A Volunteer's Journey

December 27, 2015

Getting There

 

I had come across Mindful Medicine Worldwide 4 years ago, just before completing my Chinese Medicine course. I would have loved to have volunteered fresh out of university, but at the time I had a young son to look after and studying full time for 4 years had left its financial toll.

 

Towards the middle of last year I decided I wanted to help out in Nepal. The earthquake had triggered a desire to volunteer and brought back memories of MMW. I went to the MMW website but after reading the various requirements was deterred as I decided that they were looking for people with more experience, so I kept looking.

 

I did what most people would do these days and started searching the Internet for organizations that facilitate Chinese Medicine volunteers. I came across a few that enable pretty much any type of volunteer and a few that were specifically oriented towards acupuncturists. I started contacting the various organizations to get a sense of what they were offering and what kind of impact they were having within their area of work.

 

The first organization I came across sounded like they were doing great work, despite their program appearing to be more like a guided travel pack and learning opportunity for acupuncturists. However, I applied and was accepted. Their program was very expensive though, and after seeking advise from various friends, (one with extensive experience living/working in Nepal and whom also monitors and evaluates international programs for Australian Red Cross,) I decided that the funds they required me to raise were too much and felt that there was the possibility that the organization was profiting from its volunteers with surplus funds not necessarily being injected back into the local community. My search continued.

 

After a fair bit of research I stumbled across a blog about someone who had previously volunteered for MMW. Initially, she had had a similar impression (to myself) regarding the amount of experience required to fulfill an MMW volunteer position, but had applied anyway and to their surprise, been accepted. She stated that it was the best thing they had done and that the experience had changed her life.

 

That night I gathered together all the appropriate information and sent out my application to MMW. Within a few days I had a reply and to my delight they were interested. We arranged, via email, to have a Skype interview with one of the board members and soon after I was talking to Richard in Spain.

 

Richard and I got on fairly well and he highlighted some of the areas I would need to prepare myself for. Things such as being more of a primary physician and seeing patients who may have had just had a stroke.

 

I finished the interview feeling positive about my chances but also left with the impression that I needed to refresh some of the content that had been put aside, due to clinical irrelevance in the west.

 

A few days later I received an email saying that the interview had gone well and that they would love to have me. They even asked if I was able to get there in three weeks to overlap with there current volunteer. 

 

I had had an idea of when I was able to go, as I had been pre arranging everything with my son and his mother. When I initially mentioned that I was thinking of going and that it was a possibility that I would be gone for two months, my son, (age 9 years,) reluctantly agreed but said “as long as its not for more that 8 weeks.” With his blessing and that of his mother, (we had separated two years prior,) I had my window of opportunity.

 

Up until this point I had been doing two jobs. I was working with the Department of Heath and Human Services in Victoria, Australia as a Disability Support Worker and also had a small room set up in my house. I had worked in a few clinics over the last 4 years but family illness and the immediate need for a fixed income meant I needed to procure a second job that had flexibility but also a steady income.

 

The money was fairly stable but the time spent away from my clinic meant things never really picked up and I was starting to feel like I was lacking clinical experience. My intention was to immerse myself within my practice and then return as a full-time practitioner.

 

MMW was founded by people who had previously been volunteers themselves. They ask only for a donation that will cover the cost of supplies used during your stay. You are encouraged to reach out for support within your own community in raising these funds, as this serves two purposes:

 

  1. It increases the organization’s profile and gets the message out,

  2. Raise money to cover the initial cost of supplies whilst in Nepal.

 

I set up a Gofund Me account and posted it on Facebook. I had spent a fair bit of time talking about my intentions with those closest to me and they all contributed immensely. My landlord, Beatrice Hamilton, was so grateful for what I was about to do that she told me I did not have to pay rent while I was away. This single act of generosity was really all the funds I needed, however many other people contributed, especially my family.

 

I spent a few weeks running around making sure I had whatever I needed for the trip. I went through my dispensary and grabbed 40 of the most useful herbs. I gathered some oils and various other tidbits I would use on a regular basis in clinic. I packed my bag, or at least attempted to - I soon realized I a bit over zealous and was attempting to bring too much. Normally I am quite a minimalist when it comes to travel but with the added expectation of providing a service and wanting it to be the most effective as possible, the contents of my bag expanded rapidly. I removed twenty herbs, which allowed me to close my bag, and was then ready to go.

 

Nepal

 

December 27, 2015

 

After a day of transit I arrived in Kathmandu at 8:10pm on the 27th of December. I peaked out the airplane window to get a glimpse of what appeared to be a normal airport with various vehicles transporting bags, planes etc. moving about the tarmac.

 

The plane came to a halt, we waited as the doors opened and then we disembarked. I took a step off the plane and it hit me in the face! The air was thick and if you haven’t been to a country with no regulations or restrictions regarding emissions then the initial day or two after arrival is essentially like picking up smoking.

 

I followed the rest of the crowd down towards customs and through to the exit. Customs was quick and very basic with only one customs officer on duty.

 

I had tried to book a room while in layover in Malaysia but failed to do so. In the end it didn’t matter though, because I met a medical student named Chris, who was kind enough to direct me to a Hotel. We shared a cab and I ended up staying about 5 minutes from the airport at a hotel called Narayana.

 

The next morning I awoke to thick smog lingering over the valley. I had a shower and ventured downstairs where I had a quick bite too eat and then headed out for a walk. Through years of travel, I have developed the habit of going for a walk whenever I get somewhere with the purpose of getting lost and then finding my way back, exploring the area as I go. I find it helps me to orient myself and get a feel for the place I am visiting. I walked for twenty minutes before turning around. The air was thick and smoggy that morning due to the number of people burning wood for fuel and unfortunately the smoke just settled in the valley lingering below the mist.

 

I returned to the hotel, found Chris and then organized to go for a longer walk. We acquired some facemasks pretty quickly as my throat was starting to get a bit scratchy and then set out in search of some gear. I needed a cable for my GoPro and a simcard and Chris needed some gear for a hike he was planning on his days off. We walked around for quite a while dodging monkeys, traffic and cars. We visited various temples and went into quite a few phone shops (non of which had simcards). I stopped and got some money from an ATM. 

 

Chris and I parted ways, he went to the airport to catch a flight to Pokhara and I headed to Boudhanath. I found a guest-house just outside of the stupa. It was one of the ones a previous volunteer had mentioned. 

 

 

 

 

Ropka is a guest-house that supports a children’s and women’s shelter. I parked my gear and then set off to run some errands.

 

I set off on foot partially just to get an idea of where I was and partially to see if I could find what I needed. It became evident almost immediately that something was off. I initially thought I would be in Kathmandu for a day or so but it didn’t take long to realize that things were happening at a much slower pace in Nepal. The majority of shops were closed and the power was out. Eventually I realized that it was due to a fuel shortage caused by a blockade at the borders that had been happening for a few months. I tried the closest ATM but had no luck. I guess because I had found an ATM that worked the previous day I had just assumed that it would be easy to get cash. I tried about 4-5 other banks with no luck.

 

I made a small purchase and returned to the guest-house where I ascertained that I either needed to go to New Road or Thamel Road to get what I needed. I set off that afternoon by taxi and was dropped at Thamel Road. Thamel Road is a tourist area and caters to hikers and tourists. New Road is where you go for electronic goods. I walked around and found a shop where I purchased my camera cable; I bought a nice tuque and eventually found a store that would sell me a simcard.

 

The next day I tried to find the bus station. I followed the instructions from Dave’s blog and had the picture on my phone but never found it. I asked several people all of whom shook their heads. I later figured out the bus station was more of an area and it was easier just to show up in the morning and catch the bus.

 

Now that I had my Nepali simcard, I was able to contact Hasta, who was my Nepali liaison. I had intended to take the bus out the next morning but after talking to Hasta he said a relative of his was driving there and it would be fine to catch a ride.

 

I awoke the next morning at 6:30am, slung my bags over my shoulders and set out on my way. I briefly met Hasta for the first time. We greeted each other and then I jumped in a pickup truck with four other gentlemen. The other person sitting in the back seat with me was Arjun. Arjun is a relative of Hasta’s, who was born in Chanaute and then went to Norway to study Architecture. He was managing a few projects in the area, including the rebuilding of the hospital and was travelling there to check on a few things. We talked quite a bit about what was needed and the various difficulties the Nepali people and country were experiencing. The road was quite bumpy but not too bad. We maneuvered through holes and around various vehicles for the next hour, stopped for breakfast, which consisted of puri and a potato curry, and then carried on our way.

Upon arrival in Chaunate I was greeted by Mina and Rajindra. They greeted me with scarves and welcomed me with open arms. I was shown my room and the clinic space and then offered some food. 

 The room is above the acupuncture clinic in the back section of the temporary shelter, which was built after the earthquake. It sits over a section of the main clinic that Arjun had designed and built to be earthquake proof. The external walls are pressed sheet metal and the internal walls plywood. I was perfectly happy with the room. What became obvious on the drive up was that many people were living in similar and, more often, worse accommodations.

 

After I had met the staff I set off to explore my new neighborhood. I walked back south where I had just come from and crossed the main bridge to the other side of the river. I circled back along the road crossing the footbridge and came back through the village. 

 

 

 

 

The first impression was that this small village that had been badly affected by the earthquake. I found out a bit later on, that there were only a few people still living in the town itself. The majority of people had moved up the hill and had been living in temporary shelters for the last nine months. 

 

 

 People come down during the day to run their businesses that are located on the   ground floor of the building in this photo above.

 

After my walk I returned to the clinic and started unpacking the supplies that I had brought. I took inventory of what was there, placed my herbs on a shelf that had been sitting in the clinic room and started to arrange the clinic so that I would be comfortable working in it. I spent a bit of time cleaning the acupuncture clinic and then had some small exchanges with staff. 

 

 

 

It was a busy day and there were a lot of mothers with children. They come once a month to do vaccinations. I met Hasta’s wife who coordinates the vaccination program and found myself sitting in front of the clinic with the other staff for the rest of the day. Everybody seemed to ask: “How long are you staying?”, and to my surprise, when I would tell them, they always seemed to say “only 2 months?” 

 

 

 

December 31, 2015

 

I developed a scratchy throat in Kathmandu and did not have the herbs or foods to treat myself. The second day after arriving in Chanaute, I got sick and woke up with fever and chills. I guess the combination of hot and cold had thrown my body into shambles because I hadn’t been sick in long time. The smoke and exhaust fumes probably weakened my immune system and then the hot sun and cold nights primed me for a virus/wind invasion. Oddly enough it was more of a heat pathogen, which was good because I certainly stayed warm last night.

 

I treated 5 people my first day, one emergency which I needled and massaged but he ended up going to Kathmandu as he presented with symptoms associated with a heart attack. The others came for the treatment of knee and hip pain. Unexpectedly, I found myself alone and working without a translator.

 

January 5, 2016

 

The clinic was very quiet today. I treated one person this morning and then no one else for the remainder of the day. This didn’t stop me from helping however, as my other skills were put to good use. I helped lay out the foundation for the new houses and commercial buildings being built by Hasta and his family.

 

It was Hasta’s grandfather that donated the land for the initial clinic, 35 yrs ago. The clinic was the first permanent building in the area and helped to establish the town, which over the last 35yrs, had grown to become Chanaute. Chanaute is now a beautiful little village and a central bazaar for the surrounding areas. While there I felt as though it is was exactly the type of community I would like to live in.

 

Although the earthquake was devastating, there is now the prospect to redevelop using sustainable and appropriate technological principles. Each day I would wake and notice something more I liked. All the families seemed to contribute and I would see each person doing something for the community and family. At first I saw many of the obvious things that are so different to Australia. There is a lot of garbage on the ground and the air gets filled with smoke from burning plastic now and again.  I guess it’s engrained into the culture as I see both parents and kids discard the packaging of whatever they are consuming directly onto the ground in front of them. There are no services as such and whatever garbage is brought in is either discarded onto the ground or burnt in a fire. It would improve the quality of the natural environment and lives of those who live there tremendously, if there were an organized rubbish tip or incinerator. I have become used to the smell of plastic burning but am thankful it is only temporary.

 

On a really positive note I am quite certain that 95% of the food I ate came from within a hundred meters of the clinic.

 

January 8, 2016

 

I treated eight people today. Four first-thing in the morning back to back and then another four spread out throughout the day. The patients are starting to diversify a little. Two gastric cases and one of which was slightly more complex. The female patient presented with right side pain from neck to heel with a generalized ache throughout her body.

 

Managing Expectations

 

It was very clear even from the get-go that I would have to manage my own expectations. Things just don’t always happen according to plan, (especially in the aftermath of a natural disaster). I had to constantly remind myself of the choices I had. I could of sacrificed my own happiness to make things happen according to my expectations, or I could have just gone with the flow and worked with whatever hand was dealt. I was a bit upset at times but usually chose the latter. I was seeing less clients/patients than expected and I was slightly frustrated by this. On the other hand the free time gave me the opportunity to get to know the people who I was living with and the community I was living within. This allowed me to make some good friends and get to know the midwives and Hasta’s family quite well.

 Life is very different in Nepal. The Nepalese work harder and longer hours, and survive on far less, but they are happy with what they are doing. Life is simple and food is enjoyed even though there is not a huge variety. The midwife who works 7 days a week and is pretty much on-call 24/7 gets about 8000 rupees a month. 2000 is spent on food, half goes towards helping her family, and the rest is saved or spent on other necessities. Both Bina and Mina (the midwives) are very friendly and always greet me with a beautiful smile.

 

Most families in this area and village have been severely affected by the earthquake. Lack of government assistance, shock, and lack of technical building skills have left them almost paralyzed. They fear another earthquake and are afraid to rebuild. This has meant that even those who could afford to rebuild are still living in temporary shelters.

 

There are eight families staying in temporary shelters just above the town in of the rice terraces. The shelters are constructed out of Bamboo and corrugated iron with some old doorframes here and there. The rear of the shelters back onto earth terrace and the ground is covered with nylon or blankets.

 

The people have come together and don’t complain that much, but there are obvious issues.

  • Condensation builds up during the evening and drips on people at night.

  • There is very little privacy as the shelters are single room dwellings.

  • Most people have some degree of respiratory illness, and the fuel shortage has resulted in the majority of cooking being done on wood fires.

  • There are rats that run across the sheets that have been hung on the underside of the ceiling to add some extra insulation. 

 Into my second week, I would have ideally liked to treat more patients but unfortunately the clinic didn’t really picked up. After a day of waiting and watching, I decided it would be best to stay busy. I helped with the build across the road; I helped unblock the shower drain and then built some steps in front of the clinic. I think people got a kick out of seeing a westerner with a hoe building steps in the hillside because each person who passed by, let out a slight chuckle and made a random comment.

 

I did, however, start to see some returning patients and a little more variety but the great majority of cases were bi lateral knee pain.

 

I started treating Hasta’s mother on a regular basis and felt as though I made some progress. She has hemiplegia of the right side due to stroke sequelae. Some of the rigidity in her right side seemed to relax and I found it easier to move her joints and limbs.

 

January 12, 2016

 

 

This valley is beautiful, with so much potential, and I hope that the people responsible for its redevelopment take into consideration the landscape and lifestyle of the people. I think the commercial buildings being constructed only serve the purpose of re-establishing a commercial zone to generate some income and bring people back into the village. I look forward to seeing what type of dwellings are built once people regain their confidence.

 

During my third weekend there I decided to go for a walk with Rajas, up to Palchuk. Palchuk is a local temple about two-hours walk. Rajas is an intelligent 13 year old boy who is fond of hiking and enjoys taking volunteers for walks. Or at least the last volunteer, Dave, went on a few epic walks with him. We spent about two and half to three hours getting to the temple. My fitness for climbing endless numbers of steps was shocking. After the first 500 hundred I estimate I had to stop and take a breather every other hundred. We had decided to take a short cut, which for a local would probably take two hours. It was cutting straight up towards the temple as opposed to zigzagging back and forth. Rajas would run ahead and wait or stay behind and then run and catch up. He barely puffed. I was constantly out of breath and telling myself how out of shape I was and planning on a daily walk from this point on. We got to the temple in the afternoon around 3pm. People were gathered around and those worshipping were playing some music. We descended to the temple, took off our shoes and that is when I noticed the blood. The particular ritual at this temple is to sacrifice a goat and offer its head.

 

I had brought some incense so we lit it and Rajis received his blessing. We then found somewhere to wash our blood-stained feet as the tap at the temple was dry. I am not a fan of animal sacrifice and I was a bit turned off by the sight of people carrying dead goat heads, but who am I to judge? 

 

 

 We spent a short time having a look around and then made our descent. We followed the road for half the way home and then ducked down onto one of the trails. Both Rajas and myself started to move quicker until he basically leapt over me and ran straight down the hill, whereas I still had to follow the steps. We took about an hour to descend back to Chanaute.

 

The weeks went by quickly. The clinic had not yet consistently picked up but I was averaging 8-10 people/ day. Some days I would only see 2 patients and then others 25. 

 After my fourth week I went to Kathmandu to pick up a few extra comforts. I bought some chocolate to give away, a stovetop cappuccino maker, fresh coffee and a bunch of spices. I also bought a knife, a spatula and a decent thermos for the kitchen.

 

I think people are used to me and have warmly accepted me into their community. I am rarely alone and there is always someone visiting. While Bina was away visiting her family for a few days, there was always someone who would ask me over for dinner.

 

I soon started to visit the relatives of the friends I had made. What usually started out as an invitation to just meet them soon turned into private health consultations.

 It was when I was invited over to Rajindra’s house that I realized a major problem is ventilation while cooking. His kitchen was in an enclosed room and they were using fire for fuel. I caught a glimpse of the family huddled around the fire in the morning with the room half filled with smoke. Both his parents suffer from COPD and the best possible medicine for them would be to build a stove with a chimney. Never the less I had agreed to give them acupuncture once or twice a week at home as they were too weak to make it to the clinic but I emphasized that what I can do was limited and the best thing they could do was to build a stove and a chimney.

 

Reflection

 

After four weeks, the clinic started to pick up more consistently. I started seeing patients that I had seen in the first couple of weeks, returning as they had realized that the treatment had in fact improved their conditions. Some would come with multiple friends and be so grateful and thankful, as they had been relieved of an ailment they had been suffering from (sometimes) for years.

 

The last three weeks I was there the clinic remained busy. I wasn’t seeing 30 patients a day but I was seeing enough to feel like I was being useful and contributing to the wellbeing of the community.

 

The entire experience was an opportunity to immerse myself into a culture and help a community in need of my service. I also had the chance to be in and witness a place that would soon be redeveloped. Much of what I was doing there was directly related to my skills as a Chinese doctor but just being there also allowed me to make some observations and find out about the state of Nepal and the people of Chanaute.

 

There is so much that the Nepali people need assistance with and without a doubt they will push on and rebuild in time, but for now they are left without much hope and a lot of them feel stranded. Most are aware of environmental impact and sustainability but are unable to implement due to social and financial restraints. There are numerous aid agencies offering all kinds of relief support but often programs take time to establish.

 

While I was there new regulations were announced by the government regarding earthquake-building practices and technologies and engineers deployed into each region to train people how to build earthquake proof structures. But unfortunately, only one per region and funding may take another year. This may mean that people are left in temporary shelters for yet another year. I believe the most crucial elements in aiding with the recovery of the people and rebuild of Chanaute to be:

  • Re-establishing confidence in the people about their safety and wellbeing by getting them back into homes built from local materials with earthquake proof technologies that they can understand and manage,

  • Provide people with support systems and outlets for processing their loss and shock,

  • Helping families get back into homes that are safe and non threatening to their health by educating people in the Nepali language about the risks of carbon monoxide poisoning and the benefits of proper ventilation,

  • Establishing the use of appropriate technologies to build structures, stoves and waste disposal,

  • Rebuilding the hospital to once again provide a good health service and village heart.

 

I was so lucky to have been surrounded by such wonderful people and for a community who was, and still is going through such a challenging time. To welcome me with open arms and feel as though I was at home was a blessing.

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