Tag Archives: covid-19

Around Town, Kaskikot, Nepal Life, Reflections

The Olympics of Self-Quarantine

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 So for now, thanks for reading along as I catch up on unpublished entries from the intervening time.

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

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

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

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

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

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

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

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

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

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

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America, Around Town, Earthquake, Kaskikot, Nepal Life, Reflections, Work

A House of Mirrors

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

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

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

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

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

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

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

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

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At the Base of a Tree

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

At five cicadas were interesting, like figs.

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

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

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