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Ipa

I know many people that travel often and tell stories about their 'breakthrough moment' or an 'epiphany'. Friends and family told me, when I was leaving for Nepal, that I would have amazing experiences and it would change my life. I have no doubt that this will be a life changing experience, or that my time here will be amazing. However, in my head, as I was boarding the airplane and imagining all the things that would come. I daydreamed of sitting on top of a hill and having the meaning of life showered upon me. I would break down from some hardship and then see the light through the darkness of my despair.

So far, none of that has happened. Instead, I've been learning lessons little by little. They sneak up on me, so much so that I don't realize I'm learning them until I look back and realize I've changed. It reminds me of how my mom presents an idea to my dad. If she gives the idea outright, with all its facts and all its information, he shuts it down right away. However, if she gives him little tidbits, subliminal messages, and offhand comments, in time he comes to the exact same idea or conclusion on his own.

This happened to me in Ipa (or Epa, even Nepali's can't come to a consensus on the spelling).

Ipa is our outreach clinic. Every Monday and Thursday we trek an hour and a half along the dusty, rocky, uneven road. The walk there is "Nepali flat", meaning there is very little elevation gain in the end, but you will rise and fall hundreds of feet along the way. Our walk to Ipa on October 24th was sunny and hot. We had butterflies flitting around us and grasshoppers jumping around underfoot. Leeches, thank goodness, had abandoned the hot dry grasses. Four of us walked to Ipa that day. Andrew, Allissa, Ritesh, and I. Two practitioners, an interpreter, and a pre-medical student/assistant/odd jobber.

Our first stop, as with every time we travel to Ipa, was about an hour into the walk. We made a house call to a man who has a neurodegenerative disease. We suspected, with our limited technologies, either Parkinson's or Multiple Sclerosis (MS). Allissa did an acupuncture treatment on him, and his son brought out fresh honey that they'd harvested from the wall of their house. It tasted wonderful. We broke off a piece of the fragile honeycomb and stuffed the whole thing on our mouths. Occasionally a larva got thrown in the mix, but it's just a dash of protein, right? The honey at the house in Ipa was particularly delicious after a long, sweaty walk. The sunlight glinted off both the metal plate and the golden honey, making the entire presentation seem all the more appetizing. We sucked out all the sweetness possible until we were left with only wax, which actually makes for a pretty good chewing gum substitute. 

After we treated the man, we continued on to the school house where we held the main outreach clinic. We took one room of the two room school building and used it as a treatment room. Chairs were set up outside and inside a platform with two mats. About half of the patients we treated outside, sitting in the plastic chairs.

The community likes to hang around and watch our clinic work and we encourage it. Patient confidentiality and privacy here takes a backseat. It's more important for us to be open, honest, and visible to the community. They take comfort in their friends and family being with them. In some cases, privacy is preferred, and we always accommodate for that. In Ipa, The school itself is set on a ridge with the "road" traveling right in front of it. Some of the community members or patients sat on the edge of a cliff, squatting or sitting, oblivious to the extremes of their environment, content with watching us work, gossiping, and looking after the babies of those getting treated. A pleasant breeze washed over us from over the cliff, it was especially welcomed on the hot day.

Our first patient at the clinic was a small girl with diabetes. The first time we tested her glucose it was 525. The second time it was 320. The third, it was back up to 500s. Her glucose was dangerously high and we had been trying to write to some doctors in the US about what type of medicine she needs. That day in Ipa we didn't have any glucose strips left in order to test her blood sugar levels. We performed an acupuncture treatment and said that we were working with some doctors in America to help her. She had the most amazing attitude. She hung around our clinic the whole day and our little inside joke was “yes dukchaa” which combines English “yes” and Nepali “pain” or we said “no dukchaa”. Often she would point to objects and say their name in English, showing her intelligence and eagerness to learn English. Her and I developed a great friendship that day. She started holding my hand and tugging at my hair, running away and giggling after. At the end of the day, she walked us part of the way back and then handed me a note. It was pretty long, and written in Nepali. I had Ritesh, one of our interpreters, transcribe it for me.

Here is what it said:

I am Babita Basnet. For the good health of Nepal, namaste to the well wisher [this is a respectful greeting]

Hello (Namaste) Doctor

I am 13 year old kid born in a poor typical Nepali family. I have been having sugar disease or blood sugar disease since I was 11 years old. I am always worried (scared because she had this problem). I am very interested in studying and I love all sorts of extracurricular activities but I am very worried and scared because I have been attacked by this sugar disease since I am very young. What should I do? Our economy is no good. I can’t go to many places to have my medical tests and till now I have been managed with medicines. Sometimes I feel “what will I do?” when I can’t afford for my medicines. I am just scared. Will my problem (disease) ever be solved (cured)? I don’t think so if I can’t get a good medicine that will help me with my disease. I always use insulin but it burns me and it hurts very much. How long will I have to live with this pain? I am not able to concentrate on my studies because of my family’s condition and stress of my disease.

Love
Babita Basnet
Epa, Pachkanya-6
Makwanpur

This little girl, who had been so chipper and playful all day, described her fears and anxiety over her life-changing disease in under 200 words. I didn't know what to do. I felt pretty helpless when I was reading her letter.

One of the hardest things to do here in clinic is to tell someone we are unable to help their problem. It's one of the most important things a doctor can do: honesty. On Thursday we met a lady who had a fever four years ago. During the course of her fever, she was hospitalized and lost hearing in her left ear and partially in her right ear. She came to us with a couple other complaints: headache, body pain. I looked in her ears and the ear canal and tympanic membrane looked normal, if a bit opaque. There was some redness in one and a small amount of moist earwax. None of this should have caused partial or complete hearing loss. We used a tuning fork to do a basic hearing test and it confirmed her partial and complete deafness. Andrew looked at her and said “We will not be able to fix your hearing. The fever likely caused permanent damage to the auditory nerve, something that is deep inside your brain”. As Ritesh translated you could physically see her face fall.

Often times our patients view us as magic workers- able to fix anything. We bring our foreign clothes, foreign faces, and foreign medicine. They come to us, sure that we can fix anything. They have so much hope when they come to the doctor. She had hope that we could fix her hearing through treatment. The same treatment that is fixing her husband's body pain, her mother's headaches, or her friend's menstrual irregularities. But we can’t do everything. And we had to tell her that. You could see on her face when she realized the permanence of her situation. She had to reroute her future plans. Everything that she had hoped would return vanished with our words and she had to imagine her future with only partial hearing in one ear. For the rest of her life.

 

We’ve told people this before, and I've always known the value of honesty in the clinic. But this was one of those "snuck up on me" moments. When I look back at all the previous times we've been honest with our patients, regardless of the news, I see the value of doctor-patient honesty with a new clarity. We bring hope, compassion and our expertise. But sometimes we also bring bad news, disappointment, and heartbreak. -Tessa Concepcion

Something Profound

I have a clairvoyant friend who told me I would have a profound, potentially life-changing experience while I was in Nepal. I'm in a distant land helping a very rural, select group of people heal, naturally this will be profound, duh. Even so, I can't help but wonder about her prediction and it's implications. Will this experience be so changing I will be cognizant at the time it occurs or more subtle- something I'll reflect back on years from now, hindsight offering clarity I cannot comprehend in the moment? I don't know. What I do know is my anticipation waits unabashedly for the answer.

I have not spent much time with groups of females. So much feminine energy often overwhelms me and leaves me feeling shy and self-conscious. Did I fit in? Was I being judged on my abilities to act as a "normal girl" should act? These insecurities carried into adulthood and I've spend many hours working through what "normal" and femininity mean to me.

All the volunteers in this group are females ranging from 22 to 37 years old. We come from different backgrounds and share different stories. Since I've arrived I kept the ominous prediction in my head, always thinking the profound experience would be clinically related and maybe it will, but it could also be a more interpersonal one.

We have all been requested to write a blog expressing our authentic experience here, but I've struggled with this. My ability to process the goings-on veiled by overstimulation and fatigue. The days can be long and I am often riddled with self-doubt and insecurity about my capabilities to heal and help. Sometimes the only saving grace is the people I am sharing this experience with.

I have created a bond with the volunteers that even now, in it's very early stages, I can recognize as lifelong. I'm learning that my insecurities about everything aren't just something I alone have to suffer with; each of us are overwhelmed, unsure, emotional and confident all at the same time. In this adventure, completely out of my comfort zone, I am surrounded by a group of people that will support, help, comfort and hug me. The walls I keep up to protect my vulnerability haven't come crashing down, but I am letting these women see a part of me generally reserved only for those very close. We joke, cajole, offer tough love and make fun of each other daily. I laugh often and wholeheartedly. The relationships I am building with my colleagues is challenging to express in words, it is a feeling I have of knowing this is a moment to be cherished in it's fleetingness. This is a small window of my life that will be closed sooner than I am prepared for, it casts a melancholy air but reminds me to stay in the moment and be grateful.

Feel free to read other blog posts about my travels at:namasteacupuncture.blogspot.com

❤- Terry Atchley

Bhimphedi

Tomorrow is the last day of our second week of clinic. My experience living and working in Nepal has seemed slow to evolve, but I realize is actually evolving very quickly. Last week was extremely difficult. The weather here in Bhimphedi was hot and sticky, the clinic was brand new, I was seeing more patients in one day than I've seen in a week and on top of all of that, I ended the week feeling sick and exhausted. I know from past experiences with travel that this is normally the point when I have a breakthrough. I had to remind myself of that, since it has been 12 years since I have lived abroad for a period of time. I've always been the type of person who when the going gets tough and I become stressed, I find a way to absorb that stress and "toughen up" in order to get through it. Unfortunately, this is usually when I get sick. This is exactly where I found myself last weekend...sick, tired and uninspired. When I was asked to be the team leader of the Bhimphedi satellite clinic, I knew in my heart that I was up for the challenge. I didn't know at the time that that challenge would have very little to do with the logistics of leading 2 other practitioners and keeping an organized clinic. It's turning out to have everything to do with learning how to thrive and follow my heart in an otherwise stressful situation.

 

We all have coping mechanisms. Over the years I've become quite good at learning to exist in difficult environments and adjusting my body and mind so that each one was filed away into its predesignated spot in an attempt to keep my surrounding environment running smoothly. My heart didn't usually have much of a say. My surrounding environment was probably never as calm as I thought it was and I was certainly not in a state of inner calm. In recent years, as I've tried to incorporate my heart's desire into my coping mechanism, I often ended up appearing very vulnerable....a scary feeling for the girl from the east coast! But as I started to include my heart's needs into how I reacted, I started to feel a sense of freedom from this vulnerability. I feel as if the opportunity I'm being given as the team lead for the Bhimphedi clinic will expand my heart in a way that until now, I didn't truly realize needed to be expanded. Perhaps there is a way for me to exist, calmly and peacefully from the heart, within a stressful environment. Perhaps order and direction can co-exist, within myself, with a sense of vulnerability and an open heart. This is still a bit of a scary prospect for me and one that I will probably continue to stumble over many more times, but as I've begun to discover in recent years, it's also a freeing prospect. As I learn through Vipassana meditation, perhaps this is the key to responding rather than reacting. We respond with our hearts. We react with our minds.

When viewed from the mind, everything we do here on a daily basis seems to be a lot of work...from showering to using the toilet to communicating. But when I start to relax and look at what or who is right in front of me, I realize it's not so much work...it's life. And when it's smiling back at me, I can't help but soften and smile back. I think I'm starting to see the magic of Nepal. ---Patty McDuffey

 

Kogate Clinic Project Begins

I feel my time in Nepal (only 12 days so far... crazy, feels like a year) has already greatly stretched, opened and expanded my view of culture, community, self and life in general. A perspective and growth I think and hope will stay with me forever. I feel like every moment is packed with SO much stimulus, it can feel like an overwhelming sense of raw emotions... bursting and bubbling... trying to make sense of, integrate and digest everything at once, before the next moment, equally as intense and stimulating arrives. There is just so much to take in and process... (A little alone time each day for me is highly needed).

Being immersed in some Nepalese city life and culture in Kathmandu for a few days after arrival and introduction to our Acupuncture Relief Project team was a whirlwind of exciting events while we adjusted to our different time zones (America, Canada and Australia). On reflection some highlights include a trip on the back of Andrew’s (our team lead) motorbike from the airport to the earth house hotel. Goodbye Australia and hello Nepal... a complete cultural change!!! As the thick smog filters through my respiratory system, my eyes water from the smoke and speed of the bike, animals, pedestrians, bikes, motor vehicles and fuel trucks weave a path with many honks and near clashes, and I think back to my friend saying to me before I left that Nepal/India can often feel like you have landed in a completely different universe... yet the chaos to me feels so fluid and free and somehow I felt a sense of adrenaline, excitement and a great sense of LIFE!!!

We had a very warm welcome and I felt extremely safe and at home. I was already beginning to sense that Nepal was a place of unpredictability and really keeps you on your toes... literally... those first couple of days we did a lot of walking... exploring and discovering the city and some of its treasures... lead partly by Andrew along with some of his Nepalese friends/connections... who are very interesting and inspiring people who generously shared their stories, art and knowledge of the city, temples and hot spots. (And by hot spots I don’t mean wi-fi... a concept, which has become foreign to us in Kogate and at its mention our ears prick up with anticipated attention).

Some “hot spots” for me included the monkey temple ‘Swayambhunath’ where we had some great laughs watching many monkeys jumping and playing in a small water pool (remind me to show you a video of this) and a sacred site Pashupatinath where on one side of the river bodies are burned in funeral celebrations and on the other side there are temples for fertility. The way life and death are so connected here is very beautiful... A sense of impermanence and flow... Everything seems more out in the open... the rubbish being another example... instead of feeling disgusted by it I also see it gives another understanding that we use SO much unnecessary packaging and garbage in our society and here its just more ‘out there’. In Kogate all the rubbish we use we burn so it really gives you a more immediate idea of what and how much you bring/use/dispose of.

Our journey to Kogate was an adventurous funny, somewhat scary ride with all 7 of us packed into a jeep bobbing up and down with all the bumps, lots of screams of near close encounters with oncoming traffic around bends and the often sketch (Patty’s sketch scale rating) roads and lots of girly giggling (our poor driver ...a young Nepalese man who found enjoyment from telling us cars had just tumbled down the cliff the other day... totally NOT funny information while squeezed in the back of a jeep on that road!!!!).

We arrived somewhat relived, very hungry and tired.... Only the next day could I fully appreciate the beauty of our new home and its mountainous surrounds. There is a little running creek which today we bathed in on our one day off ... it felt lovely and was refreshingly cool. We have explored some of the little trails around after our clinic days and the beauty is very overwhelming and breathtaking... as is the altitude and the steepness!!!

Setting up the clinic was exciting and the first week has been both challenging and rewarding. The Nepalese people are very sweet and welcoming, funny and grateful. I think I have treated and seen more people/conditions in the first week than a whole semester at college! From pregnant women, young children to people in their 80’s and all different social classes they arrive at our clinic late morning and just keep rolling in ... often I have around 10 family members in the room all having their input into a particular case and getting involved (at first can be very overwhelming, along with the children piling around the windows all watching, sniggering and giving you shy smiles).

Being a “primary health worker” aka “famous white doctor” has been a big adjustment in my thinking and practicing mind and I have found working with new assessment tools and exams rather challenging yet I feel privileged to learn these new skills in practice and be able to help the people where is needed. Sometimes they don’t need acupuncture or herbs, they need a medical diagnosis or a referral or simply to be heard and listened to.

One of my patients I have seen everyday this week is an older man who suffered an ischemic stroke in late February and now is unable to speak. He comes in with his wife (a very caring beautiful lady) and is only able to sound “la la la” and is partially paralyzed on his right side. I have been treating him with acupuncture, using both electro and scalp acupuncture and also doing speech training with him. I sit in front of him (or Tessa, another volunteer who is helping out does) and we sound out the vowels getting him to watch us and try his best at copying our sounds. He finds this frustrating I think yet with the right encouragement he develops a big smile! This warms my heart and I feel so humbled by these people I have met who seem to have many health concerns yet are so open, happy and grateful. Many great qualities I will continue to aspire towards as my time here with Acupuncture Relief Project continues. - Anna Helms

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