Saturday, January 7, 2012

A short description of a long departure from Nepal

The rest of the trip was an adventure, at times pleasant, at times painful. At all times we were growing our appreciation for the things we take for granted in the U.S., namely roads, cars, and readily-available headache medicine. Our last day, in Kathmandu, was touristy and gratifying; the level of bustling civilization seemed luxurious. I'm skipping many lovely details here. The city was so very different from the country, and I had little doubt that given a choice I would probably choose to be a city girl in a country like this. It isn't easy, however—to make it against the throngs of the capital, one must hustle, hustle, hustle. It was, though, the perfect end to our trip. We got to be normal tourists for a day or two and enjoyed that a-plenty. Special thanks to the Lucky Star Hotel, the Fhat Khat Bar, the Thangha shops whose names I forget because their cards are who-knows-where by now. Special thanks to all of the INCREDIBLE, hard-working people I traveled with, who did much, much more work than myself. Thanks to Subarna for being our compass and the others who helped—especially that lad with the square hat that seemed to shadow us everywhere, who the boys loved despite his cigarette smoking habit. Thanks to the forces of ancient nature that brought us the Himalayas. Thanks to all of you for taking our times of discomfort with grace and/or humor to keep us laughing and loving through (most) of the trip. Thanks to the World Outreach Foundation for making it happen and to Henna & Steve Fuller for convincing them to let me come. Thanks to the people of Nepal, who were beautiful. There is so much more to say, but it will have to wait...

There are a few quotes I am meant to include here. I can't remember them all. A few:

“Once you resign yourself to the fact that you are camping, it's not that bad.” -Steve?

“I gave up on personal hygiene three days ago.” - Bridget

“Look...it's American toilet paper!” - context and speaker into the ether

"Cipro up!!!" - rally cry of the whole team (Cipro is a strong antibiotic that most of the Mustang team ended up taking to end or stave off illness)

♥ Dhanybhad ♥

Last Day in Tukuche

It's 6am, before dawn, and most of the crew leaves on a trek some seemingly thousands of beautiful, dawn-misty kilometers down the road to the Chhairo Gompa Restoration Project—C.G. Being a very old Buddhist monastery that fell into dilapidation and is now being restored through Restoration Works International, the Chhairo Gompa Restoration Group of Nepal, via the Heritage & Environment Conservation Foundation of Nepal—with the famous John Sanday as a technical consultant (www.restorationworksinternational.org). Amidst a bustle of construction by both men and women, we viewed the two sanctuary shrine rooms that hold the artifacts of the monastery, said to be between three and four hundred years old. Half-finished reconstruction was being quietly, but still bustlingly, undertaken around us. The air surrounding the site smelled like the inside of my family business, a 110 year-old planing mill. We entered the courtyard where one lone, old and capable carpenter sawed a beam. Steve and Patricia, who had arrived earlier than us, point us two two inconspicuous and small doors to our right, promising us awe. We duck to enter the first door and are greeted by breathtaking statues—in the center is Buddha, with his female reincarnation to his left and Guru Rinpoche on his right, with other dusty figures surrounding them in this dark, ancient-feeling court. It felt like a long-known secret that we'd discovered; it felt like finding a treasure. And it was. This certainly was no ordinary destination. Murals on the walls of deities and Buddhist tales had been damaged extensively by water leakage and seem ghostly, waiting for their second life in the restoration they will undergo. The second room brings a sharp inhalation upon entering—facing you is the wily and intimidating visage of a gargantuan clay statue of Padmasambhava, aka Guru Rinpoche (credited with bringing Tantric Buddhism to Tibet), his face full of the menacing knowledge of that which is beyond your comprehension. Parts of his crown are missing, jewels plucked by the hands of looters during the time of the monastery's disrepair. One gets the impression that the perpetrators must have made themselves the objects of an eternity of curses, all Indiana Jones-style. In any case, viewing these rooms is a precious experience. It's a religious experience—something I do not feel often.

Back in town after a rigorous trek, the group tiredly but tirelessly delves into the third and final day at the Health Post. It's calmer, and with Bob stoically (but at times claustrophobically as patients crowd around his examination table) administers blood pressure tests, having very unfortunately been rendered incapable of fulfilling his trade of anesthesia by circumstances. The others seeing the rest of the patients, I walk to the end of town to sit for a bit at the Dutch Inn and Bakery. The support of the Dutch group I spoke of before has something to do with a connection with Tukche native Purna Prabha Thakali and her Dutch husband, Patrick Maas. The couple own and operate the place I now sit, the High Plains Inn and Dutch Bakery at the entrance to Tukche, which serves the best apple crumble in the entire universe. On the way back to the clinic I get the pleasure of the company of Purna, who skips out on room-cleaning duties to see the hospital in action at the close of our stay. She is a beautiful, friendly and revolutionary woman – the first in Tukche to wear pants (causing a trend that continues to this day!) She tells me freely and naturally, after 5 minutes of acquaintance, stories of her life—how she and her husband came together, how they moved away from areas that became violent with Maoist fighting in the 90's, and how they came to own the Inn. She comes with me to watch as the equipment is officially handed over from WOF to the elders, officiated by Steve Fuller, who gave a lovely, short speech on how the people had warmed our hearts—which was very true.

Purna is also responsible in some way for supporting the local boarding school for the enigmatic children that visited us at the hospital (you never could imagine children being so willing to go to the doctor—even if they were able to skip class for the privilege. It's a sad indicator, unfortunately.) Some of the girls from the school became my kinda buddies the previous day—when I'd sit outside with those waiting to get in, they'd soon enough sit closely around me. The boldest of the group, obviously a born-cool kinda chick, would ask me questions and ask for pictures of them, giggle at the pictures of their schoolmate boys, and initiate games to pass the time. After we closed down the clinic and took a group picture, Purna invited us to the school for a quick look and welcome/thank you from the kids. Their dorms were very simple, separated by gender. The headmaster ushered us into a small room, and after we were given the customary marigolds as guests of honor we were treated to a rushed one-number traditional dance performance by two of the students at the school while the others piled in, cheering and clapping in time. It was intensely sweet, another little nugget of amazingness that we got. If ever we felt happy not to be normal tourists it was in moments like this.

We rush to get on our bus back to Jomsom. We are given the warmest and most sincere exit ceremony, replete with the requisite silk sashes added in multiples around our shoulders by the elders and many others in the community. As we pull away, the hover around the bus, waving goodbye. I'm sure that my heart wasn't the only one swelling then.

Tukuche, Mustang, Nepal

Tukche - (or Tukuche, depending on which sign/translation you look at), Mustang

The Jeep, filled with us still-further-flinging medical missionaries, ran an alternative route along rocky riverbeds, then up to great heights. Don't look at how close to the edge of that glacial bed cliff you are. Just manage to be happily surprised that you can still be surprised at the spectacular Annapurna range views that surround you and us; try to take pictures through the dust-obscured Jeep windows of yet another suspension bridge over the Kali Gandaki River, threaded with bright prayer flags—bridges that are somehow never frightening to cross on foot despite being tossed by the gale-force winds. In our short one hour ride we passed through Marpha, “The Delightful Apple Capital of Nepal” as it was dubbed on entry signs, which had an unusual monastery, white and upward winding, clinging to the cliffside. The buildings cascaded down and around them and the orchards lined the stalled-bus-clogged road.


L to R: The road to Tukuche ; Cliffside monastery in Marpha ; View from the Jeep

Tukche is small and welcoming, surrounded by views of Mt. Nilgiri and other peaks, so enormous and magical that one scarcely can believe they are not illusion. We all take hundreds of pictures of them when the uncommon cold and cloudy weather sweeping through the passes relent to reveal their presence; us in the vain attempt to capture the feeling they plant into a humble soul. Alas, it is lost in translation. What we do decipher quite clearly is that the people of Tukche are happy to have our mission here. Our group joins the smaller one that made the trip here one day before, who alone saw about 130 patients the day before our arrival.


L to R: We stayed in the "old town" of Tukuche, this sign leading the way past the boarding school ; Collection box for the newly-constructed Health Post that our team works from ; The second leg of the team walks to our inn against a surreal backdrop


We have a nice, short trip across the 'old town' row buildings, white with burnt orange, turquoise blue and deep mahogany wood and rooftops padded with juniper logs, to the newly-constructed Health Post. In the bustle of setting up the clinic in the Post, with local staff manning the insanely crowded registration window, me and Steve sit down and talk with Emanta Ghusen, a kindly and important old fellow who is Chairman of the village's citizen committee and President of the oversight committee that presided over the building of the new structure. Funded by the Nepalese government and costing near to 1 million rupees (I think this is what he said, but we were speaking without an interpreter!) the Post is clean, comfortable, and accommodating. The only problem thus far is that besides sinks and bathrooms, there is nothing inside the building as of yet. Of the 16 provinces of Mustang, only Tukche, Jomsom and one or two others have these health posts/hospitals. The Jomsom hospital, where we spent our first days, is evidently the main/largest hospital in Mustang. As mentioned before, in these more remote areas it is very difficult for people to get needed healthcare, and often illnesses are just lived with. Few can afford the time and expense to go to Pokhara to see specialists or have surgery. There are few medicines to be had in this town. We test this theory and after wandering about and asking after anything akin to a pharmacy; we are referred to the shopping epicenter of old town, which is a small, simple old room with a few ancient boxes of Amoxicillin on the shelf which comprises the pharmacy. This I believe is when our heroic Amy decided to hop on the back of a motorcycle for a thrilling 2-hour round trip ride back to Jomsom to bring back some desperately needed medicines for the clinic. Let it be shown for the record that Amy is a living saint—this was just one of the many things she did daily without complaint to help the mission along. She was only betrayed by her inability to conceal her fatigue every night at the conclusion of group dinners...


L to R: The Tukuche Health Post ; Dental clinic in full swing ; The view from the Health Post was a perk ; Saint Amy attends ; Workers compose the waiting list and keep it orderly ; A wall of patients attempting to enter the building

Emanta explains that Nepal, being a poor country, has a government that cannot alone provide doctors everywhere, but he hopes that they will be able to provide on for the new Post, as well as nurses. There will likely be some reliance on foreign aid to help fund some of this. And there is, of course, the aforementioned issue of keeping qualified medical personnel in these far-flung villages. There is a Dutch group called Dhampus Stikhting that has run 3 missions to Tukche (http://www.stichtingdhampus.nl - use Google to translate the site) with a dentist named Joost Van Viijmen. They have donated money for equipment, and we also donate about $25,000 worth of dental equipment which I believe was secured through the efforts of our traveling dentists, John and Jack. Now the Post just needs to find staff.


The honorable Emanta Ghusen

As far as our mission is concerned, the new Health Post was a fantastic accommodation. Since there are no established doctors or politics here we were even more welcome. It was evident by the enormous crowd that waited throughout the day for care, despite the chilly weather, that the people of the town and the villages around it were most appreciate of our help. While standing outside in the ad hoc 'waiting area' in front of the hospital (patients were let in as called via registration—many hovered in a nearly impenetrable crowd in front of the door, which was sentried valiantly by a man named Lakshmi. Emanta again expressed their gratefulness and told us how people had traveled an hour plus by foot from villages to be seen. Over 300 were registered the 1st and 2nd days. There were some serious cases—a family severely jaundiced that had to be sent for hepatitis tests; a small, cheerful toddler with cerebral palsy; an atrophied and crooked polio leg that the patient asked to have amputated, and others along with the standard issues. This is a population with uncommonly high blood pressure pretty much across the board. There are many GI tract problems, and dental health is a huge problem. Dr. Jack remarked at the happy and thankful spirit of the people, even those that had just had multiple teeth extracted. The last dental customer of the day was a 6 year-old girl who came not with her parents, but her friends, and who endured her appointment stoically. It's quite difficult to imagine such a thing from an American child!


I am actually unable to get inside the building by late morning through the crowd at the door, so all of my pictures are of the colorful people waiting outside.


Bob attends to the blood pressure of the masses.


More mothers, babies and sweet schoolkids waiting for their turn.


The day was successful and everyone was seen. The crew retired to an evening of Buddhist meditational theory and practice (super 101) by the venerable and down-to-earth Khenpo Khyentse of the Jyatsonling Association Kaohsiung, who had attended the clinic in Jomsom but who is from Tukche. He has started a school here, called the Shree Nalanda Buddhist School. It is a boarding institution that is free for the students and which also makes a point of giving scholarships to Dalit children who otherwise might not have a chance at education. Dinner at the Hotel Laxmi, replete with comforting chicken and buckwheat dumpling soup, as well as the local apple brandy for the brave (it is basically a moonshine/strychnine substance that keeps people warm in the winters) and a fatigued but lovely chat around the fire table, and then to our chilly beds. I was finding myself somewhat acclimating to the cold nights, or maybe I was just subconsciously adding more layers to my never-shed armor. At least the bed pads were a bit cushier than in Jomsom...


Tired crew at the fire table at the end of a long day (the table is built above a recess in the ground, where metal containers with hot coals are set.) It's difficult to bring yourself to get up from the table, and sleep overcomes little Avo.

The Dalits of Nepal


Bhim Bahadur Rasali, freedom fighter!

Day 2 continued – The Dalits of Nepal

The most notable thing about day 2 was just how crowded the hospital became and how many people jostled to be seen. This day I also met Bhim Bahadur Rasaili (first name Bhim, pronounced “Bim”), a local man who is a reporter and who came to talk with us. He publishes and prints his own paper, the Himalpariko Awaj Weekly. He's a most impressive guy—he fights for the rights of the Dalit, who are the untouchable class in Nepal. Nepal does indeed have a class system and it is supposedly modeled off of the Hindu class system of India (http://www.dwo.org.np/dalit.php). We were very interested in talking with Bhim—unfortunately by the time we sat down, it was after dinner and I was so jet lagged and tired that the conversation wasn't as thorough as I would have liked. Between being exhausted and freezing cold in the dark room that we met, I did the best I could to absorb information from Bhim. Bhim is himself of the Dalit class. He also happens to be an albino, and from his self-possession I can't tell if this fact has been an added impediment or an added incentive to become the self-made man that he is. On the day I met him at the hospital he was full of questions to me, including inquiries into my opinion on the differences between Nepal and the United States and the rights of women, and other similar concerns. All I could think of was how impressed I was that this man could rise above his class designation (which relegates people to low-level unskilled labor with no hope of mobility and assigned restrictions across the board including who one can marry), to be this sharp and intelligent reporter, courageously defying barriers that most of us in the US have barely even had to think about, and he continues to try to inform people like us of what happens to those in his class. Subarna, his longtime friend, calls him a 'troublemaker'. He let us know how grateful for our services the Dalit people were—that they were happy to be treated well. That they were happy not to be treated differently than others. That most don't get treated at all on a regular basis. And he made light of his wish that they would be able to have increased services in this area, in particular for dental issues. If we could ever find funding for a dental clinic that would be most appreciated. We just wished it could be that easy, but it was indeed great to hear first-hand how impactful the clinic already was being. His information also led me to be more mindful of the class system around me. Just this day I had woken up very early and had gone to the eating area of our rooming house, at 5am, and was watching the sun rise over the grey peaks as I edited pictures. At some point I noticed a rustling from the end of the table and realized someone was sleeping on the floor at the end of the guest eating table, and finally saw that it was the house maiden that slept there, the girl who was awoken at dawn by the hotel owner's wife and who immediately set to work manually scrubbing the floors Cinderella-style and spent the rest of the day cooking, cleaning, and washing dishes. Her face was initially like stone but at many other moments, namely when being addressed, yielded to one both adorable and beautiful; she was a girl who when given the time of day and a serious gaze and smile would light up like a lotus in bloom. I asked Bhim if he thought she would be a Dalit and he said yes, of course. She almost seemed owned by the owners of our hotel but then again they were themselves likely not much higher up on the scale. Later in the trip some of our troupe wondered how this class system could exist in a country so heavily Buddhist in belief. It is a great question, and it begs us to remember that in our own country it has only been a mere half decade since our first real transition into desegregation between whites and blacks began; Rosa Parks took her historic stand on a bus in Montgomery, Alabama in 1955. And as a largely Christian nation, that same divide between dogma and practice surely had to be thrown into the debate. Perhaps someday these long-held and systemic class divides will ease, at least to become as passively less stark than in the United States...


Patients not so patiently vie for space around the door to the family clinic as things get very busy. There is no such thing as HIPA/privacy in the hospitals of Nepal.

Day 2 - Mustang Hospital, Jomsom, Mustang, Nepal


L to R:Medical supply bag with unheeded suggestion ; M.A. unpacking consolation prizes for the kiddos ; The waiting room before the storm

Today started late as the doctors and most of the rest of the medical supplies that were delayed were able to make it here when the clouds cleared at last. Things began at about 11:00 and the arriving doctors had scarcely enough time for a rushed tour before being bombarded by patients. The flow only increased as the morning turned to afternoon, and I remember at about 1:30 or 2:00, while roaming and taking pictures, getting quite hungry and hearing one of our dentists, Jack, exclaiming something along the lines of “Lunch? We're here to work!” Noble as it was, and considering how little work I was doing compared to him, I really wanted to break to rest and eat! The arrival of the bags brought many more medicines and equipment. The dental station was set up, with the saintly help of support staff Mary Ann, Carol and John (whose service rendered it ludicrous for me to also equate myself with the title of “support staff”); the OBGYN clinic went into full effect, and the other doctors saw general patients.


L to R: Dr. Margaret, Sister Goma and Teresa consult with a patient in the OBGYN clinic ; One of our first little patients and her mother ; Dr. Patricia and Steve begin their clinic ; Bridget and Dr. Sidhartha see patients; Waiting patients weigh themselves up ; Bridge and Dr. Sidhartha and patient ; Amanda, Dr. Pranaya, Dr. Jack and Bob prepare to see dental patients ; Amanda sets up the dental clinic equipment ; Mary Ann, Carol, and Amanda - dental clinic assistants ; Dr. John unpacks the dental clinic supplies ; One of the tooth extraction rooms in its nascent form; The dental clinic team preps for service

I was in charge of picture-taking and also monitoring the activity in the pharmacy. With struggle myself, Carol (before the dental clinic was up and running) and Joyce K. tried to record the outflow of medicines while assigning them to names. At some point I was the main personnel in the pharmacy and realized that the Nepalese pharmacy techs were much better at the task than I. Not to glorify my laziness do I mention this, but to highlight the fact that these young men were more than capable and willing to easily record the names of the patients and their corresponding medications. I became rather futile other than to be sure everything was in order and to socialize with the boys. Their English was limited but pretty impressive, and they were good guys. I grew pretty fond of these adorable dudes in my 3 days at the hospital: Karnan left after the first day and took a bigger role as interpreter in the general practice room. Some of those left were Sanjay Kumar Yadav, 31 years old like me, married, and the best at English; Gokul Preshad Aduikeri, a sweet 24 year old who looked like the Nepalese James Franco and who blew my mind on the technology continuum of this world when, in pharmacy downtime, asked me if I was on Facebook, and then proceeded to friend request my by mobile as we sat there. This of course being in a hospital with virtually no electronic equipment on hand!); Arjun Kisan, a baby-faced lad who became the butt of the joke when I taught the others how to open U.S.-style childproof medicine bottle caps while he was out—there was much hilarity as the others challenged him to open them of his own devices); and Hari Purja, the older man who slipped in and out at complete random.


L to R: A patient waiting for her prescription with her new doll brought by one of our lovely mission members, probably Amy! ; The pharmacy at full stock with medicines donated by the foundation ; Gokul and one of the nurse's young brothers, who was a daily presence in the hospital






Patient transport Mustang-style ; A little patient gets a toothbrush - Henna holding down the supply fort - A dental patient stylin' in the donated sunglasses she picked up at the pharmacy ; Dr. Jack extracts teeth from a yogi