The tea plantations are one of the most famous symbols of Sri Lanka and a highlight for most visitors. Easily accessible as the main train line from Colombo to Badulla passes through numerous plantations, starting mainly after Hatton train station (the jump-off point for visiting Adam´s Peak).
One of the great cultural walks in Sri Lanka is the +800 m walk up to Lipton´s seat, starting out from Dambatenne tea factory, a 45 min tuk-tuk ride from Haputale. Dambatenne was the original factory of tea-magnate Sir Thomas Lipton, and it is said that he often walked to the point now called Lipton´s seat to survey his empire. It takes around 2 hours to walk the 7 km and 800+ meters ascent up to the seat from Dambatenne tea factory, all the way through tea plantations on a paved road.
The tea-pluckers are Tamil women. They live in separate Tamil villages, located close the tea plantations, easily distinguished by prominent hindu temples. Employed by the Dambatenne Estate, they are payed 600 Rupees (around 4 US dollars) per day for a quota of 18 kg tea leaves. Whenever the bag on their backs is full, they empty it at a weighing station. If the 18 kg quota is not reached, their salary is reduced according to a specific algorithm.
It has been well documented that the Tamil tea-pluckers are among the poorest in Sri Lanka. Apart from tea-plucking being hard work, they are frequently discriminated against and the Tamil communities are not integrated into the Sri Lankan communities. My tuk-tuk drivers mother used to be a tea-plucker, but was able to give it up as her children could provide sufficient income for the household. He told me how she would complain from constant back-pain as well as chronic skin problems, not to mention the ubiquitous leeches present in the often wet tea-fields.
Two doctors are permanently stationed on the base and one of these needs to have surgical skills. I did not have to use mine. The work itself is mainly duties within general medicine including health certificates and other administrative reports. There were no emergencies the month I was there. The closest was a call from a captain on a Lufthansa flight located right over the North Pole where a patient had abdominal pain. In the end it was decided that emergency landing at the base was not indicated. Though not part of the health care system in Greenland, Thule Air Base doctors and authorities will nevertheless assist with medical evacuations from nearby Qaanaaq if needed.
As a Doctor you are provided with a car. And you have to pass a driving test at the base. I had a small apartment within the medical building/hospital ward, and we had no admissions during my time there. There is a small convenience store. The Top of the World Club (a bar/restaurant). And a fitness center. I was on Thule Air Base in August. The sun was never down and I covered the windows by plastic foil during the night.
The scenery is spectacular with approximately 20 km road to drive on outside the base. I visited the Thule Radar. And despite many visits to Greenland, this is the only time I have actually been standing on the Inland Ice. I climbed the iconic Dundas mountain, visited the old Dundas inuit village. And lastly, I visited Alert, the Canadian base only 817 km from the North Pole.
68 people live here. There is a school, church and small library, all combined in one building. The doctor visits every 3 months. Health services in these very small settlements are provided by a health assistant, employed for a couple of hours a day, and with only a couple of weeks training. Thus all health issues are normally discussed either by phone or telemedicine with Qaanaaq. Siorapaluk is connected with Qaanaaq by twice-weekly helicopter flights.
It is February. Windy and below minus 30 degrees Celsius. We travel with two snow-scooters over the frozen fiords. We bring rifles in case we encounter a polar bear on our way over the frozen fiords. We wear special polar suits including protection glasses. The sun is not up at this time of year, so everything is dark with a shimmer of light. I have no idea about the direction we are taking and have to trust the local driver. In this hostile environment, it only takes one wrong turn and we will never be seen again.
We leave Qaanaaq at 7am and arrive in Siorapaluk a couple of hours later. With me is an assistant nurse, who also doubles as interpreter, and we do as much as we possibly can in a very long day. I see all the children. Vaccinations are brought up to date. Dental status is checked. In fact I end up seeing most of the inhabitants and those not on the list turn up queuing at the door once the rumor had spread of our arrival.
A 25-year old Japanese man happened to pass by this place 40 years ago in search for extreme wilderness. He never left, and founded a family there. His reputation as a hunter is widespread. I was looking to buy a polar fox and went to his storage facility in the basement of his house. He immediately apologized, he did have polar foxes, however they were brown and not white. The white were sold out as confirmation season was approaching.
So far north, the sun is permanently down between November and February, and permanently up between June and August. Temperatures in winter may drop to below minus 50 degrees Celsius. We are too far north for the Northern lights. It is an arctic desert, with little, if any snow even in winter. The Qaanaaq fiord is frozen 9 of 12 months and only a couple of ships a year pass by with supplies, the last one in August. Trucks drive out on the frozen fiord to collect chunks of icebergs, which supply Qaanaaq with drinking water during the Arctic Winter. You are the only doctor here. The next settlement on the Coast is Upernavik, 1:30 hours south by plane, one plane a week.
I have worked as a doctor in Qaanaaq in 2006 and 2013.
07:30 It is January. The middle of the Arctic Winter. While the sun is never up, it is not pitch dark all day, as reflections of light shimmers over the flat mountains. Some have depressions in this eternal darkness. I think it is wonderful. I have an entire house at my disposition, right next to the hospital. First I empty my toilet bag (there is no cloacal system here) and place it outside the house to be collected. It is minus 35 degrees Celsius. After a quick coffee I run the 200 meters to the hospital.
08:00 Morning meeting at the hospital. It is Wednesday, surgery day. Thursday is for vaccinations, Tuesdays for examining children. Today we have two abortions scheduled. If I was not able to perform them, they would have been sent down south to Upernavik or Ilullissat.
09:00 Patient consultations begin: Two patients present with a common cold. One needs his diabetes controlled. One child presents with a rash. I need an interpreter for the majority of the consultations, as especially the younger patients do not readily speak Danish. 3 patients per hour are booked. While this may not seem a lot, the lack of prior knowledge of the patients as well as the need of translation makes it appropriate.
09:30 A hunter has been out on the ice-edge, hunting for walrus. They caught one and ate some raw meat. Now he feels weird. Could it be trichinosis? I have to look it up in the text book.
10:00 I administer a paracervical blockade, and the two abortions are performed without problems.
11:00 The consultations continue: One patient presents with tendinitis. He is a hunter, and it comes from holding the reins of the dog-sledge.
12:00 Lunch break: The nurse told me that a helicopter from Thule Air Base had just landed and brought eggs. There have not been any eggs in Qaanaaq for two weeks. I run down to the supermarket Pilersuisoq, where 15 boxes of eggs are left. I took two. I check the rest of the store out: Well stocked with dry and canned foods. Dairy products and vegetables are frozen.
13:00 Visit to the retirement home. The lack of continuity is a problem, a new doctor comes every 1-3 months. I do not know the patients but try my best together with the leading nurse to go through and update all the prescriptions.
15:00 The visiting psychiatrist is here for her yearly visit. The secretary tries to get hold of all the villagers referred for psychiatric consultation. This includes arranging transport for those living in the smaller settlements around Qaanaaq: If they don´t make it this week, they have to wait a whole year until the next visit.
15:30 Off duty. It is minus 25 degrees Celsius now. I walk the 50 metes down the hill to the public library and shuffle through the books. There is a an interesting new book out on Knud Rasmussen, signed by the author. Knud Rasmussen is well remembered here in Qaanaaq and his sledge from the Thule expeditions can be seen in the Qaanaaq museum, the building itself being his old trade station (Thule Trade Station) moved up to Qaanaaq from Dundas.