestling in a small valley on the South side of the main Spiti river. The village itself is surrounded by small fields and groves of golden poplar trees. In spite of a steady increase in prosperity since the building of the road – the valley here is a prime area for growing peas which are now exported as a cash crop to the rest of India – the village retains some of its charm and a way of life that has existed for centuries. Until recently all the homes were traditional Tibetan houses of mud and wattle, each with its store of cow dung for burning in the tandoor stove that heated the one room for cooking, eating, sitting and sleeping.

Breaking up the hard, rocky ground

That morning we went for a walk over to the next village. Strolling out through the small paddies, we stopped to watch two of the villagers ploughing a field with a pair of Choru (a robust cross between a yak and a Jersey cow). As they ploughed, the farmer sung a repetitive chant to encourage the beasts as they broke up the hard, dry soil. And then, cutting across the serenity of the scene, as though to remind us that Western ‘progress’ infiltrates everywhere, the grating sound of the Nokia theme tune broke the stillness of the rural life.

Once ploughed, teams of donkeys carried huge sacks of cow dung to spread over the fields as fertilizer, and they would then be left, ready for planting once the snows melt in the spring.

However, that way of life is slowly changing. Increasing prosperity and education have meant that many of the young people in these villages travel to the big cities for college. Having tasted a different way of life, too many no longer want to return to the harshness of this remote existence at the edge of civilisation. At the same time, the wealth brought by their cash crops and by tourism has prospered the village and resulted in a building spree. Only now, rather than using the traditional methods and local materials, the homes being built are grand brick and concrete mansions, constructed with cheap Bihari labour, and altering the picturesque feel of the place.

Sheila had described Mane as an ‘Asterix’ village, with narrow stone-walled lanes connecting all the little dwellings. In contrast, one of the saddest things I saw was one area of fields and poplar groves surrounded by a concrete wall topped by a barbed wire fence. A village where once everyone knew and trusted each other now succumbing to greed and suspicion.

An ‘Asterix’ Village

How I would love to see some way in which these remote villages could enjoy the benefits of progress – good health care, education, and easing of their harsh existence, without all the negative trappings of greed, mistrust and exploitation that seem to go with it; for the people of these valleys to be able to live in harmony with their environment, tradition and culture, rather than embracing wholesale our Western materialism.

And, as I reflect on the damage caused to this traditional way of life, I have to acknowledge my own complicity in these fractures of our world.