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Groundlessness

Acupuncture Relief Project  | Good Health Nepal | Jesse Jory

Nepal for me was a practice in being comfortable with the feeling of groundlessness. 

Have you ever been on a suspension bridge?  

Nepal, I came to learn, is full of suspension bridges.  My experience as a volunteer acupuncture physician was analogous to crossing a suspension bridge.  After our first week arriving at camp we had our first Saturday off.   It was decided that we would take hike into the local mountains to visit a village.  The day was perfect, the sky clear and we were all excited to venture out and explore.  We visited the villagers high in the mountains of Suping overlooking Bhimphedi.  Our trusted guide Tsering informed us we would be crossing a suspension bridge on our decent back down.  I immediately began to have anxiety as I have a fear of suspension bridges. That feeling of groundlessness gave me a pit in my stomach and sweaty palms as we started our decent and got nearer to the bridge.  

You see groundlessness, insecurity,  vulnerability and even uncertainty or fear are generally words that are associated with a negative connotation.  Most of us try to avoid situations that make us feel this way.  Our psyche from an early age on tells us that feeling this way should be avoided.  When we got to that bridge even Nani the dog did not want to cross it!   She proceeded to try to climb down cliffs edge before being retrieved and carried across.  Well, a long story made short is that we all made it across the bridge on that beautiful afternoon, even Nani the dog!  Some of us held each others hands, some of us had to be carried and others walked right across.  What stuck with me about my experience was why I felt this way?  How could I relate this experience to my daily life. Specifically,  how can this feeling of groundlessness be made into something positive. The bridge was a small part of my experience in Nepal, but it represented of the totality of my experience in so many ways.

Acupuncture Relief Project  | Good Health Nepal | Jesse Jory

As the weeks past I realized that this feeling kept showing up in many different ways.  From seeing a patient in the clinic and not knowing what to do,  to wondering if I had the skills to treat 20 patients a day.  In fact, even prior to starting out on this journey, I wondered if I had the knowledge to practice medicine in a place so far from what I was comfortable with.  When I reflect back on the beginning of my journey at Earth House in Kathmandu it is very much the same as that sunny afternoon on the mountainside preparing to step across the suspension bridge, a feeling of excitement mixed with uncertainty and even vulnerability.  

During my stay at the camp over the seven weeks I made my way back to that suspension bridge.  With the help of a truly remarkable brother, who took the time and had the patience to allow me to become comfortable with the feeling of groundlessness.  I sat on the middle of that bridge, I meditated on that bridge while villagers passed me by, and I even stretched out on my backside on the middle of that bridge.  I became comfortable with being uncomfortable!  It wasn't easy, and I am not saying that the next ‘suspension bridge’  I cross will be any easier, but I have a new found idea of what it means to be present in those feelings of “groundlessness” and how those moments can be a place of great learning.  

I've come to understand a little deeper that we are in all this together, interconnected and we have the ability to make positive shifts with one another in places that are challenging and “groundless” while doing good in the world. --- Jesse Jory

Birth

Acupuncture Relief Project  | Good Health Nepal | Paula Rashkow

There was definitely a special something in the air that Saturday night. We had just had a fantastic day off from clinic visiting the home of one of our rock star interpreters. As we wove through farm fields and villages, the other practitioners and I fell in and out of many conversations about what we have been observing of rural life in Nepal. Bottom line: It is hard work. We were constantly trying to figure out what kind of recommendations would be useful and realistic for these folks who farm the land of the Himalayan foothills. So much of what we see in clinic is basic wear and tear from years of walking these hills with heavy loads and the back breaking labor it is to subsistence farm without the mechanization we are used to in the west. We also see lots of COPD from cooking over open fires in the home with no chimney to ventilate, eyes becoming scarred and irritated from so much dust and sun exposure, and trickier issues of lots of GERD from an irregular eating regimen, unmanaged diabetes and hypertension all probably due to modernizing processed diet over the past few decades. While we racked our brains for solutions that could meet the resources people have to put toward these problems, we also reflected on our many 1st world health problems that stem from a lot of excess and sentient life styles and humbly acknowledge daily that we do not have all the answers by any means. If a woman could convince her husband to spend the money for a propane cook stove- would the fuel canister be a heavier load then the branches they carry for fire fuel? Would it be a cost a family could spare? Maybe trading the ever present flip flop for more substantial footwear would help joint wear and tear and the constant falls while hauling loads patients report? Could it improve the plantar fasciitis and cracked heels? Would more protein like eggs or meat help with the diabetes or chronic acid reflux and stomach irritation issues? Can people afford to make any of these investments for their health? At least we know we are helping in many clear ways in the clinic. We are turning down the level of pain with acupuncture, we are helping people get back to their daily lives, we are helping catch more serious illnesses and guiding treatment. We are supporting an organization that is setting up to become Nepali run in the next 5 years and is putting out great efforts to understand the health trends of these people by launching a survey of the district next year. The clinic is a very special community center where people feel cared for and heard. 

Acupuncture Relief Project  | Good Health Nepal | Paula Rashkow

A special part of the Bajra Barahi clinic is that the land it is built on was given to Good Health Nepal/Acupuncture Relief Project by the government and it is part of a healthcare complex. The neighboring buildings are; the local Health Post and a birthing center. We were all excited that babies were going to be born right next door and decided amongst ourselves who would get to attend the first birth. My gracious colleauges let me be first! They were being very encouraging of my fledgling interest in woman’s health. Earlier that week a birth was happening during clinic hours- we were all informed but more or less assumed we had time because most births take time. The exact moment I was informed, I had 4 patients with needles in - getting treatments, so clearly I couldn’t go to attend the birth. I go over during lunch break and discover it was a simple straight forward birth that only took 2 hours!? I am definitely sad I missed it but Andrew said if I see the birthing center doors open to just go over and check in. So back to that special Saturday night after such a wonderful and thought provoking day. I am feeling a rare energy in the air. I harness it after dinner to indulge in a self care ritual I find time for most days back home, but truthfully feel too tired for on regular clinic days here in Nepal. Magically the Wifi is actually strong enough in my room to stream consistently, which is what made it possible that lovely eve! It is what I like to call my “yoga dance party”: a sweet combination of intuitive movement, yoga balances, qi gong, stretching, core work, breath work and most importantly just a good ol’ goofy time, laughing at myself. It is just about 8pm, while in a headstand I notice the lights on at the birthing center! I run down the hall and poke my head back into the kitchen where everyone is still hanging out having our regular style post meal digestive banter and say, “the door is open at the birthing center!” Everyone sees my excitement and says- “Go!!”  “go check it out” !

Acupuncture Relief Project  | Good Health Nepal | Paula Rashkow

So we radio down across the street to see if any of the interns want to come interpret for me. And in a few minutes Sarita and Ritesh are up and I have a little travel acupuncture kit ready to bring over. We head across the courtyard and enter to see a very out of it mother to be. The woman is 20 years old (which is actually 19 because in Nepal, people count babies as 1 right from birth instead of zero like we do). It is the mother’s first pregnancy. Her eyes are rolled back into her head and she is doubled over in pain. Luckily, she is surrounded by a sweet support team of her husband’s mother and 2 sisters. 

Acupuncture Relief Project  | Good Health Nepal | Paula Rashkow

Let me also take a moment to explain what this “birthing center” consists of. It is like all buildings in Nepal, which means non-insulated concrete; cold in other words, it was a chilly night. The small building has 2 rooms- the first room you walk into is a kind of waiting room with a bed and a bench, then the second room has a table for birthing which has two poles with stirrups at the foot of it. I say table because it is definitely not a bed, it is slightly padded hard plastic vinyl. Really the whole feel of the place is cold, but it is a real resource for the community. There are healthcare workers that we call “the sisters” who live in a building very close to our compound. When the interpreters and I arrive, I introduce myself with my title here, “Hello I am Doctor Paula, I am an acupuncturist and I would be honored to assist in your birth”. I explain I can give simple points to reduce pain and help the contractions. They all consent. I join the team and aid the girl into the birth room to check on progress. 

Acupuncture Relief Project  | Good Health Nepal | Paula Rashkow

She can barely walk and uses anyone in arms reach for support. I help the girl onto the table and hold her hand. She grasps my hand for dear life. She is clearly in extreme pain and discomfort, is scared and just needs a hand to hold, hard. And although I could not speak to her in her own language, so much was communicated in that moment through her desperate grasp. She was allowing me into her world, into this moment of her life, bringing in new life. Her hand was simply asking for help. It was electrifying, terrifying and activating: what was communicated through her hand into mine. The sister, who has probably attended hundreds of births casually stated “she’s 3 or 4 cm dilated”. This meant it could be hours until birth time- she was going to sleep and would return at midnight to check in again. We go back to the waiting room and settle the laboring mother on the more comfortable bed with her sisters propping her up. She was incredibly out of it- it seemed like she was definitely not coherent, not using her mind at all, letting instinct drop her into her body, but it also seemed like she was trying to flee the pain in anyway. The mother-in-law, who was a mother of 3 herself, was laughing and telling her it wasn’t “so hard”- “time to stop being a baby and mother a baby”- the interpreter helped me understand. I looked around the room to the young boys who were there and it dawned on me that one of them must be the father of this baby on the way. Wow, they seriously looked like babies themselves! 19 years old is young by my westernized standards- and don’t forget that boys mature slower than girls ;) but it’s completely average here to be a parent at that age. Some of our patients started having kids at 14. The boys make some snarky remark I don’t understand and the lady support team shoos them to wait out in the cold night on the porch. 

The girl moans in pain and I put in DU 20 and yin tang. I figure by what the sister said it could be some time before this baby comes. I also place sympathetic and shen men in her ear. My intention is for this mom to come back into the present and feel grounded for the arrival of her child. I show Sarita how to hold and gently massage, giving acupressure to the feet connecting Kidney 1 to Liver 3 and explain how water generates wood and will help the movement of this child soon. Also I show the family members LI4 -an obvious point to massage with the hand holding she needs. I give gentle shiatsu to the leg yin channels and her belly. We stay with the family a while, then we decide to try to sleep for a couple of hours too. 

Acupuncture Relief Project  | Good Health Nepal | Paula Rashkow

I awake Sarita and head next door again and return when the midwife sister returns at midnight. We check and the mother is progressing well, she is now dilated to 7 cm maybe 8. The mother continues to be in pain although she does seem more present, able to make eye contact now and gives a slight smile when we return. In my approximation everyone involved wants this baby to come now. While I have not had any advanced training on acupuncture and labor, I did of course know all the strong energy moving points and go for the known contraction enhancing points- aka: all the points that are contraindicated during pregnancy. I start with spleen 6- there is a dance to putting in the needles and removing them because the mother is constantly moving about trying to get comfortable. I place needles in and out and spend time with each needle stimulating the point. The contractions seem to come more often now. Things are progressing well. LR 3, BL60 are easy targets also since during contractions she wants to brace her feet against the rails at the end of the bed. LI 4 can only go in for quick moments since she wants to hold hands very much. It is after rotating through these powerful points that her water finally breaks! I take all needles out and we move her into the birthing room and get her on the hard plastic table. I am thankful Kaikit back at camp gave me some press tacks- I realize they are perfect to put in place during the labor. So I place the tiny stickers with hairlike needles coming from them on the mother in all those same points that are helping the contractions. Then it is my time to step back and let the midwife sister do her magic. 

Acupuncture Relief Project  | Good Health Nepal | Paula Rashkow

The first sight of the head is really fascinating to me- all crinkled. “oh my goodness” I think to myself, “that’s why a baby’s skull needs to be so soft! Eep how on earth is the baby going to fit through there! Omg” Well I will spare you all the details- let’s just say it went just as you’d expect a birth to go- I N T E N S E- like in the movies- it is slow but steady progress with each contraction more and more of the head showing until- whoop- that’s why they call it catching a baby! And my goodness it is a beautiful child and her head went right into a very cute correct round little melon shape after all- how !? a miracle of nature indeed. The cutting of the umbilical cord: wow it is wild to see. So much life in that sinew. So many colors. The baby is wrapped up and put on a warming table one eye already open and peering into this new reality. Afterbirth: a bloody affair. All of this is turning my young interpreter friend Sarita slightly green but she does great assisting the midwife with some tools. The mother needs some attending to since she has some tearing. The midwife says the mother could have easily avoided it had she been able to get in a more proper body position- the young mom of course had no Lamaze class or any coaching to go on. Overall, she did great and the baby is happily healthfully suckling within 20 minutes to half an hour in this world! Then I get to hold the warm little thing, heart melter- she looks right into my eyes, both open now, with curiosity and I can’t believe how great it feels to have been part of this. I don’t feel right hogging the baby for too many moments of her new life – and offer her to the father- who seems totally petrified and declines laughing and saying “oh it’s ok, I don’t need to hold her right now- I’ll be holding her for her whole life” So I pass the babe to her auntie. We all share many smiles and a true sense of celebration marked by exhaustion. By that time it is probably 3 am and we do have clinic at 8 am so it is time for sleep. 

Acupuncture Relief Project  | Good Health Nepal | Paula Rashkow

As I walk out of the birthing center crossing back to our building I take a moment to appreciate the bright constellations above. Wondering exactly what their alignment is for the new little life and reflecting on what is birthed into life for me through this experience. A certain spark is ignited for the whole realm of woman’s health and how Chinese medicine and acupuncture can nourish and support our life giving force. I hope to further work with fertility, expectant mothers, and labor. It is an intense experience but important work indeed. I feel true appreciation for my work here with the ARP and this chance to touch the lives of so many old and young. -- Paula Rashkow

Two Realities

Acupuncture Relief Project  | Good Health Nepal | Danielle Reghi

Has anyone ever seen the movie, or read the book The Hunger Games? I know it is a teen drama but I am not sorry to say I have done both, and rather liked them.  The story of the Hunger Games itself is definitely fantasy, but one scene does tend to pop into my head from time to time while I am here in Nepal.  The scene when the two poor kids from district 12, get taken to the capitol to have a feast.  The kids are in awe that people have so much money, and spend their money on things like fashion, waxing, elaborate and ornate everything.  While they are at the feast there is more food than they could possibly imagine, never before have they seen so much food, and people who can eat so much.  Then a small vial of liquid comes around, and a citizen of the capital tells them that this liquid is to make them throw up, so that they can continue to eat more. That scene is basically the epitome of indulgence.  The reason this scene tends to come to mind while I am in Nepal, is not because that movie poses any semblance of reality at all, but it serves as a stark juxtaposition of extreme poverty, and extreme overindulgence.  

Acupuncture Relief Project  | Good Health Nepal | Danielle Reghi

Acupuncture Relief Project  | Good Health Nepal | Danielle Reghi

Acupuncture Relief Project  | Good Health Nepal | Danielle Reghi

These are two realities that actually do occur in real life, and even my modest life in Portland Oregon seems very excessive as I spend time here in Nepal.  I drive a car. I don’t have to walk 4 hours to get to my doctor. I shop at New Seasons, Portland’s boutique food market, and I love it.  People here basically grow all of their own food.  Not only do they grow their own food but also as subsistence farmers with no big machinery, they carry incredibly heavy loads on their heads and backs, around 50 to 90 Kilograms to be exact.  There are 2.2 pounds in one Kilogram, which would make that load 110- 198 pounds.  When was the last time you saw an American carry a load like that who was not some sort of extreme body builder?  In Nepal the houses are generally built so that the goats, chickens, water buffalo and cows live on the first floor of the dwelling, and the family lives above that.  Eventually they slaughter these animals for food, a perfect example of rural farming, and certainly much healthier than factory farming, but it is hard for my American sensibilities to wrap my head around. My pets live in my house, and my pets are treated like my family, the idea of living in close quarters with a living creature, nurturing and caring for it, then killing it is very foreign to me.  Logically I know this is the best kind of meat to eat, I know that it’s healthier than how we raise and kill animals in the states, but I suppose I have attachment issues.  I wonder to myself, would we eat as much meat as we do in America if we were forced to live with life and death in this manner?  

Acupuncture Relief Project  | Good Health Nepal | Danielle Reghi

Acupuncture Relief Project  | Good Health Nepal | Danielle Reghi

Acupuncture Relief Project  | Good Health Nepal | Danielle Reghi

Then there are the dogs.  We call them mans best friend back home.  American dogs drive in the front seats of cars, eat gourmet pet food, and probably have better health care than the average American.  In America we have a humane society that keeps our streets relatively free of unwanted suffering animals, and we also have state animal control agencies that do the same.  If one finds a sick or injured animal in Portland, there are 24-hour pet emergency centers that you can drop the animal off at and feel like you were a Good Samaritan.  Here in Nepal there are none of those things.  Hungry and injured dogs roam the streets with gashes in their sides, ribs sticking out, and mange affecting their coat.  Even the youngest dogs that are most successfully able to forage food look as if a strong wind could blow the over.  The other day a group of us was out walking and found a puppy running down the road, orphaned and afraid.  We picked her up, I named her Lapsi, and if everything goes well she will be making the journey with me back to America.  The Nepali people are inundated with dogs, they have to protect their other animals from dog attacks, and they don’t eat that much themselves, so feeding dogs is out of the question.  I imagine that when you see dogs suffering everyday, you have to steel yourself to the plight, because if you tried to feed one dog then more would inevitably show up, and you can’t possibly feed them all.  So the people here are not dog lovers, they throw rocks and bricks at them, which to a western onlooker seems cruel, but it is simply that the people have a different relationship to life, death and suffering than we do in the west.  

Acupuncture Relief Project  | Good Health Nepal | Danielle Reghi

Acupuncture Relief Project  | Good Health Nepal | Danielle Reghi

The people of Nepal are a God fearing group.  God is everywhere; there are shrines to Gods all over the place.  At the watering hole you have a shrine to the water God.  In the field you have a shrine to Shiva, the creator.  In every home there seems to be a little puja, a shrine to Shiva, or Ganesh- the remover of obstacles.  The gods adorn their jewelry; you can pick up a pendant or ring with Ganesh, carved into coral or jade. When they slaughter their animals they take them down to the temple, adorn them with blessing, and have a shaman ritualistically kill them before they eat the meat. They are a hard working people, who care about family and look after each other like they are all one big extended family.  It is not unusual to be called sister or aunty by the people you know, even if technically you have no blood relation.  In the clinic they are often sitting next to each other carrying on conversations and dispensing their own advise and when you ask them if they know each other they say, “No, we just met”.  It seems that the biggest concern that an elderly person with body pain has is that they are able to get back to work.  An unproductive person is a drain on the family’s resources and so they strive to remain useful in some way.  

Acupuncture Relief Project  | Good Health Nepal | Danielle Reghi

Acupuncture Relief Project  | Good Health Nepal | Danielle Reghi

In Nepal they are still rebuilding their homes from the big earthquake that Nepal experienced 2 years ago. Their houses seem to be made of earthen bricks that are held together with a mud that solidifies.  The floors are packed dirt and their stairs are really ladders.  In my ignorance of the area and style of houses I used to tell people, “why are you climbing ladders at your age?” or “try not to walk up and down hills while your knees are healing”.  Then I realized the ladders are actually their stairs and what they need to climb to get to bed. Or, they live on a hill, so in order to get too and from home they have to walk up and down hills. There are no showers in doors, rather a local water pump where people go to shower on the side of the dusty road, with only cold water running out of it.  They also do their laundry at the water pump, or by the river, then let the laundry dry in the sun.  Back at home in America I am a serious hot shower taker.  I take a shower once a day, and it is usually scalding hot.  Here in Nepal I am very lucky that the compound I am staying at does have solar power heated water, in limited quality.  So I am fortunate enough to have a warm shower a couple of times a week, this is definitely not the norm, and in clinic your alcohol swabs quickly turn brown in an effort to sanitize the needle site.  At our compound we also have a propane stove, and some of the wealthier families do, but the vast majority of people still cook by burning wood in their kitchen that has no ventilation. Needless to say, we see a lot of COPD in clinic due to the wood burning stoves. Because most of the houses are damaged from the earthquake, many people have constructed temporary bedrooms that the entire family sleeps in made of tin. They sleep in tin sheds.   

Acupuncture Relief Project  | Good Health Nepal | Danielle Reghi

So what is the point of my comparison? Why am I going on about wealth and poverty? The reason I feel compelled to speak to all of this is because we are so fortunate in America, and sometimes when you are saturated in the Western comforts that fact is easy to forget.  I mean Donald Trump just ran a campaign with the slogan “Make America Great Again”.  But the fact of the matter is, America is great.  We have hot showers, we have washing machines, we have indoor plumbing, indoors heating, and we don’t live in houses with dirt packed floors.  So the next time you think to yourself, “I wish I had a nicer car with blue tooth”, or “My house isn’t big enough”. Take a moment to count your blessings, then go plan a trip to a third world country and get a healthy dose of perspective.  --Danielle Reghi

Horses not Zebras

Please read this in Ira Glass’s voice from This American Life. Thanks

“Act one. Act one… Into the Himalayas”

It’s been a wild month. After I last wrote, we had the clinic running at full capacity. Fortunately we had treatment plans in place for our patients over a 5 week period, because the two week national holiday of Doshain ensued. We shut the clinic down for the patients and interpreters celebration of the holiday. 

So we took the chance to head to the Himalayas for some trekking (on our own dime). And, well, it was amazing. 

 
 
 

 
 
I was amazed by the generosity and strength of the Sherpas (an ethnic group of Nepal, that has become a general term for guides & porters of the Himal). They are very enjoyable men who by the end of the trip were calling me “sila” - brother in Nepali. And brothers they were. The hospitality of the people made me understand the draw to this region, not just for its mountains.
 
 
The mountains were amazing as well. Our little summit at 18,000 feet was a day hike compared to the neighboring mountains. But let me tell you the air is really thin up there! 
 
 
After finding enlightenment and lightheadedness in the mountains we returned to our little valley of Bajrabarahi. The past two weeks have been intense. And I have had some major epiphanies. 
 

“Act two, act two... Being a doctor"

The first epiphany; primary health care is very challenging. With a range of 17-25 patients a day I have a greater respect for primary care MD’s. There knowledge is insurmountable. And I am beginning to understand why MD’s rely on drugs so prevalently. Why they have to treat the way they do in an overcrowded health care system. 

People who are sick want to be fixed ASAP and when you have many sick people and little time, you need all the help you can get, even if its just a band aid. You become a god to your patient when you provide the instant relief, of say a powerful antacid or PPI for GERD (heart burn).  But it’s the easy fix which I see become the long term fix here, and in the states. The capitalistic buyout of medication intended for two weeks become a chronic purchase by the insurance company for Americans, only to lead to further problems down the road.

The beauty of what we are doing is following up week after week. Educating the patient, in the case of PPI’s; how to change the diet so that the stomach can repair on pharmaceuticals and then go off of them in two weeks, as originally designed.

So the thought and the philosophy of an instant fix is one to be pondered. It is time to question “medicine”, How it is practiced, and what the effective time spent with the patient is. Is that time and money put into creation and sale of the pharmaceutical or into the doctors treating the patient? 

 

“Act Three of our program... when you hear hooves, think horses, not zebras.”

 I am practicing slowing down. Everyday I become more and more confident with musculoskeletal injuries and orthopedic diagnosis, but when it comes to the internal medicine patients, I freeze as my mind races. 

“I am here as a muscle guy not infectious disease specialist!” My mind shouts!

But my role is primary care. I have to fill these shoes and I have to come to terms that I do indeed have the education and tools to do it. 

I am reminded I can observe the patient over a few days, this is rural health care. They have had this condition for 2 months, maybe two years, they won’t die tonight. 

I determine the basics and look for red flags. Do they have a fever? Blood pressure to high? Too low? Blood sugar level? Vomiting?  Diarrhea? Blood in urine?

The list goes on.

I can observe them closely over the next few days.

I change my thinking from an “alternative” practitioner in the states (who can get sued for making these decisions) to the role of the most educated medical provider in a 3 hour radius.

I have to recognize that many patients will most likely never visit a hospital because of their sect or class, which will get them blown off at the front desk or ignored by higher cast medical doctors. Or, illiterate,  they won’t be able to read signs and will not find the correct wing of the hospital to enter!

I breath, and pick apart their presentation until I can make a working diagnosis. I chill them out with acupuncture needles and determine what is the best advice they need right now. And maybe my advice is the best medicine.

 

"Act Four, Act four... What is the world” 

 

Epiphany number three is that of the organic idealist. I am rethinking how I live over here. I always thought farming and eating my own wild game in a  “paleo diet” was the ideal lifestyle. Don’t get me wrong I encourage all gardening and hunting activities. I hope to enjoy some of that lifestyle in the future. But there are 7 billion people on this planet. And here 90% of the population farms, (not the Portland hipster farm of 4 Hop plants in the back yard, nor the Iowainian farmer who can hull 4 miles of corn in a day). Im talking rice fields tilled by hand and 150 pound loads carried not by water buffalo, but by auntie. It’s unreal, and as I squat over the local tea house toilet (hole in the ground), under a 4.5 foot ceiling, staring at a little faucet coming out of the wall, intended for washing my crack by hand. I realize that I have had it all too good.  

My old obsession of allergy prevention through parasite infection have quickly disappeared. My patients arrive daily with all kinds of itchy skin and breathing issues, and there is no easy fix. My pondering of living old school, barefoot and wild, have all vanished. I stare at the farmers heels with vertical cracks resembling a map of the grand canyon. I sterilize and dress a 2 inch laceration on my patients arch from a sharp root(she doesn't even complain about her heels). Im grateful I can afford shoes. 

 
 
My patients all have gastritis, they most likely all have parasites as half of them are anemic and skinny enough that I can reach around the circumference of their thigh with one hand. I laugh at my own concern of being B12 deficient in the states. I laugh at my understanding of pain, I ski race and run marathons to feel pain, these people live with it everyday. But when I see them in the town or walking to the fields, they are all smiling. 
 
 
I am re-thinking everything, including the little things.
 
 

How much water do I waste when I shower? How much toilet paper do I use!? How much energy do I waste using hot water? How do I have so many clothes! (a race t-shirt for everyday of the month!) How do I wash all those clothes!? How much packaging do I waste buying or eating anything, (we burn all of our trash here in a slow smolder and Kathmandu’s smog rolls into our valley every day.) How do I have such a new passion for mustard greens as my abdomen has become filled of rice and dal. How can chicken (mostly bones) taste so good once a week!?  How can we eat so much meat in the U.S? How amazing is it that I can I get anywhere in Portland in one hour by public transport? How does my patient wake up at 4;30 am and walk 5hrs to the clinic to let me work on her arthritic knees with medial meniscus tears, and then walk 5hrs back home on those same knees?

It all seems so nuts!

And  then I see the pollution of the candy wrappers on the unpaved streets. The infiltration of jean jackets, selfies, hair-gel and Facebook in the youth… the narcissism of a California dream infiltrates their minds (while their family still harvests everything by hand). Im puzzled, and think to Jared Diamond’s Collapse… Is this the end? The American dream and the want for more, engulfing the most rural minds. This setting which seems so sustainable and ideal is riddled with just as much danger as home. This little valley’s death toll from carbon monoxide poisoning (due to the lack of chimneys in homes) alone most likely equals the same number of murders per capita in my home town. Are humans doomed? 

I look to my interpreters, born and raised in this small farming community. They all eagerly wait for me outside the clinic doors at 8;15 every morning. Wide eyed, grinning and ready to help, with every patient, every question and every needle. They own it. And I see the future isn’t so bleak.

---Ian Wilsonson

 

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