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Compassion is the Communication

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

I come from a large Russian Orthodox family and an even larger community. I spent my childhood wondering what any limits might be. What would that look like, where would the red tape might be, and how I was to grow within them? But I knew from a very early age (8 to be exact), that I wanted to help others. It led me down the road to becoming an Acupuncturist and volunteering with the Acupuncture Relief Project.

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

At the ARP clinic I initially acted solely through the wonderful interpreters translations. Fresh from school, I now got to apply my knowledge in a wider arena, sometimes feeling like an imposter with the newness of it all, just playing house, waiting for someone to come in and take over. But then it dawns on me that this is it. We are the practitioners here. Yikes! This just got a little too real. A visiting intern native to Nepal whose family is still several hours away shared my feelings of being unsettled in the first weeks. Though her family is reachable, the demands of a busy clinic along with independent research of pathologies and team classes after clinic several times a week can make the feelings of distance seem magnified. This was comforting to hear, and confirmed that the excitement of practicing medicine in a different country to be mixed in with the pangs of physical distance from loved ones and barriers of inner constructs was a rewarding challenge to overcome. 

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

Weeks passed and I found myself seeing past the imagined barrier and started paying attention again to beyond just words being said by the patients. Looking into my patients faces, I struggled less rely only on what my TCM education had instilled and focused what else patients were communicating, and sat with my intention of wanting to do good for others. Many times throughout I thought to myself that I’ve reached my red tape. Then, a patient under my care who was 4 months post stroke and in poor spirits at the time of the initial visit had been coming in for daily treatments now had now reached almost full functions for daily living. He could dress without assistance, able to shave with the help of a friend, and regained the use of his right hand for eating. Eating rice was still challenging but we both felt victorious; we both made through that tape! 

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

Another patient who started coming in for pain brought her own barriers. We quickly found out she was mute and I thought, “Hmmm, thought I ran through that red tape…” She was pointing to several places and making expressions of pain, and through a few orthopedic tests and more motions to gauge levels of severity we were able to get a working treatment plan together: gastritis primarily (she had been vomiting and had lost weight from it), shoulder pain secondarily, and knee pain last. Here I felt that giving the care didn’t require knowing her language per se. She and I mutually understood her needs; after a few treatments her gastritis started to resolve, and we moved on to other things on the list. I imagined this process of continually sticking to what I believed where her chief complaints to be like a mysterious mailbox destination; one isn’t always quite sure if the parcel is getting through (much like the reality of people not having mailboxes here, but mail does somehow reach its destination). She and I would wave vigorously hi and bye after subsequent visits, and the unspoken communication that had grown peaked my interest in how one is able to deliver care but not always needing to say verbatim, “I am going to deliver care to you”.

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

I had the opportunity to learn about this idea of nonverbal care a few weeks ago during a women’s clinic that came to Bajra Baraji to treat women for prolapse and screen for cervical cancer. They had set up near the ARP clinic with the goal to get as many women seen and to take samples for testing, that way if any were positive then they’d be able to commence treatment. Screening for cervical cancer has shown to dramatically reduce the number of cases of and mortality from cervical cancer in developed countries; and Nepal has the highest rate of deaths from cancer. It is especially so in isolated villages like the one we are working out of.

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

As I was shoulder to shoulder with the other doctors watching them perform examinations, eyeing patients funneling through, I was trying to imagine what they might have going on in their lives outside this moment. One patient, who looked about 50, no more than 5 feet tall and was probably someone’s mother and possibly grandmother. She had hair that was neatly braided and tied at the end with bright red yarn that had some small bells swinging on the end and a matching red Kurta; traditional Nepali dress that many women only wear on special occasions now. This woman wore the sweetest expression and carried a disposition of someone not used to being examined so closely while she gave a short explanation to the doctors about why she was coming in. 

I didn’t catch the conversation with it being in Nepali, but after the examination one of the doctors was hugging the patient from the side while she told us in English that they had found advanced abnormal variations on her cervix, a key marker for cancer not in early stages anymore. The Nepali woman hadn’t understood this part, it not being said in her native tongue. I watched her as I heard this news was being given over my head to another doctor who was taking this down, and at that moment I had an image of my own mother standing in her place, foreign words being exchanged about her health. I was overwhelmed.  I had to look at the cracks in the ceiling for a while, then observed how this doctor spoke comfortingly and unrushed to this patient with dozens more still waiting just outside.

I read somewhere that once a person goes out to seek the unknown, it is impossible to return unchanged. I think that moment occurred to me just then. It made me question how I as a practitioner should be able to communicate effectively in situations I’ve not experienced before. This woman’s ability to face the doctors and be open to understanding the situation mirrored what I should be doing for them; be open to understanding and shine with kindness.

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

This is the realization I was seeking in coming here; to see how it is to stand amongst other communities and explore parallels of culture and healing practices to my own Russian Orthodox heritage, to bridge the gaps of what is meaningful, and grow as a practitioner for myself and others who may come to seek care. 

Acupuncture Relief Project  | Good Health Nepal | Fedosia Masaligin

I believe that through volunteering with the Acupuncture Relief Project, I have reached that moment of getting to the red tape but realizing in a way that it’s just a hologram, that this is another point I have reached where before I felt was unreachable, now is another bend in the road that I just wasn’t able to see until I’ve reached this point. --- Fedosia Masaligin

 

 

My Nepal Experience

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

Nepal and people who live in this country, the Nepalese; where do I begin?  It was sensory overload the moment our flight landed in Kathmandu, the capital city of Nepal.  The first thing that hit me was the humidity and not being able to read any of the signs nor comprehend what people were saying.  At that moment, it finally kicked in that I was totally at a foreign country, far away from home.  To a foreigner like myself, things seem chaotic.  There are no traffic lights for vehicles, motorcycles, or pedestrians while everyone travels in all directions; however, to my amazement everyone is in harmony.  There is order in a seemingly ocean of chaos. 

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

Nepal is a true third world country that is now in a worsen shape by a devastating 7.8 magnitude earthquake that struck near the capital a year and a half ago.  The rebuilding process is slow at best.  Many buildings are still in shambles and are at a state of disrepair.  The earthquake was a detrimental blow to their livelihood for a country that does not have significant goods to export or commerce and relies solely on tourism to survive.  What we believe as our most basic rights for standard of living back at home do not even register here.  Their infrastructure is almost non-existent.  There is no waste management made evident by trash popping up everywhere and the only way to “get rid of garbage” is to burn them.  There are daily rolling electrical blackouts that last hours at a time.  Water treatment facilities are not available.  Public transportation involves packing 50 people in a beat up bus that should only carry 30 with plumes of thick black smoke billowing from the exhaust.  All these are just part of the daily lives at the capital city and imagine what it is like outside the capital!

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

Despite the insurmountable disadvantages stacked up against the Nepalese, I consistently see how Nepalese truly are - friendly and cordial.  Strangers will greet each other and carry on conversations like they are best friends.  You don’t see anger, impatience, or frustrations on their face.  You don’t see people yelling at each other.  You don’t see road rage.  Don’t misunderstand the situation here, they do live in a stressful environment with very little means and few opportunities to better their life.  If you have an opportunity to ask them questions, you will hear that they are stressed about life, yet they find a way to coexist and live happily, without lashing out at others.

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

I have connected with my patients and the Nepalese culture on a deeper, more meaningful level than I would have expected.  I have realized how diverse and social culture driven the Nepalese are.  There are no strangers in Nepal!  Everyone pitches in wherever help is needed.  People make the best of what they have without complaint. They have graciously welcomed us and helped us to ease into their life as one of their own, while opening up and entrusting our ability to see and treat them.  They feel grateful and indebted to have the opportunity to receive treatments, to tell their story, and to ease/improve their sufferings.  

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

One patient I will never forget and will think of fondly years from now far away is my diabetes patient who initially came in for hip pain.  Upon further questioning, I learned that she has Type 2 diabetes who is on the maximum daily dose of Metformin and has recently stopped her insulin shots.  The reason for stopping the shots was that they were expensive and that the pharmacy informed her that the insulin bottle needs to be refrigerated, which is a luxury she does not have.  Most people here do not have own refrigerators.  I felt a deep sadness that a refrigerator could be in the way of someone’s health.  At the same time, I was glad that I could inform her that insulin does not require refrigeration anymore as long as used within 28 days while stored away from extreme heat.  In addition, Metformin by itself is not enough to control her diabetes and that insulin is necessary to stabilize her blood sugar.  Her blood sugar test taken was three times the upper limit for a diabetic.   She was reluctant to go back on the insulin shots and just wanted treatment for her hip pain.  I realized it was going to take a while to convince her; thus, I comprised and agreed to treat her hip pain first, but she needed to revisit on a daily basis.

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

My goal is simple: to try to persuade her to restart her insulin shots.  Every day I worked on easing the hip pain while trying to convince her that she must go back on insulin quickly and to explain the severity of what could happen without stabilizing her blood sugar level meant possibility of losing limbs or worse, death.  It took numerous efforts and persuasions, but she is now back on insulin and is able to walk without much pain.  She feels happier and is able to sleep through the night.  What made her change her mind about insulin is not crucial, but I believe one main reason was the fact that she felt she was not just a case study but also a person with people who were genuinely concerned for her well-being.

Acupuncture Relief Project  | Good Health Nepal | Kuong Wang

I thought I was going to come in and sweep Nepal and its people off their feet by showing them what I could offer, but in reality, they were the ones who showed me what I have been missing out.  Of course, they would like to have clean running water, not having to deal with air pollution, poverty, and a shadowy future, but Nepalese live with dignity and composure.  I do not see any poopy face.  I do not hear Nepalese complaining about things they do not have.  Everywhere I go, I see bright smiles on their face and genuine content blessed with what they do have.  I walk away receiving so much more in life than what I have and will offer to them.  --- Kuong Wang

Avoiding the Finish Line

Acupuncture Relief Project  | Good Health Nepal | Sandy Homer

Upon arrival to the ARP Clinic in Bajra Barahi, nestled amongst the peaceful tree covered hills in the countryside of Nepal, I sensed a note of an “uh-oh, what have I gotten myself into” sort of uncertainty.  A freshly graduated, under-traveled, self-critical practitioner standing before the very place I would watch myself struggle and fall apart for the next six weeks.  I’m supposed to say that I know what I’m doing and I can handle this, but let's not kid ourselves- I knew I was in for a wild ride.  

Acupuncture Relief Project  | Good Health Nepal | Sandy Homer

One step at a time, I tell myself, don’t go beyond that one step- it will all unfold as it should so if I can just handle each present moment I’ll eventually get through this without completely letting myself or anyone else down.  The first day is yet another wake up call; I sit and listen intently to my interpreter as I watch the body language and facial expressions of my patients.  I often settle on gathering what information I can because my questions do not make sense or are not conveyed the way I need them to be- “keep it simple” I tell myself, “just start with the basics”.  These internal pep talks would soon become a common occupant of my everyday thoughts.

Acupuncture Relief Project  | Good Health Nepal | Sandy Homer

Beginning treatment I place my hands upon the weathered knees of an elderly woman; rough, dry and full of years of hard labor and intense weight bearing.  I hope that my smile and the confidence of my hands from nearly a decade of being a massage therapist are coming through to her as a form of trust and compassion.  I want to give her everything I know to do in one treatment and must remind myself to take small steps and make a plan for future treatments.  My desire to completely relieve her pain and send her out the door feeling better is clouding my judgement and confidence.  It is already clear what one lesson is that I must face during my time here.

Acupuncture Relief Project  | Good Health Nepal | Sandy Homer

Patient after patient comes through the door and sits in the chairs in front of me.  Greeting each one with a warm “Namaste” and parting with the same expression, I try to imprint their face and chief complaints into my memory so I can spend part of my evening researching how to better help each one.  I am in this to make sacrifices and step out of my comfort zone, to see what I am capable of when resources are stripped down to a bare minimum, but what I truly want most is to see my patients coming in with less pain and suffering.  

Acupuncture Relief Project  | Good Health Nepal | Sandy Homer

It is a tricky balance of suppressing my own desires and expectations while striving to progress my patients to a better place; to a place that works for them- not for me.  I knew I would be forced to face fears of my own self-worth, but it’s funny how different that reality is when you’re standing in the present moment rather than the foreshadowing of it.  

On my final day here I intend to take a step back and look at the clinic from the same standpoint in which I first was hit in the gut upon arrival and see what has changed.  Will I feel triumphant?  Defeated?  Exhausted?  Elated?  Accomplished?  Humbled?  I imagine it will be mix of all those emotions, but the one I hope will be absent is the evil villain of fear- the unnecessary yet persistent pest that it is, I strive to loosen part of the grip it has on my being and leave it in the settling dust on the winding roads far behind me. --- Sandy Homer

Acupuncture Relief Project  | Good Health Nepal | Sandy Homer

The Heart of Good Healthcare

Acupuncture Relief Project  | Good Health Nepal | Oscar Hewitt

It has been a pleasure to spend two months as part of the project living and working with the people of Sipadol and Bhaktapur.

In retrospect my role as a healthcare practitioner here has often been more one of a sports therapist and a personal trainer than I had envisaged. What constitutes the daily grind over here would be seen more as an athletic pursuit in the UK. All through the day you see the village women in their colourful saris and flimsy flip flops bobbing up and down along the near vertical paths through the valley with a giant pile of logs in a basket hanging from their heads.

Acupuncture Relief Project  | Good Health Nepal | Oscar Hewitt

Sometimes I would ask the patients if their pain was better and would get the reply "a little bit" or often just "no". Initially this would leave me feeling a bit deflated; however, later I started asking how the farm work was going and would get responses like "Oh yes I could harvest a lot more potatoes yesterday"! At this point the penny dropped. It became clear to me that my job was about keeping these folks at the top of their game. The only difference between these hard-grafting subsistence farmers in the steep slopes of the Himalayan foothills and professional athletes is that here the physical exertion comes out of pure necessity. If the potatoes aren't harvested the family will get less food on the table. It would become an ongoing joke in the clinic as I would ask them not to carry too much weight on their heads or stop harvesting the wheat when their back starts to ache and the very next day they would come in saying "it was better before I was working and then...".

Acupuncture Relief Project  | Good Health Nepal | Oscar Hewitt

This said, they would still keep turning up in the morning and with our palms joined together in prayer position we would respectfully "namaste" and then begin our session.

From this point my focus shifted to how to make my treatments last. I started applying sports tape to take the strain off an inflamed achilles or plantar fascia when negotiating the steep trails around the village, I used herbal pastes, compresses and liniments that patients could go away with, I would have mini revelations whilst going for walks in the hills, my quads in full engagement stepping down unforgivably steep paths thinking, "So this is why everyone has knee pain here… Right! So how can I apply this knowledge in the clinic?" To have the time and space to commit to adapting my skills and techniques to the people I was working with was an invaluable opportunity and one which began to pay off in the smiles and waves I would receive around the village. 

Acupuncture Relief Project  | Good Health Nepal | Oscar Hewitt

The most challenging difficulty, which is by no means unique to Nepal but was quite common, is getting people to really connect with what is going on inside their bodies during a session. Many people will have pushed through their chronic pain for so many years that they would not be able to accurately determine where they had their problems. Often they might just point vaguely at their legs, back, neck, arms, head, or all of the above and then just say "dhukksa'" or "pain" in Nepali. The danger of this I felt at times was becoming too focussed on chasing pain. I wanted to avoid the tendency to just stick needles in where it hurts (a frequent request). This could verge on becoming a sort of "cathartic pain exorcism" which I don't find to be of much use to anyone. 

This is not a matter of intellect or cultural nuance but, I would suggest, is the strange and elusive nature of chronic pain and suffering itself. Its insidious and pervasive presence makes a transition at some point from being an interference in one’s life to an unwelcome part of life. This process, at the physical level, involves a lot of neural adaptation that amplifies the intensity of the signal and increases our reactivity to it, whilst at the same time obscuring the specific and the detail.  

Acupuncture Relief Project  | Good Health Nepal | Oscar Hewitt

On the other side you have the emotional and mental adaptation to pain. It is not compatible with our existence and perception of self so we ignore it, block it out and often, in effect, disconnect a part of ourselves from our kinaesthetic body map. Invariably you see these mechanisms outliving their usefulness and becoming a part of people’s existence at great cost. I am interested in interrupting the cycle, opening up to other sensations or conflicting signals. In Nepal, like anywhere, people fight chronic pain every day. It is a big part of my job to bring them from fighting it to managing it. If one doesn't feel what is going on, how does one change it?

The level of commitment on behalf of the patients to attend so regularly, which was so important to the treatment outcomes, was only made possible by the very low cost service that is provided by the acupuncture relief project and its sister NGO run by the esteemed Ayurvedic doctor, Sarita Shrestha. In a society where many people, through fears of unaffordable hospital bills, are more likely to visit their pharmacy for a relatively indiscriminate handful of drugs than see a doctor, the work done here is worth so much more. It is more than just the acupuncture, massage, moxa or cupping itself. It also extends its roots far deeper into the community. It is a place where people can become informed, aware and proactive about their health as well as providing a safe and constructive place to share the burden of their pain with one another. In the aftermath of the devastating earthquake that touched so many here this is all the more important. From providing treatment and basic healthcare advice to giving shelter and basic sanitation in hours of need, I believe this grass-roots community work to be at the heart of good healthcare. ---Oscar Hewitt

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