Hektoen International

A Journal of Medical Humanities

The boys who did not come back from the brink

Ravi Shankar
Lalitpur, Nepal

house in mountains
Nepal – Embraced by Shangrila (Nghe, Barun Valley). Photo by Dhilung Kirat on Flickr. CC BY 2.0.

Lying unconscious on the stone floor, the 14-year-old boy bled profusely from a huge slash across his chest. Ram laughed, the sound resembling the screeching gears of a heavily loaded truck groaning slowly uphill. I frantically tried to staunch the flow of blood with towels and clothes—Ram’s maniacal laughter an incongruous accompaniment—as the child’s life slowly ebbed away before my eyes.

It was Dashain, Nepal’s biggest festival, a commemoration of the victory of the goddess Durga over the demon, Mahishasur. An enormous celebration, the entire world had seemed to partake in the festivities. The skies blue, the flowers in bloom, a sweet scent spread on the wings of the breeze. As travelers dressed in new clothes traversed long distances to visit families and friends, birds serenaded each other, and snow-clad mountains stood attentive on the distant horizon. Village belles looked especially svelte and beautiful in colorful clothes—flowers in their hair, a smile on their lips, their tinkling laughter echoing through the verdant hills. Never expecting a medical emergency, I was caught completely unprepared for the events that transpired.

Krishna and I were relaxing on the porch, having enjoyed a delicious lunch of rice, vegetables, goat meat, and lentil curry. Suddenly jolted by screams from the millet fields, we ran to find a grisly scene, from which six shadowy figures fled down the hillside. Carrying the unconscious boy ten meters to the stone porch of the house, we helplessly watched his life rapidly slip away.

I later learned the boy’s name was Ramesh. Having only come to the village the previous day from Pokhara (a lakeside city in western Nepal), he was staying at a relative’s house. How he came to that distant field, the identity of his murderers, and their motivations remain a mystery. Ramesh’s sad demise put me in a contemplative mood. Scared, I reflected on my short time in this seemingly peaceful village.

After graduating from medical school, I had been posted to a lone Nepalese primary health center that served a large and scattered area of nearly 50,000 people. Medical school had not adequately prepared me for rural service. A civil war that had lasted a decade continued to terrorize the village. With doctors unwilling to serve, the health center had stayed locked for nearly two years. Mirroring the situation in other remote villages during the civil war, jhankris (faith healers) had become the only source of medical care. Often respected healers of the local community, jhankris enjoyed the easy trust of the villagers, who identified with them. Doctors were frequently perceived as educated city-dwellers. Thus, in many medical cases, villagers would first call a jhankri.

On my arrival, everything appeared strange. Cursing my medical school and government for sending me to a rural health facility without adequate preparation, I often contemplated running back to Kathmandu. As a rank outsider, getting the health center’s older paramedical personnel, village residents with deep roots to the soil, to follow my orders was next to impossible. The worst part was the loneliness I felt. I missed the hustle and bustle of Kathmandu, which seemed light-years away.

Gradually I adapted to life in rural Nepal. I eventually grew to appreciate the slow, ancient rhythms of village life. Life was lived at a gentle, unhurried pace as God intended. The deep silence, which only an absence of the automobile could bring, was occasionally broken by the sweet call of birds. Nights were silent and dark, and I slept better than I ever have, before or since. Eventually, the people became less threatening, and some even became friends.

My closest friend was Krishna. In his mid-twenties like me, he and his family cared for Ram. Two or three months after my posting, we met when Krishna brought Ram to me for treatment of a skin infection. Through Krishna, I came to know the rest of the family, whom I readily adopted. Occasionally being called to quiet Ram during one of his “attacks” and talking to visitors of the health center, I slowly pieced together Ram’s sad history.

At 16, Ram had excelled as the best student in the village school, but during a raid Ram’s father and mother were slashed to death with khukris (the Nepalese knife). As his parents perished before his eyes, Ram found himself and his future at the mercy of his neighbors. Eventually becoming most comfortable with Krishna’s family, Ram spent most of his time in their large house.

The civil war had created many orphans, mostly from the poorer sections of society. While most endured nightmares in which they relived their trauma; others, like Ram, withdrew. Now a morose man, Ram, always tidy in traditional village dress—tight-fitting pants loose in the seat, a waistcoat, and a cap—would stumble about the porch of the house, his deep eyes seeing but registering nothing. Sometimes becoming uncontrollably abusive, Ram destroyed whatever was at hand and beat those who challenged him. Had they occurred with greater frequency, these episodes would have found Ram chained to a cowshed, the fate of those with similar streaks of violence. In desperation the family had called the village jhankri, who treated him without success.

Ram had the peculiar habit of bursting into maniacal laughter whenever he witnessed someone dying. Unusual even for survivors of the war, I was fascinated by his case early on, admiring his caretakers for treating him so well. As medications were mostly unavailable in the village, Ram remained untreated, but I procured a supply of tranquilizers to address his episodes of violent behavior. Though I advised Ram’s family that he would be best served in a mental hospital, they preferred to care for him themselves. Gradually becoming less violent and more withdrawn, Ram never emerged from the heaven or hell where he dwelled, even for simple conversation.

Years slowly trickled by and I eventually became faculty in a medical school in Pokhara. One day, I met an old villager who told me Ram had passed away. He was not clear on how Ram had died, and I was sad that Ram was no more. But I was also relieved that a person who had suffered so much finally had found some degree of peace. As a Hindu, I believe in reincarnation; I hope Ram’s next life will be a better and happier one.

The victims of senseless violence, Ram and Ramesh never came back from the brink; one killed, the other having lost his mind. I often wonder about the waste of life, life that could have bloomed into a beautiful flower. Many buds promise so much, but cruel nature flings them heedlessly into the callous mountain wind.

DR. P. RAVI SHANKAR is a professor of medical education and pharmacology at KIST Medical College, Lalitpur, Nepal. He conducts a medical humanities module for first-year medical students and is keenly interested in trekking and healthcare issues of rural Nepal. He is a creative writer who often writes for magazines and newspapers in Nepal.

Highlighted in Frontispiece Volume 4, Issue 2 – Spring 2012

Spring 2012



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