A desperate beauty

In New Zealand, many run from the dentist. In remote Nepal, Mike Scott found that a dental clinic run by SmileHigh became a bright spot in an otherwise harsh existence.

In the courtyard of the Mount Manaslu Lodge and Hotel, an argument rages between a trader and police.

Samagon  villagers watch the stand-off  ebb and flow between  accusations and hassled  phone calls to unknown higher  authorities.

On the dirt path outside the modest mountain lodge, the trader's yaks, their neck bells ringing, seem thankful for a rest. The beasts' cargo - milled timber - is the cause of the commotion. In the lush Nubri Valley, trading timber cut from the highland forests was restricted after deforestation afflicted other parts of Nepal. This is a problem for the people of Samagon, because the wood trade with Tibet is a lifeline.

"The Government stopped people taking trees. They stopped our income," a village leader says to explain the debate raging between trader and police. "The Government should come up with a solution, because we have no choice. The only way we can make money is to go to Tibet with wood."

About 90 per cent of Samagon's people live a subsistence life that is proving unsustainable. The potato and barley crops they grow at the high altitude of 3500m keep them fed for three months. The United Nations World Food Programme choppers in tonnes of rice, which forms the basis of their diet for the other nine months. Samagon's plight is not uncommon in Nepal, says UN Nepal spokesman Richard Reagan. The aid programme feeds 2 million of Nepal's 30 million population.

After the frenzy in the courtyard dies down, the trader decides to flout the law and make for Tibet, up the Nubri Valley. Two days later, the yak convey returns still burdened with timber. The trader was stopped at the border - no trade, no income, no food today.

You will find the spectacular Nubri Valley tucked under Himalayan giants in northern central Nepal. It is not unlike the deep end of a South Island river valley running up to the Southern Alps. In New Zealand, that is the domain of kea and thar. In Nepal, it is the domain of an ethnically Tibetan people.

Yet the beauty belies an ugly reality. According to American anthropologist Geoff Childs, isolation, high altitude, unsanitary conditions and a lack of medical facilities means 30 per cent of children die before they turn five.

It breaks the heart of Kiwi dentist Antonia Moa, who arrived in the village of Samagon as a volunteer dentist working for dental aid organisation SmileHigh.

"My impression of the life in Samagon is of desperation.

"It's quite hard to imagine how people live . . . it's just the ultimate hardship, every single day."

Dr Moa lives in Cambodia, working as the chief dental officer for an international medical assistance company.

In her spare time, she volunteers  in her Cambodian community.  Still, the contrast strikes her.

"I don't know why this affects me so much - I mean, I already live in a Third World country.

"It's just so humbling and being able to give back . . . though it doesn't feel like giving back much, it's doing that little bit."

Dr Moa and the six other dental specialists working for SmileHigh alleviate pain through action and education. SmileHigh began with the meeting of two dentists - one from Taranaki and the other a Sherpa from the Khumbu region of Nepal.

After climbing his first 8000m peak, Cho Oyo in 2003, Taranaki dentist Julian Haszard collaborated with Mingma Nuru Sherpa to do volunteer dental work in the Khumbu region near Mt Everest.

The oral health of the locals was appalling, mainly due to the introduction of processed sugar by visiting Westerners.

Since then, the pair have run numerous clinics, trained local dental hygienists and helped thousands of Nepalis with oral problems.

"When I was climbing in the Himalayas, I had the idea I would like to do something worthwhile," says Dr Haszard, who conquered Everest in 2004.

"We started SmileHigh with the idea of trying to reduce dental problems in children through education prevention."

The journey to Samagon is another step in the organisation's development. It was the first clinic held outside of a major trekking area and was run in conjunction with the UN World Food Programme, a medical team and expedition company.

"The overwhelming thing for me in coming to a place like this is realising that it is so important we do consider helping in places like this, where they are much less fortunate than we are in terms of their services - medical, health, education," Dr Haszard says.

"It's pragmatism, really. You come to a place like this, you can see that people need help, so I try to help them and I try to do it in a practical way. So bringing a SmileHigh dental team here is a practical way I can help.

"We can come in here . . . with a fairly simple approach and do a huge amount."

The future for this area lies with tourism, not agriculture or timber trekked off to Tibet. While it was opened to the lucrative trekking operations in the early 1990s, the Maoist-led civil war between 1996 and 2006 virtually locked this part of Nepal away from tourists. Only now is the tourism infrastructure of new tracks, lodges, tea houses and porter employment starting to catch up to the more developed areas, such as the Annapurna circuit and Khumbu Valley.

But the fix will not be immediate, though the arrival of climbing expeditions to tackle Manaslu, the world's eighth- highest peak, during the post- monsoon season provided income for lodges and porters.

In the meantime, efforts by the UN and independent groups like SmileHigh patch the problems. The SmileHigh clinic helped several hundred people alleviate their pain and distributed hundreds of toothbrush and toothpaste packs. And progress was made to maintain dental health, including trying to get under way the training of a dental hygienist.

But as I watched the young children singing and performing traditional dances, and smiled at the babies on their mothers' backs, I wondered which faces would disappear during the winter that is biting now.

Statistics show some of the children, many of whom were already suffering hacking coughs and runny noses, would not survive.

I remained in Samagon with Dr Haszard after the clinic to document the start of his ultimately successful attempt on Manaslu.

The purpose of his self-funded climb with expedition company Himalayan Experience was to raise money for SmileHigh. While he undertook a series of acclimatisation walks, Dr Haszard was called on to do more than treat dental problems for the people of the Nubri.

His new patients included a porter with a dirty open gash on his hand, an infant girl with a cut above her eye, a passing trader with a hole in his cheek. All came seeking help.

Despite orthodontics being his specialty, Dr Haszard pragmatically cleaned, stitched, dressed and medicated. Their alternative access to proper medical treatment was a seven- day walk down the valley or a five-day trek over a snowy high- altitude pass.

Many of those who get sick rely on prayer from the monks, community leader and headmaster Pherbu Tsewang says.

"But that is the wrong way, because people need medication. We have a health post here, but the Government does not send the doctor up here and all the medicines become expired."

Pherbu dragged out a first-aid kit.

It was well stocked, including some antibiotics left by Manaslu expeditions, but with no medical expert living in the village to administer them, they were next to useless.

"If they become sick, they will call the lamas or some other peoples to make puja and finish it.

"They don't try to give them medicines and slowly the person will die - one day, definitely."

In his paper about the Nubri, lamas and laymen of the Himalayan Borderlands, American anthropologist Childs presents some optimism. Some development projects have started, including the building of Samagon's new school, and the locals have even started their own non-government group, the Manaslu Conservation Club.

Dr Childs says to remember that the cumulative effect of many small deeds has a collective impact. Like fixing one tooth at a time.

* Mike Scott's trip to Nepal to document the work of SmileHigh was made possible with the help of Canon, Marmot, Scarpa, Singapore Airlines and Himalayan Experience.

- © Fairfax NZ News