At the beginning of my service with Camp B at Bajra Bahari, my first patient is a 70 year old male with right-side hemiplegia resulting from a stroke. I look at his chart and note he started daily acupuncture treatments two months earlier. I ask him what are his goals for treatment and he states "I want to use right hand to eat (Nepalis use their right hand to gather and mix and bring to their mouth dal bhaat - the mainstay of the Nepali diet) and to shave himself. I test his grip strength, simply asking to grab my two fingers and squeeze, comparing his right and left hand strength. His right grip is comparable to his left hand, however, when I test his dexterity, he is unable to pick up a pen with his right hand as his attempts result in his repeatedly dropping the pen.
I work with Ram Lal everyday and begin to see his powerful determination and tenacity. He is always the first appointment, for he leaves his house at 4am or 5am to walk an hour to the clinic arriving before sunrise in freezing cold, so that his ID card is the first in the pile for appointments for the day. I give him different exercises to regain his dexterity, stretching an elastic band over his right hand and extending his fingers against the resistance. I gather 50 different shaped pebbles and give them to Ram Lal to pick up each pebble and place into a bottle. As I go to do my morning Qigong, I notice he is waiting for the clinic to open and I begin a Qigong practice at 7am with him. The Qigong exercises help him with his balance, integrating the right and left hemisphere of his brain, setting new pathways for mobility and coordination. I am inspired as other patients also waiting practice Qigong along with us. The last week, I give Ram Lal a ball with the world globe printed on it to grip and build strength in his right hand. I show him on the globe where I live in the USA and show him Nepal is almost exactly at the opposite side of the world. He comes to treatment the following day and shows me how well he can grip the ball and I notice that most of the paint is already worn off, and I know he is determined to get well.
Two weeks before Camp B ends, I tell my regular patients that I will be leaving soon and new doctors will be coming in a few weeks to continue with their healthcare. At the end of this long day seeing 20 patients, my last patient, a new patient, is escorted in by two women holding and helping a 49 year old woman who appears so frail, I lay her on the bed, instead of sitting her up in the chair, she appears so weak. I am told by her sister-in-law that my patient had a stroke 2 months ago, stayed 13 days in a Kathmandu hospital and is paralyzed on the left side.
My patient Maili does not speak much, I do some sensory testing and deep tendon reflexes, and she can barely respond to my inquiries and testing. Her countenance is gray and dull. I push away my feeling of helplessness - what can I do? and proceed to explain the long road to recovery and no certainty of full recovery. Is she willing to agree to a treatment plan of ten daily visits of acupuncture to begin with and at the 10th visit, we will evaluate if there is a positive result? Her sister-in-law answers for her that she will bring her daily. Maili's left hand is swollen almost twice the size of her right hand, edema of the limbs is a common aftermath after stroke. Maili came the next day, looking a little stronger and able to sit up for the treatment. Treatment includes scalp acupuncture points, electrical stimulation, needles in extensor muscles opposing the contracted flexed muscles in her left hand and leg. By the 4th treatment she is walking in with the aid of a walking stick and her sister-in-law by her side. Maili is more alert and speaks more and I find out she is a widow-her husband died 22 years ago, she does not have children, she lives with her husband's brother and his family and her goal is to regain use of her arm and leg to farm again. She reports a sharp pain in her leg is gone, and she can walk a short distance with just her walking stick without any assistance. By the 6th treatment she is walking the distance from the clinic door to my station by herself with just her walking stick. By the 8th treatment she is smiling as she shows me her new ability to move her right leg voluntarily.
My last day in clinic I begin the day with three of my stroke cases all sitting at my station waiting for treatment. I notice the seating arrangement, on one side, Ram Lal one of my first patients, the 70 year old who inspires me and the other stroke patients with his motivation and tenacity and pride to regain what many of us take for granted, those activities of daily living like eating, shaving, even squatting by himself to use the toilet. His next goal is to drive a bus again, to honor his past career of safe driving that he won awards for during his 42 years driving a truck. On the other side, there is Maili, one of my last patient cases as I complete my seven weeks as a volunteer, and I wonder how much she will be able to recover with continued treatments with the practitioners coming for camp C, and my wish and hope and vision is Maili walking to her farm field and planting seeds, then harvesting the crops next season. Bookends. --- Maggie Shao