The Olympics of Self-Quarantine

EDITORS NOTE: Back in late May, just as this post was ready to be published, so many things happened, frontlined by the tragic murder of George Floyd and the uprisings against racial injustice that followed. All of my blog posts were delayed in coming weeks, which became months of more surprises, transitions, public reckoning, and adjustment. So for now, thanks for reading along as I catch up on unpublished entries from the intervening time.

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Here we all are nearly two months in to this bizarre reality. The team in Nepal have all been working from home, and we meet daily for a morning and evening call. I join the evening call in Nepal every day at my 7:15am in Connecticut, and getting up each day for our call has been the ordering event of my American quarantine experience, forcing me to maintain a routine that starts early each morning with human connection on the other side of the world.

The number of Covid cases reported in Nepal is still low, but major cities are on complete lockdown, with police in the streets. In Kaskikot and most of our rural working areas, it seems people are going about their daily business – corn planting season has just ended – but transportation and commerce are mostly shut down. There is a worry that Covid cases may only be starting to hit a rise now, as the first deaths have just occurred; but it is hard to know how the lack of testing, reporting and accessibility to hospitals in so much of the country plays in to the accuracy of data on case prevalence.

One particularly interesting discovery is that Nepal seems to have largely based its quarantine strategy on an extremely well-rehearsed protocol for political shut downs. Political strikes have been the main style of public dissent (or social control, depending on your point of view) for the last 25 years in Nepal. When a strike, or “bandh” (“closing”) is instituted, transportation, schools and businesses are closed, people mostly stay home, and if you need to go somewhere, you walk.  Depending on who has called the strike, and the level of power and uncertainty involved, police may patrol the streets to ask what business you are out for and decide whether or not to send you back home.

And for the moment, it seems this is more or less the same strategy that has been enthusiastically deployed for Covid prevention.

On the plus side, Nepali people are pretty used to the bandh-style quarantine. Back when I first started visiting Nepal in the early 2000’s during the civil war, bhandhs were imposed almost weekly by either the Maoists or the government. After the overthrow of the Monarchy in 2006, a notable effect was a bandh-free-for-all whereby any sub group with a pending discontent of any kind would call for a strike: drivers striked to protest fuel prices, teachers striked to protest salaries. In 2012, a series of strikes broke out across the country when the Parliament was trying to move to a federalist political system, and ethnic groups as small as 150 people called for closings to demand representation in a new state constitution. One sub-group would strike one day and everything would be closed, and the next day, everything would stay closed but now on behalf of the responding strike by another sub-group. And because bhandhs are shut downs (not simply a refusal to work), these protests were widely understood to mean that the entire public was to stay home.  So everybody would just stay in their houses or go for short walks until everyone with something to say was done striking.

With some exceptions, that is—such as the Gurung strike in Pokhara during the 2012 series, which involved both policed closures and exuberant Gurung dancing and singing at the empty traffic intersection in Mahendrapul. Which was followed later in the week by a Brahamin strike and corresponding displays of cultural force.

All of which is to say, in Nepal coronavirus has met the Olympic World Champions of self-quarantine. However I’d like to also report that for the sake of the global pandemic, a few fantastic additions have been made. Topping the charts, we have these people-catcher-thingies on long poles. Really. See for yourself. This terrific solution ensures police don’t have to potentially touch covid-y pedestrians who are found to be walking without cause or ID, and I am so glad it has had occasion to be invented and put on the internet.

As to our daily team meetings: in the odd dream of a halted, people-catcher filled world, with all primary health care either paused or redirected to coronavirus response, the tinny voices of my colleagues over Viber each morning has helped to maintain a sense of movement while most of our work and so much of the world stands still. We’ve challenged each other to home exercise goals and used our office messaging system to share videos of our respective jump roping efforts (Rajendra impressively did his with a traditional namlo rope used to carry baskets). We employed our dental technicians to make personal phone calls to all the patients in their registers to go over Covid-prevention guidelines. We began a home-made mask campaign.

We have also, finally, taken this time to launch our youtube channel. There is a huge variety of content here: tours of our clinics, cute kids doing school brushing programs, samples of community outreach parent discussions and child-friendly dental care in schools, some words from a village chairman about our project, and my personal favorite: the annual Oral Health Bhailo competition, where schools record traditional bhailo songs on the to topic of oral health during the festival of Tihar (seriously, these are devastatingly adorable). These videos really bring the people and places we work with to life and we’d love you to click around and visit us at home in Nepal! (And better yet, please subscribe to our channel!)

After all, we’re gonna be in this for a while. It’s a great time to connect.

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A House of Mirrors

 

These past few weeks, I increasingly find myself reliving the morning of April 25, 2015, when my phone woke me at 6:30am. I rolled over and Prem was on the line: a 7.8 magnitude earthquake had ripped through Nepal. I stumbled to the kitchen table in my slippers and didn’t move for what seemed like days. The papers were covered with images of fallen temples that were whole in my albums, with tent cities at familiar outdoor intersections in Kathmandu, with maps seen from high above and covered in digital markings. It was a long time before anyone could capture photos of people, especially in the rural expanses of the country, which were accessible only by helicopter for what seemed like ages. But in my mind’s eye the earthquake was a long, long parade of individuals. Today, I reread the email I sent out three days later.

It is a strange feeling to find the whole planet in crisis. Population-level disasters of this scale seem to disproportionately fall upon the shoulders and homes and rivers of the world’s most vulnerable places, while the other places try to help. In the years I have worked in Nepal, Nepali people have plodded on through civil war, three major government transitions, annual landslides and floods and hail, the 2015 earthquake, water shortages and electricity outages up to sixteen hours a day for years on end, and of course, the daily vulnerability of chronic poverty, weak infrastructure, and floppy safety regulations. The road to Kaskikot has had three bus accidents in the time I have considered it my second home. I remember thinking after the earthquake, as I watched messages flood my accounts, that people didn’t realize how often Nepal’s communities were used to seeing things broken, taken, lost, or never having existed in the first place. The earthquake was unthinkably horrible. Yet for those who didn’t lose everything–people, entire villages–that trauma was largely swallowed within a few months by massive shortages of petrol and goods due to political instability and border closings. The summer brought deadly landslides. Six months later, most of the country was no longer discussing the earthquake.

These last few weeks have been an odd, house-of-mirrors experience. While Nepal is facing pandemic, New York City and Milan and Barcelona and Sydney are also facing pandemic. My colleagues are quarantined in Pokhara and Kaskikot and Tilhar, and I’m quarantined in Hartford, and Prince Charles is quarantined in London. The realization that anything could happen to anyone at any moment has set upon us all, a realization that seems to be expanding daily. And amidst a great deal of chaos and uncertainty and worry, I find myself in occasional moments of disconcerting calm. Things were always this way. Now they are simply unveiled. We are all the defenseless Other.

Now as then, there is great beauty to uncover in difficult times. In the months after the earthquake five years ago, we improvised. I have no idea how many kilometers Dilmaya and I walked. Practically speaking, I learned a huge amount about the contributions a small community-based organization like ours can offer in disaster management. At that time we found we were well placed to spend personalized time on unique household and community circumstances, to mitigate challenges that didn’t meet a universal disaster threshold but were extremely destabilizing for the specific individuals facing them. Our focus became “the lower percentage of damage:” the houses that were not fallen, but cracked and indeterminately unsafe. It was a life-changing experience.

Every day this week I’ve joined in a group call with my colleagues in Nepal as they work from home, developing a strategy to redirect our rural health care personnel from dentistry to coronavirus. Since we launched our Dental Hub app in September, hundreds of patients and their phone numbers have been entered in our database, so our first step is having dental technicians replace their weekly clinics with “phone clinics,” calling every patient in the database. We’ve created a script for checking in with each family to see how well they’ve been able to implement isolation guidelines and what if any obstacles are in the way. We don’t yet know how this will go or how useful it will be, but it’s something to do. It’s a way to be in community.

All that said…the 2015 earthquake was irreconcilably different than the looming crisis we are facing now. To begin with, the rest of the planet is occupied with its own emergency, not fundraising and overloading the aid channels in Nepal with variably useful assistance strategies. Second, Nepal’s health care system was inadequate to meet public need before coronavirus, and there is effectively no intensive care available for severe Covid-19 cases. So even though there are so far very few confirmed coronavirus cases in Nepal, I am still trying to understand how “flattening the curve” works in a health care system where the capacity threshold is fairly close to zero. We don’t know the answer, if there is one. I’m not sure yet if anyone does.

Like many of us, I can’t help but wonder how we would understand our society if we felt this vulnerable and interdependent all the time. It is deeply unfamliar to us in the dominant American culture–replacing the community of work-productivity with the community of survival. Confronting the primacy of the nuclear family, when that family is cut off from neighbors, schools, social supports, food production, occupation, and future planning. This discomfort feels worthy of deep and shared reflection. In the mean time, I have made a call list, and have been doing one quality catch-up each day with someone I’ve missed, or who I want to make sure isn’t alone.

For whatever reason I also found myself drawn back this week to this poem, written during the (still unresolved) family separation crisis at the US border in the summer of 2018. I hope to use coming weeks to catch up on past entries and continue posting about the unfolding of this pandemic Nepal on my blog. In the mean time, wishing all of you patience and resilience and comfort as we, as a world, navigate the weeks and months ahead.

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At the Base of a Tree

The cicadas came when I was five
behind the school yard.
I put my finger on one
and then I picked it up
it was like a fig, dark and rough.

At five cicadas were interesting, like figs.

Now I am much bigger
friendly, the little goat nuzzles my shoulder with his warm snout
soft, we are alive, together easily.
And then I press my eyes shut
as I capture the insect that has invaded this carpet, which is mine
because I own it.

Sometimes I wonder how I can find my way back
from the pliant kid to the figs to the cicadas, captivated
with all their legs, their slick ribbed shells, all their songs enchanting
the school yard
all chirping and chirping tickling my ears until my ears overflowed with music
amid the crunching leaves and delicate wings
a symphony, a society, a universe blossom
after seventeen years of silence.

Sometimes I wonder
what we are afraid of
why we crush things, bugs and leaves and oceans and people
when I was five, I used
just one tiny finger
to say hello.

 

 

 

Everest Part 3: Air

<– Prelude: Pemba

<– Part I: The Height

<– Part II: Sagarmatha

Day 6: Air

Gorapchep—> Kyangjuma / 3550m (11,646ft) O2 sats 90

After I got back from Base Camp yesterday, I was absolutely spent. My muscles weren’t tired exactly, but it’s hard to describe the physical sensation of altitude to which you are truly not acclimatized. It is as if each of the cells in your body has its own individual case of asthma and is wheezing. All your organs are wheezing. They work, but you feel a kind of sluggish you didn’t know existed. It is hard too imagine digesting anything, because nothing inside of you feels like it’s doing anything except lying in bed, wheezing.  

With this in mind, I would now like to share that as I approached the hotel on my way back from Base Camp yesterday, right there in the yard was…

A LOCAL SOCCER GAME.

Are you kidding me??

In my wheezy brain, this was one of the most incomprehensible sights of my entire trip to Everest Base Camp. I was practically counting my steps back to my bed. When I got to bed, I was going to hear a knock on the door, and a happy hotelier was going to be standing there with a celebratory hot chocolate for me on the house. And, try as I might to drink this gift because it was so lovely and festive, it was to go cold on the tray, because it just seemed to complicated. AND OUTSIDE, THESE KIDS HAD THE NERVE TO BE PLAYING SOCCER.

Later that evening, we all gathered around the hot stove. The whole group had made it to Base Camp, but the Brit felt too unwell to come downstairs. I was doing comparatively okay, but I barely swallowed any of the noodle soup I had for dinner. We heated our hands, chatted a while, took our oxygen saturation levels for sport, and went to bed.

This morning, Laura (#2) was still too nauseous to drink or eat and couldn’t really get out of bed. She’s a fit marathoner who took a reasonable route up with two acclimatization days. Eventually, her husband decided it was time to call an evacuation helicopter. Out of about ten people I got to know during this week, two were evacuated. Once you know to listen for it, you can hear many helicopters throughout the day. Seriously, hanging out at 16,000+ feet is no joke. As for me, I was making do, but my O2 sats had been in the 60s for almost three days, and I couldn’t wait to get down to thicker air. 

After tea Thorsten and I said goodbye to Franco and Laura and their guide Narayan, and began our descent, along with Thorsten’s guide Dinesh and porter Kisan. Maybe it was mostly psychological, but by Lobuche I wanted breakfast. We continued, retracing our steps at four times the speed we’d labored them the first time. I passed a guy I met at the start of my walk. A few of us have been keeping track of each other in group chats. This guy had lost the trail back around Dingboche and spent an entire night outside with no sleeping bag. I was pretty impressed that he was still on his way up to Base Camp, after that. 

I arrived back at Thukla Pass, this time approaching from the other side, where the regal memorials rise in to view with indescribable majesty—the peaks on the imminent horizon leaning in as if the curvature of the earth itself is drawn toward them. It occurred to me to make sure I got another photo from this angle, where the saddle of the pass yawns dramatically at the sky; but I was so tired. I just wanted to get below Thukla and feel strong again. And, I thought, I had taken pictures once—humbly, I hope, and out of awe and admiration. But now I should just keep my camera where it was, and honor this beautiful place by passing through peacefully. 

We arrived back at Thukla by mid morning, and from here I made the choice to say goodbye to Thorsten and Dinesh and Kisan. Who, like reasonable people, were descending on the steeper route down to Pheriche, which was the route I’d come up a few days ago, idiotically giving myself even less time to acclimatize. Now I wanted to see the parallel path, slightly longer, that most people take on the way up through Dingboche. But also, I knew that I was going to have to rejoin myself in solitude at some point. It had been a great gift to walk quietly along behind others during the hardest days of the trip, and it was difficult to separate. But Thukla was where I’d come in to company, and it was the place where my path was to go its own way again. We exchanged contact information, and then I was alone with my map.

Dingboche

And I felt quite alone.

I walked and walked, losing elevation by the minute. I didn’t stop for lunch, only to occasionally adjust my clothing. Well below Dingboche, the oxygen-deprived environment remained vast and barren. I didn’t mind the absence of people, but I felt a terrible longing for trees and for needles underfoot, to provide order and comfort. For a path with two sides, instead of a mere carving in enormous open space.

Around Deboche, I came across two porters on their way to Namche. One was carrying five blue barrels and the other a load of goods in boxes. I wondered if I could make it all the way to quaint, hotel-packed, latte-serving Namche, where I’d slept my first night of the trip. I considered whether the porters might make road companions, but they alternately walked too fast for me to keep up (yes, while carrying those loads), or stopped for extensive periods of beer drinkin, and this proved difficult to plan around. So I just kept walking. 

I walked 20 miles. Around 5:15, in a frosty dusk I somehow welcomed, I bobbled in to a guest house in Kyangjuma, a few kilometers short of Namche. The hotel owner said it would be an extra 200 rupees (about $1.75) for an attached bathroom. This sounded amazing. I ordered a real dinner of daal bhaat and ate most of it. I was still over 11,000 feet, but I felt like a different person. My O2 sats had, over the course of 8 hours, gone from 65 to 90. 

I got a call from Dinesh, Thorsten’s guide, and an update on where they’d arrived (Deboche) and on how Laura and Franco were doing after the helicopter evacuation (fine). Back in internet contact, I sent messages of my whereabouts and well-being. I had my first good sleep in a few days, and was so glad to feel normal that I didn’t even feel any aches.

 

Day 7: Docking

Kyangjuma —> Lukla 2840m (9317ft) / O2 Sats 95

On the way up, at the elevation of Kyangjuma (where I passed through the first time with Tenzin Dorje Sherpa, the climber and yak herder), I felt myself high above the ground and adventurous in the cold. But on the way down, it feels cosmopolitan. The bucket of water in the bathroom isn’t frozen, and I am normal-tired, not wrecked.

After a cup of tea, I hiked about an hour to Namche Bazaar and stopped for breakfast. Unlike a week ago, this morning Namche was unveiled and shining. Its steep alleyways were nevertheless caked in layers of hardened Februrary ice, and I did a good bit of sliding around in trying to find a place to sit down for breakfast…because with a night’s sleep at lower elevation, I was HUNGRY! I ordered an amazing breakfast at the Khumbu Lodge and ate it looking out at lovely famous Namche. I called my parents. I moved to a coffee shop. I got a latte, and lingered.

I was taken in by a poster on the wall comparing various sites along the route to Everest Base Camp at different points in time. Namche: houses and potato fields where visitors camped then, a hip ampitheatre of cafes and hotels now. Pheriche: fields with stone-shingled huts in 1977, a village of tin-roofed guest houses now. Dingboche: a remote traditional village in the fifties, a mixed crop of buildings now. These images were fascinating. These were places I had been now.

But far more jarring were photos of glaciers from the 1950s and 1970s, next to the exposed rock those same massive ice sheets had become in just a few decades. The river by Pheriche, delicate fifty years ago, was dramatically widened by glacial melting in its twin photo. These changes might have seemed abstract, from far away. But standing in Namche, I momentarily felt the full force of this injustice. How could we do such things to this magnificent wilderness? When it is so much larger than we are? When it has been here so much longer? It demands so much less and gives so much more than we do. The pain of destruction stared blankly at me from the poster, incomprehensible. I ran my finger over the peeling vinyl covering that showed me where my feet had been just hours ago.

I leisured in Namche until 11am. And then it was another 15 miles back to Lukla, where I was determined to make it for the night. I didn’t take many photos on my way back. I felt the natural arc of my journey returning to its source. I had come out of the gate with fire, and now like a rocket falling back to the ocean by the natural progress of gravity, I was ready to dock at home. I was pretty tired by this time, and my toes hurt from ramming against my shoes downhill for 35 miles, and I was walking slower. I missed the boys and Didi and Prem, and the office team, and our List of Things to Do.

The clouds had once again moved in when I clomped in to Lukla. Its stone-laid street reminded me of a ski town, misty in the fog. I was so ready to have a hotel that when I found a hotel and nobody came to the desk for five minutes, all I could think of to do was go across the street to an “Irish Pub” to figure out my options, and order french fries. That turned out to be a great strategy. I have never had such fantastic fries in my whole life, and let me tell you I have eaten a lot of french fries. 

I found another hotel. I took a hot shower and then raced about chattering in the cold air, flailing at my clothes while the hot water evaporated off me. Lukla is still at 2840m (9318ft), after all, and it is February. I had dinner, did a little writing, and organized my belongings once more for the morning. I set my alarm for 6am so I could get to the airport before the first flight to buy a ticket home.

Everest Part 1: The Height

(<–Read Everest Prelude: Pemba)

Day 1 – Not Yaks

Lukla → Namche Bazaar / 3440m / O2 sats 92

The air strip in Lukla is world famous, and for good reason. One end is abutted against a vertical wall of land where the hills leap toward the sky, and the other end is abruptly concluded by an abyss. Takeoff from Lukla literally entails driving down a relatively short motorway and off the side of a cliff. Landing is the reverse: dropping down out of the sky and flying full speed at a meager strip of pavement on the edge of a canyon, at the other end of which is a wall. The cheers that erupt from the passengers after this thrilling landing are almost unwitting, a primal reflex produced by the exhilaration of (still) being alive. It was captured by my new friend Mac from China.

Since flights to Lukla can only occur in near-perfect weather, a handful of us had spent the last two days together ensconced in the Kathmandu airport. Each morning we showed up in the dark at six am as required, and waited the entire day for the weather to clear in Kathmandu and Lukla at the same time. We ate airport snacks, we tried to rent a helicopter together, we bonded through the searing disappointment of dashed efforts to fly to Lukla. And then, poof! On the third day, we were in Lukla by eight in the morning. We exchanged contact information and started a chat group to keep tabs on each other, which was nice because a few of us including me were traveling alone.

Most of the day was a gentle rolling climb without any areas that were too steep. When I saw my first herd of yaks I got so excited I jumped up on a wall, took out both my SLR camera and phone, tried to video and photo the yaks and the same time and didn’t quite accomplish either. Then five minutes later there was another herd of yaks, and then another, and soon I was just trying to stay out of the way of herd after herd of yaks made wide by their rucksacks. Then, late in the afternoon I found out that none of these herds were yaks. They were mules and “jopiya,” a mule-yak blend. Yaks, it turns out, are only at the higher altitudes.

I had thought to maybe stop in Monjo, but after days of sitting in the airport with unemployed adrenaline, I was elated to be outside and free. So at two o’clock I crossed through Monjo and began a challenging two and a half hour climb up to Namche bazaar. This ascent covers about 3000 feet of vertical elevation over the course of four and a half miles. For many travelers, the road from Monjo to Namche is an entire day’s hike. But the truth is that the tireder I got, the better I felt. 

As four o’clock approached, the sky became gauzy and cool. Namche Bazaar is a name you may have heard, recognizable even to people who don’t travel in these mountains, and late in the afternoon it appeared over the crest of a hill, like a dream. I felt something lift off of me, a yearning that has been around since my teens, to lay eyes on this amphitheater that has been the way through for so many travelers . By the time my boots were clomping over its stone-laid alleyways, fog was creeping in around Namche’s edges and over its rooftops.

Modern Namche is quite the trekking hub, but now hotels are closed for the winter and the village is cast with the quiet of hibernation. A few months from now, rooms will be nearly impossible to come by, but there were almost no people around. I found a lodge and set my bag down next to a bed by a window. I excitedly used the oximeter Pemba had given me to test my oxygen saturation. At 11,000 feet this is mostly just for fun, the way my rowing teammates and I used to wear heart rate monitors all day in college for unnecessary interesting data about ourselves. My O2 sats were still quite strong at around 92.

I was the only guest in the hotel. I changed my clothes, put my feet up next to a space heater, and ordered tea.

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Day 2: Real Yaks

Namche –> Tengboche / 3879m/ 12,696ft / O2 sats 92

I woke up and pulled the curtain back to find my room in a cloud. I had expected Namche Bazaar to be announced in glorious morning sunlight, but even the yard of the lodge was veiled in fog. I spent a slow morning in my sleeping bag and then having breakfast and tea. My body had a mild soreness that was rather satisfying after yesterday’s long walk, but the dull persistent ache in my head was less enjoyable. I didn’t realize that that was the beginning of the effects of altitude change. 

I set off late, around ten, and quickly became unsure which of Namche’s many footpaths to follow back to the trail. I had a map on my phone that was to be put to good use throughout the week, but it was no time before a passerby simply pointed me in the right direction. 

After making a pretty long walk from Lukla to Namche yesterday, I had decided on a normal day, a choice I considered leisurely. I chose one of the trails that cuts along the edge of the mountainside, is flatter and easier, and has fewer hotels along the way. It’s still a trekking route but on the map it looked like it might also have more transit by locals going about their everyday business. The clouds hung low all day, making the dusted hills look like black and white etchings.

It wasn’t long before I came upon a man herding yaks—and this time they were real yaks. They look nothing like yesterday’s mules. They have wide bodies and long rugged hair. We said hello to each other. 

So that is how I spent the morning herding yaks around a mountainside with Tenzin Dorje, walking at yak herding pace, a light swirl of snow about us. I learned that Tenzin is a Sherpa climbing guide who has summited Everest twelve times, and many other major summits in Nepal as well. He herds yaks in the off season. The yak bells made a gentle, optimistic clanging music as we walked and he whistled to his herd. After descending down to the valley, we stopped for tea in a wood-paneled house run by a delightful young woman named Dixya. She was delighted that I spoke Nepali, and I was delighted for her to teach me to say “May I please have a cup of tea” in Sherpa.

From the cottage, I bid farewell to Dixya and Tenzin Dorje. The afternoon was a long solo climb up to Tengbuche under a low sky. I had considered going another half hour or so up the road to Debuche, but by the time I crested the deserted, snow-covered ridge in Tengboche, I was feeling the chill of the dusty air. And besides, Tengbuche was too beautiful to rush away. There was a monk on skis. I decided to wake up here tomorrow, and got a room in the only open hotel. Even the monastery appeared shuddered.

In the high season, over eight hundred people a day pass through any given station on the Everest Base Camp route. My hotel had long, empty hallways and a long empty dining room where the hotel staff played cards all evening at one end. I was the only guest. Oxygen saturation is only 64% of sea level in Tengboche, but my O2 sats were still going strong at around 92. 

The bucket in the bathroom was frozen solid.

 

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Day 3: Loner

Tengboche —> Periche—> Thukla / 4640m (15,157 ft) / O2 low to mid 70s

I’ve been feeling quite strong, so today I decided to take a route that many hikers take down, but fewer take up. It took me to a higher elevation, in Thukla, than the more common stop at Dingboche 200m lower. I felt fine hiking all day, but the last bit is a continuous 400m climb to over 15,000 feet, and when I sat down in my room, I definitely felt the altitude. So, point penalty to Spero for over-enthusiasm. 

The day getting to Thukla however was lovely. I awoke to a glorious, shining morning in snow-covered Tengboche. The monastery, dormant and friendless in yesterday’s afternoon’s mist, presided confidently over the sleeping buildings and searing white ground around it. Unlike the hushed mystery of yesterday’s walk in the low hanging clouds and fog, today was a sunglasses and SPF-50 kind of day.

I wound along the river, and the terrain changed to glacial riverbed warming under an electric blue sky, encircled in mighty peaks. I ran into a number of people portering goods to and from Namche Bazaar to higher elevations. The first was a pair of young men who, when I came upon them as I was crossing a bridge, had set down their loads on the other side and were hysterically laughing while taking photos of each other leaping into the air. They had left Namche the SAME DAY—-the place I hiked from yesterday—and made it here by about 11am, on their way to Periche. (That’s my day and a half of efficient hiking.) They said they were each carrying 96kg and getting paid about .35/kg. 

Next the path moved into the glacier bed and became more vaguely defined. Fortunately, around this time I happened upon a pack of porters carrying sheets of corrugated tin and slabs of faux-wood paneling to Periche. So any time I wanted to confirm the route, all I had to do was look for a walking door moving across the plain. I found this so funny that I took about fifty pictures of doors with legs resting in the gaping wide mountain landscape.

As I left the doors with legs behind, the afternoon became more and more solitary, with only an occasional hiker passing in the opposite direction. I crossed a pass in where the morning sun had given way to theatrical, solitary and proud gusts of wind, and Pheriche appeared in the valley. When I arrived down in Periche, I was utterly gratified to see a hotel with door-loads all around it, awaiting the day’s delivery that was coming along behind me. I stopped in at a hotel and chatted with a few locals who said it would take me about another two hours to hike to Thukla. So up I went. 

The climb was stunning, but there was something lonely about the desolate landscape and the wind gusting up the plain from behind. The afternoon clouds had settled in again, and the skies were no longer optimistic and bright.  I arrived in Thukla around four, feeling far away from everything. And, once I set down my bag, admittedly nauseous. There is a very big difference between 12,700 feet and 15,150 feet. My O2 sats had dropped to the low 70s.

When it was clear I was “feeling the height,” two gentle and matter-of-fact hoteliers made me vegetable soup and filled up my bottles with hot water for free. I knew immediately that tomorrow I’ll have to take it very easy and adjust to the altitude. I invited the hotel dog into my room to stay for company, but he wanted to sleep directly on my pillow, and ended up curling up just outside in the hall instead.

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Bonus: Find the Walking Door on the Way to Pheriche

A Piece of Christmas Cake

 

For about two years now, we have been hard at work lobbing the new province government for health policy that includes primary oral health care. I’ve found myself hesitant to blog about many of the twists and turns in this aspect of our journey because political issues feel so sensitive while they are unfolding. And yet this phase of our adventure has produced some of the most colorful, absurd, harrowing and triumphant experiences we’ve ever experienced. Advocacy is, after all, a combination of showing up at government offices, making connections, making connections from connections, inviting people out to see our work, giving presentations, writing policy recommendations, rewriting policy recommendations, cajoling officials for meetings to discuss policy recommendations, and drinking tons and tons of tea and coffee over many coffee tables. These activities are exciting enough in a well-established, stable government. We are working with a government that is has been in perpetual transition for decades, with roads that wash out, with wise men and power saris, with astrological events that dictate the movements of both presidents and wedding parties.

I mean, all kinds of things happen. It is a shame not to tell you about some of them, some of the time.

Recently, we had a breakthrough: Province #4, ours, re-established a previously defunct “Basic Oral Health Training” for primary care providers. We spent almost all of the summer of 2018 madly campaigning for this training. The five provinces of Nepal and the provincial government structure itself had at that time only recently been established – prior to 2017, the federal government was sub-divided by 75 districts – and it would still be some time before personnel had their job parameters defined in the new structure. But our efforts that summer eventually paid off, and recently, through a winding chain of events and people, writes and rewrites, submissions and resubmissions, and patience possible only thanks to some amount of beer, a province-level Basic Oral Health Training budget training descended from the heights of government.

The training is not actually designed yet, so it is fragile and easily gutted, but this also our first major policy breakthrough at a high level of government. It taught us a ton about collaboration, persistence, and the emerging structure of Nepal’s new decentralized governance structure. Even this small-big step would have been impossible to accomplish by working alone.

So this winter, our sights are trained on the Province Training Centre, where the official Basic Oral Health Training will be delivered. This training has a long history in Nepal that I will share at a later time; suffice to say that the essential focus of Jevaia over the last decade has been implementation of care after health care workers have taken Basic Oral Health training that’s provided outside our organization. So by nature, our role has involved a lot further training and refining of skills. If there’s one thing we’ve been up to our, um, teeth in (sorry it was too easy), it’s training and professional support for midlevel providers to do “basic oral health care” in Nepal’s primary care system. That’s why we exist, and it’s how all of our health post clinics and community programs survive against tremendous headwinds.

Now, as you can see this is all very serious business, and our recent meeting at the Province Training Centre rose to the gravity of the occasion. With this shiny, hopeful budget allocated, it is essential that we lobby for a training program that reflects what we’ve learned in over a decade of up-skilling midlevel providers to deliver rural oral health care. So we printed out materials. We reviewed key strategic points. We went to the Province training center.

“You guys!” Rajendra, our Medical Coordinator, cried as we crossed the threshold of the Province Training Centre, examining his feet with a mix of alarm and delight and curiosity that is unique in this world to Rajendra. “I’ve worn the office slippers!” He giggled, and then looked shocked, and then giggled again. Indeed, a brief review of Rajendra’s feet confirmed that he was in fact wearing a pair of the shower shoes we use inside our carpeted office, and his sneakers were still safely stowed on the shoe rack by the office door.

I began to giggle too. “Maybe nobody will notice?” I said.

“Sita Ram sir!” Rajendra announced to our Program Director, excitedly. “I’m wearing the office slippers!” He couldn’t help it. He’ll agree with me when he reads this.

We were led in to the office of the government’s oral health Training Coordinator, where we left our shoes and shower slippers at the door, conspicuously not blending together.

We had a lengthy, complex, and sometimes coded meeting with the Training Coordinator. We were thrilled to find out that a technical working group is to be formed and we are invited to send a representative. The Training Coordinator requested that we also submit an evidence basis for our recommendations, and I will spend the next week compiling a selection of scientific literature around an “augmented Basic Package of Oral Care.” (For you nerds out there, the BPOC was developed with the support of the World Health Organization back around 2003 and is well documented in the literature; meaning we didn’t invent it, our business is to translate it in to practice in the face of real-world challenges.)

From the Training Centre, we re-donned our shower slippers and moved to the Health Division, the government department the Training Centre sits under. There, at the door, we ran in to none other than our past Jevaia program director! Nabaraj now works as a training coordinator in the province offices – perhaps a hopeful sign for us. We were warmly welcomed and led in to a cavernous office with an enormous with a desk at one end, and, per Standard Operating Procedure, tons of couches arranged against all free wall space. The couches were populated by a dozen or so visitors, people we didn’t know, who were both together and separately in an ambiguous state of meeting with the official we had come to see: The Health Directorate.

We took up arbitrary seats on couches where seats were available. This scattered Sita Ram far on a westward couch, while Rajendra, Rajendra’s shower slippers, and I secured side by side perches on an eastward couch. From there on out, in order for us to talk to Sita Ram, we had to either sign or speak very loudly over cross-talk from the northward visitors, who occupied the longest line of couches and either were or were not meeting with the Health Directorate, and may or may not have all been a single group with a unified agenda. There was no way to tell. Luckily, our former director Nabaraj was able to sit nearby me, on the adjacent westward couch, with only a fat faux-leather arm separating us, which made for good chatting and time to assess the situation.

We remained in this configuration for some time, until the room quieted and, based on a cue I could not identify, the Health Directorate affably invited us to introduce ourselves.

All of the people on all of the couches remained at their stations as we took the floor from our arbitrary seats among them.

Sita Ram went first, and then Rajendra. And then it fell to me to introduce myself and provide a general history and outline of our project, and why we were at the Health Division. In Nepali, with all the important couches watching.

The Health Directorate was gracious and curious. He asked us a series of astute questions about the need for primary oral health services in Nepal and about evidence and evaluation for our project model. He has a PhD in the sciences and absorbed our answers thoughtfully.

“You are here,” he said, “at the right time.”

We held our breaths. This was a good start.

Suddenly, the door opened and a group of men walked in.

All the heads on all the couches rotated toward the door.

“Namaskar, sir!” exclaimed a young, brisk man at the front of the group. The Health Directorate rose to meet them.

“We have brought you” –the young man held out a package, importantly– “a Christmas Cake!”

A murmur rippled across all of the couches of people. The Health Directorate reached out to receive a festive box. He thanked the men profusely. Without disrupting our key role as a riveted audience, I was able to lean over to Nabaraj and deduce that the men had come from a local hotel where the government hosts many of its meetings and gatherings.

“A Christmas Cake!” exclaimed the Health Directorate. “How wonderful!”

“How wonderful!” hummed the Couch Sea.

It was decided in short order to adjourn to the next room for Cristmas Cake. The entire room of people rose and passed through a door behind the Health Directorate’s desk, which led us in to a board room with a long, shiny table. The Health Directorate sat down at the head of the table; Rajendra, Sita Ram and I took seats all the way near the other end, and the as-yet-unidentified substantial company filled up the positions in between. The hoteliers huddled around the Health Directorate and bowed their heads over the Christmas Cake box, which was opened delicately to reveal a white iced fruit-cake with a neat candy-cane trim.

Paper plates were produced out of nowhere.

The Health Directorate began the careful process of dividing the roughly 6-inch cake in to precisely calibrated slices for the large room of attendees. Each offering was gravely placed upon a paper plate and passed to the right. Each person then continued passing the plate until it had circulated the long board table and ended up with the person sitting to the left of the Health Directorate. The Christmas Cake circulation continued thusly until all had been served. To the best of my knowledge, there was not a single Christian in the room, including me.

“What delicious Christmas Cake,” we cooed in turn.

Back at the office later, everyone wasted no time in celebrating the shower slippers for their trip to the Province Offices today. “How’d it go?” the rest of the team asked.

“Amazing,” we said. “We have no idea what happened.”

I sat down at my desk to begin compiling our package of research articles.

*

 

 

 

 

 

Tuli Aamaa

 

On December 12, Tuli Aamaa died. She was 94 years old and has been one of the oldest, most endearingly tired people I’ve ever known since I first met her seventeen years ago. Tuli Aamaa means “big mother” – in Nepali culture aunts are mother-figures, and they are either big or small depending on whether they are older or younger than your parent. Bishnu and Didi’s father was the youngest of five brothers, and Tuli Aamaa was his older sister-in-law. So she was our Big Mother.

Tuli Aamaa and her husband had settled down in the valley, just where the jungle path dumps us out on the highway in Pokhara. So when she came to visit us in Kaskikot, it was usually early in the morning, and she walked up the entire jungle path, a route that takes me about an hour of climbing at a good clip.  Tuli Aamaa would arrive with her walking stick and a litany of woes. These woes – and Bishnu will back me up on this – would have us giggling within minutes of her arrival and for a good while after she left. In a breathy exhausted voice, high pitched but only in the range of a dull butter knife, Tuli Aamaa would tell us, and anybody who was around, perhaps even the chicken or a wooden post holding up the porch or, barring these, the morning breeze, that everything was wrong with her, and it was enough already, it was time for her to die. She never looked pleased, and yet this activity brought her such return of satisfaction, or perhaps relief, that she hiked all the way up a mountain to participate in it, and then all the way back down the mountain a few hours later. It was wonderful.

Amazingly, Tuli Aamaa has always been the oldest person in the world, and she never got older. She looked just as old in 2005 as she did when I saw her last February, in 2019.

Tuli Aamaa with baby Pascal in 2005.

Tuli Aamaa with baby Pascal in 2005.

Yesterday, on the solstice, Didi and Pascal and I went out to Tuli Aamaa’s house, where her relatives are sitting kriya, the thirteen days of mourning. We sat outside talking with her son Ram Chandra dai, and found things here and there to help out with as callers came in and out of the house. Didi helped Tuli Aamaa’s daughter in law Tara bouju prepare her daily meal, which has to be cooked in a single pot during the kriya period.

And then the three of us left to walk up the jungle path, along the route that Tuli Aamaa always took to visit us. It’s also the way that Aamaa climbed after she gave birth to Didi 42 years ago in Tuli Aamaa’s fields. Aamaa took refuge briefly in Tuli Aamaa’s buffalo shed, before carrying her newborn, our Didi, up the mountain the very day of her birth. I have always been captivated by this story, but today it seemed phenomenal all over again, the traverses these generations have made over these stones. Pascal bounded up ahead of us, and found some luxurious blue maiyur feathers, and wanted me to take his picture with them behind his mom, standing on the same stones his grandmother once carried her over.

Later, I unearthed a picture of Tuli Aamaa’s field, and her famous buffalo shed, that I took when I was first introduced to these climbs and their histories back in 2005…

…and then I found one I’d taken the same day, in 2005, of Tuli Aamaa in the buffalo shed where Aamaa and Didi spent their first incredible moments together.

She looked just as old in this photo, as ever. As far as we could tell, she was always ready for this day, that to the vast majority of human beings seems a cliff edge, but to her was only another day.

We’ll miss you, and your loving, irrepressible climb through this world, Tuli Aamaa.

*

 

 

 

 

 

 

 

 

 

 

 

Goddess

 

Bishnu had baby Dali six weeks early, on August 2nd. We got the news while we were all finishing dinner at Didi and Prem’s. On the English calendar, Pascal’s birthday is a day earlier, on August 1st, but by a twist of the planets, on the lunar Nepali calendar Pascal and his cousin share a birthday of Saun 17. This convention-defying-cross-cultural-intercontinental-astrologically-phenomenal-birthday-coincidence —a shared birthday in Nepal, but not in America—has us thrilled. We texted Bishnu and Youba and Dali a Welcome to the World picture, marveling over a coincidence, fourteen years plus eternity in the making, that has initiated our Dali’s life.

Dali’s name is actually: Serena Subedi Bhatta.

Aamaa is coming back with me to the US to meet her granddaughter, an American citizen. We’ll fly directly to San Francisco, but we can’t leave Nepal until after summer professional development the last week of August. So we’ve passed the weeks talking with Bishnu on the phone, and each Friday I download new photos and ferry them to Kaski where Aamaa and Hadjur Aamaa and the neighbors pore over them. Aamaa’s favorite is the one with Youba holding Serena just minutes after her entrance in to the world, shiny and swaddled. Aamaa likes to pull this one up on my iPad and zoom in and stare at it for ten, fifteen minutes at a time. 

“It’s like, the longer you look at it,” she says, “the more you want to look at it. You can just look at it and look at it.”

Bishnu had a difficult and sometimes unnerving pregnancy. Serena was born six weeks early, at 3.9 lbs, less than 2 kilograms of sugar, I told Aamaa. She spent a month in the NICU. Bishnu wouldn’t bring any baby shower gifts home until it was almost time for the baby to leave the NICU and join her there. I’ve found myself thinking back to the day fifteen years ago when I stood outside Gandaki Hospital with Didi, right after she wasn’t able to see a doctor at what was supposed to be her last prenatal checkup, when we ate cel roi at a roadside stand. A week later Didi’s first child was stillborn at full term. 

For a long time after I moved to Kaskikot, I didn’t know that Aamaa had little a sister. One day Aamaa was reclined on the bed, lying sideways with her head on her arm and an elbow pointed out at me, when she mentioned that her sister had died in childbirth, along with the child.

“Wait,” Didi said the other day, her eyes widening when I told her about Bishnu’s baby shower. “People her gave her baby presents before the baby was born?”

The day of our departure for America gets closer. We are scheduled to fly out on Teej, the festival of women. In the strange way that our lives here seem to cycle back like knitting stitches, it was Teej when I arrived in Kaskikot in August, 2003. I had stayed in Kaski for two months, gone back to New York, worked as a waitress, and then called six months later to say I was coming back to Kaskikot. I arrived under the hot gaze of summer and found Didi and Bishnu dancing in Maula, where the whole village was gathered for the festival of women. Didi was newly married to Prem, and I realized she was pregnant. And that is how our year together began, with dancing.

Our summer is a theater of rains, curtain after curtain, a production that will eventually deliver the harvest. By then we will be in America. Teej begins from Sept 1, when Aamaa and I will leave Kaskikot, and goes to September 2, when we’ll fly out of Kathmandu. It’s funny how people attempt to impose order over the unknown when they are about to embark on a long journey. I like to leave my living space robotically clean and organized, and I will compulsively sift through 5-month old stacks of mail and fix wobbled stools that have been committedly ignored for months. Aamaa’s strategy appears to be getting fixated on the cucumbers. They are ripe and fat on the the vines around the house. 

“Laura,” Aamaa says, “we’ll bring cucumbers to Tulo Mama in Kathmandu.” The breed of cucumbers Aamaa grows in Nepal isn’t like little American cucumbers. They can grow to a foot or two long, and the circumference of a coffee can.

“We’re going to bring cucumbers to Kathmandu with our luggage for America?” I ask. Tulo mama is our Aamaa’s eldest brother, our ‘big uncle.’

“…Is it allowed?” Aamaa asks a bit sheepishly.

“Sure, cucumbers are allowed.” I realize this is happening no matter what. “Let’s definitely bring cucumbers to Kathamandu.”

Aamaa has just a few outfits to take to America, but food items are another story. Provisions are sorted over the entire month of August. We pick all the ripe cobs off the corn stalks, roast some in the fire for snacks, give some away, and hang the rest all over the house to dry by winter. Last time we left for America, we also cut down the empty corn stalks, leaving only the millet to ripen by late fall. But this time Aamaa skipped planting millet altogether, and she said we’re not going to cut the empty corn stalks down because they will dry out on their own. I keep surveying the gardens and feeling that the tall scraggly corn stalks are going to look a bit like an army of tuxedos at a beach party by October, when everyone else’s fields are left only with slender waist-high millet and rice plants. But that’s her plan and she’s Aamaa, so we leave them be. The house remains hemmed in by walls of stripped corn stalks.

A sack of rice is sent to Didi in Pokhara. Periodically we revisit the cucumber question.

“We’ll take a large stash of cucumbers to Didi, and a smaller bag for Tulo Mama in Kathmandu,” Aamaa revises.

“Ok.”

“It’s allowed right? To take cucumbers to Kathmandu?”

“This will be my first go at taking a bag of cucumbers to Kathmandu, but I think it’s allowed.”

“Just a small bag.”

“Ok,” I assure her.

One evening Aamaa ponders: “How will we get to Pokhara when we leave here on Teej? Because, see we’ll have luggage and we need to bring the big sack of cucumbers to Didi.”

“We’ll call Hari Bhaai in Caragaun and go in his taxi.”

“Will it fit all the cucumbers?”

“Um….” I search for the right answer. How many cucumbers are we talking about? I decide to gamble. “Yes. Hari bhai’s taxi will definitely fit the cucumbers.”

In addition to a little baby outfit, I want to bring something special to San Francisco for Bishnu’s little Dali, who’s acquired about twenty times her bodyweight in baby clothes during her short life so far. I make a plan. Pascal comes with me on the expedition. 

We spend Saturday afternoon hiking up the Kalika Hill, and I film him leading the way, finding berries and hidden water springs, waving a stick of bamboo around at the skyline and narrating our journey until we reach the Kalika Temple. We ring the large bells at Kali’s door; the clanging and echoes out over the trees, the familiar houses below, over the valley.  I pan my camera over sheets of rain that have blanketed the foothills, and frozen into a bruised mist on the north and south horizons. We search over the laid stones of the Temple ground and choose a rock that Pascal holds in front of my camera, little chips of flint gleaming under a stormy and imminent sky. I will bring it to a silversmith and have it made in to a necklace. Our descent is fast under gathering clouds, sandals pounding and tapping over the brambles.

As the summer draws to a close, relatives stop by to bid Aamaa a safe journey. Aamaa sends them off with cucumbers or ears of corn. A few days before the buffalo calf is due, some men from Parapani come to purchase pregnant Isabella, who nobody calls Isabella except for weirdo foreigners like me and Ann. Aamaa has cared for Bella during her whole pregnancy, cutting her grass and watering her and keeping her living quarters clean. I am grumpy that Bella will be taken just before having her baby and providing us a week of delicious milk. But four days later, we find out that Bella’s calf was born dead. The buyers withhold $40 of the remaining amount they still owe to Aamaa.

Aamaa is sad about Bella. All that work for nothing. “What’s wrong with her?” she asks nobody. We won’t know now. We are quiet over Bella’s loss for a few mornings.

“We don’t need to bring any cucumbers to Kathmandu,” Aamaa updates me later. “Tulo Mama has to leave for Nepalgang before we get there.”

I’m disappointed; I was excited to see Tulo Mama. He is the oldest of Aamaa’s three younger brothers and the one who dotes on her. But he lives in the far West and even though he always asks to talk with me on the phone when he calls, in seventeen years I’ve only met him in person twice.

The last two weeks of August I don’t get up to Kaskikot, because we are completely consumed with our summer professional development training. I take Dali’s rock to a jeweler and search through gems before finally pairing it with a fiery pink ruby. The week ends on a breathless and exhausted August 30th, Friday afternoon.  Bethy helps me pack up my room all in one go, throwing things in to bags over just a couple hours, cleaning the kitchen, ferrying items between the office and my apartment. By the time we get in to a taxi to go up to Kaski it is 8:30 at night, and we arrive at 9:30 to find Aamaa sitting in the house surrounded by friends. Swirled up in their saris and shawls, Saano didi and Parbati Bouju and Mahendra’s older sister are there, and an aunt has come to visit – Aamaa’s sister in law, who would have grown up right here with these women and her brother, Aamaa’s husband. The old friends are sitting on stools in the old main room of our house, by the kitchen, where I have fallen asleep to the chatter of so many women. As we organize our things in the outer room, a wave of gratitude rolls over me, carried on the familiar soothing sound of their muffled voices on the other side of the wall.

“Tulo Mama delayed his travel so he could meet us in Kathmandu,” Aamaa revises when Bethy and I take up seats on a bed. “So, we can bring him cucumbers.”

“Great.”

“Tomorrow we have to pack the cucumbers in a sack.”

“Right.” I reply. “I am ready for cucumber packing.”

Night brings brings a steady rain that clangs on the roof long in to a lazy Saturday morning. It bathes everything, washes away the work week, the summer, the soil around curling roots that are retreating beneath our feet as we prepare to walk away from this village and into another world. It rains as we get up for our last day in Kaski, as we have our black tea, as a man and woman I don’t know arrive and sit on the porch and begin talking with Aamaa.

Bethy and I are ready to spend Saturday helping Aamaa pack up the house—but it is unclear what this involves. Before I can identify a plan of action, Aamaa has disappeared with one of the morning’s visitors and they’ve returned with armfuls of voluptuous cucumbers. The cucumbers, each a foot or two long, are dumped in a pile in the middle of the yard, slick with rain, and the two women disappear again. Then neighbors start showing up – Saraswoti, Saano didi, BAA! – all with more rainy cucumbers. It turns out the visitors are vendors from Pokhara, come to purchase cucumber stock. Aamaa’s yard is transformed into a cucumber staging area. It takes an hour to pick the rest of our cucumbers and combine them with cucumbers from contributing neighbors. The female vendor sorts them in to excellent and sub-excellent status cucumber piles while the male vendor chats with Bethy about countries he’s traveled to. When the yard is fully covered in piles of cucumbers, an amazing ghetto-fabulous hand scale is brought out, made of two plastic tubs hanging on a hand-held balance. Aamaa produces a collection of rocks.

“Wait a second,” the vendor says cautiously.

“This rock is one kilogram,” Aamaa announces, picking up a black, smooth river stone. “And this one is a half kilograms if you combine it with this other little one.” 

The vendor tries out the rocks in different combinations, weighing them against each other.

“Huh,” she says. “Well there you have it.” 

Weighing and calculating against river stones commences on the ghetto fabulous plastic tub scale. Some 100 kg of cucumbers are weighed and sold. Aamaa makes about $15.

“Now,” Aamaa says to me shortly thereafter, “we still have to pack up the cucumbers for Didi and Tulo Mama.” 

“Yep.”

“The big sack of cucumbers is for—“

“I think I’ve got it.”

The afternoon passes. The evening arrives. The cucumbers are packed in to a large sack for Didi and a handbag for Tulo Mama. Dinner comes and goes. We have taken the cases off all the blankets and put them in the only dresser in the house. The floor has been repainted with a smooth layer of clay. Aamaa’s single bag sits in the window. Our last night falls.

I slip out of the house to brush my teeth, and there is Kali rising above the empty uncut corn stalks, a wide triangle of hillside, holding the village in her lap. The damp summer air has cloaked away all but her gray glow in the night sky, revealing only a broad a density etched into meager starlight. I stand facing her familiar outlines, and feel suddenly, like a darkening storm, the women who have come through this house and have sat by this fire and grieved by its ashes and made nourishment over its flames. The inexplicable, inevitable certainty of the four of us draped over the blankets after sunset, while she presides over us, immutable divine feminine, creating again and again from dust.

Watch over us, I find myself asking.

I see us in my mind, walking out to the road. I see our hands holding Serena in San Francisco. I see us moving from place to place, but with a sudden and forceful clarity understand we are tied together here, under her gaze, where we have always been.

Stay with us.

It is time to go to bed.

The next morning neighbors trickle in to see us off to America. BAA! arrives, and then goes home again to retrieve tikka powder to put on our foreheads. Aamaa still can’t stop talking about the cucumbers. After Saano didi’s husband has taken the large sack of the cucumbers out to Deurali where Hari Bhai will pick us up in his taxi, there are still cucumbers lying about and we’re not sure who they are for. I end up with three of them in my bag and we eventually remember these were gifts for my office.

Today is the beginning of Teej. In a few hours when we are in Pokhara, we’ll see off Prem’s cousins who will come to take his porcelain, wrinkled mother back to Piodi, her snow white hair tilted forward as she is carried away piggy-back down to the road, so she can celebrate the Festival of Women at home in her village.

But now we are waving through the taxi window, and driving down, down, down the switchbacks while our house disappears behind us. The driver and Aamaa make small talk over the weather.

“All this dry hot summer, and the last two days, nothing but rain,” Aamaa remarks.

“Didi bahini rhuera hola,” the driver replies, talking about Teej. “Maybe it’s the tears of our sisters.”

“Maybe,” Aamaa answers offhandedly. The hills roll by. “It could be.”’

*

To Meet in a Dream

 

We are having a family get together in Asheville, North Carolina. My dad is turning 80 this summer, and it’s Father’s Day, and Bishnu is pregnant with a baby girl. She and Youba arrive on a red-eye from San Francisco, Bethy and I fly in from Connecticut, and my parents drive over from Chapel Hill with Ricky and Julie and the kids. We plop our bags in a cluster of wood-paneled cabins shaded by rustling trees. It is the first time we have all been together since Bishnu got married last year. Now she is Bishnu Subedi Bhatta.

Bishnu and Youba have made the questionable decision of asking for name suggestions. We bat around ideas as we eat ice cream and go to the playground and climb Chimney Rock, where, even though there is an elevator, Bishnu takes the stone staircase up to the top, plodding along step by step while Youba fawns hopelessly over her. At the summit we take a family photo, the North Carolina hills yawning green in to the distance, an endless rustle that is too far off to hear from the top of Chimney Rock, giving way to blue.

In the six years after I first showed up in Kaskikot and before Bishnu came to the US, we would talk on the phone from time to time. It was always morning on one continent, and evening on the other, and in the decade since then I can’t say the phone connection has improved much. Through the static I’d hear about how Saano didi and Mahendra’s families were doing, and whether the millet or corn stalks with their stacked Groucho Marx mustaches had recently been planted or cut down. I’d tell her about New York City, where I was living, and say that Mom and Dad and Ricky were fine. We ended most of our conversations the same way.

“Ok then, well let’s meet in a dream.”

“Where should we go this time?”

And then we’d plan a meeting at the Kalika Temple, or in the kitchen with Aamaa, or on a mat in the yard to paint our nails, or at the festival of Teej. And then we’d say goodbye, and go to sleep to meet in a dream. And always in Nepal.

It has always seemed to me that Bishnu and I were born in to this world with a thread between us, translucent, like the kind used in mobiles or dental floss or to catch carp, because it is unassuming, tensile, and indestructible. The kind that seems as if it can be spooled out forever without reaching the other end that’s buried somewhere in its bottomless coils.

I decide to print the Chimney Rock photo for Father’s Day, which requires sneaking away in to Asheville. We need three copies of the photo for Dad, Ricky and Youba. While I’m out in Asheville I send a text to the family chat to ask if I need to pick up any ingredients for dinner. My mom replies.

Bishnu is cooking dal Bhatta.

I giggle at auto-correct, which has apparently learned Youba’s last name already. My mom means “dal bhaat,” traditional Nepali food–but the more I look at this, the funnier I find it anyway. My fingers tap over the keys.

Does this mean they picked a name for the baby?

It is Youba who replies.

Dal sounds like a boy. Shouldn’t it be Dali?

My mother and I become ecstatic over this. Bishnu’s kid is immediately christened Dali Bhatta. Mostly it is only my mom and me who think this is brilliant. It could be worse, though. My mom called me Loolie-tabooli-tabootznicky…and by “called” I mean “calls.” This is a true story. I was named for my grandfather Louis, and my family turned it turned into Tabootznicky.

We spend the rest of the weekend fishing in the pond, making s’mores on the porch, and turning the kids upside down. Bethy and I are staying in a cabin with Youba and Bishnu, and my mom has brought Bishnu an old notebook along with a pile of belongings from her now-“old” room in Bethesda. We flip through its pages, mystified and awed, like the Dead Sea Scrolls. It contains, in Bishnu’s handwriting: a list of instruments needed for the prehistoric version of the Kaskikot Dental Clinic; draft text for a sticker about fluoride toothpaste to be printed and posted in Kaskikot shops for vendor outreach; and practice answers to questions Bishnu expected to be asked at her visa interview with the US Embassy in 2008. She does a dramatic reading in the living room.

I remember when we bought Bishnu’s first pair of jeans. She looked as out of condition in jeans then as I did in my floppy kurta salwaars, each of us yet to learn to fit our bodies to these foreign garments that we irrevocably longed to inhabit. The more time Bishnu spent attending different trainings and programs that year, the more time I spent at the house with Aamaa alone, learning to move the goats about and cook and plant and cut. When Bishnu was away, Aamaa and I developed a quiet and comfortable flow together. Then Bishnu would come back for a day, arriving on the last bus at 7:30 at night, and I would feel a pang of sadness. The loss of the illusion that I was useful. I would fall back in to following Bishnu around and learning from her for the next twenty four hours. The spool would turn inward, we were drawn together, arguing, sitting in the kitchen, going to the temple, teaching each other about our worlds.

Bishnu always left to go back to her training programs early in the morning. They got progressively further away- Sarangkot, Pokhara, Damauli. America. (I didn’t know it then, but there would be a time when Bishnu was to wake me early in the morning in Bethesda, before going to work in Virginia.) On these mornings I could never motivate myself to wake up any earlier than necessary. Instead I would close my eyes to stave off departure, and then in the dawning bloom of morning, Bishnu would come take my shoulder to say goodbye, and slip out the door to catch the 7am bus. It always seemed, once she had been here, that she was going terribly far away; suddenly, I would be at a lose end. For a few hours, everything seemed empty.

And inevitably, after some period of months, I would spool away to America, and we would meet in a dream.

It is 2019. In my parents’ cabin, I assign my nephew Jonah, Ricky’s eldest and and a lanky eight, to instruct his three and four year old sisters as to how we are going to surprise three fathers with their family photographs. Jonah orders his sisters about for fifteen minutes, placing them behind the curtain, behind a couch, and practicing a chaotic toddler chorus of “Happy Father’s Day!” It is decided that I am to cue the surprise with a casual unsuspicious phrase, for which Jonah has selected “Wasn’t it nice weather today!” With this, my nephew and nieces are to spring from their hiding places and proclaim the happiness of Father’s Day.

The plan goes remarkably well. Youba’s features spread momentarily in to an arrangement of euphoric surprise: he is going to be a dad. And then, a collage of moments fluttering around us. We coo over Dali Bhatta. Jonah and Eli and Nell swing elatedly in the hammock, laughing hysterically over each other, until my dad and Ricky and Youba take their places. The trees around the cabin fall in to a still sheltering, rustling blessings over us, and the sun drops slowly over the hammock, delayed like a water droplet on velvet. We are gorgeously suspended in time.

Bishnu and Youba have booked a 6am flight. So it is still dark when Bishnu comes in to wake me the next morning. I roll over and can almost feel the straw mat under arm as Bishnu whispers, “Bye Laura, we have to go to the airport.” I wrap my arms around her and Dali Bhatta, suddenly both at peace and without coordinates; it is an old feeling, ancient as the notebook and the Dead Sea Scrolls, bottomless as a whole new human being.

The enormous future seems unimaginable in this pre-dawn, where we stretch away in to a miraculous dream, until we are real again.

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2004

Mothers Just Up the Road

Our most recent clinic launched in the village of Deurali, where Hira runs a clinic at the Health Post every Wednesday. We were in Deurali a few weeks ago for a supervisory visit–or more specifically, a veteran technician K.P. was visiting Hira for mentor supervision, Rajendra our medical coordinator was supervising K.P.’s supervision, and I was there to see Rajendra supervising K.P. supervising Hira. So as you can see we’re doing our best to address any issues around lack of supervision and monitoring for primary care operators in rural Health Posts.

Hira’s been doing awesome in her clinic and already has a week of post-certification professional development under her belt, but we’re still working on building the patient flow in Deurali. This is no surprise; everywhere in the world, people are slow to seek dental care, especially for preventative and early-stage treatment. Rural Nepal is no different, and Health Post dental clinics don’t get much traffic unless paired with strong outreach and a referral system. We’re still getting rolling in Deurali, and this month the local Team Leader, Prashanna, organized an outreach gathering for a local Mother’s Group where his wife is an active member.

We piled in to a car at the office and arrived in Deurali mid-morning, having looped through the neighboring village of Rupakot to pick up Kamala, a talented clinic assistant who works in the Rupakot dental clinic and came to assist Hira for the day. Hira packed up a field kit from the Health Post, and we unloaded the supplies a short walk up the road at the Mother’s Group community building. This building was damaged in the 2015 earthquake, so we found ourselves in a completely normal half of a building with half a roof. The other half was open to both sky and the sweep of surrounding hills, not to mention that the road had recently been bulldozed and taken a chunk of the hillside with it, so the concrete floor dropped off precipitously, in mid-air, creating the effect of a film set on the edge of a cliff.

Behind the half-building, people began setting up a plastic chairs and stringing up a tarp for shade. Because it was the first adult outreach program in Deurali, our two education coordinators Bidhya and Shreedhar had come from the office to lead the workshop and model it for the local team leader Prashanna, who will soon become Deurali’s master of ceremonies for such events. Bidhya and Shreedhar are also new to our team, so this was their first adult outreach too, and they’d spent a good deal of time going through our teaching protocols and creating clever new materials to use. Hira and Kamala set up the treatment area to provide free screening, limited treatments of fluoride varnish and silver diamine fluoride, and referral tickets to the regular Wednesday clinic up the road.

People began to trickle in, take their seats, and chat. When the chairs were full, Prachanna and the primary health worker from the Health Post kicked off the morning. Then they handed the session off to Bidhya and Shreedhar, who inaugurated their roles on our team by doing a phenomenal job by engaging the crowd in an animated discussion. They covered everything from oral hygiene to junk-food-free schools to explanations of Hira’s available services in the Health Post.

I really love this example of Bidhya working what’s called “people-centeredness.” People-centeredness actually specific a term used by the World Health Organization as part of its quality-of-care framework. But what does it mean in practice? Health care that is attuned to lived experiences, that is easy to relate to, that is compatible with the physical and cultural environment. People may not leap out of bed to go get dental care, but they often have no problem talking at length about their teeth and the stories inside of them. What I saw watching Bidhya and Shreedhar work the crowd was not a lecture, but a dialogue not so different from the way that Aamaa and I sit around with Saraswoti and Saano Didi and Maya Bouju in the evenings, cataloguing the day and comparing notes about the world. There is a wealth of available wisdom already present in any community.

After the presentation, people waited as long as four hours for a screening in the half-of-a-community building. There was a 104 year old man, a woman with a difficult home life that made it challenging to arrange an initial screening at the Health Post, and a series of patients perfectly timed for interventions recently covered in our Professional Development Seminar on Aging. Watching as residents passed the time in plastic chairs, waiting their turn and talking about their teeth and other life topics, I pondered the fact that the Health Post, which offers the exact same services plus more, with the exact same provider, every week and ten minutes up the road, has struggled with patient flow. But the plastic chairs under the tarp was people-centered.

Hira screened about sixty residents before the wind picked up and began blowing rain in to the wallless clinic space. Before we repacked everything, she gave out forty referral tickets and delivered a swath of preventive fluoride treatments. I think she’ll keep busy in her clinic the next few weeks!

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