Sindure Signs

 

Sindure village is one of the old feudal capitals of Nepal, where a king once ruled over Lamjung district before unification in the mid 1700s. The drive from Pokhara takes about 6-7 hours…the last three are very bouncy.

IMG_3007Our day began in a downpour at 6:30am, with the usual wakeup activity: loading a dental chair on to the top of a Landcruiser. We packed in various boxes of medicines, adjustable stools, plastic goggles, and this fancy Hello Kitty timer. Because Virex disinfecting soak is 20 minutes, exactly, and one must have a proper timer.

Also, we had an extra passenger and her little boy who were headed home to their village. They set up in the front seat, and the little boy kept arranging himself with his knees splayed out and the bottoms of his feet together, so Neha quickly named him Laughing Buddha. Mean time, we squashed ourselves in the back of the cruiser and set off in the rain, picking up our senior technician Megnath on the way. And then we were off to our first ever clinic opening in the district of Lamjung.

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We settled in and the cruiser bounced joyously along. It was strange to be headed off to Lamjung again, where we spent many long hot days after the earthquake at this time last year. I was apprehensive about how our clinic setup would go, if the whether would clear, if the road would be passable, if a lot of things. And it was Sunday the 26th, exactly one year after my beloved friend Mary passed away on another rainy and pregnant day last summer. I stared out at the passing rain and fog, thinking about each moment I’d spent on this morning last June, checking my phone for updates from the other side of the world, stunned and devastated by a sudden change of events.

Then again, the bracing car ride left minimal opportunity for rumination. A few hours in, we stopped for tea, and shortly afterwards, Laughing Buddha barfed all over Gaurab in the front seat.

Well, the best part is yet to come.

We arrived at the Health Post in Sindure at 2pm to find that, while work had been done on the clinic room, such as making sure it had a roof over the entryway, the room itself was filthy. To give you a frame of reference, here are pictures from main room of the Health Post, which sees patients regularly to distribute medicine and make referrals. Unlike our dental clinic, the Health Post is not performing surgical-type procedures—nevertheless, setting up a dental clinic with rigorous infection control is, well, basically up to us.

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Still, there’s a reason we rely on rooms provided by the community instead of building ourselves new facilities. I’ve seen how that can be the difference between imposing new resources haphazardly, and mobilizing existing capacities to raise things to the next level first.  Then it’s a good time to push the boundary, which in this case as in many others, has not yet been approached. After all, with some sweeping and a few buckets of water and phenol, our dreary clinic room started looking a lot better.  There’s no water source at this Health Post, so Dilmaya, Neha, and the Health Post Assistant good-naturedly hauled buckets of water from a “nearby” house at least a quarter mile away.

A few hours of washing, drying, and setup, and things are improving already. This room will need a nice bright coat of paint on its stained walls – we provide the paint, the team does the labor – but for now, here is JOHC Technician Jagat Dura in his new office!  And we’re not even at the best part yet.


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During our pre-opening day, a veteran technician and our medical field officer go over everything from top to bottom with the new technician (who’s already had weeks of training before this) and clinic assistant.  It was awesome watching Megnath Adhikari, who started with us in 2013 and now runs the Puranchaur clinic, reviewing with the new clinic team everything from how to put the top on the autoclave to how to fill out the patient forms to when to change their gloves. Our infection control protocol, when followed, is stricter than that observed by many field teams and local hospitals. The new teams always look so new and wide-eyed that it throws me off every time. To be fair, imagine if you took a few weeks of training in dental medicine, and then, say, your congressman came in and asked you to pull their tooth out?!  But then, as the months go by, inevitably these green clinical teams turn in to people like Megnath, who started out with sagging jeans and a quizzical look, too. This growth in skill and confidence, which I’ve witnessed over and over, is one of the coolest things about this program. It inspires me to believe that this is a system that could be deployed widely by the government with the right investment in training and resources.

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Senior technician Megnath Adhikari reviewing use of the autoclave with the Sindure team

In the evening we stayed at the home of our technician, Jagat. His mother cooked heaps of food and poured us one cup of local moonshine after the next. I was so tired I kept falling asleep and had to get out of bed for each succeeding round of dinner.  And still…the best part is yet to come.

Sindure is a predominantly Gurung area with different traditions of respect than many of the other areas where we’ve worked. The local President had spent the evening with us, and after everyone was overfed, it was time to sit around and sing for a while. I’m not a very good traditional Nepali folk singer, but I’m a decent self-taught drummer and chime-player. So, having secured an empty plastic bottle and a set of tin cups, I am confident saying my role in this process was solid, although you can’t hear it in this video cause I was filming.

The next morning dawned in a downpour, which cleared as we made our way to the clinic for opening day. The clouds nestled down in to the hills like cotton and we climbed up over them. Sindure was too beautiful to leave out a scenic photo.

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In an opening ceremony, we were each given gifts, and I received the finest one, a magnificent Gurung-style ornament made by our technician’s grandmother. These shiny dangles are made from cracker and candy wrappers! I love this thing.

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The door to the clinic was officially opened by the Singing President, who had apparently recovered from last night’s revelry and lay down honorably as the first patient.  Jagat performed his inaugural checkup, supervisor standing by, with a crowd peering in the door and looking very enthusiastic about this whole thing.  Who knew dentistry could be this entertaining?!  And we’re still not at the best part yet.

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Now then…nothing like showing off your new filling!

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It is currently the busy rice planting season, which is about the worst time of year to open a dental clinic because everybody is in their fields. Nevertheless, we had a pretty solid attendance from a fleet of Female Community Health Volunteers (official women’s health workers trained by the government) and some other folks here and there.

We plucked various people off the road, such as one man walking by on his way to plant rice. All in all, the new clinic was inaugurated with about 25 patients, with Megnath carefully supervising the new team, and seeing that was especially gratifying.

As our day was coming to an end, I happened to look up at the sky. And for only the second time in my life – the first time being on the sacred day thirteen after Mary passed away – I saw the following sight:

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Look! I cried, look! Everyone turned their faces up and let out a collective breath of delight. I ran over to a clear patch of ground to try to get a picture, but my camera was having trouble focusing while pointed directly in to the sun.

“It looks just like a roti!” exclaimed the man who had stopped by on his way to plant rice.

Now then, my mind chirped, this must happen a lot. Weather patterns are repetitive; I mean, I know where to find all the rainbows in Kaskikot, and in what sort of light. It’s so predictable that I’ve usually climbed a hill and pointed my camera already by the time a rainbow is emerging. Still, I consigned, how lucky for me to receive this lovely gift today in a brand new place.

“Do you see this kind of rainbow often?” I casually asked the man who had stopped by on his way to plant rice. To confirm my suspicions.

“I see rainbows all the time,” he said, “bent sideways like this. But I’ve never seen this kind of round rainbow in my life!”

I clicked and clicked in to the sun, and the shutter went off only one time. Almost immediately, the clouds moved back in and the wonderful roti faded away.

Later that night, after a long, bouncy and exhausting ride home, back in bed in Pokhara, I lay in the dark and pulled the photo up on my phone. I turned it this way and that, looking for something. I kept thinking of Mary saying trying to show me the big hand in the sky, and how I couldn’t find a thing until much later. I zoomed the photo in and out and scoured for clues. Then, tired and lonely for her, I held the phone back and sighed. And there, right where I couldn’t miss it, was a perfect Buddha, the sun shining from its heart.

Once I saw it, I couldn’t not see it.

 

 

 

 

 

 

 

As a little extra flourish, an unmistakable smiley face, etched off to the right hand side, grinned at me as if to say: how obvious do you want me to get, you little shit? I clicked my phone off and fell asleep with it lying near me on the bed.

Welcome to Sindure, world.

*

A Life of Love

A Life of Love

In the Clouds

Dear Mary,

First of all, don’t worry, this isn’t setting an annual precedent–it’s not like I’m going to write to you every single year on June 26th, which you would find dreadfully contrived. However, I have a few things to tell you about the past year, and I’m thinking about you today.

A year goes by so fast.

Remember those four college guys you told me I should totally convince my parents were okay to stay in my apartment while I was in Nepal last summer? That didn’t work out so great. They threw beer cans in my neighbor’s garden and now my neighbor won’t talk to me. In fact, my neighbor, who chain smokes cigars but used to bring me fresh vegetables from his garden, told me that if I put my recycling in the wrong bin, he’ll take it out and relocate my recycling to my porch. Still, no major damage inside the apartment, and I got a solid month’s rent, so on the whole, I’d say the renters were a win, for me if not my neighbor. You’ll definitely take my side on this one.

The little memory card from your service is on the bookshelf across from my desk. I flip it every few months between your photo on one side, and the picture of the cloud that looks like a hand holding the sun. One afternoon, when you were really exited that you’d taken that picture, we sat in your living room and you tried to show me how the cloud was shaped like a giant hand reaching down from the sky, but I couldn’t make it out. Right here, you said, this is the thumb, going along like this, and the other fingers go along like this. I squinted and turned the paper around and I couldn’t find the hand of God anywhere. You didn’t seem particularly amazed that I couldn’t see this image that was so obvious to you. Eventually, we moved on to something else. Now when I look at it each day I can’t see how I missed it. The hand of God is right there. I can’t not see it.

Just a few days just after I returned from Nepal last summer, I was driving to Wallingford and couldn’t believe you weren’t there.  I consoled myself by deciding we would build all the bamboo houses again.  That would fix things.  We’d hike for days in the hot sun, negotiate with tin vendors and take long bumpy tractor rides, surf waves of despair followed by hope followed by despair and hope, again. We’d be confused all over and learn it all over from the beginning. I’d hike up to that airy ridge in Lakure in the burning sun and drink knockoff Redbull, again. Yes. But when I got up the next day, nothing had changed. The bamboo houses were still standing, and you were still gone.

Often I think about all the people that have died. The list that has grown even this year, when I couldn’t call you. Fifty people were just gunned down at a club in Orlando. So many people die violently or young or right in the middle of dinner. You had a long life full of beautiful things, you were at peace with yourself and the world, you left a tapestry of all of us who love each other because of you and in your memory. I tell myself I should be grateful, and I am. But I miss you anyway.

You are still in the “favorites” in my phone because I can’t delete your name from the list. Once, I was getting in the car and without realizing it I tapped your name and dialed your phone. You picked up your voicemail and started talking to me right there in my car and scared the crap out of me.

VERY FUNNY, YOU TURKEY.

Also, listen, things have gotten really hectic in politics, and I think Bill and I should consider going out as a presidential ticket. I haven’t asked him yet but I think he’ll consider it.  We sometimes watch the debates together on the phone, the way you and I used to have wine dates in our kitchens when it had been too long since our last visit. While Bill and I watch the debates we text and afterwards we debrief till 12 or 1am and I explain all the reasons that I’m right and I represent the future. I am pretty sure that if we ran – of course we’d have to decide which of us was going to be the president – but anyway if we ran, I’m pretty sure we’d have much better ideas than a number of the people who have been running. We’d make you absolutely crazy and you’d roll your eyes over dinner.

Next year I start a field placement for social work school. I’m going to work with Cambodian refugees. This is something we should talk about for a long time. I know I’ll do my internship without you, but it just won’t be the same.

I never did the follow up talk I had planned in the library, and I never tried to get on Fox news again, after that adventure where you convinced me to call and get myself a TV interview about the earthquake in Nepal. I just couldn’t bear the thought of being back in the television studio where I texted you, and especially not the thought of standing before a crowd at that same podium in the library meeting room, looking at the door you sat behind. But strangely enough, I walk past the other side of that door every time I go in the library to get my parking ticket validated. I glance over at the spot where you and Bill sat listening to my talk, and then hustle past it.

Why do I feel better when I’m missing you the worst? I think you should have explained this to me before you left.  The absence is in the shape of you, right where you fit here. I think more people should be made aware of this. It’s a real fucker, as you’d say. You wouldn’t say “fucker” though. You’d make the “f” with your teeth and squish up your nose and then jab the air with your pointer finger, and then slide your gaze sideways from the imaginary fucker back to me. Like this thing about this fucker is slightly classified information that I get to know because I’m with you.

The clock would gong in the living room, and we’d say, it is getting so late!

Also, can something be slightly classified? Isn’t it all or nothing?

Isn’t it all or nothing? 

I’m going to declassify everything. But there are just so many things we didn’t get to.

I think you would approve of how I’ve grown this year. We don’t have a lot of time to spend being afraid or making ourselves small. My life is very blessed with family and friends and challenges of merit. After our visit to Tripureswor Ward #6 last summer, just days after you died, I came home early for your memorial service, but my friend Anne stayed behind. She and Saila dai did a puja for you in his magnificent temple garden. Anne saved prasad for me, a tiny branch with two tear-shaped leaves. She mailed this delicate offering to me months later from Moorehead, Minnesota. Isn’t it an amazing thing to have friends like that? The branch sits on my mantle next to the hand of God. It connects me to you, and Anne, and Saila dai, and those hot and trying weeks after the earthquake, to the bamboo houses, which I can’t trade for you, which is not a deal you’d take anyway.

Well…maybe you’d consider it.  You had a pretty good time here I think you’d take another day.

You will always be one of my favorites. Call, ok?

I love you kid,

Laura

p.s. me trying to get you to sing “imagine that” while listening to it through headphones…first the song, in case you need to reference the lyrics up there

..and this, which I can’t listen to without laughing

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And one from Nepal I think you’ll like…

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The Video Nepal’s Been Waiting For

 

In thirteen years, I have spent at least one of every season here.  I’ve cut rice and planted millet.  I’ve harvested wood.  I’ve cut wheat, and planted corn and churned milk the old fashioned way.  I’ve chased the chicken around and painted the house for Dashain.  Most of these things I’ve done multiple times, and believe me, I received plenty of impassioned feedback as I tried them out.  These are all activities people in rural Nepal learn from toddlerhood.  Seeing a grown woman who can’t flip a pan of rice grain properly is basically impossible not to comment on.

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I’ve pretty much learned a lot of these things because I absolutely insisted on doing them terribly while I figured them out.  In some cases, I’ve really earned my stripes.  In others, let’s just say that people have become happy with the American version of, for example, collecting water.

But there’s one season I’ve purposefully avoided, and it’s the rice planting one.  Even tasks I don’t much enjoy, such as those involving fertilizer (i.e. buffalo poop), are things I have determined to throw myself in to.  It’s like how, when I used to take winter diving lessons, we had a “fun day” where we got to use all of the diving platforms at Montgomery Aquatic Center, and that meant that, for fun, I had to make myself jump off the petrifying 10-meter platform that was level with the third-floor spectator section.  I absolutely hated fun day.  But it never remotely crossed my mind that, if the 10 meter platform was available, I wouldn’t jump off it.

This brings us to the topic of the hot, buggy, wet rice planting season.  I think you get my point.  I stayed in the U.S.  No fun day.

It’s not like this was very clever and nobody noticed.  Every year I am asked when I will come to plant rice.  People will list all of my accomplishments to date, and exclaim as to how I have never participated in this one activity that is so central to the culture and basic survival of Nepal.

Ok, so here it is.  I determined to jump off the 10-meter platform this summer.  Partially because as you get taller, it doesn’t look as high.  I over came my distaste for the idea of the monsoon last summer, and this summer, I appreciate the torrential rain tremendously.

So last weekend I joined Saano Didi’s family in their rice paddies.  Govinda’s daughter Sulojana came with me.  And the amazing thing about waiting 13 years to do this: not one person cried out at how terrible I was at planting rice.

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“You have to teach her, sikaunu parchha, you have to teach her,” all the ladies cooed.

Silky mud, bright clothes, plants in your hands.

“Laura, you’ll be back in November, right?” Neru asked.

“Yep.”

“Because that’s when we can eat this rice.  Make sure you’re back.”

 

 

 

Waiting Out Rain

 

I’ve just arrived in Nepal, and the dust and diesel is shining on the streets of Kathmandu, stilled by summer rain.  Honestly for a whole decade I didn’t want to be here during the hot and buggy monsoon, but last summer I discovered that of course, like any season, the rainy time has a unique and indispensible magic.  The water clatters and pounds, washing everything and making us wait.  It comes down too hard to walk around or do anything.

Just wait.

It’s strange to re-enter this season which was so intense last year, when I arrived to a stunned and grieving city dotted with blue and yellow tents.  It seems that this country has basically just plugged on, absorbing the earthquake on to its pile of other messes, the unlucky people who lost the most – possessions, limbs, relatives – doing what people do: surviving.  The next day just keeps coming, and for anyone whose life wasn’t irreparably altered, that catastrophe isn’t the topic of conversation any more.

Things for me, however, have changed a lot.  When the earthquake threw us in to the ring with the big multinational agencies, it helped show our tiny staff the value of our community-level expertise.  This spring we launched our dental project in Lamjung district where we did earthquake relief.  

In the fall I also started a Master’s Degree in social work, and I’ve been able to incorporate a lot of what I’m learning in to our program right away.  Guys, seriously, a lot of this stuff I’ve been trying to explain has an entire body of theory and practice associated with it called human rights!  People are doing rights-based health care at the United Nations!  I found out I am basically an expert on rights-based dental health care in rural Nepal…WHO KNEW?!  (Who becomes an expert in that by accident?)

Ok, just wait.

Also, a few years ago, we thought we should do some baseline surveys in our villages.  Not too focused on the concept of sample sets, we thought we’d survey ALL the households…3,374 of them distributed over various hills and more hills, actually.  Because as long as you’re doing it, do it, right?  I wrote a survey with input from various people, we trained some high school students as surveyors, and just last week – 2 years later – we completed a 58-page report on this survey (thanks, Sarah Diamond!).  Come to find out there’s very little current research of this kind in Nepal, and this report is a thing.  I am taking it around like my visiting cousin and introducing it to everyone.  Here is a picture of our report.  Let’s call her Cousin Mae.  She’s in color, with pie charts and clones and everything.
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All this has come together in a very cool way.  Over the course of this year, three major U.S. Universities have developed a potential interest in partnering with us for research or medical collaboration.  It feels awesome!

So with all that in mind, this summer, I’ll be doing a few things:

  1. Visiting each of our ten clinic locations (past and present).
  2. Establishing a Rural Dentistry Coalition in Nepal to advocate for policy level recognition of our model, so that rural dental clinics can be established systemically for all villages through the national health care system (eventually).
  3. Laying groundwork for future research partnerships (hey, positive thinking!)
  4. Revisiting some of the places we did earthquake relief  (unforgettable)
  5. Planting rice with Aamaa and getting myself in to as many embarrassing situations as possible (inevitable, really).

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I am very ready for all of this following knee surgery in February.  At physical therapy, I do a warm-up each day where I put the treadmill on “maximum incline” of about 20 degrees and walk for 10 minutes.  Yay!  Now I am here and our newly launched Sindure Clinic is reached by a 5 hour hike.  That means physical therapy + dental clinic supervision at the same time.  This is not a deal you can find just anywhere, people.  Take note.  It’s not even a limited-time offer.

I’ll sign off with a few lines from a recent article in the Guardian that I really appreciated.  It can be very hard to stay motivated doing this this kind of thing, even though it’s true I sometimes get to pretend my iPhone is a grain-sifting woven pan and put it on my head, and we can reliably say it’s not a cubicle job.  But the pervasive story of the American (Social) Entrepreneur is hard to see past, with its celebration of saviorism, speed, and simplicity…as if there’s an equation to solve or a prize at the end.  But society doesn’t work that way, and often building things is just hard work.  You only stick out when you screw up; most of your ideas are 78% wrong the first 8 times, but there’s something good in there; when you disappear, that means it’s working.  If being humbled isn’t exalting, you’re in the wrong business.  I decided to tape this bit up on my door:

“I understand the attraction of working outside of the US. But don’t go because you’ve fallen in love with solvability. Go because you’ve fallen in love with complexity. Don’t go because you want to do something virtuous. Go because you want to do something difficult. Don’t go because you want to talk. Go because you want to listen.”

And then…just wait.

*

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