Tuesday, September 24, 2013

Leeches and Lions and Squat Toilets... oh my!

Thursday morning we had breakfast in Kathmandu and piled into a jeep headed out of the city towards Kogate.  Another truck in front of us was loaded with our bags and tied down with a tarp followed in front.  We were excited to escape the city and the pollution just to see a little greenery and of course begin our clinical third world journey.  Though we were not looking forward to the bumpy ride ahead that we were warned about.  It wasn't too long before we were heading up and down passes witnessing some breathtaking views.  There were many close calls with oncoming traffic, but all and all I was impressed with the roads.  They were bad of course, but not horrific.  The terrifying part was the tight turns and the unknown of what car was around the next curve that we might crash into.    

We stopped at the top of a pass for some tea while we waited for our truck with the bags to catch up.  I caught a glimpse of a peak of a mountain from our view, but still too much haze and clouds to see it in its full glory.  I know that time is coming.  Since we are practicing in a different region, we won’t have the views as previous practitioners, but for me that works out fine.  It will make the upcoming trek worth it even more as well as my Everest day trip.  There was a sign posted on the side of the restaurant that was translated for us... "Come see famous white doctors".  We were ecstatic... we were famous!! 

About three hours in we were all becoming a little loopy and yawning, perhaps from elevation gain?  Our driver was getting a kick out of 7 female girls screaming and bopping of heads.  He eventually put on some Nepali music to further set the mood for our journey to our new clinic.  I recognized and appreciated that we were going to uncharted regions for ARP, setting up entirely new 3 separate clinics, and as the hours went by we knew we were really going "way the F*** out there".  We came to a standstill when we noticed the truck in front of us stalled.  The drivers poured water over the engine so that it could cool down.  Soon we were on our way again, but it wasn't too long until we came across it again, but this time we noticed it wasn't going to make it up the hill.  Our driver jumped out to assist, while we stayed in the car.  Suddenly our car slid back suddenly and again we screamed like a bunch of little girls.  Another jolt backwards and I opened the door and jumped out abandoning ship.  Looking back, that was cowardly but quite amusing to us all now. Not as funny as the driver sticking a rock behind the tire, the same rocks we were rolling over.  Did he really think that would help from keeping our jeep from sliding back further?  They started pushing the truck and eventually after getting a running start we were all back on the road.  

Soon we started heading into the clouds and began noticing beautiful foliage and vegetation except for stinging nettles, though it makes a fine tasty soup.  We made it to Bhimphedi and passed through town quickly and traveled on a one-lane bridge to continue on to Kogate where we eventually were greeted with a beautiful waterfall, reminiscent of Avalanche Lake at Glacier Park in Montana or even Multnomah Falls in Oregon.  I didn’t know what to expect, but I was envisioning something similar and was just in awe.  I secretly held back some tears just from being overwhelmed with the experience and maybe perhaps realizing just how secluded we really were going to be for the next 7 weeks.   After a long 5.5 hours or so, we arrived and descended into the village and were greeted with children and the interpreters with a Khata and beautiful marigolds with jasmine.

We walked right into the building and into the common area where food awaited us.  We didn't have lunch so we were excited to meet our cook, Zhambu and taste our first preparation from him.  It wasn't soon until we were warned that there were leeches crawling on the ground.  Holy shit... leeches.  Seriously?  Andrew stood up and shook one out of his shirt, a nice big fat one.  We kept looking around on the floor and checking our legs and sure enough I had one on my knee.  Ugh.  I pulled it off with a napkin and just sat there a bit shocked.  Well, it is what it is.  At least I got my first one out of the way. It is the very end of monsoon season and the rain still comes, so we suspect another 2 weeks of leeches.  Let's hope for the best.  We sorted our rooms and I immediately took out the sage stick I made and brought from Oregon and smudged our rooms, the entire building, even the toilet and myself.  No running water, just a hole in the ground to squat in and two buckets to wash our hands and face.  I knew this was going to be rough, but man I was hoping for just a tad more comforts.  Andrew mentioned that previous practitioners had indoor plumbing, western toilets, marble floors and perhaps better food.  One can be envious of hearing this or turn it around and feel pretty invincible for roughing it and being a part of opening brand new clinics in an entirely new region. This is a raw and completely new experience for us compared to past practitioners.  Needless to say many kinks need to be worked out and we have to be flexible.  There is something to be said about needing to use the bathroom three times a night, when you have to watch for spiders and leeches and squat in a smelly pit.  My stream aim has improved since the first night, but still needs work.  I will never ever complain about camping again.  Never.  

The next day was a busy one, sorting through all the supplies and organizing what needed to go where.  We sterilized all that we needed to upstairs on the roof with bleach and dried in the sun.   Later in the afternoon we met our interpreters.  Two of which have been with ARP for a few years, but the rest were completely new and a little terrified as were we.  We paired up and talked so we could introduce each other.  I met with Sumanmager, a 23 year old whose hobbies include meeting new friends and visiting new places.  He wants to be a social worker and is single and enjoys his freedom!  He was born in Kogate and was very nervous talking to us, saying it was his first time meeting Westerners.  I reassured him saying I was equally, if not more nervous because it was our first time too.  We soon had role-play sessions where one interpreter would act as a patient, the other an interpreter and then us as the practitioner.  We soon learned just how difficult this was going to be with the language barrier.  Asking more than one question at a time is useless and difficult.  We have to retrain ourselves to go slow, rephrase questions and hope we have some clarity into what exactly is going on with the patient.  We shared our expectations of each other which was really eye opening.  Later after dinner we talked about lancing boils and how this will be one of many common cases coming into the clinics.  Andrew graphically told us how to lance, cup and drain the boil going at least 1 to 1.5 inches deep to make sure we hit it right, or we will just cause more pain.  Have a cup ready for the pus and blood and glove up.  We went over pharmaceuticals and all of us just sat there with deer in the headlights after realizing that we are going to be prescribing western meds.  We write a prescription for antibiotics and the patients can go to the local health post.  We have herbs and basic first aid supplies; Tylenol, Benadryl, etc.… but need to think what is best for the patient.  We truly our doctors out here, primary if only care provider to these people.  Again overwhelmed, we have to just keep our wits about us and do the best we can.  We also had a class on safety and realized that all our education about tuberculosis, HIV and hepatitis and needle sticks came to this point.  Trying to stay safe, healthy, watch for leeches, crazy spiders, lice, beware of hiking or going out after dark for tigers, not catching contagious diseases or whatever else.... it really is a lot to process.  Other people are on an island or in Europe and I chose to have my limits pushed in a poverty stricken country prone to communicable diseases after graduation.  The uncommon in the common world. 

Breakfast this morning was enjoyable; corn flakes and crepe-type pancakes with peanut butter and honey.  I decided to splurge and have one of my starbucks instant coffee packs I packed.  There is only so much NescafĂ© and milk tea one can have, although the milk tea is simply delicious.  During breakfast Andrew treated one of the interpreters for a leech bite that had become inflamed and caused some swelling.  We ground up some Huang Lian Jie Du Tang for a footbath and Andrew tried to bleed the area a bit.  Some tears of discomfort came, but she seemed fine afterwards.  We sent her home with some Benadryl and hope she will be better for the next day.

We spend the rest of the afternoon sorting needles and herbs, deciding what was going to go to Bhimphedi and who was going to go for the first week of rotation and opening.  Patty was assigned team leader and will be staying there permanently so that there may be come consistency in patient care and I offered to come out for the first week and help.  We already have 40 on the books.  We are certainly nervous.  It will be chaotic, especially with brand new interpreters and whatever might get lost in translation.  Our evenings will be filled with researching our cases of the day and preparing our class to teach.  I suspect we will be exhausted.  We finally had the sun shower set up on the roof so I bravely went for it.  Not a fan of cold showers, but I'll be damned if I get a boil.  No sun, so no warm water.  It is what it is.  I felt myself becoming slightly agitated with the continuous swatting of flies, the looking for leeches every other minute, the shrieks of others who find them on their bodies and no electricity or bouts of it here and there, but I know things will continue to improve and that this is all building character and a true part of the experience.  I am trying to be more in the present and not worry about my pet sitter and cat at home, or licensing process, or how my practice will go when I get home.  I do wish I had enough money when I return to go and sit on an island and sip cocktails even for just a few days in the sun, but this journey will lead right into working when I get home and that is welcomed and needed.  There is beauty in this hard work and intense conditions.  I am fortunate to have this experience to serve people as a doctor and have such an impact on their lives.  The lesson to learn is endurance, patience, compassion, trust, and so many more that I have yet to realize.  

Wednesday, September 18, 2013

Kathmandu > Bhimphedi & Kogate

It is Thursday morning and we leave Kathmandu after breakfast for the clinics.  A supposedly very bumpy 5 hour jeep ride awaits us.  We have only been here since Monday, but it feels like a couple of weeks.  Funny how traveling can do that to you.

Today we had a wonderful person names Anil who is an artist here in Kathmandu.  He led us on an hour walk to the Monkey Temple aka Swayambhunath which included a plethora of stairs to the top.  We were huffing and puffing and were happy for the training for the LangTang trek later on next month.  The sun was out in full force and already at 9AM I was over the heat, but we had some cool breezes here and there.  I decided today after a significant headache overnight to wear my mask.  We are walking through dusty streets, past trash, dodging motor bikes and cars, chickens, dogs, merchants and the air quality is just rough.  The hot weather made it hard to breathe with them on, but it was needed.   I saw a peak of a mountain in the distance but the haze was still too dense to see anything else but some hills that were pretty impressive.  

When we made our way up to the temple we were greeted with more monkeys.  A really spectacular view though down to the valley and prayer flags galore.  We walked left around the top of the temple and spun the prayer wheels lining the walls.  I pulled away from the group as I noticed these beautiful panoramic canvasses hanging that depicted mountain ranges and looked for the artist.  I was happy to talk with him a bit and even take a picture of him.   I haggled (or negotiated) a lower price which is what you do here in Nepal (always negotiate down), and bought a beautiful oil painting from him for a gift and was happy to buy from local artists.

After another 40 minute walk, we made our way to Swayambhu Environmental Park (here) and took a little time to rest and look at the huge Buddha deities in front of us.  There was some construction going on one, but still a sight to see.  Interestingly enough the construction scaffolding was put together with bamboo and we questioned the integrity of the frame.  Our guide for the day then took us to a wonderful rooftop restaurant overlooking Durbar square, where we had a superb lunch and Haley and I even split a coca cola.  Was that the best thing ever!  Following lunch we head downstairs to Anil's gallery where he generously took the time to show and talk to us with great detail about Thonka art.  Check out the link (here).  It reminded me of Iconography and I shared with him along our walk earlier that my mother was an Iconographer and how intricate the detailing and egg tempura technique were along with the gold leaf.  I personally felt much correlation between the two religions in regards to their artwork.  It was highly impressive and I felt he could have his own gallery in Soho.  He just returned from an exhibition in Shanghai which proved to be successful so I am hoping to hear more good news for him.

After lunch Andrew took us through the square where folds were gathering for a festival taking place the next day (the Kumari festival explanation).

When we made it back to Thamel and we were exhausted, but needed to go shopping for last minute items for the clinic.  We then had dinner at a great little cafe where I spotted a bottle of Jameson and was thrilled to have a drink before we head back to the hotel to pack up and get an early start to head out towards Kogate.

Though I am still adjusting, it is proving to be more and more interesting.  We really do not know what to expect and I have learned to just go with the flow.  For the first time in a while I do not have to tour manage.  As I observe Andrew the past few days making arrangements, talking to people on his phone and checking the clock, I smile with delight and admire him taking care of us, but even more so that I don't need to worry about the next thing to be coordinated.  That in itself has been a treat.

I will be excited to publish my next entry and share how things are going out there.  No expectations and an open mind.  That seems to be the wisest thing I have said in a long time.  Oh Nepal, don't make me all soft and woo woo.  

Monday, September 16, 2013

Jet lag at its finest

Well here we are.  Made it to Nepal about 7 hours ago and here I am sitting in the hotel lounge listening to some Howlin' Wolf playing in the background.  I think that sets to mood just fine to type up a quick entry.  I am tired, that is no lie.  My ankles are swollen like sausages, but so it goes when flying internationally.  I watched a total of 5 movies throughout my flights and lord how I love that Tylenol PM.

As we descended through the clouds to land in Kathmandu, it finally hit me that I was going to be here for two months.  Not long at all of course, but still... long.  What have I gotten myself into?  All I needed to do for the bus ride to the hotel was close my eyes and I would be transported to New York, with the incredible amount of horn honking.  A polite honking though, just to let you know they are right next to you.  It was a bit of a tense ride, but more in awe than anything.  So many people in the streets, on bikes, vehicles along with just randomness mixed with so many other elements.

We were met at the airport by Andrew from the ARP and some lovely people to help with our bags and shuttle us over and help with us to our rooms.  A very quaint one awaited us and all I wanted to do was lay down before anything else.  A quick rinse and we were off to dinner.  The team altogether.  4 practitioners from Oregon, 1 from Canada and 1 from Australia. We wandered around the streets for just a bit, enough to learn how not to get run over in the streets by motorbikes and such, or how to gently and kindly turn down a merchant who is so eagerly wanting to make that sale. There is so many wonderful things to buy here, I was to overwhelmed to even attempt while struggling with jet lag and my initial introduction.  We at least attained a feel for what to expect.  Crowded like Mexico City, but so incredibly different and beautiful in the most chaotic of ways.

We have a couple days here in Kathmandu then head South for 4 or 5 bumpy hours and see what awaits us at the Bhimphedi and Kogate clinics that we are opening up on Sunday.  We have a few days of training and preparation to take care of, but I am very eager to start meeting and treating people.  it is surreal to be here though and I cannot wait to see what lies ahead.

Friday, September 6, 2013

Check one, two... is this thing on?

It has been a long time since I have published an entry for my blog... about two years actually.  I remember being so dedicated in my mind that I was going to write every week, or at least every month, well surely once a quarter would suffice.  How wrong I was.  I read through all my entries tonight, laughing at the younger, naive Joy.  I find it amazing how much my mind has shifted, how my thoughts, goals and desires have transitioned, and the incredible people who have come into my life the past few years.

I graduated just under a week ago and leaving for Nepal in 8 short days on September 14th.  What?  How did this all happen?  Am I really doing this?  I sit drinking a glass of wine staring at 3 x 50lb bags full of medical supplies I am shuttling over wondering when I am actually going to pack and what exactly am I going to pack?  I still have a week. Procrastination at its finest.

I acknowledge this entry is not going to be very exciting or long, but I realized the importance of resurrecting the blog not only to document my impending adventure overseas with the Acupuncture Relief Project, but to help fill the void I have been missing with writing and sharing my thoughts as ridiculous they may be.  It will be important for me to keep up with blogging for my practice and hey, all the kids really ARE doing it.

I implore you to read my past entries as some of them really are quite amusing, but keeping in mind that was the younger Joy writing (because I am SO old now).  I never thought I would be sitting here tonight NOT working Music Fest NW, but preparing to leave the country to volunteer my time with such virgin Acupuncture skills that I have, to help the less fortunate for two months in rural Nepal.  There is no doubt that this is going to be quite the adventure.  Do keep an eye out for future entries and I shall do my best not to let too much time lapse before the next one.

"Mellow is the man
Who knows what he's been missing
Many, many men
Can't see the open road"

Over The Hills and Far Away - Led Zeppelin