This extract from a book that brings to life the stories of the people of Zanskar is based on the region’s first allopathic nurse, Dolma Lamo, who often endured extreme conditions to help women in need.

One winter in the late 1960s, when ghosts and malignant spirits were blamed for premature deaths, a woman from the remote Lungnak valley of Zanskar struggled to give birth to her first child. Enduring labor without painkillers in a cold, dark room, she succeeded in giving birth to a healthy baby. As the newborn baby lay naked on the cold earthen floor, the mother started bleeding heavily. An aamchi listened to his pulse and administered herbal treatment. An astrologer threw dice to determine his fate. His condition continued to deteriorate. When death was predicted, a relative took the unusual step of consulting a newly qualified nurse.

The nurse was Dolma Lhamo, and she lived about three days’ walk from the Lungnak Valley. When the relative reached her home in Pipiting, Dolma invited him inside. Over the traditional cup of hot butter tea, they discussed the woman’s symptoms. Dolma suspected that the placenta had been left intact. Without medical intervention, the woman could have suffered a long, painful death. There was no doctor or clinic in Zanskar and the nearest hospital with only four beds was in Kargil, a town 200 kilometers away. The mountains were impassable in winter and there were no roads into Zanskar, so the hospital was almost useless. To complicate matters, Dolma had no pony. But she was a big, strong woman with quiet determination. Wrapping herself in two thick woolen gonchas, she hid the tsampa and hard cheese in the folds of her dress and then collected her small medical kit. His home, situated on a hilltop, overlooked a descending range of vast white snow fields. Stepping out, he looked at the view and thought about the long journey ahead. That woman will not survive for the next three days. Dolma decided that she would keep going without stopping, from morning till evening and till the cold dark night. Climbing a small hill, she circumambulated the village stupa and set off.

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Apart from the dangers of early childhood Zanskaris generally enjoyed strong health. The main healthcare providers were the Amchis who practiced Sowa Rigpa, the ancient healing system of Tibet and the Himalayas. Highly respected with a deep understanding of family history, Amchis had a deep knowledge of medicinal plants. He used juniper leaves, sea buckthorn, rhubarb and rhododendron, along with other strongly scented shrubs, wild flowers and rare herbs. The local diet was healthy but limited and consisted mostly of roasted barley flour, soups, vegetables, and dried cheese. People also enjoyed strong communal bonds and a stress-free lifestyle. Researchers who visited the valley in the 1980s were surprised to find that many people were living well into their 90s.

Nevertheless, maternal care was poor and respiratory diseases were common. The mortality rate among newborns was particularly severe. The origin of the infection was largely unknown. Washing was difficult due to the extremely cold temperatures as well as the lack of running water. Painkillers, antiseptics, antibiotics and vaccinations were largely unavailable. Goat dung diapers were ideal because they absorbed waste and kept babies warm. Birth attendants have been known to perform many internal examinations without washing their hands. Babies who are misplaced or born prematurely almost certainly die. Newborns who survive delivery often fall ill with fatal fevers. In 1980, a team of researchers found that 30 percent of children died before reaching the age of three. One woman reported losing five babies, each within hours of giving birth.

Postmaster Tashi told me, ‘My parents had 13 children, and we were lucky that seven survived.’ ‘People often had at least ten children, but only five survived. Most of the children died in November, December, March, April – when the weather changed. Just one feeding will not be done properly, the child will start coughing, have chest pain and fever and will die.’ …

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Dolma moved forward quickly, lost in thoughts of the woman’s suffering as she walked. It was easy to follow the deep, wide snow paths of previous travelers, and she soon entered the vast network of paths connecting the central villages of Zanskar. Within about an hour, she reached the white mud houses falling down the hill at Karsha. …

Usually, Dolma would rest and exchange pleasantries with her fellow travelers, but there was no time to waste. When people approached, she briefly explained her mission and continued moving forward. By afternoon, the tracks merged into a muddy river of footprints. The road ahead was covered with powdered snow. Walking became difficult. The snow was so deep that with every step he was sinking into it up to his waist. Snow leopards, bears and wolves become a threat as night falls. Tibetan wolves have no fear of solo travelers. They can grow as large as donkeys and attack sheep, horses and humans alike. Still, she kept walking, swinging her body to and fro in the rolling gait of old people, raising her legs high, moving one foot after another slowly in the moonlight.

When I asked how she managed to keep working through the night, Dolma responded with great enthusiasm. ‘I kept moving forward because of my father. They faced a lot of difficulties in sending me to school when I was young, so I decided to never give up.

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…Parents may have taught children to read Sanskrit, but daughters of ordinary farmers did not usually go to school. Since most Buddhists were ignorant of Urdu, this left them vulnerable to exploitation…

Dolma’s father endured one of these long-forgotten injustices. This experience troubled him so badly that he decided to send all his children to school. Dolma became the first schoolgirl of Zanskar…

Dolma’s father was ostracized for pleading with people to send their daughters to school. ‘People used to say that a person without education should not send his daughter to school. ‘He was called a man of no purpose,’ Dolma tells me. Seeing his father’s suffering awakened in him the determination to succeed. He continued his studies even after most of the children had dropped out. After passing the ninth class examination, the government provided them scholarships and the opportunity to study teaching or nursing. Since every family in her village had lost a child, she knew which path to pursue: ‘I wanted to help my community and especially women, so I decided to become a nurse.’

There were no colleges in Ladakh and science was taught only in two high schools. At the age of just 16, he left the Zanskar Valley on foot, crossed several mountain passes and headed towards Srinagar, a city about 500 kilometers away. After four years of study, she returned home in 1967 and became Zanskar’s first nurse.

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After two days and one night of arduous walking, Dolma reached Testa. ‘My hands and entire body were frozen,’ she recalls. ‘My clothes were wet.’ The woman’s heart was still beating. Dolma’s wet cloaks were taken off and spread in front of the fire…

Dolma drank traditional hot buttered tea, caught her breath and went to work, gently pulling the umbilical cord and removing the cord from the woman’s body. He wrapped the newborn in warm clothes. The woman was fortunate to give birth in the winter, giving her time to recover before the intense physical work of spring planting. Both mother and child survived.

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That winter, Zanskar villagers exchanged stories about the nurse from Pipiting who spent two days without stopping to save a dying woman. Pregnant women and worried family members began arriving at Dolma’s village to seek his help. Over the next decades, they assisted women in labor in villages spread over thousands of square kilometers of mountainous terrain, crossed 5,000-meter-high passes, worked on rope bridges, steep mountain paths and trails that sometimes disappeared due to avalanches and landslides.

Using only kerosene lamps and torchlight, she administered tetanus shots and folic acid, checked whether children were in good condition and sent family members to collect clean river water to wield ice axe. When she herself became a mother, she kept visiting remote villages for two or three days. Often, she endured dry summers and long winters…the mortality rate of infants improved. Women survived slow, painful deaths. The word kept spreading. People used to reach his house at all times of the day and night. They started treating him with great respect. His father was ultimately proven right.

Postmaster Tashi says, ‘People have a lot of respect for him.’ ‘In winter we only had dolma. He changed our lives completely. It was amazing.’ An old folk song praising the bravery of Dolma Lhamo can still be heard in meetings today…