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Return to Baseline

Acupuncture Relief Project  | Good Health Nepal | Andrew Schlabach

Three months of lecture, review and physical practice and my three young students are looking at me with the blank stares of incomprehension. I’m temporarily at a loss for words. What went wrong?

As part of our long term goals in Nepal, it is our aspiration to train several Nepali born practitioners to serve in our clinics. We have partnered with a small school in Kathmandu, Rural Health Education and Service Center (RHESC) which has similar goals. This Japanese sponsored project began in the early 1980’s as a rural hospital but now finds that their facilities are landlocked within the crowded sprawl of the Kathmandu Valley. RHESC has been using acupuncture in conjunction with their rural hospital for over 30 years and now as part of their sustainability efforts, they have opened a small school. Their program has been accredited by the Council for Technical Education and Vocational Training (CTEVT) but they are hoping to expand to a full baccalaureate degree in the future. As an advisor to their Board of Directors, I have been been assisting with the development of RHESC’s curriculum, serving as a guest instructor, and we host many of their students at our clinics. This partnership with RHESC is a key that we have been looking for since we began in 2008… a pathway to legitimate licensure for our trainees.

Read more: Return to Baseline

Today, I am very happy.

Acupuncture Relief Project  | Good Health Nepal | Kyndl Mueller

After clinic one day I had the opportunity to experience a wonderful delve into the down country culture of the local folks I've befriended over the last couple weeks. Gunaraj, one of our interpreters, invited me to his house in the village just north of town, and so I joined him on his walk home, along with his cousin Sita who is also our receptionist, and our clinic manager Ritesh. 

Read more: Today, I am very happy.

My Bone Problem

Acupuncture Relief Project  | Good Health Nepal | Jessi Brown

Today I fitted my elderly patient with her (hopefully) semi-permanent shoulder cast. This woman came into the clinic a few weeks ago. I remember treating her knee pain and when the visit was finished, she said, “What about my bone problem?” and pointed at her shoulder. 

This is a classic pattern at our clinic. Right as patients are leaving, they add on a few extra problems and ask for medicine for it. I have to tell them to talk to me about it next time they come in. So, I told this patient to bring her x-rays and we would treat it next time. I assumed it was just arthritis in the shoulder. WRONG. 

Acupuncture Relief Project  | Good Health Nepal | Jessi Brown

The next time she came in, she removed her sweater. Her humerus bone jutted up through her skin every time she moved her arm. We looked at all the info she had. A couple of months previous, she had fallen with her arm out to the side. She’d broken the bone at the elbow and the shoulder. The humeral head had actually split in half. 

Acupuncture Relief Project  | Good Health Nepal | Jessi Brown

I still look at the films a lot and I even now, can’t tell if the spine of the scapula and glenoid cavity was broken as well. There is no complete x-ray series here. Nepal operates on a ‘get what you get and don’t throw a fit’ imaging policy.

When I saw the patient again, I tried to talk her into going back for surgery because her bone is floating loose in her arm.  Even with my insistence, it became very clear that she was not going to go. Her heart is not strong enough to go through the procedure. Her family is worried about her age and possible complications. In addition, the surgery could cost between 1,500 to 7,000 US dollars, depending on what connections the family has. 

I shifted my thinking to a non-surgical, management solution for this woman. I had our reception staff call her to come back into the clinic. Drawing on literally one afternoon of Ted Lauer’s class, I made a Plaster of Paris cast that will hopefully stabilize her shoulder. In addition, this should protect her arteries and veins from being punctured by the humeral shaft fragment if she bumps it or falls again. 

Acupuncture Relief Project  | Good Health Nepal | Jessi Brown

The cast is not fancy and my technique wasn’t great. A few parts of the cast stayed softer than I wanted but I think it will hold up for at least a year. I showed her and her elderly sister how to tie it. I also tied knots in the too large sling that she was given at the hospital. I showed them both how to close it the right way so it won’t fall off all the time. Hopefully it helps her pain a little by preventing so much movement of the humeral fragments.

This patient is so sweet and so small. Earlier this year, my grandma broke her wrist in a FOOSH (fall on an outstretched hand) injury and I happened to be there for her doctor visit. The doctor did not explain her options to her very well and just pushed her into the surgery. She did not understand that she had the option for the doctor to put her into a hard cast and let it heal, probably as well as it would heal after a surgery.

Thankfully the procedure with my grandma was successful and seems to have worked. Regardless, I hadn’t wanted her to get the surgery. Hardware fails in young healthy bones. In old, osteoporotic bones, it is even more likely to fail or the skin cannot heal from the incision. It was frustrating to watch this doctor just push her right to what he knew would “fix” the problem. 

Acupuncture Relief Project  | Good Health Nepal | Jessi Brown

Here in Nepal, I turned around and tried to do the same thing to this patient. I wanted to help her get the treatment that I thought was right but it wasn’t what she wanted at all. The solution I came up with is far from adequate but at least I can feel that she is a little more safe and that she is happy. Eighty years is a good life here in Nepal and I don’t want to risk what she has for a surgery that she doesn’t even want.

Aside from that, I have been getting a lot of counseling from my friends to hang in there for this last week. I am anxious to be back to the life I have created at home, but I want to try to enjoy my time here as much as I can.  I came here to help and to work and it will be over soon enough. I am excited that after this last week of work, a couple of us will be traveling to the village of Bandipur. It will let me see a more of this country before I head back out.

Acupuncture Relief Project  | Good Health Nepal | Jessi Brown

Being here is helping me get more clarity about what I want out of my work and home. It’s making me take a look at some of the people in my life who are not showing up for me in the way that I need. It’s painful for me to think about exerting a little bit more control over what happens in my own life. 

For various reasons, I’ve grown accustomed to getting along with people and just being happy with whatever others ask of me. I am starting to find a freedom in knowing that I have control over my own needs. Currently I’m frustrated at how impatient I’m being with everything but I know that when I get back I will be able to show up better for my patients and friends. I’m trying to stay focused on the work. Even though I feel a little burnt out, I want to keep learning whatever I can from the people I’m here with. I’m glad I was here to help this woman with her shoulder. I’m glad to be strengthening a friendship with Bex and to have met the others on my crew. These are good things. My anxiousness to go home is mainly because of the good things waiting for me there but I can be patient. I hope. --- Jessi Brown

Acupuncture Relief Project  | Good Health Nepal | Jessi Brown

Worth it

Acupuncture Relief Project  | Good Health Nepal | Hong Lu

Having lived my whole life in a developed country, with most of my needs magically looked after for me, it was a cultural shock to see the many inadequacies the Nepalese people experience. From the pollution in the air to the chaotic traffic conditions everywhere; from toddlers roaming the roads unsupervised to stray dogs scouring the streets searching for food; it seems there is little regulation among the people yet somehow, they find a way.

Acupuncture Relief Project  | Good Health Nepal | Hong Lu

I have had much to learn about the healthcare in Nepal. I have a young, female patient I have been treating in the Bhajrabarahi clinic. She has suffered from epigastric pain for over 15 years. In my first week in Nepal, I had a glimpse of her suffering having had a bout of dysentery from eating the wrong food. I experienced one night of diarrhoea yet she has suffered intermittent diarrhoea for so many years. I could only imagine how she continues to survive. Yet she finds a way.

Acupuncture Relief Project  | Good Health Nepal | Hong Lu 

I had another profound experience where a patient was exhibiting stroke like symptoms in the clinic. It was difficult to tell if he was in fact having a stroke at the time so the ambulance was immediately called. I was in fear for his life but compassionate in supporting him all the way. I discovered the ambulance would take an hour to arrive and the nearest hospital was a three-hour trip away. I was shocked beyond belief at the circumstances and questioned how he would ever survive. We finally determined that he had had a seizure and not a stroke. Two days later, he was back into our care. Somehow, despite all obstacles, he found a way. 

Acupuncture Relief Project  | Good Health Nepal | Hong Lu 

As I walk through the farming fields in Bajrabarahi, I am greeted by hardworking women carrying large baskets of heavy compost strapped to their foreheads. They focus their eyes on the ground in front of them and bend their upper torsos forward, to soldier on to their destination. I am in awe of their physical strength and stamina. However, the daily demands also mean that many of these women develop chronically painful knees and necks. I am grateful to have the opportunity to treat some of these women in the clinic. Their knees will never fully recover, yet they continue to work and they find a way.

Acupuncture Relief Project  | Good Health Nepal | Hong Lu 

These are some of the experiences I have thus far glistened in the clinic. I feel like a seed that’s in the perfect environment to grow. My growth is not limited to my work as a practitioner, but also as a human being. I honestly felt I was grateful for all that I was blessed with back home in Australia, but I am now infinitely more aware of how much I have. My admiration of the Nepalese people lies in their capacity to adapt to life’s circumstances and their amazing resilience to endure. The warm gratitude and friendly respect I receive from everyone here makes any sacrifice to be here absolutely worth it. --- Hong Lu

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