Bhottechaur, July 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.