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Medicines, Travellers and the Introduction and Spread of ‘Modern’ Medicine in the Mt Everest Region of Nepal

Published online by Cambridge University Press:  17 May 2012

Susan Heydon
Susan Heydon
Affiliation:
*Dr Susan Heydon, School of Pharmacy, University of Otago, PO Box 56, Dunedin 9054, New Zealand. Email: [email protected]
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Abstract

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The significant contribution of medicines in the introduction and spread of ‘modern’ medicine has, with the exception of vaccination, been neglected in historical studies, yet medicines have been a significant factor in people’s experiences of sickness and in their use and non-use of health services. Although medicines are implicitly acknowledged in the literature as important in the provision of healthcare, this article uses a case study of the Mt Everest region of Nepal during the second half of the twentieth century to argue that medicines have had an explicit and central role in the introduction and spread of modern medicine in this region. It also highlights the importance of travellers in the process. While this article focuses on biomedical products, modern medicine, as elsewhere in the wider Himalayan region, continued to be practised within a changing but plural medical environment. The first part of the article discusses medicines and travellers who, in the absence of biomedical services, were the main source of medicines prior to the mid-1960s, while the second part considers medicines and Khunde Hospital, which was built in 1966 by the area’s most famous overseas traveller and became not only the area’s main provider of modern health services but also the main source of medicines.

Keywords

Medicines‘Modern’ MedicineMedical PluralismTravellersNepalSherpasSir Edmund HillaryKhunde Hospital
Type
Articles
Information
Medical History , Volume 55 , Issue 4 , October 2011 , pp. 503 - 521
Copyright
Copyright © The Author(s) 2011. Published by Cambridge University Press

References

1 Norman Hardie, In Highest Nepal: Our Life Among the Sherpas (London: George Allen & Unwin, 1957), 121.

2 In this article I have mostly used ‘modern medicine’ to refer to what is variously referred to in the literature as Western medicine, modern medicine, biomedicine, scientific medicine, cosmopolitan medicine or allopathic medicine. Multiple terms reflect multiple views. In Nepal, ‘modern medicine’ and ‘modern medicines’ are commonly used, as is ‘allopathic’.

3 Annual Report, 1935 and 1936, Nepal. File: Nepal, General, Annual Reports 1937–1945 EA 1 Box 132 240/1/2 part 1A [Archives New Zealand/Te Rua Mahara o te Kawanatanga, Head Office, Wellington, hereafter ANZ].

4 Report on Routes by Explorer Hari Ram, Records of the Survey of India: 8(2) Exploration in Tibet and Neighbouring Regions, 1879–1892 (Dehra Dun: Survey of India, 1915), 383.

5 ‘I have always made my explorers take a supply of medicines with them, mostly of native kinds, with only a few ordinary European sorts to present to people on their journeys.’ Memorandum on the Trans-Himalayan Explorations for 1871 by R.E. Montgomerie, Deputy Superintendent G.T. Survey, in charge of the Trans-Himalayan Exploring Parties in Records of the Survey of India: 8(1) Exploration in Tibet and Neighbouring Regions, 1865–1879 (Dehra Dun: Survey of India, 1915), 116.

6 Michael Worboys, ‘The Spread of Western Medicine’, in Irvine Loudon (ed.), Western Medicine (Oxford: Oxford University Press, 1997), 249–63: 255.

7 Jude Hill, ‘Globe-trotting Medicine Chests: Tracing Geographies of Collecting and Pharmaceuticals’, Social & Cultural Geography, 7, 3 (2006), 365–84; Ryan Johnson, ‘Commodity Culture: Tropical Health and Hygiene in the British Empire’, Endeavour 32, 2 (2008), 70–4.

8 Alex McKay, Their Footprints Remain: Biomedical Beginnings across the Indo- Tibetan Frontier (Amsterdam: University of Amsterdam Press, 2007).

9 Ibid., 176.

10 Susan Heydon, Modern Medicine and International Aid: Khunde Hospital, Nepal 1966–1998 (New Delhi: Orient BlackSwan, 2009). Between 1996 and 1998 my husband (a medical doctor) and I were volunteers for the Himalayan Trust at Khunde Hospital. This experience, together with ongoing involvement and subsequent visits, has underpinned my research. It has given me access to the archives of the hospital and, as I wrote in the introduction to the book (27–8), an entry into the local community and people’s lives that was more difficult for an outside researcher. As such, I did not wish to abuse this privilege or people’s hospitality by asking questions that people would not want to answer. I also knew that there were people with whom it would have been useful to talk, especially those more ambivalent towards the hospital and modern medicine, but because I was associated with the hospital they would have been reluctant to criticise it. I have used ethnographic accounts to help fill some of these gaps.

11 Susan Reynolds Whyte, Sjaak van der Geest and Anita Hardon, Social Lives of Medicines (Cambridge: Cambridge University Press, 2002), 10.

12 Mark Nichter, Global Health: Why Cultural Perceptions, Social Representations, and Biopolitics Matter (Tucson: University of Arizona Press, 2008), 85.

13 My use of the expression ‘the Sherpa’ refers to the ethnic group and is in no way intended to homogenise the considerable variation that exists within and between different groups of Sherpas.

14 Sherry Ortner Paul, ‘Food for Thought: A Key Symbol in Sherpa Culture’ (unpublished PhD thesis: University of Chicago, 1970), 166–75.

15 John Draper, ‘Beyond Medicine: Sickness, Healing, and Order in Sherpa Society’ (unpublished PhD thesis: University of Sydney, [1995]).

16 McKay, op. cit. (note 8), 27–8.

17 Ibid., 28.

18 Michael H. Fisher, Indirect Rule in India: Residents and the Residency System 1764–1858 (Delhi: Oxford University Press, 1991), 414–22; Asad Husain, British India’s Relations with the Kingdom of Nepal 1857–1947: A Diplomatic History of Nepal (London: George Allen and Unwin, 1970).

19 Eugene Bramer Mihaly, Foreign Aid and Politics in Nepal: A Case Study, 2nd edn (Lalitpur, Nepal: Himal Books, 2002 [1965]).

20 Hemang Dixit, Nepal’s Quest for Health, 3rd edn (Kathmandu: Educational Books, 2005), 13.

21 Ibid.

22 Lily M. O’Hanlon, At the Foot of the Fish-Tail Mountain (Varanasi: Pilgrims, 2005).

23 Ibid., 30.

24 S.D.R. Lang and Ann Lang, ‘The Kunde Hospital and a Demographic Survey of the Upper Khumbu, Nepal’, New Zealand Medical Journal 74, 470 (1971), 1–8. A common alternative to the spelling of Khunde is Kunde.

25 Jan Minderhoud, ‘The Christian Presence in Nepal before 1951’, Indian Church History Review (December 1990), 144–64.

26 Author interview, Ang Rita Sherpa, Chief Administration Officer, Himalayan Trust, Kathmandu, 29 June 2003.

27 Stanley Stevens, Claiming the High Ground: Sherpas, Subsistence and Environmental Change in the Highest Himalaya (Delhi: Motilal Banarsidass, 1996 [1993]), 343.

28 Draper, op. cit. (note 15), 96.

29 Louise Hillary, A Yak for Christmas (Garden City, NY: Doubleday, 1969), 161.

30 Author interview, Dr Lhakpa Norbu Sherpa, Dunedin, 16 January 2005. He was the first Sherpa to gain a PhD and a former warden of the Sagarmatha National Park.

31 Heydon, op. cit. (note 10), 100–12.

32 Draper, op. cit. (note 15), 371–89.

33 Ortner Paul, op. cit. (note 14), 168.

34 Ibid., 170.

35 Author interview, Dr Kami Temba Sherpa, Khunde Hospital, 15 February 2010.

36 Ibid.

37 Report on Routes by Explorer Hari Ram, op. cit. (note 4), 386.

38 Ngawang Tenzin Zangbu, Stories and Customs of the Sherpas, Frances Klatzel (ed.), (Kathmandu: Mera Publications, 2000), 58.

39 R.W.G. Hingston, ‘Medical Notes’, in E.F. Norton, The Fight for Everest 1924 [1925], repr. (Varanasi: Pilgrims, 2002), 350–3. The list includes a ‘Congo’ medicine chest. See Hill, op. cit. (note 7).

40 Eric Shipton, Upon that Mountain [1943], repr. (London: Pan Books, 1956), 124.

41 F.S. Smythe, Camp Six: An Account of the 1933 Mount Everest Expedition, 2nd edn (London: Hodder and Stoughton, 1938), 77–8. At this time, expedition ‘Sherpas’ included Tibetans as well as ethnic Sherpas.

42 Ralph Izzard, An Innocent on Everest (New York: E.P. Dutton, 1954), 67. Paludrine is an antimalarial drug. The more neutral term 'porter' has replaced 'coolie'.

43 Hardie, op. cit. (note 1), 120.

44 Izzard, op. cit. (note 42), 67.

45 Christoph von Fürer-Haimendorf, The Sherpas of Nepal: Buddhist Highlanders (London: John Murray, 1964), xv–xvi.

46 James F. Fisher, Sherpas: Reflections on Change in Himalayan Nepal [1990], repr. (Delhi: Oxford University Press, 1997), 148.

47 Hardie, op. cit. (note 1), 120.

48 Ibid., 119.

49 Author conversation with Shyam Pradhan Krishna, Khunde, 6 December 1996. Shyam went to Khumjung as a teacher in 1965. I do not know how extensive this practice was or for how long it continued as I was unable to follow this up with Shyam who died in 1998. The overseas staff who were working at Khunde Hospital in 1966 were unaware that this was occurring.

50 Author interview, Sir Edmund Hillary, Kathmandu, 16 April 1997.

51 M.B. Gill, ‘The Sherpas: A Survey of an Isolated Mountain Community’ (unpublished fifth-year dissertation: Department of Preventive Medicine, University of Otago, 1961), 16.

52 Edmund Hillary, Schoolhouse in the Clouds (London: Hodder and Stoughton, 1964), 40–9; Heydon, op. cit. (note 10), 49–51.

53 Hillary, op. cit. (note 52), 48.

54 Ibid., 42. Hillary later received a bill for 800 rupees (US$105).

55 Ibid., 49.

56 Ian McIntosh to Hillary, 21 September 1963. File: Himalayan Climbing Expeditions & Schoolhouse Project ABHS 6949 W4628 NDI 64/14/2 Part 2, ANZ.

57 Michael Gill, Mountain Midsummer: Climbing in Four Continents (London: Hodder and Stoughton, 1969), 176.

58 Ibid.

59 Ibid., 175–7; Hillary, op. cit. (note 52), 47.

60 Gill, op. cit. (note57), 177.

61 For a history of Khunde Hospital, see Heydon, op. cit. (note 10).

62 Despite its small size, it has always been called a hospital.

63 The hospital has no trained pharmacist or pharmacist assistant.

64 Ian Harper, ‘Mediating Therapeutic Uncertainty: A Mission Hospital in Nepal’, in Mark Harrison, Margaret Jones and Helen Sweet (eds), From Western Medicine to Global Medicine: The Hospital Beyond the West (New Delhi: Orient BlackSwan, 2009), 303–29.

65 ‘Outline of Patients seen from 1/1/67 until 31/3/67’. File: Annual Reports 1967–1983, Khunde Hospital archives [hereafter KH].

66 J.R. McKinnon, 'Health Problems of Khumbu: A Review of the First Nine Months Work at Kunde Hospital', Report to the Minister of Health, His Majesty’s Government of Nepal, 6 October 1967. File: Annual Reports 1967–1983, KH. This report was later published as 'Health Problems of Khumbu in Nepal: The Work at the Kunde Hospital', New Zealand Medical Journal, 67, 140 (1968), 140–3.

67 Outpatient register, KH.

68 McKinnon, op. cit. (note 66), 2.

69 Letter from the Himalayas No. 2. From Mrs Lesley Evans, Hillary Hospital, c/- British Embassy, Kathmandu, Nepal. File: Articles and letters from ex Khunde doctors (early), KH.

70 Author interview, Nima Yangen Sherpa, Kathmandu, 1 July 2003.

71 Dorothy S. Mull, Jon W. Anderson and J. Dennis Mull, ‘Cow Dung, Rock Salt, and Medical Innovation in the Hindu Kush of Pakistan: The Cultural Transformation of Neonatal Tetanus and Iodine Deficiency’, Social Science and Medicine, 30, 6 (1990), 675–91.

72 Author interview, Dr Lhakpa Norbu, 2005.

73 Heydon, op. cit. (note 10).

74 Ortner Paul, op. cit. (note 14), 166–7.

75 Martin Gaenszle, ‘The Shaman and the Doctor: Conflicting Systems of Interpretation and Diagnosis in East Nepal’, in Dorothea Sich and Waltraud Gottschalk (eds), Acculturation and Domination in Traditional Asian Medical Systems (Stuttgart: Franz Steiner Verlag, 1994), 53–60: 56.

76 Author interview, Nima Yangen, 2003.

77 In the ‘Outline of patients’, op. cit. (note 65), 10% of patients were diagnosed as having respiratory complaints.

78 Lesley Evans, 17 August 1968. Letters from Nepal from Dr Richard and Lesley Evans to their family, 1968–69 (hereafter Evans papers). I am grateful for their permission to consult this wonderful collection.

79 McKinnon, op. cit. (note 66), 6.

80 Author interview, Nima Yangen, 2003.

81 Ortner Paul, op. cit. (note 14), 103–4.

82 John C. Chalker, Madhu Kapali and Bhagwati Khadka, ‘Health Post Usage in a Mountain District, in Eastern Nepal: A Focus Group study’, 16 May 1990, KH.

83 19 April 1982, Hospital Advisory Committee Book (hereafter HACB), KH.

84 Letter from the branch officer, Salleri, to the doctors, Khunde Hospital, 24 August 1982, HACB.

85 10 September 1982, HACB.

86 Outpatients at Khunde Hospital, Appendix 3, Heydon, op. cit. (note 10), 319.

87 McKinnon, op. cit. (note 66), 2.

88 Temporary settlements, such as those in the higher summer pasture areas, were even further away.

89 Boys were more likely to have had some education.

90 McKinnon to Dr Das, Director, Department of Health, Kunde Hospital: Six Monthly Report Dec.'67/May'68, KH. The hospital reports, initially six-monthly and annually from 1970, have different titles, spelling and dates. While it might have been useful to standardise in this article for the sake of clarity, the titles are retained as written on the document for reasons of authenticity. The variability is characteristic of Khunde Hospital’s history.

91 Lang and Lang, op. cit. (note 24), 6.

92 Kunde Hospital Report for the Year Ending 31st October, 1971 – Including an Analysis of Cases since 1st January, 1967–1971.

93 Judith Justice, Policies, Plans & People: Foreign Aid and Health Development (Kathmandu, Nepal: Mandala in association with University of California Press, 1986), 81.

94 H.V. Wyatt, ‘The Popularity of Medicines in the Third World: Origins and Consequences for Poliomyelitis’, Social Science & Medicine, 19, 9 (1984), 911–5; Whyte, van der Geest and Hardon, op. cit. (note 11), 104–16. Due to the different sources for obtaining medicines, variable record keeping over time by the overseas volunteers and a probable lack of interest in the issue, it is not possible to quantify the percentage of injections compared with orally administered medicines with any degree of certainty. Future research will focus on different types of medicines and patients’ perspectives.

95 Hillary Sherpa Hospital Report 23 August [1968] to 27 February 1969.

96 Kunde Hospital Annual Report 1 September 1983 – 31 August 1984.

97 Ibid.

98 Kunde Hospital and Village Clinics Annual Report 1997.

99 Heydon, op. cit. (note 10), 58–9.

100 Ibid., 80–1. Since the late 1970s most of the funding for Khunde Hospital has come from the Sir Edmund Hillary Foundation in Canada.

101 Kunde Hospital Annual Report 1 November 1969 to 21 October 1970; personal communication, Diane McKinnon, 24 November 2005.

102 Report on Kunde Hospital compiled for the WHO/Pan American Health Organisation/International Biological Programme investigation of high altitude facilities, 18 July 1968, KH.

103 Lesley Evans, 27 February 1969, Evans papers.

104 Hemang Dixit, The Quest for Health, 2nd edn (Kathmandu: Educational Enterprise Ltd, 1999), 89.

105 21 June 1975. File: Dear Successor, KH.

106 Letter from Paul Williams, pharmacist, Shanta Bhawan Hospital, Kathmandu to McKinnon, Himalayan Trust. File: Assorted papers, KH.

107 File: Old drug receipts and orders, KH.

108 Kunde Hospital Annual Report August 1987 to August 1988.

109 World Health Organization, The World Medicines Situation (Geneva: WHO, 2004), Annexe Table 3.

110 Kunde Hospital Annual Report August 1987 to August 1988.

111 [Kunde] Hospital Annual Report for the Year Ending October 31st, 1974.

112 Letter from K.B. Mathema, Programme Officer, UNICEF, copied to Dr H.D. Pradhan, Senior Public Health Administrator, Department of Health Services, to Dr Rob Riley, Khunde Hospital, 13 August 1976. File: UNICEF, KH.

113 Kunde Hospital Annual Report 1 June 1991 to 31 May 1992.

114 Heydon, op. cit. (note 10), Appendix 5, 322; Kunde Hospital Annual Report 2008/2009.

115 Kunde Hospital Annual Report for the Year Ending 30 June 1976.

116 9 February 1982, HACB.

117 Ibid.

118 Khunde Hospital Annual Report February 1993 – January 1994.

119 Kunde Hospital Annual Report August 1987 to August 1988.

120 Author conversation with Dr Kami Temba Sherpa, Khunde Hospital, 15 February 2010.

121 Shahzad Hussain, Farnaz Malik, Abdul Hameed, Safi A. Ahmad, and Humayun Riaz, ‘Exploring Health Seeking Behavior, Medicine Use and Self Medication in Urban and Rural Pakistan’, Southern Med Review, 3, 2 (2010), 32–4.

122 Mohan P. Joshi and Balkrishna Khakurel, ‘Drug Rationalization: Now for the Hard Part’, World Health Forum, 18 (1997), 348–51: 348.

123 Kunde Hospital Annual Report February 1995 – January 1996; Dan Morrow, Nawang Doka Sherpa and W.H. Fallon, ‘Dentistry at the Top of the World’, Journal of the Canadian Dental Association, 64, 8 (1998), 558, 560.

124 Amchi Tenzin Bista and Amchi Gyatso Bista, Himalayan Doctors and Healing Herbs: The Amchi Tradition and Medicinal Plants of Mustang (Kathmandu: Mera Publications for Lo-Kunphen Mensikhang, 2005).

125 <http://www.sacredland.net/medintro.htm>, accessed 13 December 2007.

126 Personal communication, Rangit Gurung, Supervisor, Himalayan Trust Forestry, 2 February 2010. The Himalayan Trust nursery at Phurte grows some plants.

127 Personal communication, Christopher Heydon, 15 December 2009 and Mingma Temba Sherpa, Khunde Hospital manager, 11 February 2010.

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