The miracle worker of the mountains

Hidden in the high Himalayas at the edge of the Tibetan plateau is a valley that time and man forgot. At over 12,000 feet, buffeted by winds that have sculpted the barren limestone into an awesome beauty, lies the breathtaking Spiti valley. Seventeen kilometres from the forbidden Tibetan border, the whole area was "closed" to the outside world by the Indian government until May 1992. Its 10,000 inhabitants survived in medieval squalor. Illiteracy was rife, unemployment horrendous, infant mortality high and, with virtually no medical care, most of Spiti's population had chronic, but eminently curable ailments.

Stories of sick and dying children had trickled out of Spiti for years. In 1983 they were picked up by a softly spoken Englishwoman who was visiting the Indian hill station of Manali. This was Joan Pollock - and she would prove to be Spiti's saviour.

Pollock is an unlikely crusader. Trained as a nurse in Charing Cross hospital, she worked for many years as an operating-theatre nurse. Then in 1972 the Salmon Report was published. "Somewhere along the way," she explains, "the whole system was changed. They got rid of the way we were trained. The reason we became nurses - to help and comfort patients - went straight out of the window. It was decreed that we were to become a breed solely concerned with some ridiculous system of brownie points, treating patients as statistics, and moving away from the basic ethos of nursing. We were all scheduled to become administrators - and I simply couldn't cope with that."

So in 1977 Pollock gave up nursing, trained to be a guide, joined an upmarket travel agency and found herself guiding select groups of tourists all round the world. While she was in Manali she became distressed by the persistent reports of suffering children in Spiti. When the valley finally opened up, in May 1992, she decided to accompany Dr Laji, an old friend and the medical director for the whole area, to investigate the situation .

Getting into Spiti was anything but a smooth ride. Perched astride a volcanic/earthquake fault line - where the Asian and Indian tectonic plates clash - the subterranean activity renders Spiti's few rudi- mentary roads extremely hazardous. Landslides were a constant nightmare and often the only way out was to get a shovel and move the mud and boulders by hand.

Taking unpaid leave from the travel agency, and after collecting a bag full of medicines and rudimentary instruments, Dr Laji and Pollock manoeuvred an ancient Jeep slowly up the Kunzun-la pass, at 15,500 feet the second highest in the world. "The valley was stunningly beautiful," Pollock says. "It was totally pure and unspoilt, and the people were genuinely friendly. But the contrast between the heart-stopping beauty of those magnificent mountains and the squalor of the people's lives in the valley was crucifying. It was as though we had time-warped into the Middle Ages. The 'houses' were made of mud and wattle. There were no niceties like sanitation, or clean water. Waste was thrown into the alleyways. It was survival at its most primitive."

Every single Spitite they met presented them with medical problems. Although there was a government hospital, it was an empty shell. As the valley was snowed in from November to June, with a temperature that dropped to minus 40 degree, it was understandably difficult to find staff. It was the same thing with schooling. There were a couple of government teachers somewhere, but the majority of children were illiterate.

The Spiti valley had once been under the jurisdiction of the ancient 11th-century kingdom of Guge, which in turn was part of the Tibetan Empire. Being part of Tibet, the state religion, Mahayana Buddhism, prevailed throughout the region. And although the monasteries were well equipped to endow the monks with religious education, the villagers were not catered for and, with a few exceptions, remained illiterate. The scholastic situation was further aggravated by the valley's inaccessibility, the harsh living conditions and poor professional remuneration.

Pollock and Dr Laji drove and, when roads ran out, walked to small, remote hamlets. Once there they would find that the bush telegraph - nothing so modern as telephones existed - had alerted the locals, and considerable crowds of patients waited to be treated. Sometimes the sick would queue from before dawn.

An alarming number of men suffered from cancer of the stomach, caused by drinking too much chang - a lethal Tibetan brew made from fermented barley. The neonatal rate was appallingly high. Women died before the age of 50 from sheer exhaustion, too many babies, anaemia and respiratory problems. The children suffered from skin lesions caused by dirt while, sadly, 30 per cent of them were deaf, a result of respiratory infections.

Those early clinics were often held in the open, with the pair operating when necessary, using local anaesthetic - there was none of the statutory niceties like surgical masks. But it wasn't until a tiny boy nearly died from meningitis in her arms, that Pollock became a one-woman Medecins Sans Frontiers - without the fanfare or publicity.

She returned to London and began to work tirelessly for Spiti. Overcoming her acute shyness, she cajoled donations from drug companies, despite having nothing dramatic - no images of dying babies, mass graves, or skeletal prisoners like in Bosnia and Kosovo - with which to promote funding.

"I'm not into the dramatic bit," she smiles. "Our job is more difficult because there are no histrionic appeals to camera, and no appalling statistics calculated to appeal to a jaded public suffering from acute compassion fatigue."

In the eight years since Pollock first went into the valley, she has brought in numerous doctors - GPs and specialists. All are expatriates who pay their own expenses and receive no salary. As a result, the hospital is nearly complete. The modest stone building now boasts an operating theatre where visiting surgeons perform keyhole surgery. Two recovery rooms are manned by the patient's relatives and two wards are operational. In the village, the infant mortality rate has been drastically reduced, and life expectancy has risen considerably.

Conscious that long-term improvement has to start with the young, last summer Pollock took four London schoolgirls on "Operation Scrub", to teach Spiti's children the rudiments of cleanliness. In an essentially feudal society where patriarchal dominance is still prevalent, she has empowered the women, commissioning them to make their uniquely beautiful woollen shawls or lanzgzas, which are intricately woven with colourful geometric designs. These are sold in London, and the proceeds passed directly to the women. This aids them financially but also preserves their ancient cultural heritage, especially in the face of the onslaught of modern tourism.

Pollock doesn't appear to have a shred of the egotism displayed by many of the aid workers and "disaster groupies" who staff international agencies. She's uncomfortable when talking about herself - "I'm only one spoke in a big wheel" - but when I asked what motivated her she admitted, "I suppose it is the nurse in me."

With the hospital nearly up and running, Pollock feels it is time to move on. There are other forgotten valleys, other needy people - people without a voice whose plight is not gruesome enough to warrant the media spotlight. As she says: "I have no intention of retiring."