Acupuncture Relief Project | News from Nepal | Acupuncture Relief Project | Volunteer Community Health Clinic | Nepal

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez

Patients come on a first come, first served basis, often arriving a little before 6am, slipping their appointment cards under a designated stone on the reception window sill.  Many will have taken several hours to get to the clinic then may have to wait for some time to be seen, but time has a different value here and we get few complaints.

This different concept of time can manifest in many ways.  A patient will often postpone their follow up appointments in order to celebrate a new moon or a festival.  Between all the different ethnic groups that make up Nepal, there are more holidays celebrated here than there are days of the year, but neither intolerable pain nor life-threatening conditions are allowed to interfere with these occasions, or the intense periods of preparation and ritual often involved.

My last visit coincided with the riotous celebration of Jatra, the local three-day festival that occurs every third year in honour of the goddess, Bajra Barahi, whom our village is named after.  The festival is to ensure good crops for the following three years, and every possible tactic is implemented.  Tumultuous processions to the temple involve vibrating holy men carried in settles, sacrificial goats, buffalos, and chickens, specially brewed alcohol, and prostrating pilgrims measuring their length with bystanders throwing offerings of rice, tikka powder and petals in their path.  The playing field facing the clinic was transformed into a dizzying carnival of fairground stalls alternating with vendors of sweet, sticky snacks and knick-knacks.  Weaving in between these crowds, a continuous stream of villagers led their sacrificial livestock down to the temple below, accompanied by the sound of drums and horn instruments, whose wails would drift in through our windows from morning to night.  The atmosphere at the temple itself was a heady blend of incense, heat and smoke from fires, chanting, bells, all culminating around the juniper-decked shrine where sacrifices were made.  It was a sight to behold.

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez

Offerings are a big thing here.  The rustle of cellophane emanating from a pocket as clothing is removed is usually a good indicator that candies will shortly be handed out as freely as blessings.  The clinic kitchen constantly overflows with fresh produce, homemade popcorn, and local delicacies brought in by our generous agrarian patients.  This particular type of greens, Jaringo, was a favorite. Traditionally eaten during the Nepali month of Chaitra, it is highly prized for its health benefits. 

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez

This patient arrived at 7.30 in the morning having walked for 2 hours in heavy rain and apologized for not being able to carry a second cabbage (the first was already one of the biggest I have ever seen and the patient one of the tiniest).

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez

I love being part of this community and the surrounding country, and we always try to get out and see as much as possible in our spare time. I must confess that weekends and holidays are usually a welcome relief; a chance to rest, but also study, and process our clinic experiences. Although it is generally pain that brings people into the clinic, we are effectively primary care providers and each day is like an episode of House where we have to sift through a head-spinning array of symptoms, trying to differentiate between the medically serious and the curious. Most of our patients aren’t used to talking about their symptoms so it can take a few treatments to unravel what is really going on, but at the same time, as any emergency would entail a 4-hour +/- bumpy jeep ride to Kathmandu for those fortunate enough to live near a road and transport, we need to be mindful that nothing should reach that stage. Unfortunately, our ability to properly assess the patients House-style is hampered by the difficulty in persuading them to go for diagnostic tests if it involves traveling anywhere by vehicle. This can all be quite nerve-wracking for us as their care providers, but many of our patients seem more comfortable with the idea of potentially fatal illnesses than car-sickness, or even just the difficulties of navigating the few public transport options on their own.

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez

I thrive on the work here. It challenges me in a way that I probably won’t find anywhere else. There are so many pieces to the puzzle and Chinese medicine skills are just a part of it; family dynamics, cultural differences, the patient’s own fears or beliefs, even something as basic as getting the patient to eat or drink enough can dictate the success or failure of our treatments. Tactics such as placing cavalier blood pressure patients next to stroke patients, or stroke patients next to other stroke patients, allows the sharing of stories and encouragement that can be pivotal to the success of a treatment.

Being part of a team, being able to share and discuss our case stories, relieves some of the pressure and helps us to work out how to do our best. The rewards can be amazing however. While we track the incremental improvements as we go along, it is often only when closing out with patients that we come to understand our impact here – the number of patients who are now able to return to work, to take care of their families, to have less fear for their health, stroke patients that are able to get back on their feet and regain degrees of independence.

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez

There are many NGOs doing amazing work but both the vision of ARP and the warmth of this community has an allure that makes it hard for me to stay away. The project continues to grow and mature.  In 2017, the main clinic ran for 10 months, allowing for more consistent patient care and employment for the staff. Satyamohan, previously an ARP interpreter and now a graduate from the acupuncture school in Kathmandu, rejoined the clinic as an acupuncturist, hopefully the first of many. The ongoing support and continuing education classes provided for the incoming practitioners, Nepali interns, and interpreters give everyone the opportunity to step up their game, to best serve both this patient population, and ultimately, all future patients. Being able to be a part of this is an opportunity that I truly treasure. --- Emma Sanchez

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez 

Acupuncture Relief Project  | Good Health Nepal | Kimberly Shields

When I started fundraising for this volunteer trip, many friends asked me why I chose to come to Nepal with ARP, and my simple response was, “to step out of my comfort zone.”  I have very limited international travel experience, and I knew that providing healthcare in a developing country for an extended period of time would challenge me on various levels, providing me with an opportunity for both personal and professional growth.

Fast-forward to my 8-hour layover in Istanbul, Turkey, en route to Nepal.  As I roamed the airport, I realized that several conversations were happening around me in languages unfamiliar to my English-speaking tongue, and I suddenly felt a loss of connection within an airport full of people.  My ears searched for words of my native language amongst the crowds of people in transit and waiting, but to no avail.  Finally, after some time, I heard English words spoken from the mouth of someone sitting at a table adjacent to mine, and I initiated a conversation with the man who spoke those words that were familiar to me.  Only a few hours had passed since I stepped off the plane, but I was already longing to connect with someone amongst the crowd of foreign travelers.

Acupuncture Relief Project  | Good Health Nepal | Kimberly Shields

When my flight arrived in Kathmandu, there was a lot of confusion amongst passengers about the process of obtaining a visa.  One older gentlemen was having a problem with the visa machine, and urgently trying to solicit our help in his native tongue, Italian, but no one could understand him.  After my failed attempt at trying to pick out pieces of his language in order to assist him, the Finnish man I had befriended on the plane said to me, “It’s difficult when you don’t have a common language.”

How do I find a way to connect with patients when we don’t share a common language? As a practitioner, we rely heavily upon verbal and body cues from our patients.  Now I’m in a setting where the patients’ verbal cues, and even many of their body cues, are communicated through the interpreter.  The interpreters play a vital role in the patient-practitioner relationship here, but my direct connection to the patient becomes lost through translation, so my challenge has been to find other methods of connecting with patients.

Acupuncture Relief Project  | Good Health Nepal | Kimberly Shields

I asked myself how I could demonstrate to my patients that I was actively engaged in their treatments.  The first thing that came to mind was through direct eye contact.  When I speak with patients, I make a valiant effort to look directly at them.  At times, it has proven to be more difficult to remember to do than others.  My tendency is to want to look at the interpreters, as they speak the language that’s familiar to my ears, and perhaps, even more so now that we’ve developed a rapport over my time here.  I’ve also noticed that a patient’s tendency is to also look at the interpreter, as they speak their native language.  Many of the patients have been coming to clinic long before I started here, and they too, have developed a rapport with the interpreters, most of whom live within the community.  Yet there are also many moments in which I do make direct eye contact with patients as I’m asking questions or giving advice, and in these moments, my perspective shifts from a practitioner trying to solve a problem, to a person connecting with another person, in spite of our language and cultural differences.

Another means of connecting with my patients has been through touch.  As many of the patients are coming in with pain conditions— usually a by-product of wear and tear from years of manual labor— I use palpation, both as a diagnostic tool and as a means of connection.  I feel for areas of tenderness around the knee, as the patient describes his/her level and quality of pain.  I palpate the back to feel for areas of tightness and tenderness, and any vertebral subluxations or spinal misalignments.  If a patient complains of abdominal pain, I feel for certain signs, such as McBurney’s (appendicitis), and palpate the abdomen as I talk to the patient about symptoms, to get an idea as to which organs are involved.  A couple of weeks ago, I developed a ritual of applying oils for pain on most patients.  Although medically beneficial, I’ve found myself using the oils more so as another avenue of physically connecting with my patients at the end of their treatments.

Acupuncture Relief Project  | Good Health Nepal | Kimberly Shields

My favorite way of connecting with patients is through laughter.  Usually patients are in pain or sick when they enter the clinic.  Sometimes cracking a joke lightens the mood, and makes the patient feel more at ease.  When I feel the stress of getting through my patient load for the day, humor and laughter help to alleviate the pressure.  I find that the days in which I laugh more feel lighter, regardless of the types of ailments I treated that day.  I hope that when I laugh with patients, it enables them to get a glimpse of me beyond my white coat, as I know it allows me to pause for a moment and create a deeper connection beyond that of patient-practitioner— creating that connection with a fellow human being. --- Kimberly Shields

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