An Automotive-Medical Tale from Nepal

Dear Tom and Ray:

Last March I was on a medical mission in a remote part of Nepal. There were nine of us in a seven passenger Toyota Land Cruiser; me, an American, and 8 Nepalese. At 9:30 PM, after traveling fifty miles in 5-1/2 hours (9 mph) on the roughest and darkest dirt road of my life, the engine died and wouldn't restart. The hired "driver/mechanic" had only a screwdriver and minimal knowledge of engines, so Dr. Subarna Acharya, a cardiologist from Kathmandu, brought his medical skills to the fore and eventually diagnosed a case of inadequate perfusion; the fuel line was blocked. After an hour of trying to clear the line, which included cranking the car until the battery died, we decided to call it a night, sleep on the floor of a nearby house, and tackle the problem in the morning with two plans of attack: (1) blow the line clear, or failing that, (2) put a jug of diesel fuel on the roof and run a rubber hose to the engine, i.e., hang an intravenous line to get us to the next town.

We awoke at first light to (1) a blocked fuel line, (2) a dead battery, (3) a flat tire, and now, about 3/4 of a mile distant and heading our way, (4) a forest fire. The latter added a certain sense of urgency to getting the car started. Dr. Acharya was finally able to blow the blockage back into the tank to clear the line but now we had another problem: with a dead battery we couldn't pump fuel from the tank to the engine. Not to be deterred, the good doctor took his blood pressure cuff and removed the gauge and pump from their rubber tubes. He then rolled up the cuff, put it in the fuel tank filler pipe, and ran one tube through the middle of the cuff and into the pipe. The other tube he kept outside. Blowing through the outside tube, he inflated the cuff, thus sealing the filler pipe, and as he kept blowing, air from the other tube pressurized the tank enough to bleed the line and push fuel to the engine. Being careful not to lose the prime, the cleared line was reattached to the engine. A push-start of the Land Cruiser got it running and, feeling the relief any doctor would experience bringing a patient back from near-death, Dr. Acharya said to me, "Jack, I just did an Intra-Aortic Balloon Counter-Pulsation on a car!" We were back on the road.

Jack Starmer
Health Care Nepal