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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

Good Morning Nepal!


Good Morning Nepal! It’s 5:30 a.m.

We at the Vajra Varihi Health Clinic are tossing our sleepy heads in bed while Monks twenty steps out the door are gonging, blowing gloriously long pipes and chanting from the deepest place in their bellies (a daily ritual known as puja:  expressions of honor, worship, & devotional attention). Turning over again, the signal for dog singing of all shapes and sizes has begun. Children are walking to school taking no notice of the woman carrying plates loaded with red petaled flowers, candles and other mysterious herbs blessing their doorsteps. A procession of villagers begin to enter the inner courtyard of the Monastery and circle the Gompa clockwise, spin prayer wheels, and pass their best hopes out to the Universe. It’s almost 6:00 a.m.; We have been blessed with a lovely rooftop garden and I can’t resist witnessing the awakening of our village, Chapagaon, from this viewpoint, with a possible glimpse of the Himalayas. Ahh, there they are...  and like everyone else on our team, I just can’t believe in one week I will walk amongst them!


Our workday is hours away, however I and my friend Diane have assigned ourselves the task of feeding a few stray dogs that call the inner courtyard their home. Off to the market for a dozen eggs and some milk, I am hoping to build their reserves for the Winter.  The Monks share rice with them, so perhaps with the Mange cure we’ve been giving them (boiled lemon skins, from the renowned British Veterinarian Doctor Juliette Baircli de Levy), a few baths, and most importantly recognizing the light in their eyes, this year will be better, and maybe, just maybe, someone will carry on.


Black chickpeas and chapatis for breakfast and I am off to stock the treatment room. Once the doors open, the patients who have often been waiting there for hours, stream in with their shimmering eyes. Many walk for great distances or ride the dizzying microbus for hours, as if it were nothing, having heard from a friend or relative of great benefits received from the clinic. Two things I have noticed in my Nepali people are their extreme patience and their great ability to heal. They come frequently, which is how acupuncture shines, and they believe in the medicines of the Earth.  Belief and intention - we talk about it all the time in acupuncture circles; The Nepali people live it.


Some many beautiful, cheerful days of patients sitting together sharing their stories, healing together. My favorite patient, Nuche is recovering from a stroke.


Each treatment another finger can move, the range of motion in his shoulder increases, his foot lifts a little higher. He smiles, he endures, his gratitude is heartbreaking. As he leaves my treatment room with his homemade walking stick and shyly one more time says Namaste, I understand how very lucky I am to be here, in this moment, with this extraordinary man. --Jeanne Mare Werle

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