Details

By Sarah Maiden

Created: 23 October 2019

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 this woman in her village, about 2 & ½ miles away over hills and valleys, I tried checking her vitals. During that encounter, I assumed the machine was malfunctioning due to sunlight or lack of proper circulation because it was reading 67. In my Western ignorance, I assumed anyone with a 67 percent oxygen saturation would clearly be dead – as opposed to squatting on the roadside chatting with me, discussing walking miles to the clinic, and leisurely watching the rolling clouds flow over the gorgeous valley. However, on the following day, she stayed true to her promise and hiked the giant hill 2 &½ miles to our clinic seeking help with her breathing. Her blood pressure had dropped to 85/60 at this point, her biceps so tiny they barely filled the cuff. She kept repeating that she wasn’t sure about being in the clinic because she’s just going to die soon anyway. I gave her my typical response, “I understand. Maybe we can make this time easier for you.” I was able to stall her for two hours. First I gave acupuncture. Then, I put the Albuterol inhaler to her lips and pushed it twice because she didn’t have the strength to do it herself. She had walked the distance uphill to the clinic alone, like any typical badass Tamang 80 year old with advanced COPD would, of course!

I told her to get her son to push the button at home and gave instructions for using the medication, unsure if it got through to her seemingly alert oxygen-deprived brain. Finally, the healthpost staff showed up, late, and gave her an Albuterol nebulizer. Considering her state, I assumed they would keep her there while I returned to my waiting tent full of a dozen patients and relatives. An hour later, I spotted her tiny figure out of the corner of my eye, making a run for it down the lane. I had my interpreter yell out, “Hey grandma!,” before we realized that she wasn’t suddenly pausing for a breath (why would she do that?), but was standing at the edge of the road urinating straight down onto the ground, clearly wearing nothing under her long colorful patterned skirt. “Hey grandma!,” we tried again. She turned around. I couldn’t bear to force the tough old mountain lady into anything she didn’t want. “You want to go home now, don’t you?” “Yes,” she replied, perhaps with a few comments about the importance of feeding the goats or playing with her grandchildren. “Okay I understand if you have to leave now but we might have some other medicine that will help. Do you feel better now?” “Yes, much better.” “Can you please come back on Friday?,” I ask, with a sigh as I sincerely respect her patient autonomy, as this relationship was built on the trust established by chatting her up on the roadside. “Yes,” she answers, as if the uphill hike with advanced COPD and oxygen saturation at 67 is a complete walk in the park. She gives me the little sideways headshake implying Nepali agreement, and takes off at a pace that would startle any 80 year old American. 

Read more: Human Suffering

Details

By Kate Cauley

Created: 11 May 2019

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.

Read more: Bimdev Says His Daughter’s Name

Details

By Mallory Harman

Created: 28 January 2019

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 of her chin in the shapes of upside down “E”s — symbols she later said have no meaning. Wisps of silver hair framed her face and pulled back into a small bun, displaying the sizable golden plates gouged through the centers of her ears. Their worth could be seen in their weight — thick, circular slabs resting uncomfortably on the cleft above her earlobes, a ruby shimmering at the center. The large beaded necklace she wore weighted by a heavy studded golden cylinder indicated she was a married woman. This necklace was the cleanest thing she was wearing, the neon green beads sparkling atop her dirt-laden choli (traditional top).

As I approached her, she sat stoic, still. Her vibrantly colored clothes countered the message of her icy demeanor — I felt unsettled by this contradiction, and the air of peculiarity around her. I sat down on my mudha (a brightly colored Nepalese bamboo stool), pretending to finish my previous patient’s chart, and finally looked up. Her eyes pierced mine — strong, sharp, intimidating. She stared at me as if she was sizing me up - all 4’11” of her. For a moment I sized up myself, too. “Namaste” (hello), I said in my best Nepali accent, holding my hands up in prayer at the center of my chest. Before she responded, the interpreter looked from me to her, mimicked my greeting and said, “Lasso” (“lah-so”). To my embarrassment, and subsequent confusion, I learned that this was the proper greeting in Tamang language. My patient, like many of the patients I saw in Tistung, was a Tamang woman.  

Tamang Women

Read more: Tamang