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Compassion Connects The Series

Documentary filmmaker Tristan Stoch returns to Nepal in 2015 to follow up on his 2012 work Compassion Connects. This new series of seven short films focus on Acupuncture Relief Project’s current work in rural Makawanpur Nepal. 

During our premiere screening in Portland Oregon, several guest speakers shared personal stories about their experience in Nepal. Some of these stories have been shared here. Please Enjoy.  

 

Episode 1: Rural Primary Care

In the aftermath of the 2015 Gorkha Earthquake, Andrew Schlabach, Director of the Acupuncture Relief Project and Tsering Sherpa, Director of Good Health Nepal begin a new primary care clinic in the rural district of Makawanpur. This episode explores the challenges of providing basic medical access for people living in rural areas. 

 

 

Sheri Barrows: Why Acupuncture?

Board of Directors, Secretary/Treasurer, Acupuncture Relief Project
Participating on the Board of Directors since ARP's inception, Sheri was able to spend the 2015/16 season in Nepal with the clinic teams. Seeing first hand the complexity of practicing medicine in rural villages she came home with a better understanding of the challenges in accomplishing our mission.

 

This last year I was extremely fortunate to have taken a long hiatus from my paying work so that I could be in Nepal to help get the new clinic set up and to witness first hand how things were going in both Bajrabarahi and Bhimphedi. I had a hard time deciding what I was going to talk about tonight because there were so many stories to choose from but I kept coming back to one story that really moved me.

I was in the Bhimphedi clinic, standing near the door and I looked outside and watched a man being helped through the gate by about 4 people. He needed the support of all of them because he had had a stroke and the left side of his body was severely paralyzed. When it was his turn, he was brought into the clinic and Rachel Hemblade from the UK became his doctor.  We learned through his wife that his name was Jagat and the stroked had happened about a year before. He was completely unable to speak and vocal testing showed that he could only achieve a barely audible sound for one vowel.

The thing that broke my heart with Jagat was how completely and utterly dejected he was. He had gone from being a 35 year old husband and father of three kids and a valuable community member to being totally dependent on others.

I have never in my life met someone as completely hopeless as Jagat was on that first visit.

Rachel told Jagat’s wife that for the best results he should come to the clinic every day for at least a few weeks and she asked if that would be possible. They live up in Bhimphedi 3, which is about a 4 hour walk from the clinic, but they were able to make arrangements to stay with family that lived just down the road. Rachel then enlisted the help of all of the family members that were at the clinic with him that day, including one of his young sons.  She showed them some physical therapy exercises and she showed them how to help him form the sounds of the English vowels and told them they should practice all of it twice a day. When Jagat came to the clinic the next day I greeted him near the gate and though he wasn’t able to show hardly any facial expression I saw a faint sparkle in his eyes that hadn’t been there the previous day. By the end of that second treatment Jagat was able to make the sounds of all the vowels and he had regained a slight amount of movement in his left foot and hand so that when he left the clinic he was able to use a cane in his right hand and just one person supporting him on the left. As he passed me going toward the door I was so thrilled by his improvement that I gave him a little cheer and this time when he looked me in the eye there was a strong sparkle and a slight twitch at the corner of his mouth as he tried to smile.

Between the Acupuncture, Massage from Sarah and the homework he so diligently did, Jagat improved very quickly and by the end of the first week he no longer needed his wife to speak for him and was able to answer all of Rachel’s question himself, albeit slowly, and the muscles in his face were able to form a smile that lit up the clinic. Also by the end of that first week he was walking to the clinic by himself with just the aide of his cane and by the end of the third week he was able to stop using the cane all together.

After a month or so Jagat went back home to Bhimphedi 3 and would make the 4 hour walk to the clinic a few times a week for treatment.  His doctor during Camp B told me that by the time she left in December, he had recovered about 70-80% of the abilities he lost to the stroke. 

This story of Jagat is just one of so many examples of how the clinics make a difference and change peoples lives and I cannot begin to tell you how meaningful it has been for me to have been there and experience it for myself. 

 

Episode 2: Integrated Medicine

Tackling complicated medical cases through accurate assessment and the cooperation of both governmental and non-governmental agencies, Acupuncture Relief Project extends the reach and effectiveness of it's medical model. This episode follows the stories of two patients who's care required a coordinated effort.    

 

 

Sarah Richards: Heart

Acupuncture Relief Project Volunteer 2012, Team Leader 2015
Sarah has been a body worker since 2000 and has been to Nepal twice with ARP. She has recently stepped into the role of Volunteer Coordinator as a way to continue service to the project and to help support practitioners endeavoring to bring their healing arts to the people of Nepal.

 

I'd like you to bring your memory to the beginning of this last segment, To the story of the woman Hira Maya who had a life saving diagnosis that led her to heart surgery one year before this interview took place.  

I had the honor and the extreme privilege to be there last year and treat her. I already knew of her interesting case based on the blog written about her the prior year and was eager to see her and hear how she was doing. 

When she first came in, this is what I observed:

small, slight, tiny and yet heavy and weighted
pale
quiet
withdrawn
shy, timid
under-nourished
very shallow and labored breath
hesitant 

I say hesitant because she was not sure she wanted to receive any Tx, she thought we just wanted to do the interview and so she wasn't expecting, or maybe even wanting Tx. But with a little coaxing she agreed to let us take vitals and to get on the Tx table for a little body work.

I don't have enough time to go over all the details, but after 3-4 short Txs to address the major rib cage trauma and scar tissue from having heart surgery a third world country, here is what I observed:

bright
talkative
colorful
smiling
making eye contact
willing and eager to receive treatment

and most importantly to me, she was breathing deeply and with ease

I know this change sounds dramatic, but it truly was....and it left a searing impression on me. Very little Tx resulted in dramatic change. Her presence, her essence was palpable from across the room, where before it was diminished.

Now, it is my belief, based on my experiences in Nepal, that it was not only the Tx but also the nature of the clinic itself that created this change in HM. The fact the Hira Maya had a place to go where health care workers were deeply concerned with her well being lifted a heavy weight off her chest.

The ARP clinics are a gathering place for community, a hive where healers and patients come together with curiosity and compassion, where deep listening occurs, where gentle touch is applied and where cultures collide to create a vortex of possibility.

My favorite part about the ARP experience is that the clinics in Nepal provide a testing ground for practitioners to to see what really matters in medicine. It affords a concentrated experience where your skills get stripped down and your fears highlighted to illuminate your greatest strengths and also your weaknesses. Maybe it's needles, herbs, touch, attitude, stamina, technical knowledge, intuition, presence, empathy or compassion, it all gets tested. 

This sort of experience paves the way to build the foundation of understanding who we are as healers. Or like the phoenix, in some cases the experience burns and destroys only to then re-birth and re-build, this is where authentic healing and wisdom unfolds, for patients and practitioners alike.

Hira Maya gave a me a precious gift, thru her trust in me, she illustrated in a very vibrant way that when a clients case seems extreme, that when I'm not sure I have the skills to ease their suffering, when I ask myself how can a simple massage soothe something so complicated, 

here comes the gift.....

presence, willingness, deeply listening and taking action from the heart, and rooted in compassionate loving kindness IS enough! I AM enough!

And it is with the strength of this knowledge I honor Hira Maya and bow to her in deep gratitude for this teaching and healing!

There is more to this story, yet my time with you is short, keep an eye on the ARP blog for updates and more stories like this.

Because I have valued my experience greatly with ARP I am developing the role of Volunteer Coordinator as way to continue my service to the project and support practitioners on their journey of growth, if you find yourself inspired by this event tonight, please reach out, volunteering is the biggest donation that we can receive!

 

Episode 3: Working with the Government

Cooperation with the local government yields unique opportunities to serve the rural population. Acupuncture Relief Project is invited to help establish a new integrated medicine outpost in Bajra Barahi, Makawanpur, Nepal. This exciting prospect enables ARP to forge a new clinic model applicable throughout Nepal.

 

 

 

Diane Wintzer: Primary Care

Project Coordinator, Acupuncture Relief Project Volunteer 2008, Team Leader 2010, 2012
A graduate of Oregon College of Oriental Medicine, Diane runs a very busy practice in Camas, Washington. Drawing upon her experience with Outward Bound she has helped Acupuncture Relief Project develop their training and mentorship programs.

 

About 9 months ago, I received a call from a senior patient whom I usually treat twice a month. She had a special request that day.  She was wondering If I could rub some good smelling oils on her that would help her breath easier. According to my patient, her primary care doctor had just diagnosed her with bronchitis for the 3rd time this summer, and she was really having a hard time breathing. She was very difficult to hear over the phone, and I weighed out my desire to see what was going on against how much energy it would take her to get to the office. I knew it was a hot day, it was a 30 minute drive for her, and the passenger seat in her car didn’t recline which was hard on her back.  I told her I’d like to see her, and that I had some things we could do to see if it would improve her breathing.

A few hours later my patient arrived. I noticed her ashen skin tone, her weakened voice, and her off-balance shuffle as we walked to the treatment room.  But the check in was business as usual. I asked questions about her most recent visits to her PCP, her blood sugar numbers, and what she was getting done around the house. She reported a recent fall that left some bruising on her legs, but could not really say why it happened - she didn’t trip - she just sort of tumbled. She had been to a “fill-in” PCP (not her usually doctor) 2 days prior for her coughing and breathing difficulty, and after some assessment, he prescribed cough syrup with codeine and told her to get some better rest, and he provided antibiotics.  In truth, my patient wasn’t sure if the doctor told her she had bronchitis or pneumonia.

She continued to share.  She’d been sleeping in the recliner for a few nights because it made her feel better. She hadn't felt much like eating or getting outside. I noticed my patients short sentences, the time it took her to share, again the quiet voice, and her lack of clarity around things. She got onto the treatment table, and as I examined her bruising, I noted that it did not match up to the story all that well. She had fallen hard, and due to blood thinners, she was severely bruised from her ribs to her knees. I noticed my patient minimizing her injuries.  I noticed her anxiety increasing rapidly while laying back on two pillows. I switched gears, sat her up in a chair, put some ear needles in to calm the anxiety, and began to compile the list of symptoms: Extreme shortness of breath; Leaning forward to naturally make breathing easier: Elevating her shoulders to use accessory muscles for breathing; Severe pitting edema in the lower legs that was not normal for her; The gray color to the skin; The confusion around details when she is usually sharp as a tack and full of story. I tried to take a blood pressure reading… it was barely readable.

I looked at my patient and without wanting to freak her out, simply stated that it was time to call an ambulance and go to the hospital because she was in cardiac distress. She had enough in her to argue me just a bit, just enough spirit to reach for the bronchitis diagnosis and being run down, just enough to tell me of the retirement party she was going to after this appointment of an old co-worker, and that the ambulance was too much money. I wrote out the base line symptoms quickly on paper and slid them in front of her so she could see them, and reminded her she was not going to be able to compensate for very long.

To make a long story short, my patient ended up with a diagnosis of acute Congestive Heart Failure, and had a week long stay in the hospital. A few weeks later the doctors managed a heart surgery where they repaired some failing valves. Just last week, after 9 months, she felt strong enough to come back in for acupuncture treatment. Recovery was hard as she, in the end, realized that she had been declining for a while, and just missed it. Today though, she was sharp as a tack, full of stories, and back to her household projects. And of course, she wanted some good smelling oils rubbed on her back.

Most days, this is not the case.  Emergencies do not walk in the door frequently.  People come in with sore backs, sore knees, insomnia, stress, digestive distress, fertility help, constipation… you name it, but some days the story someone tells has some anomaly in it, some aberration that stands out, or I just get some intuitive hit that something is not lining up. The more stories, the more patient touches, the more willingness to engage my patients, the more I find my idea of medicine being stretched. I am grateful to ARP for nurturing my ambitious heart and curious mind and expanding my ideas of what it means to be practicing acupuncture. I had no idea that being the best acupuncturist I knew how to be, would be a moving target, and would include days where my needles never came out of the package.

 

Episode 4: Case Management

Complicated medical cases require extraordinary effort on the part of Acupuncture Relief Project staff and volunteers. Illiteracy and the inaccessibility of medical facilities are major obstacles requiring innovative case management. This episode follows 4-year-old Sushmita in her battle with tuberculosis. 

 

 

Terry Atchley: A long way from help

Acupuncturist, Acupuncture Relief Project Volunteer 2013, Team Leader 2015
A native of New Orleans and graduate of the Oregon College of Oriental Medicine, Terry traveled to Nepal to help open a new primary care clinic in Kogate. This experience allowed Terry to treat a multitude of illnesses and develop her connection to people through words, touch and understanding.

 

Grief can be the garden of compassion. If you keep your heart open through everything, your pain can become your greatest ally in your life's search for love and wisdom.” Rumi

At 2am on my last night in Kogate I woke to someone pounding on the door. As the only medical team in this remote region we were sometimes called for emergencies. The patient was a young pregnant woman with pain and bleeding. I got dressed and hiked the steep trail to her house. As I entered her home, I saw the young woman was scared. She looked at me for reassurance and safety. I spoke with her and learned she was seven months pregnant and had a history of late term miscarriages, one which occurred when she was alone in a field.

I checked her vitals and listened for a fetal heartbeat, but heard silence. At this time I believed she was having a miscarriage and began to explore my options. I called for a rusty old land cruiser that functioned as an ambulance to take her to the nearest hospital which was two hours away down a very rugged terrain. I tried my best to comfort her as we waited. I felt helpless and incompetent. There was nothing I could do, but bear witness, hold her hand and offer comfort.

The dusty vehicle arrived with a single driver, it had a lengthwise seat in back with a spare tire on the floor and an ancient oxygen tank. I was not able to travel to the hospital with her and would not be able to follow-up with her after she got there.

The next day, as we were leaving Kogate, I received an update. She had given birth to a stillborn on the way to the hospital.

I think of this patient almost daily. When I returned to Nepal in 2014, I was eager to see her. I wanted to tell her all the things I couldn't say in the moment. Sadly, I learned she no longer lived in the village. She had divorced her husband and returned to her parents house in India.

This experience broke my heart. But this heartbreak helped me learn what it truly means to be a healer.

I had to look beyond objective findings, results or a cure. I believe being an excellent healer means sometimes we have to let go of the outcome. I had to let go of the notion that I needed to solve every problem to be validated as a practitioner. The answer to this case was not found in all the intellectual learning from school, but in my heart. I gave the only thing I could give in the moment- compassion. I had to release the expectation I had of myself as a practitioner and accept that my ability to care for a patient sometimes has nothing to do with medicine and everything to do with love. 

 

Episode 5: Sober Recovery

Drug and alcohol abuse is a constant issue in both rural and urban areas of Nepal. Local customs and few treatment facilities prove difficult obstacles. Partnering with Sober Recovery, one of the few inpatient acute detox rehabilitation facilities in Nepal, Andrew Schlabach and Tsering Sherpa train volunteers in the use of acupuncture. 

 

 

 

Episode 6: The Interpreters

Interpreters help make a critical connection between patients and practitioners. Recruiting local young men and women, Acupuncture Relief Project provides a unique training and employment opportunity. This episode explores the people that make our medicine possible and what it takes to learn job. 

 

 

 

Bex Goebner: Death and Dying

Acupuncturist, Acupuncture Relief Project Volunteer 2015, Team Leader 2017
Bex lives in Northeast Portland with her partner and two young boys. In 2015, she visited Nepal and found some of the most meaningful teachers of her life in the patients she treated there. She is forever grateful for the mind-blowing, heart-opening experience that ARP has offered to her.

 

Lal Bahadur Lama had been an entertainer and artist for most of his life, though at the time I met him, he was a farmer. He grew up in Kathmandu, where he was trained as a painter and sculptor. In his early years, he would leap the steps of the Monkey Temple and position himself on a ledge. From there he would draw the snowy shadows of the Himal.

After he married Vagawoti Lama and took up residence in the village, he became part of an entertainment troupe. His beautiful wife would smile when she attended his stage shows for the King and Queen in their summer palace. On one of his favorite nights, Lal and his nephew wheeled out a life-sized elephant he had built and painted. As he stood in front of the king, Lal flipped a switch and the elephant’s spring-loaded trunk swung up in a posture of salute while the crowd cheered.

As a farmer, he missed his artwork, so he took up a side job with the Nepalese forestry department, where he could wander around taking photos. He decided to use some of this work to open up a photo shop in the village. He quickly put himself out of business by giving all his inventory away to his friends. He was bummed about this failure but proud of his generosity.

In 2015, I arrived in the village of Bhimphedi to find this 71-year old man. The clinic hadn’t opened yet but I got a call to his house for a respiratory emergency. I’m still not quite sure how it happened, but I was able to get him stabilized. ARP doesn’t typically do home visits, but I began going to see him most nights of the week.

Usually after dinner, I would visit his cold room to listen to his lungs and check his oxygen levels. I would hear his heart beat and notice that the second sound lingered too long. I would press into his right foot to make a deep pit and count the minutes until it refilled. I'd take a look at the rusted welding tank that fed him, making sure that his family hadn’t turned it down to save money. After I did this, I would sit next to him and hold his left hand, the one that wasn’t swollen. When he could catch his breath, he’d tell me who he had been.

Lal was dying from the end stages of emphysema, though he’d never smoked a day in his life. The honeycomb cysts in his lungs came from growing up in a Nepalese home with an indoor cooking fire. It was worsened by walking the polluted streets of Kathmandu, where the brick industry blackens the air.

Thirty times after I visited Lal, he died in the middle of the night. All of the funerals I had seen in Nepal were Hindi funerals. The dead were taken to the rivers, covered in marigold flowers and burned. Lal was put into a simple white coffin painted with a thick red cross. He was lowered into a deep hole in the dried riverbed and his flowered bedspread was folded on top.I kneeled there while the women wailed and people threw handfuls of dirt and roses into the hole.

In the end, we share the best memories we have and these memories go beyond where we live or the clothing we wear. It doesn’t matter whether we are the dying person or the witness in the room. At that moment, we cannot help but be united in our humanity.

 

Episode 7: Future Doctors of Nepal

Acupuncture Relief Project begins the process of training and licensing local practitioners. This critical step towards sustainability requires partnership with other organizations as well as the national government. This episode looks at the people and the process of creating a new generation of Nepali rural health providers.

 

 

 

 

The Interpreters

Acupuncture Relief Project  | Good Health Nepal | Rachel Chang

For me, meeting the local interpreters, acupuncture students and our cook, and getting to know them on a personal level, has been the most amazing experience.

The high unemployment rate in Nepal means that many young people try to seek opportunities abroad and are likely to end up exploited as cheap labour. The average yearly wage of a Nepalese is $240USD and for many, going on a holiday is but a dream. I had a chance to listen to the stories of some of the youth I met and worked with.  Prior to working for ARP, some were unemployed or had unstable low paying jobs, and pursuing higher education was something that they couldn’t all afford to do. Seeing their potential, ARP offered them a meaningful way to earn money and contribute back to their communities. Here are their stories:

Acupuncture Relief Project  | Good Health Nepal | Rachel Chang

Suman is 24 years old from Kogate village and has worked with ARP as an interpreter for 3 years.  He finished high school and completed one year of a Bachelor in Humanities before dropping out due to financial difficulties.  Suman tried out for a job to work as a government worker but was unsuccessful, so he helped his parents in the fields to plant, harvest, and carry heavy loads of firewood. He was considering applying for work abroad when he met Tsering, the coordinator for ARP, who at the time was staying with Suman’s family while looking for a place to set up the clinic. Seeing his potential, Tsering encouraged him to try out as an interpreter for ARP. Suman had long dreamed of becoming a social worker, hoping to give back to his community. He sat and passed the interview and went on to complete the interpreter training. 

From having no idea of what acupuncture was, and no experience in healthcare, Suman was initially very nervous but has become one of our most competent interpreters. He has really enjoyed being an interpreter and watching people's health get better with acupuncture. He decided to try out for the scholarship to study acupuncture this year. He expresses that he is very grateful and that if it weren’t for ARP believing in him, he wouldn't be where he is today. 

Acupuncture Relief Project  | Good Health Nepal | Rachel Chang

Bibek L. is 27 years old and from Hetauda village.  He previously worked as an assistant electrician but was finding it hard to survive financially. Three years ago, he was on his way to Kathmandu for an interview to work in the Middle East when he bumped into his friend Suman, who told him about the opportunity to train as an interpreter with ARP.  He immediately took a detour to the ARP interview and has not looked back since. He also hopes he can study acupuncture in college mid this year. As currently ARP is operating for 6 months in a year, he finds being jobless for the other 6 months very difficult. He said, ‘if I get the chance, I want to be an acupuncturist, not just an acupuncturist but a very good acupuncturist!’

Acupuncture Relief Project  | Good Health Nepal | Rachel Chang

Pawan is 22 years old from Kogate village and has been interpreting with ARP for 1 year. He moved in to live with his grandparents after his parents separated when he was 16.  Having no monetary support to continue his education, he dropped out after studying one year of a Bachelor of Science. One year ago he was given the opportunity to be an interpreter for ARP. He wanted to study acupuncture in college but because he didn't graduate from a government school, he wasn't eligible to apply for a scholarship. The three year acupuncture course costs approximately $4,000USD not including living expenses, and this for most Nepalese youth who have no financial support, is unaffordable.  During the 6 months when ARP is not operating, he would go back to his village to work in the fields, cut grass and carry heavy loads of firewood. After this camp ends, he said he might have to work in Dubai for 2 years to save some money. When I asked him what he would do there, he said, 'maybe work in a supermarket...' which is a pity as with his talent and skills he could do very well in Nepal if only he is given the opportunity. He loves playing the guitar, and during our meal breaks, provides us with music and entertainment.

Acupuncture Relief Project  | Good Health Nepal | Rachel Chang

Jesica is 23 years old from Bhimphedi. After seeing how much acupuncture could help her community and the fulfillment her brother found from working as an interpreter, Jesica decided to follow in his footsteps, joining ARP 2 years ago. Prior to that she was working as an accountant for a brick factory that operated seasonally and was closed during the monsoon season. Not only is she a brilliant interpreter, but her head for business makes her an excellent organizer, keeping everyone in line.  She changed her career and also decided to study in acupuncture school this year. 

Acupuncture Relief Project  | Good Health Nepal | Rachel Chang

Rupa is 19 years old, a third year acupuncture student from Kapan. Initially she had passed the entrance exam for nursing but her father got admitted into hospital for lung cancer and she missed out on the opportunity. Then she heard about the new acupuncture course and with a hunger for knowledge she decided to enrol in it. In April last year, her whole house collapsed during the big earthquake and her elder sister was trapped under the rubble unconscious. Being injured herself with bleeding hands, knees and head, Rupa dug for 40 mins to get her sister out. She had no shoes to wear for days and couldn't get to the hospital to visit her sister and father as it was three hours away and there was a transport strike. Since then, there is no one in the family who could financially support her as dad is in hospital undergoing chemotherapy and her sister is still recovering from the quake. She has no money to even buy textbooks. The acupuncture course is rather new in Nepal and there's no practical component, so students know only the theory but don't have experience in needling. ARP approached the college and affiliated with them by allowing final year students to observe and train in our clinic. Rupa said since she has been able to observe in our clinic and help with interpreting, everything she has learnt in college started making sense. She is so eager to learn and after seeing the positive changes our clinic is making on people's lives, she found herself evermore passionate about acupuncture. 

Acupuncture Relief Project  | Good Health Nepal | Rachel Chang

Bibek M. is 20 years old from Kogate village and has been working for ARP as a cook for 6 months, making sure all the practitioners and interpreters get fed. Before joining ARP, he was exploited and worked long hours (from 6am to 2am the next day) in a guesthouse earning only $20USD per month.  He had also worked as a labourer loading construction materials such as bricks and sand onto trucks. Due to the physical stress of his jobs which aggravated his hip problem from a childhood injury, he had to take a break and return to his village. As his parents were elderly, and all his brothers had left home early, he was the only one left to work on the fields. From plowing the fields with an ox, he had multiple infected skin wounds left untreated. At the time, ARP was operating a camp in Kogate village where he sought health care for four months and got significantly better.  Later ARP offered him the position as the cook for our camps.  Bibek said working with ARP for the past 6 months has been a great learning experience.  He got to meet and become friends with practitioners from different parts of the world.  As he dropped out of school in 7th grade, his English language skills are limited. His goal is that by next fall he can be fluent enough in English to be part of our conversations. Every evening I would spend some time teaching him simple English phrases and in exchange he taught me beats on the madal drum. Bibek says he can now finally support himself financially, and hopes that he could earn enough to support his family and one day get married.  After this camp ends, he intends to study a cooking course for 3 months in Kathmandu. 

As the clinic only runs for six months a year, the chef and the interpreters are all on short term contracts and staying afloat both financially and motivationally is incredibly difficult. Their only real option is to spend the intervening six months at home with their families or look for work abroad, a commitment that might prevent them from returning to work for the next camps.  All 4 of the interpreters are extremely keen to study acupuncture and would make incredible practitioners, but whist the tuition of $4,000USD for three years seems like a bargain to us, it is out of reach for our friends, and that is before you factor in living expenses.  

We may feel sad listening to their stories, but these young people are happier than many of us in the first world who have more than what they could imagine because they are passionate about what they do and they really want to contribute to society. Watching them happily singing folk songs and playing the madal drum on the bus ride to and from a picnic, I thought to myself that they really have no idea how amazing they are. 

Acupuncture Relief Project  | Good Health Nepal | Rachel Chang

Why am I doing this again? To witness and experience firsthand economic inequality, the problems associated with the disparity between the rich and extreme poor. To not ignore suffering and see the world for what it really is in order to propel me to create something of long lasting value for humanity so that our children can live in a better world for the future. As the Native American saying goes, ‘we don't inherit the earth from our ancestors, we borrow it from our children.’  I am grateful to all those who have made it possible for me to be a part of this project and hope that they realise how much their contribution means not only to the livelihood of these young people but also in keeping their dreams alive. ARP's goal is to be able to run not only for 6 months but all year round, which will not only benefit the patients but also help reduce unemployment by providing full time jobs to the locals such as the opportunity for the acupuncturist students to be employed as local practitioners when they graduate, giving unprivileged youth who are full of potential the opportunity to shine. ---Rachel Chang

Context is everything

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez

Time is flying by and we have less than a week before this camp’s rotation is over and the clinic will close until September.  The first week or so here was a mad scramble to work out how to treat two to three times more patients than I would normally see in a day; how to work through an interpreter; how to modify my intake for this population to get the information that I need; and how to screen patients for more serious health issues than I would come across at home.  I became more comfortable with this dance, allowing me to really focus on assessing the effectiveness of the treatments and what could be done to get patients into the best possible shape before we leave.

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez 

In the beginning, when I asked my patients how their complaint had been since the last treatment, the reply was often “no change” or “just a little better”.  No change can literally mean “no change”, but more frequently, it can also mean “not completely better”.  Spending time out in the community and seeing my neck pain patients haul heavy baskets on their head, or my back pain patients bent over planting potatoes or chasing an ox, reminded me to check if there had been positive changes after their treatment and what they had been doing when the pain started to flare up again. Is this knee patient slow to improve because it isn’t the right treatment, or because she has to walk for 4 hours to get home because the blockade means that there is no fuel for the buses?  Was their elbow pain fine until they cut the corn?  Would the shortness of breath and chest pain be better by now if they weren’t forced to burn wood indoors for heat and cooking, and weren’t surrounded by steep hills?

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez

Most of our patients have had little or no previous contact with medical professionals and aren’t accustomed to speaking about their symptoms.  Refreshingly, they haven’t read too much into the latest article in the Health section of The New York Times or googled potential diagnoses, and consequently symptom descriptions are often more abstract.  Furthermore, there are over a hundred distinct castes and ethnic groups in Nepal and almost as many dialects, so while Nepali is the official language, it is not necessarily the form that many of our patients might best use to express themselves.  Our interpreters are the most talented, patient, big-hearted and persistent crew you could wish for, and even if they speak the languages of multiple ethnic groups, it is inevitable that some nuances of description will get lost.  Both Eastern and Western Medicine demand degrees of clarity as to what we are treating.  I appreciate now how useful it would have been to have better tongue and pulse diagnosis skills.  Pain scales and percentages of improvement are foreign concepts, as are range of motion tests, so progress is gauged by measures that have more day-to-day meaning, measures that bring me into their lives.  Can they now squat to do their tasks?  Does it take less time to walk to the clinic?  Can they now grip the broom with just one hand?  Maybe it still hurts to lift a bucket of water but pulling the blanket over the bed no longer causes pain.  

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez

For me, the interaction with this beautiful, big-hearted community has been immensely rewarding.   Despite setbacks in recovery, the difficulties that my patients experience in getting here, the sometimes hours-long wait in below freezing temperatures, our patients keep coming because they believe in the treatment, they appreciate our presence and our efforts, and are grateful for even the most minor improvements.  For some, it is in the balance as to whether the benefits outweigh the physical costs, but they are tenacious, willing to persevere, and diligent about following lifestyle and exercise recommendations.  In the first weeks, I had some tougher exchanges where, pressured by the long line of people waiting to be seen and unsure as to what more I could do, I had been defensive and brusque in response to a couple of patients venting frustration about their lack of improvement.  On reviewing their charts at the end of the day, I was ashamed to realize that both were patients who had walked for more than 4 hours each way over rough terrain in the depth of winter, stymied by the current absence in public transport and lack of medical assistance closer to home.  

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez

I am confident that the majority of the patients who have passed through the clinic over these past months are in much better health, but for a few, we will have to decide together what will be their best course of action after we leave.  What can I suggest for the patient with rheumatoid arthritis of the wrist whose progress continues to be set back by everyday tasks?  When do I concede that my patients with high blood glucose should be referred to the hospital several hours away for medication because we are running out of time to lower their numbers via diet and treatment?  Will the hypertension patients be vigilant about checking their levels?  

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez

Acupuncture Relief Project  | Good Health Nepal | Emma Sanchez

As the Nepalis say, ‘What to do?’  For the moment, this clinic runs for just six months a year, staffed by foreign practitioners, but a big part of what appealed about this particular relief project is its investment in the big picture.   Not only does this clinic and it’s satellites show how Chinese medicine can go above and beyond fleshing out the gaps in rural healthcare, but it also serves as a training ground for the first generation of Nepali acupuncture students who come to observe and assist alongside us.  There is so much potential here and I’m excited to have had the chance to come and participate. ---Emma Sanchez

The Pushing Away, Pulls You In.

When it's all said and done, leading a team in any capacity is not an easy job. Being a medical volunteer here also stretches each of us. I thank my team for working from day one in a new remote town, and also a new clinic! Yes, newness can bring challenges, but, like any spiritual growth, there is major relief that comes only pushing through the most climactic and painful time. It's like sitting down to meditate and you are faced with all the itches and discomforts in your body. You want to jump up and scream and run from it, but you know, only sitting a few moments longer will bring the most blissful freedom you can imagine. 

How do I show up every day to lead others through their tunnel to the light? How can I be a true leader when I'm still the student; still learning how to surrender myself? How to let go of my own ego, time and time again, in the face of challenges? How to catch myself when I speak incorrectly of others? And how to guide with patients and love and right action? This is no easy task. Others who come to lead a team may not have taken this task this way, as there is so much “medical work to do”, but I did. And I have so much to still learn. No expectations. Practicing constant gratitude to The Most High. Letting go. Letting Qi flow. These are some of the big lessons. Maybe of a lifetime. 

Acupuncture Relief Project  | Good Health Nepal | Asiya Shoot

In the Compassion Connects video by ARP, Andrew Schlabach tells his team that one of most difficult things of this work, is that one case you return home thinking about. That one patient you couldn't help just right. “You forget about the hundreds of patients you helped and they got better, but it's that one patient that stays with you.” This has happened to me. And I can't stop thinking about her.

In case review one afternoon, practitioner Shin Kim introduced us to a 23 year old female who was coming in for back and neck pain.

She had a large plastic bag filled with x-rays, medical charts from various clinics and hospitals, lab tests, and a stack of medical bills. Also seen in her charts, was  a referral letter with a detailed clinical summary, written by the awesome volunteer practitioner Bex Groebner from Camp C, February 2015. 

It stated: 

 “…We are concerned about the potential of spinal tuberculosis (TB) for Ms. R.S. symptoms. We would like to rule this out before moving on to more complex diagnoses.” 

The patient had a Positive Mantoux (TB) test from the health-post in Bimphedi. She also had spinal X-ray, MRI and CT scan, showing a lesion at the 12th thoracic vertebra, high white blood cells and inflammation markers, as well as low hemoglobin. 

The illness began 18 months before her visit with Bex, when she presented with:

High fever, chills, headaches, nausea and vomiting, loss of consciousness, daily vertigo, photophobia, insomnia, tender mid abdomen and flank, and high level of pain upon palpation to neck and back. She was treated with high doses of antibiotics then, and since that time was still experiencing most of these symptoms.*

This patient R.S. was referred to get a proper diagnosis and care over 9 months ago, but here she is showing back up at our clinic in Bimphedi! Shin explained how she expressed concern because she still had not gotten any diagnosis besides “Anemia and Spinal Degeneration”, and furthermore no relief of her back pain and symptoms. She reported being more than upset that she has been sent from one place to another for months, spending so much money, and that she was in great despair. Shin also stated that she looked skinny and weak, with dark circles under her eyes, and that her back muscles were super tight. He gave her an acupuncture treatment of mostly back points that she could hardly tolerate due to pain, and started her on Chinese Herbs. 

Acupuncture Relief Project  | Good Health Nepal | Asiya Shoot

I went in to see her the next visit myself to better understand her situation, and try and come to a quick and decisive plan of action.

From the moment I sat down she started talking about all her complaints, confirming that everything she had reported back in Winter of 2015, she was still experiencing. The only thing that was better was that she was a little less nauseous after the few days of herbs, and was vomiting less after meals. She was very emotional, both sad with tears and also angry.

She was very uncomfortable laying on her back and could not handle minor pressure when I tried to massage her in this position, nor settle long enough for a craniosacral treatment. She demanded to be treated sitting in the massage chair. 

I talked with her about my concern that she had a positive Mantoux test and that, just like Bex had requested, it was important that she ruled out Spinal TB. She told me “I wanted to have a biopsy to my spine as well, but the doctor I saw said I didn't need one, and wouldn't let me get one”.  Instead she just kept getting referred for more x-rays and labs. I told her that this has been a recurring issue we have seen with other patients. Unfortunately it is very hard to get the proper doctors in Nepal to do TB testing, diagnose it correctly, and then get the proper antibiotics administered by the WHO. This is why I felt strongly she should try again to go get the biopsy.

Acupuncture Relief Project  | Good Health Nepal | Asiya Shoot

 This was my concern and why she remained on my mind - How many patients are there in this world who are not receiving proper medical follow-up and care? If the patient doesn't have support, especially if they are illiterate, poor, elderly, have mental health issues, or simply fear medical establishments, do they ever receive the medical care they truly need? Even in America, who is responsible for the patient once they are discharged? Once they are referred on? Sent home with a handful of medications? 

 ARP does its best to teach and instill in the volunteers to have proper discussion, explanation and agreements with patients of what is expected, and to have clear follow up. However, the doctors we refer our patients to do not always send the patients back to us. Over the last year we have started to write this in the referral letters, and communicate to the patients the need to return to us. Somehow between the camps this patient got lost. Perhaps this was due to the earthquake coinciding with that period of time. But I also think this was because she didn't end up being administered in the hospital she was first sent to. You hope that once she makes it there she would be taken care of and treated, but instead she was sent in circles again, from one doctor to another. The general population put so much trust into the medical professionals that they don't question, or rather, even know what to question, to get the answers they need for adequate help! 

Acupuncture Relief Project  | Good Health Nepal | Asiya Shoot

After sending her back to the TB hospital in Kathmandu, Andrew and Tsering went to visit her after the surgery.  They listened to her and comforted her, which I believe is the most therapeutic offering ever, as “people truly start to heal the moment they feel heard”. Tsering told me that just that act of listening, he saw a shift in her energy and demeanor. Our relationship to pain and the power of emotions is an interesting thing we know through science, and through Chinese Medicine. Andrew spent a lot of time counseling her upon not doing any more x-rays for now, since she did more than enough already, and that she needs this time mostly to rest. He also taught her some stretches for her back and chest. He then asked her if she was willing to stay in her hometown of Kathmandu in the future, and receive acupuncture, body work, and herbs from a local clinic for minimal fee, which she agreed to. Tsering then let her know we would follow up with her in a few days once she had the biopsy results. 

As for the biopsy results, they were negative for TB. I believe this result and having an answer was a relief for her. 

However, I still can't help but wonder, why is she so sick? After being sent around to so many doctors, she still doesn't have an allopathic diagnosis besides “Spinal Degeneration”. How many patients show up in our office with this same story? If you have done the testing they are able to do, and get an answer of “what it is not, at this time”, is that enough? 

Acupuncture Relief Project  | Good Health Nepal | Asiya Shoot

The first thing I think about was the possibility of the positive Mantaux TB test being wrong. We know that False-Positive reactions can happen. 

Then I think, perhaps we are just looking at someone with pain from osteopathy and compression, as the MRI’s show, due to years of carrying heavy loads. Perhaps she has emotional and mental pain from a history I know nothing about. Maybe she is so anxious from going to one doctor to another looking for answers, spending so much money and energy. With more time with her, more listening, perhaps I would have clarity about her distress and illness.

I also consider what else it could be from an allopathic perspective, and come to the realization that even with getting a diagnosis for some pretty severe diseases, we would still be administering symptom control to improve her quality of life. This would mostly be pain relief treatments. In the allopathic medical system she would probably be given a lifetime use of pharmaceuticals, such as strong anti-inflammatory drugs, that she may not be able to fund. Working to help maintain mobility and control spasticity through stretching and exercise, would also be important, as would receiving micronutrients, promoting organ function and hormonal balance, and treating other accompanying symptoms including appetite, bowel health, insomnia, and definitely emotional trauma and stress management. After thinking about it, she would be getting this long term supportive care and treatments from the local Acupuncturist we connected her to. This is the power of Chinese Medicine system, we look at patterns of disease our patients presents with and treat accordingly. Although our diagnosis has a different name, often, even when the allopathic diagnosis isn’t known or understood, we can still greatly help by this approach.

Acupuncture Relief Project  | Good Health Nepal | Asiya Shoot 

Tsering told me upon that second visit in Kathmandu, she was in better spirits, and reported she was feeling much better with the herbs. She had actually sent her relative in Bimphedi to us, to get more herbs for her while she was in the hospital. So yes, there was progress and help here. 

What I think about most now is how fortunate we have someone like Tsering on the team, to not only connect her to the right people, but actually cares enough about each patient to take the time and energy to assist us with their case! This is very rare in a NGO relief-work organization, and has highlighted the importance of having someone for this role for these patients to not be left to the way-side. She is not the only patient ARP has had to follow up on in this way, and won't be the last. We see patients everyday who need more advanced medical treatments than what we can offer, most of which are in Kathmandu. Not everyone however has the ability to receive it, but the handful who do, we still consider "our" patients. This is what it means to give patientcare, and not just patient treatment.

Acupuncture Relief Project  | Good Health Nepal | Asiya Shoot

In Nepal I can let go of living conditions and any attached expectations of the way of life, because that is how it is when you travel. Let go of hot water, choice of food. Let go of being comfortable, of having consistent transportation. You become one with the people, and the place.

But how can you let go of fighting for a persons health, and humanitarian efforts? When you know it shouldn't be this way. That it doesn't have to be. 

It is a balance between doing everything in your ability, and then trusting that the rest is up to a Higher Power. And still it breaks your heart. But I guess, like I have said many times this last year, it is that breaking of my heart that causes it to open. 

And maybe that is what it takes to keep us on this path of service, of returning year after year. Not many people understand it. I have come back to that same poem I wrote in my last ARP blog (http://www.acupuncturereliefproject.org/news-blog/202-meant-to-be-together) in 2013, the lessons of just Being. Of surrendering. Of knowing that this life is a constant flux.

“Your hand opens and closes 
and opens and closes. 
If it were always a fist or always stretched open,
you would be paralyzed. 

Your deepest presence is in every small
contracting
and expanding,

The two as beautifully balanced and coordinated
as bird-wings.” (Rumi)  

Acupuncture Relief Project  | Good Health Nepal | Asiya Shoot

At the end of it all I see clearly that we medical volunteers return home, but the work continues for the interpreters, ARP board members, and especially for Tsering, Satyamohan, and Andrew who show up to work daily, or return year after year, giving everything they have to these patients in need. This is not an easy task by any means, trust me, and it takes a "one of a kind" spirit. 

Like Prophet Mohammad (p.b.u.h.) said, "The leader of a people is their servant." 

I know it isn't much, but I want to take the time to thank them, and wish them all the best to keep moving forward in the years to come (God willing). 

Asiya Mahdiyah Shoot MS. LAc. EAMP, LMP, CNP, CD(DONA) 

*For more information please look out for her case study.

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