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By Emma Goulart

Created: 04 February 2013

Stepping off the plane into Kathmandu immediately put my senses on overload. Trash everywhere, burn piles in the streets, dusty haze hanging still in the air, beggars that make your heart contract, ragged stray dogs balding and weak. The traffic is horrendous, some sort of organized chaos that takes your breath away in more ways than one. Kathmandu city is notably loud and Nepal's winter is so so cold, without any escape.

... And yet, there is so much priceless beauty in the peoples eyes and in these sacred temples that it just stops you in your tracks.

After our adventure in the big city, we arrive to Chapagaon and I feel appreciative of the farmlands that surround our landscape here. Right away we head on a walk to become familiar with the neighborhood. The roads are more like what you might find on a backpacking trip, rocky terrain and slippery slopes, though littered with plastic wrappers. Around the backside of the clinic there are seemingly endless terraced farmlands. This time a year these gardens are filled with either mustard greens, bolting yellow mustard flowers, emerald green scallions or 2 foot tall fava beans. The majority of the fields have been covered in a cover crop until this last week. Now they are all transforming into rows waiting to be seeded. I take this as a hopeful sign that warmer weather is to come.

The day before beginning to treat, we are braced with a few questions to think about. What good is your compassion here without any wisdom? That question resonates inside, turning my stomach over on itself with the responsibility I feel for being a Doctor here. Understanding the difference between Treatment vs. Care and what exactly we are here to do. Its not a matter of how good our needle technique or Chinese Medical theory is. Instead we are here to see a larger picture of how to give our patients their best care. While doing so, holding both compassion and wisdom at the forefront. The compassion to be present and the wisdom to know when to treat and when to send out for the appropriate care.

Now we are three weeks in and I realize the magical exchange that happens within these clinic walls. Sinking into the flow, i feel as though I have had a moment to reflect for the first time. For the first few weeks, I felt as though hit by an emotional truck. The initial impact of the patients stories have hung heavy in my heart and I felt unclear how exactly to digest it all. Then one morning this week it became clear, that this is a mutual experience of giving and learning. I am here to heal and grow just as much as the patients coming into our clinic. This lifts the foggy veil of responsibility that has clouded my mind and allows me to work from a clarity. Only in this way will I be able to interact from a place of wisdom and compassion, delivering the best care i can give. --- Emma Goulart

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By Andrew Schlabach

Created: 19 January 2013

Learning to focus on measurable clinical outcomes is a skill that takes practitioners many patient touches to understand let alone master. Every year at our clinic in Nepal, Acupuncture Relief Project team leaders and I help practitioners learn to do better exam work, observe and record critical data and measure patient progression. My fellow colleagues, volunteers and teammates often reflect to me how tired they are of hearing me say “be objective.”, “how are you measuring that?”, “I know they are getting better but by how much?”, and finally “don’t rely on the patient to tell you how much they have improved... measure it! prove it!”. I certainly don’t mean to be a pest but I do want our practitioners to improve their diagnostic and prognostic skills. It is not enough to just treat hundreds of patients in Nepal... we have to be sure we are either getting them better or finding them someone who can.

This all seems like a straight forward process until you actually get into the treatment room. We are constantly confronted by the realities of the developing world: poverty, poor living conditions, lack of referral resources and hundreds of environmental factors like the absence of clean water, air pollution and poor sanitation. We also face many cultural and social obstacles like domestic violence, alcoholism, disenfranchised castes, disadvantaged ethnic groups and poor education. Then of course there are the human factors of old age, loneliness, depression and hopelessness. Even though most of our patients live a simple agrarian life, the day to day stress of basic survival for themselves and their families often weighs heavily on their well-being.

After months of balancing these many complexities it is easy to lose sight of our basic objectivity. On my recent return to the United States, I asked myself ”What did you accomplish”? The answer was so broad I wasn’t sure I could even grasp it. Hopefully I can illustrate some part of it in this story.

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If you have seen our short documentary Compassion Connects you might remember seeing this young women (below right). Thirty-year-old Kanji Maya Tamang is one of three Tamang women who travel from the small village of Bhardev to our clinic in Chapagaon. Kanji Maya tells us in the video that she is coming to our clinic for menstrual pain. The full story is actually much more complex.

Kanji Maya was indeed coming to the clinic for menstrual pain, however, this pain was caused by a series of four miscarriages each followed by a curettage procedure. Her monthly cycles were now very irregular and painful. The bigger issue was that she was under enormous pressure from her family to become pregnant again. In Nepal, producing offspring is of critical importance to a families survival. In fact, at thirty-years-old and childless, Kanji Maya was at risk for her husband to take a second wife. While taking a second wife is a cultural norm in rural Nepal, the replaced wife is often shunned by the family and relegated to a life of hard labor, loneliness and poverty. We have treated many women of this status in Nepal and we have all seen how devastating this can be. Kanji Maya desperately needed more time and through many tearful sessions with our practitioners, she slowly began to have more confidence that we would be able to help her.

Personally, I rarely practice fertility medicine as it is not an interest for me and their are so many other practitioners for whom this is their passion. This case however had my attention and I could see so many implications as to how we were not just looking after this one young woman, but rather we were attending to the health of an entire family. As a team, we constructed what we thought would be an effective treatment plan. Then over the course of several months and several different volunteer practitioners, we went to work to implement that plan. Kanji Maya traveled several hours by bus twice a week to receive our treatment which at first focused on regulating her cycle, then later focused on building uterine blood, so that she could sustain a pregnancy. Towards the end of my stay in 2011 we had accomplished everything we had hoped to and I counseled Kanji Maya that the timing was right for her to try to get pregnant again. The team taking over for me continued her treatment for several weeks thereafter and in the Spring of 2012 we received the news that Kanji Maya was indeed pregnant. In early August she delivered a healthy son.

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In the brisk mountain air of January, Satyamohan and I ride our small motorbike up the twisting road to the small village of Bhardev. A smattering of small white pines line the edges of the narrow road. At each bend a cathedral of Himalayan peaks pierce the horizon as my fingers burn from the cold. After reaching the pass we descend into a beautiful grassy valley littered by small clumps of thatched roof houses. A few minutes later we pull up in front of a squat, mud-and-brick building and as we dismount we are greeted by a small group of brightly dressed Tamang women. We are quickly escorted inside where the celebration is already long underway.

Pasni, the Weaning Ceremony, is one of the many hundreds of celebrations in Nepal. Relatives gather to witness and celebrate the child’s first taste of rice and for sons, this takes place when he is 6-months-old. We are escorted into a large smoke-filled room with mud floors. Dried corn and strips of meat hang from the low ceiling and a group of women attend an earthen hearth with a wood fire. They are busy preparing the meat of young water buffalo which was slaughtered just this morning. My eyes burn and the acid wood smoke causes my nose to run. I see many family members lining the inside of the small space, all drinking chhaang (rice beer) and talking all at once. One man gets up and entertains the group with a lively dance and everyone joins in by singing traditional folk songs.

Satyamohan and I are served heaping plates of spicy meat, rice and vegetables. One by one people come over to talk to us. They tell us how happy they are to have this new baby and how thankful they are for our clinic. Every story has the same theme. “I came to the clinic... then I sent my wife, she sent her brother, he brought his wife...” and on and on. It seems like pretty much everyone in Bhardev and the surrounding area had been touched by our clinic in one way or another. This new baby was just one tangible example. And who is to say really... Was it our medicine that brought to boy into this community? Perhaps it was just our kindness and support that allowed Kanji Maya the little more time she needed. Maybe it was just luck.  

As I look though the smokey haze at the joy that is filling the hearts of so many people... let’s just call it an immeasurable success. --- Author: Andrew Schlabach

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By Tara Gregory

Created: 30 December 2012

Over the last 6 weeks treating in the clinic here in Nepal time has flown by.  As I prepare to leave in just 3 days patients tell me that it seems like I have only just arrived days ago.  I agree, I'm not ready to leave this new family and community that has been building.  I should have known that time would do funny things here in Nepal before I arrived, given that the time difference between here and my home in Oregon is not the standard 13 hour time difference.  No, there is also a 15 minute difference added into the time change.  So much is packed into each day it seems as though a month is fit into every week.  I feel that all I can do is surrender to the process, just flow with the fast pace, and hope that in time everything will settle and my consciousness will catch up!

As time flies by I'm left with questions whirling in my head. Most questions center around what my role is here in Nepal as a health care provider.  Is my role to get patients better quickly so that they can stop coming in for treatment in the shortest amount of time possible? Is my role to provide a safe space for patients, a place for them to experience a pause from the rest of their week?  A receptive ear to listen to the suffering experienced and the joys of their lives?  The abusive husbands, the grandchildren abroad, the weddings planned, the abandoned children adopted. Do I help provide a place where community can build, a place where bonds between patients establish themselves.  Offerings made... One patient quietly slipping another money, who can not afford necessary medication. The answers come and go and shift in response to the day and the patients who arrive in my treatment room.

Throughout this process I'm faced with so many questions and unknowns, I'm constantly challenged to just stay engaged and be present.  With time moving so quickly it is easy for me to want to slip away to a quiet place for a moment, to reflect, replay experiences, and in that way process all that I'm learning and witnessing.  Instead I challenge myself to just stay engaged with this moment.  Sometimes it is easy, watching the sunset reflected on the Himalayas, welcoming 8 new puppies into the world, the excitement of our building being under siege by the neighborhood clan of monkeys. Other times it is harder, holding a 11 year old epileptic monk as he seizes in my arms, days when the trembling of my patient suffering from Parkinson's Disease is hard to calm down, and knowing that my patient with high blood pressure will never get the necessary medication due to lack of finances and family support. These challenges have helped me cultivate an ability to stay grounded and present during intense situations. 

Gazing at the Himalayas this morning I hope that my time here will shape me like the elements have shaped the mountains.  Cultivating strength, groundedness, and perseverance on the inside while being soft enough on the outside to be touched and shaped by what comes my way. ---Tara Gregory