Author Archives: Katrin Becker

….. And then it was time to return home.

We reviewed our whole trip and discussed the implementation of our recommendations.

We met with the KADO solar panel project manager and donated a solar lantern for their review and modification. These excellent LED lanterns were designed and donated by Faith and Anthony Harkham, Canmore, Alberta, Canada. We are very indebted to them for their design work and donation.

Despite the threatening clouds and rain the following morning , we managed to get a flight back to Islamabad from Gilgit…which saved us many hours travel on the KKH and closer to our departure city.

It was a very productive and enjoyable trip. It would not have been possible without the great support and hospitality of the people of Hunza !

I would especially like to thank Imran, Zulfi, Mubeen, Ashraf, Alam Jan and the rest of the KADO staff for their tireless support during our visit and being responsible for making it a success.

Early in the morning of July 12^th we set off from Passu to the Yashpirt summer pasture on the Batura Glacier (fourth longest glacier in the Karakorum).

Our team included Imran, 2 porters Ghulam Haideo and Ameer Ahmed Jan, Pat and myself.

Our objective was to hike up the lateral moraine above Passu, cross the Batura glacier, and hike along the northern edge ascending above the glacier to the shepherd’s summer camp of Yashpirt at 3302m.

In spring, residents of Passu area travel with their goats/sheep and yaks to the summer pastures of Yashpirt. They return to Passu in the autumn moving their animals to winter pasture lower down.

Our focus was to do health assessments and health education with the shepherds in the pasture.

We started out early to avoid some of the mid-day heat. We had nice temperatures as we ascended the moraine. The temperatures increased as we crossed the broken up, convoluted glacier and increased further as we hiked along its northern edge. We had some relief from the intermittent shade of the lush wild rose bushes, juniper, willow and tamarisk as we moved closer to Yashpirt. It should be noted that there is no easy access to potable water from the trail head until close to Yashpirt. In the late afternoon we ascended to the juniper protected Yashpirt summer pasture to be greeted by two shepherds. They had just come down from the high country with their 2000 sheep and goats. We had a cup of chai before they put their animals into their nightime safe enclosure to protect them from predators. The main predators in this area are foxes, wolves and snow leopards.

This year the residents of Passu decided to delay their move up to the summer pasture until a week later because of the weather.

We did health assessments on those shepherds that were there and discussed some of the potential health issues associated with people living close to their animals.

We discussed reducing or preferably eliminating adding salt to chai and increasing daily water intake. We discussed the greenhouse idea and solar powered electric fences to avoid overgrazing.

We camped on a beautiful grassy area looking across at the upper Batura glacier, Batura Peak and surrounding ice floes.

We were treated to the powerful sounds of calving ice from the glacier throughout the night.

We donated a solar lantern and Pat donated his sleeping bag before we descended towards Passu the following morning.

It was a beautiful hike out with spectacular views down to the Passu Valley.

The following day we visited the Aga Khan Health Centre in Gulmit. At present there are no doctors there.(there had been two doctors there the last time I visited).They have a midwife(from Chipursan) and an LHV currently working there. Their e-health program is currently inactive at present. They are currently trying to negotiate with the KADO IT Centre to share some of their internet capacity.

Apparently there are currently 2 doctors stationed at the government hospital in Gulmit.

We then crossed the lake on a nice sunny day heading towards Karimibad.

The lake is still a busy place and perhaps a bit less dusty than in the past.

We had a very productive meeting with the staff at the KADO headquarters in Aliabad prior to our departure to Gilgit.

On July 11^th we got the opportunity to attend the annual Salgira Festival in Passu. We were welcomed by community and scout leaders to the festival.

There was a number of speeches, religious readings and singing by local school children/scouts and community leaders.

We met some local members of the KADO board .

We adjourned to Imran’s parents house for lunch and had an interesting meeting with Imran’s brother Nawab who is a past chairman of KADO and currently works with the Aga Khan Foundation. We were joined by a number of community leaders and educators. We also met Imran’s mother, uncle, sister, Nawab’s wife and children.

We woke up to a crisp, clear, blue sky morning. The early morning sun brought back warmth and great light to the pasture. After chai and chappatis at Tai Bibi’s house we donated a solar lantern to the community, said our goodbyes and started out across the snow covered, sun soaked Pamir in the direction of Shimshal. It was sad leaving these gracious, hospitable and friendly people who had generously opened up their lives and homes to us during our visit.

We left camp around 6.30am as the sun made it’s way over the surrounding peaks stretching further across the Pamir as we gained a little elevation out of camp. Shortly into our walk we were joined by the respected elder Mr Mehman Baig who joined us on our trip back to Shimshal. It was great to share the trail with him and learn more about the traditional way of life in the Pamir.

The hike back to Shimshal was a good opportunity to reflect on the health, social, economic and personal challenges the shepherds face in the Pamir.

Both summer and winter pasture residents spend many months of the year without any access to health care.

As these places will never have direct access to a resident doctor or nurse because of the remoteness and low population density, I think it is imperative that we develop better, more sustainable ways of bringing health care to them.

I think a basic health/hygiene/sanitation/nutrition community education program tailored for residents of the Pamir would be helpful. A short, basic health course for 2 or 3 interested and motivated shepherds would also be helpful. These individuals would be responsible for managing any health issues in the pasture.

I think developing an e-health program that would support the basic health worker in the pasture, link them to the Shimshal Health Centre/ Gulmit Health Centre and the specialist Health Services in Gilgit would significantly improve the health care for residents of the Pamir.

Bringing mobile/internet connectivity to the Shimshal Valley will be a good start to this plan. It was quite a change coming back to the warm temperatures, wheat/alfalfa filled fields and relative low altitude (3,000m) of Shimshal.

We met with the medical staff of the Shimshal Health Centre later that evening and discussed our visit to the Pamir, made some suggestions and plans for follow up of some of the shepherds we saw in the Pamir. We also had a long discussion re their perspective on the current TB status of the residents of Shimshal. Zulfi agreed to send me the reports from any previous TB studies in the area. We discussed the preliminary results of Imran’s mini random household study.

We later had a lovely dinner and meeting at Doulat Amin’s house with Ashraf, his family, his aunt from Gilgit (AKRSP) and religious leaders from Gulmit and Shimshal.

We finished off the day with a special meeting with Shimshal Community Leaders back at the hotel. We described our visit to the Pamir and discussed ways to improve the health of seasonal residents of the Pamir. There was many gracious words exchanged and we were presented with the gift of traditional Hunza hats, which we very much appreciated.

The next day we met with local accomplished mountaineer Mr Rajab Shah and his family at his home in Aminabad. He is a true inspiration. He is a great community leader, visionary, mountaineer, founder of the Shimshal Mountaineering Association, religious leader and family man. He has climbed all 5 of Pakistan’s 8,000m peaks including K2.He has been a great inspiration to many young mountaineers in the Shimshal Valley; a valley that has produced many great mountaineers over the years. He is humble, gracious and always so generous with his time and hospitality each time I visit Shimshal.

We met his 6 year old grandnephew who was born with hydrocephalus and had to have emergency surgery to install a shunt to relieve the pressure on his brain. He continues to have frequent seizures and is physically and mentally challenged. We discussed home physiotherapy exercises to reduce contractures, physical and emotional support strategies, safer feeding techniques, music therapy and discussed getting access to a regular supply of anticonvulsants.

We later visited our driver Sajjad’s home and met his family. He also has a 6 year old son with physical and mental challenges. He was the first twin born at term. The second twin did not survive. Both cases have significant challenges for both families, especially in a country and remote location with few medical resources.

Mr Shah agreed to do a video interview with Pat.

We met a group of gold mining families from Chilas working along the river. The children looked malnourished and did not attend school. They move back to Chilas during the winter months.

We stayed the following 2 nights in Passu.

Shimshal Pass summer pasture at 4700m.We woke up to a crisp morning with scattered clouds. At 5am women were milking their sheep/goats and yaks in the stone walled enclosures in subzero temperatures. There was a calm, focused silence among the shepherds in the animal enclosures. By 8am the milking was finished and the women headed back to their houses for chai and chappatis and start the process of making cheese and butter.

At 9am we met with community leaders who welcomed us to the summer pasture with very kind words. We started our mobile health clinic at 10am.Our aim was to complete health assessments on all of the shepherds at the summer pasture. To make this happen we extended our clinic to 10.30pm to assess the shepherds who were away from the settlement during the day. We saw a number of cases of hypertension, skin and eye infections, one case of jaundice (likely HepB), some anemia and depression.

Later that day while working in the sheep/goat enclosure a young 17 year old woman had a seizure. I saw her just after she collapsed. She showed signs of a non-tonic/clonic seizure. She had significant post ictal drowsiness, which lasted approximately one hour. She apparently had been having similar events over the previous month. Based on her living /work circumstances, there is a good chance that she has neurocysticercosis. This is a disease caused by the ingestion of the worm Taenia soleum, which travels to organs such as the brain, produces cysts that calcify and become the focus of seizure activity. It is a disease associated with people working in close contact with animals such as sheep and goats. Arrangements were made for this lady to travel to Gilgit for further diagnosis and treatment. I recommended a lady with jaundice and fatigue go down to the Shimshal HC for further investigations and treatment. We ended up seeing all the shepherds in the summer pasture over a 12 hour period.

My overall impression was that those people working in the pasture were generally in good health despite their harsh life and poor nutrition. The more healthy in the Shimshal community were more likely to travel to the Pamir. The diet of the shepherds consisted mainly of chappatis/cheese and chai. It lacked protein and many micronutrients. We saw no evidence of fruit or vegetable consumption. On special occasions people will eat yak/sheep or goat meat. There is too much salt + chai consumed, which likely contributes to the large amount of hypertension and heart disease seen. Common health problems included headaches, “breathing problems”, “asthma” (which often turned out to be gastroesophageal reflux), gastritis, hypertension, backpain/arthritis (knees especially), eye, skin infections, cataracts (high UV exposure with little protection), gastroenteritis, anxiety and depression. There was little discussion on menstrual or gynaecological issues because of cultural reasons. Our next visit should include a female midwife/nurse or doctor so these female related issues can be explored further. Some potential medical problems include brucellosis, tuberculosis and anthrax.

A number of recommendations were made to improve the overall health of the shepherds in the summer pasture of Shimshal Pamir.

• Increased water intake and less chai to reduce headaches and prevent dehydration…people are working hard physically at a high altitude.
• Eliminate or at least reduce salt in chai.
• Increase ventilation in the house while cooking.
• Improved attention to hand washing/personal hygiene/sanitation and disposal of human waste i.e. recommend the installation of a number of latrines in the summer pasture so human waste can be concentrated in one area away from human dwellings and water source.
• We stressed the importance of separation of livestock from human living quarters to prevent the spread of worms/parasites such as Taenia and Echinococcus.
• We discussed the construction of basic greenhouse structures to experiment with growing vegetables at a higher altitude.

I think it is worth further exploring the health benefits of local herbs/wild flowers and other plants i.e. Bozlenj (tea used to lower blood pressure) and Banafsha (used for altitude illness and blood pressure)

We did leave a solar lantern to be used by the community as needed.

We left funds to purchase sunglasses for all 35 shepherds living in the summer pasture. These sunglasses would be signed out from the community leaders each spring and returned to the community leaders in the autumn before people head back to Shimshal. The aim of this program is to reduce the incidence of premature cataracts in the community. Zulfi agreed to purchase the sunglasses in Gilgit and return them to the summer pasture.

We discussed the use of solar powered electric fences to rotate yak grazing habitat and reduce the amount of back and forth travel each day by shepherds and animals to find suitable grazing. We noted a lot of the land close to the shepherd’s summer settlement was overgrazed.

We discussed the future use of satellite supported e health connectivity between the shepherds in the pasture, Shimshal HC, Gulmit HC and Gilgit specialist health services.

During our visit, Zulfi donated one of his sheep to the community to celebrate our visit. The sheep was cooked and shared by all.

We awoke to some fresh snow and cooler temperatures. We started out a little later than originally planned (7.15am) because of the conditions. We started up a very muddy, steep incline in fresh snow. Our single poles came in handy to get some traction along the steeper muddy trail.

Fortunately the snow stopped about 90 minutes into our travel. Shortly after this the clouds lifted and we were gifted with warm sunshine and no wind. It gave us the opportunity to dry out some of our gear and improved the trail conditions.

We continued the long hike along the banks of an extensive river drainage.

Further up the drainage, we met Susan, an OT from Calgary with a guide and porters. They had come down from Shimshal Pass after a few days of trekking. She had been bicycling with her friend Liam from Calgary and had taken a little time to visit Shimshal Pass. We stopped and had a tea break and nice visit in the warm sunshine. We continued along the river drainage, with a gradual ascent through a yak pasture, crossed a small bridge and had a chai break at a larger shepherd settlement. It was a beautiful setting, close to the river with great views down valley. We then started the ascent to a small pass above the huts and valley. At the top of the pass we marvelled at the great views down valley and the open meadow towards the Pamir pasture.

After a short break, we continued the long walk across the grassy meadow towards Shimshal Pamir. We watched many yaks happily grazing on both sides of us. The lush green of the Pamir meadow was in stark contrast to the arid rocky slopes of the approach. On our way we met a shepherd friend of Zulfi as he herded the yaks back to the shepherd settlement. A little later we got some more snow and the temperature dropped. The conditions confirmed we were close to 4700m at this point.

We passed 2 beautiful lakes to our left and continued along a muddy, yak trodden path towards a small

Zarat leading to the summer pasture settlement of the Shimshal community at 4700m. It is an idyllic setting with a wide open meadow, lakes and high snow-capped surrounding peaks. It is located very close to the China border.

We were greeted enthusiastically by Ashraf’s mother, Tai Bibi outside her stone pasture home. She prepared a lovely meal of yak cheese, chapatti and chai for us. We appreciated very much her giving up some of her valuable time away from her animals. Her great hospitality during our stay was very much appreciated.