Ece's Time Spent at Bhotechaur Clinic

Saturday, December 13, 2014

Mindfulness and Mindful Medicine Worldwide

I've arrived in Nepal! I wanted to take some time to tell you a little bit about the work I've begun in Nepal with Mindful Medicine Worldwide. I'll tell you more about the day-to-day life in the clinic next time.

The two buildings at the top of the hill are the Bhotechaur Hospital; my clinic is a room in the lower pink colored one, and I am staying in a room in the upper building with blue accents. I drink buffalo milk tea regularly at the building at the bottom of the hill!

Volunteers are carefully selected for this program. It is not enough to be willing to work in a rural foreign clinic with limited modern comforts in a busy clinic-- electricity and hot water are unreliable, and buildings are not heated-- but the organization wants volunteers with an open heart and as their name suggests, volunteers who are practice being Mindful.

Here's a picture of the inside of my clinic. Three beds; one normal sized and two narrow.

So what does it mean to practice Mindfulness? I've struggled a lot with defining this concept in words alone, as it is something you do (a verb!). It is being present in every moment, being fully alive rather than going on autopilot. You can practice it in a myriad of different ways; meditation and tai ji are some ways that help me remain Mindful. Tai ji has the added benefit of aiding my physical health through exercise and alignment, but both practices help me to clear the busyness out of my head. I feel that it is important to clarify that sitting and standing meditation are not a means to an end, though; meditation is for the sake of meditation! Meditation is being totally present in the moment, with nothing else going on.

This is a picture of the entire town of Bhotechaur. (Bhotechaur is actually spread out over 8 little farmtowns). You can see the Bhotechaur hospital at the top of the hill, and the Helambu Himalaya (possibly a little of the Lapsong region too) in the far background.

Saturday, December 27, 2014

A Nepali Wedding!!!!

The very young bride and groom! Age 18 and 17, an arranged marriage. My clinic manager Devi invited me to her nephew's wedding! She invited me on a Wednesday as she boarded the bus to go to the wedding, telling me to come on Saturday. Well, at first I was rather confused. Me: "You're going to the wedding now?" Devi: "Yes, going now" Me: "But I should come on Saturday?" Devi: "Yes, with Sabina, on bus." Apparently Nepali weddings are big parties lasting between 2-4 days. Anyone who knows anyone in the semi-immediate family (parents, siblings, aunts, uncles, and grandparents) are invited.

Friday evening I walk down to the bazaar and find a party going on! It's pretty small, but there's this big bamboo thing that's been constructed with intricate strings wrapped around and a little fire going in the middle. There's a couple people sitting around putting things into the fire (bits of wood or bits of red colored rice), singing prayers, and there's several little plates of food near the fire (offerings). Apparently, it's part of the wedding! There's a several day party at the groom's house and a several day party at the bride's house.

Some young friends I made Saturday morning in the bazaar at the Bhotechaur location wedding party

Saturday morning I wake up and I put on my party clothes (I just had a kurtha surwal made) and run down to the bazaar where I hear music playing before clinic opens. There's people in all their fine clothes, makeup, and gold, dancing and a full (Nepali) band!! Sarita and Paru (from clinic) soon join me and we watch people dancing, listen to the music, and drink tea. Someone comes around and puts red rice tikkas on our foreheads. A decked out minivan pulls up, and this young man in a funny grass necklace comes out of the nearby buildings and walks around it three time with incense. People keep stopping him to shove money in his hat or hands. Every time he walks around, more people follow him. Some of them throw rice, some of them dance. I find out that this is the groom, on his way to the bride's part of the party. In Nepal, this may be the first time the bride and groom meet. The minivan fills up to the brim (including the full band), and drives off. At the end of the day Paru, Sarita, Sabina and I walk down to the bazaar again. Since the morning party left, a bunch of women wearing red have remained in the bazaar all day. They play drums, take turns singing songs and dancing. We are fed, and then fed some more. Apparently the bride and groom's family have to feed all the partygoers 24-7 for the extent of the wedding. I ate sell, a kind of not-too-sweet rice flour doughnut, crispy puffed spiced rice, little sweet hard rice flour balls, and plenty of veggies and rice. Then Sabina and I hop on the bus.

The bus is so full that folks are sitting on the roof--which is illegal but not strongly enforced! After a little engine trouble and spending some time wondering if we'd have to walk the remaining distance to Devi's home (where the party is going on--it would have been about a 3 hour walk up and down the Himalaya), we make it safely to the party! We spot Devi in the crowd almost immediately; she is going around and being a very gracious host to everyone. I'm immediately brought over to the bride and groom. I awkwardly place a red rice tikka on both their foreheads and give them money. The bride offers to pour water over my hands to clean off the extra goop. I'm then taken over to a 7-year-old boy who is sitting with his two older sisters and is also, apparently celebrating something. I also put a tikka on him and give him money.

Then, we dance!! Some cute old ladies teach me the traditional Nepali dancing style. You have to wave your hands around a lot in little circles while first turning right, then turning left. This one middle-aged guy was going around jumping/squatting/dancing with a bowl, and if he touches your feet and dances in front of you, you have to put money in it. Sabina tried to get out of dancing by manning the camera (she got some great shots), but I eventually grabbed the camera away and made her dance too. As soon as we stopped dancing, we were given MORE food. More of the delicious sell, doughnuts, veggies, tea, and then raksi, the local moonshine. I was a little hesitant to try it since it was being served in big bowls (and sharing cups/plates/utensils is a HUGE no-no), but eventually I was able to get a very tiny serving. It is distilled from millet, and is very, very strong. We finish our snack and about 15 minutes later Devi finds us again and tells us that we absolutely must have dinner now! So.... we go off to eat again. Rice, beans, goat (? maybe buffalo) meat, potatoes, cauliflower....yum!!

After dinner I speak a little bit with some folks that know some English (I'm the only foreigner at the party). I try to use the little Nepali I know as best I can. We watch the dancers while we chat. Nepali people don't ever display public affection, not even hand holding- so this applies to dancing as well. Most of the dancing so far has just been group dancing, but now that it's getting later and slowing down a little bit the dance floor is more empty, and I get to watch a young couple dance together. It's really beautiful, there's all the same turning right and then left with the hands in the air, but they twirl and circle around each other, with the man leading. A shy 20 something gentleman asks to dance with me (he doesn't speak a lick of English so Sabina translates), and so I dance too! We dance the rest of the night-the young men are constantly trying to drag more women onto the dance floor. A lot of folks keep walking up to me and telling me they thought I was Nepali, and complimenting my dancing (note: they only compliment my dancing after realizing I'm a foreigner). The bride and groom remained seated and ready to receive guests almost the entire night. I'm not sure if they even got up to dance. I spent the night in a spare room (quite literally only a bed and standing space) at Devi's house. In the morning I sat with a bunch of cute old ladies to have leftover sell and tea. There was then a little farewell ceremony with bestowing tikkas and kata (silk scarf), and beer, coke, mandarins, and apple slices on some extended family that had travelled from some distance to attend the wedding. They made me join in too! Then around noon we packed as many people as possible (standing room only) onto the back of a pickup truck and hurtled down the bumpy roads back to the hospital (with may stops along the way).

Saturday, January 3, 2015

Living the Dharma

5 years ago, I planned a trip to China. Along the path of planning, somehow visiting Nepal became the main purpose of my trip, and visiting China became of much lesser importance. With little to no prior exposure to Buddhism, I decided to begin my trip with a one-month Lam Rim course (introduction to the Buddha Dharma) at Kopan Monestary in the Kathmandu Valley of Nepal.

My stay there has had a profound impact on the course my life has taken, and yet at the time, I decided that I took Buddhism "too seriously" to take refuge in the Buddha Dharma and to call myself a Buddhist. I did not want to make a commitment that I could not (or would not) keep. Since then the question of my spirituality faded into the background as I began my study of Chinese Medicine, which is deeply rooted in Daoism (as is Buddhism).

Now that my formal education in Chinese Medicine has ended, I have the time to contemplate the whole picture of my life. My practice of Chinese Medicine remains most important, I am constantly studying ways to better serve my patients (this is the Bodhisattva practice of Buddhism). But more and more I feel the draw to commit to a formal spiritual practice rather than just dabbling in this or that.

I've begun re-examining Buddhism, which has again been playing a stronger role in my life this past year. Should I take Refuge? Am I Buddhist? By being Buddhist, am I refuting all the other spiritual paths that I believe to be true? I've always strongly held the belief that all the paths are just different ways up the same mountain (or as a kind gentleman phrased today, all are corners of the same bar of chocolate).

Daily Nepali life is immersed in a type of spiritualism that I have not seen in the US, or many other modern countries. Buddhism and Hinduism are fluid practices between each other, and I've even met Nepali Christians and Muslims! They truly practice, taking time out of their day to go to temple--and not at a prescribed time like Sunday Church. With that example, I find myself examining my daily life. As I am more familiar with Buddhism, I look to that example.

In my understanding of Buddhism, to take Refuge in the Buddha Dharma (to "be" Buddhist) takes 3 vows: to take refuge in the Dharma, the Sangha, and Buddha. I feel the main purpose in this lifetime (and all my other lifetimes) is for spiritual development, which I do through serving my patients and studying from great spiritual teachers; this is the Dharma (Buddhist or otherwise). The Sangha are my Dharma brothers and sisters; other people who are seeking a deeper purpose to life. I already find myself seeking companions and advice from these like-minded people, though they may be from all different walks of life. Buddha is a name for the higher self; mine and that of all sentient beings. The universal consciousness and oneness.

And so, I have discovered that it doesn't matter if I "am" Buddhist or not, but what I am a practitioner of the Dharma. I let go of my attachment to that particular label, and am just allowing myself to be as I am.

Sunday, January 11, 2015

Nepali Life

Life here is rough, so it's understandable that many of my patients look older than they are, and yet they continue their humble daily existence. Nepali people spend their day in the field wearing flipflops or going barefoot, hunched over or squatting down to dig up potatoes by hand or carrying giant bundles of grasses for miles. Their diet consists mainly of rice (which is inexpensive) and a small portion of SPICY vegetables or potatoes with a little bit of lentils. Once in awhile they enjoy a bit of chicken, or if they can afford a buffalo or a cow (buffaloes are more common) they can have a little milk in their tea--which has a TON of sugar. If they happen to attend a wedding (which lasts 2-3 days, see previous post!), they will eat buffalo or goat meat. Meals are often cooked over a fire, indoors, with no proper ventilation. I should mention that the Nepali government is preparing to set up legal guidelines to indoor ventilation, so people are slowly switching over to gas stoves! Electricity is unreliable, so there are no refrigerators and no central heating.

The winter here is still pretty warm in the daytime- I often find myself stripping down to just a shirt and skirt with leggings (or the traditional kurta surwal), but nighttime is really quite chilly. Once the sun starts to set, I find myself putting on first one sweater, than a second, then my light coat, and finally wrapping up in a shawl, hat and gloves. After dinner (around 6-7) everyone disperses to get under their bed covers to read or maybe watch tv for a little bit. Rooms are shared; usually 3 single women and 3 single men to a room, or a married couple together in one room. I'm lucky enough to have my own room, though that means I don't have the benefit of body heat to keep the room at least a little warm. I have a hot water bottle for that!

Dipendra and I out for a morning walk before clinic opens

It's interesting to see life truly run by the elements. People wake up before daylight in order to be out in the fields by the time the sun is up. Laundry must be done in the morning so the sun can dry it during the day. You don't take a shower when it is a chilly day, or when you have a cold, or when you are menstruating, and only once a week for the first months (or the first few months) after having a baby. When it is dark, you go indoors and slow down.

There is certainly a beauty to living by the elements, but it isn't without it's consequences. My patients suffer from a lot of joint pain, coughing, and a myriad of other disorders. I should mention that Nepali people are tough stock-there are many older village people with nothing but minor health complaints. Most of my patients come in complaining of knee pain and lower back pain. I also have several patients who have suffered from stroke, several of which are very young (one young man had a stroke at age 19). Many post menopausal women have uterus prolapse. No one seems all that concerned about their chronic cough (everyone seems to have one) unless it is disturbing their sleep. "Gastric" (acid reflux) is also the norm--due to the combination of ST/SP imbalance/xu and all that spicy food! For you Chinese Medicine folks, common diagnoses are LV and KD yin xu or LU and KD yin xu.

Despite all the hardships, life here is very good. The Nepali people are warm and friendly, and living among the mountains is an unforgettable experience. There certainly is a good reason why foreigners come back again and again; for the spiritual experiences with Buddhism, Hinduism or a blend of the two, for trekking, or for the culture. I'm very happy to be here and humbly offer my novice skills in healing and enjoy the benefits of gaining experience while enjoying Nepal!

Tuesday, January 27, 2015

Purpose

I've been feeling quite homesick. It's inevitable as I've haven't had a stable home since July. I'm thankful for my new Nepali friends as well as the other volunteer at the second clinic (first Ari and Lisa, now Bonnie), but I also appreciate the difficulty of being away from anywhere stable and the opportunity that that little hardship presents.

Clinic staff; goodbye party for Devi (with the scarves, flowers, and red tikka)

As humans, it is through trials that we are transformed. Many people feel this in small ways; they have a fight with a significant other that brings new understanding and deepens the relationship, or someone may struggle to learn a new concept and feel a sense of accomplishment once it is finally grasped. But how often do you peer into your own soul? When do you take time to think about your Purpose? Relationships ,(romantic and otherwise) may offer a reflection, but it is an altogether different experience to directly peer into your own depths.

Saru (midwife) and I visiting the tea garden

The truth is, I returned back to Nepal because of the emptiness and loneliness I felt when I was last here. At that time, I had spent my 21 years on this planet thinking about the ‘next step’ and waiting for my life to begin, which I referred to as ‘becoming a real adult’. First I have to graduate high school, then college, find a partner, get my career started, be financially stable….subconsciously I believed that achieving these steps would bring about stability, knowing, confidence, and happiness. It took the realization that I choose the wrong career when earning my bachelors degree to start to break that tenuous belief.

Maybe a trip to the other side of the world will clear my head and set me on the right track…

So I came to Nepal, not yet knowing what I was searching for. I learned that accepting uncertainty, instability, and impermanence were what it really means to be an ‘adult’. I suddenly realized that I had unwittingly become a ‘real adult’. First came elation, then came pain and loneliness. I understood that there are no series of achievements in life where everything becomes magically perfect. Signing a piece of paper; regardless of if it is for a business contract or a marriage does not automatically make that thing perfect and whole. Life is always challenging and always changing. Even when we are surrounded with people, we are still a discrete, separate unit and have to work to maintain our relationships and continuously strive for happiness.

Even within my profound sense of emptiness I felt more alive than I had ever felt. No longer was I constantly distracted by the ‘next step’. I had stepped off of the prescribed path and was fumbling around in the dark with many more new questions than answers. But this new path felt more right. I had begun my search for my Purpose.

Through Chinese Medicine I learned more about the connectivity that exists where we sometimes feel separateness. The cosmos, the planet, and all living things are all interrelated. Humans (and maybe other living things) were given the gift of introspection, and so held a special place between Heaven and Earth with the potential of becoming a Sage (enlightened). The difficulty here existed in that these great teachings were delivered in a more-or-less standard modern teaching style, even with NCNM’s efforts to maintain a Classical approach. This standard model encourages that old ‘next step’ feeling, and leaves that dark, lonely, and oh-so-alive path overgrown with weeds.

I desired to again return to that path, and was drawn to Nepal where I had first discovered it. Of course, you don’t need to go anywhere to find what is inside yourself, but a complete change in everything familiar lends itself to introspection.

It’s difficult to feel that sense of Purpose and not have any prescribed way to achieve it. There’s no one to walk the path with you, for it is your path and yours alone. We all have teachers that help us along the way, or a friend that walks with us for a while, and if you are listening and watching you will find signs to point you in the right direction. And while I feel confident in my metaphors, I actually have no idea what I’m doing; but something propels me along nonetheless. So, there is the loneliness, the pain, and that amazing, brilliant, profound sense of being really alive.

Saturday, February 21, 2015

Women In Nepal

My time volunteering has come to a close. I can't believe how fast it's gone and yet I'm very ready to move onward. I'll still be travelling a bit more before starting up my own clinic in Chatham, NY, but I am eager to serve the people, in particular women, there. In preparation to do so, I want to reflect a bit on the women of Nepal.

As I've mentioned before, life here is rough. Unfortunately, it's rougher on women than it is on men due to male-preferred culture. Boys are preferred over girls because boys stay in the family home and continue the family business. Girls get married off in an arranged marriage (love marriages are still rare in Nepal) and move into the husband's home. Since the males stay in the family, there is a stronger tendency to put resources into them; namely education. Luckily, things are changing and more and more women are growing up educated, but it is still largely disproportionate. Since boys are busy getting educated, girls are expected to do work around the house from a young age, and are constantly busy. Since the boys spend 6 days a week in school, the are not part of the 'chore wheel' and when they have a day off from school, it's truly a day off.

In my main clinic in Bhotechaur, all the staff are live-in, so I got to be friends with both the women and men that work there. In Chanauti (the second clinic), though, there is only one live-in staff. It just so happens that all of my friends there are male--since men are the only ones with free time. While men help with the family business and the family farm, women are the ones who do laundry (by hand) and cook--meaning they are busy from dawn until late in the evening since dinner is typically 7 or 8pm. When I ask my educated female friends (in Bhotechaur) what they did on their days off before moving into the clinic, it is always laundry and rest--maybe grabbing some spicy snacks with a friend.

Me and our 'retired' clinic blood pathologist. She still has a full day of work in her home!

Since women are married young, they also have a very long time in which they have to manage their reproductive years. It's great that the general population is being educated on the benefits of having fewer babies, but there aren't a whole lot of options in terms of reproductive control. Most women opt to use Depo shots--which completely stops menstruation--which is donated by the US government. I'm not a huge fan of any of the hormonal reproductive control options, but to stop menstruation by high doses of hormones is the worst of the bunch. Of course, it's better than having 10 or 15 babies.

As a result of all the above factors, I have seen a lot of women with lower abdominal pain, burning urination, vaginal itching, white discharge with odor, and many, many women with uterus prolapse. Insertion of uterine mesh has been increasing, and while it helps in some ways, harms in others. While there are many people both men and women with burning and tingling in their hands, it is disproportionately female since women spend so much time with their hands in cold water washing laundry (in Chinese medicine we call this 'cold damp bi/obstruction'). I'm happy to offer some relief to these women, but a lifetime of hardship is hard to completely undo.

I've also noticed that postpartum Nepali women have significantly more abdominal stretching, even at a young age, than western women. I've discussed this with the other acupuncture volunteer and we suspect that this is due to the low-protein diet--less elastin in the skin. Nepali women often wear long pieces of fabric wrapped around and around their abdomen postpartum onward, possibly to help hold their organs in place! While most of my patients are older, I feel very fortunate that I've had the opportunity to help some younger women as well, and help them avoid a lifetime of pain. I recently had patient age 23, postpartum with uterus prolapse. While prolapse is rare in someone so young--and rectal prolapse is more common than uterine postpartum--it can occur based on where the baby's head pressed into the vaginal wall on it's way down the birth canal. Some muscles are weakened by the pressure, and then prolapse can occur. She came in not for the prolapse itself, but because the pain in her abdomen was interfering with her ability to do farm work. I was able to do both internal pelvic care (I've been trained by Tami Kent in Portland) and acupuncture with her. I don't know how to assess uterus prolapse, but her pain has been greatly reduced! I'm so happy to have been able to serve her and many other women like her.

Sunday, March 1, 2015

Teaching is learning too

Sarita and Saru giving me one last hug in Bhotechaur!

My last days at both the Bhotechaur clinic and Chanauti were truly lovely. At both clinics I was honored in the Nepali tradition, with katas (traditional silk scarves), flower malas, red rice tikkas, and some gifts. I will miss everyone very much! I'm so thankful for modern technology and the ability to at least stay in touch a little bit.

The staff in Chanauti...Nepali people rarely smile. The pup in front is Kali Bunti, she's teething! Bonnie, the other volunteer in the picture might be bringing her to the US.