Never underestimate the power of anxiety

Here we are.  You and me, blog.  Been about two years.  Much has stayed the same, a ridiculous amount has changed.  Following my incredible time in Nepal was a big hustle back home resulting in exhaustion and depression. While treating people with Acupuncture is a wonderful skill to have, I eventually realized I was not living the life I wanted and something needed to change.  Financially, creatively, collaboratively... I needed more.

My constant thirst for knowledge has never disappointed me and I took a big leap this summer.  I enrolled in a boot camp for software development.  I did a massive amount of research online, with friends in the field, even shielding my intrigue from my boyfriend (a hardware engineer), to make sure I was not under any influence other than my own drive and intrigue.

Four months later, I am close to finishing the program, though have a good amount of curriculum to finish.  The kicker is that this field is constantly changing, therefore constant studying is an integral part to a competent developer.  I will be on the hunt in about a month or so, seeking out an entry level junior developer position in a completely unknown territory. Another transition in my life, and completely terrifying, but exciting at the same time.  For the first time since receiving my Masters, I have hope again in my financial future.  I feel a sense of purpose and self worth and look forward to working with creative folks who I constantly strive to surround myself worth.

I should have started this a bit ago, but learning a new language, let alone SEVERAL has been daunting.  My brain still hasn't switched into a programmer brain, but I am not going to let that stop me in moving forward.  One needs to take the initial steps to better their life.  Realizing something is or isn't working is vital to forward movement.  I am proud and anxious to see where I will fit into this field.

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.  

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?  

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 Nescafé 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.  

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.