“She’s scared,” the nurse translates to Dr. Cary Rasof, who has just diagnosed the woman’s mother with Hepatitis B.
“But your mother is old,” Rasof replies, trying to calm her down.
The woman relaxes slightly. Indeed, her mother has lived with Hepatitis B, a potentially chronic condition that gradually damages the liver, into old age. Likely, she will too. Either way, she’s still fearful after getting the diagnosis—both for herself and her child.
Rasof found himself in this refugee camp by chance. Not tied to an organization or funding, Rasof is an independent volunteer who has committed his life to serving others based on the principles of seva—an Indian term for selfless service. Rasof relies on 17 years of volunteer experience and the connections he’s made to get from project to project, and to help fund the testing and treatment for Tibetans with Hepatitis B.
While in Ladakh working on a project to create better health care access for a remote village, he learned of the disproportionately high rate of Hepatitis B among Tibetan refugees, and put together a public awareness program encouraging Tibetans to get tested. After giving 10 presentations, nearly all of the 2,000 in attendance agreed to undergo testing. Of those, approximately 10 per cent have been diagnosed with the virus, most unaware they were infected.
Rasof and Sidol, a Tibetan nurse from the nearby city of Leh, walk past a generator sitting at the entrance of the ramshackle clinic. Inside, the nurse-doctor duo pull up chairs around a small table. A medicine cabinet with semi-stocked shelves stands in the corner of the mostly empty room. Next door, a team of nurse assistants hunch over a table with vials of blood laid out on it.
“Out of 800 [patients], 80 have tested positive so far,” Sidol informs the doctor, looking down at her files. He nods, knowing the consequences and the importance of getting treatment.
Hepatitis B is a worldwide disease. According to the World Health Organization, the virus has infected approximately two billion people and 350 million suffer chronically, causing an estimated 600,000 deaths per year. The disease is most prevalent in Asia and the Pacific islands, accounting for 78 per cent of those chronically infected in the world. The highly infectious virus spreads through childbirth, blood transfusions and sexual transmission.
In the Tibetans’ case, it’s most often transmitted through birth. Some who contract the disease cannot completely fight it off, leading to an increased risk of liver damage, cirrhosis of the liver and liver cancer. Though for many, including most of the refugees, the disease lies dormant, allowing them to conduct relatively normal lives.
Signalling the end of the day, the refugee camp’s driver pulls up in his dust-caked jeep designed for the rough Ladakhi terrain. Rasof and the all-women medical team pile into the vehicle to get a lift back to the main clinic. The jeep drives past a large metal sign that says, “IMMUNIZE. Miss not a single child” before stopping at a slightly larger, better maintained clinic.
Rasof walks into the office of Karma Gendun, the Executive Secretary for the Tibetan Primary Health Centre, and pulls out his laptop. He types up a medical report form for their staff to use as a template, paying close attention to its proper formatting.
Rasof has to feel comfortable dealing with bureaucracy in order to be effective in his work. He will sometimes approach the regional medical authority to discuss his plans and register his project. To more effectively handle this small project, however, he chose to involve as few people as possible.
“I would recommend staying subtle and under the radar because once politicians are involved there is confusion,” Rasof says. “We are for the people and keep it that way.”
Gendun walks in and takes a seat behind his desk. The two discuss treatment options and costs. The conversation turns to specific cases as Gendun pulls out a sheet with the names of patients who have been treated with traditional Tibetan medicine. Though it’s too early to definitively prove how many have been cured, his figures show that 30 per cent no longer show signs of the disease. The results demonstrate that the treatment is a potentially effective and safe option without the side effects of conventional drugs.
The Tibetan treatment is a hopeful sign for the community. It’s a local solution to a global problem, and just the kind of solution Rasof likes to see. He got into this line of work to create seva opportunities for others. As more Tibetans get tested and seek treatment, more Tibetan doctors get to help their own people.
“Personal and global transformation comes from being of service to others,” Rasof says. “It is through this notion of loving and giving that we change and grow and improve ourselves and our world.”