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Beginnings and Endings

I'm sitting outside on a hot, sunny day with a view of the village of Chapagoan and a crystal clear view of the Himalayas in the distance...and of course there is a cat on my lap.  As writing is not my forte I have lamented for a week about writing this blog although thoughts about what I would say have streamed in and out of my head for the last two weeks.  What would I say about an a experience where every moment is a richly layered ever shifting kaleidoscope of thoughts and feelings?   How can I possibly express this in writing to other people when it feels so deeply personal?  But part of opening myself up, opening up my heart is to share these experiences with others. 

The first few weeks of clinic are overwhelming and exciting.  Everything is so patients, a long work week, working with an interpreter, living in close quarters with a group of people.  It brought up feelings of insecurity and made me question my competence as a practitioner.  I felt somewhat disconnected from my patients, from my teammates, and really from myself.  But I got up every morning, felt my discomfort, and went to work anyway. 

On a bus ride to Boudha something shifted for me.  Riding the microbus in Nepal is quite the experience.... They will pack on as many people as possible and I felt fortunate to have a crowded seat.  I was sitting next to a petite older woman who would look up at me from time to time with a sparkle in her eye and start talking to me in Nepali in which I would look at her say "I have no idea what you just said" and then we'd just smile at each other.  She had her arm on my bag and when I tried to move it to give her more room she looked at me, gave a head bobble, and said 'tik chaa' which means 'it's ok I'm fine'.  At that moment I realized she reminded me of so many of my patients... men and women that I have started building relationships with and look forward to seeing every week.  I also realized how much I appreciate and rely on the interpreters I work side by side with on a daily basis to bridge the gap in communication so I can have these rich experiences with my patients.

I've felt myself gaining confidence and by allowing myself to be myself I started really opening up to my experience here.  There is something beautiful that happens in the treatment room between myself, the interpreter, and the patients.  I've stopped worrying so much about getting it right and started just feeling into the experience, connecting with everyone involved and although some days are still crazy there is a flow that is present.

I've fallen in love with Nepal and the people here.  I've gotten close to my teammates and I'm starting to form friendships with the interpreters.  Nepal in all it's glorious craziness and beauty feels like home and through shared experience I feel like I'm part of a community, a family.

In eighteen days I leave for Thailand and right now that is heartbreaking.  The other day I had a particularly touching moment with a patient and when I went to the dispensary to fill herbs it hit me that I was leaving soon and I lost it.  I let myself cry, wiped my tears, and went back to treating. These moments are happening more often as I realize I'm starting to grieve the end of my time in Nepal.  The more I open up and allow myself to really be here the more I open myself up to the inevitable heartbreak of an ending.  But within this heartbreak is a deep gratitude and appreciation for the people and experiences that have and continue to impact me.   This is life.... Relationships, friendships, experiences are always in a constant state of flux. Endings allow for the freshness of new beginnings and when I'm in Thailand I will fully be in Thailand having whatever experiences arise then.  And by us leaving the new team will get to have their own experiences here.

I asked Satyamohan, one of the interpreters, today if it was hard for him every time a group left.  He replied yes it is difficult for him.  I then asked if it's gotten easier as he's been doing this for quite a few years.  He said it has but that he's a human being so it's never really easy.  And that's it...regardless of culture, age, gender we are all human beings sharing our pain, our heartbreak, our laughter, our joy, and in all of that our love for one another.  ---Natalie Gregersen

Heart, Brain and Courage

Sarah Richards Massage Therapist Volunteer Nepal

I swear that when I asked the Wizard for the brain, he gave me the heart instead! Luckily, I have chosen a career path where leading with your heart is completely acceptable. For the last 10 years I've had a successful massage practice relying solely on my instincts, intuition and following my heart.

Here at the clinic in Chapagaon fear and anxiety have surfaced in me because we are asked to track results and do case studies like clinical practitioners. We need to quantify, measure and prove efficacy, and this is where that brain would prove to be a bit more useful!

While being here in Nepal, some of my insecurities have surfaced. The amazing  acupuncture practitioners constantly awe me with their breadth of knowledge, medical skills and healing abilities; rarely can I even speak their language! I've panicked a few times wondering what am I doing here? What were they thinking when picked me to come here? Are they gonna see right through me and realize that I don't feel like I know what I'm doing? I am so fearful  of letting them, and myself, down; being present, a good listener and showing compassion come easily for me, but here I also crave to be a good clinician as well.

Can't we measure our clinical progress with smiles, moments when a patient finally lets go, kind comments and gratitude? How about the gifts we receive in appreciation; don't  eggs, mustard greens, jello and homemade liquor count somehow?!

Maybe I'm struggling to track and measure my progress exactly and precisely as is desired, but here's what I can relay:

- I had a patient tell me that the gods are singing when I am working on her -  that has to count for something, right!?

- Mini Monks! I have made a couple of regular patients from the Buddhist monastery next door, which is for young monks ages 8-18, hence "mini". One has even asked for my email address in case he thinks of more questions to ask me.

- My schedule is booked with 10 massage patients almost every day, I became very popular very fast!

- I am called "Doctor Sarah" here, so at least it sounds like I know what I'm doing!

- I've had a patient weep on the table because she is overwhelmed that she has somewhere to go where people genuinely want to be kind to her and take care of her.

- I get feedback from the acupuncturists that patients are loving their massages and they are feeling better. And the acupuncturists, since they are treating so many patients community style, are appreciative that there is someone spending more hands on time with the patients since that can be a critical piece of healing.

- I have had the pleasure of adding Tibetan singing bowls to my treatments. These are antique bowls that when massaged properly make an amazing sound and vibration. It has been a powerful tool, the sound and vibrations reach inside and massage where I cannot touch. The patients recognize the bowl as, well a bowl, like something they might cook in, and at first are not sure how it could possibly help them. But once it starts singing they relax in a way that my hands cannot always achieve on these rigid Nepali bodies.

- I have patients who could have acupuncture at one of our satellite clinics closer to their home, but travel 1.5 hours by bus to our main clinic because I am here. One such gentleman has improved greatly but continues to make the journey each week because he enjoys his massage so much. He has invited me to visit him in his home and is planning to bring two other family members to see me.

- I am co-treating a patient with daily massage and acupuncture, this young man has contorted his spine in order to relieve the pain he feels from a herniated disc. He gets up off the massage table smiling and his mood shifts from sullen to happy, his body standing 50% straighter and with significantly less pain.

I came here to be challenged, to expand and grow. I have 3 weeks left to grow as much as I possibly can in beautiful Nepal. I think that I am constantly challenged by my own limitations, but in order to move forward I need to love and embrace those limitations first, and then I can set them aside. I am using this blog post to help me see myself a little more clearly, and now I can't wait to get back in the treatment room and love my patients the best way I know how!

Next time I'm in Oz I'm gonna thank the Wizard for choosing to give me the heart!

Insecurities Secured

What am I doing here?
To share and expand.

Why me?
Only you can do what you do.

Am I good enough?
You are perfect enough.

Am I smart enough?
Never stop learning.

Will I make a difference?
Every second.

---Sarah Richards

Wiggling Your Toes

I walk the dusty streets from Vajra Varahi Health Clinic to a small Newari village most mornings. My interpreter and I wind through alleys full of interested street dogs. We cut through schoolyards where uniformed children gather on their way to learn and we pass through fields where women look up from their chores to utter a quiet "Namaste". I wonder silently to myself on these walks - Will her smile be bigger today? Will her spirits be lifted? Will today be the day when she finally wiggles her toes?

I make this walk to treat an 81 year old beloved mother, grandmother, wife, and stroke survivor. The stroke happened just over a month ago leaving her paralyzed on her left side. I squeeze into the makeshift treatment room next to my patient as she cautiously sits upright. My interpreter relays my questions and the patient's responses from just outside the room where he kneels on the cold, hardpacked dirt floor. My patient leans against one of her daughters, the one who takes charge of her mother's home care. The daughter always greets me with a big smile, she helps with treatment by encouraging her mother and making jokes to lift her spirits. My patient's husband often comes as well to sit with his wife if there is space. A few grandchildren, ranging in age from four to twenty, peer over my interpreter's shoulder. The makeshift room smells musty in the chilly brick home; its walls are plywood, there are wooden shutters for windows, the family has hung tarps to block the cold-wind from seeping through the cracks. My patient lays swaddled in layers of blankets, tucked into her tiny space to keep her warm.

Most mornings her progress report is the same: "She sat outside in the sun yesterday. We massaged her arm and legs just like you said. Yes, she's doing her exercises every day." On good days I hear, "She walked two steps on her own today. She sat upright by herself for a bit." On difficult days the patient asks, "Why do I feel so heavy? I am so tired. When will I be better? I want to walk with my goats again. I have to get better soon for my family."

I thought I learned in school how to treat stroke sequella with acupuncture. Work with the Yang Ming channels, use the e-stim machine, stimulate the scalp points while the patient tries to move their limbs. The treatment protocol is the easy part. What I didn't learn was how to be a coach and cheerleader. I precariously try to balance those tasks while I struggle to manage the patient's expectations. Every day I dread answering the question, "When will my mother be better again? We are doing everything that you have asked of us." I can't give them an answer to that question when I don't know the answer myself.

She may slowly improve over time with frequent treatments and continued exercises at home, but then again she may not. What I do know is that it will take months of dedicated work from the patient, her family, and from us, the practitioners, for her to regain mobility. But there is no guarantee.

The changes are painfully slow. Both the the patient and her family have a hard time seeing any change at all. It is my job to remind them with every visit. "You're doing great! Wiggle those toes, even if they don't move, just keep trying! Look, you just moved your foot!" I tell them she is doing better, that I can see her improvements. I remind them to be patient, to stay positive, to keep trying. But I say these words to the family as much as I say them to myself. Be patient, Stephanie, real change takes time. Stay positive, don't give up hope. Keep trying, keep encouraging her, she needs to know that she is getting better. Just keep treating.

So I walk the dusty streets from Vajra Varahi Health Clinic to a small Newari village most mornings to see my patient, and I wonder silently to myself on these walks - Will her smile be bigger today? Will her spirits be lifted? Will today be the day when she finally wiggles her toes?

Today, after four weeks of treatment, was the day that she wiggled her toes.

---Stephanie Grant

With Joyous Diligence

Since I’ve been here, besides treating patients, I’ve been reading some books of Buddhist thought.  One book that speaks to me deeply is called Medicine & Compassion, A Tibetan Lama’s Guidance For Caregivers written by the Venerable Chokyi Nyima Rinpoche and David R. Shlim, M.D. 

One thing from the book that sticks with me is the idea of treating patients with joyous diligence.  The thought is that you gain energy because you enjoy the work.  It is also one of the 6 virtues of a Bodhisattva, having perseverance.

As I’ve been treating patients I’ve noticed some are easier for me to treat than others.  There are many reasons for this.  Some of their cases are very complex and my experience and confidence are lacking, the language barriers and the subtle things that get lost in translation are numerous, and sometimes just the pure energetics between people can be a challenge.  When I run into these walls, I try to bring myself back to the idea of joyous diligence and the action of having perseverance. 

The other day I saw a woman for her second treatment and as I looked at her chart it was very complex and I thought, “What am I possibly going to be able to do to help her?”  The beloved interpreter and I started in, and the patient revealed that she had been bitten by a dog.  I looked away from her chart and up at her and realized that I had dodged a bullet trying to figure out how to treat the things on her chart, but that we were going to head in a totally different direction with her whole new barrage of ammo.  After a few basic questions about the incident we got to the place of making choices about her treatment.  Number one…if the dog was vaccinated we don’t need to send you to the health post but we do need to contact the owners and get the vaccination report to be sure.  Number two…you need to go to the health post for vaccination because we can’t get a vaccination report and the dog owner doesn’t care that his dog bit you.  Number three…don’t ask for a vaccination report for the dog or go to the health post and risk getting very sick.

After tears, worry, and deep concern from all parties involved, I cleaned the wound and told her that I cared for her and I didn’t want her to get sick.  She said she had no money and I assured her that was nothing to worry about and that we would take care of it as long as she agreed to go to the health post for a rabies vaccination.  More tears, no way of paying us back, her husband had passed away a year ago, no money.  I again assured her that the only choice she had was to go to the health post because if she got sick, it would only make matters worse.  She cried and said, “Those dog owners don’t care if I die because I am poor.”  We reminded her again that we cared and that was why she needed to go to the health post.

I was just about to say, “Ok, these are your options and if you don’t want to go you don’t have too.” And she said, “Ok, I’ll go.  You have convinced me that I don’t want to be sick.”

So away we went with her to receive her first of three injections.  After it was all over we got back to our clinic and I treated her to ease her emotions.

At the end of our treatment she thanked us for not letting her get sick and die, and told us that now we too had become her family because we cared for her.

Upon reflection of the situation, I realized that when I let go of my agenda for her care, she also let go and agreed to let us help her.  I have also been struck by the fact that we fly half way around the globe to care for people, but how do we treat our neighbors and people of our own village?  With joyous diligence?

---Amy Schwartz

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