Between the Corn and the Millet

I try to imagine Aamaa’s life as it was back then, when the water springs in Kaskikot weren’t concrete taps but delicate pools that stirred up silt if you took from them too quickly. As a girl and young wife of 13, she sometimes had to sleep overnight in line while other women had their turns gently lifting the water jug by jug. By the time Aamaa was 22, she was a widow with two young girls of her own, and it would still be years before a bus came to Kaskikot, or a door was put on the entrance to her one-room house.

There have been many impossibles in Aamaa’s life. She raised two educated daughters who could split wood and carry twice their weight by grade school. The civil war started, but it was elsewhere, in other villages. The electric mill came; the bus came; the tourists came; other people converted their houses to homestays and restaurants. Aamaa’s house is off the road in a cul-de-sac of mountainside that nobody wanders past by accident. Even after some foreigners bought the patch of land on the hill behind the house and built a fancy hotel there, passers-by from Korea and Israel and Japan and Australia hiked past with their eyes straight ahead on the sprawling white peaks, rarely looking down to notice Aamaa and Didi and Bishnu there in the sunny yard, drying grain.

The likelihood that I would wander through the door one day has always seemed both insane and inevitable.  And over the last fifteen years, I’ve mostly thought of my life opposite Bishnu’s.  We were the two girls born at the polar ends of the universe, the ones who looked at each other and thought, what if I were her?  She’s been in the U.S. for eight and a half years now, while I spend significantly more time in Nepal than she does.

Aamaa was always more like the soil: everywhere, earthy, constant, essential.  She has all the nutrients and produces all the food and water and shelter.  Aamaa keeps the house alive, the field and gardens fertile from cycle to cycle, the fire crackling.  No matter how many people show up, Aamaa feeds us all. And no matter how many people go away, no matter how empty this house gets or how many of her birthdays pass, she keeps the water jugs full and the seeds sorted in dusty bottles. Aamaa has spent five decades in this village.

I had no idea Bishnu had applied for Aamaa to get a tourist visa to the U.S. to see Bishnu graduate from her Master’s program in information technology. Nobody told me that Prem and Didi took Aamaa to Kathmandu for the very first time last May to go to the U.S. Embassy, or that on the way there, Aamaa didn’t eat any cooked food because she couldn’t be sure who had prepared it. A few weeks later, I answered my cell phone in the parking lot at Walmart, and Bishnu announced that Aamaa had been given a five-year multiple entry tourist visa to America.

“What?” I said.

“For my graduation!” Bishnu explained ecstatically. She hasn’t seen her mom since 2013.

This explanation seemed failed to explain all the questions I couldn’t think of.  Obviously the idea of having Aamaa make this trip has floated through my brain millions of times, but it was the ultimate what if ever.  The craziest version of everything.  Part of me thought that maybe this was all kind of a whim – a thing that might happen next year, or something. But Aamaa had sold the buffalo within a week.

On my way to Nepal in June, I tried to imagine having Aamaa with me on the way back. First I tried to digest the most obvious and superficial matters. For example, how would I explain the enormous statue of a teddy bear bent over with an apparent stomachache dramatically bottom lit in the Doha airport?

I can’t even explain that to you.

When I arrived in Kaski, everybody’s greetings had adjusted to the most up-to-the-minute state of affairs. “Laura! You’re here! How long are you staying? So, you’re taking Aamaa back with you, eh?”

Only Aamaa and I seemed cautious and uncertain with our excitement. The whole thing is so surreal that even the discussion feels like an entirely new and foreign continent. For fifteen years Aamaa and I have had what is now a very well established routine: I come to Kaskikot, we eat together in the kitchen, we go plant things with neighbors and churn milk and carry water from the tap, I fix up some things that need fixing in the house, we gossip about family here in Nepal and all the far away people not in Nepal. Aamaa knows them all – my whole extended family and a good number of my friends who have been to visit – largely through stories. But she’s the stable point, not just for us, but for herself also.

“So we’re going to America, huh?” Aamaa says as we are sitting on the porch, as if testing out the statement.

“Sure seems like it, right?”

We stare out at the tall curly corn stalks, crowding out the grassy millet that’s planted between them.

“What is the name of your District?”

“Pascal, do you know how many states there are in the U.S.?” I ask, and he doesn’t know, so I explain again about Virginia and Maryland and Connecticut and North Carolina.

We discuss departure dates because I have to change plane tickets that currently have me going home from Cambodia, where I’m visiting Bethy in August; Amaa knows Dr. Bethy, because she’s been here too. We mull over how long Aamaa’s trip to America should be. A month would probably be good – she might be bored after a month?

“I’ll go after cutting down the corn, and I’ll come back to cut down the millet,” Aamaa suggests with sudden firmness.

That seems good, I agree.  That is more orderly – maybe because we can see the corn.

Long silences. What, exactly, should we should be planning?

“Bishnu suggested I should get some kurta salwaars made,” Aamaa says. “I guess you aren’t really allowed to wear a sari in the U.S.”

“You’re allowed Aamaa. But a kurta salwaar might be more comfortable.”

“Ok we’ll plan a day to do that in Pokhara,” Aamaa states. “I guess we have to leave time to have it stitched and everything, right? We should go soon.”

“It only takes a couple days, but we can go soon.”

“Nah, you should just pick something out and I’ll meet you at the tailor,” Aamaa adjusts. “I don’t know anything about picking fabric.” Honestly, in sixty years, Aamaa has never walked in to one of Nepal’s fabric shops and picked out material for an outfit, which is how literally everybody in Nepal gets their clothes.

“No no no,” I insist, “I think you should definitely get to do the fabric choosing. Pick your own color, something you like.” I have to talk her in to it.

A few weeks later Aamaa takes the bus to Pokhara and waits for Pascal and I to come meet her at a chautara in Chiple Dunga. She can find her way to Didi’s house, but for the most part she prefers assistance to get around the city. Between the three of us, Pascal is the only one who can properly read in Nepali. We set off up the road to go to the fabric shop.

Laura chiama, let’s have some ice cream,” Pascal suggests wisely, because I am the sucker who will pretty reliably buy us all ice cream. As we pay, Aamaa has sat down on the low wall at the foot of the store, which is not a seating area, and Pascal and I go with it. I hand Aamaa her first ice cream cone.

“Do I eat this bottom part, the biscuit?” Aamaa asks.

“Yes, but don’t eat the paper,” Pascal instructs.

“I’m not going to eat the paper,” Aamaa says.

I can’t even remotely transpose any of this to Connecticut. I ask a passer-by to take our picture, and as you can imagine, she looks at the three of us – the Aamaa who has very obviously just beamed in from the village, the entirely incongruous American, and this regular Nepali boy being raised in the city – and gets a huge grin as she takes our picture. What could our story possibly be?

We set off again. Aamaa has brought along a broken umbrella from the house. “Laura, where’s a place that we can fix this umbrella?” she asks. I blink, there must be an answer to that, but I’ve never thought about an umbrella-fixing place.

“We should probably just replace it,” I say, feeling guilty for my wastefulness and mental laziness. I don’t have the energy to try to figure out where the umbrella fixer might be and there’s really no excuse for it.

As we wander to the center of town I’m distracted and disoriented because everything is inside out. When I first came here I couldn’t say a word or do a single thing for myself, and in Kaski, Aamaa runs everything.  We get a few kilometers off her turf and suddenly she is the foreigner and I’m the one who knows what we’re doing. She has also brought with her a heavy bag of cucumbers and other items for Didi and Bhinaju and the boys, and she’s carrying it on her shoulder, the way people do in the village where nothing is flat.  Pascal is twelve and he goes sprinting out in to traffic as we cross the street and I pay him no heed whatsoever because I’m dodging people to keep eye on Aamaa, having no calibration for how much I do or don’t need to hover over her in traffic. We probably haven’t walked through the city together more than two or three times in a decade and a half, and never just us – not once.

We arrive at the fabric shop.

There are hundreds of colors and textures of cloth to choose from. Aamaa looks hopeful that I will take over. As a young man begins removing options from the shelf she bends over them. He throws one on top of another and another and another and another. Her hands settle on a jubilant orange outfit.

“I like this one,” she suggests. She looks at me as though asking if that one is a good one to like.

Within ten minutes, Aamaa and Pascal and I are pawing through dozens of kurta salwaars, trading opinions on what Aamaa should wear in America. She picks two, and we take them to the tailor, who takes out his tape measure. He’s going to make something just for her, in her size and shape, to wear between the corn and the millet.

“I think you should do short sleeves,” I say. “Definitely short sleeves.”

“I don’t know – I think they should be a bit longer. To the elbow,” Aamaa says. The tailor agrees – maybe longer sleeves for an Aamaa. No way, I say, short sleeves look best on a kurta and it will still be hot in September. Aamaa studies her arms for a minute, apparently imagining them in a very standard piece of clothing she’s never had.

“Yeah. That’s how I want them,” she concludes. “To the elbow.”

*

Lifts

 

The bus to kaski is very hectic right now: in addition to the heat, and the rain, the road has been sporadically damaged by flooding and landslides.  After last week’s sweltering ride with Aidan and Pascal, I decided that this afternoon I would try getting a ride with Nabin who lives up in Parapani and drives a taxi.  He’s always willing to drive me home at the end of the day for a pretty good price, rather than drive his car back up to Kaski empty.

I called Nabin on Tuesday to fix our plan, and then rang him up again as we were leaving the office at 5pm on Wednesday. He picked up, but the connection was bad and I couldn’t catch what he was saying.  I decided it was “I’ll call you right back,” and then I hung up.  I texted to say I’d be ready at 5:30, and went back to my room to putter around on the internet for a while.

I called Nabin at intervals but he didn’t answer.  The clock drifted past 5:15, then 5:30, when the last bus leaves from the bus park for Kaski.  At 5:45 I thought, I better move out if I’m going to get to Kaski today.  If I couldn’t get a hold of Nabin, I was already stuck making the hour long walk from Naudanda – potentially in a downpour, in the dark – because the last direct bus had left already.  I put on my backpack and walked out to the main thoroughfare running to Lakeside.

One advantage of being a foreigner is that you can do things like stop a random guy on a scooter and say, “Hey, would you mind just taking me up to the next intersection?”  I stopped a random guy on a scooter and asked him to take me up to the next intersection.  I hopped on the back of his bike and as we approached the intersection, I shouted over the wind, “So where are you headed?”  The guy was headed straight on to Pirthivichowk, and the bus park was up a road to the left, so I thanked him and said I’d hop off there.

“Oh what the heck, I can take you to the bus park,” the guy said, and turned left.

I’ve never tried this strategy for lift-getting before, ever.

As we drove up the road to the bus park, the guy said he’d served with the US Navy in Bahrain for eight years.  I didn’t even know that was a thing – is there water in Bahrain? – how to Nepalis end up in the US Navy? – and he told me more about it, but I couldn’t hear him over the wind in my ears and the honking traffic, so all these things remained mysteries.  Back in Nepal, he wasn’t doing much at the moment, he said.

“So where are you headed?” the US Navy guy asked.  I explained about Nabin, and about getting to Kaskikot tonight, and that I supposed I’d walk from Naudanda.

“Oh what the heck, I’ll put some gas in the bike and take you up to Kaskikot.”

“What?”

“Why not, I’m not busy.”

“But that’s really far!  It’s probably 45 minutes on the bike.”

“No problem.  I’ll just get some gas first.”

“How much will it cost?” I asked, wondering if that was the least of the confusion.

“No cost.”

“But – but – but……”

The guy pulled over to get gas.  I pondered the situation.  The next bus to Naudanda might not leave for another 30 or 45 minutes.  It would be dusk, if not night, by the time I arrived in Naudanda, and then it might rain, and I’d have another 60 minute walk.  It seemed like I should be worried about why this stranger wanted to take me up in to the hills at dusk to a place he doesn’t live, but I wasn’t.  I tried to get worried and instead I thought, “Wow, it would be pretty great to get a scooter ride up to Kaskikot right now.”

“Ok, let’s go,” I said.  I determined to give him some gas money, at least.  Also, I have a black belt in taekwondo.

For the next half our or so, we rode up the switchbacks, watching the valley recede in to the hazy, rose-tipped blue of evening.  The day fell away below as we climbed up in to the hills.  I cinched the hood on my rain jacket to provide a little wind protection, but the guy was a reasonable driver and the breeze from the movement felt good. Occasionally I stuck my arm out in the direction of the beautiful scenery, as if it was some kind of compensation I could offer for this inexplicable act of generosity.

We came upon a sloshy patch of suspicious looking mud and disembarked.  The two of us regarded the scene: a pit of soft mud with the gash of a thick tire through it, left by something much larger and heavier than the scooter, and surrounded by pools of brown water.

“I can walk from here,” I said.  I was feeling kind of guilty.  “It’s only about half an hour or so. I’d have had to make an hour walk from Naudanda.”

“Still half an hour of walking?”

“I’ve walked from here many times,” I insisted.  “It will be a real mess if your bike gets stuck.”

The guy looked concerned, partly with the matter of my walking, and partly with the oppression of humans by an inert patch of mud.

“Please let me contribute something for gas,” I offered.  He declined.  He had time on his hands and it was a pleasant trip.  I thanked him, asked his name, and we took a selfie.  Raj Kumar Gurung.

A motorbike came up behind us with two young dudes on it.  They sped over the mud pit.  Raj Kumar Gurung looked from them back to his scooter.

“Let me just give it a try,” he said.

“But if–”

“I’ll just try it.”

Raj Kumar Gurung, US Navy, revved the scooter and launched it in to the mud pit.  It rolled through to the other side.

“I’m coming!” I said, and stepped directly in to sucking mud-slosh the consistency of hummus up to my ankle.  “Be right there!” I cried, rinsing off some of the brown hummus in a puddle, and then in a clear stream that had had developed across the road on the other side of the mud pit.

Raj Kumar Gurung said that instead of returning back to Pokhara the way we’d come up, he’d continue straight on past Deurali and meet the road in Naudanda.  At this point, he was going to drive past my stop regardless.  I decided to get off a half mile or so early to stop in and say hi to Thakur sir, one of our founding oral health program members, and I insisted that Raj Kumar Gurung at least have some tea before continuing on, but he demurred again.  Off he sped, having lifted me directly from Lakeside to Kaskikot just as night was falling.

*

 

 

 

 

 

 

 

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:

Trench Number Two

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.

*

 

 

 

 

 

 

 

 

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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