Volunteer, Erin Ward, in Bhotechaur

7/20/2013

I’m always amazed by how many patients brave the rain to come in for their acupuncture treatments. We have a new treatment room in the building next to the hospital that overlooks the mountains, so it’s really pretty on the off occasion when it’s not raining. Working in a foreign country maintains its challenges because of the language barrier, but the more I travel the more I see the similarities among people. Patients can still point to where they have a problem, and their facial expressions easily tell you how they feel. Nepali people love music in the treatment room, so my translator Sabina, will usually play songs from her phone, and anybody else with phone music contributes too! I love to dance, and the patients enjoy teaching me how to dance to Nepali music, and we all love food, so they frequently bring fruits and vegetables from their farms as gifts.

 

Nepal is a country that lacks boundaries compared to America, so patients bring their friends to keep them company during the treatment, and the ones sitting with needles talk across the room and comment on each other’s reactions to the needles. The people who work in the office next door come and watch, and anybody who is waiting for treatment or just hanging out at the hospital peers through the windows to catch a glimpse of a foreign person practicing an even more foreign medicine. I was surprised when the entire clinic staff stopped what they were doing to observe the first time I needled myself. Nepal has an amazing sense of community, so the patients tend to come in groups, and they all wait for each other to finish. This does make it confusing for me to determine who has and hasn’t been treated, but the patients know who’s next and they usually hop up on my table before I have a chance to look around.

 

It’s a running joke in the clinic about my “naked patients”. My regulars laugh at me as I play tug-of-war with my new patients to take off their 18 scarves because I need to treat their back and glut muscles for back pain. Some patients are very conservative, and even the men are a little shy about taking off their pants when I need to treat them for sciatica. Thankfully, most of the guys wear shorts under their pants, but why they do that is still a mystery to me! Everything here is very informal, so patients don’t think twice about answering their cell phones during the treatment, or the hospital staff about running to take their clothes off the laundry line during the treatment because it starts to rain.

 

This is my first time really living like the patients I treat, and it’s completely changed my perspective. I understand where a lot of their problems come from, and it makes me highly empathetic. Sarita, our clinic supply manager, invited me to her house for dinner a while back, but we did a little work in her garden beforehand and she let me try on her “doko”. It’s a huge basket that Nepali people use to carry things around. It goes on your back and there’s a thick rope that wraps around your head. After the first time I tried it on, I realized why most of my patients have back pain from carrying it on your back, elbow pain from trying to lift it up to take it off and especially headaches because it puts so much pressure on the forehead. The people here also do most of their chores in “tukluka”, which is simply a squatting position. You are bent over with your knees bent every time you want to do laundry, cooking or just sitting around. Plus hiking the hills all day long, I understand why so many patients have knee pain. The greasy and spicy food explains all of the gastric pain, and the serious dehydration contributes to all of the gouty arthritis and high uric acid levels. I remember the first time I ate dinner with my hospital staff, they gave me a huge heaping pile of rice, and about a 4 oz cup of tea. Luckily, the water quality in the foothills in Bhotechour is much better than Kathmandu, so my patients are relatively compliant when I tell them to drink more water. The kitchens here consist of wood fires lit indoors with basically no windows, so COPD and asthma are common. Paresthesia is another everyday symptom, and I had a minor panic attack the first time I woke up with numbness and tingling in my arms and legs. That is, until I realized it was due to the plank of wood I’d been sleeping on combined with a mild case of malnutrition (blood deficiency from eating too much rice and not enough fruits/vegetables/protein for all my TCM folks out there).

 

There really is no comparison for working in a foreign country. The patients are very appreciative and really look to you as a doctor for help and guidance. It’s a huge motivating force, which is probably the only reason volunteers can consistently treat 20-30 patients per day. It also reinvigorates you when patients argue about why you are putting needles in their feet when they tell you they have a headache. There is no greater understanding than a love and compassion for other people. In the end, everyone feels better, including me. 

Molly Cofman's Bhotechaur Update

5/20/2013

Communication is such an interesting thing to contemplate in this setting.  In general, although usually the Nepali people offer smiles easily and plentifully, I have found this to be a socially stoic place.  There are not too many emotions on display here even for patients who are happy with their progress. I have far too many times been lead astray by the very serious, stern look on someone’s face as they describe their symptoms to my interpreter, only to be surprised when she turns to me and says, “They are feeling much better!” Emotion is felt, but it is not performed.

I did not have many expectations coming into this tour of service, but one that I did have was the anticipation of relying on my physical diagnostic skills rather than verbal.  On this front, my expectations have been met, but in ways that I could never have anticipated.  All of the subtle ways that we communicate, our posture, the glance of an eye, the small gesture of a hand or a finger, things that when we are in our own culture we do not consciously know we are observing, but we are observing nonetheless; these small subtle things slowly become much more visible when you are relying on them to understand why a person is suffering.  Beyond taking the pulse and looking at the tongue, two major diagnostic tools in Chinese medicine, I believe that now I am learning as much about my patients just by watching as they speak in a language I can understand only some of.  In many ways it is a beautiful gift to get to observe so keenly without the distraction of words.  I wonder if I did this in my western life if there would be fewer misunderstandings.  It becomes quite clear what amazing storytellers we can be about things and experiences in our lives when you are in a situation where you cannot rely words or verbal expression to understand what is going on.  

On the other side of this consideration of communication, is of course my ability to communicate to an audience that barely understands even when I am attempting their language. Teaching yoga without being able to explain things as I normally would, giving advice to patients, asking directions; it has all become a funny combination of Nepali words, childish English phrases and many (I am sure very odd looking) charade like gestures.  Eventually the point gets across (I think) but I do wonder at the end of the day how many conversations were understood by both parties in the same way.  Like most things here, you just keep doing the best that you can and hope for the best.  When people feel better, I take heart that at least something good has been exchanged.

There are many ups and downs, but Nepal and its people continue to inspire me.  This is the place that you can get sunburned on your way up a mountain, and get pummeled with hail on your way down.  This is the place where you can climb to the top of a hill and be enveloped by a passing cloud.  This is the place where festivals and holidays seem to happen every other week and people relish the time to celebrate and be with their families.  This is the place that sometimes a mouse will crawl over your head during the night and occasionally you have to share your bed with spiders (really big ones).  This is the place that lacks structure and resources, but reaches far beyond any quota for community and kindness.  Life is simple here, and the rural people, while having little to nothing, have wealth that far exceeds many of what I have witnessed in the west.  I continually feel humbled by the people who come and allow me to care for them, and feel incredibly grateful to have something to give.

3/20/2013The black and gray winter dress code of Chicago seems downright sullen against the kaleidoscope of color here.  My favorite time to walk is around 4:00pm when the streets flood with children coming home from school in their uniforms and families are in the streets exuding a playful energy.  Children hang out of bus windows and yell “hello” with proud grins on their faces when they see a foreigner walking down the street.  Trash lines the streets punctuated with gangs of dogs and the occasional cow against a backdrop of ornate temples and gompas.  Prayer flags are plentiful, as is laundry hanging from any reasonable place that it might dry including trees, bushes and rocks.  Beautifully costumed women, delicately made up and adorned with jewelry upon closer examination boast dirt under their fingernails, cracked feet and spit in the street.  

Life is simple here in Nepal according to Western standards, and yet challenging beyond the imagination.  Sitting on top of a hill (mountain) there are farms and small villages as far as the eye can see.  For farmers, there are no days off and daily life consists of literally backbreaking work.  Although there are hospitals in Kathmandu and various NGO supported clinics in the rural areas (most of which don’t last more than a few years), most people do not have access to any kind of consistent (or as I am thus far informed, quality) health care.  The patients coming for acupuncture are walking sometimes five hours to sit on the grass outside the clinic with the hopes of getting help.    

As in any small village, there is very little privacy for me here.  I live at the clinic, and as I am typing these words two children peer through my window, curious about the new “acupuncture doctor” who is now present in their village.  I am getting accustomed to being stared at, not unkindly, but out of pure curiosity.  The darkness and the language challenge me but already I am adept at washing clothes by hand and if you get the timing just right, your clothes will dry on the line in the midday sun in just one or two hours.  Our diet consists of rice and curried vegetables, determined by what is available at the farm next door, and I will soon enter the cooking rotation as I gain familiarity with the art of Nepali cooking.  On occasion the servings of rice are so generous, that through laughter and playfulness at the table, the heaps of steaming grain are named for various famous mountains.  Everest of course is almost always present on our plates.  No meal goes without its share of sniffles from the spices and chilies and my left hand stays obediently in my lap as the art of eating with my right hand (no utensils) gains familiarity.  

The clinic and the patients are becoming more and more familiar.  Last night was an exciting night; being the only emergency facility for miles, we had four admissions to the ‘hospital’ in addition to having seen almost 40 patients for acupuncture during the day.  Advanced COPD, typhoid fever, one healthy baby delivery and one other sick pregnant woman.  Of course the clinic is only comprised of 6 beds crammed into one very small room, so today, while seeing patients, I was accompanied by a new born baby boy, the COPD patient and different members of his family throughout the day and the woman recovering from typhoid.  Typically, I am seeing between 20 and 30 patients a day.  Needless to say, it is quite a new rhythm!   

Volunteer Brett Rushworth moves to new clinic

Three weeks ago I moved to another clinic site in a rural farming village about 2 hours from Kathmandu. I am the first acupuncture doctor to work at the clinic and before my arrival no one in the community knew of acupuncture and its benefits. Now in three weeks I have over 250 new patients and growing. Last week between 40-60 patients were showing up for treatments per day. Some of them traveling over 4 hours and waiting all day to be treated. I have my hands full...

Kelsey Dixon at Sechen Clinic

What Can I Say?

 

I met K at the prescribed time this morning. We smiled and gestured awkwardly for a bit, exchanged the few phrases of Tibetan I can understand, and waited for Sonam. I didn't see anything large enough among K's accouterments to contain his chest x-ray, which immediately made me wonder if he in fact had it with him, but my effort to ask him about it left us both very confused.Thankfully Sonam showed up a few minutes later. Unfortunately, she verified that he was in fact x-ray-less. So it would be a slow start: he and I hiked back up to the monastery to retrieve the x-ray, and then called Sonam again, 45 minutes later.On to the bus. Actually, three buses, and rather an adventure with a 6 and a half foot tall 66 year old monk who rarely travels outside the immediate vicinity of the monastery.On the way, I noticed a number of little stations on the side of the road, consisting of men crouched behind a towel spread on the ground laden with various bottles and other containers full of impressively bright and varied liquids. "What's going on there?" I asked Sonam, fearing the answer. "Medicines. They're local medicines: domestic produced," she told me. I swallowed.In just over an hour, we made it. 'National Tuberculosis Center,' I read, in big block letters, right next to the National HIV/AIDS Center. I even saw a truck with an HIV/AIDS Global Fund logo on the side. This was the real deal. We approached the font gate...and then we were told that the National Tuberculosis Center was closed for day, as it is a holiday called Gai Jatra, literally 'Festival of Cows.'We can go back tomorrow, and we will. This is Nepal.On the way back, K handed both Sonam and I a small baggie of little black teapills. "What's this?" I asked. "Pills," Sonam said, probably wondering yet again at my ability to ask such obvious questions. "Religious pills," she clarified. I gathered that they were a thank you gift, and watched Sonam take one out and gratefully chew it. I followed in suit, and then I prayed that tomorrow would bring more progress.

Joseph Jablonski in Chapagoan Clinic

After over thirty hours of travel, two hours of customs in Kathmandu airport, and an hour thrill ride in a cab I finally arrived at my location: Vajra Varahi Healthcare Clinic at Vajra Varahi Gompa in Chapagoan, Nepal. When they opened the large gates of the gompa (Buddhist monastery) to allow for the cab, I knew that I arrived at my location and at my new station in life.

Marcella, the clinic manager, was the first person to greet me. After a warm exchange of Namastes she showed me around the building and led me to my living quarters – my new home. Within an hour Macferson, her husband Lee, and Ben arrived. The new clinic team has been assembled: two acupuncturists and a massage therapist.

During and after dinner we were given our orientation: clinic procedures, working with the translators, case loads and scheduling, meal schedule, expectations, and load shedding. Load shedding is an interesting Nepali concept of power delivery. To ensure that the country receives adequate electricity the government has scheduled black outs. Chapagoan, for example, receives about eight hours of electricity a day. Usually we get two four hour blocks of scheduled power. Each day the times are different and the schedule isn’t always accurate.

After an evening of talking, sharing our experiences, and exchanging wide-eyed amazement we all retired to our respective rooms: Macferson and Lee to theirs, Ben and I to ours. After some brief chatting we both decided to turn in for the night. Incredibly, as my heavy eyes began to close, the wildlife (all the stray dogs) awoke. It turned into a night of tossing and turning to the serenade of barking and howling. Ahhhh…glorious.

Saturday morning at breakfast we all decided to head into Boudha with Marcella as our guide. The trip would take about ninety minutes and three busses. Public transportation in the Kathmandu Valley is an adventure. Busses, mini-busses, and tuk tuks make random stops along the road. A barker hangs on the side of the packed vehicle and scans for possible riders. He yells out the destination and when someone shows interest he bangs on the side to let the driver know to come to a stop – or at least slow down enough to let people jump on. This, my friends, is a far cry from the CTA…much more exciting.

Boudha is a spiritual center of Nepal. It is the home of the Great Stupa. Travellers and pilgrims come here to walk around the stupa three times, pray, burn offerings, and heal karma. The mass of humanity is incredible. As a special treat, Marcella suggested that we pay a visit to the White Gompa and offer kata scarves as offerings to Chokling Rinpoche, Chokyi Nima Rinpoche, and our benefactor Phakchok Rinpoche for blessings. This was done during a Drupchen, a nine day holy observance of non-stop mantra chanting. We reverently entered the gompa, walked alongside the left (clockwise) to the back of the altar and then we each presented our katas to the respective rinpochet. Each blessed us and presented us with a book and herbal medicine. Before our departure we were stopped by one of the monks and invited to a back room for an audience with Phakchok Rinpoche.

 

For over an hour Phakchok Rinpoche talked to us over tea about his experience as a Lama, Buddhist philosophy/theology and his thoughts of and experiences in America. As well, we had a candid and very cordial conversation with him about our lives, experiences as healthcare/body-worker practitioners, our relationships, and expectations. Phakchok Rinpoche shared with me his painful experience with Thai massage. I promised him that when I’m honored to have him on my mat, we will by-pass discomfort and win him back to the honored practice of Nuad Boran.



The following morning we had breakfast at Saturday Café which overlooked the Great Stupa, did some grocery shopping and headed back to Chapagoan. Sunday, the first day of the Nepali work week meant that the streets and all of the busses would be crowded. Our first two connections went without much drama. The third leg of our adventure was a bit more challenging. One packed bus after another passed without stopping. After waiting for almost an hour and no luck, we decided to walk the several kilometers home. Soon after we started walking, like a chariot from heaven, a packed bus pulled over and invited us aboard – on the roof. We scampered up the back of the bus and found places on the roof among other fellow Nepali travellers. Before we reached our destination the driver pulled over and ordered all of us off of the roof. Apparently, it’s against Kathmandu traffic laws to ride the roof of vehicles – blahhhh.

 

 

The night is now getting late and we start working in the clinic bright and early tomorrow morning. I still have to pick up my laundry that’s drying outside, do some studying, reading and prepare for a new experience – new life.

 

 

Namaste…
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