Amanda: Bhotechaur Clinic

Bhotechaur Clinic… My New Home

September 28, 2014

I am not sure if I’ve made this clear but Nepali drivers are crazy… Fearless. They drive through mud puddles, ponds and masses of people and oncoming traffic. Potholes and dirt roads are a few pebbles in the road for them. And so when on my trip to the clinic in Bhotechaur my driver was more rattled than me, it was not a good sign. The extra long monsoon season had put a pattering on the steep mountainside roads. There were Tibetan prayer flags hung in the trees overhead. It was quite beautiful. It was also clear that there had been a few recent mini landslides that had to be shoveled off the road. The steep inclines were muddy and wet with deep tire tracks. My cabbie had never been to Bhotechaur before and, judging by his grunts and sighs, I doubt he will come again.

I was welcomed to the clinic with tea and chuda (a flatten bitten rice that is fried with peppers… “coursani” in Nepali). It’s quite tasty. The hospital staff consists of myself, Binod who is like the pharmacist, Dipendra who is like a LPN or PA. They are my brothers, or “Bhai.” Then there is Paru, a nurse, and Sorita, a medical assistant. They are my “didi” or, sisters. I have a sweet translator named Sabina and the hospital is run by Devi. Devi manages the hospital but is also a practitioner of sorts. The hospital has an inpatient room with 6 beds, a surgery, a delivery and gyn room, an X-ray room and a great view. It is definitely not a trauma 1 center but it is a quaint rural hospital. My clinic is a building just adjacent to the hospital with 3 beds. It’s small, but comfy.

My first day on the job consisted of treating my room and clinic to a dusting and spider cleaning. SPIDERS OF NEPAL are scary. They are massive. If I could manage a photo I would take one, but I can’t subject myself to the terror of having to see one unnecessarily. On my first day, I saw a woman who was an inpatient at the hospital. She had high Uric acid levels, a cough with lots of phlegm and hip pain. All common ailments here, I’ve discovered. It was her first treatment and on her second day she requested acupuncture again before she was discharged. She was doing much better. I’d say the combination of western meds and acupuncture had a win that day.

The first week at clinic was a bit slow- I saw 2-4 patients a day. Most come in for pain…. Knee pain. Low back pain. Neck and shoulder pain. There were a few cases of abscesses. Not sure what that is all about. I started treating a man who recently had a stroke. It happened 3 days prior to him coming to the clinic. He traveled for a full day to become an acupuncture inpatient. He and his son will stay until the beginning of desai (the biggest Nepali holiday. It sounds like it is 15 days but I am not certain and it celebrates family). On the first visit, my man with the stoke couldn’t move his left side well. He had numbness, tingling and weakness in his left arm and his leg. He also had blurred vision and eye pain on his right side. His son had to assist him while walking and through his ADL. On his first visit I did the drop arm test. His left arm fell nearly to his leg. After the treatment I did some active and resisted range of motion work with him and I taught his son how to help him with this as well. The next morning when I saw this man, and I did the drop arm test his arms remained almost parallel. I was shocked. It was such a huge improvement. I did not expect suck good results. It will be nice to see how things continue to progress.

The switch to village life has been quite nice. I wake up at 5:30-6am and go up on the rooftop and meditate for a bit, then I take a walk for about an hour. By the time I get back it’s tea time. Between tea time and breakfast/lunch at 10:30 we practice Nepali and English. The clinic is open from 10-4 unless someone stops in earlier or later and I am around. One day I gave a treatment by 7am. When it is slow in the clinic I sit in on some of the hospital patients. Thus far I’ve seen a lot of colds, 2 snakebites (yet another thing to fear here. Oh I’ve also been told that there was a tiger in the area, so I have to be cautious from dusk to dawn), a few injuries and some first trimester sickness or pregnancy check ups. The evening consists of reading and more language practice. I’ve started War and Peace for the second time. This time I hope to finish it.

Blending Like a Local…?

September 28, 2014

I was told that monsoon season ended in the beginning if September, but it seems to be going a bit longer. It feels like it has rained for the past week straight. I hope this means a good ski season this winter. The fog has been blocking my wonderful views. One morning it started out nice and sunny so I thought I would have my first go at hand washing my laundry. As I put my clothes on the line to dry it proceeded to get cloudy and rain. Needles to say my clothes were wet for a few days.

I’ve been learning a bit about Nepali cooking. Paru, Sorita, and Binod have been teaching me a few things. Each day the staff who all live at the hospital with me take turns cooking. My turn is coming but probably not for another week. They want American style food. Not sure what I will make… All suggestions are welcome. Food each day consists of dal bat and dal curry for first meal and last meal. Basically, it is a bunch of rice, some dal in a broth and a veg curry. It is delicious. I find when I visit KTM I miss the curry. I am put out by the proportions of rice. It is a ridiculous amount. I must eat between 2-3 cups of rice a day. I can’t handle it. We joke about bhat bellies and family packs. Thankfully the scales here are in kgs so I don’t feel fat, even though I get called healthy, moto or fat, and too seto or white. We eat with our hands and it makes me wonder who the cruel person was who invented chop sticks because eating with your hand is 100x easier.

My little Nepali family is great. They have been so sweet. Binod is the goody younger brother; he’s always singing and dancing and flirting with some of the daytime staff. Dipendra is the quiet big brother. He translates Nepali and Hindi songs for me and tells me I’m very smart. Naturally we get along. The two of them have nicknamed me dimples. There is a song in Nepal about a girl with dimples and everyone makes me sing it. It starts ‘simple simple Kanchi ko, dimple parne gala.’ Everyone here seems to be able to sing and dance. These are things I can only do in the shower. Sorita is the quiet older sister and Paru is the goofy younger sister. These two are always looking out for me when they are laughing with me or at me… Not sure on which. Devi of course runs the ship. She sets me up with acupuncture patients and helps me when I need something.

They have me teaching them yoga or exercises for an hour in the am. It’s not everyday because I don’t get up as early as them and I don’t know that much about yoga. It’s a mix of soccer exercises, qi gong, and yoga. They are working on ridding their family packs and I could use the stretch and laugh. Watching Binod is great. He is like a cooked piece of spaghetti.

I am plugging away at teaching them English. This far I have ‘thumbs up’ ingrained into their brains. Sabina, my translator, makes fun of my frequent thumbs up use. I have also gotten them using chitchatting and just kidding. I think wicked has to be the next word because of my New England background.

I am writing this from my clinic and out the window there is a woman on her hands and knees cutting grass with a hooked blade. Just a little insight to Nepal. Clinic has been a bit busier but still pretty slow. I’ve just been seeing 4-5 patients a day. I’ve continued to see great results with my stroke patient. Most of his numbness and tingling have gone; there is some ridiculous numbness in his shoulder. He is walking on his own and his strength is doing much better. He left today for 3 weeks. He is going home for dashain and plans on coming back on a motorcycle.

I’ve started to see 2 other stroke patients. Strokes are common here. One is a 20 year old boy who had a stroke 2 years ago and the other is 53 y/o male who had a stroke 7 years ago. The changes in these patients haven’t been as rapid as with my inpatient stroke guy- partially because they don’t come daily, but it is more likely due to the fact that they had their strokes a while ago. I’ve treated more back and knee pain, some sciatic pain. I have also been seeing a woman with gyn issues: amenorrhea and low abdomen pain d/t a c-section 5 years ago.

This morning I treated an officer for back pain. 5 days ago he had a fever. He took a course of antibiotics and anti-fever medication. The fever returns as soon as he stops taking the anti fever medication. He still has a cough, alternating fever and chills, n/v, and a bitter taste in his mouth. P was wiry and T had a slight yellow coat. The back pain was interesting but the rest if the case was textbook Xiao Chai Hu Tang. It will be interesting to see the response on a few days. Tomorrow I am heading to KTM and Patan to treat a patient. Hopefully, I’ll have time to enjoy a bit of Patans darbar square.

October 26th

My first trip to trip to Patan started off with Devi and I on a very packed bus. I should forewarn you this post was much better the first time I wrote it but I accidentally deleted it while uploading the last photo.

So the bus... It was busy. Dashain was starting in a few days and everyone was heading back to their family’s village. A Nepali man was all too kind and forced me to take his seat, so I shared two seats with his three children. I’m sure there is some formula where 4=2 but I’m not an accountant.

When Devi and I arrived in Patan that evening, we were welcomed into Santee’s house with rokshi (house made booze…something between bourbon and vodka, and lentil cakes. After some drinking and talking Devi left to visit her family and I stayed at my new friend Santee’s house. The visit was arranged so that I would be able to provide Santee with some acupuncture. She had a herniated disc some years ago and was left with a scar a foot long traveling from her mid back around to her hip. The scar had opened a year or two ago and was infected. The tissue below the scar was tight and adding tension to the already opened scar. I did a scar treatment and an herbal wash for her that night. After the treatment Santee started telling me about the history of Patan and her culture. She was Newari; the Newari were the first settlers in the Kathmandu valley.

That night I was introduced to her German doctor friend, who ironically managed to know my German friend. Santee, the new German, Gita, and Santee’s sister, Ganga (the strong strong rokshi brewer) all sat around chit chatting. Gita invited me to join her and two of her doctor friend for some traveling over Dashain. I had no plans and a holiday so naturally I said yes.

The next day I woke up at 5 am. And Ganga took me around patan. We went to mahaboudha temple, darbar square and golden temple. It has to be one of my favorite moments in Nepal. All the Nepali men and women are up doing puja at this time. The men sit on one stoop and sing prayers and the woman on another. People travel to the temples and get tikka. It’s quiet and peaceful and amazing. The golden temple is my favorite temple thus far. It’s hidden in the city of patan. It’s small and golden.

That day I gave Santee another treatment and then met up with Gita, Anna and Imke, wonderful Germans! We made plans to travel around the katmandhu valley and finish out traveling back at Santee's for the biggest day of Dashain celebration. After two days of work in the village I set of for Dashain travels.

The four of us met up for breakfast and then set out for Panauti. Panauti is a religious site, like most square feet in Nepal. Panauti has a small temple. It is a beautiful site for cremation. You had a nice view of the mountains and it is a meeting place of two rivers. Supposedly, if you stand where the two rivers meet and you can see the third river you are enlightened. I have to say, I saw two rivers coming in and one going out. If that out going river is the mythical third river then Buddhism and enlightenment is much more simple then it's made out to be.

After spending some time in Panauti we decided it would be a great day to walk to namo boudha. My friend Harv did his volunteer time there and said it was a beautiful temple. The map made it look close and it was a beautiful day, so the Germans and I set out for the hill top temple. It was hot and sunny and two hours later we were still walking. It was not as close as we thought. Everyone we met kept saying it's 30 mins from here, or it's an hour from here. Almost 3 hours later we made it to the top of the temple. Locals don't have a good sense of time, distance or geography. That's is one thing I've discovered…. Humm. Maybe I do fit in well here. On the way up to the temple we passed a beautiful stupa with Tibetan refugees making pilgrimage to the temple. He chanted and danced around the stupa. It was perfect timing. The temple at namo boudha was beautiful. It was red, gold, and massive with a great view of the mountains and the surrounding the KTM valley.

The next day we traveled to Bhaktapur to visit the darbar square. Patan, Kathmandu and Bhaktapur all have darbar squares or kings square. However, the darbar square in Bhaktapur is the most impressive. It is massive… like a town all in itself. One day was not enough to explore the square properly. Than and it was Dashain so there were buffalo and goats being sacrificed everywhere. We didn't enter many of the temples because we saw crowds of young boys herding buffalo into some of them. I have mixed feelings about Bhaktapur because of the sacrificing and the fact that my camera was sacrificed as well. One minute I had it the next minute it was disappeared.

After visiting Bhaktapur we went to nagarkot and stayed at a woman named Pramila's house. Pramila offers home stays. You can stay at her house and work on the farm or help around the house. Gita and Pramila were friends so we had promised to celebrate Dashain with her family. Pramila's house has a wonderful view it over looks the mountains and KTM. We sat on her porch after a few long days of walking and being tourists; we were offered tea biscuits and a gift from the sky… It was clear with a great sunset over the snow-capped mountains. We sat around eating some delicious dal bhat and played cards. We played a game called doumbal. The three Germans, a French guy working in the farm, Pramila, her two kids and myself played this game. It took me minute but after first round the American started owning the game. The kept joking that the American was cheating. I won big and I won the most rounds, but I also lost big and didn't win the game. It's a keeper.

The next morning we woke up to celebrate Dashain with Pramila and her family. The morning started with tikka from Pramila. Tikka is a blessin. You are given a big red rice filled tikka on your forehead. A flower and fruit and treats. After tikka you are allowed to eat nice Nepali dhal bhat dal curry breakfast. It was so good we all had seconds not realizing that Pramila was also taking is to a shamans house as well to get tikka from him. With more fruit and more food. After eating more that 4 stomachs can handle we set off on a skyline walk from nagarkot to changu nayapul. Another religious temple on a hill.

The walk was much needed because we were all so full. We walked about three house and arrived at changu. It was very quite in the town all of the locals were celebrating at home. Changu was a nice temple however I only stepped inside for a moment and stepped right out. Anna, Imke and I are a bit squeamish when it comes to the sacrifices. I wish I say more of the temple but one temple is similar to the others and I’d rather avoid the blood.

That day we rushed back to Patan to make it to our third tikka of the day at Santee's house. The Newari tradition is a bit different. With different colors for tikka, wheat grass instead of a flower, and a malai: a necklace that is a simple red piece of cloth. It's similar in that you are given a bunch of fruit and a whole lot of food.Anna, Imke and I were exhausted after the last 4 days of travel and we decided to make our last day of holiday a quiet relaxing day as opposed to the initial plan of hiking shivapouri national park. We stayed at home and made breakfast, we did laundry and read. We were staying in bagdol at their host family's house while they were on vacation for Dashain. It was so quiet and wonderful. I taught the Germans what my Nepali didis taugh me about cooking and we made a nice dal bhat dal curry for dinner. It was a perfect day. So much touristy things can really tire you out. I have to say the German hospitality is great. That night Anna and Imke left me a German chocolate on my pillow. I will miss them and their kindness very much.

The next morning we said our saddened heart felt goodbye.

Home coming and home going.

The trip back to bhotechaur was a blast. I now have a new favorite method of travel. Bus top travel. Why get on a bus as a human, only to be squeeze and josseled around, surrounded by coughing, spitting and vomiting. You wind up becoming a sardine. It’s much better up top, when you get to drive under prayer flags.

Getting back to bhotechaur was nice; 5 days of being a tourist is too much for me. The city with all its dust, and the bustle of people are fun, but the quiet and calm of the mountains are all to relaxing.

Getting back into working was easy. I had missed my patients. First thing in the morning, my stroke guys came in for their treatment. There seems to be 3-4 that come at the exact same time; they are the morning rush. They all get a similar treatment but with subtle differences based on their body mechanics. At first, I was following the CAM stroke protocol but realized it could be a bit better… so I modified it. I spiced it up with some JAS and added some scalp electro. It seems to be working really well for 2 of my patients. They also come a bit more frequently than the other 4 guys.

I have started seeing more women with menstrual pain and low abdomen pain d/t past c-sections. One of the woman I was treating with low abd px and amenorrhea for a few months got her period after 2 txs and a week of herbs. She was happy and sad all at the same time. I’ve discovered a lot of unique cultural traditions surrounding mensturating women. Women who are currently menstruating are not allowed in temples and they are not allowed in the kitchen. Typically in a Nepali household the woman is the cook, so from what my friends have told me, there are some exceptions. The women who come into clinic typically have lots of cramping and discomfort around the time of their period. Many of the women show PMS symptoms of fatigue, breast tenderness and increased low-back pain.

After two days back in Bhotechaur. I was off to the clinic in Chanauti for a few days. The morning started early with a 2 hour motto ride down the muddy hills towards the riverbed where the other clinic sat. It was kind if interesting traveling from the mountains down to the river; it felt like entering into more of a rain forest environment; equally as beautiful.

The clinic has 6 beds and another great set of staff. Min and Mena the midwife and nurse, Rajendra- not sure what he is besides great, Anil and korbila. After a delicious breakfast of dal bhat dhal curry and a luxurious egg I dove into work. The first day I saw about 26 pts between 10/11 and 3. Including a home visit a block or so away from the clinic. Anil was writing the patients name and what pain they had down on a ticket. Mena would show them to a bed and I would read there ticket saying knee px and joint px. Then I would take their pulse, and look at their tongue. If I had time I would poke around their belly before putting needles in. I spent about 7-10 minutes with a patient before moving on to the next patient. The first day felt a bit like a factory. Knee px, back px, shoulder px and foot px were what people complained of. It was like an equations- complaint plus this pulse equaled this treatment etc. One young guy had tonsillitis for many years and had taken many antibiotics that didn’t help. He was an interesting case I did a bit of blood letting. When I saw him the next day the px was gone but the glands were still inflamed as the tonsils were still red. The second day I saw 34 pts by 2 o’clock. It’s hard to picture myself moving that fast but it is possible. I proved it. It was very interesting… You find a flow. It was also a bit tiring. Many of the patients the day before came back and their joint pain was gone in one joint or lessened. They seemed happy and I was glad to have been able to help.

When I was in Chanauti I went home to Rajendras. His family cooked for me. And I played with his two sons. He had a beautiful house on a hill a short moto ride and a decent walk away. I slept in a room that opened up to the outside. I woke to a beautiful sunrise.

Tihar and Dewali

The clinic was to be closed once again for Tihar. It’s a five-day celebration with singing, dancing and puja. The clinic only closed for two of the main days, but that meant two days of holiday celebration for me as well. … I should tell you it was wicked awesome.

Tihar is a five-day celebration in Nepal. The first day of the celebration begins with celebrating the crow, the second day the dog is worshiped. Dogs were painted and given tikka and special treats. The third day the cow is worshiped. This day is also laxmi puja; Laxmi is the goddess of fortune. On this day, everyone does puja on their houses. During the day, between patients, we made malas to hang over the does to all the different rooms of the hospital. And at night we lit candles all around the hospital and ran around giving the house puja using red and yellow rice paint. After puja was done at home children come door-to-door singing and dancing in exchange for rice, coconut or dried fruit, chocolate and a few rupees. It is a jolly time in the villages.

For the final two days of the festival I traveled to my friend Santis house in Patan. She is Newari so the forth day of Tihar is self puja. Traditionally, the forth day of the festival the ox is celebrated. In the morning Santi and her father hand painted 14 mandalas for every person coming to dinner.

For self puja every one lights innocence and burns a candle. Then Santis mother came around and blessed us and our food and then we blessed our food. The day involved eating some friend fish and drinking some chang or rice beer. Drinking the Chang was required even by my 12 year old friend.

A group of us headed up to Santis rooftop to watch the fireworks while some of the brothers went off to play cards. Tihar and Diwali happened to line up. Diwali is the festival of lights. Kids run around with sparklers. Fireworks and singing go off all night. It reminded me of forth of july.

The last day of the celebration was brothers and sisters holiday. It is similar to self puja except the sisters put tikka on their brothers and wish them good fortune. They serve them dinner and in return the brothers offer a gift to their sisters. Here is a group of all of the brothers from brothers day puja. It just so happens I ran into Brett. He was an old MMW volunteer who returned to Nepal for a 3 month visit.

Goodbyes… are never really that good.

JANUARY 12, 2015

The last week in the clinics was very hard. It didn’t seem like 9 weeks had passed and it sure didn’t seem like I was leaving in a week. I was heading out of Bhotechaur and Chanauti but there were three people coming in to replace me. We had all planned on meeting for dinner in boudha so that I could give the new volunteers a few tips and help everyone get on the right busses to their respective clinics. Ece was heading to Bhotechaur while Ari and his partner Lisa were heading to Chanauti. I had planned on heading to Chanauti with Ari and Lisa to help them get settled for a few days. Then I was going to stop in with Ece for a few days and help her get acclimated to the clinic in Bhotechaur.

I ended up spending the week in Chanauti with Ari and Lisa. We cleaning up the clinic a bit and helped getting Ari and Lisa get acclimated to the large quantity of patients that they would be seeing. Ari and Lisa brought a ton of fun tools to the clinic. Ari is an acupuncturist and Lisa came to assist him so we spent time teaching Lisa gua sha, moxa and cupping. Lisa will be so helpful. The hardest part of working in the Chanauti clinic was keeping the pace of the treatments. Having someone to take out needles at the appropriate time would have been wonderful. Plus she could do some of the adjunctive which will allow more patients to be seen. It takes some of the load off.

My last week in Chanauti was HARD! It was hard work, exhausting and difficult to say goodbye to everyone. But I had to head to Bhotechaur. I was hoping to have a few goodbyes with my patients and of course my staff family. Paru, Sorita and I had attempted to plan a pizza mission where we took the last bus to KTM for pizza and took the first bus back in the morning, but we ran out of time. I arrived back in Bhotechaur after a two-hour bus ride and an hour and a half walk. Paru made me a final dinner at Bhotechaur. Most of the staff at Bhotechaur were good cooks, but Paru’s dal baht was the best; plus she made me some special aloo chips.

After some packing I spent the morning helping ECE with a few patients. We went over the electro machine and a few files of repeat patients.

Before the bus came to take me away the staff threw me a goodbye celebration. Everyone from the hospital came around and gave me a mala and tikka. Older Sorita started the celebration with a few beautiful words. I will forever remember her and her kind soul. I was speechless for a bit. This was the saddest I’ve felt in the past decade.

Thank you for everything Nepal. I look forward to coming back in a few years!

See more of Amanda's beautiful pictures here! https://maharayenepal.wordpress.com