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Molly Cofman's Blog

January 31, 2013

I have arrived safely in Kathmandu! Smog seems to hug every corner of the city, and my senses are overwhelmed immediately by people, vehicles and animals coming and going from every! Amongst the smell of exhaust that permeates the air, there is a subtle sweetness from incense that fills in the remaining spaces of the dense air. A monkey walks across the electrical wires overhead, while the taxi weaves in and out of traffic in such a way that you can only hope that the driver at least values his own life so that you may trust that you will survive the ride too. I sit with another volunteer in the restaurant of a Tibetan woman whose smile could melt an iceberg, and fill my belly with momos by candlelight, as the electricity has gone out in the city while we were walking to the restaurant.

My first night is spent in a simple guest house, and with no heat I put three layers on and bury myself under the covers with the hopes that my body heat will eventually be enough to stop the shivering. Already I am telling myself that I'll have to toughen up a bit. The gongs, drums and bells at the Stupa in Bhouda, where I have stayed for the night, encourage me out from under the now warm covers at 5:00am, and I do a little yoga before heading out to circle the Stupa with the monks. I'll be heading up to take a look at the clinic this morning, and am excited to meet the people who will surely become my family for the next few months. Amidst all of the new sights and sounds, I feel displaced, uncertain, excited and overwhelmed. Even with the newness of everything around me, I have to keep reminding myself that I am in Nepal. Then, as I was digging through my bag to find an address, I found a piece of chocolate...:) The right kind of medicine for this first day here I think!

I will enter into ten days of a silent meditation retreat, and then get myself settled in the clinic. I understand that patients begin lining up quite early in the morning, so I think that I will be working hard...which I am so excited about. I will share the experience as I am able, as I am certain there will be some stories to tell!

February 24, 2013

It is difficult to know where to begin this email, as although I have been in Nepal less than a month, so much has happened. The irony of this is that nothing happens quickly here, or on time. Life happens as it happens, within the loose and elusive structure of something called time. Nepal is an explosion of sound and color. The black and gray winter dress code of Chicago seems downright sullen against the kaleidoscope of color here. My favorite time to walk is around 4:00pm when the streets flood with children coming home from school in their uniforms and families are in the streets exuding a playful energy. Children hang out of bus windows and yell “hello” with proud grins on their faces when they see a foreigner walking down the street. Trash lines the streets punctuated with gangs of dogs and the occasional cow against a backdrop of ornate temples and gompas. Prayer flags are plentiful, as is laundry hanging from any reasonable place that it might dry including trees, bushes and rocks. Beautifully costumed women, delicately made up and adorned with jewelry upon closer examination boast dirt under their fingernails, cracked feet and spit in the street.

I think that I will be in trouble if I do not mention the silent meditation retreat, although even now I find it difficult to articulate. With good humor I can share that the silence was not difficult, welcome even, and the sitting in meditation for 10 hours a day was extremely challenging at times (only once or twice did I find myself doing Zumba in my head when I was supposed to be focused on my breathing☺). The resilience that I have for taking ice cold showers (only two in ten days because it was that cold, yikes!), waking at 4:00am every day and eating only a simple breakfast and lunch every day surprised even me. We are adaptable creatures. The experience was amazing and transformative. One of the teachings struck a deep accord with me: “See things as they are, not as you want them to be”. A simple and yet poignant message; such a beautiful reminder of how we can be the origin of our own unhappiness.

Life is simple here in Nepal according to Western standards, and yet challenging beyond the imagination. Sitting on top of a hill (mountain) there are farms and small villages as far as the eye can see. For farmers, there are no days off and daily life consists of literally backbreaking work. Although there are hospitals in Kathmandu and various NGO supported clinics in the rural areas (most of which don’t last more than a few years), most people do not have access to any kind of consistent (or as I am thus far informed, quality) health care. The patients coming for acupuncture are walking sometimes five hours to sit on the grass outside the clinic with the hopes of getting help.

As in any small village, there is very little privacy for me here. I live at the clinic, and as I am typing these words two children peer through my window, curious about the new “acupuncture doctor” who is now present in their village. I am getting accustomed to being stared at, not unkindly, but out of pure curiosity. The darkness and the language challenge me but already I am adept at washing clothes by hand and if you get the timing just right, your clothes will dry on the line in the midday sun in just one or two hours. Our diet consists of rice and curried vegetables, determined by what is available at the farm next door, and I will soon enter the cooking rotation as I gain familiarity with the art of Nepali cooking. On occasion the servings of rice are so generous, that through laughter and playfulness at the table, the heaps of steaming grain are named for various famous mountains. Everest of course is almost always present on our plates. No meal goes without its share of sniffles from the spices and chilies and my left hand stays obediently in my lap as the art of eating with my right hand (no utensils) gains familiarity.

Two days into my stay here, after seeing patients, we went in search of raksi, (pronounced “roxy”) the local liquor made from millet. There is a man “down the hill” who makes it. It also happens to be wedding season. The clinic sits high on a hill, and wedding music wafts up the mountain from all directions. The music is beautiful and festive, with horns and drums constantly tantalizing the dancer in me. We make our way down the dirt trail, only to find that the raksi man is not home, so we wander a bit farther down the hill to take a peak at one of the weddings. One of the patients from the clinic is there and graciously invites us in. We duck into a dark cement structure dense with the smell of earth and animals, and climb a ladder to the balcony where we sit on the dirt floor and are fed raksi and a few morsels of food. Children and adults alike stare unabashedly at me and every once in a while I can coax a shy smile out of a curious little one. There is music and dancing and it is chaotic and beautiful.

After a drink or two, we head back up the hill toward the clinic, a climb steep enough to kill any subtle buzz that the raksi may have caused. As we reach the clinic, we see that another wedding is filling the streets just beyond and decide to continue our explorations. The ceremony had already concluded, but we are encouraged by those in the street to follow them to the wedding house for a celebration. The bride and groom sit outside the door and await a special ceremony for them as they enter their new house as a couple. Women sit on the front porch singing in the most beautiful voices imaginable, songs that celebrate the new couple. People are dancing, and I am pulled into the circle for a few moments, feeling excited to participate and worried about being disrespectful in any way. The joy was almost palpable.

With a second wedding down, on only my second day in Bhoutechar, we made our way back to the clinic once again. We hadn’t had electricity in two days, so by candle light, the clinic staff huddled around the kitchen table and played a game before dinner.

The clinic and the patients are becoming more and more familiar. Last night was an exciting night; being the only emergency facility for miles, we had four admissions to the ‘hospital’ in addition to having seen almost 40 patients for acupuncture during the day. Advanced COPD, typhoid fever, one healthy baby delivery and one other sick pregnant woman. Of course the clinic is only comprised of 6 beds crammed into one very small room, so today, while seeing patients, I was accompanied by a new born baby boy, the COPD patient and different members of his family throughout the day and the woman recovering from typhoid. Typically, I am seeing between 20 and 30 patients a day. Needless to say, it is quite a new rhythm!

I am also getting used to the flies. Some days are better than others, but they are our constant companions in the clinic. Gratefully, I have found a willing student body in the clinic staff for yoga amongst everything else. If you’d like to stop by, class is at 6:30am on the roof every other morning…there is lots of laughter to coax the sun out of its slumber, and the flies don’t usually bother us there.

Little by little, the armor of uncertainty about being here is through the alchemy of proceeding with an open heart and mind, falling away. The juxtaposition of ornate, plentiful, gritty and desolate accompanied by the ever-present scent of tea and rice on people is like a game for my senses. I’ve much to learn and I am ready. I do believe that as I volunteer I will make a difference, and broader than that, I look forward to continuing to explore how this difference can be sustainable, if even just for this one clinic

March 14, 2013

I am settling in to life here. I dare say I am feeling comfortable and each day I am successfully adding a few new words to my Nepali repertoire. I can say many sentences now, and the patients giggle as I try to incorporate my new skills, but reward me with appreciative smiles as I struggle with the sounds and nuances of their language. To me, the language is like a song in both receiving and articulation. Sing the notes in tune and you will be understood, but be cautioned that if just one note is out of sync, you will be met with a glazed stare until you are able to correct yourself. Be also cautioned that if you transpose any note for another, you possibly create a sentence that has no meaning, or worse, means something that you shouldn’t be saying.

I am living in a place where the men speak louder than angry Italians, food grows everywhere, tin roofs are pinned down onto mud walls with bricks, tires and tree branches, and people have magical smiles with deep creases framing their eyes to prove that the smile has been in place for quite some time. The wind from the mountains blows fiercely at about 5:00pm each evening like a sentinel announcing that the work day is coming to a close, Laligurans trees heaving with bright red flowers dot the mountainous landscape dense with farms and jungle and people have next to nothing but are nonetheless extraordinarily generous in spirit, belief, ritual and celebration. Each day is full of discovery, learning and subtle gifts, and organizing all of the details is slightly like herding cats in my head. My day begins at 5:30am and I am teaching yoga to the clinic staff every other morning. We now have people from the village joining us periodically, and I am hoping to somehow expand this opportunity to patients. On alternate days I go for a morning walk. This began as a meditative ritual, but is now a group activity☺ After a shower and some tea, I begin to see patients until the work is done. In the evening, depending on how the day has gone, I write, study or spend time in the village visiting until dinner is ready. It is a simple but full schedule and by Saturday evening I am exhausted. Sunday is my day off and if I do not have supplies to pick up or work to do, the day is open to whatever adventure may come.

As my language skills grow, my understanding of Nepali life is also growing. There isn’t much that resembles privacy here. Life is lived on display from the moment you rise and walk to the nearest waterspout in your pajamas to brush your teeth, to the moment you oil your hair and retire to bed. The women are masters at carrying things, and sometimes a bit enigmatic at it too. Underneath their beautiful scarves and gowns, which they wrap around themselves with exquisite expertise, there is what I now fondly call the ultimate ‘travel bag’. Most women (and some men) have a thick white canvas strip of cloth that wraps around their waist no fewer than seven to ten times. I am told that this cloth is intended to support the back, although I am skeptical of its ability to do so. For women, however, it also serves as a treasure chest. When women unwrap themselves in the clinic, I am sometimes dumbfounded by all that they are carrying in these wraps. One of my favorite first exposures to this practice was the 75-year-old woman who with each turn of the cloth produced a cell phone, a money satchel, three apples (which she happily distributed to my interpreter and I), some cookies and a packet of spices. With all that these women do with their hands, I find this methodology to be an astute choice: a beautiful display of the functionality of Nepali life.

One afternoon, when the patient work was done, three of us set out for a walk. Of course I am learning that a walk often means that you walk for maybe ten minutes before you come across the house of someone you know and then you just hang out for a while before you walk back to where you came. Today, we set off for a one to two hour walk and after fifteen minutes or so were in front of the house of a woman who volunteers to clean the clinic. After introductions and a look around the farm, we picked some saag (spinach) from her yard for dinner. She then invited us to sit and have tea while she boiled a root vegetable similar to a potato for us to eat. As I sat on the mud front porch, I found myself marveling at the simplicity and beauty of it all. Her three children were helping to prepare the tea and playing in the dirt in front of the porch. Within a few minutes I had a baby goat on my lap, laligurans in my hand, a golden thread around my neck as a blessing from the temple, hot black tea in my other hand, and children laughing and playing around, sometimes sneaking a peek to make sure that they had at least part of my attention. I understood in this moment that I must be adjusting, because I felt so amazingly at ease and although I couldn’t understand much of the conversation, it felt as if this moment was something that had played out many times in my life before. The graciousness of the people here is breathtaking. They live in mud huts, cook on a pile of sticks in the middle of a mostly empty room, wear the same clothes every day, and yet cannot wait to share anything that they have on hand with a visitor. Who would have thought that a cup of tea and a boiled potato could make you feel so special? What a beautiful reminder for me that it is not what you give, but how you give. Anything done with an open and generous spirit, even the smallest gesture, will surely feel like an enormous gift to the recipient: added inspiration for my current, sometimes seemingly daunting task in the clinic.

This past weekend, I climbed a mountain in flip-flops. I wasn’t planning to climb a mountain, but as things go in Nepal, plans often change and usually there isn’t much of a choice. It is a particular kind of grace and fluidity that being present in Nepali life demands. I pray that I am able to maintain some of this presence even after my stay here. Today, everyone got all dressed up to walk to the tea garden that is about an hour away. Somewhere within the first ten minutes of the walk, one of the clinic staff decided it would be a good idea to climb up and over the mountain rather than take the road in a (my judgment) more civilized manner, around the mountain. We began to ascend one of the steepest inclines that I can remember hiking, when it begins to dawn on me that we are going to hike, not walk, in our skirts and amusingly inappropriate footwear. For a moment about ten minutes into the hike, when I had already slid twice and ripped the hem of my skirt, everything in my body wanted to revolt and turn around and not go in defiance of the choice of trails. I then looked down at the remnants of my “going away” pedicure, my trusty (and dusty) reef flip flops and my long skirt and thought, “Well if this is how they do it in Nepal, I surrender.” The next thought that crossed my mind was that many of my patients do this each time they come to the clinic, only I am certain that most of them travel much farther than we planned to go and out of necessity rather than play. Three hours later, scratched legs, muddy toes, torn skirts and all, we arrived at the tea garden to the reward of a beautiful sunset and delicious tea. (Oh yes, and we took the road home.)

Part of the gift of climbing that mountain is a new found calm that I feel in the clinic. My two hour journey straight up through boulders, dirt slides, terraces being dug for farming and very thorny bushes was a pivotal moment of understanding for me. The more I get to know and understand my surroundings, the more I realize that while there is one main road, the true roads of Nepal are the small dirt paths that branch off the road everywhere and traverse the vast terrain connecting all places like the intricate vasculature of the countryside. To what many people would be a hiking trail is an honest road in Nepal, but you better know where your road starts because you often have to duck between farms amongst goats and cows to find it. When you hear someone say, “This patient walked three hours to get to the clinic” there is some understanding of how difficult this must have been. When you walk straight up a mountain for two hours on a “good Nepali road” and realize that this literally breath-taking, somewhat perilous walk is the norm for most Nepali people traveling from place to place, the sense of understanding shifts completely. My understanding of (and compassion for) commuting in Nepal deepens as does my wonder of how the heck I am ever supposed to be successful at treating someone’s hip or back pain when they leave the clinic and journey home in worn out plastic flip-flops three hours up and down these precarious ‘roads’.

Yesterday there was a ‘program’ at the clinic to celebrate ‘Women’s Day’. For the first few hours of the day, I thought it was ‘Omen’s Day’ and was very excited to find out more about this celebration. A day about omens, how cool. This is one of the many times that the accent in translation has misled me. We often joke about Nepali English…it could be a whole language unto itself. I was set for what I knew would be a busy day of patients, when all of a sudden 50 or so people descended on the clinic, including board members, loud speakers and young girls adorned and ready to dance for the crowd. This is one of the things I am still getting used to here. You never quite know what is happening from moment to moment or day to day until it is happening. No one had whispered a word about this event…or at least while I was in the room, and all of a sudden I had twenty five patients waiting to be seen while loud music starts booming outside the clinic window and curious visitors are vying for a chance to see acupuncture in action, elbowing their way into the dingy, fly infested, crowded clinic. For a moment I panicked. There was so much noise, I could not hear the patients let alone my interpreter, and what is normally an unsettlingly exposed setting for patients was now a gallery of bodies displaying acupuncture needles against a backdrop of a raucous women’s rally. I admit there were a few moments where I had to remind myself to have a sense of humor. Amazingly, although I felt my feathers being ruffled a bit by the whole scene, the patients were seemingly un-phased.

My work in the clinic is becoming rich and more rewarding that I could have ever imagined. Some days are chaotic and exhausting, and others reach their end with grace and ease. Generally I have three or four treatment beds going at once, with three patients lined up in chairs waiting their turn. The patients answer my questions about eating, bowel movements and all sorts of other bodily functions amidst an audience of everyone else in the clinic often including members of their own villages. Only sometimes do I get shy giggles from the women. I try to maintain any amount of discretion that I can, but sometimes a patient has to lay with their butt exposed and that is just the way it goes. The rough days are often punctuated by something special, like the stroke patient, Parabati, who practices regaining her vocal ability by softly singing us a beautiful Nepali song, or the four year old girl with a genetic birth defect inhibiting her development who at first would not even look at me, but now tugs at my lab coat and offers Namaste with her tiny hands in a prayer position. In addition to my own duties, I am spending time with the other staff members when I am able. Last week I watched a tooth extraction and was at once appalled and appreciative. Appalled because with a little injection of lidocaine and a pliers, the operation was performed. Appreciative because the very next thought I had was, ‘well if anything happens to my teeth, at least I don’t have to find a dentist’. There have been several births in the last two weeks, of which I have participated in three. Last night I was the first to welcome the baby boy into the world, given the job of cleaning and swaddling. The opportunity was both moving and overwhelming…the emergence of life…

I could never have imagined any of this, although I had dreamt of it many times. It makes me think about all of the contemplating that we do in our lives. I’ve always been a firm believer in that thinking is valuable, but doing, taking that first step on the path is the only way to really know. I have certainly caused my own heartaches by getting stuck in thought rather than taking action. Experience is real. It is in the doing that we are living, not the thinking. I am filled with gratitude each day that I have this opportunity…and am approaching each day with compassion in the hopes that my efforts make a difference.

I now have some young girls waiting to dress me up like a ‘Nepali woman’, and I can’t make them wait any longer…

March 27, 2013

As I am glancing back over my last few weeks of journaling, I can’t help but smile as I realize that most entries start with “today was a very special day” or “today was an extraordinary day”. I suppose that when life is new every day, it is no wonder that these phrases repeat themselves over and over on the pages of my reminiscing, but it is also helpful on the difficult days, to look back and see these words as an encouraging reminder. Tonight I am sitting at a monastery in Kathmandu looking up at an almost full moon. This is my third full moon in Nepal and even the clinic staff is commenting on how quickly the time is going. I think back to the first night here, having arrived under a full moon, gazing up at the bright sky and wondering what the stars had in store for me. Under that moon I was filled with hope, nervousness and a slight fear of the unknown. Under this moon I find that my heart is filled with ease and although each emerging day still carries with it the unknown, the fear has dissipated and taking its place is determination and an evolving clarity.

I feel my old habits and attachments slowly fading away, and am recognizing that smells, sights and sounds that were once strange, overwhelming and sometimes even offensive, are now simply part of my day, taking the place of the old familiarities. In some ways it feels as though I am suspended, floating in a place where nothing exists but this experience. It is a magnificent and wondrous thing to feel an old way of life falling away, but to recognize too that the bonds that connect me to my loved ones are unchanged and perhaps even strengthened in the absence of old habits. My days of feeling homesick do not involve things or places, but rather people and connections. I am surrounded here by strong family units, and fluid, close communities and am finding much inspiration in their collaborative way of life.

It has indeed been a special few weeks. I have had the opportunity to visit some of the homes of the young Nepali health care workers in the clinic, and also a few of my patients. I experienced my first big storm during the day in the clinic and also survived another women’s rally booming just steps away from the clinic window. On Shiva’s birthday, I witnessed for the first time children patrolling the streets, holding strings, branches of bamboo or pipes across the road, stopping traffic in order to collect money. These children are bold, shouting at bus drivers and motorcyclists alike, egged on by family members and other villagers. I came to find out later that the money they collect on this day is used to buy wood so that they can build big bon fires to celebrate Shiva. A different kind of ‘lemonade stand’ than I am accustomed to.

Last week there was one morning in particular that was quite special. Not because it started with three patients in a row that didn’t feel they had improved at all, which pushed the buttons of both my compassion and ego simultaneously, but because for the first time since I have been here, someone voiced their appreciation for my presence. It was an odd and moving moment and I admit, standing in the midst of the hectic clinic, for just a moment my eyes welled up. Laxman, a schoolteacher who I had met previously in the village, came to give his friend a ride home. As he ushered her out of the clinic, after battering me with amazingly intelligent questions about acupuncture, his gaze locked on mine as if there were a strong magnet suddenly between us and he thanked me. His message to me was about hope, communicating that my willingness to provide this service gave many people hope where there was none before. For just a moment I was immobilized by the sincerity of the sentiment and then the magnet released me and I fell back into rhythm with the day. What a poignant reminder of how sharing your appreciation verbally can be so powerful. I function here within my own hope that I am doing something good, and the rest of the day all I could think was, “Gosh, Laxman, I hope you are right.” Last week also held the experience of the first big rainstorm that we have had during the day here in Boutechour. Thunder, lightening, rain and hail all came with enthusiasm from morning until night and the feel of the clinic and village changed dramatically. There was a hush that I have not yet experienced, and a subtle reminder that life is in large part dictated by what the weather provides. Although the weather outside was turbulent, it was the quietest, most relaxed day in the clinic that I have had yet. Only 14 patients braved the elements to come in. With no electricity and a reluctance to use our candle supply, there were moments that I could see very little of what I was doing. I was reminded of the blind acupuncturists in Japan and with a small smile inside, I slowed my treatments down and really felt and listened with all that I had in an effort to treat with the utmost precision despite the temporary lack of light. Because patients were not so brave with their return trips, we often had many people huddling in every free space of the clinic until the ferocity of the rain let up for a moment. Then there would be a mad dash for the door and the homeward bound journey.

In and amongst all of the small little treasures of each day, I have begun to explore more deeply the surrounding rural areas. The first excursion was to visit the home of a Nepali volunteer at the clinic, Usa. We embarked on our journey after a busy Saturday and headed off excitedly for the three-hour walk. It was a warm and beautiful evening, and we began to descend the mountain toward the river in the distance. I am finding the mountains to have the same sort of distance illusion that the sea has. Looking across a hill and seeing a village often gives a false sense of close proximity, while the reality is that the village could actually be an entire days walk away. It is a deception that takes some getting used to. With each turn of the road or trail, it seemed that Usa and I entered a new ecosystem as the diversity of the middle hills of Nepal was revealed to me in small chapters. About an hour and a half into our walk, passing through a small village we were met with shouts, big smiles and waves. We had wandered right into the village of several of my patients and within moments they were all fighting over who got to make us tea. When the host was finally chosen, we sat for a while and visited with Usa interpreting for all of us. This was a magical moment. After a while, we began our journey again promising to stop by the following day on our way back to Boutechour.

As our trip continued on, it dawned on me that all of our steep descending could only mean one thing. The trip home was going to be uphill…all the way. The old anecdote about going to school in the snow up hill both ways rang through my head and I giggled at the thought that it could actually be true here in Nepal. It grew dark before we reached our destination, and my footing grew a little more uncertain as we continued our descent across rocks, tree branches and crevices, but at last, we made it all the way down to the river. After washing in the local faucet, it was time for dinner and Usa’s mother was not shy about piling her delicious food onto my plate. We then retired to the bedroom and Usa said, “Ok, now we rest” and turned the lights off. Of all the times that I have wondered how late I would have to stay up into the night at someone’s house that I was visiting, this was an amazing moment. I was exhausted, fed and all I truly had to do was pull the covers over my head.

The next morning, we woke early and went on a small discovery walk of the area. We explored the bazaar, the local clinic and went down to the river itself. There is something fresh and invigorating about being by the flowing water; as if each moment continually regenerates itself just as each portion of the river constantly regenerates by way of its movement. Usa’s village was a totally new perspective on Nepali life, each village having its own unique characteristics. As I was waiting for lunch to be made, I sat on a stool on the roof of Usa’s house and after taking many pictures, closed my eyes and reveled in a rare moment of stillness. The sounds and smells of the village gently ebbed and flowed and I felt peace and contentment sitting atop the brick house. After lunch, we had to set out on our journey back, having promised so many people that we would stop and visit.

On our way back we discovered that we had actually passed many of my patients houses, and were beckoned from the path many times as these women invited us to come see their houses. Our second stop was at the house of a 78-year-old widow, whom I had just seen the day before for the first time. She ushered us on to her porch and we just sat and talked for a bit. Usa then told me that we had to go eat some fruit, and having been fed already three times, I said that I just couldn’t possibly eat anything else. It turns out what she meant was that my patient had invited us to pick berries from her trees and the three of us happily and with many shouts of delight and giggles picked our way through the trees rich with wonderful berries. Two bags and one water bottle full of berries later, she insisted on us having tea before we left. I sat on that porch somewhat in wonder of all that this woman was responsible for in running her farm by herself. She shared that she had been widowed for about seven years, and I think that having our company was really a treat for her. It was the first time since being in this country that I worried about someone being lonely.

The next village was the first we had visited the day before. We shared our load of berries with everyone, and the clan of women sat and talked, asked questions of me and offered us tea many times again. Watching these women in their element was a gift beyond words. I felt in many ways like perhaps this was the first time I was actually seeing Nepal. To see the women without make-up, holding their farming tools and their children, to realize that they ‘get dressed and adorned’ to walk to the clinic on appointment days, to see their homes and how they interacted with one another; it was stunning. Seeing my patients in their homes brought to light a new understanding; an understanding with which I realized would help me to take care of them with more acuity.

As we neared our last hour of walking, Usa needed a break and sat down on the steps of a village. The timing was impeccable because no sooner did we stop, than the school just next to our resting post released their students. I definitely feel a little out of place here in general, but what happened next was like nothing I had ever experienced. One or two children caught sight of me, and within a few minutes I was surrounded by about forty school children, blue government uniforms dirty from the day at school. Once they had circled around me, they just stood and stared, most expressionless, but staring nonetheless. I tried out a few of the Nepali greetings that I knew and got a few shy responses, but mostly the children just stood and stared. After a while we realized that the only way to break up the show was to travel on. A few bold children followed us for a way until the loud stern voice of their teacher reeled them back. After seven hours of walking and visiting, Usa and I made our way back to the clinic.

My second excursion was a stay at my interpreter’s house, only an hour’s walk from the clinic. After a full day’s work with patients, we set out, again down the hill, for Sarita’s village. After a warm welcome from family and other villagers I witnessed a transformation in Sarita from healthcare worker to farmer, and soon we were off to feed the cows and milk the buffalo. I felt momentarily like a fool, as it had never until this moment dawned on me that she might put in a full day of work at the clinic and then return home to much more work in helping her family run the farm. It was truly humbling. Sitting on the dirt floor of the kitchen, eating porage made from the fresh Buffalo milk that we just harvested and carried down the hill filled me with a deep appreciation for the special glimpse of this life that I was so generously invited to see. Interesting too to find that Sarita seemed much more beautiful and at ease in her home and watching with amazement the grace with which she lives the farming life, I was gifted with a new depth of knowledge and understanding.

As I explore more deeply the rural areas of Nepal, I am finding that even the very simple accommodations at the clinic are far more luxurious than most rural homes. Surprisingly, I feel much more comfortable in someone’s home no matter how sparse and rustic the accommodations. Although the life is hard and the work constant, living closely with the land seems to suit me and I am trying to learn all that I can. It is an interesting and sometimes precarious position to realize that when it is all said and done, I get to return to a life that I choose, while many that I am serving will have no such choice in their current lives. What I continue to create for myself after my time in Nepal I hope in some way is guided by the grace and presence that I think I am learning here, rather than expectation and fear. I find that my heart is often still torn by the work that I am doing here. On one hand, I know that I am serving people in need. On the other hand, their lack of access to health care is a problem that runs significantly deeper than and has a solution that is much bigger than one volunteer could ever hope to impact. I think of the ‘Starfish Story’ sometimes to guide me and also see with more clarity that living life with a sense of service, whether in your own community or a community in need (and we could argue the difference here over margarita’s) holds immense potential for a beautiful life.

May 19, 2013

The moon has hung low over the mountains these last few nights; a waxing sliver glowing a haunting orange in juxtaposition to the brilliance of the lightening that fills the sky during the evening storms. My sense of discovery has shifted to a more subtle level, away from the colors, sounds and smells, plunging into the depths of raw humanity and intense contemplation. The changing season has brought with it the onset of Typhoid fever, and among the many patients admitted, four of our own staff have succumbed to fever and jaundice. Gratefully, my health remains strong, albeit a little tattered by fatigue. In mid-April, we celebrated the Nepali New Year with a feast followed by singing and dancing in the training room at the clinic. The celebration was a mix of child’s play and silliness that I have not seen the likes of in a long time and it was immensely refreshing to see even the clinic manager, a normally enigmatic and slightly stern character, leaping around and singing as if she had just won the lottery. Our celebration tools consisted of a drum and a tambourine, and the rest was left to our voices and bodies, leaping and contorting in all sorts of made up games. As the weeks go by, it has been a wonder to watch my yoga class transform from a wriggling, giggling group that offered commentary throughout the whole class, to a group that now sits in meditation as they wait for class to begin and together move and explore through the postures like a flock of graceful birds. Realizing that the arrival of the next volunteer is not so far in the future, I have become at once aware of the immense effort and the very limited and finite influence that will be the summation of my time here.

A few weeks ago, I entered into what I am now fondly calling the ‘dark ages’ of this experience. I am not sure if it was fatigue, isolation or the still slightly tormenting struggle of not being in charge of my food, but I hit a low both physically and emotionally. There were admittedly a few tears. As I ponder the reality of this time, I recognize that the sensations of ‘newness’ were not quite as acute and exciting, and the seeming weight of familiarity had taken hold. There is a part of me that thinks I was breaking some barrier, like when a tight muscle begins to give way, it spasms and shouts with discomfort before relinquishing its tight hold for a softer existence. Softening and familiarity should bring with it some comfort, which of course it does, but it also brings with it the potential onset of habit and dullness that inhibit life from being lived with full awareness. I now hold the responsibility of not only caring medically for the patients that I see and the staff that I work with, but also caring for them as individuals. Although according to the Buddhist teachings, we should strive to have the same love and compassion for everyone, in my still naïve state I find that attachment begins to exist when I become close with people as individuals and friends, and somehow with it comes a greater sense of responsibility and occasionally slightly less objectivity. What this really means is that I become more aware of my own limitations and indulge momentarily in a minor depression at the fact that my ego is governing my evaluation of success. This brief darkness, once I was able to see some light, brought me right back to my first meditation experience in Nepal and the teaching of the Buddha. Observation of each moment…no judgment, no expectation, no story of what we want the moment to be…only an observation of what it is.

Just as the evening winds turned into immense storms, turbulent, chaotic and transforming, so too did my mood begin to shift. Regardless of my internal battles, the work itself continues to be incredibly rewarding and enlightening. The last month has brought with it some interesting and heart breaking cases. I am still not sure how people hear about the acupuncture services here, but three weeks ago a truckload of people from a village about an hour away pulled up the ridiculously steep hill leading to the clinic. One of the villagers, a man of about 40 years, was in a wheel chair. As they all worked together to get him out of the truck, I assumed that he was another stroke case, of which I have had many. It turns out that a truck had hit this man several years ago. The accident rendered his left side slightly mutilated and paralyzed, and his speech very challenged. He asked me in a joking kind-hearted way if he was dead, and if it was possible for me to bring him back to life. No pressure. His left leg, marred by an enormous scar, was as cold as I imagine the snow on Mount Everest to be, but his heart and his outlook were as warm as the sun at midday. I treated him along with all of the other village members in a jovial and communal atmosphere and then they piled back in the truck and headed off into the sunset, literally. The following week, my eyes filled with a different kind of tears as I went to touch his leg and found it to be as warm as the right leg. As he answered my questions, he was able to articulate words… a few in English, nonetheless…much more clearly. It was a very inspirational and moving afternoon for everyone that was there.

There are others, though, that are not so miraculous, like the young boy of seven years with a kidney disease that has not responded to the Western medicine available here, Ayurvedic medicine or acupuncture. In this paradigm, there is nowhere else to refer him to and all that we have is to just keep trying. Although the patients are responding very well in most cases to the acupuncture, it seems that much of the real work is educating about simple nutrition, hygiene and lifestyle habits. I suppose this is heartening for me because it seems that in this way I can leave some good tid-bit of information behind when I go. In this way too, I am getting to see a purity of practice that I have not before witnessed in that the cause and effect is so clear here. When I give advice about eating to a man with gastric pain, in most cases he comes a few weeks later without much pain and better energy, having shifted to a more healthful eating schedule. So simple, and so beautiful. When it is cold, the patients have cold diseases; when it is hot, the patients have hot diseases. The complications of modern life do not have to be weeded through in getting to the root of an etiology. In juxtaposition to this, however, many of the same medical challenges (my opinion) that exist in the western world exist here. Most strikingly, patients are often given prescriptions for medicines that can be refilled indefinitely. It is not uncommon for me to see patients that have been on painkillers, steroids or gastric medicine for years with little to no progress.

Communication is such an interesting thing to contemplate in this setting. In general, although usually the Nepali people offer smiles easily and plentifully, I have found this to be a socially stoic place. There are not too many emotions on display here even for patients who are happy with their progress. I have far too many times been lead astray by the very serious, stern look on someone’s face as they describe their symptoms to my interpreter, only to be surprised when she turns to me and says, “They are feeling much better!” When a local woman got killed at the water fountain because the cement suddenly collapsed on her, there were very few tears shed, and yet the grief was palpable and the sense that life will continue was shockingly strong. For a short time there was a massage volunteer here and on her first day in the clinic she fell to tears. The next time one of the patients present on that day came for treatment he asked me why the other volunteer had experienced ‘lacrimation’ (watering eyes). In the short time that I have been here (relatively speaking) I get the sense that these people feel deeply and strongly, but without the same attachment to emotion that I am used to in the western cultures. Emotion is felt, but it is not performed.

I did not have many expectations coming into this tour of service, but one that I did have was the anticipation of relying on my physical diagnostic skills rather than verbal. On this front, my expectations have been met, but in ways that I could never have anticipated. All of the subtle ways that we communicate, our posture, the glance of an eye, the small gesture of a hand or a finger, things that when we are in our own culture we do not consciously know we are observing, but we are observing nonetheless; these small subtle things slowly become much more visible when you are relying on them to understand why a person is suffering. Beyond taking the pulse and looking at the tongue, two major diagnostic tools in Chinese medicine, I believe that now I am learning as much about my patients just by watching as they speak in a language I can understand only some of. In many ways it is a beautiful gift to get to observe so keenly without the distraction of words. I wonder if I did this in my western life if there would be fewer misunderstandings. It becomes quite clear what amazing storytellers we can be about things and experiences in our lives when you are in a situation where you cannot rely words or verbal expression to understand what is going on.

On the other side of this consideration of communication, is of course my ability to communicate to an audience that barely understands even when I am attempting their language. Teaching yoga without being able to explain things as I normally would, giving advice to patients, asking directions; it has all become a funny combination of Nepali words, childish English phrases and many (I am sure very odd looking) charade like gestures. Eventually the point gets across (I think) but I do wonder at the end of the day how many conversations were understood by both parties in the same way. Like most things here, you just keep doing the best that you can and hope for the best. When people feel better, I take heart that at least something good has been exchanged.

There are many ups and downs, but Nepal and its people continue to inspire me. This is the place that you can get sunburned on your way up a mountain, and get pummeled with hail on your way down. This is the place where you can climb to the top of a hill and be enveloped by a passing cloud. This is the place where festivals and holidays seem to happen every other week and people relish the time to celebrate and be with their families. This is the place that sometimes a mouse will crawl over your head during the night and occasionally you have to share your bed with spiders (really big ones). This is the place that lacks structure and resources, but reaches far beyond any quota for community and kindness. Life is simple here, and the rural people, while having little to nothing, have wealth that far exceeds many of what I have witnessed in the west. I continually feel humbled by the people who come and allow me to care for them, and feel incredibly grateful to have something to give.

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