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

Please read this in Ira Glass’s voice from This American Life. Thanks

“Act one. Act one… Into the Himalayas”

It’s been a wild month. After I last wrote, we had the clinic running at full capacity. Fortunately we had treatment plans in place for our patients over a 5 week period, because the two week national holiday of Doshain ensued. We shut the clinic down for the patients and interpreters celebration of the holiday. 

So we took the chance to head to the Himalayas for some trekking (on our own dime). And, well, it was amazing. 

 
 
 

 
 
I was amazed by the generosity and strength of the Sherpas (an ethnic group of Nepal, that has become a general term for guides & porters of the Himal). They are very enjoyable men who by the end of the trip were calling me “sila” - brother in Nepali. And brothers they were. The hospitality of the people made me understand the draw to this region, not just for its mountains.
 
 
The mountains were amazing as well. Our little summit at 18,000 feet was a day hike compared to the neighboring mountains. But let me tell you the air is really thin up there! 
 
 
After finding enlightenment and lightheadedness in the mountains we returned to our little valley of Bajrabarahi. The past two weeks have been intense. And I have had some major epiphanies. 
 

“Act two, act two... Being a doctor"

The first epiphany; primary health care is very challenging. With a range of 17-25 patients a day I have a greater respect for primary care MD’s. There knowledge is insurmountable. And I am beginning to understand why MD’s rely on drugs so prevalently. Why they have to treat the way they do in an overcrowded health care system. 

People who are sick want to be fixed ASAP and when you have many sick people and little time, you need all the help you can get, even if its just a band aid. You become a god to your patient when you provide the instant relief, of say a powerful antacid or PPI for GERD (heart burn).  But it’s the easy fix which I see become the long term fix here, and in the states. The capitalistic buyout of medication intended for two weeks become a chronic purchase by the insurance company for Americans, only to lead to further problems down the road.

The beauty of what we are doing is following up week after week. Educating the patient, in the case of PPI’s; how to change the diet so that the stomach can repair on pharmaceuticals and then go off of them in two weeks, as originally designed.

So the thought and the philosophy of an instant fix is one to be pondered. It is time to question “medicine”, How it is practiced, and what the effective time spent with the patient is. Is that time and money put into creation and sale of the pharmaceutical or into the doctors treating the patient? 

 

“Act Three of our program... when you hear hooves, think horses, not zebras.”

 I am practicing slowing down. Everyday I become more and more confident with musculoskeletal injuries and orthopedic diagnosis, but when it comes to the internal medicine patients, I freeze as my mind races. 

“I am here as a muscle guy not infectious disease specialist!” My mind shouts!

But my role is primary care. I have to fill these shoes and I have to come to terms that I do indeed have the education and tools to do it. 

I am reminded I can observe the patient over a few days, this is rural health care. They have had this condition for 2 months, maybe two years, they won’t die tonight. 

I determine the basics and look for red flags. Do they have a fever? Blood pressure to high? Too low? Blood sugar level? Vomiting?  Diarrhea? Blood in urine?

The list goes on.

I can observe them closely over the next few days.

I change my thinking from an “alternative” practitioner in the states (who can get sued for making these decisions) to the role of the most educated medical provider in a 3 hour radius.

I have to recognize that many patients will most likely never visit a hospital because of their sect or class, which will get them blown off at the front desk or ignored by higher cast medical doctors. Or, illiterate,  they won’t be able to read signs and will not find the correct wing of the hospital to enter!

I breath, and pick apart their presentation until I can make a working diagnosis. I chill them out with acupuncture needles and determine what is the best advice they need right now. And maybe my advice is the best medicine.

 

"Act Four, Act four... What is the world” 

 

Epiphany number three is that of the organic idealist. I am rethinking how I live over here. I always thought farming and eating my own wild game in a  “paleo diet” was the ideal lifestyle. Don’t get me wrong I encourage all gardening and hunting activities. I hope to enjoy some of that lifestyle in the future. But there are 7 billion people on this planet. And here 90% of the population farms, (not the Portland hipster farm of 4 Hop plants in the back yard, nor the Iowainian farmer who can hull 4 miles of corn in a day). Im talking rice fields tilled by hand and 150 pound loads carried not by water buffalo, but by auntie. It’s unreal, and as I squat over the local tea house toilet (hole in the ground), under a 4.5 foot ceiling, staring at a little faucet coming out of the wall, intended for washing my crack by hand. I realize that I have had it all too good.  

My old obsession of allergy prevention through parasite infection have quickly disappeared. My patients arrive daily with all kinds of itchy skin and breathing issues, and there is no easy fix. My pondering of living old school, barefoot and wild, have all vanished. I stare at the farmers heels with vertical cracks resembling a map of the grand canyon. I sterilize and dress a 2 inch laceration on my patients arch from a sharp root(she doesn't even complain about her heels). Im grateful I can afford shoes. 

 
 
My patients all have gastritis, they most likely all have parasites as half of them are anemic and skinny enough that I can reach around the circumference of their thigh with one hand. I laugh at my own concern of being B12 deficient in the states. I laugh at my understanding of pain, I ski race and run marathons to feel pain, these people live with it everyday. But when I see them in the town or walking to the fields, they are all smiling. 
 
 
I am re-thinking everything, including the little things.
 
 

How much water do I waste when I shower? How much toilet paper do I use!? How much energy do I waste using hot water? How do I have so many clothes! (a race t-shirt for everyday of the month!) How do I wash all those clothes!? How much packaging do I waste buying or eating anything, (we burn all of our trash here in a slow smolder and Kathmandu’s smog rolls into our valley every day.) How do I have such a new passion for mustard greens as my abdomen has become filled of rice and dal. How can chicken (mostly bones) taste so good once a week!?  How can we eat so much meat in the U.S? How amazing is it that I can I get anywhere in Portland in one hour by public transport? How does my patient wake up at 4;30 am and walk 5hrs to the clinic to let me work on her arthritic knees with medial meniscus tears, and then walk 5hrs back home on those same knees?

It all seems so nuts!

And  then I see the pollution of the candy wrappers on the unpaved streets. The infiltration of jean jackets, selfies, hair-gel and Facebook in the youth… the narcissism of a California dream infiltrates their minds (while their family still harvests everything by hand). Im puzzled, and think to Jared Diamond’s Collapse… Is this the end? The American dream and the want for more, engulfing the most rural minds. This setting which seems so sustainable and ideal is riddled with just as much danger as home. This little valley’s death toll from carbon monoxide poisoning (due to the lack of chimneys in homes) alone most likely equals the same number of murders per capita in my home town. Are humans doomed? 

I look to my interpreters, born and raised in this small farming community. They all eagerly wait for me outside the clinic doors at 8;15 every morning. Wide eyed, grinning and ready to help, with every patient, every question and every needle. They own it. And I see the future isn’t so bleak.

---Ian Wilsonson

 

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

I come from a large Russian Orthodox family and an even larger community. I spent my childhood wondering what any limits might be. What would that look like, where would the red tape might be, and how I was to grow within them? But I knew from a very early age (8 to be exact), that I wanted to help others. It led me down the road to becoming an Acupuncturist and volunteering with the Acupuncture Relief Project.

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

At the ARP clinic I initially acted solely through the wonderful interpreters translations. Fresh from school, I now got to apply my knowledge in a wider arena, sometimes feeling like an imposter with the newness of it all, just playing house, waiting for someone to come in and take over. But then it dawns on me that this is it. We are the practitioners here. Yikes! This just got a little too real. A visiting intern native to Nepal whose family is still several hours away shared my feelings of being unsettled in the first weeks. Though her family is reachable, the demands of a busy clinic along with independent research of pathologies and team classes after clinic several times a week can make the feelings of distance seem magnified. This was comforting to hear, and confirmed that the excitement of practicing medicine in a different country to be mixed in with the pangs of physical distance from loved ones and barriers of inner constructs was a rewarding challenge to overcome. 

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

Weeks passed and I found myself seeing past the imagined barrier and started paying attention again to beyond just words being said by the patients. Looking into my patients faces, I struggled less rely only on what my TCM education had instilled and focused what else patients were communicating, and sat with my intention of wanting to do good for others. Many times throughout I thought to myself that I’ve reached my red tape. Then, a patient under my care who was 4 months post stroke and in poor spirits at the time of the initial visit had been coming in for daily treatments now had now reached almost full functions for daily living. He could dress without assistance, able to shave with the help of a friend, and regained the use of his right hand for eating. Eating rice was still challenging but we both felt victorious; we both made through that tape! 

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

Another patient who started coming in for pain brought her own barriers. We quickly found out she was mute and I thought, “Hmmm, thought I ran through that red tape…” She was pointing to several places and making expressions of pain, and through a few orthopedic tests and more motions to gauge levels of severity we were able to get a working treatment plan together: gastritis primarily (she had been vomiting and had lost weight from it), shoulder pain secondarily, and knee pain last. Here I felt that giving the care didn’t require knowing her language per se. She and I mutually understood her needs; after a few treatments her gastritis started to resolve, and we moved on to other things on the list. I imagined this process of continually sticking to what I believed where her chief complaints to be like a mysterious mailbox destination; one isn’t always quite sure if the parcel is getting through (much like the reality of people not having mailboxes here, but mail does somehow reach its destination). She and I would wave vigorously hi and bye after subsequent visits, and the unspoken communication that had grown peaked my interest in how one is able to deliver care but not always needing to say verbatim, “I am going to deliver care to you”.

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

I had the opportunity to learn about this idea of nonverbal care a few weeks ago during a women’s clinic that came to Bajra Baraji to treat women for prolapse and screen for cervical cancer. They had set up near the ARP clinic with the goal to get as many women seen and to take samples for testing, that way if any were positive then they’d be able to commence treatment. Screening for cervical cancer has shown to dramatically reduce the number of cases of and mortality from cervical cancer in developed countries; and Nepal has the highest rate of deaths from cancer. It is especially so in isolated villages like the one we are working out of.

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

As I was shoulder to shoulder with the other doctors watching them perform examinations, eyeing patients funneling through, I was trying to imagine what they might have going on in their lives outside this moment. One patient, who looked about 50, no more than 5 feet tall and was probably someone’s mother and possibly grandmother. She had hair that was neatly braided and tied at the end with bright red yarn that had some small bells swinging on the end and a matching red Kurta; traditional Nepali dress that many women only wear on special occasions now. This woman wore the sweetest expression and carried a disposition of someone not used to being examined so closely while she gave a short explanation to the doctors about why she was coming in. 

I didn’t catch the conversation with it being in Nepali, but after the examination one of the doctors was hugging the patient from the side while she told us in English that they had found advanced abnormal variations on her cervix, a key marker for cancer not in early stages anymore. The Nepali woman hadn’t understood this part, it not being said in her native tongue. I watched her as I heard this news was being given over my head to another doctor who was taking this down, and at that moment I had an image of my own mother standing in her place, foreign words being exchanged about her health. I was overwhelmed.  I had to look at the cracks in the ceiling for a while, then observed how this doctor spoke comfortingly and unrushed to this patient with dozens more still waiting just outside.

I read somewhere that once a person goes out to seek the unknown, it is impossible to return unchanged. I think that moment occurred to me just then. It made me question how I as a practitioner should be able to communicate effectively in situations I’ve not experienced before. This woman’s ability to face the doctors and be open to understanding the situation mirrored what I should be doing for them; be open to understanding and shine with kindness.

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

This is the realization I was seeking in coming here; to see how it is to stand amongst other communities and explore parallels of culture and healing practices to my own Russian Orthodox heritage, to bridge the gaps of what is meaningful, and grow as a practitioner for myself and others who may come to seek care. 

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

I believe that through volunteering with the Acupuncture Relief Project, I have reached that moment of getting to the red tape but realizing in a way that it’s just a hologram, that this is another point I have reached where before I felt was unreachable, now is another bend in the road that I just wasn’t able to see until I’ve reached this point. --- Fedosia Masaligin

 

 

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

Nepal and people who live in this country, the Nepalese; where do I begin?  It was sensory overload the moment our flight landed in Kathmandu, the capital city of Nepal.  The first thing that hit me was the humidity and not being able to read any of the signs nor comprehend what people were saying.  At that moment, it finally kicked in that I was totally at a foreign country, far away from home.  To a foreigner like myself, things seem chaotic.  There are no traffic lights for vehicles, motorcycles, or pedestrians while everyone travels in all directions; however, to my amazement everyone is in harmony.  There is order in a seemingly ocean of chaos. 

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

Nepal is a true third world country that is now in a worsen shape by a devastating 7.8 magnitude earthquake that struck near the capital a year and a half ago.  The rebuilding process is slow at best.  Many buildings are still in shambles and are at a state of disrepair.  The earthquake was a detrimental blow to their livelihood for a country that does not have significant goods to export or commerce and relies solely on tourism to survive.  What we believe as our most basic rights for standard of living back at home do not even register here.  Their infrastructure is almost non-existent.  There is no waste management made evident by trash popping up everywhere and the only way to “get rid of garbage” is to burn them.  There are daily rolling electrical blackouts that last hours at a time.  Water treatment facilities are not available.  Public transportation involves packing 50 people in a beat up bus that should only carry 30 with plumes of thick black smoke billowing from the exhaust.  All these are just part of the daily lives at the capital city and imagine what it is like outside the capital!

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

Despite the insurmountable disadvantages stacked up against the Nepalese, I consistently see how Nepalese truly are - friendly and cordial.  Strangers will greet each other and carry on conversations like they are best friends.  You don’t see anger, impatience, or frustrations on their face.  You don’t see people yelling at each other.  You don’t see road rage.  Don’t misunderstand the situation here, they do live in a stressful environment with very little means and few opportunities to better their life.  If you have an opportunity to ask them questions, you will hear that they are stressed about life, yet they find a way to coexist and live happily, without lashing out at others.

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

I have connected with my patients and the Nepalese culture on a deeper, more meaningful level than I would have expected.  I have realized how diverse and social culture driven the Nepalese are.  There are no strangers in Nepal!  Everyone pitches in wherever help is needed.  People make the best of what they have without complaint. They have graciously welcomed us and helped us to ease into their life as one of their own, while opening up and entrusting our ability to see and treat them.  They feel grateful and indebted to have the opportunity to receive treatments, to tell their story, and to ease/improve their sufferings.  

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

One patient I will never forget and will think of fondly years from now far away is my diabetes patient who initially came in for hip pain.  Upon further questioning, I learned that she has Type 2 diabetes who is on the maximum daily dose of Metformin and has recently stopped her insulin shots.  The reason for stopping the shots was that they were expensive and that the pharmacy informed her that the insulin bottle needs to be refrigerated, which is a luxury she does not have.  Most people here do not have own refrigerators.  I felt a deep sadness that a refrigerator could be in the way of someone’s health.  At the same time, I was glad that I could inform her that insulin does not require refrigeration anymore as long as used within 28 days while stored away from extreme heat.  In addition, Metformin by itself is not enough to control her diabetes and that insulin is necessary to stabilize her blood sugar.  Her blood sugar test taken was three times the upper limit for a diabetic.   She was reluctant to go back on the insulin shots and just wanted treatment for her hip pain.  I realized it was going to take a while to convince her; thus, I comprised and agreed to treat her hip pain first, but she needed to revisit on a daily basis.

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

My goal is simple: to try to persuade her to restart her insulin shots.  Every day I worked on easing the hip pain while trying to convince her that she must go back on insulin quickly and to explain the severity of what could happen without stabilizing her blood sugar level meant possibility of losing limbs or worse, death.  It took numerous efforts and persuasions, but she is now back on insulin and is able to walk without much pain.  She feels happier and is able to sleep through the night.  What made her change her mind about insulin is not crucial, but I believe one main reason was the fact that she felt she was not just a case study but also a person with people who were genuinely concerned for her well-being.

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

I thought I was going to come in and sweep Nepal and its people off their feet by showing them what I could offer, but in reality, they were the ones who showed me what I have been missing out.  Of course, they would like to have clean running water, not having to deal with air pollution, poverty, and a shadowy future, but Nepalese live with dignity and composure.  I do not see any poopy face.  I do not hear Nepalese complaining about things they do not have.  Everywhere I go, I see bright smiles on their face and genuine content blessed with what they do have.  I walk away receiving so much more in life than what I have and will offer to them.  --- Kuong Wang

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