News BlogLatest News From Our Volunteers in Nepal

 

Acupuncture Relief Project  | Good Health Nepal | Kate Cauley

Not long ago, I watched a man carefully walk into clinic, cane in hand, right arm and leg trapped in contracture from a stroke. He sat down silently and handed me his chart. I read the words hemiplegia…. aphasia… I turned page after page as other patients filed into the clinic to sit in the open chairs, waiting for me, the “new doctor”. I sat on my seat, my mudha, and continued to stare at the stroke victim’s chart as this new world faded around me.

As a practitioner in the United States the resources to work with stroke is limited to very rare opportunities in hospitals. My experience with stroke had only been in textbooks, lectures and TCM theory. This was new.

Taking a moment to compose myself, we greeted each other in the customary way of the Nepalese: I said namaste as I pressed my palms together and assumed direct eye contact. Bimdev returned the gesture with one hand raised, his right hand betraying his illness, and muttered an unintelligible reply. I began my work, taking vitals, touching his scalp, hands, arms, and feet. Looking into his eyes, I knew I was nowhere near instilling that patient doctor trust so crucial to healing and that I needed to gain it if I were to help this man.

Acupuncture Relief Project  | Good Health Nepal | Kate Cauley

I brought Bimdev’s chart back to my room that night to search for more information. He’d been going to the clinic for many years so his chart was big, but the practitioners before me had little more to say than that Bimdev was a quiet guy who never offered much information during the intakes. His hospital records filled in the blanks. Rheumatic fever, possibly a result of an untreated streptococcal infection when he was young permanently damaged the mitral valve in the left ventricle of his heart. Four months ago Bimdev’s stroke was due to the medical consequence  of an emergency appendectomy. The doctors had no choice but to take him off his blood thinners in order to perform the lifesaving surgery. The blood thinners had been protecting him from blood clots. During Bimdev’s recovery a clot formed and went directly to the left hemisphere of his brain leaving him with weakness in his right limbs, and difficulty speaking and understanding conversations.

The next morning at clinic, armed with my textbook diagnosis. I started our session with a few words. My interpreter spoke while I looked directly at Bimdev. “I am so sorry this happened to you. This illness has left a hole in your heart both physically and spiritually. I can’t help you without your consent. Do you want my help?” Bimdev nodded yes. It seemed an obvious answer, but we needed this contract. We were going to do this together. We began our work.

Acupuncture Relief Project  | Good Health Nepal | Kate Cauley

Our first few sessions began  with massage oil on his right arm and hand, pressing and following the six acupuncture meridians along the arms. It was as much a trance for my mind as it was for his. With three patients an hour, I still wanted to spend a moment forming a relationship with each patient. Verbal communication was often overwhelming for Bimdev, so massage provided  our connection. After extending contracted joints and massaging his right arm, I would massage his left hand and arm just to remind the right and left of their innate capacity to  communicate with  each other.

Bimdev was improving everyday. As the days went by, we practiced vowel sounds and he worked on moving his mouth to form oos, ees, ahhs.  Repeat, repeat repeat, creating new connections in the brain. It was amazing to watch, and I reminded him often of his progress. Everyday was a variation of  massage, acupressure, speech therapy, and needles. The acupuncture and ESTIM were speeding the progress. I activated scalp points for speech and other therapeutic points to extend his contracted muscles. Together we awakened tonifying points for recovery. The weeks went by too quickly.

Acupuncture Relief Project  | Good Health Nepal | Kate Cauley

There is no privacy in Nepal. Doors have no door knobs - they swing right open in the wind if they are not  bolted. The neighborhood “tap”, where the village gets water, is also for bathing and washing and is about as social a spot as a Western office water cooler. The rules of private property are also very different. During my free time I roamed across terraced fields, past open doorways, and no one seemed to care.

Patients had no sense of privacy in the clinic either. If there was something worth watching it was not uncommon to have a curious crowds craning necks or peering through the clinic windows. This was very difficult for Bimdev he did not  want people to see him try, yet his condition was irresistible to any passing spectator. The crowded clinic was often more than he could bear, and when he was escorted by his wife, he would insist she wait outside the clinic while we worked. One morning Bimdev was accompanied by a young woman who I can only describe as grace personified. Even Bimdev seemed in awe of her, his face brighter and lighter in her presence. So lovely in movement and beauty, I was charmed by her immediately. This young woman was Bimdev’s daughter. I introduced myself and asked her name. She spoke English and said her name was Malati. After a few weeks of pointing at handmade flashcards of kukur (dog), anar (pomegranate), pani (water), ahma (mother) and getting nowhere, we had our inspiration. “Bimdev,” I asked, “would you like to say your daughter’s name?” Eyes welled for both of us.

From this moment on, Bimdev’s chart is full of enthusiastic scribblings of progress and setbacks as we both learned how his brain worked. Not speaking the same language was a large hurdle for us, but the days when my interpreter was busy with therapy on another patient was when Bimdev and I found our own language. I would point to my mouth, press my lips together and make the simple sound mmmmm. He, no longer uncontrollably puffing his lips, mirrored my gesture and sound. “Yes!” I’d say, and then it was mmm mmm mmm for days.  We added the vowels at each session ahhh, aaaa, eeee, ieeee, oooo ouuu, uoo.  After mastering m, we went after l. I  asked him to put the tip of his tongue to the roof of his mouth and he complied, something that was not possible only weeks ago, llll, llll, lll. Though Bimdev’s ability to form words with his mouth was improving  he still wasn’t able to  put the consonant with the vowel sound yet so the clinic was full of he and I making noises mmmmm, llllllllll, and tt. His mouth was always forming words ahead of his speech  one day, I asked Bimdev, mmmmmahhhh. Bimdev’s lips formed the letter m quickly then he soundlessly opened his mouth to an ah. After a few repeated attempts he did it, maaah, maah, mah, mah, mah.  

The set backs, which were numerous, were actually learning curves. One day, out of the blue, he started making clicking sounds. We amused each other with the new action and sound, but the rigid tongue movement to the roof of his mouth got confused with the gentle la, and it would take a while for him to register the softness of his tongue for different uses. We were stuck on ka, a sound I believe came from kukur (dog), which set us back for almost two weeks. The speed at which we moved seemed fast, but perhaps it was the milestones we set and the enthusiasm that made it manageable for both of us. It was  only very recently that I ask Bimdev to say, Mala. He began, ma, ma, ma, ma. I touched his knee and pointed to  my mouth, la. He looked down from his usual eyes on the ceiling ma, ma pointing again, his tongue just touched the roof of his mouth, in la form, but no sound. “Yes!”  We tried again for three days, until it was a perfect, Mala. “Ramro,” I said. Good.

Four weeks into my camp stay and my walks through town often included passing Bimdev in town. We would make eye contact as if we had a million things to say to one and other, which always translated into big breaking smiles on his face. Sometimes I would see him in front of a store with other men and I would  holler, “Namaste, Bimdev!” His reply, an ear to ear grin. The other day, while he was leaving, I said “bollie batola,” see you tomorrow, which had him smiling so hard I could almost hear him laugh. Perhaps I made the impression on him, that both of us were trying to speak and it was ok to try and repeat.

Acupuncture Relief Project  | Good Health Nepal | Kate Cauley

It was nearing the end of my stay at the clinic when I explained, “Bimdev, this is the last week of clinic.” I continued, “Dr. Emma has been following the work we are doing and she is going to work with you when I leave.” He bobbed his head back and forth, the traditional yes, which still looks like ‘no’ to me. “I was hoping you could say Malati before I left.” Bimdev’s eyes were a little solemn. We gave each other the customary namaste and he walked home on his own, no longer needing a family member to look after him. The next session we sat down and practiced the three syllables separately. Then the first two together, I touched his knee and pointed, teee. And there it was. His mouth formed the eee with no sound and he had done it. We practiced again and got three beautiful, quiet, Malati. This beautiful man just said his daughter’s name.

I am sorry to have met Bimdev under these circumstances, yet it is hard to leave him. Bimdev and I have challenged each other. I hope our time together has made his heart a little stronger and bigger, I know it has mine.

As a practitioner in my fifth year the experience at Suswasthya Clinic has had a profound effect on me. I have loved every moment here. As my focus returns to home I wonder how I can improve my clinic in the US to be more efficient for treatment of musculoskeletal pain issues and offer more affordable treatments to long term and palliative care patients who need regular care. I know I am a stronger, more versatile, communicative practitioner because of my time here. I am forever grateful for the interpreters and staff who have been generous with their time and experience and Nepal is pretty awesome too. Nepal is sooooo awesome. Tsering Sherpa once assured me, “If you can physically make it to Nepal, Nepal will take care of your Mind and Spirit.” I trust-fell right into his words. I settled into my routines at clinic, and the Nepal I perceived gave way to a discovery I can only identify as feeling completely at home. ---Kate Cauley

More Articles

  • The Ripple Becomes a Wave

    The Ripple Becomes a Wave

    Our patient sits on a mat that is hand-woven with rice stalks, separating her from the cold stone floor. It’s early and our clinic hasn’t opened yet but this woman’s

    Read More
  • Seeing Nepal in a New Light

    Seeing Nepal in a New Light

    The morning sun glitters through the windows and my rhododendron plant stretches its leaves up to reach the light. I put on the kettle and sit down to eat my

    Read More
  • Volunteers Back in Nepal

    Volunteers Back in Nepal

    When I arrived in Nepal I was an anxious graduate student fresh out of acupuncture school during the Covid-19 pandemic. Having spent two years practicing medicine over zoom, I was

    Read More
  • The Tin Shed

    The Tin Shed

    Ramkrishna’s eyes brightened with recognition as we entered. His room… a small tin shed. A collage of colors and rust patinas cover every surface of the salvaged corrugated metal. Six

    Read More
  • Volunteer Acupuncture Care

    Volunteer Acupuncture Care

    “Finding our own definition of success means becoming aware of what we value. Often, this means rinsing years of conditioned thinking from our minds. ” - Anonymous I recently returned home to

    Read More
  • COVID-19 Update

    COVID-19 Update

    Dear friends and donors, I want to thank you all for your continued interest and generosity towards our ongoing work in rural Nepal. March 16th, in response to the global

    Read More
  • End of Life Care in Rural Nepal

    End of Life Care in Rural Nepal

    Basanti is a 32 year old woman from the small village of Bajrabarahi, about three to four hours from Kathmandu (depending on your mode of transport). Ten years ago she

    Read More
  • The Color of Love

    The Color of Love

    In my first week with Acupuncture Relief Project, a grandmother came to the clinic complaining of abdominal pain. She had eaten some bad buffalo meat and was now suffering from

    Read More
  • Integrated Medicine for Rural Primary Care 

    Integrated Medicine for Rural Primary Care 

    “Easy! Easy!” My motorbike’s rear tire spins out to the left as it loses traction on the rain soaked, stony... road? path?. It’s a cold wet Saturday morning and I’m

    Read More
  • Wound Care

    Wound Care

    Recently while working in the Bajrabarahi clinic I had the opportunity to help someone with an infected wound. A middle aged woman came into the clinic with a swollen, painful

    Read More
  • Rice Harvest in Nepal

    Rice Harvest in Nepal

    I don’t know about you, but I grew up eating rice for basically every meal. My job in the house was to make sure the rice was washed and cooked

    Read More
  • The Faces of My Patients

    The Faces of My Patients

    tamangwomen I looked down to check that I had everything. I wore my white lab coat, new name tag, and had pens in my pocket. My supplies were all laid

    Read More
  • Nepali Women

    Nepali Women

    Cricket highlights are buzzing in my left ear, as I peel apart crinkling, plastic sleeves of a wedding album. My patient’s fourteen-year-old son splits his attention between the static screen

    Read More
  • Naturopathy in Nepal

    Naturopathy in Nepal

    Four years ago I fell in love with the most impoverished district of Nepal called Humla. Though I was there to research malnutrition, I quickly realized the desperate need of

    Read More
  • Human Suffering

    Human Suffering

    Yesterday, I saw an 80 year old patient whose oxygen saturation read 75. In America, anyone under 90% gets an immediate oxygen cannula in their nose. When I first encountered

    Read More
  • Bimdev Says His Daughter’s Name

    Bimdev Says His Daughter’s Name

    Not long ago, I watched a man carefully walk into clinic, cane in hand, right arm and leg trapped in contracture from a stroke. He sat down silently and handed

    Read More
  • Tamang

    Tamang

    She sat there like a queen, or a dictator, regally poised in a red plastic chair, her gold-tasseled nose ring eclipsed by her broad nose. Faded tattoos traced the corners

    Read More
  • The Best Medicine of All

    The Best Medicine of All

    I’m totally overdressed, now sweating in my puffy jacket that only a few hours ago seemed totally adequate to stave off the morning frost. The Nepali middle hills tower and

    Read More
  • My Home Away From Home

    My Home Away From Home

    After living in Bajrabahari at the Acupuncture Relief Project headquarters for 3-1/2 months it has become my home. As I think about my “other home” in Portland Oregon it seems

    Read More
  • This Is A Place I Call “Home”

    This Is A Place I Call “Home”

    Sitting in front a window at the Roadhouse in Thamel, realizing I’ll be leaving Nepal in less than 8 hours, feel like unreal. There is a strong voice inside me

    Read More
  • Heart Wrenching at Times and Exhausting at Others

    Heart Wrenching at Times and Exhausting at Others

    It has been a month now I have been living in Bajrabarahi, Nepal and I am in a nice groove. I am consistently seeing around 15-20 patients a day in

    Read More
  • Walkabouts in Nepal’s Agricultural Nirvana

    Walkabouts in Nepal’s Agricultural Nirvana

    As an American Acupuncture volunteer for Acupuncture Relief Project (ARP) in Nepal, I stepped into an eastern culture that is a distant shadow of my own, regarding the traditional farming

    Read More
  • The Work of Farming

    The Work of Farming

    I’ve been moving around for awhile, but for most of my life I lived in one place. There is much to be said about having roots and feeling at home.

    Read More
  • Everyday Acupuncture Podcast

    Everyday Acupuncture Podcast

    Here in the west we are used to seeing acupuncture clinics in an urban setting, and it is often sought as an adjunctive therapy used in combination with other modalities.

    Read More
  • Jatra: The goddess

    Jatra: The goddess

    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

    Read More
  • Beyond the White Coat

    Beyond the White Coat

    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

    Read More
  • Baskets and Knees

    Baskets and Knees

    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,

    Read More
  • A Day in Bajrabarahi: Where There are No Doctors

    A Day in Bajrabarahi: Where There are No Doctors

    When we open the clinic doors at 8:30, there are usually already a handful of patients waiting outside in the crisp morning air. Patients arrive throughout the day. There are

    Read More
  • Ten Years in Nepal: A Tale of Three Brothers

    Ten Years in Nepal: A Tale of Three Brothers

    The day started like most days, a brisk late-autumn morning with a light frost on the ground and clear blue skies. A breakfast of churra (beaten dried rice), chickpeas and

    Read More
  • Death

    Death

    Today's topic: Death! (the author does not pick blog topics; the blog topics choose him) I began thinking about this after hearing that one of our ARP staff members, Tsering,

    Read More
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

Follow Us on Facebook

Your Donations Help

In addition to volunteering their time and energy, our practitioners are required to raise the money it takes to support their efforts at our clinic. Please consider helping them by making a tax deductible donation in their name.

DONATE NOW

Support our work

Donate Volunteer Get in Touch

Support Us