Monday, November 11, 2013

Nearing the end

It is the last week of clinic and I was warned to expect a flood of emotions as my time ends here in Nepal.   It has been an intense two months with many struggles and interesting perspectives both about human nature and myself.  I lighten up a bit knowing that in less than a week I will be back halfway across the around the world, trying to fathom what just happened.  I still don’t know what epiphany or life-changing thing has occurred to me or if it was even supposed to, but I believe that happens down the road when you are back in civilization, when things have more meaning and there is ample time for reflecting.

We have started telling our patients that a new set of doctors are coming in later this week and that they have all of their information in their charts, and that they will take very good care of them.  There are some patients that you just connect more with, and can’t help but feel sad and at the same time be completely and selfishly happy you have only a few short days before you head home.  Here in Bhimphedi, we essentially ran our own clinic.  Patty, our team leader and Anna from Australia, as well as our interpreters, did an amazing job.  I think one of my many frustrations was the fact that we did feel a little segregated out here, which was hard for me initially.  Two other practitioners from school who I really never bonded with were back in Kogate, and was hoping for more time with them and it just didn’t happen.  That is how the cards played out.   I also felt that each team just had their distinct experiences and every time we were together, we just gravitated to our separate groups.  I think this may have been one of the big downfalls of the entire experience for me, the inability to keep us all together, but if everyone had the same experiences in life, it sure would be quite dull.  Still, I missed that bond and acknowledge it is just another facet of my emotional Cancerian self.  Each location had its perks and downfalls, which made it hard not to have a little bit of envy at times.  Kogate was the hub, and we basically had to take 3-hour bus ride every weekend after treating patients for team meetings.  I don’t believe anyone but the three of us will ever understand or appreciate the amount of energy that was drained as well as immunity from us each time we commuted up the hill and back, and I wish we had more time to stay stationary.  Packing and repacking for a weekend getaway only to wake up at 5 in the morning to schlep back on a packed bus to head right back into clinic and treat 60 plus people was hard, but we did it and maybe we ended up in Bhimphedi for that reason specifically and be able to handle that added stress along with the patient load.  I have 10 years of tour managing under my belt, which essentially means I was constantly in transit and you would think I would be fine with all the moving about, but I had such a desire in the beginning to stay in Kogate.  It was quiet, less trash, and had more personal space, a river outside the door, beautiful trails and perhaps more downtime.  With the exception of another satellite clinic 2 days a week, Kogate had fewer patients than Bhimphedi and I longed to be able to have some of that peace and tranquility, but that is not what played out and in retrospect, being bombarded with patients daily and living in a loud house, with guests in an out all the time, limited privacy, early morning wake up calls by neighbors beginning their chores really suited me in the end.  I am not sure I would be able to handle not being busy and at the end of the day, I came here to work and that is certainly what we did.  Bhimphedi certainly had its perks, having our house mom, Krishna cook us every meal, yummy food (outside the endless rice) and endless tato pani (hot water… except for showers of course).  We also had somewhat better access to the Internet, albeit sparse, annoying, and random.  These last few nights we have been invited over for dinner from our interpreters and others and it has been a pleasure getting to know our community here and see just how simple life can be.  I was happy to call Bhimphedi my home.

I am also incredibly lucky I had Patty and Anna by my side and with me nonstop.  We bonded really well and they put up with my grumpiness and complaints and other ridiculous nuances.  We also kept each other going through the rough moments as well.  The three of us treated in one room, which while a bit crowded, was really amazing to be able to bounce questions or thoughts back and forth to each other, or share laughs throughout the day when the delirium hit.  With seeing 20 plus patients a day, we had to be quick without completely discounting the process and importance of the intake and being able to really connect with our patients.  We had to be able to discern between cases we could help with and cases we knew acupuncture might not be useful for considering we had limited supplies and resources as well as an incredible amount of new patients daily that took away availability for follow up patients.  We also had the advantage and ability to prescribe western medicine.  There was no doubt we were primary care providers and as many ‘deer in the headlights’ moments there were, it did not take much to think through things clearly or discuss the best options for situations.  This made me feel a little bit better considering I spent as much money a house cost on my education at OCOM.  Not only do I feel incredibly confidant with taking vitals, I have had several experiences with diseases that I feel more comfortable in for offering advice, or at the very least educating patients on their health.  I had a couple of patients, one specifically who did not know where his records were or how to get them and I made it a point to tell him he had a right to them and track them down.  The next week with a big smile on his face, he brought them to clinic and I could see how much that empowered and meant to him. This is something I will take home with me and so incredibly excited about beginning my practice at home and having these flashback moments to the encounters I had here.

Some days were better than others in clinic.  I found myself becoming more and more frustrated with words getting lost in translation or the simple concept of drinking water (many Nepali people will not even drink water). I found it interesting how one patient would overhear you interviewing another and when it came time for them they would say that they also had the same symptom in the same location and asked for herbs.  After a while your intuition just kicks in. Everyone wants herbs or western meds since they don’t have to pay for it.  A treatment essentially costs 5 rupees… that are .05 cents.  I also found myself going through the motions when it came to treating knee pain, but there is experience in repetition.  The biggest joy in my days came when my younger patients would come in.  I had several children that were initially scared of the needles, but also a few who were complete pros, no flinching at all.  I also had one or two little boys that would come in more often then they really needed to, and I was convinced that they either had a crush on me or really enjoyed acupuncture.  I like to think it was both.  Prescribing herbal formulas was incredible practice but became challenging when we started running out of herbs and then had to become creative and think what other formulas we could use instead.  There were many times that I wondered if I was making a difference, if these people were really getting better or not.  It finally started showing in these last couple weeks, you could just see it in their faces, in the bags of guavas they bring you and of course in their subjective opinion regardless if you could objectively quantify the change or improvement.   I am thankful for all the cases, all that Andrew taught us in our evening classes (he is an excellent teacher by the way), all the experiences and the confidence I have built up and everything I am able to bring back home to my patients.

During festival season (Tihar) we were invited by one of our interpreters to her house to celebrate and participate in one of several ceremonies.  To be part of an authentic observance was truly a highlight.  I often wondered if any of our interpreters or younger people I see in the town ever think about leaving Bhimphedi or their villages they come from.  Do they ever wonder what else if out there?  From our window we see the twisting road heading back towards Kathmandu and I often wondered if anyone else stared out their window looking at the road, just dying to escape their life, similar to the really hard days I had in the beginning just wanting to escape that very road back to the airport.  It later hit me that perhaps they just don’t know what else is beyond here, and how incredibly blissful that must be.  I have seen quite a bit, both in my personal life and as a tour manager.  I have had some experiences many people don’t usually have and I often wonder if this has ruined me, where nothing quite surprises or shocks me, or becoming bored too quickly, always searching for the next high.  My dear friend wrote a song and his lyrics stick with me now… ‘behind every desire is another one, waiting to be liberated when the first one is satiated’.

This past weekend, our last weekend in Kogate, we all met for our last meeting to discuss and reflect these past two months.  One comment that stuck with me from one of our younger volunteers was the incredible feeling she had writing her name under the practitoners box and how significant it was that someone was under her care.  They are coming to see US and they put their health in our hands.  We heard that people were coming from the border of India and areas far away and that they heard that we were doing amazing things, healing people and improving their care.  It certainly is amazing to hear that someone had a 75% reduction in pain and they can carry a load without any pain now or walk up hill without wearing their patuka anymore.  The fact is if we were not here, they would be OK.  These people are resilient and we are not saving the world.  We don’t need the self-validation, but for me personally I needed more exposure for truly caring for people and being able to understand them and touch them without understanding a word they are saying. 

Many of the patients this week have either told us we need to stay or asked if we would come back.  The interpreters told us that patients are saying they are happy with their current doctors and why we can’t stay and what if the new doctors aren’t good?  I can see myself returning to Nepal for the simple reason of trekking, but I think it would be nice if funds and time allows for me to come back with an even newer perspective of treating these people again.  Right now though, I am pretty taxed, I have my fair share of pain and nutritional deficit, but it will be pretty hard to forget everything that has happened here and I suspect it will take a few months of reflection until things really sink in, and it might take a lifetime to understand more about Chinese Medicine, but I no longer think of myself as something so narrow as just a licensed acupuncturist.  For the past two months I was a Doctor... Dr Joy.  I handled stoke patients, maintained jaundice patients, wrote referral letters for diabetes reevaluation, evaluated imaging, sent out for neurological testing and wrote prescriptions for a slew of drugs among so much more.  I am so enthusiastic that I chose to work in the medical field.  To constantly be challenged and absorb knowledge is what we should all strive to do in this life.  Being able to actually selflessly give to someone else, even a stranger, is also essential for true compassion.