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. 

If you build it, they will come

I've been writing a little bit each day since we arrived in Kogate. This post is long, so get yourself comfortable and enjoy. We've been in Nepal for almost a month at this point, but it feels like longer. This blog post is a mix of observations and descriptions. It's my experience so far. If it's discombobulated, well, it's been written over several weeks. Thanks for reading and feel free to share your thoughts with me.  

The basics: I arrived in Nepal around noon on Monday, but by the time we went through customs, arrived at the hotel, showered and regrouped it was time for dinner. Exhausted, we all asked questions about the clinic and went over a few basic logistical bits before returning to the hotel to sleep. All jet lagged, we've been waking up around 3AM for the last week, the first night included.

Tuesday, we went to the temple mentioned in the previous entry as well as a pagoda. A lot has happened since then and details are lost on me. We went to two different art galleries in Kathmandu. Andrew is an artist and, unknown to many, Nepal is a gem of original art. I hope to buy several pieces if finances work in my favor. Wednesday we had a local man named Anil take us around town to various temples, including the Monkey Temple, and eventually to his art gallery. He is an artist of mandalas, amazingly intricate and detailed pieces of deities and meditation symbols. He also has a steady spiritual practice; by culture he's Hindu, but religiously he's Buddhist. He was very successful for a Nepali (or just in general I believe) and had a recent exhibition in China. He's only 24, but so ambitious I think life will be good to him. At least, I hope it will.

We also went to Durbar square, the oldest part of Kathmandu. Construction for this started in the 11th century, a time when the US was still untouched. When I visit places so ancient I try to picture myself there at that time. The smells, the views, the people, the sounds. I can never really do it and all I have are lame images from a movie- someone else's creativity imprinted as factual in my head. Either way, the square has architecture different than any other area in the city, but since I know nothing of architecture I'll say it just looked older than anything else. Thousands of people were crammed in this square that day in preparation for the Kumari festival, which started Thursday. Kumari is a living goddess and can only be seen by the layperson at certain times of the year. Kumari is usually a young pre-pubescent girl chosen around 5 years old and taken to live in a temple until she reaches menarche, then she is no longer a goddess and another little girl is chosen. The test to become this goddess involves being locked in a separate temple filled with 'demons' and if the little girl doesn't cry, scream or run away, she passes the test and is honored by becoming a goddess. There are no kickbacks to her family, not money exchanged, and when the little girl is no longer a goddess she is able to return to her family. Back in the day, despite the extreme honor of the title, the Kumari was destined to a life of poverty because after she is stripped of her title she is not allowed to work or marry. That has since changed, but could you imagine spending ages 5-13 in a temple, worshipped, guarded and honored, then return to your family?

There have been many hilarious moments on this adventure so far and I will do my best to describe them here. On the first day in Nepal we ate mo mo's, which are Tibetan pot stickers, and after I bit into one I looked at the piece and noticed half a decent sized bug remaining. The rest was in the bite in my mouth. Welcome to Nepal. I spit it out and felt a bit queazy the rest of the day, but no digestive ailments yet.

Another silly bit occurred when Allissa, another volunteer, and I went shopping in Thamel. Thamel is the touristy area in Kathmandu. The streets are crowded, all look the same and are lined with knockoff cheap outdoor gear, pashminas, yak wool, and various knickknacks. It can be overwhelming and it's very easy to get lost, which we did. We were supposed to be back at the hotel at 5:30 for a debriefing, but we were walking in circles unsure of where we were and not seeing any familiar markers (which aren't easy to spot). Allissa insisted we take one of the rickshaws back, I was resistant because I didn't think we'd fit but we took it. Rickshaws are bicycles attached to a small two person seat, I'll assume you can see them on the internet or around Portland if this doesn't make sense, but the seat is tiny and so was the driver. First of all, he didn't want to lose our business, but he didn't know where the hotel was. Secondly, I did not think this tiny little man could pedal us girls who combined probably weighted more than his entire family. Well, I was wrong, that dude hauled it, until we reached a small ramp in the road. The driver tried to gain as much momentum as possible beforehand, but we didn't make it. We started to roll backwards and I was certain we'd fall out. The driver jumped off, held the handlebars and attempted to pull, but his sandals had no traction and he just slid and we rolled back. The rickshaws are certainly not sturdy and we aren't light. We kept offering to jump out for this part, but he wouldn't let us and had to get help pushing, in total it lasted a few seconds but we were hysterically laughing the entire time. Once we make it up Allissa realized she knew where we needed to go, which was actually just around the corner. This made us laugh even more- from where we started we could have turned the corner and been back in seconds, but the ride was worth the 2 USD we spent purely because we laughed so much.

Thursday morning we left for the clinic. All seven volunteers squeezed into the equivalent of a clown car and prepared for a very long, bumpy, sometimes scary ride. We took videos of our reactions to the driver passing motorbikes on blind hairpin turns and of the roads. I hope to post a few when I have a reliable internet source. I wish the videos could truly convey how scary the roads can be at times. We were followed by a tiny truck carrying all the gear for the clinic. Several times we had to stop and wait for the truck to cool from overheating. When we passed Bhemphedi, the road, which is an overstatement, turned into riverbeds and steep inclines. The truck got stuck a few times and our van rolled backwards while the driver was out helping the truck. This was terrifying because I was in the very back and unable to abandon ship if necessary. Luckily, the driver placed a tiny rock under the driver side wheel, so we wouldn't roll anymore, but we still inched back. I guess these cars don't have emergency breaks... The ride was long and filled with nervous laughter. We made jokes about the snack we stocked up on (the Reese's Pieces and cookies I brought were a hit), the strange looks we received from locals, the roads and wondered what the clinic would be like.

To say the clinic is remote doesn't seem to convey how far we really are from anything. There is sporadic electricity, but no running water. The clinic building doesn't have electricity or running water. Dust is everywhere, even though we sweep constantly. The buildings are made of cinderblocks with screen-less windows. Massive spiders (larger than my hand, seriously, with fur! I am so terrified of them I can't sleep at night, but they don't bite) and leeches are everywhere (some leeches hurt, others are just gross and leave blood stain reminders of their presence). This is not a place for phobias. I haven't felt clean since I arrived in Nepal and I'm getting used to my own smell. At least everyone else smells too.

The area is beautiful. We have a million dollar views of mountains and a cool stream runs by. There are goats, chickens, buffalos and cows freely roaming the area. Corn stalks are turning brown across the water and the air is always damp. Clouds and fog roll in throughout the day and when the sun comes out it's hot. It smells clean here and there is no light pollution at night. It's been cloudy, but I know when it's clear the stars will be amazing. It's quiet, but sometimes I hear an occasional bus horn in the distance. There are no cars here. The buildings share the land with a school and the children peer in through the windows and watch us, but won't answer when spoken to. Instead they shyly back away, but come running back when we turn around. Their ability to watch us for hours is amazing, I wonder if these kids ever struggle with ADD. Then again, we are the first white people they have ever seen, not to mention we are moving into their space with strange things, speaking a strange language. I'd watch us too.

We are fed three meals a day and are served tea in the late afternoon. We had milk tea yesterday, which pleased me to no end, but it's not a regular occurance. The food is salty and filled with carbs and sugar. My body is adjusting, but I'm generally hungry about 3 hours after every meal and when I wake at 4AM I think it's from hunger. The beds are a finger-length thick pad on wooden frames and we sleep in sleeping bags. The bathroom is a squat toilet on the floor and we are very lucky to have toilet paper, but once they install a hose we won't get toilet paper anymore and will have to use water. There is no shower, but yesterday we set up a camp shower on the roof. I haven't used it yet; I'm waiting for the sun to come out. I've resolved to limited showering and hair washing maybe once a week, but that's a stretch.

We spent yesterday unpacking all the supplies and gear for the clinic. Then we washed and sterilized everything in bleach and boiling water. It was a lot of work. Setting up a remote clinic such as this takes so much planning I can't imagine the logistics of everything and something is always forgotten or doesn't work. We'll just have to learn to deal if we don't have it or get creative.

Signs have been placed all around the area saying "come see the famous white doctors!" We are called doctors here. Given what Andrew has been prepping us for, this is true. A doctor is a qualified practitioner of medicine and that is what we are. Andrew reminds us to take the acupuncture out of it, we are helping these people any way we can, acupuncture is our medium, but we are trained to do so much more.

We had training with the interpreters yesterday too. They are all Nepali, all very young and all scared. We are scared and anxious too. Two interpreters speak english very well and have worked with ARP for two years. The rest have never spoken to a native english speaker and seem apprehensive about their abilities. I'm apprehensive too. We are expected to treat 20 patients a day, that's 4 an hour, and the communication breakdown can slow us. It feels like we will be mostly doing triage style treatments for the first few weeks until we get to know our patients and become accustomed to the swing of things.

-----------------------------------------------------

Sunday was the first day we treated patients. It was overwhelming. My first patient was a 14-month old baby with a fever. The child was wailing and not happy to be there. I had absolutely no idea what to do. I've never treated a child and acupuncture isn't easy on them. Not to mention he was crying as though I was killing him. Later the other volunteers told me they were happy that child wasn't their patient. I just gave him liquid tylenol and told them to come back tomorrow. I hope his fever goes down and I hope he doesn't cry (side note, he did come back and he did cry, but his fever was gone). At the end of the day, self doubt and various ideas of things I could have handled differently pop into my head. I struggle to let it go and trust myself, but it's a challenge, especially without my support group from home. Everyone here is encouraging, but I think we all feel thrown in the deep end and expected to swim. I hope it gets easier or at the very least I become slightly more confident.

-------------------------------------------- week 2----------------------------------------

Day three of treating patients. I was in the weeds the whole day. I started with a challenging patient with dysmenorrhea. It feels impossible to diagnose patients. The interpreters don't know all the words I'm trying to use, and I have to think of different phases. For example, there is no way to ask if they have eye floaters. Sweat is a challenging word. The Nepalis are on a lunar calendar, which is completely different than ours. Therefore, their concepts of time are different. The interpreters have to convert what the patient says into our language and time frame, but I doubt the accuracy. Patients come in with menstrual issues, but every one of them says their cycle is 28 days. I doubt this. Plus, half the patients come in with "whole body pain". That is a broad subject.

Life for the locals is hard. Their skin in sun weathered and tough. The needles don't go in easily and everyone looks either really young or very old. I've treated two pregnant patients, one was 16 and the other 17- both married and living with their husbands family. A lot of the men here go to Dubai to work on the oil rigs, leaving very young women to live with a different family.

-----------------------------------------------

It's amazing how self image improves when you go weeks without seeing yourself in a mirror. My pants fit much looser, but I think it's because I don't have a dryer to shrink things back. If anything has been lost it's water weight. I do think I'm burning more calories than I'm eating and as it gets colder, my shivering will burn more. There isn't really any protein in the diet and the spoonfuls of peanut butter don't cut it.

Clothes washing is done in the river. We get a large metal bowl, dump in camp soap and a little lavender scented Dr. Bronners (not that it helps). Clothes go in a little at a time and we use our hands to recreate what a washing machine does, minus the spin cycle. Then the clothes are rinsed in the river and line dried. I don't think they are getting very clean and I think our technique could use some work. Scrubbing on a rock may eventually be in order.

An update to the clothes washing, we now let out clothes soak in a bucket of soapy water all day. This technique is less laborious, but I miss the scent of fresh washed clothes in a washing machine. I miss good smells in general.

----------------------------------------------

My stash of Reese's Pieces is getting smaller and I dread the day they are gone. Chocolate is a necessity here and each day after lunch I allot myself 5 little pieces and yearn for more the rest of the day. I bought granola bars in Kathmandu for backup, but when I tasted one I did not like the flavor and doubt I'll end up eating them. I also bought spicy peanuts. This may not have been the best choice. Sugar is what I crave. I'll soon have to start eating a spoon full of peanut butter, but it's not sweet and doesn't quell my sweet-tooth.

--------------------------------------------------------------

We are operating three clinics; one in Bhimphedi, one in Kogate and one in Ipa. Bhimphedi is pretty close to the size of a village and has been the most crowded clinic. From the day it opened they have been slammed, treating over 40 patients a day with only two practitioners. Here at Kogate, with 4 practitioners, we've averaged about 34 total a day. All I can say is I'm glad I'm not in Bhimphedi, but we have to rotate at each location and I'll soon have to spend a week down there. Luckily, we'll have three practitioners there soon; maybe then it won't be as overwhelming as it sounds.

There is a satellite clinic in Ipa, a region we have to hike over an hour to get to and we have to carry all the supplies we'll need. The path is "Nepali flat", which means it's arduous and far from flat. We climbed up, then dropped all our elevation, only to have to gain it again. The views are stunning- when it's not cloudy. We wanted to be able to see the Himalayas off in the distance, but it was too hazy. Andrew and I walked to the clinic with Ratesh, the most fluent translator. I was sweaty and tired by the time we reached the clinic. It just so happened to be the warmest day yet. We treated 29 patients. Andrews interviewed the patients while I scrambled around on the floor needling them. The clinic in Ipa is operated in a school. We have several chairs set up and a mat on the floor if we need to treat abdomens or backs. Keeping with the theme in Kogate, there is no electricity and no running water in the school.

Nepalese have hard lives. They hike up and down the mountains carrying ridiculously heavy loads of grains, vegetables and various grasses to feed livestock. At Ipa, most of the patients complained of knee pain, which acupuncture treats with high success rates. We use the electric stimulation machine attached to needles in the eyes of the knee. Most patients felt a little better after the first treatment, but still had to hike back home, sometimes over 4 hours away.

After a busy day at the clinic we still had to hike the difficult trail back. My back was sore from sitting on the floor all day and I felt exhausted. I swear my pack felt heavier than it did that morning. I was hating life for the first half hour of the path. The elevation makes me winded (or as my Australian colleague says, "puffed"), plus it was dark. The trail seemed even more difficult when we couldn't see what's ahead. I was exhausted by the time we made it back. I even took a super cold shower in the dark afterwards because I felt so gross. Believe me, that says a lot.  
---------------------------------------------------------------

It's currently Friday, the clinic opened last Sunday. We are getting in the swing of things and people are coming. Earlier this week some government officials came to the clinic. They took video and photo of us, asked questions to the interpreters and had a none too friendly way about them. Turned out they gave us some bad press on TV, but printed a positive article in the newspaper.

Nepal had a revolution in 2008, Maoists took over, making promises of improving the country and equally dividing wealth. Of course, this didn't happen. There have been no elections since the take over and the country has only gotten poorer, which doesn't seem possible. Supposedly there is to be an election this year, so all government officials are spinning their propaganda, including negative press about helpful acupuncturists. I don't think the election will actually happen.

-------------------------------------------------------------------

Many of the patients come in for pain, gastric issues and fever. I've also noticed many of the children have sores and scabs all over their bodies, I don't know what from, but I'm guessing poor hygiene is a large contributing factor. Two patients presented with what we are guessing is impetigo, a highly contagious bacterial skin infection (think MRSA).

We also get to drain many carbuncles, boils and various other puss related issues. I say we, but what I really mean is someone else. Just talking about it in our classes makes me want to gag. I'm sure I'll eventually have a patient with a puss-filled something or other, but I haven't yet. All the skin issues the patients come in with really makes me want to compulsively wash my hands. We're supposed to palpate pretty much everything, but touching a dirty scabby leg really takes me out of my comfort zone. I'm sure by week 7 I'll be an old pro at squeezing ooze out, but right now I feel trepidatious.

One practitioner had to pop a pingpong sized cyst on an elderly woman's ankle. I didn't witness the actual popping, but I treated the same patient a few days later. We had to drain it again, but I had help and only clearish-cloudy liquid came out.

There is another patient with a huge lump the size of a baseball on the back of his neck. A few of the practitioners were very excited at the prospect of popping this, despite my reservations about puss, I would definitely watch. Upon further inspection we realized the mass is vascular, which means it has a blood supply and we can't pop it. It also increases the likelihood it's a tumor and not a cyst.

-----------------------------------------Week 3---------------

A few nights ago the sky released a fury that I haven't seen in years. The rain poured down and lightning flashed all around. Given our elevation, we were particularly close to the flashes. It was a little scary, but lovely at the same time. The storm happened at 2AM; we found out the next morning that two buffalo and a goat were struck by lightning and a man fainted- so the locals say.

I love thunderstorms and they are a regular occurrence.The only downer is if we have to hike to Ipa in the rain, that's not fun. Allissa had to do this and she came back with 7 leech bites and at least five more on her pants.

I can see a mountain peak from my window and last week I declared I would hike to the top. Earlier I'd seen a wicked switchback trail up to it and since I'd made the claim I figured I better follow through. So, when everyone else was watching Crazy Stupid Love on Saturday I decided to hike up there. Now, I made the mistake of not telling anyone I was going and sort of just wandered off. Not my brightest moment, but it was really nice to have some time alone.

The hike crossed the stream and climbed up to a ridge-line. I discovered another trail leading up to the mountain and figured I could take the switchback trail down and back to camp creating a nice loop. Well, I went rogue towards the top, lost the trail and just wandered up. I felt like I was in the Sound of Music. The peak had patchy grassy areas and provided views of all the valleys around. I was awestruck. I could see a hawk soaring below, the clinic, another river and the beginnings of the Kathmandu valley. Unfortunately, clouds began to roll in and I could hear thunder. The top of one of the higher peaks around is not a good place to be when a storm is coming. Since I'd deviated from the trail I couldn't find the one I took up, but I could see the stream that passes our home in the valley below, so I headed in that direction. The fog rolling in made visibility a challenge and I started to panic a little bit. I hiked past some grazing cows and found a trail. All I could think was how dumb it was not to tell anyone where I was and how awkward the conversation would be if I tried to ask a Nepali for directions. I cursed my inept language abilities and walked a little faster. As many impending storms do here, it dissolved before reaching me and I lost elevation fast enough to release my freak out. I made it back fine, although I did find a nasty orange leech (the kind with a cruel venomous bite), but it was only stuck on my skirt and hadn't settled in on my skin yet. They bite trough clothing, so you're never really safe.

---------------------------------------------------------------

At the end of my shift yesterday I had a patient come in with a wound. It was a three-year old girl who had fallen while playing with the"bigger" kids. She had an almost three inch gash across the lateral side of her forehead. The bone was visible, but the blood clotted enough that the bleeding had stopped. My first reaction was, "that needs stitches. Now." But Bhimphedi is too far away and the bus only goes once a day leaving Kogate at 7AM and returning at 5PM. The mom and little girl's only option was to come to us. I decided to clean the wound and told the family to go to town first thing in the morning, even though stitches would be more of a challenge at that point. The girl was such a trooper, she only winced a little when we cleaned in the wound, a single sad tear dripping down her cheek. I hope they come back after having the wound addressed so we can see how it looks and make sure it's not infected.

--------------------------------------------------------------

We constantly have patients who have never been to a doctor. Ever. So we are the first to see whatever their ailment is. I treated a woman with a softball sized palpable mass in the right lower quadrant of her abdomen. Sometimes the pain was sharp, sometimes not. I wanted to tell her to go get that checked out immediately, what if?? What if it's cancer? What if it's a tumor? Uterine fibroid? I have no idea, but I'm treating it. She's coming in twice a week for 10 visits, let's see what happens.

Andrew always says the first thing to really get to know an ailment is to look at it and touch it. A few weeks ago when we were unpacking and cleaning clinic supplies we noticed speculums of various sizes. I remember thinking, why do we have these? School did not prepare me for vaginal exams! Or really a lot of the physical exams we might have to do- genital or otherwise. I have a woman coming in with hemorrhoids and I'm a little nervous I'll have to take a look...

-----------------------------------------------------------

I'm starting to get regular patients. I haven't had any break through, amazing healing moments with anyone, but I'm hopeful it will happen soon. The patients come in and say they feel a little better, but that's not measurable and I wonder if they just say it to be nice, when really nothing's changed. This is where all those orthopedic exams come in handy. I lament brain dumping after all those tests we repeatedly learned in school. Luckily, we have classes here reviewing a few. This week we talked about knee pain. Everyone here has knee pain. Understandably, the terrain is rough and they squat all the time.

---------------------------------------------------------------

Stray dogs run rampant. They all have a similar look about them, but the coloring is different. A curly tail, fluffy dirty dreaded hair, adorable faces and a perpetual puppy mannerism. It's difficult not to pet or feed them. They sleep in curled up little balls in the middle of roads and walkways. The Nepalese don't keep dogs as pets- they throw rocks at the strays and kick them. All of us volunteers become irate at witnessing this. Animal cruelty is never ok, but we have to realize we are visitors in a culture different than ours.

There is one adorable little pup that lives around our compound. He has a fluffy black and white coat, hot spots over his body and goopey eyes. I'm sure he has a nasty infection in his eyes and may even be partially blind. I feel bad for him, but at the same time I can't help him either. I just coo at him when I seen him and make sure he knows I'm not a threat to his wellbeing. It's nice to have the pups around, but I miss cats and haven't seen any since I arrived here. I think their fate is worse than the dogs.

-------------------------------------------------------

Rockshi is a locally made liquor. It's flavor is part moonshine, part rubbing alcohol. Every time I took a sip I got goosebumps. It smells and tastes terrible, but surprisingly get better the longer it breathes. By better I mean bearable, it never gets good. It's fermented grain, either millet, corn, barley, whatever they can find around here; corn being the most abundant. I didn't drink much, I couldn't, the taste is too rough. But a huge bottle of it is only eighty cents, so if a difficult week creeps up, I may have to fork up the big bucks and have a few sips.

Last Saturday we had a bonfire, listened to the interpreters play guitar singing Nepali folk songs and passed a few bottles around. Lightning bugs floated around us casting a magical air around the group. It was lovely.

-----------------------------------------------------------------

We laugh all the time. It makes dealing with the challenging situations bearable and is a stress relief. Unfortunately, not all of us are having a fabulous time. It throws a wrench in the group dynamic to have one person unhappy, but then again, one of the best ways to grow is to persevere through uncomfortable situations. Take away our ability to easily distract from what we desperately want to ignore and we either complain or deal. Haley, a fellow volunteer, has a bracelet that says,"Harden the fuck up". It has become our group motto, in the most loving and caring manner. When we have to hike to Ipa, we take one of the bracelets. When we complain, we remind each other to harden the fuck up, then laugh. It's not easy being here, but having a group all feeling the same and supporting each other is worth the discomfort.

-----------------------------------------------------------------

It's currently a cloudy, drearily lazy Saturday. Yesterday we hiked 3-hours from Kogate to Bhemphedi to meet up with the group down there. We could have taken the bus, which in hindsight would have been the better option, but we slept too late and missed it. It was raining when we hit the road and continued for the rest of the hike.

I go to great lengths to avoid leech bites at this point. I've had a few, including an unfortunate one found on my upper thigh happily sucking away. The bites don't hurt when the leeches are present, but they release a chemical slowing blood clotting which leaves a large bloody mess alerting you of the violation. A few days later, the bites start to annoyingly itch.

The hike down to Bhimphedi was filled with leeches. At one point I found well over 15 on my boots. While I no longer scream and beg others to get them off me, I do feel gross to have so many on my person and resolve they all must die a violent death. Immediately.  

We don't have the internet in Kogate. We've tried with several different techniques, but each raises our hopes just enough to crush our dreams of contacting the outside world when technology refuses to appease. Yesterday we learned the clinic in Bhemphedi has internet. It works sporadically and reminds me of the days of dial up, actually, it is a dial up connection. If you remember this time in the early internet days then you also remember the tests of patience required. All four of us crouched around someone's laptop sending the internet gods our most positive vibes in the hopes of receiving just a word from home. Luck was on our side and I was able to contact my mom and boyfriend (they were even awake and responded!!). Hearing from home always leaves me homesick, something I'm pretty good at suppressing given our lack of contact with anyone other than each other.

Bhemphedi is like another world compared to Kogate. It's an actual town with shops, cars and buses. The clinic down there has electricity, but I didn't get to see it because we went straight to the house the volunteers live in and tried to use the internet. We took the bus back up to Kogate in the afternoon. It's been a long time since I took a bus in the third world. It was crowded with people, large sacks of grain or what appeared to be sawdust. Goats were shoved in the undercarriage of the bus and those passengers who couldn't fit in the bus road on top. The bus stopped often, with each stop the crowd thinned just a little. We are the last stop on the bus line and were in it for the long haul. I listened to my iPod and when one of the ear buds fell out of my ear, a little girl sitting in the isle on a sack of rice placed it in her ear. Eventually everyone wanted to listen. I don't think they liked my music choices, but I enjoyed watching the excitement on their faces as they passed the iPod around the bus.

-----------------------------------Week 4---------------------------

I'm finding it hard to be in the moment. The days are long and tiresome. I haven't meditated and when I go hiking I'm not processing what I've seen. I think about the beauty of the scenery and how I don't want to reenter the real world- not that I am for a while. I love being out of a city. There are literally no cars here. Occasionally we see a plane fly by, but mostly it's just the sounds of nature, people, cows, buffalo, goats, chickens, dogs and bugs.

At night we scream, we call it night screaming. It's amazingly therapeutic. We just stop out into the dark and scream as loud as we can. One of the translators, Ratesh, does this nightly and introduced us to the idea. It might sound strange, then again, life here could be considered strange to anyone not experiencing it.

The power goes out often and while it's annoying when it goes out during dinner or a lecture, it's great for sleeping. It's a darkness I haven't been in. The cloud coverage and elevation block any chance of moonlight. I can't even see my hand a few inches from my face. We keep candles and headlamps handy at all times.

I leave tomorrow to hike in the Langtang region of the Himalayas for 10 days during the festival mentioned several posts back, I'm already looking forward to having internet again!

I've arrived!

Jet lag is a cruel beast. I've been in Nepal for two days and fatigue has set in. My body clock has no idea what time it is. I want to sleep at two in the afternoon and wake a 4AM. Actually, that's not much different than my normal insomniac tendencies, but it's 5:30 in the morning now and I'm wide awake. I can see the grey light of morning seeping through the window getting lighter as I write. Car horns are slowly beginning to beep like alarms and the quiet of night it dissipating. What better to do than write an entry...

I saw bodies burning next to a river yesterday. We have a few days in Kathmandu before we head to the clinic and sightseeing is the objective. Andrew, the leader of the group and founder of the Acupuncture Relief Project, is serving as our tour guide. He took us to Pashupatinath Temple. The temple is on the banks of the Bagmati River, which eventually feeds into the Ganges, the holy fiver. Along the river are funeral ghats, platforms where bodies are burned. This is a Hindu temple and according to their belief, reincarnation is constant. The soul lives forever but the body is merely a vessel for this lifetime. Therefore, when one dies the body is nothing and burned the day it dies. Death is as honored, acknowledged and ceremonious as life. When someone in the family dies, a male in the family must light the initial spark of the fire and also must offer a small bone from the departed to the river before the ashes are dumped. Women are not usually present, I was told this was because up until the 70s wives were still burned along side their husbands, whether they wanted to die or not. I'd avoid the ghats too.

On the opposite side of the river were temples devoted to fertility. This speaks to the close relationship Nepal has with life and death. I wish my culture would honor death in a similar manner, then perhaps I wouldn't fear it as much as I do. I feel we avoid the inevitable, hide it and try to pretend it didn't happen. Sometimes funerals feel like just another task to take care of, instead of an honoring of what was lost. Previous to arriving here I decided this trip would be somewhat devoted to understanding my own relationship with death. I don't necessarily fear my own death, I've somehow maintained the ridiculous idea that I'm immortal, which translates to a lack of acknowledgement of my own mortality. Instead I fear the death of loved ones and my inability to deal. My grandmother passed last year, this was the first close relative I've lost, which is rare for someone 30 years old. Since then I've had perhaps an irrational fear of others dying. I'm not ready. I like things as they are. I believe this life isn't all there is and reincarnation is definite, but I do believe the relationship I have with everyone in this lifetime is all there is until the next one. The void left behind when someone is no longer alive feels vast and empty. It's something I cannot control, which means I have no concept of how to handle it. Acceptance and surrender are probably required, but until then I'll fear what will come no matter how prepared I am.

The temple we visited is a pilgrimage site form Hindus and also a world heritage site. We weren't allowed in the larger temple, that is reserved for Hindus only, but the top is gilded in gold and there a jewels inside, which armored guards monitor. Animals are sacrificed, regularly, except cows. We had a local tour guide tell us many things, most of which I cannot regurgitate, so please take a look at http://en.wikipedia.org/wiki/Pashupatinath_Temple.

Today we are going to places I visited last time I was in Nepal- the Monkey Temple, AKA the Swayambhunath Temple, and Durbar Square. Feel free to google, because I have no information about them, only pictures from a previous visit.

I've posted pictures on my Facebook page, I am trying to use a tablet while I am here and it's proving a challenge to post photos with this blog, so please look there and friend me if you are not able to see them. https://www.facebook.com/terry.atchley/media_set?set=a.916838551235.1073741829.20402772&type=3

This is it.

I have a favorite movie- Eternal Sunshine of the Spotless Mind. I love it to point of memorizing lines, a habit making it annoying to watch with me. I mention this because there is a moment that truly sealed the deal for me. The general plot, for those who haven't seen it, is the story of a breakup. Joel and Clementine have a tumultuous relationship and after a torrid fight, they break up. Clementine participates in a procedure that erases every memory she has of Joel. Subsequently, Joel finds out what she did and wants the same procedure preformed on him. Long story short, the memories are erased in reverse order form the drunken fight leading to the breakup to the initial meeting. Half way through, Joel trudges through the good and the bad memories. In the end, he no longer wants to erase Clementine even though he is heartbroken the memories are cherished. This is where my favorite part comes into play.

It is the initial moment Joel meets Clementine. In a shift from how the meeting actually occured, the present Clementine tells Joel:

Clementine: This is it, Joel. It's going to be gone soon.
Joel: I know.
Clementine: What do we do?
Joel: Enjoy it.

I say this because- this is it. I'm on my way and not matter what happens, I better enjoy. It'll all be over too soon and I'll be left with memories, photos and possibly a parasite (but let's hope not).

I'm currently flying to L.A. for my first of two layovers. I'll be traveling for almost 24-hours, from Portland to Los Angeles, Seoul and, lastly, Kathmandu. I've spent months preparing for this trip. Trying my best to complete every meticulous detail of every aspect of my life. Six months away is something I never thought twice about. No big deal, catch you on the flip side with awesome stories and pictures most who weren't there will never want to see. But this time is different, more challenging and heart-wrenching. Maybe it's because I've experienced a great deal of loss and transition this year. Maybe it's because I'm getting too damn old to drop everything and leave. Maybe it's because I have many reasons to stay. Either way, I can honestly say I am excited for the experience and terrified of what I am leaving behind. I miss my cat. I miss my boyfriend. I miss my friends. I miss my family. I have missed these things for weeks before I even left. I hope that mitigates the longing while I am away.

I can say I feel lighter now that I am on the plane. If it's not done, it's not getting done. I tried my best to contact everyone so I could to tell them goodbye and if I missed you, I'm sorry. I finally have no distractions. No chances of getting one last little task done. I can devote all my attention to what is ahead of me. Treating patients. Coming up with lesson plans. Trekking. Helping people. Fantasizing about spending my birthday, which is several months away, on a beach or surrounded by monkeys. I'm off, let the adventure begin. This is it! Enjoy!

Nom Nom Nom...

I have only $1,000 left to raise!! Please consider making a donation or spreading the word!! Thanks everyone! 

Donate HERE!
Or you can mail donations:
Acupuncture Relief Project
C/O Terry Atchley
925 NW Hoyt St. #523
Portland, OR 97209


I've been dreaming of food lately. Actually, not only dreaming- I'm becoming a glutton. Yep, that's right, glutton. It's not a nice term, when I hear the word I picture Jabba the Hutt or that dead guy from the movie Seven. Gross. But seriously, I've been imbibing in every single craving. Cheeseburger? Don't mind if I do! Pizza? Hell yeah. Anything fried? Give it to me! I am an eating machine. Mom says I'm storing up, which I can't completely deny. I won't have access to any typical American food in Asia. Hell, I'm pretty sure I'll avoid meat while I'm there (keep reading for an anecdote to further the obvious reasons why meat might be avoided in a hot country without refrigeration). Anyway, after three years of learning all facets of health, including dietary changes, I find myself feeling physically gross and mentally beating myself up for eating poorly. I'm in a downward spiral of deliciously unhealthy food and I can't stop! Surrender is the first step in recovery, therefore, I surrender to the food gods. I will eat what I want for this week, then pull it together, just one more plate of fois gras, I promise. I can quit any time...

Action shot of poopy tail slap.

Post poopy face slap.

Last time I was in Nepal I saw a goat slaughtered. I didn't want to, but it's not something one can look away from once it started. The orphanage had goats, a water buffalo with her baby, and an anorexic looking cow. The water buffalo produced milk and I was able to milk it, once, until her poop covered tail slapped me in the face. Never again. I also had the fortune of seeing the cow artificially inseminated. 


I digress, back to the goat story- I'm not sure why the orphanage had so many goats and while I was there five more goats were born. They were adorable and spastic. I just wanted to cuddle with them as though they were kittens, but goats are not cuddlers and they're bony. For a week, Laxmi, the president of the orphanage, would point to one particular goat and say, "that's the one" and make a motion of slitting her throat. I didn't get it. I also didn't get the point of all the goats. They were herded out each morning to the recently harvested rice paddies and allowed to eat all day. They made a ton of noise, used every inch of the property as a personal toilet and really didn't contribute back. Well, that one poor lil' guy did.

At the end of one of the festivals there is a tradition of slaughtering a castrated male goat. I'm not sure why, but better to appease the gods than leave them angry. It is also one of the only times during the year that people eat meat. It was very ritualized and humane. The goat was honored, thanked and beheaded in one foul swoop. The fur was mostly removed with boiling water and it looked like every single inch of the body was used in a curry dish, with the exception of the legs. The legs were left out in the sun to dry into some type of jerky.

At one point, prior to arriving in Asia, I considered myself a moderately adventurous eater. Well, I'm not. Textures get to me. This dish was particularly chewy and there were bits of meat with skin and fur still on it covered in curry. I couldn't handle it. I felt myself gagging. Not finishing a plate seemed much too rude, especially given the sacred nature of the meal. I ate as much as I could, then tried to pass the rest off to the person I was traveling with. When that didn't fly, I tried in the most stealth manner to dump the rest in the catfish pond behind the squat toilets. Side note, they had a catfish pond. I think the only purpose was to dump certain meat related food scraps. Vegetarian food scraps went to feeding the goats, buffalo and cow. 

The goat slaughter was traumatic and sad. I can't handle meeting my food before I eat it. If someone were to kill and eat me, I certainly wouldn't want to meet them beforehand. The goat curry was served for about three days, none of that time was it refrigerated. It wasn't even cured meat. Just cooked meat, hanging out in a metal bowl with a plate covering it. We ate it. I'm still alive, so I guess it's ok. 

Walking through markets offered another opportunity to see meat in various slaughtered states. Pigs hung ass up draining blood, chickens being de-feathered, goats tied loosely to a pole waiting patiently for their fate. I swear if I didn't love meat so much I'd quit eating it after this experience.  

The typical dish in Nepal is Dal Bhat. Below is something I previously wrote about this meal:

"Everyone in Nepal eats Dal Bhat, which refers to a meal consisting of steamed rice (bhat), a cooked lentil soup (dal) and curried vegetables called Tarkari. This meal is eaten twice a day, generally mid-morning and early evening. The Dal may be cooked with onion, garlic, ginger, chili, tamarind, coriander, garam masala, cumin and/or turmeric. I've also had Dal Bhat with yogurt and some portion of pickled fermented very spicy veggies.

I ate this meal daily at the orphanage and loved it. I craved it for months after returning home, even though I ate it every single day for three months. In cities with a few more food options, the locals would still only order Dal Bhat. Could you imagine choosing to eat the same thing everyday, forever? I feel this speaks to the deliciousness of the meal. 

This is generally eaten with your right hand, as all meals are. Variations of flat breads are an great accompaniment to sop up all the yumminess. Dal Bhat Tarkari is a healthy, versatile meal."  

I still love Dal Bhat and I look forward to eating it again soon. In fact, I loved almost all the food I ate in Nepal. I did start to crave meat while I was there and, oddly enough, yellow mustard. I yearned for yellow mustard, not djion, not spicy, just plain old boring yellow mustard. I wanted to put it on everything, only yellow mustard was not available. I didn't see any type of mustard available anywhere.   I rarely eat mustard at home. I certainly don't crave it. It's not even my favorite condiment. I convinced myself I was clearly malnourished and it was manifesting as an intense mustard craving. To this day, I still believe that even with no evidence to prove it. I wonder what I'll crave this time around.  

There are no chain restaurants in Nepal. I never saw a McDonalds or Starbucks. Hell, there isn't even coffee in Nepal. Ok, that's an exaggeration, there is coffee available in touristy areas, but I hear it's not good. Besides, why waste your time drinking crappy coffee when so many great teas are available. Milk tea was my absolute favorite. It was essentially chai tea brewed in milk with sugar. It was heaven. I drank it every chance I had while away from the orphanage. The orphanage offered us tea each morning, but it was different. Their's was black tea seeped in water with sugar and salt added. It tasted so strange and initially I thought it was gross, then I started to tolerate it more. I never fully loved it and constantly thought about milk tea.

Lastly, I fell in love with lassi. Lassi is a drink made from yogurt, fruit, sugar and water. Now, at the time of ordering the first lassi, when the love affair began, I didn't know they were made using unfiltered water. Had I known this I probably would have avoided them, but the relationship began; I was hooked and I couldn't turn away from the sweet nectar. Mango is the best flavor ever!! I cannot wait to drink those again. 

At the orphanage I filtered every ounce of water I drank. This was such a laborious pain in my ass that I considered not doing it. Just at my weakest moment I'd see a child with explosive diarrhea and reconsider. Touristy places offered filtered water using a ceramic gravity filter and, as I've stated before, I did not get sick while I was there. This time I hope to have the same luck and to maintain my fastidious water drinking habits throughout my Asia travels. SE Asia makes me much more nervous than Nepal when it comes to food and water consumption, but I'm sure I'll have more to say about that while I am there. 

Who put the fun in fundraising??

I believe I have an estimated $1,900 left to raise before I leave for Nepal on September 14th. I greatly underestimated the amount of time, work and extreme stress this ordeal would cost me. Fundraising is hard. Duh. Yet, I thought it would be a breeze, perhaps because I was told every volunteer (almost) always raises all the money needed and I didn't really need to worry too much. Either way, I am eternally indebted and at a loss of words to fully express my gratitude to the people in my life donating and following my travels. I find myself walking around with a smile and I am filled with appreciation and awe. 

Recently a few people interested in volunteering with ARP next year have asked for advice on fundraising. While I do not consider myself an expert at this and I question whether I will raise all the funds necessary; I can share what I've learned over the last few months. 

First of all, I annoyingly posted an endless amount of links on Facebook, probably to the vexation of my FB friends. Upon initial posting the money came rolling in! This was a deceiving occurrence, eventually most people donated and there were several weeks of stagnation. Nothing happened and I realized I had to work way harder. Now, I'd like to think that if I wasn't a full time student, taking board exams and struggling with 12-hour class/clinic days, that this might not have been so laborious, but I doubt it. The stress with school combined with the self-created stress of worrying about fundraising really put a damper on life. Every experience was a new opportunity to ask people for money, but I didn't. I created a motivational song to help myself- to the annoying tune of "Call Me Maybe" (Hey, I just met you and this is crazy, but here's my number, donate? Maybe?) No, I never actually sang it aloud and would berate myself when I felt I missed an opportunity to ask for money. 

I grew up in the south, where social formalities are widely followed. You don't talk about money, politics or religion. Therefore, asking new acquaintances for money? Way too taboo. Additionally, I'm not a schmoozer, you know, the type that seem to instantly build a rapport at initial meetings. My friend Katherine once said, in an attempt to explain my personality to someone I had not met, "Terry's great, she'll insult you within the first five minutes of meeting her, but you end up loving her!" Not everyone would find this endearing, but I do because it's true. 

I also heard tales of others holding grudges against those friends and family members opting not to donate. This could be a huge downfall and an unnecessary burden. I'll admit I was disappointed when people I thought would contribute did not, but the overwhelming number of people that did donate erased all unsupported feelings. I do not have the space to hold resentments and I am sure those who did not donate have their reasons and it's not up to me to judge. Instead I hold great admiration and love for each person contributing- from those donating $5 to $500. 

For many weeks I was stuck in a terrible state of uncertainty on what would be the most cost effective was to raise money. I didn't want to throw a party, which I think would have cost too much of my own money. Not to mention the embarrassment if no one showed up! Furthermore, I am not from Portland, so I don't have the established networking base. My friends are sprawled across the country and the people I do know in town are students, like me. We don't have any money. 

My saving grace was a gift card donated from Le Pigeon. My partner is one of the sous chefs there, so I had an in. Not to mention the restaurant maintains an outstanding reputation in town and has some of the best food I've ever tasted. When I received the gift card I figured I better do a raffle, but I needed more stuff to give away. 

I consider myself rather shy with people I don't know. After the first time I met my partners parents, his mother described me as quiet, to which my partner said- "are you sure you met Terry?" Needless to say, I take a minute to warm up to people, after which I guess you can't get me to shut up. The task of going places, explaining what I needed and waiting for a response terrified me to the point of insomnia. I chose places I would like gifts from and ventured out to ask for contributions. To my surprise, places were extremely nice about it. Some handed me a gift card on the spot, others gave me business cards to the marketing departments. The best and most surprising came from those around me. Being in acupuncture school linked me to acupuncturists, massage therapists and even a chiropractor. Each willing to donate a treatment! 

The last bit was finding people to buy the raffle tickets. Campus was the perfect place. I avoided asking people at school for donations directly to the ARP because I figured they were in the same boat as me. Penniless. But the raffle tickets took off! 

I also included a pre-stamped envelope and a note about the ARP with my graduation announcements. At this moment I can report I have only received one of those envelopes back, but I compulsively check the mail daily. Lastly, my parents and friends have helped tremendously. My dad tells everyone he works with and my friends post on Facebook and share emails. 

These are just the bits I've done and I'm sure the other volunteers have equally helpful tidbits and stories. I hope those considering volunteering are not deterred by fundraising. It's a challenge and not always fun, but I absolutely love the feeling I have when I see new donations or tell people about this organization. This feeling outweighs all the stress and anxiety associated with asking for money. It's profound, warm-and-fuzzy like a hug, it's a feeling of being loved.  

If you would like to donate to the Acupuncture Relief Project: HERE

OR you can mail a check to: 

Acupuncture Relief Project

C/O Terry Atchley
925 NW Hoyt St #523
Portland, OR 97209

The end is the beginning.

When I was little I loved the last day of school. The excitement from the completion of another year, the sheer  anticipation of three whole months of nothing, the sound of Alice Cooper's "School's Out" always playing on my radio. College graduation was equally exciting, with feelings of pride and accomplishment thrown in the mix and topped off with several nights of heavy drinking. Ah, the days of a quick recovery from too much booze. I do miss those days. With undergrad I was scared of entering the real world, but maintained an idealistic stance that anything was possible. Then Hurricane Katrina happened and nothing seemed possible. My path took several turns, most of which were completely unexpected and truly amazing. I can gladly say I spent my 20s sometimes aimless, sometimes driven, but mostly doing what I wanted as I saw fit. 

This year, not only did I turn 30, but I'm also graduating from a demanding masters program. Life as I have known it will never be the same. The last three years have been humbling, uplifting, torturous and at times joyful. I certainly did not have nearly as much fun as I did in my formative educational years. I feel like I am waiting for it all to sink in. The debt owed. The uncertainty of my future. The endless to-do lists running through my head. I feel preoccupied with the immediate tasks of fundraising, preparing to leave the country, filing out paperwork and writing checks for licensing. After Nepal I am going to SE Asia for three months to relax, see some cool sights, eat some exotic foods and recover. But what about right now? Am I missing it? Is it all passing me by? The magnitude of what has been accomplished is lost on me. I mentally checked out from school weeks ago. I've devoted the little free time I've had scheming on ways to ask people for money, a task which takes me miles from my comfort zone but has prepared me (a little) for becoming a small business owner. I'm preparing for the next step but terrified to take it. 

This week I'm trying to stay in the moment. It's challenging. There is a little voice in the back kicking up a stink about things I should be doing, but I am choosing to ignore it. Right now, for as long a possible, I am focused on this great achievement. I encourage all of you who are graduating with me to do the same. Let's relish in this for just a second, then continue on with that pesky to-do list.   

Trekking!

I'm taking a class on public health and today the lecture was on AIDS/HIV. In Africa and parts of Asia, AIDS is endemic, meaning it's found regularly in the community. Most of the children at the orphanage told me their parents died from AIDS. I heard rumors the disease traveled to Nepal through sex trafficking in India. Many times this disease is co-infected with Hepatitis B and tuberculosis (TB). TB with AIDS is the leading cause of AIDS related deaths worldwide. Apparently there are several types of TB, including types that are extremely drug resistant (this past month a total drug resistant form was discovered in India). 

Places without proper healthcare tend to have populations misusing the tuberculosis drug treatments. The treatment can last up to 9 months and the costs are significant. What does this matter? Can acupuncture cure these diseases? Well, no. We can't cure immune-compromising diseases. Fortunately, one of the requirements while I am at the clinic is to educate the local staff by teaching a class on blood borne pathogens and clean needle technique. The staff will then be able to educate the local community.   

In regards to treatment for AIDS, acupuncture can help patients by boosting their immune system, relieve the symptoms of the disease, and reduce the side effects from the medications. Although, in developing countries, I doubt patients diagnosed with HIV/AIDS receive the drug cocktails available in more developed countries. Acupuncture offers low cost treatment for various diseases, in contrast to western medicine which can use high cost medications to treat illness. Ideally, using eastern and western medicine would be the most effective form of treatment. At the clinic we are opening in Nepal, these patients are able to receive treatment free of cost. They can come every day, every week, for the entire time we are there and not pay a cent (or rupee as it were). 

I've been getting vaccines over the last few weeks, but diseases like TB, Hepatitis C and AIDS do not have a vaccine. I push these scary facts to the back of my head. But, having anything traumatic happen in a third world country is way worse than if it were to happen at home. I don't say this to be morose, but it is something to take into consideration. I am actively choosing to put myself in an at-risk population in order to help those who do not have access to healthcare. I am doing this because I want to. I can close my eyes at night and picture the faces of the children, the homeless begging and I want to help. Acupuncture is my medium and fundraising is how I will get there. Please consider making a donation. If you already donated, ask someone you know to donate. 

Donate HERE!

If the ARP website is having glitches, cash and check donations are always accepted!! Feel free to mail donations to:

Acupuncture Relief Project

C/O Terry Atchley

925 NW Hoyt St # 523

Portland, OR 97209

Checks can be made out to The Acupuncture Relief Project.

On to my favorite activity- trekking! The clinic will close for several days in honor of the Diwali festival, therefore we have time to trek in the Langtang region. I do not know much about this trek, but what I do know is we'd start at 1670m and hike up to 5050m, the trek will last about 10-days and go into the Himal region bordering Tibet. The Langtang valley is sandwiched between the main Himalayan range to the north and a slightly lower range of snowy peaks to the south. Langtang Lirung (7246m) dominates the valley to the north; Gang Chhenpo (6388m) and Naya Kanga ri (5846m) lie to the south; and Dorje Lakpa (6966m) protects the East end of the Valley. This high and isolated region is inhabited by Tamangs whose religious practices, language and dress are much more similar to those of Tibet than to the traditions of their cousins in the Middle Hills. By the way, this trek is paid for out-of-pocket, no donations are used to support the staff while the clinic is closed. 

Previously, I've hiked the Annapurna Circuit. This trail is a loop around the three Annapurna Mountains and generally takes people between 19 to 22 days to complete. Sadly, I hiked it in 14-days. I wish I had a good reason for plowing through this amazingly beautiful area of the world, but I don't. I hiked with someone who cared about speed and instead of speaking my peace, I harbored resentment and just kept going- furious the entire time. I will have three weeks at the end of my time in Nepal, I am considering re-hiking the circuit alone and at a pace which makes me happy. 

The Annapurna Circuit is considered one of the best treks in the world. I find this to be true.  The trek goes through four regions: Lamjung, Manang, Mustang and Myagdi. Lamjung and Myagdi are in the lower elevations, which are predominantly Hindu. The Manang and Mustang regions are in the higher elevations and predominantly Tibetan Buddhist.  The people of the Mustang region relate more to Tibet and this region has actually been part of Tibet through periods in history. There are some regions in the Mustang area that were not open to westerners until 2005! 

The trek itself was like nothing I'd ever done before. The trails link all the villages and currently a road is being built. The road is detrimental to the hikers and a catch-22. The hikers hate walking the dusty road while lazy travelers zoom by in jeeps. But the road will make access to these areas easier for locals and will increase the tourism to the villages whose economy is based on travelers. Luckily, not all of the trail is turning into a road and there are times when seeing these mountains for the first time I felt like a new explorer. Often when I hike my mind clears of the muck, which is probably why I love doing it so much. I wonder what the first people to ever see these areas thought and what much of the world looked like before people came and changed the terrain. I loved hiking in the Himalayas because not much of the terrain has changed, at least in the higher elevations. Even the villages I walked through look as if they haven't changed since they were built. The one thing I found interesting was all the German bakeries popping up. Nothing is better than a fresh baked chocolate croissant at 14,000 feet. 

I look forward to hiking the new areas of Nepal I've never seen before. Please take a moment to donate to the ARP and thanks for reading. 

Also, here is a short 3-minute video about what I'll be doing in Nepal!

Video!