Champe Clinic

Out to the satellite clinic today in Champe. Its about a half hour walk from chapagaon. Through town, down a hillside covered in terraced gardens, across a suspension bridge and up over the other hillside. 

 The roads are more like what you might find on a backpacking trip, rocky terrain and slippery slopes, though littered with plastic wrappers. My interpreter, Pragel, is a 26 year old who is dedicated to Vajrabarahi Health Clinic, working as the manager. He gracefully walks in front of me with Adidas sandals. And here i am, in my Solomon hiking boots, watching my every step, careful to not slip down the cliff side to our right. This time a year the terraced gardens are filled with either mustard greens, bright yellow mustard flowers bolting, emerald green scallions or 2 foot tall fava beans. The majority of the fields are covered in a cover crop of winter wheat. 

  As we’re headed down the first steep slop, we catch up with a woman about 40 years old. She is carrying a large basket the same size as her upper body in height though twice her size in width which is hanging from a strap around her forehead. The basket is filled with tangerines and so we offer to buy some, mostly just to get a little weight off her back. She pulls out a scale form on top, packs a plastic baggy of tangerines, weighs them out and then hands it over. While she’s busy making our bag i tested the basket, guessing it weighed about 60 pounds. This is a perfect example of the majority of our patients. Women in their middle ages who have been using their head to carry incredible weight while they journey miles and miles by foot. 

(common way women carry goods)

  The ritual at Champe is that once arriving to the village, you sit for a cup of tea across the road from the clinic. There are already people sitting out on the dirt in the road waiting for the clinic to open... no pressure. This particular satellite clinic seems much more relaxed than the others, we only had 10 people today. Though I've been warned there will be 20 plus booked easily on a normal day.

(champe clinic)

   One of the patients was a woman who has been coming for acupuncture for a few weeks. She’s completely blind in one eye and having pain and blurry vision in the other now. Two years ago she had a cataract removed from this eye, but clearly the trouble is far from gone. Her eye was glossy and coated with a film, as though plagued by a fungus. Instead of showing a bright and sparkly brown color, her eye looked hollow and iridescent as though it were a fortune teller globe.

  My job today was to explain that what we have to offer is not going to stop or reverse the degeneration of her vision. This is when the faith in your interpreter is really important. Trusting that they have delivered this heavy message with the same empathy you have in your tone and translated into the same gentle Nepali words. She just sat there without responding for a while. After a few minutes she started to explain that its really hard to do her work in the field and how she has to get better because she has to harvest the food for her whole family. She said the western doctor is too far to get to since its so hard for her to travel. 

    In other words, “you’re all i’ve got.” So, we keep treating. We keep treating until we're absolutely sure we cannot do anything at all. Maybe the acupuncture is just here to ease some of the emotional pain she has because she knows that soon she wont be able to harvest food anymore. And then what?

Pictures

Most days are extremely smoggy.. though the locals call it fog. Yesterday we had a clear day so i wanted to shard a few pictures of our surroundings. (which i just saw for the first time too)

 This is a picture of the gomba (the buddhist temple) which is the building next door. The two buildings are related, so we constantly share our space with monks. Pretty sweet.

This is a shot from the top of the gomba next door looking out over chapagaon and beyond

This is a picture from our home/clinic looking out towards the mountains. To get a taste of the layout.

Around our village i see a few of the nepali eagle. A truly beautiful sight in the sky with a large wingspan and a cool black and white color pattern. On saturday, visiting Swayambhu ('monkey temple') there were HUNDREDS of eagles in the sky! 

Little monkey family hanging out on the bench

Entrance to swayambhu, also known as monkey temple... or  just, tourist trap since thats what it was    (i don't recommend it really)

Feeling heavy

  Incredible how you can drop from the top of the mountain within the same treatment... and by the end of the day feel like crawling into a little hole under into the earth. I thought i was so clever today during my treatment, truly a feeling of being on top of the mountain.. though it didn't get me so far.

  A 17 year old boy has been coming in with excruciating back pain, pain that he says he’s had since he was little. His father has always had the same pain and cannot walk now because of it. I did standard orthopedic testing in the first visit and deduced that his pain was coming from his SI joint. Though after a number of treatments that should have helped, he wasn’t getting much relief at all. So, today (from a tip of my clever teammate) I measured his leg length and found out that his right leg is considerably longer than the left. This would make perfect sense then, that his father has the same pattern. I explained all of this to him and how he could get an Xray to find out the exact measurement and then have a sole made for his shoes. I was assured by the interpreter that there was a man down the road who made shoe inserts and that it was both easy and inexpensive. The patient showed that he understood by using the Nepali head waggle to say 'yes'. It looks like an unclear 'no' by US standard, but here its an affirmative yes. Great, i thought, as i filled out a referral for him to take to the health post across the way.

 While working on the next patient i realized that he was still sitting where i left him, referral in hand. An interpreter was talking to him about something still. I came over to find out what the trouble was and i was told that he couldn’t afford to get an Xray (An Xray in nepal is the equivalent of 5 US dollars). Nor could he afford to get a new insole for his shoe. Right. Im in one of the poorest countries in the world. Well, i stayed optimistic in nature as i explained that "no worries, we’ll try to do what we can with the acupuncture." Though, i cannot make his right leg grow. 

  I continued back to my other patient who was in the middle of explaining her knee pain. Trying to keep my happy forward momentum still going from the high, i told her to pull up her pants so i could start needling. I assured myself that i know i can do knee pain! She started hiking up her tights, while mumbling something. My interpreter translated: "oh and i have this rash too." Well, on the lateral side of her lower leg was an open wound, about 2 inches around and oozing a wet discharge. I put on my gloves to palpate it. No pain, hard to the touch, open wound. It fit the exact profile for tuberculosis. Eh.

 In that moment, a scene from the movie Finding Nemo came to mind, when the beautiful light at the bottom of the ocean turns out to be a crazy water monster and Marlin says “good feelings gone” before swimming away.

 How do you tell someone you think they have tuberculosis? Or not pay for a 5 dollar Xray so a patient can get the correct insole made? I dont how to do all that, but i had my first shot at it today. What a heavy feeling.

Clinic Begins

Whew! Survived the first day. Each of us saw either 9 or 10 people, so about half of what we’re expected to be pulling out, and im still feel worked like a dog! Mostly everyone came in with pain today, knee pain, shoulder pain, back pain, ankle pain, wrist pain, pain pain pain pain pain. I can do pain. 

   The day started off at 9am. My clinic room was ready, my music was set to the monotonous paradise-like tune (mostly to keep me calm), and im sitting there wondering why in the world i took a cup of coffee at breakfast. My interpreter, Sunita, shuffles in 3 people and BOOM, it starts. During the first patient I had, I was visibly shaking so bad (the coffee, of course) that i had to use my other hand to stabilize my needling hand. Thats worse than my first time treating at school clinic! Maybe it was due to the fact that i had 3 people intently watching my every move, all wondering if they have been assigned to an adequate ‘doctor.’ Will she be as good as the last person, will she do the points i like, will she hurt me when needling like the other person once, etc etc. Though, by the second and third patient I had gotten myself a little more under control and at the end of the day, i felt like a pro. In these moments i am thankful that i have been taught how to connect to others with sincerity and a smile. AND i know a few phrases of nepali, which was the true charmer, i must say. Or maybe more like the comic relief hearing this curly haired, blue eyed white girl try and speak.

Chapagaon, where we’re living, could be called a suburb of Kathmandu city. Though you cant see the city, its close enough to catch the 30 minute bus ride, every 20 minutes. We are surrounded by mountains here, but you cant really see them until the afternoon when the smog burns off. Everyone farms here! Not only do all houses have a little plot of garden alongside their house, there are also farmlands that start right off the backside of town and span for miles. Its beautiful. 
The clinic building is what we are dorming in as well and it sits next to the monastery where there are about 80 monks living (all under the age of 17). Our clinic and the monastery are in a gated area with a large ‘yard’ all around that is mostly used by the monks playing hacky sack or soccer. I noticed people playing bocce ball too with coins. Lol.. might have to join for that.

 The building we are in is like a refrigerator. With marble floors and concrete walls, no matter how warm the sun feels outside, its freezing in here. The nights are so cold it hurts in your bones and really there is no reprieve. lol (that ones for you b). Good thing i brought a sleeping bag that keeps me nice and toasty... But going to the bathroom in the night is pretty painful. No toilet paper here, so we hose ourselves down with freezing cold water and then ‘dry’ ourselves with a designated towel. Which we then wash off with freezing cold water. Pooping here is super shity. hehe... no pun intended. It REaaaallly makes you appreciate certain luxuries of home. 

 Im  not able to upload pictures for now. But i will soon hopefully. 

Hope the next time YOU sit down on your toilet to go number 2, you really appreciate that paper! 

 Everyone has a garden here in these villages. It is so nice to see farming everywhere. There are some Newari villages, an older group of nepali people, who keep the first floor of their homes for the goats, cows sheep.

Here are some of our potential patients. They work hard, carrying slash for miles on their backs. (lots of neck and shoulder tension here)

Kathmandu City

 Kathmandu rivals for the filthiest city Ive ever been in, though the dominican republic comes in as a close tie. Trash everywhere, burn piles in the streets, dusty haze to breathe, beggars that make your heart twist with contracture, ragged stray dogs balding and weak... the list doesn’t end. The traffic is horrendous, like mexico city but 10 times scarier (or maybe i’m just getting older). Some sort of organized chaos, it takes your breath away for more ways than one. Somehow it just works. I had a few moments of gut dropping sorrow for being here, and how nice home is. Its notably loud here and so so cold. 

....And yet, there is so much priceless beauty in the peoples eyes and in these sacred temples that it just stops you in your tracks. The constant tourist battle presents of either quickly grabbing your camera or just capturing the snapshot in your mind. The pictures wont ever give it justice... But its the only way to show something. 

We leave Kathmandu tomorrow morning to head to the clinic and it all starts up on friday. I cant even try and sum up everything we have done in the past few days, so the pictures below are an attempt. Now, the only thing i can do is try and mentally prepare for what the clinic will bring. It will have nothing to do with my needle technique, nor how well i know TCM diagnosis. We talk about the concept of treatment vs care. What we are here to refine is our method of care. The wisdom to know when to treat and when to send someone for the appropriate care that they need. While doing it all in a timely fashion seeing 12 people between 9:30-12, and 8 more from 1-4. That is a BIG difference from what ive been doing at my school, where we see 1 person every 1.5 hours. I feel like im in the eye of the storm at the moment, gearing up like Andrew Luck before a playoff game. (that one's for you mama). :)

There is compassion and there is wisdom. Without wisdom, what good is our compassion here. Thats the question that is brought up to us. The question that makes my stomach turn over on itself with the amount of responsibility I feel for being a ‘doctor’ here. Though when friday comes, i will be putting all of my insecurities to the side and showing up fully present, with clear eyes to give treatment and care. 

Here are a few pictures to share...

Tibetan buddhist woman in ritualistic prayer to the largest stupa in Nepal, Boudhanath

 Prayer wheel for old and young (a grandfather with his grand-daughter-very sweet)

The Stupa, Boudhanath

 Hindu women walking down the street alongside the old royal palace before it was overthrown.

Prayer flags!

 Taxi... no thanks

 A women resting at the entrance of a hindu temple

People soaking in the sun on the steps of hindu temple

People coming to feed the birds and the cows. Cows are auspicious here, you cannot kill them nor eat them. Anything that says ‘beef’ at a local restaurant in nepal comes from water buffalo, or ‘buff’. 

 Prayer wheel for both the old and the young (a grandfather with his grand-daughter-very sweet)

Travel

Waiting at SFO airport, with the flight delayed slightly and the woman next to me pulls out a receipt to do origami with...

Which i think is very cool. Another thing i thought notable were the flight attendants on the plane who were all dressed up in stereotypical asian attire... and also all beautiful women. Heres a picture i snapped while walking through first class...

Okay... now i THOUGHT i was going to be staying in the airport terminal for the night to wait out the 16 hour layover. But, i was pleasantly surprised with a complimentary hotel at the hyatt in seoul. I highly recommend it if every laid over here!

 Heres a picture of the spa area with a hot and cold dunking bath, steam room and shower area lined with stone walkways. I enjoyed this following my work out this morning. Feeling energized and ready for my next (7hour) flight to Kathmandu.