Life-affirmative Threshold

A common question I am asked upon my return home is, “how was Nepal?” Usually my answer is, “It was great, but intense.” It is impossible to sum up this experience in a casual conversation.

I suppose a better way to describe my time here would be to offer examples of profound moments and daily observations I've experienced.

The set up:

Daily activities are roughly the same. The town starts to rustle with noise around 5am, this is when Auntie wakes to start cooking our breakfast. Our neighbor's tea shop opens and I can hear someone hocking up copious amounts of phlegm, sounding similar to gagging followed by the sound of spitting. Chickens are released to scavenge for scraps the dogs haven't eaten from the road; their chicks chirping incessantly. Dogs bark randomly, at any hour of the day. I can smell the fire someone has started either to cook breakfast or burn trash. The odor permeates my room, it is a smell unique to Nepal. The area smells of car exhaust, dust, livestock, burning plastic, boiled milk, butchered animals, curry and incense; each odor alternating dominance at any moment.

Numerous times throughout the day a man pushing a rusty metal 4-wheel cart similar to an oversized wagon delivers goods. It is filled with firewood, propane tanks, 50 kilo bags of animal feed or rice. Sometimes he gets stuck on a rock in the road and struggles with the momentum of the cart, which inevitably comes to a halt. The man is small and muscular, he uses his right shoulder propped against the handle of the cart to push it. I always stop to watch him and struggle to stop myself from helping him push it down the road, not that I think I would be of much help. Modernity takes a back seat to methods perfected through routine and time.

A brahman comes begging for alms in the morning. Auntie gives him 5 rupees, no questions asked, no blessing in return. Offering him money is just what you do when he calls to you from the gate. He waits until someone makes an offering before moving on. Everyone donates, even the Christians.

A large group of Indian workers saunter past on their way to a construction site in the jail down the street from our house, tongue-gaping stares in our direction.

The street isn't busy with vehicles, but there is a steady stream of foot traffic passing. Everyone stares at us. Some say Nani to me in reference to the dog we've adopted. She's famous on the street here and the kids play with her before and after school. She's been included by the local pack of dogs on the street, but if she wanders too far outside her turf, she's attacked. Nani plays with a slightly older puppy on a regular basis. They wrestle, battle over found toys (mostly disregarded shoes, scraps of cloth and the occasional sock) and chase each other sprinting down the road, Nani always trailing behind given her small nature.

Everything is washed at the local spigot across the street. Laundry is hand scrubbed with a bar of soap and brush, put on the clothes line near by and covered in a thin layer of dust by the time it's dry. Dirt is everywhere. Cleanliness is a futile effort. All dishes are metal, hand washed and put to dry on the ground in the sun. It is such a contrast from the almost sterile conditions I was taught to maintain at home.

I am surrounded by the foothills of the worlds tallest mountains. Last night I walked over to a cliff overlooking a drying riverbed. The mist covering the tops of these hills created a scene from a painting I remember in the recesses of my mind. A lone Nepali walked through the rocks below on his way home and I felt an acute awareness to the size of the world. This ant-sized man, the large riverbed, these giant hills and me; all coexisting. I felt transported to another era.

The clinic, patients, volunteers:

The clinic is a five-minute walk away from the house. We've seen several cases of suspected TB. Many have tested positive with the skin test and all the cases we've seen are extra pulmonary, meaning either on the skin, in the bone or lymph system. The skin test has a high prevalence of false-positive results and can pop up positive if you have been in close contact with an infected person. The prominence of TB is alarming, but most of the patients who have been diagnosed have suffered with a mysterious ailment for several years and are happy to hear a confirmed diagnosis. At least TB is treatable, although there was an antibiotic resistant type discovered in India...

This year I haven't had the clinic experience I had last year. I am overseeing the volunteers who are in the clinic daily. I am around to offer another perspective to practitioners when they are stuck with a patient. I'm here to help with other details, but I miss treating patients and having the interactions with the locals and interpreters. I feel like an outsider and participant, a dichotomy difficult to blend. I came with the intention that this trip isn't about me and my experience, but it is impossible to come here and not have transformation. For me, it has been much more subtle and introspective, my entire being hasn't been jolted like it was last year and I am grateful for that. I don't know what type of leader I would be if I were dealing with too much of my own shit and unable to be present with the group when they need me. It has been a pleasure to witness the practitioners work through their doubts, acknowledge their limitations and learn so much about themselves and this medicine. I am sad the clinic is closing in a few days. Things are winding down and an air of melancholy lingers. I find myself equally ready to depart and unprepared to leave, as is generally the case when I travel.

Death:

I recently witnessed the the final breaths of a dying patient. I've never been so near someone about to transition. The fear in his eyes haunts my memory.

Last year we went to the Pashupatinath Temple, where the funeral ghats in Kathamadu are located. I'd never seen bodies burning. The experience was profound for me; death, right out in the open for anyone to see. Wailing women crying, ceremonial head shaving of the son when a father passes, smoke drifting by as I inhale, water carrying the ashes to the Ganges and me bearing witness to it. Traditions for death are sacred. Hindus wear all white for a year after the death of a family member. Bodies are burned within 24-hours and in some ethnic groups widows are unable to remarry, especially if they have children. Up until the 1970s it was common for widows to throw themselves on their husbands funeral ghats and burn right along with him.

I want to gain a better understanding of my relationship with death, but thus far, it still scares me. I realize there is no way of knowing when death will come, for myself or those most important to me. I try my best to embrace opportunities and celebrate each moment as if it were my last. Sometimes I find myself too wrapped up in the mundane and forget life's fleeting nature, coming to Nepal reminds me how precious it is and I look forward to returning home to my loved ones. 

Warm Foothills

I've participated in a couple Vipassana retreats over the years. These are 10-day silent retreats in which one sits for 10 hours of the day focusing on the breath and gaining awareness of the body. It's a grueling task and the first few days are pure hell, but by the end I never want to start talking again. Around day seven something in me shifts. I get over the discomfort from sitting in a lotus position on the floor and begin to actually enjoy the silence and tolerate the physical aches.

Every Monday I hike up to Kogate, sometimes with a practitioner but most times I am alone. The trail is part dirt road and part trail meandering through villages before climbing up a steep incline to a ridge line and slowly drops down to Kogate. I hike up listening to music and greeting every passerby. Most speak to me in Nepali, but I'm usually alone and have no way of knowing what they are saying. I've started saying, “Namaste! Kogate!” I think they must be asking where I am going. The trek has become routine for me and each week it is a little less arduous. Hiking is my form of meditation. The rhythm of my music sets my pace. The fresh air replenishes me. Sweat cleanses my skin. My muscles awaken and ache. I settle into the moment. This is what I'm doing for the next three hours, just walking.

There was a time in my life when I resisted the calmness of hiking. I'd judge myself. Critic my pace, always too slow. My aches meant I was a fat slob and out of shape. Self judgement ruled the entire experience and I would become enraged. It's a wonder I stuck with it. The payoff was always the completion of the trail, a vista view, waterfall or isolated campsite. A distance hiker friend of mine used to say the best part about hiking was not hiking. The moment you arrive at your destination, take your pack off and know you accomplished something. This, I believe, has been what kept me hiking all these years. The reward always beats the anger and judgement.

During my hikes up to Kogate I've noticed I judge myself less. Anger has not entered my thoughts. When I feel tired and slow, I say it's ok and just keep walking. When my muscles ache, I feel it and am thankful I have the strength to keep going. I've accepted my pace and the aches associated with climbing a trail. I don't know when it happened, but my self criticisms have decreased a little and I realize I am starting to accept myself as I am.

This wasn't always the case. I spent many years hating myself because I didn't have the figure I idolized, the brains to solve cross-word puzzles, the drive to run a marathon or anything I compared myself against. Maybe it was turning thirty and realizing I'm not going to suddenly turn into the perfect version of myself. Maybe it is having someone in my life who accepts me just as I am. Maybe all the time I spent alone, hiking up a mountain and taking my pack off at the end, was a layer of self hatred shedding.  

The Precarious Puppy Problem

It happened, despite knowing the risk involved. Gut instinct said call it off, turn around and walk away. But, we adopted a puppy. We've named her Nani Baag (Nani-little girl, Baag- lion). We feed her, made her a little shelter and play with her. She follows practitioners to the clinic, but occasionally gets kicked by locals. We try to discourage her from wandering too far, but at the same time have to let her learn lessons from her environment.  

So? What is the danger in taking in an abandoned 8 week old puppy? For starters, we are only here for a temporary time. We pamper this butterball and create a comfort with humans she will never find again. The community here does not care for dogs, they might have them around to guard the house, but they do not treat them like family members. Dogs are a nuisance. They are dirty, mangy, aggressive at times and terrified of humans. The people kick, beat and abuse the dogs. It's a different society. It's not my place to judge nor change it. Therefore, our care-taking of this puppy is a problem. What will happen to her when we leave? I imagine she'll be treated like all the other local dogs. She's a fighter, but our departure will be heartbreaking.

Aside from that, our neighbors hate dogs. The dogs poop near their house and under the clotheslines. They scavenge and beg for food. One of the old neighbors throws rocks at them. Furthermore, we heard the neighbors may have expressed their grievance with us having a puppy to our hospitable host, Auntie. The last thing I want is to create a rift with the neighborhood. That's a poor representation of the Acupuncture Relief Project and a lack of foresight in the team, myself included.

Yet I find the puppy comforting. Nothing beats hugging an adorable little bundle of puppy after a rough day. Her little face makes everyone smile. It is extreme selfishness that we have her around still. I know this and I am as responsible as everyone else, if not more so as a leader. I miss my animals back home. I  struggle to witness what I see as cruelty to the animals. I know I can't do anything about it and this helpless feeling is uncomfortable. I know this might end badly for Nani, for my emotional state, for the group of volunteers, but I don't know how to stop caring for her.  

Is it possible to take the puppy back to America? Yup, it sure is. It will cost money and someone must actually commit to taking her, teaching her and realizing that puppies grow up. Her puppy cuteness will grow into a teenage dog who eats everything, destroys personal items and could reek havoc to those unprepared for a full grown dog. One volunteer initially said she'd take her, but she is wavering due to the financial commitment. I don't have the money, plus Nathan already has a dog I struggle to like most of the time. Despite my affection for this puppy, I know I can't take her home and my heart breaks a little each time I hold her.

It's not all bad. There is a dog family with a puppy a few months older than Nani Baag. The two pups are friends and we are hoping this little pack will adopt her into it. All three of them play together and she is learning dog socializing skills.

'Ke garne' is a Nepali term meaning, what to do? It is said with a shrug of the shoulders and an admission of acceptance. The bus isn't running today? Ke garne. You've run out of the medicine I need? Ke garne. We've adopted a puppy we shouldn't have? Ke garne.  

Same Same, But Different

I didn't expect this round in Nepal to be like last year, but there is a familiarity quelling the deep yearning to return I had while away. This year I am in Bhimphedi, the town my group struggled with last year. The patient numbers have consistently decreased in Kogate since my camp left. I am disappointed because Kogate is one of my favorite places but thankful we go up there- even if it's just for one day a week.

I'll do my best not to list off all the differences between last year and this year, but I will say that last year was roughing it, this year is like staying at the Ritz! We have internet all the time! Bhimphedi is powered by a hydroelectric dam, so the power never goes out! We even have a hot shower! There are shops selling things like Snickers bars and fruit! The health post can administer IV fluids, draw blood and has an actual doctor. Granted the doctor is trained as a pediatrician and is just biding time until he can return to Kathmandu to make more money, but still he sometimes shows up.

One more difference, then I'm done, I swear. I'm not treating many patients this time around. Instead I'm leading a group of five practitioners who are participating in this program for the first time. It's been a joy to watch them experience Nepal with fresh eyes. I remember being shocked by the car rides, uncomfortable with burning my trash, annoyed by the noise and dust, in awe of the beauty and saddened by the sickly animals everywhere. This is not to say I'm immune to my surroundings. I will forever pause to stare at the mountains. I'm still aware of my trash output and the smell of burning plastic, however familiar is still icky. My nose gets clogged with the dust just like everyone else, but I expect these things. Now different things get to me, such as the dog situation here.

Bhimphedi has more stray dogs than Kogate, which is an element I didn't have to deal with last year. Let me just say, I can't take the sad dogs anymore. Today I saw a dog with a terrible gait (probably from getting hit by a car or motorbike), sickly skinny and generally just the saddest looking dog I've seen. Uncontrollably my eyes started to water and a lump in my throat made it difficult to swallow back the tears. The first thing I thought was, what the hell is wrong with me?? I am not an easy crier. Those sad Sarah McLaughlin pet rescue commercials don't phase me! Then I realized they don't bother me because I just change the channel. Reality is a channel I can't change. I can look away, but I still hear the yelps of fear and pain as the dogs are beaten. Or the growls of aggression and territorial behavior when a dog wanders just outside its unmarked region. Today was a day I couldn't handle it. If I could save the sad pups, I would, but that's not why I'm here. I have compassion for them, but wisdom to know I cannot change their situation. Besides, I'm really a cat person.

Leading the group brings it's own challenges, many of which I couldn't really prepare for. For example, I didn't know the type of personalities my group would have. Sticking six women from different backgrounds in one house can end up like an episode of some bad reality TV show about divas. Lucky for me the group of women I ended up with are durable, knowledgeable, open to experience anything Nepal has to offer and open-minded. Many have the discipline to wake at 6am and practice taichi, yoga, qigong and meditation. They are inspirational and I am grateful things have gone well so far. Although, we are only two weeks in and I've heard people begin to get a little crazy at about week three, so anything can happen... Stay strong ladies.

Now, I have a way to prove the durability of the group. A bout of the plague (vomit/diarrhea) has passed through almost the whole group. No one wants the shits on a squatty potty, much less vomiting. One practitioner vomited in front of the house, went to get a bucket of water to clean it up and was told to just leave it because the chickens would eat it. And eat it they did. Aside from all the stray dogs, there are endless amounts of chickens, roosters and chicks wandering the streets, eating vomit and rocks. Each sick practitioner has bounced back and some have even stayed at the clinic, despite “having pee come out their butt” as one lovingly phrased it.

Not only are the practitioners experiencing Nepal, but learning the challenges associated with treating patients in our clinic. Complicated presentations come in daily. Is this a deep vein thrombosis? Does this patient have TB? How high is too high for blood pressure when damn near every patient has unregulated hypertension? When do we refer out and when do we treat? What if this patient with possible transient ischemic attacks has a life-changing stroke before he can make the trek up to Kathmandu to attend the one hospital in the country that has the capability to do a MRI and CT?? What about that patient with emphysema so bad he cannot be without oxygen for more than a few minutes? His family keeps turning off the oxygen because the Jacques Cousteau sized oxygen tank runs out every two days and it's a financial burden they cannot bear. What do we do?? I get these questions daily and I don't always know what to do. I'm here to teach classes related to ARP and the clinic, support the practitioners and make sure things are running smoothly. Not knowing everything is a state I'm uncomfortable in. I've been lucky to have Andrew around to help, but he leaves Sunday and I'll be on my own to navigate the unknown. What-ifs plague me sometimes, but I remember a few lessons I've learned and have become a little better at accepting my limitations and admitting when I don't know. I will rest with the discomfort, try to second guess myself a little less and know that in the end the patients want love and compassion. I can help facilitate that.

Check out the photos I've posted here.

“Travel is the discovery of truth; an affirmation of the promise that human kind is far more beautiful than it is flawed. With each trip comes a new optimism that where there is despair and hardship, there are ideas and people just waiting to be energized, to be empowered, to make a difference for good.”

I haven't written in quite some time. My last blog post was about the final night in Kogate. That was a tumultuous night and the end of a very transformative experience. After leaving Nepal I traveled around SE Asia with my boyfriend (now fiancée). I've often wondered why I didn't keep writing blog posts, it wasn't for a lack of tales to share.
I've come to several conclusions. First, I experienced writers block. The minute I landed in Bangkok everything shifted. I still smelled like Nepal, but no longer felt connected to myself as I had there. Secondly, I wanted to keep several memories sacred, safely bundled away. This didn't happen at first. When Nathan and I reconnected, most of the time I compared how Thailand was vastly different than Nepal and would share silly stories. By no fault of Nathan, I could see the glossed over look and the lack of understanding, like sharing a private joke with someone who wasn't privy to the initial hilarity. He didn't get it. I knew this would happen and was almost prepared. I created a wall around the memories. I smile to myself when reminiscing, but start sentences with “In Nepal” much less often. Why didn't I share my adventures in SE Asia? Well, partial writers block, laziness and an unsubstantiated feeling that no one would read my writing anymore (don't know why I thought this, but I did).
Here I am one year later. I'm working as an acupuncturist, betrothed and returning to Nepal. For those curious, I work at two clinics in Portland. One is a community clinic, similar to the set up of the clinic in Nepal. I'm happy to provide low cost care to those in my community unable to afford private treatments. On the flip side, I also provide private treatments at a clinic on Alberta street. Business is slow in the private sector, but I'm hoping to learn tricks on client recruitment and marketing.
The proposal: Nathan carried around a beautiful ring for two months of travel before finally asking. I found the ring in his bag within the first week we reunited, but he did not know this (I secretly looked for the box in his pocket at every romantic sunset, there were LOTS of romantic sunsets). When he asked we were watching the sunrise over Angkor Wat, Cambodia. I'd talked about my excitement over seeing the temples for months prior to leaving and, unknown to me, Nathan planned to ask at this moment for months. Which explains why my mom asked on a daily basis if I had any news to share upon our arrival to Cambodia. It was a very private proposal and I look forward to eventually having a party to celebrate with friends.
I'm returning to Nepal!! I've been asked to lead Camp C of the Acupuncture Relief Project this year. I am honored to participate again and will be taking a much different role. I will lead/guide/teach/befriend 6 volunteers from various areas in the US and Australia. Only one volunteer visited Nepal 20 years ago, the rest have never been. I do not know what to anticipate, but if I learned anything from my previous visits it will have something to do with releasing attachments, maintaining malleability, remembering anything can and will happen, but it will be ok. My current mantra is “I can do this” because, let's face it, this is an incredibly intimidating task. That is to say, I am more than excited to return. I think of Nepal on a daily basis. From the prayer flags hanging in my treatment room to my current patients to the chickens I see roaming around someones yard, Nepal surrounds me regularly. I am still wearing the glass bracelets we purchased at the end of the Langtang trek. Some have broken off, but they were squeezed onto my wrist and I cannot take them off without the glass cracking. Honestly, I thought they would have broken off by now. I also still wear a necklace given to me by a monk at Boudhanath Temple with a written prayer of protection intricately folded and wrapped with string. I cannot take this off either, it is tied in a knot too tight to fit over my head. I guess I still need some protection. Some might think I have a hard time moving on, but I prefer the idea that these talisman serve a purpose (guiding me back perhaps?). I don't have to know what it is, but as I said, the bracelets are glass and the necklace is a tiny string. Both will eventually break, but until then I like having 'em around.
“No one tells you how hard it is to come back.” These words were spoken to me by a fellow traveler as we lamented the end of our travels. Granted, this was several weeks ago and our travels ended many months prior. Travel books just stick with the adventure part, who writes about the return? I understand why. Poetic prose aside, returning home sucks. Really sucks. I know I slipped into a depression like none other I'd had before. I am slowly on an upward swing, but my soul is still unsettled. A deep sadness creeped in, paid the landlord and loitered within me creating a yearning I cannot quench. Why sadness? You had a great adventure, you have a partner, things seems to be falling into place, what are you sad for?? My self judgement took over and I am my harshest critic. Do I know where the sadness came from? Not entirely, but I suspect I was grieving the loss of a life I thought I would have. The life of someone who embraced freedom wholeheartedly, up and moved to an unknown land, a person free of the banality of life. Not so. Perhaps some view this as naive and out right dumb of me to think, but I did. I drank the kool-aid all travelers share. The tasty and addictive beverage part adventure, part freedom. The urge to leave again resides within me, it is not as loud, but the whispers keep me awake at night. I know I am not finished exploring. I know I can always drop everything and go, but there is a strong force that says, eh, not really. Who knows what life can throw at me, what if that was the last time I could leave the country for so long? Ah, good ol' what-ifs. Funny, but this was something I remember struggling with last year about this time. Seems the lessons from Nepal are always present. I also realize the “first world problems” described. But I am a product of my environment and I live in a developed country. I'd just like to acknowledge that things aren't as bad as they could be and if feeling a desire to explore the world is the worst of my problems, then life ain't terrible. I know, doesn't stop the feeling, but I know. Also, going to Nepal IS travel, but it is also work, very hard work that I adore, but not the footloose and fancy free exploration following a whim of fancy. Nepal feels like a second home.To those who read my blog while I was away: Thank you so much for your support, attention and interest. It's not easy to share with the infinite abyss of the internet and in a time of short attention spans, I was happy to know you cared what I said.
I must raise the money to return to Nepal, luckily not as much this time (thank the universe!!). I have to raise $1320. I deeply fear that everyone will incredulously gawk at my request for more donations, but I am hoping that those of you who know me and have read my entries will understand the necessity and altruistic nature behind my return and offer support.
DONATE HERE!!!!

We Give Them Love.

I'd like to share the story of my last night in Kogate. The events that transpired left a very lasting impression on me and I find writing therapeutic.

I treated a young 6 month pregnant woman during my time at the clinic. She presented with a history of miscarriages, only one I knew of at the time. The previous year she was 7 months pregnant when she went into labor- in a field, alone. She gave birth to a breeched baby by herself, so the translator told me. Unknown to me at the time, she'd had two previous miscarriages prior to the field birth. She seemed anxious about her current pregnancy and I did my best, with my limited means and knowledge, to comfort her in the final months of her pregnancy. As my time ended at the clinic, I informed her a new well-qualified practitioner would be replacing me. She did not like this information and stated she would not come to the clinic if I was not going to treat her, then she offered her house for me to stay so I could remain in Kogate. I very strongly considered this heartwarming gesture. I treated her on my last day in clinic and told her to remain calm and take it easy during the last two months before the baby.

Our last day in clinic ended with a spontaneous Nepali dance party. Many of the women from around the area gathered, played drums and demanded we dance. A good time was had by all. We were woken at 2 AM with a knock on the door. My pregnant patient was experiencing bleeding and pain. Haley, Allissa and I, quickly got dressed and hiked the 20-minutes over to her house. Allissa is in training to help with births back in Canada, but overall, none of us were prepared and the presentation didn't sound good. When we arrived at the house we saw a small puddle of bright red blood at the doorway and entered to see the patient on the floor wincing in pain.

To set the scenario, the house was a single room building with a thatch roof. Inside to the left of the doorway was a cow and calf eating grass. To the right against the wall was a small bed-frame with out a mattress and a fire pit with a window on the wall above it. No chairs, no mudas, no tables.

We walked over and began asking questions. When did the bleeding start? A few hours ago. Are you in pain now? Yes. She was visibly pale and in pain. Her blood pressure was quite low, but her other vitals were normal. This is when we learned she had a history of 3 previous miscarriages, late in term. We decided it was time to take a look below. She said she felt like "something was coming out" and I thought she meant the baby.

Thank god Allissa was there because I can honestly say I know nothing of childbirth, from the amniotic sack to the placenta. I don't know what's going on in there. I can remember learning that acupuncture can induce labor, help with pain, turn a breech presentation (over time, not when in labor) and that a few points should be avoided during pregnancy. The last bit mentioned is what kept me from learning more. Let a pregnant woman's body do it's thing with the baby. I can help you get pregnant- someone else can deal with the rest. That was my mentality until this patient and after this experience I vow to learn everything there is to know about pregnancy.

Anyway, we took a look and there was definitely something coming out. I though, "is that the head?!" but Allissa informed me it was actually the amniotic sack. It's what pops when women say their water broke. The sack hadn't popped yet, but was protruding from her and about the size of a softball.

At this point we stepped outside to regroup and call Andrew (who was in Kathmandu) for advice. We were able to make one very short call relaying the situation and to ask for help. Andrew just said call an ambulance, then the prepaid minutes ran out and we were alone with this situation.

Fist of all, the nearest hospital is over 2 hours away down a very bumpy, dangerous mountain road. Secondly, the ambulance has only a driver, no paramedic or EMT was inside to help the patient. In fact, the ambulance is just a land cruiser without space for a gurney. There is a lengthwise seat for the patient to attempt to lay on, a spare tire on the floor and an ancient oxygen machine.

The patient and her husband didn't want us to call the ambulance because they didn't have money. It would cost 2500 rupees (25 USD) to get her to Hetouda, the nearest hospital. We told her we would pay for it and she agreed to let us call. We used a phone from one of the many bystanders now lingering in and around the house. Most were family members.

I guess she moved because the protruding sack burst. A bloody watery mix covered the dusty floor around her, but she seemed to be in less pain. We sat with her for an hour and a half rechecking vitals and listening for the baby's heart beat. I did not hear it.

The patient didn't cry or display any emotion. She reacted to the pain, but was able to participate in the Nepali conversation going on around her. Mostly just local gossip.

We were unsure what to do when the vehicle arrived. Do we ride to the hospital with her? What if she goes into labor on the way down the mountain? Do all three of us go or just me since she's my patient? These would not have been questions if it was not our last night in the clinic and if there were not Maoist strikes going on preventing any transportation due to danger. If it was a regular day, I would have gotten in the car with her and held her hand the whole way, but I didn't.

I made sure she was comfortable and told her one last time that everything was going to be ok, then I shut the door and watched the ambulance drive away. I couldn't go with her for several reasons. Logistically, I would have been stuck in Hetouda without ID, cash or even a bra on. Also, if she had gone into labor, I would have been of no help. She is more experienced than I am when it comes to birthing, I've never even watched a Youtube video or The Miracle of Birth.

Afterward, it was about 5AM at this point, we all walked quietly back to the house, the magnitude of what happened lingering in the air. I suggested we look for shooting starts so we could make a wish for her and the baby's safety. We did.

As the lights from the ambulance became less visible in the distance my mind immediately went to what I could have done differently. Could I have prevented this? Were there signs? I can  declare gross negligence on so many levels given my limited scope of practice. The rational side of my brain comforts me and says I did all I could. The emotional side questions, debates, doubts and worries. The worst part of it all is I left. I left her at the ambulance. I left her in Kogate. I left her alone when she needed me the most. I should have held her hand longer. I should not have told her not to worry. I should have sent her to Hetouda earlier in the day when I treated her, just because. I had an intuitive hit about her a few weeks before when we were returning from one of the trips to town. An ambulance passed our vehicle up to Kogate and I thought, "I hope that's not my pregnant patient." I just felt uneasy about her and kept telling her to come into the clinic every other day, just so I could make sure she was ok.

We found out the next day that she did give birth on the way down to the hospital- a still born baby. I was never able to tell her goodbye or that I wished I could have done more. I don't know if she was ever able to show the emotions that go along with such an event, but I have. I've cried for her many times since leaving the clinic. I think of her all the time. I send her healing energy as often as I can. I lack the words to fully describe what it's like to witness the loss of a life in this manner. I am plagued by what-ifs; my memory haunted by her face, the blood, the smells and the fading ambulance lights.

I miss the clinic. I miss the patients and the community. I miss the quiet. And I miss her.




Addendum: Some time has passed since I left Kogate and this young patient, but in my many hours of reflection I remembered this story.

During our last few days at the clinic the entire volunteer group was together eating dinner when Andrew posed this question to us- did we make a difference to the people of Kogate?

Each offered a subjective opinion relaying stories and breakthrough moments with patients. I found this question a challenge to answer, of course I think I made a difference to the people of Kogate, but equally important- they made a difference to me. I've changed in so many ways, many of which are not yet apparent. The experience seeps out slowly, as I expect it will over time.

But how much of a difference did we make? We can't help everyone and the program is only 5 months. Unlike many volunteer groups that come to Nepal, we offer follow through with patients based on the length of time we are here. This is beneficial for continued care and gathering statistical information, but makes it very challenging to leave. Many healthcare-based groups come to remote areas, treat thousands of patients in a week, then leave and claim they helped and treated many. But did they? How do they know if the practitioner only saw the patient once and never followed-up? This is where ARP is different, but the question how did we make a difference is still present.

Tessa, a pre-med student and odd-job-doer of the group offered this analogy:

While walking along a beach, an elderly gentleman saw someone in the distance leaning down, picking something up and throwing it into the ocean.

As he got closer, he noticed that the figure was that of a young man, picking up starfish one by one and tossing each one gently back into the water.

He came closer still and called out, “Good morning! May I ask what it is that you are doing?”

The young man paused, looked up, and replied “Throwing starfish into the ocean.”

The old man smiled, and said, “I must ask, then, why are you throwing starfish into the ocean?”

To this, the young man replied, “The sun is up and the tide is going out. If I don’t throw them in, they’ll die.”

Upon hearing this, the elderly observer commented, “But, young man, do you not realise that there are miles and miles of beach and there are starfish all along every mile? You can’t possibly make a difference!”

The young man listened politely. Then he bent down, picked up another starfish, threw it into the back into the ocean past the breaking waves and said, “It made a difference for that one.”

We continued our conversation discussing how we helped our patients differently than an allopathic practitioner would. MDs in Nepal vary greatly in competence levels and I've learned most patients leave hospitals without more understanding of what is wrong than when they entered.

During my stay at the clinic I spent a bit of time educating patients. I can read medical records, x-rays and MRIs and explain the results to the patients. I can assess an ear infection and prescribe the appropriate medications needed. I can flush compacted earwax and clean an infected wounds. Many times patients refused to see allopathic doctors, even when we suggested they should. Sometimes patients would come in with an ailment they'd had for years. For example, hearing loss from a typhoid infection as a child. These patients would carry with them all their hopes and dreams of returning to normalcy and we would inform them we could not help. I learned this in the clinic- sometimes all we can do is be there, hold their hand and say, "I cannot change your situation, but I care about you and I am here."

That is not an easy lesson to learn, which makes incidents like the aforementioned one painful. Ritesh, a translator, chimed in on our conversations by saying, "We are different because we give them love."

And sometimes that is all you can do. Give them love.

I remember more than I've seen and seen more than I remember...

My time at the clinic is winding down. The number of days crawling dangerously close to   the last. I am sad. I've struggled to keep up with entries during the second half, well, I was better for a few days, then my computer deleted everything I'd written. After that I lost motivation. Here I am, three weeks later starting all over again. I hope the redo does justice to the experience, but I know it won't completely convey a time impossible to recapture. This is my best effort.

The Trek:

I left off on the cusp of trekking. As you can clearly tell, I survived, but it wasn't without strife and acceptance (two major themes of Nepal). The Himalayas are a growing mountain range. The Indian continent is trying to push itself under Tibet, therefore the worlds largest mountains are still getting larger.

After my previous visit to Nepal, the most common question asked was if I saw Everest. The world's highest peak is a monster among giants. Did I see the range it's in? Yes. Everest specifically? Meh, maybe. I always just said yes, so if I told you I saw Everest, I lied. Sorry.

The Langtang range is north of Kathmandu bordering Tibet. In fact, many of the mountains we saw were in Tibet. Andrew said as the crow flys from Kathmandu to the base of the himalayas is about as far as Portland is to Mount Hood, but it still took us seven very uncomfortable hours by car to the trailhead.

At times the only way to cope with roads here is to put in your headphones, close your eyes and mentally visit your happy place. The road to Langtang is one of those roads. Landslides are common and none of the roads are really "paved" by Western standards. Steep drop-offs, large boulders in the middle of the road, washouts and land-cruisers several decades old make for slow travel.

We trekked for 10-days. The first few were clear and warm, then a category 5 cyclone passing through India hit. That's when things took a turn towards miserable. I wish I could say I loved the trek. I wish I could say- rain or shine, I'm a hiker dammit! But it wouldn't be true. Hiking in a steady cold downpour for four days took all oomph. At first I took it in stride- we couldn't hike up to an overlook of the Langtang glacier? That's ok, I'm pretty tired anyway. But the point I lost it was when we crossed a recently created runoff waterfall of torrential standards. We had to link arms, jump across slippery rocks and commit to hiking in saturated boots for several days. Not only that, but the trail turned into a messy mud and dzo shit covered extravaganza. Dzos are a cross between a cow and a yak. Yaks cannot survive below 10,000 feet, but this hybrid can and it shits- a lot.

Side note, I love my hiking boots. I've had them for over seven years and they've been with me to every foreign country travelled. At this point, they fit my foot perfectly and show the wear and tear of so many years of love. Before coming to Nepal I chose to replace the sole of the tattered footwear; opting to save the money I would have spent on new boots. The sole held together reasonably well, but the rest of the shoe did not. There is really nothing like a mix of shit and mud sloshing around frozen toes.

Anyway, luck was on our side on the last day of the trek. We were finally able to witness the glory of Langtang mountain (7245m). The clouds parted for a few hours and the himal did what they do best- offered awe inspiring views and reminded me of how small I am in this world.

Spirituality maintains a high priority here. Chorten's, Tibetan stupas, line the trails. These carved stacked rocks carry the prayers of suffering. Local belief states, if you hold a rock up to your forehead, say a prayer of your suffering and place the rock on the chorten you release your suffering into the collective universal suffering. I did this many times.

Emerald green lakes lead the way to Gosaikunda (4380m). The lakes were made by Shiva's trident during his stay in the Langtang range. The sacred lakes attract pilgrims from all over to worship during the full moon in August. A spiritual cleansing ceremony can be preformed by sprinkling your head, mouth and face with the cool waters. I walked over and participated.

While we hiked out of Langtang, the village, we stopped at a Tibetan monks house for a prayer of protection. He invited us into his tiny smoke filled abode to meet his wife and bless us on our journey. His wife spun a prayer wheel and repeated Om Mani Padme Hum as he placed an engraved gold colored medallion on my neck. I never take the necklace off now.

The ride back from the trek was more treacherous than before due to all the rain. The local bus couldn't make it back to Kathmandu because the road was too slippery. We made it safely across the worst bit, but learned the road related breaking point of a fellow volunteer. At a crucial moment when the car had to navigate a large boulder we inched dangerously close to the edge. One of the volunteers scooted all the way to the opposite end of the vehicle, screamed and began to cry. Her terror was authentic and similar to what the rest of us were feeling, but her reaction induced chuckles.

I would love to say this trek was great, but I allowed myself to maintain a negative attitude. Yet another lesson I've had repeatedly thrown in my face unable to learn the first time. I put blinders on to the beauty of the moment by continuously wishing my situation was different. In hindsight, I can think of it as a chance to see another part of this amazing country instead of the bitter resentful thoughts of how it didn't go the way I expected. I created my mood through my attachment to a self-created outcome. When things didn't go how I wanted I turned acrimonious. All the spiritual cleansing didn't seem to take immediately, but I realize more so now how my desire play a malicious role in my inner harmony.

The Thrill is Gone:

After trekking in rain, cold and mud I was elated to return to Kathmandu for 12 hours. Long enough for a hot shower, some internet and a meal free of rice and lentils. Again, my desire for a certain outcome was challenged by Nepal. There was a country wide black out, which is common, but it destroyed my chances of facetiming with loved ones. Furthermore, the hotel was overbooked and placed me in a room without a shower. No big deal, I don't need a shower in my room, I just need a hot shower. Unfortunately the shower was down the hall in a windowless room and the power was out. I waited several hours for the power to return, but after so many days of festering in my stink, I couldn't take it anymore and took a headlamp shower. Silver-lining: it was hot. I was eventually able to use the internet when the power returned around 11pm, but was in such a moody state it might have been better to just go to bed.

We left the next morning at 6am for Kogate. The break threw a wrench in our momentum at the clinic. October and November are lined with festivals here, so after Dashian the Tihar festival began. Hardly any patients came to the clinic for the first few weeks we reopened. The days went slow and I felt homesick, as contact with home often leaves me feeling. The newness faded and the mundane day-to-day activities were no longer as exciting as they initially were. There goes another Nepali carrying a bushel of branches heavier than the person carrying it. Those school kids are peering in my window once more watching me put socks on. Dal bhat for lunch, again. The things I'll immeasurably miss from my temporary abode annoyed me the most at this time. I just wanted a break, a chance to have an experience and not feel the lesson of it pressing on my emotions and mental state. It didn't happen and I got over it anyway. My regular patients began coming back, the Tihar festival (more to be mentioned later) was an amazing experience and I eventually released the weight of negativity I carried with me.

ARP Blog Post:

We are all asked to write a blog post for the ARP website. Here is the one I wrote:

I have a clairvoyant friend who told me I would have a profound, potentially life-changing experience while I was in Nepal. I'm in a distant land helping a very rural, select group of people heal, naturally this will be profound, duh. Even so, I can't help but wonder about her prediction and it's implications. Will this experience be so changing I will be cognizant at the time it occurs or more subtle- something I'll reflect back on years from now, hindsight offering clarity I cannot comprehend in the moment? I don't know. What I do know is my anticipation waits unabashedly for the answer. 

I have not spent much time with groups of females. So much feminine energy often overwhelms me and leaves me feeling shy and self-conscious. Did I fit in? Was I being judged on my abilities to act as a "normal girl" should act? These insecurities carried into adulthood and I've spend many hours working through what "normal" and femininity mean to me.

All the volunteers in this group are females ranging from 22 to 37 years old. We come from different backgrounds and share different stories. Since I've arrived I kept the ominous prediction in my head, always thinking the profound experience would be clinically related and maybe it will, but it could also be a more interpersonal one.

We have all been requested to write a blog expressing our authentic experience here, but I've struggled with this. My ability to process the goings-on veiled by overstimulation and fatigue. The days can be long and I am often riddled with self-doubt and insecurity about my capabilities to heal and help. Sometimes the only saving grace is the people I am sharing this experience with. 

I have created a bond with the volunteers that even now, in it's very early stages, I can recognize as lifelong. I'm learning that my insecurities about everything aren't just something I alone have to suffer with; each of us are overwhelmed, unsure, emotional and confident all at the same time. In this adventure, completely out of my comfort zone, I am surrounded by a group of people that will support, help, comfort and hug me. The walls I keep up to protect my vulnerability haven't come crashing down, but I am letting these women see a part of me generally reserved only for those very close. We joke, cajole, offer tough love and make fun of each other daily. I laugh often and wholeheartedly. The relationships I am building with my colleagues is challenging to express in words, it is a feeling I have of knowing this is a moment to be cherished in it's fleetingness. This is a small window of my life that will be closed sooner than I am prepared for, it casts a melancholy air but reminds me to stay in the moment and be grateful.          

Feel free to read other blog posts from fellow volunteers at: ARP  

❤- Terry

  

Thanks for reading. I'd love to say blogging on this website is super easy from my Ipad, but it's not. It's really a pain in my ass and I don't have enough internet to change blogging sites (nor really know how). I can't post all the cool videos and photos I want and since the internet in Nepal is veeeeeerrrrrrryyyyy slow I don't entirely trust that everything won't be lost. That said, I have posted many photos on the facebook, I think the link is public and I encourage you to take a gander. It'll really enhance my stories!! Click here to view my photos.