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By Seven Crow

Created: 31 January 2012

Now that I have been in clinic for a couple weeks, I am able to observe the effectiveness of the community style of acupuncture that I am giving. Treating multiple people in the day turns out not to be as hard as I thought it would be, but rather I have found I have a limit to how many people I can see, at this point in my life, without losing quality of care. Going beyond my magic number creates a fast food assembly line aspect that requires a very similar treatment each time. Some practitioners, such as Miriam Lee, swear by using the same few points over and over again. I, on the other hand, do not find that to be specifically helpful to the various patterns of disease I am seeing. So what to do?

My magic number does tend to fluctuate depending on the day of the week (for example later in the week I have begun to tax my energy reserves), how many new patients I am seeing, which clinic I am working in, how complicated the cases are, do I need to constantly reassess in great detail or is it a repeat treatment case, am I adding in more than needles, and so on. Plus, treating nearly 20 patients a day, six days a week is a new phenomenon for me. So far I have seen more patients in 2 weeks than I had in one quarter at OCOM (Oregon College of Oriental Medicine)! I am humbled and amazed at the skills I seemed to have acquired along the way in order to treat in such a fashion (and make people happy with my care)!

Something else I have noticed is the patients expectations are more realistic here than in the west. Back home people want miraculous results after one treatment and do not want to come back multiple times in a week. Sometimes this is due to cost, other times it is due to time availability. Here they come multiple times a week, walking great distances, and get results very quickly, even though they have limited opportunities to change their daily habits, or take herbal medicines long term. I am yet again astonished by the dedication the Nepali people have to their own, and their families, healthcare. I cannot tell you how many times I have heard the story of trying other forms of medicine and pills, but not getting results, it being too expensive or difficult to understand, then coming for acupuncture and end up feeling heard and healed! My heart swells to know they have found one part of the puzzle, and that I have the honor to help!

I have also witnessed the community style offering a chance for social healing. People from different castes, age groups, and language dialects  all sit around together, talking, making jokes, helping the doctors or each other’s children, all the while with needles sticking out of various parts of their body. This type of medicine is invaluable to care! However with any great thing there will be difficulties.

Earlier this week, a man came in to the clinic to get help for his family. There were a few things going on and while I consulted with him it became clear that he was looking for acupuncture to help his mother come back from Alzheimer’s. While I have been in many end stage situations, including suicide, I have never had to tell a patient (in this case the son of someone) that acupuncture could not make them better. I explained that acupuncture could offer relief of some symptoms and medication side effects, but not reverse this particular condition. The man looked lost and turned to one of my colleagues for a different answer or confirmation to my words. I could feel tears welling up in my eyes delivering the news , while also feeling frustrated I could not follow through with the conversation. I had to leave him in the care of another due to the three patients I had upstairs with needles in for Bells Palsy. Thankfully, my fellow colleague, Jessica Maynard, had the afternoon off and was able to visit the family and explain the situation with greater care.

It was in this moment that I suddenly felt the weight of being a doctor and primary care physician. People come to us with their health and trust that we can help them, or at the very least inform them of what is happening and offer some suggestions. Back home this responsibility is neither required of us or given to us, and when opportunity presents itself we rarely take it on due to liability, or scope of practice. Yet, we pierce their skin with needles, manipulate muscles, joints, qi and blood with massage, cupping, or gua sha, and give them internal medicines with light, severe, or no side-effects, all which should be followed up with adequate care. On top of this, they get miraculous results for diseases they were told had little to no cure! It is because of my trip here that I feel very strongly that we Chinese medicine practitioners should be considered doctors and primary care physicians throughout the world. Not just because our medicine deserves this respect and recognition, but because our patients deserve the same respect, trust and care they give us with their permission to treat.

While I had come to this decision living in the United States, it is here in Nepal, where my knowledge, wisdom, skills, and compassion has been tested, and what we do reveals just how effective these intricate (and yet simple) techniques can create a better quality of life. Being depended on as the go-to care because other avenues have failed to provide adequate solutions, or cost-effective medicines with minimal side-effects, is not a burden, rather a great honor. It is not that Chinese medicine is just cheap, therefore making it effective (although that does contribute to the answer), but rather it works with the individual body to create homeostasis and health for that person. While some people may present with the same pathology, they do not necessarily share the same symptoms 100% due to underlying conditions or constitutions. Treating here has taught me these skills more than 4 years of education; however the chance to study the medicine in the first place, and pass it on, leaves me with an extreme sense of gratitude.

On a lighter note, the same day I was met with the reality of having to deliver bad news from time to time, a woman patient of mine came back to tell me with glowing, shen filled eyes that she was healed and could now travel back to her village. She bowed several times, saying “Namaste” over and over, and then handed me a bag of fresh fruit as a parting thank you gift. Nothing could have pleased me more. She felt remarkably better, and completely empowered, to tell me she felt our healing sessions had come to an end. That simple exchange reminded me why I became a “doctor”, and instilled in me a profound thankfulness for all that I learn from my patients. As one patient said to me “you do what you do, I do what I do, but we both make the world go round”. Truth to that! --- Seven Crow

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By Brad Carroll

Created: 09 January 2012

“Dhanybhad” and “dukhchha” are two of the first Nepali phrases I learned during my stay as a volunteer practitioner at the Vajra Varahi Healthcare Clinic in the village of Chapagaon. The first phrase is defined as "thank you" while the second is translated as "pain". Although the definitions of these two phrases can be interpreted universally, my perception of the meanings of these words has changed, transformed and evolved during my experience.

What I once believed to have been two words that were easily defined and observed, they now present in a more abstract way that has lead me to reflect upon and seek a deeper understanding. In this pursuit, many questions have surfaced relating to my observations of pain, gratitude and the results of care based on the effectiveness of the overall patient/practitioner relationship. For example, how is pain determined and processed individually and how does a single condition effect people so differently? How much does physical pain effect an individuals emotional health and overall quality of life? How is quality of life for an individual defined and do I have a role in judging and or determining this for a patient? Why, as a practitioner is it so easy to accept the appreciation, gratitude and praise from patients when its them who is providing the opportunity to learn, grow and practice skills and utilize knowledge. Overall, how can one learn to understand and empathize with another’s pain in order to communicate more effectively how a treatment can effect a condition? How much does culture effect perceptions of pain and the ability to humbly provide and receive thanks? And finally, how does this information help practitioners in the field of therapeutic massage?

Although I may never have adequate or thorough answers to these questions, the thoughts provoked from them have come to symbolize my experience in Nepal and provide a pleasant reminder of my mission as an individual and practitioner in the healing fields. As I prepare to leave Nepal my own form of “dukhchha” has developed from the thoughts of missing the wonderful people and culture that welcomed me into their community. For all the patients, interpreters, staff and practitioners that helped cultivate this experience allowing professional and personal growth for me, I wish to express with all sincerity......”dhanybhad!” ---Brad Carroll

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By Andrew Schlabach

Created: 19 December 2011

Living and working in Nepal is a very difficult experience to summarize. It involves an elaborate collage of sensory, emotional and spiritual aspects that can be observed but which somehow defy categorization. Only after many months of treating patients, training interpreters and helping facilitate our practitioner teams does a theme slowly emerge as a seed on the very borders of my consciousness. A message from the universe answering the very question that is always on our minds. "What is this experience about?" I'm certain that this question gets processed a little differently by every volunteer, however, for me clarity is born of what to others might seem like a completely ordinary moment.

In November of this year we began a new outreach clinic in a small village called Champi. I personally love doing outreach clinics as it gives us the opportunity to expand the scope of the Vajra Varahi clinic in Chapagaon by providing support to communities that have very little access to care. Champi is a village that can not be reached by motorbike so twice a week one or two practitioners take a backpack of supplies and an interpreter, embarking on a beautiful walk across the valley. Descending a steep ravine to cross the river on a narrow iron bridge only to then make a breathless climb back up the other side. Crossing the terraced fields of mustard, winter wheat and potatoes we make our way to a small heath post where we set up a modest but very busy clinic.

Our first few trips to Champi were exciting forays as people crushed into our limited room. One particular day volunteer Jennifer Walker and I worked feverishly side by side. Our little room had 20 patients, the two of us and our extremely overworked interpreter, Sushila, all trying to hear and be heard. In the havoc of this Nepali reality we interviewed, assessed and treated as rapidly and effectively as we could. I clearly remember a moment in the early afternoon when I felt an overwhelming joy fill me. Something about the complete absurdity of the scene collided head-on with the sublime perfection of what everyone was doing there. People with pain, paralysis, digestive disorders and bodies just plainly punished by years of manual labor all reaching out for someone to care. Someone to take the time to connect with them and explain why their arm no longer functioned or to offer some relief to their pain that was keeping them awake at night. And from our side, our desire to be of service and grow as physicians. Everyone's needs being met in one collective heap of chaos. And then came the seizure...

Out of the corner of my eye I saw a man suddenly stiffen. His leg was rigid at an unnatural angle shaking like a power pole in a hurricane. His head arched ominously to one side. I had not noticed this man before as he patiently waited for his turn to be seen but now he had my full attention. In fact, he had the whole room's attention. Drool poured from the man's mouth as the seizure persisted for... how long? Time has a funny way of bending around these events in a way that no one can really recall the facts clearly. My 19 year old interpreter had never seen a seizure before and was certainly shaken but she very professionally stood by me as I simultaneously tried to reorient the man and interview his wife. Like a thousand patients before him, the story I was getting out of his wife made little to no sense at all. The best I could understand was that the man was 40 years old and he had been having seizures with increasing frequency for about one year. This was not a good sign as seizures rarely develop in adulthood unless there are pathological changes in the brain (like cancer). As the seizure abated and the man began to regain his orientation I noticed that his right hand became contracted and was pulled tightly to his chest. The lightbulb in my head first flickered and then illuminated the fact that the man had suffered a stroke. As soon as I was asking the right questions, the story flowed from the man's wife easily and, well... mostly clearly. Jennifer administered a gentle acupuncture treatment while I encouraged the man and his wife to bring all of his medical records to Chapagaon so that we could review his case and give him a better understanding of what had happened and what could be done about it, if anything.

After reviewing his records I found that the man had suffered a full occlusion of the left common carotid artery. In layman's terms he had a clot block the blood flow to the entire left side of his brain resulting in severe brain damage. I was impressed by the extensiveness of the MRI visualization he had received as well as the life saving stints that had restored the flow of blood to the brain. I knew that this type of medicine in Nepal had probably cost his family their land. And now here he was. He could not speak, walk or move anything on his right side. He could only communicate with his wife though eye movements and small head gestures. Worst of all in my opinion is that no one had bothered to explain to them what had happened. They saved his life and then sent him home without any further support.

By now you are probably wondering, how on earth do you find gratitude in that? You would be right... It's difficult. This kind of heartbreaking story is an everyday occurrence here, however, I found gratitude in all that happened next. In the weeks that followed I did not see any miracles but I did see a compassionate, competent team of volunteer physicians and an extremely inspired group of interpreters go to work to restore hope. Together they educated the family and set out a plan of action prioritizing the recovery of his speech. In addition to providing acupuncture treatment they spent time working on vocal exercises. They trained his wife on how to continue these exercises on the days he did not come to the clinic. It was not long before he was making basic sounds and mouth shapes, the building blocks of speech. Back in Champi, he paraded around our small treatment room showing the patients how much better he could walk. To be honest, it didn't look all that good and it took a lot of assistance, but it was a start. The more important part was the fact that he wanted to share his progress with his fellow patients; his new found community of support and cheerleaders. His eyes were now bright with a desire to begin a new journey.

When I look at these pictures I see all of the patients that benefit from our care. What I also see is the part that paints my heart with gratitude. It is not so much what you see as it is what is happening.... a doctor, a patient and an interpreter all coming together for one perfect moment in time. Sharing a presence and focus for the achievement of one goal. Connection.

Over this holiday season I hope that your lives will be as rich with gratitude as mine. Thank you so much for your interest and support of this project. --- Andrew Schlabach, President, Acupuncture Relief Project.