There was definitely a special something in the air that Saturday night. We had just had a fantastic day off from clinic visiting the home of one of our rock star interpreters. As we wove through farm fields and villages, the other practitioners and I fell in and out of many conversations about what we have been observing of rural life in Nepal. Bottom line: It is hard work. We were constantly trying to figure out what kind of recommendations would be useful and realistic for these folks who farm the land of the Himalayan foothills. So much of what we see in clinic is basic wear and tear from years of walking these hills with heavy loads and the back breaking labor it is to subsistence farm without the mechanization we are used to in the west. We also see lots of COPD from cooking over open fires in the home with no chimney to ventilate, eyes becoming scarred and irritated from so much dust and sun exposure, and trickier issues of lots of GERD from an irregular eating regimen, unmanaged diabetes and hypertension all probably due to modernizing processed diet over the past few decades.
While we racked our brains for solutions that could meet the resources people have to put toward these problems, we also reflected on our many 1st world health problems that stem from a lot of excess and sentient life styles and humbly acknowledge daily that we do not have all the answers by any means. If a woman could convince her husband to spend the money for a propane cook stove- would the fuel canister be a heavier load then the branches they carry for fire fuel? Would it be a cost a family could spare? Maybe trading the ever present flip flop for more substantial footwear would help joint wear and tear and the constant falls while hauling loads patients report? Could it improve the plantar fasciitis and cracked heels? Would more protein like eggs or meat help with the diabetes or chronic acid reflux and stomach irritation issues? Can people afford to make any of these investments for their health? At least we know we are helping in many clear ways in the clinic. We are turning down the level of pain with acupuncture, we are helping people get back to their daily lives, we are helping catch more serious illnesses and guiding treatment. We are supporting an organization that is setting up to become Nepali run in the next 5 years and is putting out great efforts to understand the health trends of these people by launching a survey of the district next year. The clinic is a very special community center where people feel cared for and heard.
A special part of the Bajra Barahi clinic is that the land it is built on was given to Good Health Nepal/Acupuncture Relief Project by the government and it is part of a healthcare complex. The neighboring buildings are; the local Health Post and a birthing center. We were all excited that babies were going to be born right next door and decided amongst ourselves who would get to attend the first birth. My gracious colleauges let me be first! They were being very encouraging of my fledgling interest in woman’s health. Earlier that week a birth was happening during clinic hours- we were all informed but more or less assumed we had time because most births take time. The exact moment I was informed, I had 4 patients with needles in - getting treatments, so clearly I couldn’t go to attend the birth. I go over during lunch break and discover it was a simple straight forward birth that only took 2 hours!? I am definitely sad I missed it but Andrew said if I see the birthing center doors open to just go over and check in. So back to that special Saturday night after such a wonderful and thought provoking day. I am feeling a rare energy in the air. I harness it after dinner to indulge in a self care ritual I find time for most days back home, but truthfully feel too tired for on regular clinic days here in Nepal. Magically the Wifi is actually strong enough in my room to stream consistently, which is what made it possible that lovely eve! It is what I like to call my “yoga dance party”: a sweet combination of intuitive movement, yoga balances, qi gong, stretching, core work, breath work and most importantly just a good ol’ goofy time, laughing at myself. It is just about 8pm, while in a headstand I notice the lights on at the birthing center! I run down the hall and poke my head back into the kitchen where everyone is still hanging out having our regular style post meal digestive banter and say, “the door is open at the birthing center!” Everyone sees my excitement and says- “Go!!” “go check it out” !
So we radio down across the street to see if any of the interns want to come interpret for me. And in a few minutes Sarita and Ritesh are up and I have a little travel acupuncture kit ready to bring over. We head across the courtyard and enter to see a very out of it mother to be. The woman is 20 years old (which is actually 19 because in Nepal, people count babies as 1 right from birth instead of zero like we do). It is the mother’s first pregnancy. Her eyes are rolled back into her head and she is doubled over in pain. Luckily, she is surrounded by a sweet support team of her husband’s mother and 2 sisters.
Let me also take a moment to explain what this “birthing center” consists of. It is like all buildings in Nepal, which means non-insulated concrete; cold in other words, it was a chilly night. The small building has 2 rooms- the first room you walk into is a kind of waiting room with a bed and a bench, then the second room has a table for birthing which has two poles with stirrups at the foot of it. I say table because it is definitely not a bed, it is slightly padded hard plastic vinyl. Really the whole feel of the place is cold, but it is a real resource for the community. There are healthcare workers that we call “the sisters” who live in a building very close to our compound. When the interpreters and I arrive, I introduce myself with my title here, “Hello I am Doctor Paula, I am an acupuncturist and I would be honored to assist in your birth”. I explain I can give simple points to reduce pain and help the contractions. They all consent. I join the team and aid the girl into the birth room to check on progress.
She can barely walk and uses anyone in arms reach for support. I help the girl onto the table and hold her hand. She grasps my hand for dear life. She is clearly in extreme pain and discomfort, is scared and just needs a hand to hold, hard. And although I could not speak to her in her own language, so much was communicated in that moment through her desperate grasp. She was allowing me into her world, into this moment of her life, bringing in new life. Her hand was simply asking for help. It was electrifying, terrifying and activating: what was communicated through her hand into mine. The sister, who has probably attended hundreds of births casually stated “she’s 3 or 4 cm dilated”. This meant it could be hours until birth time- she was going to sleep and would return at midnight to check in again. We go back to the waiting room and settle the laboring mother on the more comfortable bed with her sisters propping her up. She was incredibly out of it- it seemed like she was definitely not coherent, not using her mind at all, letting instinct drop her into her body, but it also seemed like she was trying to flee the pain in anyway. The mother-in-law, who was a mother of 3 herself, was laughing and telling her it wasn’t “so hard”- “time to stop being a baby and mother a baby”- the interpreter helped me understand. I looked around the room to the young boys who were there and it dawned on me that one of them must be the father of this baby on the way. Wow, they seriously looked like babies themselves! 19 years old is young by my westernized standards- and don’t forget that boys mature slower than girls ;) but it’s completely average here to be a parent at that age. Some of our patients started having kids at 14. The boys make some snarky remark I don’t understand and the lady support team shoos them to wait out in the cold night on the porch.
The girl moans in pain and I put in DU 20 and yin tang. I figure by what the sister said it could be some time before this baby comes. I also place sympathetic and shen men in her ear. My intention is for this mom to come back into the present and feel grounded for the arrival of her child. I show Sarita how to hold and gently massage, giving acupressure to the feet connecting Kidney 1 to Liver 3 and explain how water generates wood and will help the movement of this child soon. Also I show the family members LI4 -an obvious point to massage with the hand holding she needs. I give gentle shiatsu to the leg yin channels and her belly. We stay with the family a while, then we decide to try to sleep for a couple of hours too.
I awake Sarita and head next door again and return when the midwife sister returns at midnight. We check and the mother is progressing well, she is now dilated to 7 cm maybe 8. The mother continues to be in pain although she does seem more present, able to make eye contact now and gives a slight smile when we return. In my approximation everyone involved wants this baby to come now. While I have not had any advanced training on acupuncture and labor, I did of course know all the strong energy moving points and go for the known contraction enhancing points- aka: all the points that are contraindicated during pregnancy. I start with spleen 6- there is a dance to putting in the needles and removing them because the mother is constantly moving about trying to get comfortable. I place needles in and out and spend time with each needle stimulating the point. The contractions seem to come more often now. Things are progressing well. LR 3, BL60 are easy targets also since during contractions she wants to brace her feet against the rails at the end of the bed. LI 4 can only go in for quick moments since she wants to hold hands very much. It is after rotating through these powerful points that her water finally breaks! I take all needles out and we move her into the birthing room and get her on the hard plastic table. I am thankful Kaikit back at camp gave me some press tacks- I realize they are perfect to put in place during the labor. So I place the tiny stickers with hairlike needles coming from them on the mother in all those same points that are helping the contractions. Then it is my time to step back and let the midwife sister do her magic.
The first sight of the head is really fascinating to me- all crinkled. “oh my goodness” I think to myself, “that’s why a baby’s skull needs to be so soft! Eep how on earth is the baby going to fit through there! Omg” Well I will spare you all the details- let’s just say it went just as you’d expect a birth to go- I N T E N S E- like in the movies- it is slow but steady progress with each contraction more and more of the head showing until- whoop- that’s why they call it catching a baby! And my goodness it is a beautiful child and her head went right into a very cute correct round little melon shape after all- how !? a miracle of nature indeed. The cutting of the umbilical cord: wow it is wild to see. So much life in that sinew. So many colors. The baby is wrapped up and put on a warming table one eye already open and peering into this new reality. Afterbirth: a bloody affair. All of this is turning my young interpreter friend Sarita slightly green but she does great assisting the midwife with some tools. The mother needs some attending to since she has some tearing. The midwife says the mother could have easily avoided it had she been able to get in a more proper body position- the young mom of course had no Lamaze class or any coaching to go on. Overall, she did great and the baby is happily healthfully suckling within 20 minutes to half an hour in this world! Then I get to hold the warm little thing, heart melter- she looks right into my eyes, both open now, with curiosity and I can’t believe how great it feels to have been part of this. I don’t feel right hogging the baby for too many moments of her new life – and offer her to the father- who seems totally petrified and declines laughing and saying “oh it’s ok, I don’t need to hold her right now- I’ll be holding her for her whole life” So I pass the babe to her auntie. We all share many smiles and a true sense of celebration marked by exhaustion. By that time it is probably 3 am and we do have clinic at 8 am so it is time for sleep.
As I walk out of the birthing center crossing back to our building I take a moment to appreciate the bright constellations above. Wondering exactly what their alignment is for the new little life and reflecting on what is birthed into life for me through this experience. A certain spark is ignited for the whole realm of woman’s health and how Chinese medicine and acupuncture can nourish and support our life giving force. I hope to further work with fertility, expectant mothers, and labor. It is an intense experience but important work indeed. I feel true appreciation for my work here with the ARP and this chance to touch the lives of so many old and young. -- Paula Rashkow