Perseverance

Today is October 26th which means it is just shy of 3 weeks until our last clinic day.  I will then have 2 days in Kathmandu to finish any last minute errands, including an hour flight view of Mt. Everest and my last night relaxing at the Hyatt in Boudha (thank you hotels.com free nights).  Until then, it is a straight dose of perseverance.  The Langtang trek which took place over a week ago now was an amazing time.  There was no doubt it was physically and mentally challenging.  We were hoping for better weather, but there was a typhoon which hit India during our time which made for 4 days of rain and very few to no views.  Luckily on the second to the last day we managed to climb above the clouds for a few hours and witness some breathtaking images.  Those of you have not seen the pictures can check them out here.  A good time was had by all.  We met some wonderful people including our porters who were with us the entire way schlepping our bags up and down and a Danish lady who ended up being a knitting teacher (Jean!!) and helped me with some tips while making my first irregular scarf.  I think next time I trek that I would rather avoid going in a group.  There is something to be said about taking your time and planning your own stops, but I am grateful for the adventure and knowledge I gained so I can come back.

Trekking is what the majority of people associate with when they think of Nepal.  Or, they envision a bunch of people meditating on mountain tops wrapped in yak wool and baby goats gently chanting, but the interesting thing about what I am doing is that I am able to truly experience the rawness of Nepal here in the towns and villages where I am treating.  I see the daily lives of Nepali people, the endless trash on the streets, the barking dogs, the kids throwing rocks at the dogs and goats, the amplified coughing of and spitting of mucus (didn't like when I lived in NYC, don't like it now) and the other uncomfortable things that we look away from with disgust.  The beauty within the people here is indeed in their perseverance and their warm 'hellos' while walking down the street, whatever their pain or hardship might be.  I definitely had some different expectations in mind when I first arrived, but now over the half way mark and most likely a little desensitized, I am just telling myself that this is what it is and having that respect, both for how I feel and for what life just simply is over here.

I feel a bit better about things.  We spoke up about the food situation.  Ramen noodles for breakfast or white bread is not very filling or nutritious, and a little less rice and more vegetables would be grand.  It is carb city over here.  We get most of our protein from peanut butter and the random egg here and there, but it has been communicated that we need more meat!  Again, opening up new clinics is challenging for everyone, including our house Mom.  Going with the flow, but definitely asking for what we need.  I still wake up at 5:30 AM every morning from the noise.  It seems everyone wakes at this time and starts doing their daily chores (basically clanging and banging of washing dishes and exchanging morning conversations at an increased volume that not even my ear plugs can buffer).  Still cold showers along with sparse, if any at all internet connection.  The house in which we stay is more of a boarding house.  There are many people who come in and out (we have a lock on our door) and there still never seems to be a moment of peace or privacy (the three of us share a room), but so it goes.  I started having some vertigo again this week which of course is a little disturbing, but just trying to get through it.  I suspect the weather and barometric pressure, a little bit of deficiency (OK quite a bit) is to blame, BUT staying on the positive I started doing some yoga this week and ventured out to research the road and learned that there is quite a stretch of somewhat OK paved asphalt on the way out of town that I could actually run on.  I did bring a pair of running shoes, I DO wake up at 5:30AM and it really put a spark under my ass this morning to give it a try.  It might be the only time I could have some peace some time to myself.  Also, carb city is not boding very well for my physique, so if I have three weeks left until I come home and then indulge in the holidays and good ole American consumerism, I might as well move my body and get back into running, something that seemed to slow down during the last quarter before graduation and I miss it... just exercise in general.

Clinic continues to be fantastic though.  We still do not have the ideal set up, but we are making do.  Many of my patients continue to return and I am honing in on one for my case study.  Yesterday I had a patient have a seizure right in front of my eyes.  It was scary and a very valuable experience.  I had to research if she had had one before (which she did) and then refer her for more testing including a CT scan as we suspect a possible tumor.  That is never fun to tell anyone.  I have no doubt over these last few weeks I will be flooded with many emotions as I try to focus on my patients and remember the main reason why I am here.  There seems to be another 3 day holiday coming up (the festival of lights) so it seems the clinic will be closed which means we essentially only have 14 actual days of clinic left.  A little frustrating when we are trying to see people as much as we can, and see what improvements they are making before we leave and pass them on to the next camp of practitioners.

So, yes.  Perseverance, staying present, trying to soak it all in, keeping the head up, laughing at the insanity, trying not to be grumpy pants at the chaos and drama, and looking forward to coming home and feeling guilty about using a western toilet or washing machine and seeing and talking to all the people I care about.  AND I am also excited to open my mail when I get home to see my license.  Joy Jeanette Ann Earl, LAc.  (wasn't planning on the full on name, but that is what the birth certificate reads).  I have an interview lined up for temporary work when I get home and plan on practicing part time in Forest Grove and have an open house planned early December, so things are good!  I am very thankful that I am needling and prescribing herbs every day.  I am actually retaining all my knowledge from school and not letting it slip away. It was my goal to continue my education overseas, and I don't regret a thing.  Life it too short for that.

The night before Langtang

It is Wednesday evening and I am back in Kathmandu.  We leave early in the morning for a long drive up for our Langtang trekking adventure (here).  This morning the other girls in Kogate met us in Bhimphedi and we took a sumo drive into Kathmandu.  We all look a little rough and needing some time off.  Upon arrival at our hotel at the Earthhouse, I went shopping for some last minute needs for colder temps.  It is still quite warm in Bhimphedi, so I am looking forward to some change in weather and some mountains.  I had a hot shower today and was able to sit on a western toilet.  That was really something special.  We went to dinner together and I decided to take off by myself afterwards to grab a late night Jameson (or two) at a lovely cafe nearby playing some light jazz and type this blog.  There is only the waiter and a couple off in the distance.  It is bliss.  Kathmandu is quite filled with tourists when 3 weeks ago we were the only other Westerners about it seemed.  Supposedly when we come back here in November before we leave it will be prime trekking season and there will be even more folks about.  I feel a bit more comfortable here in the city this time around.  A bit less overwhelmed perhaps.  I mean we have been in rural Nepal the past couple of weeks, squatting and washing our clothes in a bucket, so anything slightly resembling a touch of comfort is welcome right now.  

Here is a random picture of our beloved peanut butter.  

Now look closely and you will see the cover is a bunch of cows eating what seems to be grilled cheese or cheese sandwiches of some sort.  Now I don't know why this picture might be the best descriptive label for peanut butter, but there you go.  We have one boiled egg, peanut butter and honey with Sel roti (here) every morning for breakfast.  Nepali donuts... yum.  

It was decided that the 3 current practitioners stay in Kogate and the 3 of us currently in Bhimphedi stay put after our trek for patient continuity.  While initially annoyed, I realized the importance of it and the fact is we do have our own things going on already, different personalities, etc...  I am sad to not get a bit closer with the others or have the experience and slightly more peaceful environment out there, but I am thankful for Anna, Patty, our interpreters and of course our house mom, Krishna, who already has sewed us clothes and takes great care of us!  I know we all have challenges, and this is the way it played out and at this point just wanting to go with the flow, whether out of exhaustion or just not wanting to deal with additional stress.  We are starting to recognize patients on the streets now in town and follow up visits seem to be finding much relief for many.  It does seem more welcoming there, but we all have been awful homesick lately.  Perhaps this is what happens 3 weeks in.  It is almost that we are dragging ourselves into the clinic each day,  still seeing 60-plus patients between the three of us, working out of boxes and looks like we will not be moving into the building we first thought, which means we have to wander down the road for a bathroom when we need it, if we find the time for a bathroom break during our busy day.  We have been coming home exhausted.  Andrew wants us to head to Kogate each weekend, which requires us packing, getting on a packed bus both ways.  It basically is just a good amount of transit which makes things a bit more physically challenging for us considering we still are getting about 5 to 6 hours sleep each night.  Of course there is the option of walking back and forth and last weekend Anna and I decided we would rather walk than bus there.  It is no lie when I say the walk there is straight up... 3000 feet elevation gain.  We started at 2PM and realized at 3 or so we were walking the wrong way so we backtracked.  We thought we might make it there by 8PM.  We were told there would be short cuts that delete some switchbacks, but we were a little weary and just wanted to follow the road.  Low on water and overall energy, I was hurting. Eating mostly rice and carbs and not too much protein really showed.  All of the sudden while taking a break against a rock, one of our interpreters jumped out and said 'hey!, we saw you from way up high and that you made the wrong turn".  By this time it was getting dark and he was walking us the rest of the way.  But the shortcut was straight up, and I mean switchback straight up.  It took us about 40 minutes just going straight up this cliff with leeches falling on us and the most huffing and puffing I have ever done.  We met the director and other interpreter at the top, and they said we still had another hour to go.  If we had missed that shortcut, we would not have made it to Kogate until 12AM.  Needless to say we made it back in the rain and dark. I had one big leech on my back and a couple in my shoes, but that was basically it.  We stayed two nights in Kogate and took the bus back Sunday morning... an early morning packed bus ride and straight into clinic to treat patients.  Eat, sleep and treat.  That never changes. That is what YOU payed good money for, all you donors!

There is no question we are all working very hard out here and how necessary this break is for all of us. I am looking forward to enjoying some incredible views and fresh air while giving myself an attitude adjustment.  We come back to only 3.5 more weeks to try and get our patients better as well as preparing a case study which I really want to strive hard to accomplish and do well at.  I have a few patients in mind... stroke victim, amenorrhea patient trying to become pregnant, and a dupuytrens case.  I had a break through on Monday I feel.  It was the day when I was feeling quite ill with a throat infection, tooth ache and possible ear infection, but I realized I was excited to see my patients, and truly invested on them getting better.  We have been told this is the hardest year for ARP, and most challenging for opening a new clinic and I wish it was a bit easier, but I think that day finally kicked something into gear for me, like this is it.  This is what it is.  Your back is going to hurt, you are going to eat a lot of carbs and less protein, there is going to be early morning wake up calls, that cow might wander back into the clinic room again, the internet is never going to happen, the electricity will continue to go off and on and you might pee on your leg when you go to the bathroom in the middle of the night, and that's OK.  I want to come back from the trek and do my best, get some yoga in, learn how to make Raksi (here), soak in all I can and bring back all of these things I am experiencing into my practice and share all I can with my loved ones so that I may be a better person.  It is pretty simple when you think about it.  Just be kind and not an asshole.

So not the most illuminating entry this time.  Blame it on the Jameson(s) if you will, but I know it is important to keep sharing my thoughts and not to sugar coat this.  Life is hard here. People carry 50 pounds of grain on their freaking heads. 

I am off to see some fucking mountains.  Picard out.

Third World Problems

Patty and I arrived in Bhimphedi last Sunday  (Sept 22^nd) via a 3-hour bus ride packed to the brim with passengers and burlap sacks of various grains and vegetables from Kogate and surrounding villages.  The bus is the only way between the two places unless you walk (which we plan to do both ways at least once) or by car/motorbike.  The road is essentially a series of tight turns with switchbacks and loose gravel along with jaw clenching drop offs brushed with beautiful green hills full of vegetation and glimpses of streams.  The bus stops every now and then to load more people and cargo, and by the end of the trip, the bus has people hanging off the sides just to get to their destination.  The driver plays Nepali pop music as loud as he can over the speakers and while I admit though blaring at times, has been quite enjoyable and helps the trip go by a little faster, be a tad more comfortable and a little less jolting on the head. 

Bhimphedi is very hot and humid.  The weather is just now starting to change towards cooler air, but there is still a good amount of rain.  We hear Kogate has been getting poured on daily… so goes the tail end of monsoon season.  Terry, Haley and Alyssa are currently back in Kogate and we hear the leeches are in full effect and that their electricity is limited with all the rain.  Neither of our camps have Internet.  The three of us here in Bhimphedi have been getting bits and bops of a signal, mainly in the morning but are barely able to check or send emails.  We suspect when we return from the Langtang trek that both destinations will be cooler and drier and perhaps a bit more organized. 

It has been an interesting time here. Bhimphedi has shown to be challenging on many fronts.  We were supposed to arrive and walk right into clinic to treat patients, but we were told that there were political hang-ups that still needed to be worked out so the building was not available due to said politics.  Tsering has constantly been traveling to the nearby city, Hetauda to deal with papers and gently massage the officials in charge of allowing our project to use the health building here, which we still have not moved into as of now.  We have been using a community yoga room with a side room attached.  We walk down the road for a bathroom and back to the house every day for lunch.  The first day of clinic was pretty chaotic and exhausting.  We were and still are working out of boxes, while our interpreters are wearing multiple hats trying to schedule patients for follow ups and coordinating all the new patients.  Patty and I have been seeing 20 people per day and coming home just completely beat.  We essentially have been treating people, eating and sleeping (well sleeping as much as we can).  I wake at 4:30 AM every morning to the sound of really extroverted roosters and music coming from the community room and then the rest of the neighborhood begins waking up and banging around, doing chores, burning their trash or shouting across the way to each other (Nepali telephone).  I think I slept about 4 hours a night for the first week.  It is much different from Kogate.  Bhimphedi is a very busy town, with not many places to escape to or have a moment of silence.  One evening while walking home, we found ourselves trying to pass in front of a pack of wild dogs growling at us.  We turned around and started running fairly quickly the other way.  We found a boy to help walk us past the pack, but I was certain they could smell our fear.  Needless to say we survived and later laughed at the series of events unfolding around us.  The house in which we stay seems to always be filled with construction workers, neighbors, the local jailer from the prison down the road or friends that the house Mom, Krishna hosts.  We go outside to use the bathroom and cold shower and stay in our room for the most part after clinic and dinner.  I definitely seem to be struggling with finding a little peace and acknowledge that this is one of the hardest parts about being here…  the lack of privacy, peace and quiet.  The one benefit to Bhimphedi is that there are no leeches, but huge spiders.  The house mom does a good job of keeping things tidy, but we had quite a scream when Patty noticed one walking across my bed one night.  The squat toilets continue to vex me.  It is a skill to try and squat without wetting yourself and making sure your business goes down the drain.  Hygiene is not a priority here of course so you have to make sure you have proper form and supplies before heading into the toilet and doing your best to keep things clean. 

On an upswing and as exhausting as it is right now, treating patients has been great and I am ecstatic to be keeping up with my skills.  I find myself reading before bed when I find some energy and never thought that a month after graduation that I would be reviewing TCM patterns and point actions along with herbal formulas, but our patients have been interesting as well as challenging, and we desire good responses from out treatments.  We have become needling machines and now have some follow up patients that we are starting to recognize.  We even begin joking with them and are learning a few Nepali words.  Everyone here drinks too much milk tea (yum) and not enough water and seem to have knee pain.  I told my interpreter to tell my patient in an amusing way that the reason everyone suffers from knee pain is because they squat so much for the toilet.  After translating that, the room busted out with laughter and I said that even I have knee pain from squatting and I have only been here 2 weeks!  Just think about it.

As far as patient cases go though, we are seeing quite a bit of wind damp bi syndrome.  We also see more than enough of stomach pain (gastritis, burning pain).  Folks are bringing in their medical records for us to look at which has been beneficial and challenging to make some sense of.  I am amazed how many people are on birth control and then hear complaints of lower abdomen pain.  I question the hospitals and health care here.  It seems they just throw medication at them, and many have no idea what they are taking it for or why.  It is perplexing, but grateful that I can even prescribe antibiotics to make sure many of them are on the right track.  I am seeing results.  Several people are coming back with decreased pain or even full resolution of their initial complaint which makes me feel great considering we spend about 20 minutes total with each of them in one day.  I have been increasing my warming needle and estim protocols along with prescribing herbs, but for the most part it is a quick intake, tongue and pulse, needling and moving on to the next patient.  At least people are getting some acupuncture, and they all seem thankful… as chaotic a scene it is here.  At many points throughout the day, you just have to laugh even though you want to scream or can’t handle the tough and ridiculous conditions anymore.  It does turn comical at some point… complete surrealism. 

All and all this week seems to be better than last; we have another practitioner out here now, Anna as well as another interpreter and receptionist.  It really is helpful, but just means we can see more patients, so still the same number for us individually if not more.  We have about 70 + patients booked per day for the three of us.  We certainly are here for work and I am just doing my best to stay healthy and have some reserves left.  We are feeling a little tired as well as a little low at times and while the food is tasty, a heaping serving of rice at every meal does not bode well for those with anemia.  We do our best to ask what we need nutritionally and seem to be sustaining, it is just a big amount of carbs.  I am thankful for my beef jerky that I brought from home.  Tonight was a much-needed night of lighthearted conversation outside on the porch with Bibek and Krishna along with some other neighbors.  We ate outside and had some rakshi (fermented yumminess) and shared pictures of our boyfriends around the table.  Clearly we are starting to miss some comforts of home.  We are looking forward to the trek next week during Dashain (here) for a much needed break and I look forward to returning to Kogate afterwards to experience the patients there and finish off my time in that environment.  Until then, I continue to be flexible and open to what happens next, laughing and trying to keep myself sane with the third world swirling around me just like the ashes of our burning bathroom, bodily-fluid-soaked trash we ignited tonight after dinner on the side of the street.  What would you do for a Klondike bar?