June 8, 2014
It is my 3rd week here in Nepal, volunteering as an acupuncturist at the Rural Community Hospital Bhotechaur. The surrounding village is an oasis from the bustling Kathmandu city, with fresh air and endless landscape of different shades of green. It is indeed refreshing to witness the monsoon supporting the livelihood of the villagers. I am glad to be living in the comfortable hospital quarters with a team of lively staff, sharing loads of laughter every day.
Work at the clinic has been slow due to the farming season. It is understandable because farming is the priority of the villagers here as they depend largely on their harvest for food and income. It is observed, also from medical doctors, that the farmers would deem their illness as of less importance than their harvest and would seek medical help when they are done with the planting season.
The patients that I have encountered at the clinic are mostly women who are full-time farmers. They spend more than 6 hours in the fields, barefoot and bent over, often carrying heavy loads in a basket that is supported by an inelastic band across their foreheads. As a result, many of them experience pain in their knee and elbow joints, lower back muscles and stiffness in their neck muscles. As I help to relieve the pain in their knee joints, Sabina and the local women themselves mused over their “Nepali feet”. Almost all the villagers who are farmers have cracked heels and blackened nails, some with splinters deeply embedded in the soles of their feet.
Often, I would hear the women cough, with phlegm in their airways and I would sniff a little nearer to them and reach over to their abdomen to feel for the squashed pack of cigarettes in the secret compartment of the endless layers of cloth wrapped around their waist. I would tap of the pack and tease the women a little and they would laugh and cough even more. The Nepali women in the village are an admirable bunch. They manage and care for the family, preparing most meals with wood-fire and working in the fields from daybreak until the late afternoon. The thick layers of cloth wrapped around their waist, I heard, supports their back as they work long hours in the fields, giving them “energy”.
On one evening in my first week at the clinic, I went on a home visit with Devi, the clinic manager. She was paying a visit to the elderly parents of a fellow women’s group volunteer at the clinic, helping to take their blood pressures and to check their medications. The elderly couple was very hospitable despite their humble living quarters and offered us homemade chappati, curd and tea. The elderly father’s blood pressure was really high and some of his existing prescriptions were expired; Devi would return with new medications.
I realized the importance of the home visits as we dropped in on more households along the way back to the clinic. It was a form of outreach to the villagers as many are unaware of health-related and sanitation issues, as Devi educated briefly and advised on health conditions and made suitable recommendations. Many are unaware that acupuncture would be able to help ameliorate their health conditions, besides the conventional medicine, which some villagers find, beyond their means. This, I’ve learned, a simple way to create awareness for complementary therapy.
June 13, 2014
For a couple of weeks, I observed that a handful of women who visit the Bhotechaur Clinic for acupuncture therapy experiences smokers’ cough, a wet cough that is productive of phlegm. I found out that many of them smoke cigarettes; some had been smoking for decades. I thought it would be interesting to find out about their knowledge and attitudes towards respiratory-related health conditions and so I decided to conduct a Focus Group Discussion (FGD) with these women as participants. A FGD is a form of qualitative study in which a group of people is asked about their opinions, beliefs and attitudes towards a certain subject. It is an interactive process where participants are free to engage in conversation with other group members. With the support of Grainne, Devi and other clinic staff, the FGD was conducted on 13 June and went well.
Seven women turned up for the discussion and gave consent for their participation. The discussion was held in the training room in the Bhotechaur Clinic, which was conducive. Devi introduced the objective of the study and moderated the session in the Nepali language, asking a series of questions that I have prepared regarding respiratory health such as what are the likely causes of respiratory ailments, the preferred treatment that the women would seek when afflicted with respiratory illnesses and how they would prevent the occurrences of such conditions. Paru and Sabina did a great job transcribing the hour-long session, attentive and scribbling away.
The women were shy at first, reserved in the sharing of their knowledge and experiences openly, despite being peers from the same village. A handful of them had limited knowledge with regard to respiratory ailments; others attributed the cause of respiratory ailments to the habit of cigarette smoking, drinking of the local alcohol jad and allergy due to weather changes. Devi had to prompt for responses, as the women were not accustomed to such discussions. After the session, we thanked the women for their voluntary participation. They then enjoyed refreshments of tea and bread and their transportation expenditure were reimbursed. Sabina then helped to translate the session from the Nepali language into English.
The findings of the discussion were not profound, however, interestingly, a traditional remedy for common cold was mentioned by one of the women. I am thankful for the opportunity to conduct such a discussion with the women from rural Nepal as well as for the support of the local staff in helping to make this session a smooth and fruitful one. This discussion was conducted in hopes that health education regarding respiratory ailments can be better shaped and disseminated to rural areas of Nepal and I do hope the women enjoyed the discussion and will benefit from it.
June 28, 2014
After 3 weeks of volunteering in the Bhotechaur Clinic, I had the privilege to visit and provide acupuncture therapy at the Mahankal Health Clinic in Chanauti for 2 days every week. On the morning of 10 June 2014, I took my first 2-hour bumpy motorbike ride towards Chanauti, covering 47km, half of which are unpaved roads filled with gravel. The panoramic view of the villages, fields of rice and corn and the Melamchi River, however, was refreshing and breathtaking. The clinic faces the Melamchi River, which stretches on endlessly, with waters gushing infinitely on scattered low-lying rocks.
The Mahankal Health Clinic is a simple two-story rectangular building with the clinic consultation and treatment rooms on the ground floor and the offices and living quarters on the 2nd level. I met the lovely staff of the clinic, Rajendra, Mina, Kumari and Anil and commenced therapy for patients visiting the clinic. Many of them suffered from pain in their body joints, especially in their lower back and knee joints. Every week, for 2 days, with the help of the clinic staff in translating the Nepali language and in facilitating the registration and flow of the patients, I managed to provide therapy for more than 60 people.
Slowly I familiarized myself with the facility and adapted to the routine of the weekly visits. The rhythm of providing therapy at the clinic slowly fell into place as I greeted the patients, asked about their chief complaint, assigned them a treatment bed, positioned them comfortably for treatment and administered acupuncture on them. When the treatment sessions are over, the patients will dress up, chat with the staff and slowly leave the clinic. Time always passes quickly and I find myself exhausted at the end of each clinic session. Nonetheless, I get to relax with evening walks along the river and enjoy a great sense of satisfaction when patients express improvement in their conditions when they return for follow-up.
I remember my first evening in Chanauti when Rajendra invited me to his village home for dinner. I was warmly welcomed by Rajendra’s extended family; the older folks sat around the porch and chatted, occasionally referring to me in their conversation, Rajendra’s mother overfeeding me with tea and snack and Rajendra’s sons communicated excitedly with me in English. As the sky began to darken, I noticed Rajendra’s son lighting up a twig with the wood-fire in the kitchen and then handing the twig to his grandfather. Rajendra’s father then started singing a prayer in a low voice, waving the twig in front of his grandson, occasionally circling it around his abdomen and then spreading some ash on it. I found out from Rajendra that this is the village’s culture, a ritual to improve one’s health. It is interesting to observe a health-related village ritual in rural Nepal, especially when healthcare services are increasingly available in Nepal. The village culture definitely holds a strong presence in the lives of the villagers.
When I hear of patients who walked for hours to get to the clinic and then hours back to their village after acupuncture, or walk for an hour to catch an hour’s bus ride to the clinic for treatment, I truly wonder how much help and relief I can provide with acupuncture therapy. It is the peak of farming season now and everyone is busy in his or her field; rain or shine, bent over forward for hours, carrying heavy loads of more than 20kg. Nonetheless, I am glad that I am able to help these villagers in any little way.