Ke Garne, It's year 2069!

'Ke Garne,' 

the infamous nepali phrase I will never forget,

'What to do?'

I can't begin to tell you the different sentences from our patients that often precede this simple phrase. Long drawn out, and horribly painful stories of unjust situations, told by women crying about being beaten by their husbands. Or about losing a loved one unexpectedly. Or having a terminal illness. The stories here are incredibly hard to hear and as a practitioner you sit and listen wondering what you can possibly say to console this individual. How to find the right words for someone who lives words away from your own reality back home. Right when you realize there's been a gap and a response from you is now appropriate, the patient will throw their hands up lightheartedly and say "ke garne." Your translater will then throw their arms up lightheartedly, mimicking the patient, and say "what to do."
Whew! Another impossible moment averted thanks to a simple phrase. One of my favorite people in the world pointed out how it makes perfect sense that the people of Nepal have adopted such a saying. Due to the history and conditions of this country, what else is there to say really? 

It is the year 2069, after all! Many of us joke that this experience is a little glimpse into what our western world may be like in the year 2069. A post-apocalyptic, ravaged country with power shortages, pollution build up leading to burning trash in the streets, smog filled skies, lines for local water, overpopulated and chaotic busy cities overcome with critters and stray ragged dogs, a farming culture for survival and religion. If the 'west' were to continue in the same trajectory, I don't believe our little group joke is totally out of the question. 


Some lasting images embedded in my mind:

 finding goods at the local dump

 basic means to eating

 washing clothing

 toilet

 water lines

 firewood 

critters picking through trash

KE GARNE

Special Moments

(me and sunita, an amazing interpreter)

I don’t know that i will ever come back, is the thing. But, how do I say that to my patient who is welling up with tears about my departure? 

This last week has been hard, because I cant put off the fact that our camp is leaving and less than half the amount of practitioners are coming in our place. Some of my patients wont be able to continue treatment. About half of the patients we see have been coming for a while... They know now how the system works and that we have to go. The other half have started new with us. We took their intakes on the first day and have seen them every time since. Many of these patients have had significant relief from pains or problems that have plagued them for years. Often decades. Sometimes we are the only doctors they have ever seen! So, to hear we are leaving is very, very sad for some.  

On our end, theres an infinite list of reasons why we are all looking forward to getting out of Nepal. Rolling blackouts, sharing rooms, (very) polluted air quality, parasites, infections, no hot water, lack of toilet paper, nothing but lentils and rice.... really, I could go on. Though as soon as 9am hits and a group of familiar faces shuffle into the treatment room, I forget about leaving. Leathery weathered hands clasp together, greeting me with 'Namaste' and friendly shinning eyes, hopeful. So hopeful. Between 9am-4pm I forget all the unpleasantries about this country. In fact, during these hours of the day I don’t want to leave at all. How could I?

Today a patient Ive been seeing since the beginning, gave me a bracelet she made. She then dragged me outside in front of the clinic to take a picture with her phone. When we were outside she told me in broken english “you very good doctor, I will miss you.” Its the first gift Ive received from a patient, ever. She wanted to know if I would think of her when I go back to my home country. 

I will think of her forever. She represents to me an understanding of what i’m doing as a practitioner. The bracelet I now wear around my wrist, I wear with pride. I feel proud today for being a part of this incredible gift of bringing health care to some in need.  

(patient at our satellite clinic, Champe)

The Nepali BUS system

Oh boy! Let me start by saying that this is the most intense experience Ive ever had. And everyone in the group agrees, so its not cause i’m a home-bodied pansy. 

The buses here are the same size as a minivan vehicle. Yeah, you know.. the cars that hold like 7 middle school girls in dirty soccer uniforms. 7 girls TOPS! Here in Nepal, these minivans pack in a LOT of people. Men, women, boys, girls, old hobbling seniors, chickens, 50 lb bags of rice.. pretty much anything. One time we counted over 30 people on this bus. No joke.
There’s two people who work each bus; the driver and a pubescent 13 year old boy who collects the money. This young boy rules the bus, forcing people to sit on other peoples laps,  banging on the side of the bus to indicate a stop or a go and is a rip off artist for foreigners. Like me. Theres always a different price for the same bus ride and somehow it continues to get more expensive every time. Theres also no way to argue with the kid. No matter what, he’s always seemingly really tough and not to be messed with. Okay but backing up to just straight up logistics.. How the Nepal Bus system works....

 These minivans each have their own destination city/town and you find out which one goes where by developing a special kind of hearing. The minivan sliding door remains open as the car cruises by and the money boy literally hangs out the side yelling the city name over and over. So when we’re in Kathmandu we listen for the boy yelling “satubattu”... however it sounds something more like “saubausaubausaubau.” And then there really no guarantee that the bus will fully stop, so you kind of just clammer on and sit where your told. Taking this bus alone as a white female is less than satisfactory as far as Nepali experiences go. I don't recommend it. I have a semi racy story of being covered in smelly men reeking of the local moonshine. The drunkest guy, who was conveniently placed in my lap, wanted to practice his english, though he only seemed to know one phrase. “I am drinking.” To which I replied “ramro” which means good/great/cool/nice/etc etc. Speaking in Nepali was a mistake however, because that gained even more attention from my new ‘drinking’ bus buddies. They then harassed me the entire 40 minute bus ride back to town.

Anyway! It all worked out in the end and the moral is to not ride the bus alone.

(This isn't half the amount of people who can fit the same space)

SUCCESS!

During my first week here a 17 year old girl came in to the clinic with her mom to be treated for headaches. The mom-child scenario always poses as a tricky situation, because we’re all in one room. What ALWAYS happens is the mom ends up answering all of her childs questions, yelling them across the room. Then everyone in the room knows about the kid, who resorts to sinking deep into her chair and not coming back for further treatment. And no, it doesn’t matter how quietly you make your interpreter talk, if you were thinking that. I’ve tried it. 

So the girl comes in, moms yelling from the other side of the room where Dr. Joey is trying to get HER intake and I just resort to scooting my chair back so we have a whole room collaboration going on. The girl has had migraines her whole life. They are temporal headaches and extend deep into her eyeballs. She describes her eye muscles feeling like they are straining deep inside.. Especially when shes reading. *DING* 

“Have you ever been to see an eye doctor?” I ask, trying to be as non-assumptive as possible. Some people have never seen a primary care doctor their whole life, which means its totally possible. “NO!” her mom yells. “Why would she?” The whole room of older ladies has erupted in discussion over the topic, like a farm of cackling hens. “Well, the headaches may be due to poor vision.” The mom is very skeptical, sizing me up with glaring eyes and insists that they don’t have enough money. So we settle on acupuncture for a few weeks to see if that will help first. Weeks had gone on like this, where I would insist that a trip to the eye doctor is probably the key to her childs pain. But Mrs. Skeptical says no, time and time again.

And then.... Yesterday I saw this beautifully cute girl peer into the treatment room with brand new shiny glasses on, shooting me a little coy smile. 

No more headaches. Success! (Now on to "gastritis")

Exercise, Monkeys, Woodwork, Food Torture and Gastritis

The monkeys finally showed up. We were wondering if we’d be the lucky camp that didnt have to deal with their bossy ways. No such luck. In the morning, when i head to the rooftop of the clinic for my daily exercises I now have to keep an extra eye out for the monkeys. Usually i have plenty of warning because a pack of dogs will be desperately barking at something and the sound of rocks being thrown by people will get closer. Even though im expecting it, im still startled by a figure jumping on the ledge in front of me. They kind of remind me of city raccoons because no matter how scary you may sound they dont even flinch. instead they sort of lean in a little closer, daring you to do something. For the first few days that was it, my morning workout was done. Now ive realized that they will do their thing and i can do mine. So imagine what the neighbors think, the white girl next door on the roof with her exercise band is weird enough. Nowadays its the crazy white girl doing stretchy band with a pack of monkeys. The monks who live next door and look down on our rooftop are thoroughly enjoying this morning ritual, i assure you. 

Another preferred form of exercise is going for a stroll around the neighborhoods. My favorite neighborhood is on this loop. It is a little glimpse of the Newari culture, which is the native people to nepal. With a cobble stone road paralleled on either side by ancient brickwork buildings, distinct woodwork shutters and doorways. The intricate woodwork is remarkable and so unique to this culture. I’ve never really seen anything like it. In front of every doorway are groups of women spinning wool, children playing games and men shuffling out cards. In these households the animals live on the first floor and family above. During the day everyone sits outside in the sun to get some warmth before the nighttime comes again. So as we walk through, we see families all hanging out alongside the cows, water buffalo, goats, chickens and ducks. I imagine that its like a snapshot into traditional times, before the larger cities made their lasting influence on the culture.

A few of our interpreters are Newari. They speak their own language though most speak nepali as well. We were invited to a gathering a few nights ago at Satyamohan house for a newari celebration. A coming of age type gathering, though the girl was 9 or 10. (most marry young here). In this experience, i learned about food torture. Food torture is when you are handed a plate and many women with different dishes come around over and over and over to deliver a big heap of more food for you to eat. I learned really quick how to say no to this, by holding my hand over my plate affirmatively. Though the women look at my build with a slight disgust in their eye and will plop another mound of food between my skinny fingers.  So, saying no doesn’t get you very far i guess. 

(this picture is from a wedding, not food torture night)

This leads me to gastritis. The infamous word of nepal. Lol. EVERY single intake with a patient in clinic has gastritis among the list of complaints. Hm.. wonder why. Maybe its because the plants grow in sewaged waters, or maybe its because there is no refrigeration here since we have rolling blackouts, or MAYBE its that the drinking water would make a science petri dish overflow with colorful flora and fauna. Gastritis is not really something we can treat effectively here since the root of the cause is inevitable. This week, our little friend gastritis came knocking on my door. I assure you, its not fun.

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)