This is one of the outreach clinics I treat at.  Right there, outside of a shut down school.

                                                                                                                  Overlooking this.

Here, some of the patients wait for their treatments and chat with each other.  There are no appointments.  It's first come, first served.  I try to treat as fast as I can, so people aren't waiting long.  One day, I treated 21 patients here.  E-stim and moxa are a general given for most patients, but sometimes we bring herbs here if we can't do enough with needles and adjunct methods.  We break for a 30 minute home-cooked lunch at one of the patient's houses.

On our way we motor down road that looks like this, passing...

               

                                                                                        farmland and farmer's houses

the place where locals get water for cooking, washing and bathing

                                                                                                                     a brick factory.

This 9 year old mini monk comes in complaining of ear pain.  Clinically, my first thought is ear infection.  It’s such a common pediatric ailment, and the weather has been so funky lately, everyone’s feeling ENT symptoms.  The mini monk speaks no English, and he came in with his older monk friend who speaks just a tad.  It was after clinic hours, so none of our professional interpreters were there.  It usually means we just do the best we can with what they give us.

OK, ear pain.  In Chinese Medicine, the word “pain” tells us almost nothing.  We want to know what the pain FEELS like, the subtle nuances of subjective experience and location of pain are our bread and butter.  I ask, and I get nothing in response.  No words, no facial expression, nothing.  Plan B.  “When did you start feeling the pain?” “This afternoon.”  Good, at least that’s something – it’s acute ear pain.  Explaining how to hold a thermometer sublingually is a whole other blog topic..  Temperature is normal. Also good news.  “Any sore throat?  Headache?  Difficulty swallowing? Body aches?”  The mini monk shakes his head in total exasperation, and yells something at the older translator monk.  “He says he hears two different sounds in each ear.”  Uh oh.  Out comes the otoscope.  Is this a super nasty ear infection, striking fast and hard?  Did he get something stuck in his ear?  Tympanic membranes are fine.  No redness, no bulging, no exudate.  There’s a drop or two of water in one ear, but otherwise two very healthy ears.  Is this neurological?  Back to square one.  “Other than hearing two different sounds, tell me more about this pain in your ear.  Once again, what does it feel like?  Is it hot?  Is it heavy?  Does it feel like its pushing outwards? Any pain in your cheek, teeth or throat?”  “No, there’s no pain, just the two different sounds.” 

Why people come in and say they are experiencing pain, when the subjective experience isn’t painful at all is an interesting one.  I get this ALL the time here.  It’s as if “pain” is a synonym for “problem.”  Pain is in fact a problem, but not all health problems are painful. 

“So when did this difference in sound begin? Did you say this afternoon?  What were you doing this afternoon right before it started?”  “It happened in the shower.  Some drops of water got in my ear, and now I hear two different things in my ears when the teacher is talking during class.” OOOOkkkkay!!  Water in the ear. Totally uncomfortable, but no medical emergency. No sweat! “Stand up.  Do like I do.  Stand on one foot.  Now hop and shake your ear out at the same time.  No no, other foot – same side as the ear with water in it.  Come on, hop like me.”  Mini monk looks at me wide eyed and starts hopping, but hopping straight up and down, very slowly to make sure that his head doesn’t fall off as he goes.  “Come on, shake your head to the same side, harder, like this.” With violent shakes of my head I hopped on.  The monk finally obliged me and began hopping on one foot and shaking his head to BOTH sides. “No no, that defeats the purpose.  Just one side, the side with water in it. No no.  Okay, stop.  Just shake your head to the one side.”  The monk’s eyes are puzzled.  “Should I shake my head or not!?” “Yes, shake your head, but don’t hop.”  The monk shakes his head as I ask him to, but again to BOTH sides.  “No no, stop. Just shake to one side.  YES!  Keep going like that, now hop on one foot at the same time!  Like this.”  For whatever reason, the unilateral head shake turns bilateral with the addition of the one-legged-hop. 

I sigh deeply, drop my shoulders and my head.  “Okay stop.  So when you remember to, shake and hop…kind of like we just did.  The water should come out soon.  If you’re still hearing two different sounds in your ears in class tomorrow, come back and see us.  Don’t worry, you’ll be fine. Bye now.  Namaste.”  I motion for them to shuffle out. The two monks quietly recite back to me the common Sanskrit word meaning both hello and goodbye, trepidatiously putting their hands in the accompanying prayer position, while stumbling over each other as they exit my treatment room.  They don’t know whether I am a witch doctor, or a crazy person, or legit medical personnel. 

4 years of expensive school and I can jump up and down with patients! He came back the next day to say it was better.  Good.

We have no refrigerator.  No oven.  Only 2 burners on a modified gas range.  When cooking dinner for 5 people, you've got to be concise and creative.

Each day, we go to market and get fresh produce.  We're forced to eat local, organic and in season.  Heaven! 

Since the closest "supermarket" is a 2 hour walk (each way), or a 20 minute bus ride (each way), we pretty much stick to what we can get down the road.  Basically we eat the same kind of food every day.  To spruce it up a bit, Joe decided to make momos - Nepali's delicious dumplings - on his dinner night last week.  It's a hefty project, so we jumped in to aid the cause.

Step 1: Chop the veggies

Step 2: Look busy

Step 3: Make the dough

Step 4: Fill the dough and boil

Step 5: Eat!

When load shedding cuts the power (I am told we'll have more power during the monsoons, since the electricity is hydro-electrically powered), we often cook and eat by candlelight.  Very classy.  I even made my first cake in a pressure cooker, since there's no power to fuel the electric cupcake maker.  Is there anything a pressure cooker can't do??

We’re running out of water again!  No broken pieces this time, but someone forgot to pump water from the main supply into the clinic water butts, the reserve drums atop our building.  Since the water was almost out anyway, Joel asks Lee and Joe to clean the naturally occurring growth at the bottom of the butts.  Huge HUGE thanks to Lee and Joe for getting in there and cleaning our butts!

We decide to head to our local café and get dinner there.  Just as the guys were done cleaning out our butts, big rains came.  This was great for the final rinse of the drums, but just as we were about to head to Lila’s (the best cook in Nepal aside from our own Urmilla), our building began to flood! Apparently the people who built our building forgot to slope the terrace so water would run OFF it, and instead angled it towards the center so that water run INSIDE it.  They planned for a threshold to dam the water that flows under the terrace door and floods our top floor, but the marble for the threshold sits in pieces NEXT to the door.  Not helpful.  We got upstairs to the flood as Joel was pushing the floodwater back out onto the terrace with a big squeegee yelling to Lee in a frenzy, “captain! we’re taking on water!  i think we’re goin’ ta sink!”  If the floor was angled inwards, Lee reckoned, there wasn’t anything that could be done to stop the flooding.  All efforts were futile.  We moved some furniture out of the way, and watched the water pour in.

Lila’s awaited us.  With delicious hot food.  Lee has since procured waterproof grout, and is awaiting the marble pieces cut to fit the threshold.  Hopefully that will be done in time before the pre-monsoons end and the real ones begin. 

The communist party issued a "bandh," a strike which prevents anyone from opening shop and from vehicular travel.  Parties which hold stake in the upcoming constitutional redraft endeavor to use fear and force to influence their way into power under said new constitution. We are told that the May 28th deadline will likely be postponed again, and that week-long strikes are to be expected thereafter.

The US Department of State issued this explanation of the situation on their website about Nepal:

"May 02, 2011 :
COUNTRY DESCRIPTION: Nepal ended a ten-year Maoist insurgency in November 2006 and established an interim government in January 2007. Constituent Assembly elections held in April 2008 formed a Constituent Assembly to serve as a parliamentary body and to draft a new constitution by May 2010. However, the Constituent Assembly did not finish drafting the new constitution by this date and extended the deadline to May 28, 2011. The Constituent Assembly declared Nepal a federal democratic republic and abolished the monarchy in May 2008. The Unified Communist Party of Nepal-Maoist, which received a plurality of votes in the Constituent Assembly election, formed a coalition government in August 2008. The Maoists stepped down from government in May 2009, and a new coalition government under the leadership of the Communist Party of Nepal -- United Marxist Leninist (CPN-UML) was formed. In June 2010, this government officially resigned and became a caretaker government. A new Prime Minister, the UML’s Jhala Nath Khanal, was finally elected in February 2011."

Our experience wasn’t dangerous.  More on all of this to come.

For more information about the political economy of Nepal, or simply it's history, this is a data filled website from the State Department.

We head to Boudha right after close of business to attend the final day of puja at the White Gompa.  We decide to go at the beginning of the last day, at 3am.  Lee heads up early on the motorcyle to secure us all a place to stay for the weekend.  Bless his soul, Lee tries 3 different guest houses before the 4th has availability.  He gets two rooms, one for the guys and one for us with an adjoining rooftop terrace overlooking the Boudha Stupa.  He scours both rooms for any sign of buggies, and then makes the reservation.  Marcella has her own apartment in Boudha, where she stays whenever she’s up there. 

Marcella, myself and the guys take an uneventful bus trip up to Boudha, where we meet up with Lee and Misty in time for dinner.  We eat a lovely meal and decide to head in early, given our wee hour waking time for puja.  Lee and I head upstairs to our room, and walk in to 3 MASSIVE waterbugs crawling out of the bathroom.  The Westside Highway middle of summer in Manhattan waterbugs have nothing on these Nepali suckers.  These are the biggest and fastest exoskeletal crawlies I have ever seen.  Couldn’t do it.  Wanted to so badly, but after the previous week’s no shut eye debacle, I couldn’t face a possible repeat.  For the 3 we saw, that made how many we had yet to see??

It was already dark, and Lee only had one helmet, but I sheepishly pleaded to head back down to Chapagaon.   We called our friend, Joel, who lives at the clinic and manages the construction of a temple just behind the monastery, to alert him of our crazy adventure and to ask him to leave the clinic unlocked. We set off for the first time riding back in the dark, on unmarked roads, my first motorcycle ride with Lee, and my first unhelmeted ride ever.  It was do or die.  I put my arms tightly around his waist, my head down, we said our prayers and off we went.

We did it in one shot!  I even recognized when we took a wrong turn.  The headlight of the motorcycle is shit, so it was scary as hell when oncoming headlights blinded us, but a ride that takes 45 -60 minutes during the day in normal traffic took us 30.  If I hadn’t been a cyclist before and comfortable weaving in and out of traffic with my hair blowing in the wind, I don’t know if I would have been able to handle it.  By the time we made the final turn onto the road to Chapagaon, I was feeling so tough and impressed with Lee’s and my nighttime navigation, that I almost forgot how wimpy I was for opting out of the roach motel.  We did not make it back for the puja.

19 more: whatcha got??

Another plumber comes, identifies the problem, says he can’t get the part.  Lee goes to a nearby hardware store to get a replacement valve, where plumber #2 happens to be.  He says he didn’t know Lee was a plumber too.  Lee fixes the valve, and the clinic has running water!!

The plumber comes, says he can’t help.  Lee identifies the problem, can fix it, but can’t get right part.