In the foothills of the Himalayas, Bhajra Barahi is made up of steep hills, the slopes of which have been terraced for farming. These plots of rice, cauliflower, mustard, squash, corn and radish cascade down toward the deep valleys with houses dotted all along the way. The main Bazaar of town has a busy road with busses and trucks rumbling through, but within a short distance the roads stops. Many homes and communities and their surrounding farmlands are accessible only by foot. Narrow foot-paths or rock walk-ways traverse through the forest and fields between the terraces. These paths are frequented by women carrying huge baskets resting on their backs and strapped over their foreheads that are full of vegetables, grass for animal feed, or wood from the forest that they will use for cooking fires.
People work very hard putting in long hours almost everyday. Most of our patients are farmers from the surrounding communities. Some live very close, others walk more than 3 hours to make their appointments.
One of the most common complaints in the clinic is knee pain. I’d wager that it’s the chief complain of at least 1/3 of my patients. Most of the knee patients are older ladies who’ve worked their knees hard their entire lives. These ‘knee-ladies’ are the same ladies who carry the baskets. At first myself and the other acupuncturists were curious why knee pain was so common here. After just a few walks exploring the surrounding country side, we wondered no more as we passed these ladies in flip flops with basket loads that looked bigger than their bodies. No wonder!
During my first week of clinic as the knee-ladies, and a few knee-gents kept rolling in, I remember thinking “okay, more knee pain, no big deal, pretty straight forward…” It was interesting to treat, but I was waiting for the more ‘exciting stuff.’ At first the knee pain just didn’t seem as interesting or challenging as internal medicine complaints like COPD or stroke recovery. That all quickly changed!
Much work here is done squatting in fields or on roof-tops cleaning the day’s harvest. Toilets here are all the squat style as well. Healthy knees are essential in order to walk and to squat. One of my patients commented, “I have to stand to use the toilet like a dog.” Having your knees give up on you has major consequences here.
As the knee patients kept filtering in and I got to know them better, I started to have much more respect and reverence for the knee. Managing the osteoarthritis of a 60 year-old women who is still carrying heavy baskets of wood and grass up and down steep hillsides all the time is more challenging that I first imagined!
Although a complete resolution of symptoms is unlikely for all of these women, regular acupuncture combined with herbs helps to reduce the pain and inflammation and slow down disease progression. Some progress quickly, and others more slowly, but I’m happy to say that most of my knee patients are making at least some progress. It’s heartening to see them come into the clinic smiling because they were able to walk further without rest or they recently could start squatting again. Hopefully by the end of the camp I’ll have become a master of the knee! -- Sugandhi Jordan
