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.