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More than just acupuncture

Acupuncture Relief Project  | Good Health Nepal | Zoe Nash

In Bimphedi, a small remote village in the hills south of Katmandu where the Acupuncture Relief Project has a clinic. There is also an orphanage. The children that are there are coming from the streets in Nepal, from broken families, from families where the parents died, from village around the country that get sent to Katmandu to get allotted around the country to different orphanages. 

It is a small community of children from the ages of 8-18, where they sleep in bunk rooms together, they eat together, they play together, they working the garden planting their vegetables and there is small school inside.  

Acupuncture Relief Project  | Good Health Nepal | Zoe Nash

The education curriculum provides the basic fundamentals of education. However basic level ‘sex’ education is not included. It is not subject that is comfortably spoken about in Nepal. This is partially problematic in an orphanage and these children do have a family unit in which they express themselves or discuss such topics with any close family member. 

This isolation and taboo matter that is an experience that all human being will go though can cause a suppression of emotions leading to either confusion or un-integrated ways of relating to others as they develop and move though adolescents.

We connected with the orphanage and together made a plan to give the children there an extra-curricular class on puberty.  

We entered the compound and children where playing football and other games in the field, enjoying their time to be free from duties. 

Acupuncture Relief Project  | Good Health Nepal | Zoe Nash

We walked about the garden, saw that they are growing their own vegetables that all the children have to out their hand into to. The area where they eat and large kitchen with pots of rice and dahl baht were being boiled in preparation for dinner time. We saw the rooms where they sleep, the simple bedrooms with no material possessions, toys or posters, just bunk beds and one small cabinet.

We went to the room where we were to teach to wait for the children to arrive. They came in and looked eager to hear what we had to share.  

Acupuncture Relief Project  | Good Health Nepal | Meghan Keysboe

We began to share through Tsering Sherpa interpreting, (one of the directors of the Acupuncture Relief Project). Meghan Keysboe a practitioner on the project began discussing the physiological changes that occur during puberty. What to expect in these times of change, or growth, how their bodies will change, their hair, their skin, their interests, and how normal all of this! Not to be alarmed or ashamed of any of these physical and physiological changes that are occurring that everyone goes though this and its totally normal and does not last for forever!  Some where already going puberty and found this communication about what was happening to them so refreshing and insightful, knowing they are not alone and that what is happening to them is healthy and a positive moment and change in their life. 

I spoke to them about diet and nutrient and how important it is to eat a balanced diet of fruit and vegetables and how junk food leads to illnesses such a diabetes, high blood pressure, and depression. 

Junk food is making its way to the remote areas of Nepal, biscuits, crisps and soft drinks which are causing nutritional deficiencies and sugar addiction in these areas. 

Acupuncture Relief Project  | Good Health Nepal | Jesse Jory

Lastly Jesse Jory the other practitioner on the project spoke to them about mindfulness at this time. How to take care of themselves emotionally like writing down their emotions, communicating to their teachers about what’s happening to them on a personal level, spending time in nature, and the importance of getting enough sleep. These are all very important tools to use in this time of turbulence and to find their centre point within themselves at this time in their lives will support them always though all the transitions in this lifetime. 

This experience was one of rich reward, seeing the children’s facial expressions of interest and understanding up as we spoke to them about matters that no one had addressed to them before.. 

This story is another example of how the Acupuncture Relief Project is building the community base and how we can broaden our positive impact in the areas and provide the missing pieces of education is really exciting for the development of the project and how it can continue to expand to serve the communities reaching out to these children.  --- Zoe Nash

Trust The Process

Acupuncture Relief Project  | Good Health Nepal | Lucy Kervin

It’s been one week in Nepal and 3 days of clinic in Bajra Baraji. I’ve gone through so many emotions and learned so much about practicing primary care in a rural area. It’s been amazing but I have to admit that the first day of clinic was tough. That little voice in my head started saying stuff like, “You’re not a good enough practitioner, you don’t know enough, you can’t help anyone!” It’s hard enough to not let that voice rule over my thoughts in the best of times, let alone completely out of my element in a new country. I felt in over my head, seeing things like ear infections, gnarly wounds, ulcers and so many things I would refer out to a medical doctor back home. I was told the first week was going to be the hardest but I didn’t think that first day would end in tears. I barely made it to my room to wrap myself up in my zero degree bag to take some time to write in my journal.

Acupuncture Relief Project  | Good Health Nepal | Lucy Kervin

In our ARP clinic guide, it says “Trust The Process”, and that’s exactly what I needed to do at that moment: allow whatever was to just be. So I allowed myself to feel it all, the uncertainty, the loneliness, the self doubt. I closed my eyes and let those emotions fill my whole being. I began to imagine an older version of myself, the one who has been changed by this experience, who has been through this before. She knows you cannot heal the things you cannot feel, and she places her arms around me. I breathe out loving kindness and compassion to myself and the capacity grows. I am able to tend to myself like I would a child, pick myself up and hold tight; I am exactly where I need to be right now. 

Acupuncture Relief Project  | Good Health Nepal | Lucy Kervin

I woke up the next day feeling changed, stronger and more centered. It was Saturday, our day off from clinic. I was going to put all my things away, make a little home here, do some laundry and go for a hike in the hills. I love being in nature and was excited to see what was growing in the forested slopes I can see all around us at the clinic. On my way to meet up with the group, I had to hop over a small ditch, and I’m still not sure what happened except I hopped and then ended up face planting right into the ground. I was stunned. I think I had my hands in my pockets because my chin took the brunt of the fall. Immediately, folks from the village who were passing by ran up to help me. I felt ridiculous falling down like that, I hadn’t even reached the hills yet! But as I repeated “Thank you, thank you, I’m ok, I’m ok!” I could see the concern on their faces and got that sick feeling when you realize you hurt yourself more than you thought. I could feel something warm and wet running down my chin and the front of my jacket, I felt in my mouth, my lip was split. 

A former version of myself would have been furious with me at this point, but after my grounding session the night before I knew that being hard on myself was the last thing I needed at this point. I got back up to the clinic and called out to my supervisor, Bex. She took one look, “Yeah, that’s gonna need four stitches.” She was close, I got three.

Acupuncture Relief Project  | Good Health Nepal | Lucy Kervin

I’m on the mend now, taking a round of antibiotics and alternating between herbal washes and slatherings of neosporin. I know this happened for a reason, I don’t know the reason right now but I’m trusting the process. I told Lila, the health post assistant, who gave me the stitches and was very concerned for me, “No worries, I’ve had worse!” And it’s true. I’ve had a compound femur fracture, broken bones in both feet and both wrists, knee surgeries and a few laparoscopic surgeries. My body is covered in scars. One of my favorite authors, Clarissa Pinkola Estes says, “Be proud of the things you have endured. The scars are like a treasure map to the self, the deep self.” As I run my fingers across the scars on my body and feel for those healed wounds that you cannot see, I am proud. I am one of many wounded healers in this world. I look to my patients, I run my hands across their scarred bodies, see the things they have endured and am in awe. What I learn here will completely change who I am as a person and as an acupuncturist and will reverberate into so many areas of my life I cannot even begin to understand. I try to keep this in mind each day as I enter the clinic and allow this process to unfold.  -- Lucy Kervin

Bookends

Acupuncture Relief Project  | Good Health Nepal | Maggie Shao

At the beginning of my service with Camp B at Bajra Bahari, my first patient is a 70 year old male with right-side hemiplegia resulting from a stroke.  I look at his chart and note he started daily acupuncture treatments two months earlier.  I ask him what are his goals for treatment and he states "I want to use right hand to eat (Nepalis use their right hand to gather and mix and bring to their mouth dal bhaat - the mainstay of the Nepali diet) and to shave himself. I test his grip strength, simply asking to grab my two fingers and squeeze, comparing his right and left hand strength.  His right grip is comparable to his left hand, however, when I test his dexterity, he is unable to pick up a pen with his right hand as his attempts result in his repeatedly dropping the pen.

Acupuncture Relief Project  | Good Health Nepal | Maggie Shao

I work with Ram Lal everyday and begin to see his powerful determination and tenacity.  He is always the first appointment, for he leaves his house at 4am or 5am to walk an hour to the clinic arriving before sunrise in freezing cold, so that his ID card is the first in the pile for appointments for the day.  I give him different exercises to regain his dexterity, stretching an elastic band over his right hand and extending his fingers against the resistance. I gather 50 different shaped pebbles and give them to Ram Lal to pick up each pebble and place into a bottle. As I go to do my morning Qigong, I notice he is waiting for the clinic to open and I begin a Qigong practice at 7am with him.  The Qigong exercises help him with his balance, integrating the right and left hemisphere of his brain, setting new pathways for mobility and coordination.  I am inspired as other patients also waiting practice Qigong along with us. The last week, I give Ram Lal a ball with the world globe printed on it to grip and build strength in his right hand. I show him on the globe where I live in the USA and show him Nepal is almost exactly at the opposite side of the world.  He comes to treatment the following day and shows me how well he can grip the ball and I notice that most of the paint is already worn off, and I know he is determined to get well.

Acupuncture Relief Project  | Good Health Nepal | Maggie Shao

Two weeks before Camp B ends, I tell my regular patients that I will be leaving soon and new doctors will be coming in a few weeks to continue with their healthcare. At the end of this long day seeing 20 patients, my last patient, a new patient, is escorted in by two women holding and helping a 49 year old woman who appears so frail, I lay her on the bed, instead of sitting her up in the chair, she appears so weak.  I am told by her sister-in-law that my patient had a stroke 2 months ago, stayed 13 days in a Kathmandu hospital and is paralyzed on the left side.

Acupuncture Relief Project  | Good Health Nepal | Maggie Shao

My patient Maili does not speak much, I do some sensory testing and deep tendon reflexes, and she can barely respond to my inquiries and testing. Her countenance is gray and dull. I push away my feeling of helplessness - what can I do? and proceed to explain the long road to recovery and no certainty of full recovery. Is she willing to agree to a treatment plan of ten daily visits of acupuncture to begin with and at the 10th visit, we will evaluate if there is a positive result? Her sister-in-law answers for her that she will bring her daily. Maili's left hand is swollen almost twice the size of her right hand, edema of the limbs is a common aftermath after stroke. Maili came the next day, looking a little stronger and able to sit up for the treatment.  Treatment includes scalp acupuncture points, electrical stimulation, needles in extensor muscles opposing the contracted flexed muscles in her left hand and leg.  By the 4th treatment she is walking in with the aid of a walking stick and her sister-in-law by her side.  Maili is more alert and speaks more and I find out she is a widow-her husband died 22 years ago, she does not have children, she lives with her husband's brother and his family and her goal is to regain use of her arm and leg to farm again. She reports a sharp pain in her leg is gone, and she can walk a short distance with just her walking stick without any assistance.  By the 6th treatment she is walking the distance from the clinic door to my station by herself with just her walking stick. By the 8th treatment she is smiling as she shows me her new ability to move her right leg voluntarily. 

Acupuncture Relief Project  | Good Health Nepal | Maggie Shao

My last day in clinic I begin the day with three of my stroke cases all sitting at my station waiting for treatment.  I notice the seating arrangement, on one side, Ram Lal one of my first patients, the 70 year old who inspires me and the other stroke patients with his motivation and tenacity and pride to regain what many of us take for granted, those activities of daily living like eating, shaving, even squatting by himself to use the toilet. His next goal is to drive a bus again, to honor his past career of safe driving that he won awards for during his 42 years driving a truck. On the other side, there is Maili, one of my last patient cases as I complete my seven weeks as a volunteer, and I wonder how much she will be able to recover with continued treatments with the practitioners coming for camp C, and my wish and hope and vision is Maili walking to her farm field and planting seeds, then harvesting the crops next season. Bookends. --- Maggie Shao

The Magic of Determination

Acupuncture Relief Project  | Good Health Nepal | Kaikit Wong

I meet Buddhi for the first time at the end of the second last week of the camp. He had a stroke 5 years ago which affected the mobility of his left arm and hand. Although he can walk quite normally without limping, the stroke left constant burning sensation in his left hip and leg. 

I think to myself, "OMG, I only have 6 days left in camp. What can I do for this man?"

Buddhi has almost no strength in his left arm, and poor grip in his hand. I ask him to hold a stone the size of his palm. He gingerly wraps his fingers around it, lifts up a few millimetres, then drops it. 

I ask Buddhi what he expects me to do for him. He wants just for his hip pain to go away. He believes there isn't much hope for his hand to recover.

"OK, " I said. "We will concentrate on treating your hip but I still want you to work this hand." I make him come for treatment everyday even though he travels a few hours to get to the clinic. I also gave him homework to practice holding the "magic stone" for one hour at home.

I treat him with scalp acupuncture, acupuncture on his left arm, hip and leg with electro-stimulation. This will be the same treatment repeated for the next few days.

The next day when Buddhi came in, I ask him to take the stone out of his bag and show me what he can do. I have a big surprise. Not only can he grip the stone, he is waving it above his head, with a beaming smile on his face. We clap and cheer his success. He said he had been practising until 6pm from the time he got home. 

Acupuncture Relief Project  | Good Health Nepal | Kaikit Wong

"Now try this stone." We progress to a stone smaller than his palm. He frowns with concentration, chasing the stone around while trying to hold it and losing it awkwardly. "Go home and keep practising." We continue the same acupuncture treatment.

On the fourth day, Buddhi proudly shows me how he has overcome the smaller stone. I hand him his clinic card and challenge him to grip it with thumb and finger of his weak hand. With much focus, he closes thumb and finger on the card. He looks at me, his eyes filled with disbelief. Tears were welling in my eyes. We clap and cheer again. The next task is to practice finger grip on a pebble and placing down with control.

By now, I refrain myself and the interpreter from helping him with his dressing and packing his bag. He may be slow but I insist that he uses his weak hand, instead of favouring the good hand. This forces the brain to rewire his weak hand. It is believed that stroke patients can lose the use of their weak limb through "learned nonuse" (Doidge, 2010)

On the fifth day, his finger grip improves. He is able to hold a pebble with 2 or 3 fingers and place it down with control. The burning sensation in his hip has reduced. Yet he is complaining of pain in his head due to daily scalp acupuncture.

As we part, I encourage him to continue practicing with the stones for the next few weeks while waiting for the clinic to reopen. As his brain rewires, he may, one day, be able to resume most of the use of his affected hand and return to farming again. That is the wish he expressed.

My stint in Nepal has come to an end. Buddhi's case touches my heart deeply each time I think of this experience. With his determination, he has shown me the magic in those stones that I picked from the roadside. ~ Kaikit Wong

 

Reference:

Doidge, N. (2010). The Brain That Changes Itself: stories of personal triumph from the frontiers of brain science. Scribe Publications Pty Ltd. Australia. Chapter 5.

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