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.