Author Archives: All The Pieces

Around Town, Between Worlds, Nepal Life, Oral Health Care Project, Work

Sindure Signs

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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

Between Worlds, Reflections

In the Clouds

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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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Kaskikot, Nepal Life

The Video Nepal’s Been Waiting For

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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.”

 

 

 

Aamaa, Around Town, Earthquake, Family, Nepal Life, Oral Health Care Project, Work

Waiting Out Rain

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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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Aidan and Pascal, Around Town, Family, Kaskikot, Nepal Life

Moving Still

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An exciting week of office work led up to this year’s Maghe Sakranti, which always seems to coincide with some travel experience, astrological event or, in this case, Aidan’s 8th birthday, IMG_3858which, if you think about it, is the same thing.

The main topic of my conversation with Aidan and Pascal since I arrived two weeks ago has been black forest cake. Birthday cake came in vogue in Nepal about five or six years ago – as far as I can tell, it was discovered on TV, and has been translated in to an epic mashup of east-west-birthday-wedding-puja sort of candle-lighting experience that is not to be missed. Anyway, after a hectic week of office meetings and shopping for light fixtures, I caught the last bus up to Kaskikot on Thursday to head home for Maghe Sakranti with birthday cake for Aidan.

Because of Maghe Sakranti, the bus was packed with people heading home to Kaskikot. “Kaskikot packed” means that there is no standing room left inside the bus, and additionally, the people with poor tactical skills who’ve sat in aisle seats have someone’s butt in their ribs or armpit or smushed directly onto their faces. Most definitely, all people with seats are holding either a random package, bag of tomatoes, or someone else’s child on their lap.

As a master bus-rider, I possess a hierarchical mental catalogue of exactly which nooks and crannies make for a tolerable ride relative to a shifting set of variables. I approach “Kaskikot packed” with the focus of a honing pigeon.

IMG_4380It is immediately obvious that today is a top-of-the-bus day. Air is high on my list of prioritized variables, and all of the strategically located nooks and crannies inside the bus are taken or have been invaded by the limbs and odd angles of people who are technically not using these spaces. It’s a total free-for-all. For some reason, Nepalis have an awe-inspiring tolerance for this kind of physical disarray; I on the other hand, while happy to fit myself in to a pretty small nook, need it to be evenly balanced on all sides and protected from random entry, no matter how small my zone is.

Never fear, this is situation is accounted for. I hand Aidan’s cake to the Ticket Bro – all the guys who collect money on buses are Bros of the first degree, with wiry bodies and saggy pants – and clamber up a metal frame to the roof of the bus. The Ticket Bro, who knows me well (ok, I stick out, and besides I’ve provided many unreasonable entertainment opportunities for the general bus-riding public), hands Aidan’s black forest cake up to the top of the bus. I wedge it in flat between a box of beer bottles and a floppy sack of mystery items that’s soft enough to sit on. Soon I too am wedged in evenly on all sides by other passengers, which is exactly the way I want to be. I bend my knees protectively over the cake and we lurch away. The climb to Kaskikot isn’t a long distance in miles, but it’s all up, one switchback whipping around to the next.

The air begins to rush past and in settles a familiar, soothing reeling. The bus is climbing and honking, people are sticking out every which way, we are ducking the occasional branch – FWAP! – as the trees whoosh by. A wave of exhilarating calm envelops me, soft and malleable.

There have been three accidents on this bus route since in the thirteen years I have been riding it. Each time there is a bus accident, everyone including me swears off this road, these good-for-nothing-regulations, these drivers. The police crack down on the rules; buses are improved and added to reduce passenger load. The new bus I am on today looks like a greyhound, with upholstered reclining seats. But inevitably, the people turn this bus in to a wild beast. It’s inertia.

IMG_8687It just can’t be avoided.

Which, in a way that’s hard to explain, is why it’s so calming. Like in many poor countries, there is no illusory order here: everything is paint splatter all the time, and nobody’s pretending it’s something different. Everyone is hanging on to the spinning planet with one finger, and it is still working, at least until it’s not. Over time you realize that you too are paint splatter. You might think you aren’t now. But when order falls away, all of us are wilderness.

After the tragedies that have happened on this road, I know I shouldn’t admit it’s thrilling to catch the bus just in time, climb up to the roof, and duck branches while people talk on their phones and sway side to side eating peanuts like we are on Amtrak. But it isn’t a thrill because it’s dangerous (for the record, in purely statistical terms, driving on the beltway is just as dangerous)… it’s a thrill because it doesn’t feel dangerous. It makes sense. Because we are all flying through the trees together; because chaos and order have switched places, and everything fits despite the appearance of anarchy, and we are not dead yet.

In the mean time, some racing tiger inside of me catches the trees dashing by. I can feel the grumbling pavement even from up on the roof of the bus, and the Ticket Bro heedlessly climbs up and down the side of the bus like a chimpanzee while it is whirling around a corner. The valley below us recedes, and that wild thing in me, with a racing companion to match its speed, is still.

I’ve found this pocket of tranquility in other fast places.  When I catch a seat on the back of a motorbike and take off, zipping up my jacket. When I’m flying down a path in the trees with a sickle and rope in my hand, my flip flops smacking tap-tap-tap-tap on the rocks. Occasionally I have whirled into this thing when jumping on to the subway in New York, snagging a tread of some larger tapestry in the crush of a ten-million-person city with a trillion little shards of disorder that still fit in to something bigger.

In the subway, this is a private knowing. But on this bus, the miracle is out in the open for everyone to see: unruly, electric, FWAP! It’s still working.

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As we climb the lone road up through Sarangkot and closer to Kaski, people filter out at their homes, lugging their bags and boxes and children. The Ticket Bro clambers up and tosses bags off the top of the bus, and our resting props are gradually removed. My stop is the last stop. Soon all the other passengers decide to move down inside the bus, but because I am a honing pigeon I know that none of my approved nooks inside are available yet, and I stay on top of the bus, alone with Aidan’s black forest cake. I lie down so I don’t have to worry about oncoming branches, and crowd myself in with boxes and sacks to block the breeze, and float up the road on my back, watching the night sky roll by. My thoughts spiral in and out, moving still.

Of course, I can’t see where we’re going from this position. No problem. This road only leads to one place.

*

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Around Town, Nepal Life, Oral Health Care Project, Work

Memorable Trips

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It has been six months since our post-earthquake housing projects in Archalbot and Bharte. We’re launching dental programs in or near these areas in 2016, so today Aamod needed to visit the Lamjung District government offices in Beshishar to get signatures that are required complete agreements in our new sites.  Yes, this sort of thing must be done in person in Nepal, not by fax or email or any other method, so Aamod has to travel 3 hours from Pokhara to Besishahar to get the signatures.  We decided that Dilmaya and I would accompany him to Lamjung and get out a few kilometers before Besishahar to visit The Bamboo Village in Archalbot. We wanted to see how everyone was were doing, and we also had to decide what to do about the earth bag house that didn’t get finished over the summer.

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Three good looking people suffed in to two front seats in a van to Lamung

We decided to go with local transportation.

There is a fuel shortage right now due to strikes along the Indian border, so prices for gas have skyrocketed, and most regular people are getting their cooking fuel on the black market. Transport has compensated by raising prices, by running fewer buses and taxis, and, obviously, by stuffing even more people in to the same number of car seats.

I took tons of photos last summer when Archalbot was building, so today we brought prints to give back people. I highly recommend this practice – it’s always much appreciated because until cell phones, most people had very few photos of themselves. Even now, sorting photos is always An Event. Older people will people examine each thing in the photo in great detail – the buffalo, the way their sari is tussled, the water pot in the background – and will ask questions like, “Only one of my sons is in this photo. Where is the other one?”

The first house we arrived at belongs to one of the last houses we helped with.  Last June there were about ten people with a few babies living in the tiny house hidden behind the clothes line.  Now they are still living in their new house and it looks great.

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While we were talking with this family, people from Archalbot started to notice us and come shouting excitedly down the road.  Remember Uttam’s sister in law, and the day she and her husband left to go cut bamboo after much cajoling?  She came bouncing down the hill shouting out to Dilmaya and me.

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The next house we came to was Uttam’s family – I admit this house is tied with the Golden Cottage for my favorite of all 150+ houses we helped with after the earthquake. I was thrilled to discover that, while living in the shelter they built last summer, Uttam and his brothers rebuilt houses on their own land. Just four days before we arrived, they had relocated the tin roof we provided on to their new stone house, which has yet to be completed and plastered. What a fantastic example of everyone pitching in the thing they have, and of the dignified resiliency that is so characteristic of Nepali people.

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July 2015

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June 2015

 

 

 

 

 

 

 

Uttam's family recently moved their shelter tin on to this new permanent house.

Jan 2016 – Uttam’s family recently moved their shelter tin on to this new permanent house.

Uttam’s older brother had also rebuilt his house – so the whole complex has moved back on to the family’s land in six months time. I was really pleased to see that the older brother’s new house is made from plastered bamboo chim – the same building style we pressed people to use when we provided roofs for the original shelters. This house is actually cheaper and far more earthquake resistant than a heavy stone house (you can see Uttam’s stone house in the background).

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We spent a lot of time giving people photos of themselves. This activity produced too many great moments to choose from!

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Overall, the houses that we helped people build in Archalbot look good. In a few cases, people are living in them full-time. In many, they are sleeping in their bamboo shelters while cooking and storing belongings in their damaged houses. In a few, the shelters remain but aren’t being used, either because the family has relocated altogether or just decided not to actually stay in it. Kripa’s family used their tin to rebuild the buffalo shelter where we glamped.

Glamping, June 2015

Buffalo & Goat Hotel, Jan 2016

 

 

 

 

 

 

 

 

The earthbag house is an interesting story. Our role here was as facilitator – my friend Robin had training and materials to build one earthbag home, and we provided a connection with a community that needed a house. I documented this process last summer right up to the point we had to put the building on hold for the monsoon, with promises to return this winter.

Well here we are this winter. The family with the half-earthbag, half-bamboo house has built a pretty impressive collection of houses out of it and they are living there full time.

There are many things I have to say about the earthbag house, so I’ll write about that separately. One of the things we had to figure out on this visit was whether or not we had enough manpower in Archalbot to call Robin back with tools and supplies to finish the house….and the answer was no. So this earthbag/bamboo house will stay as it is, which is a bit frustrating, but that’s that.

After tea and snacks back at our HQ in Kripa’s house, Dilmaya and I left Archalbot and walked back down to Bote Orar. We crossed the bridge that has replaced the one with a loose cable that held us up in the muddy road with a ton of corrugated tin for an hour and a half last summer. We got ourselves some knockoff Redbull in homage to the gallons of knockoff Redbull that kept us going during those hot months.

Aamod came reeling down the road from Besishahar and we clambored in to another crowded, swervy van. As the day became later we and switched to a bus in Dhumre, we settled in for the last two hours of our journey.

Yes, this is where it happens.  The inevitable road travel story.

As it turned out, somewhere up the road people were striking because an accident had struck someone in the road yesterday. There was a blockade that went for miles.

When we reached the blockade it was already dark out.  Our choices were to either wait it out until some undetermined time in the bus, or to start walking.  So we got out of the bus and set out past the endless line of stopped vehicles, some with people in them waiting for the 100% unpredictable hour or day that the blockade would be opened. The highway wound its way alternately through small towns and the middle of nowhere. We were still over an hour’s car ride from Pokhara.

There were still motorbikes coming by, so we made a plan to divide up.  Dilmaya and I hopped on the back of the first bike that could fit both of us, and rode it up to the mouth of the traffic jam. We waited there until Aamod caught up behind us half an hour later on another bike, and then we walked the last half mile or so to where people where crowded around the usual tires and logs blocking the road.  Behind the blockage was a group of women was sitting in on the pavement, not talking much. Some were fiddling on their phones. It occurred to me that they had probably just lost a family member or close community member on this stretch of road just 24 hours earlier – a strange contrast to the miles and miles of hassle that stretched out from either side of their circle.

Now we started past cars lined up in the opposite direction. Just to be clear: we were not a walkable distance from home.  Even by Nepali standards.

All of a sudden a jeep began rolling out past the innermost barriers of the blockade, headed in the direction we needed to go.  I turned around and saw it was an ambulance.

We sprung in to action. Aamod stopped the jeep and spoke with the driver who, understandably, told us that he could not let us hitch a ride in an ambulance. Aamod got on the phone with his brother in law, who is a doctor, and I stalled by keeping one arm in the rolled down window of the ambulance and talking to the drivers in Nepali.

“Sir, what ever shall we do? It’s quite cold out. We can’t possibly sleep here in the road.”

“I don’t know what to tell you- I’m not allowed to take people in an ambulance.”

“I see I see, but this is an unusual circumstance….” Etc.

I keep at this until Aamod has his brother in law on the phone, which he hands to the ambulance driver. Who then opens the back of the ambulance – and in we go.

And thus our day ends with us bouncing along in the back of this ambulance back to Pokhara. At one point, we drive through a checkpoint, and I lie down with my arm over my face, feeling slightly guilty, while Dilmaya sits next to me looking concerned and wearing a surgical mask that she has with her for general dusty road travel purposes. We roll through the checkpoint.

“Can I get up now?”

“Lie down! Not yet.”

It’s 9pm when we get to Pokhara; the ambulance driver amicably drops me off within walking distance from our office.

As Dilmaya, who was my partner in crime for the entire two-month adventure of our post-earthquake housing extravaganza, said: “Laura miss, our road trips are always very memorable.”

Oh, and one other thing – remember how the point of this trip was that Aamod was going to get papers signed by the district officials in Besishahar?

Yeah, well, there was some kind of meeting today and all the government employees were out of the office. So we have to go back to Besishahar for the signatures again.

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The early morning road from Pokhara to Besishahar

 

Oral Health Care Project, Reflections, Work

Puranchaur Clinic

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Today I made my first visit to our clinic in Puranchaur, which launched a year ago in winter 2015. We rode motorbikes – I hopped on one with our program director Aamod, and I stuck my friend Freeman on the back of the other bike with our field officer Gaurab. Freeman lived in rural Afghanistan for two years and his training involved things like “how to drive through a blockade,” so I figured it would be okay.

FYI, re: riding on the back of a motorbike:

  1. Paved road –> plus side: fast / minus side: scary
  2. Rutted dirt road –> plus side: good workout, bracing / minus side: rather sore bum, dust
  3. Previously paved road that has deteriorated and broken up in to a patchy mess with some dirt packed around in it –> plus side: there’s a road, so you’re not walking / minus side: everything else

IMG_6319The way to Puranchaur comes in at a solid #3 for a vigorous 64 minute joy ride.

Fortunately, we were greeted at Puranchaur by the sight of a very well-built Health Post. All of our clinics are in buildings provided by the community, and where possible it is ideal if the building can be in or next to the existing government Health Post. But Health Posts aren’t usually this nice.

It was immediately clear that we’ve received good local support at this stage of the game in Puranchaur. There was a lively crowd of patients waiting on the balcony, and this clinic is run by one of our more experienced technicians, Megnath.

See for yourself:

We went through our supervision checklist, which includes a rigorous infection control protocol that I wrote myself by talking with dentists and rural trainers, then making modifications based on my own knowledge of the environment, because I realized that none of the existing guidelines were really adapted for these conditions. Amazingly, the only existing protocols I could get my hands on were for dental hospitals with electricity and technology – think, UV disinfection – or, alternatively, unwritten procedures used in temporary dental camps, which presume very high patient volume and the lack of any stable infrastructure. Can you believe that I could not locate a single infection control protocol designed for a permanent rural dental clinic in Nepal? 80% of Nepal’s population and nearly all the government Health Posts operate in rural conditions!

Which is why now I know more than I ever planned to about gloving and re-gloving, positioning of safety boxes, and timing of Virex disinfection, among other topics.

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Our rewarding visit to Puranchaur has me thinking more and more about the larger idea of our project. It’s great when we’re able to establish these services and it sure is gratifying to come all the way here, after hours and hours of sitting at a desk, meetings on Skype, researching oral health data, giving talks and raising money, and see patients coming in to a clinic in Puranchaur on a Wednesday afternoon. It’s also awesome to me that none of these people associate their clinic with me or my slideshows or any kind of charity, which is not what these services are intended to be. All that is good stuff.

On a bad day it seems like it just isn’t enough. There are so many problems here. A toothache is definitely one of the worst things in the world if it is in your mouth…but it’s not as bad as child trafficking. These clinics don’t solve problems of violence or lack of basic security or opportunity. Sometimes it seems like a lot of effort to still end up in a world that has those problems anyway.

But one thing I think we’re isolating bit by bit has to do with recouping lost opportunities for self-determination. Something our little project does increasingly well that I don’t see very often in this sector is to understand and respect the present capacities of individual people and the communities where we work on all levels. That means letting go of the UV disinfection, but it also means having a proper replacement and monitoring it. It means making services accessible, but then holding people accountable for accessing them by choice, rather than spoon feeding and disempowering everyone for our own gratification. It means that explaining to an old lady that she will not be blind if we pull her tooth out, and making the service psychologically available, is just as important as having a dental clinic that’s physically available.

This is hard to do. It requires an unreasonable amount of patience and the willingness to constantly sort out where to impose control and where to throw everything you think is correct out the window. Inevitably, there are moments where it seems like you’re dong everything wrong and it’s all for nothing.  At some level, I think it only works if you find people as interesting and challenging and curious as the problem you are trying to address.

That’s what has me wondering what we’re really getting at here. I’ve always felt like, even with the visible services this dental project provides, for me as a person, it’s an exercise in something else I haven’t understood yet. Maybe this is just a story I tell myself after a good day, but we would live in and more dignified and peaceful world if we cared as much about actual people as we do about ideas of people.

Today, one old lady with a toothache spent a good bit of time explaining how she’d treated it by putting tobacco in there.  The tobacco helped. Megnath couldn’t extract her tooth because she had complicating heart issues that require referral to a hospital – but he had a nice long conversation with her about the tobacco, anyway.

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Aidan and Pascal, Around Town, Didi and Bishnu, Family, Gaky's Light, Kaskikot, Kaskikot, Nepal Life

The Walk Home

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There’s nothing like my first visit to Kaskikot after having recently arrived in Nepal. Granted, sometimes there’s a year in between visits, and in this case I was here just last summer after a long winter stay. But still – today did not disappoint.

I woke up to the charming experience of Pascal throwing his arm on my head. Let’s face it: this room where Didi and Bhinaju live is too small for all of us now, but we are persevering while the house is being built. It is the nights when I share a bed with Aidan and Pascal that I question my judgment in teaching them taekwondo while they are awake.

While Didi made tea, we all lay in bed debating whose fault it was that we’d all spent the night practicing kickball rather than sleeping. Then we documented our morning in selfies.

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Late morning, I met up with some of our graduated Gaky’s Light Fellows for lunch. It was so great to see everyone and hear what they are doing. Sandip is marketing for an online news outlet. Ramesh is deciding where to apply for his bachelor’s in journalism. Nirajan is in Kathmandu, working for Teach for Nepal, and Nischal is entering his second year of bachelor’s. Umesh and Narayan have a solid paid gig singing traditional music each night, and Narayan has his own radio show. Bhagwan is a residential supervisor in a school hostel. When Puja and Asmita finally got there a few hours late, we all made plans to go boating later this week.

Next was getting up to Kaski. With the fuel shortages, this is more challenging than it’s been, as the bus is running infrequently. Not to worry!  I caught the back of a motorcycle ride and then secured a taxi to the bottom of “the jungle path” that climbs straight up from the valley to the house. Forget the bus, man.

So first of all, at the beginning of this path you have to cross over the Gandaki river, which is usually dry at this time of year, but swells in the summer and fall. We used to wade through it, but a few years back it got this nice concrete bridge. So I’m crossing the bridge, and…it just stops in midair. The last half of the bridge is suddenly no longer there.

It takes me a few minutes to negotiate the drop over the ledge of the bridge with a torn ACL in my right knee that won’t let me jump down on to the rocky bed five or six feet below. I make my way over, progress to the bank a short way away, and there at the bottom of the path up to Kaskikot is this leathery guy resting next to a bundle of wood. He looks kind of resigned. I chat with him for a minute and then he asks for help lifting the bundle of wood.

“My son is really strong, he can carry this kind of load,” the man says woefully. “It’s just pretty heavy.”

Nevertheless, the bundle must be lifted, so we give it a try- fortunately I am more qualified than your average random American to hoist a bundle of wood on to someone’s back so it can be slung from their head and carried across a dry riverbed – but it is too heavy, he can’t get upright under the weight. He sets it back down, resumes his seat in the road, and looks resigned again.

“What’s with this bridge?” I ask. “Half of the bridge is missing.”

“I know!” He says. “The other night, I drank up a full belly and came here and fell right off of it.” He points to his forehead and says, “I got a bit of a bump right here.”

IMG_6126“I hear you,” I reply. “I’m not even drunk, and I nearly fell off the bridge too.”

“Just went right over,” he recalls.

“Should we try this bundle of wood again?” I ask.

“Ok, but you have to come around the front and give me a hand.”

I heave the wood on to his back again and this time give him a hand to brace against as a counter balance, and he stands up.

“Thanks, bye,” he says, as if it makes sense that I appeared for this interaction.  Off he goes.

Partway up the jungle path I run in to two kids coming down.  They stop me.

“Where are you from?” they ask me in English.

“America. Where are you from?”

“Puranchaur,” the little boy answers.

“Oh, I’m going to Puranchaur on Tuesday,” I say. It’s one of the villages where we launched last year. I ask what grades they are in: four and eight. “So,” I say to the fourth grader, “do you brush your teeth at school?”

“Yep,” he answers.

“Huh. For about a year, right?”

“A little less than a year,” he says.

“Cool,” I answer, and down the path they go.

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Finally I come out the top of the jungle path and emerge at the water tap in Kaskikot.

“LAURIEEEE!” the ladies cry. “Here you are, just in time for wood cutting to start tomorrow! Last year you came to cut wood, and this year you’re here to cut wood!”

YES. This is the gold medal of the Welcome Olympics. And yes, when I go to cut wood, I understand that it is a memorable experience for all of us.

On my way to the house, a few other people – completely independently – express their approval that I have arrived just in time for wood chopping. I am winning at Nepal.

At last, I drop over the spine of the ridge and there is home. Baby O’Neil is tethered outside, her wet nose pointed quizzically my way; she has grown some brown fur.  The hillside is dotted with jubilant yellow mustard flowers.  There is the familiar line of the Annapurnas rising in to the dusky sky, distant and close. No matter the path that brings me to this piece of land, it always appears the same way, luminous and inevitable.

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Aamaa, Between Worlds, Family, Reflections

The Obvious Practicalities

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The other day I came across a dazzling, haunting article in the New York Times. The Lonely Death of George Bell opens with a chaotic photo of George Bell’s apartment. He was a hoarder, and until you look at the photo directly, it meets you more like a cubist painting than a photo of an apartment: an angular, colorful, dump.

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The story follows a public administrator in a bleak office in Queens as he searches for George Bell’s next of kin, distributes George Bell’s assets, makes arrangements for George Bell’s cremation and burial. These tasks unfold in unceremonious anonymity – in fact, a significant amount of procedure is devoted to proving George Bell’s body is George Bell. No friends or relatives come forward to identify him. He was discovered in his apartment only after neighbors called to report the stench of his lonely end. This is the story of thousands of deaths in New York City every year.

To me, the article itself serves to witness and exalt George Bell’s silent passing, as well as what might have been among the most authentic feature of his life: isolation. In a way it is a glorious tribute, nearly impossible to look away from.

As you will see from the letters at the bottom, not everyone agrees.  But I was taken with this rare and unapologetically voyeuristic look at the mechanics of death in its most cold and undignified form.  In Western culture, we rarely visit death undressed. Jobs that in other parts of the world – certainly in Nepal – fall to the community in an old and well-traced set of patterns fall for George Bell to the Queens County Public Administrator.

George Bell’s situation is extreme, but it in other ways it simply exposes a shared fear and denial of death in the West: how the body, sacred in many cultures, is foreign and terrifying to us once it is dead.  It must be managed by professionals, or at the very least, out of sight, and as a society we treat any honoring of the spirit as a bonus round after the paperwork has been completed. We take this for granted, as if it is obvious because it is practical.

When I happened upon The Lonely Death of George Bell this week, I was editing a radio story about young widows in Nepal. The piece is about how widowhood rituals are changing for young women, and features 21-year Bishnu Pande, whose young husband died while working in Qatar. He never met their six month old daughter.

This topic is close to my heart, because historically, young women who lost their husbands have been forced to live out lives of ritual mourning, and Aamaa is a direct result of these traditions. She hasn’t worn the color red in 35 years. There was never any question of remarrying. Her husband’s family didn’t entirely abandon her, but they’ve done little to help her. When I arrived in Aamaa’s life, her daughters were in their early twenties, and her identity as a widow had long since blended in to the larger idea of her. I have always known Aamaa just as who she is, not as a woman bereaved. She has good friends, and people to look out for her, and she goes to weddings and dances.

And yet, for all practical purposes, Aamaa has lived a life of ritual widowhood. She is alone. Dancing is on limits, but ritual celebration – wearing sindur powder, receiving celebratory tikka, red clothing – are forever out. Moving back to the home where she grew up is out. A new marriage is definitely out. Her role in society is that of a woman who lost her husband, and has been since she was a 23 year old girl.

That will not be Bishnu Pande’s story.  But something will be.

So today I come across George Bell while editing a piece about Bishnu, having spent over a decade as part of Aamaa’s life. And it’s clear that what is obvious is not just what is practical. And neither is the ritual discipline that Aamaa observes. The obvious is just what we’re used to. Our treatment of death seems inevitable because it stems directly from our collective, subconscious attitude toward life, toward the nature of existing. Which can span the range of possibilities from Aamaa to the Queens County Public Administrator.

I feel like these hours I am spending with Bishnu Pande in my ear come at a time when  she and I are both somewhere in the middle. We’ve approached this crossroads from opposite sides: I from New York, where George Bell died, and Bishnu from Kaskikot, where Aamaa’s husband died. Her culture is learning to shed ritual, and I feel that mine has lost something vital and is scrambling to get it back. It’s like we’ve bumped in to each other in the middle of some misty dreamscape, each of us missing someone and renegotiating the collective attitude we’ve been taught.

Some letters to the editor have already been posted the article on George Bell. One says:

At first I wondered why “The Lonely Death of George Bell” was on Sunday’s front page above the fold. As I got into the article, I couldn’t put it down…Mr. Bell’s sad experience reinforced for me the importance of reaching out to relatives, friends and all those in a situation similar to Mr. Bell’s so that they have dignity in their final days. He deserved better.

And then another:

What could possibly justify this callous violation of George Bell’s privacy?…Mr. Bell could not have made his wish for privacy any clearer if he had specified it in his will, and no decent purpose is served by inviting us all in to trespass on his home….With this article The New York Times inflicted on Mr. Bell a final indignity.

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George Bell in 1956. / The New York Times

George Bell (L) in 1956. / The New York Times