The Power of Catching a Goat

 

At the end of each of my visits to Nepal, there is usually a collection of ridiculous, entertaining, and lovely things that haven’t found a home in any of my blog posts, but deserve to be known to the world. Herewith is enclosed this winter’s box of treasures.

1. Grab Your Desire

Signage is a very reliable source of amusement in Nepal. This is definitively the most awkward hotel welcome sign ever, surpassing even Hotel Touch Nepal, a winning entry from last summer. And yes, the hotel is actually shaped like an octagon, which under the circumstances I assess to be both logical and insane.

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2. All the Religions at the Same Time

Because Santa suit and Nepali pop song and traditional (Tamang?) dress.  This is how we do the Christmas street fair, y’all.

3. The Power of Power

For the entire decade and a half I’ve spent in Nepal, there’s been an ever-increasing amount of load shedding due to lack of electricity. The flashlight and solar power industries are enormous; our own office has $2,000 worth of back up battery power just so we can keep the lights and computers on. Everybody simply takes scheduled power outages to be a fact of life, familiar as rush hour traffic–in the winter when hydropower is lowest, load shedding lasts for up to 16 hours a day.

So apparently, just this fall, a new minister was appointed to the Energy Department, and revealed that the load shedding problem is, well, entirely due to collusion between the government and the energy industries. ENTIRELY.  Therefore, he simply declared load shedding to be over. After fifteen years, the lights went back on, and that was the end of it. I am telling you, there wasn’t more than 5 hours of load shedding this whole month, in the dead of winter.

I asked my friends why everyone isn’t absolutely up in arms about this. The answer was simple: everyone’s just glad the lights are back on. And besides, if anyone gets annoyed, they will probably be turned off again.

4. KP’s Dental Technician Henna Tattoo 

On the closing day of our university screening program, we discussed lessons learned, watched a slideshow of our week, and traded contact information. I had asked our technician Anita to bring some henna, and I did henna tattoos as people filtered out. Our technician KP demanded to have one placed on his chest, so obviously, he got K.P. and a tooth. His biggest UCSF fan, Helen, approved.

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5. The Power of Catching a Goat

My last morning in Kaski I got up and, as per routine, wandered outside to brush my teeth. As I was puttering around in the yard and splashing freezing water on to my face, I looked up to the terrace behind the house to see our 11 year old neighbor Amrit creeping up behind his goats, trying to catch and tether them to their posts, while muttering in a sinister tone: “DON’T UNDERESTIMATE THE POWER OF CATCHING A GOAT.” He would pounce just as a goat slipped through his hands and clomped off a yard or two away before losing interest and lazily looking around for something to chew on. Then Amrit would creep again, intoning, with intense focus: Don’t underestimate the power of catching a goat.

I highly recommend this as idle morning entertainment while brushing one’s teeth.

When I woke up the next day in Pokhara thinking about Amrit and started giggling hysterically in bed, Aidan and Pascal explained that there’s an action hero called the Blue Cat Man, who apparently goes around saying, “Don’t underestimate the power of the NILO. BIRO. MAN.”  It’s like the power of power, but with blue cats.  I unfortunately didn’t take a picture of Amrit with a goat, so here’s me with a goat.  You want to catch a goat now too, don’t you?

6. Paragliders in the Mirror

On Saturday afternoon following the closing program of our screening camps, when our field staff left to go back home, I went for a run to clear my head. The paragliders who we often see sailing down from Sarangkot make their landings in various spots by the lake in the valley, and every now and then I happen upon them at the moment they float down to the ground. That afternoon, as they drifted out of the sky, they were perfectly mirrored by other paragliders rising to the surface edge of the lake. The paragliders came down and attached themselves to their own feet, like Peter Pan and finding his shadow.

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7. It's My Shit

During their week of clinic audits and past patient assessments, Bethy and Keri came to spend a day in Kaskikot, and in the evening, we got to singing with Grandma. Thanks to Keri’s choice to blast “Holla Back” off her laptop, we ended up teaching Grandma to say, “It’s my shit,” and I did post a link to this before, but I am embedding it here because when you watch Grandma declaring that her shit is hers and not to be messed with, you will see why this is an absolutely brilliant thing to have happened.

8. The Prime Minister on a Tractor

The other night I looked up to see an evening news broadcast of Nepal’s Prime Minister inaugurating this tractor. He is covered in celebratory marigold malas far past the tops of his ears, making it hard to achieve either neck rotation or peripheral vision. In the TV broadcast, the gathered audience shuffles tenuously along on the muddy ledge around the paddy, clapping admiringly as the Prime Minister drives the tractor for about a full minute on the evening news, with no background commentary or voiceover whatsoever from the news anchors.  He stops and disembarks, and then the segment ends, while I squeal and point at the TV, my dinner forgotten on my plate, and the rest of the family is going…”What?” I present you the photo that was published in the Himalayan Times, with its caption.

I mean, What?

Prime Minister Pushpa Kamal Dahal plants rice in a field using a modern tractor during the inauguration of the Super Zone programme under the Agriculture Modernisation project, in Baniyani VDC of Jhapa district, on Tuesday, January 3, 2017. Photo: PM Secretariat

Prime Minister Pushpa Kamal Dahal plants rice in a field using a modern tractor during the inauguration of the Super Zone programme under the Agriculture Modernisation project, in Baniyani VDC of Jhapa district, on Tuesday, January 3, 2017. Photo: PM Secretariat

8. The Power of The Stage

Our sweet Pascal is 11.  He is named for the little boy in The Red Balloon who makes a strange and magical friend that leads him to see the world.  While Aidan is our Joker, Pascal is serious and perceptive.  He and I have always had the bond of The Observer, that sensitive creature who is perpetually catching up with the world on the outside, but seeing a little more than the next guy on the inside.  One night during this year’s holiday street festival in Pokhara, Pascal came to the hotel to find me and we spent some time walking around in the crowd.  We came upon a stage where kids where dancing until the scheduled performers came out.  Pascal paused a moment, and then jumped up and…he’s on the back left in the striped shirt.

9. These extremely uncomfortable mannequins in Kathmandu Mall.

Why, world? Why? Who approved this?

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Hope Against Entropy

(Editor’s note: apologies if you’re on my email list and receiving this a second time.  It won’t happen too often.  If you’re not on my email list, you should be!  Please write “SUBSCRIBE” to laura@jevaia.org).vision-nepal-global-exposure-workshop-088-2

Good morning from sunny Pokhara!  I arrived yesterday and enjoyed a nice homecoming tour of all my regular haunts. Since August, Pascal has rigged up a home-made antenna on the roof, Aidan’s other front tooth has finally come in, and the corn has been cut down in the garden in front of our office, replaced with new seedlings.  I absolutely love this season in Nepal – the cold, wide air, the clear mountain skyline which is obscured by fog during the monsoon, the evening snuggles with my nephews under warm blankets.  Tonight I head up to beautiful Kaskikot to see Aamaa.

photoI’m so excited to tell you about our plans for this winter.  After 10 years of chipping away at all this, we are just days away from a two-week collaboration with dentists, researchers, and students from Berkley, UCSF, UConn and the University of Puthisastra in Cambodia. It is a strange and wonderful feeling to be preparing for such a large and qualified group of visitors after so many years of working away with few outside witnesses to our efforts.  There are many great things wrapped up in upcoming this ball of projects.

The first is helping to implement a UCSF/Berkley study of oral health and nutrition in mothers and their children.  Our own JOHC field teams will get to work with the researchers to conduct this study in one of our villages.  The second project is training our technicians in some new techniques, which they’ll incorporate in to their sustainable clinics.  Third, we have the chance to bring dentists to our rural clinics for medical audits.  Believe it or not, after an entire decade, this will be the first time we’ve had foreign dentists come to visit our clinics.  

And finally, we’re going to pilot an evaluation of past patients who’ve been treated by our technicians over the years.  If you don’t think that sounds like Christmas, listen here! This means comparing the outcomes achieved by our local dental technicians to the results produced by fully credentialed dentists in prior studies of the same treatment techniques. img_3285 This is a HUGE step towards our goal of having Nepal’s national health care system adopt rural dental clinics in to all of its health posts. Why? Thank you for asking!  Because the main criticism is that community-level health workers aren’t qualified to perform dental medicine…even though that excludes millions of people from care.  But we’re making the case that, rather than write off local health workers, the medical field must find ways to properly train them to provide the best care possible in their settings.  And that’s what we’re doing!

Ok, so those are the technical points.  Now let’s talk about me organizing for fourteen people to show up next week from California, Connecticut, India and Cambodia.  We have a schedule, a budget, a training plan, hotels, flights, and t-shirts.  We’re doing our best to keep things under control.  But we are up against the entropy of Nepal, people.  THE ENTROPY OF NEPAL.  Pretty much anything could derail our plans and contingency plans: a wedding, a political strike, rain, someone’s grandpa dying, a forestry meeting, a buffalo falling ill.  A buffalo having a baby.  A traffic jam.  A flat tire.  Lost luggage.  Fog on Sunday afternoon.  Somebody decided to drive this point home for me at the recently renovated, lusciously carpeted arrival terminal in the Kathmandu airport, which has a new row of fancy kiosks for visa filing:

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On the plus side, sometimes fate works to your advantage.  Consider our office.  This fall, our landlord’s son got married.  The son received a number of couches by way of dowry.  They don’t fit in our landlord’s apartment, so I arrived to find them in our office, which now looks rather like a furniture store.  If you have any idea how much I have obsessed over the setup of our office, you will especially appreciate this stroke of….er….luck…

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Well, in solidarity, I think I’ll leave you there on the edge of your seat.  Except for sharing a photo of this year’s Race to the Rock, which was one of our best yet.  If you missed it, please consider Jevaia in your end of year giving.  After all, we’ve made it this far – through many political trials combined with road mishaps, fuel strikes, weddings, earthquakes, and baby buffalos – almost exclusively on the wings of individual donors, and here we are entering a very exciting new chapter.  Thank you for being a part of the ride with me and all of us.

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In the Trenches

 

This summer I’ve been spending a lot of time sitting at a computer, in our lovely bright office, which is definitely a first.  Last summer, for example I was hiking for 10-12 hours a day in the hot sun visiting earthquake-affected homes in Lamjung, and in general, my time in Nepal is spent covering ground, carrying things, and changing elevations.  Well finally, today was a more typical day in the trenches.

We had scheduled our advocacy meeting with the Health Post committee in Bharat Pokhari.  We’re holding these meetings to push for local funding like we did in Sarangkot.

I woke up at home in Kaskikot.  I had to meet Dilmaya at the bus station in Pokhara at 8:30am, and the local bus from Kaski leaves too late and goes too slow to get me there on time, so I’d cleverly arranged a ride with a neighbor in Kaski who drives a taxi.  However, the road between where he lives and our house is totally washed out with the monsoon, so I woke up at 6am – POINTS FOR ME, THAT’S THE MIDDLE OF THE NIGHT IN MY WORLD – and walked 20 minutes to the other side of the muddy section to meet him at 7:05.  Naturally, I discovered at this point that we were still waiting for another passenger, an ill lady slowly making her way to us.  While I got nervous and then annoyed that I’d be late, there wasn’t much to do.  This is why you don’t stay in your village instead of in Pokhara the night before catching an 8:30am bus for an important meeting.

Naturally, we made it to the bus station on time despite all signs to the contrary.  Dilmaya and I took 1.5 hr very, very bumpy ride out to Bharat Pokhari, cutting over some intervening foothills.

After another 20 minute walk up the road to the Health Post, and we had arrived by 10am for a 12:00 meeting.  No sweat – two walks and two vehicles later, all before breakfast.  Aamod came bouncing up the road on his motorbike and, with plenty of time to pass before the meeting, we went in to visit Bharat Pokhari’s weekly clinic.

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Bharat Pokhari was handed over just this past spring, which means that its protocols are up to date, subject only to how well they’re being observed.  But funding wise, things are in limbo.  The clinical team has been showing up and working without pay, trusting that between us and their local government, someone is going to come through.  In all transparency, we signed a funding agreement with Bharat Pokhari before we launched the clinic, as we do everywhere.  But seeing these through is challenging in every single place, so realistically, we’re in basically in negotiation with Bharat Pokhari’s leaders about it anyway.

We’ve already met with both the Health Post Chairman, a young and ambitious Public Health graduate, and the Village Chairman, who is older and more traditional; these two hold the main influence, technically speaking, over how funds get budgeted.  We’ve briefed both of them extensively over coffee in Pokhara.  The Health Post Chair was very much down with the idea of piloting a new health service in Nepal’s rural system, and as a public health specialist was easily oriented to the larger vision about what this would mean; but, like many Health Post leaders, he’s an appointed transplant who will be moved to a new location within the year.  By contrast, the Village Chairman is very, very local, with social clout and a more complex set of competing interests.  Any meeting is functionally meaningless without both of them present.

At 12, nobody had arrived yet to meet us.  We used the time to mill about Bharat Pokhari’s Health Post, an impressive, hefty hospital-like building constructed with foreign funds, in which many rooms appear to be empty or minimally used.  At 1, we were still waiting in a spacious meeting room with one very talkative local leader who discussed with us, at length, how difficult it is to get everyone together for a meeting.  We agreed.

Around 1:30, this wonderful looking man came in, and it turns out that in addition to being on the Bharat Pokhari government committee, he is our dental technician’s 86 year old grandfather – a magnificently venerable age for these parts.

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1:45pm, we were still waiting for the Village Chairman, who, in theory, had called the meeting.  But then he had apparently been summoned urgently to the municipality in Pokhara.

By 2pm we decided to go for tea with anyone who would come with us, and there we finally got in to a vibrant conversation with some of the health post staff, local leaders, and passers-by about the permanence of the dental clinic.  It dawned on me as we talked “informally” over tea that we weren’t even ready for a meeting of 10 or 15 social leaders in Bharat Pokhari, and that in Sarankgot we were lucky with how quickly things got organized.  Here, we’re still lobbying individual people.  It was probably advantageous that we ended up in a public space, chatting in a tea shop with locals sitting around about how the village should be using its public funds.

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Bharat Pokhari Health Post

We returned to the towering Health Post with our precarious baby clinic inside.  It sits across from a similarly built community center that the same international agency is building; when I asked for what, I was told, “community things.”  I sighed and, knowing it was a bit too simplistic – but nevertheless, true at this moment – said to Dilmaya, “It’s so easy to build something one time and go, isn’t it?”

By 3:15 we decided we had made the most of our day, and climbed on to bikes to head home: me with Aamod, and Dilmaya with the Health Post Chairman, because, we’re in Nepal.

At 3:30, as we were literally rolling down to the road, the Village Chairman showed up.

We got off the bikes.

All of the positive talk from our earlier coffee with the Village Chairman seemed to have dissipated. Tired, we began again at the beginning, making the same case we’d made just a week ago.  We’re realizing that’s just part of how it works.

Finally, around 4pm, Aamod and I left Bharat Pokhari on his motorbike, which is 9 years old and regularly stalls out.

“Should we take the short road?” he asked.  I know this is a trick question that translates to, “I am planning to take this steeper, bumpier short cut, and I am letting you know that we will not be going the other way, which is only for sissies.”

The bike stalls out.

“Well, why take the long road if there’s a short road?” I oblige. “I don’t really know any of these roads.”  Actually, those things are all true.

The bike starts.  We take the short road.

About ten jostling minutes down the short road, just as we are yelling loudly over the bike about how our day of meeting-hazing in Bharat Pokhari was a necessary step in which we feel we put the time to good use, a bike comes up in the other direction.

“The road is closed below!” says the Guy Going Up the Hill.

“What do you mean ‘closed?'” Aamod asks.

“No road,” the Guy Going Up the Hill explains.

I mentally sigh; now we will have to ride 10 minutes back up the bumpy short road, and then down the long road.  We still have a coffee scheduled at 5:30pm with the Village Chairman from Lwang Ghalel.

“I think we should see it,” Aamod says.  “I mean, how closed can it be? I came up this road this morning.”  I know this is a trick question that means, “I don’t want the road to be closed, so I’m going to ignore the obvious and keep going.”

“Well, if you came up the road this morning, what does ‘no road,’ really mean, anyway?” I oblige.

We pass another bike coming in the opposite direction.

“THERE’S NO ROAD BELOOOOOOOOOOOoooooooooooo…w!” he zooms by.

“Maybe there’s no road,” I suggest traitorously.

“Let’s just see,” Aamod replies.

We pull up to some construction workers – the ones turning around all the bikes.  Presumably the same people responsible for the missing road.

“No road below!” the construction workers inform us.

“None at all?” Aamod asks, because, we should be sure.  “Can a bike cross?”

“Absolutely nothing,” they confirm.  Finally.

“Let’s just have a look,” Aamod says.

“I think it’s going to be closed,” I confess.  “Maybe we should just turn around here, we’re wasting time.”

“How closed can it be?” Aamod asks.

So it takes us about 30 minutes to drop Aamod’s extremely heavy bike down this seven foot trench, maybe cut for concrete piping, roll it across the uneven loose dirt and rocks at the bottom, and get it back up the other side.  I now have a lot of dirt and exhaust up my nose.  But, we have won the road.

“That was definitely faster than going back up to the long road,” Aamod points out as we set off again.  I know this is code for “I never suggested we wouldn’t get drenched in sweat and that rolling this five ton bike out of a ditch wouldn’t be part of the process, and it was still worth it because we have won the road.”  He calculates the amount of time each stage of the going up would have wasted, and, indeed the total is longer than the half hour we have spent in the trench.

“Yes, that’s true,” I agree, mildly confused about my final evaluation of having won the road.  “It would have taken way too much time to go back up.”

“You know, the thing is in Bharat Pokhari,” Aamod shouts over the wind, “is that if they just give us a fixed challenge, we can solve it.  But if the challenge keeps changing, it’s gonna be really hard.”

He’s definitely right about that, and we discuss it as we zoom down the short road.  If there’s a real and defined obstacle to overcome to sustain our clinic, we can strategize through it, but if the landscape keeps changing and people aren’t really working with us, we’re pretty much doomed.

“What’s wrong with these people?”

“Yeah,” I shout over the wind.  Politics in Nepal is a whole special level of screwed up, I think.

“They just dig a trench across the road and leave it like that.  They at least need to lay a walkway across before they go.”

“Oh that,” I call out.  “I thought you meant—”

And then my sentence trails off.  The short road presents us with:

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Trench Number Two

Now we’re between two trenches.

“Well, we have no choice but to cut across this one too,” Aamod states.

“That does seem to be the case,” I agree with happiness and enthusiasm.  It’s either this one, or the first one again.

A bike comes up the road on the other side of the trench and, peering over the opposite side, turns around in dismay. We, however, roll Aamod’s heavy bike in to the trench – for a second time – and lay stones, gun the motor, push the thing from behind, the hot exhaust huffing hot on to our ankles.  I eat a lot more dirt.  I am not very effective at this, so Aamod is doing most of the work, although I get exertion points for lifting a heavy bike at the wrong time and pushing it in the wrong direction, and also for laying stones behind a cloud of exhaust.  And then we are through.

We set off again.

“It’s cause you said that thing about the obstacles,” I offer.

“We should stop for a snack,” Aamod says.

As we finally get near town, we stop for pakora and knockoff Redbull.  We deserve it.  I rinse the dust out of my mouth and wash my arms and shins.  Our 5:30 meeting!  Aamod calls the Lwang Ghalel Chairman.

No answer.

It starts to rain.

We sit for forty five minutes, talking strategy, thinking about new clinic launches, considering how to adjust the initial setup and benchmarks along the way, based on what we’re rapidly learning now.  We still have three other post-handover sites and four mid-term sites to manage.

Aamod calls the Lwang Ghalel Chairman again.  No answer.

More rain.

“Can we call it a day?”

“He’s not coming.”  That was a day all right.

We get back on the bike.  It stalls out.  We restart it.  Aamod drops me off in Pokhara.

Good night.

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The WorldEdge Restaurant

 

Now and then I realize I have a collection of items that are too good not to share but have been too random to include in other posts. I present you now with this summer’s collection, the Worldedge Restaurant.

1. An old lady tending to a street a cow.

As deities, cows freely wander the streets of Nepal, and there are a number of regulars on the stretch that runs between Jarebar and Lakeside. They rummage through the gutters and depend on the kindness of strangers. One day I noticed this old lady attentively grooming one of these gentle animals by the side of the road in the middle of the afternoon.

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2. Paragliders sailing over the valley.

I snapped them one day on the bus ride home to Kaskikot.

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3. Hotel Touch Nepal Worldedge Restaurant

I walk past this establishment each night on my way home, and either nobody was able to reach consensus about which words to include in the business title so they went for everything, or they just have a bit of confusion regarding core mission. In any case, I’m thinking it’s probably best not to use Hotel Touch Nepal for lodging purposes.

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4. This shop of things made entirely out of tin.

Such as storage chests, chimneys, and watering pots.

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5. Pascal and Aidan entertaining themselves at home while the electricity is out.

Because you need power to charge things, but not to dance in the dark.

 

 

6. Aamod’s Shrek Bike

When Aamod puts this cover on his motorbike each day outside the office, it convincingly resembles Shrek. Unfortunately I failed to photo his actual motorbike every day for two months, so on the last day I tried to recreate Shrek on a bicycle, which is why he looks a little anorexic.

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7. A plant lake

During the summer, Phewa Lake apparently becomes so sodden with greenery that it turns in to an enormous garden with boats in it.

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8. The Delhi Airport

Officially and unequivocally the most lavishly decorated circus of an airport on the globe, today’s edition of the Delhi airport brings us this buoyant use of indoor space, and these bottle holders – or something – in the airport hotel fitness center.

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9. Aidan practicing his martial arts during a golden rainstorm.

Life is beautiful.

 

 

Sindure Signs

 

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

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

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

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

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

Well, the best part is yet to come.

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

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

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


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

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

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

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

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

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

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

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Now then…nothing like showing off your new filling!

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

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

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

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

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

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

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

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

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

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

Once I saw it, I couldn’t not see it.

 

 

 

 

 

 

 

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

Welcome to Sindure, world.

*

A Life of Love

A Life of Love

Waiting Out Rain

 

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

Just wait.

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

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

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

Ok, just wait.

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

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

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

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

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

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

And then…just wait.

*

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Moving Still

 

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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Memorable Trips

 

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