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?