Another Room in Heaven

For someone who has spent 15 years in Nepal, I’ve travelled very little in the country, choosing instead to burrow further and further in to a single community, a single home, a place where now twelve year olds have always thought of me as a part of their world. It was only a few years ago that I suddenly thought: I’d like to explore. I’ve started stetting aside a few days every few years to go climb out on a spine of rock some place, in some location that percolates on a back burner in my mind until it bubbles over and asserts itself: this is the time, go here.  Then life adapts around it.

The Way to Muktinath

One way to travel is to go to see things that are new and unfamiliar and exciting or challenging – like that time I went to Murad Khane in Afghanistan, or when I floated in the Dead Sea, or the month I spent in New Orleans doing oral histories for StoryCorps after Hurricane Katrina.  But this is something else, a magnetic pull to a place that is already inside me, a dot on a primal map created a long time ago.  In 2013, Prem and I went to Mardi Himal by a little-traveled route comprised largely of goat trails snaking along a blade of snowy ridge that rims a basin of Annapurna giants. It was winter, everything wide and blinding, the sunrise spilling pomegranates and mandarins and pineapple juice all over the jaws of the cold earth. When I got there, it made sense.

Now it is summer. Muktinath sits north of Pokhara between Lower and Upper Mustang, a stone’s throw from the Tibetan border, and houses a famous complex of Buddhist and Hindu temples. For some time now I’ve been pulled north, toward the areas of Nepal influenced by Tibetan culture, and also where the landscape climbs up and stays high, where the trees fall away and leave a desert mountainscape that stretches off to the Tibetan plateau, a mystery, an uncrossable border. In the winter even local residents often come down from Mustang to the valley to escape the unforgiving snow and cold.

Prem Bhinaju and I met a bus by a curb in Lakeside early on Friday morning. It was headed to Jomsom, which is only a 15 minute flight from Pokhara, but unlike crystalline winter, the summer is dense and foggy and flights have not come or gone from Jomsom in a week. That leaves us with what should be a ten hour bus ride. You know where this is going.

There’s the obligatory 2.5 hour delay when a bearing that has to do with steering left needs fixing, and magically, the Bagloon Highway presents an auto shop strewn with hulking shells of buses and tractors and cars and unidentifiable transport components, so we pull over to fix the bearing. We set off again around noon under ten-ton heat, but I am relieved to be on the move with my day pack and with Prem, my most familiar travel companion. The road winds upward and the Kali Gandaki River drops below us, black and rumbling with coal-colored silt that will settle by the time the torrent gets to in Pokhara, where it is called the Seti Gandaki, or White River. The road becomes a road story that I can’t tell because my mom reads this blog, but even passengers local to Jomsom are praying and squeezing their eyes shut while we loll side to side on a road that, from afar, looks like a child dragged a pencil across triangles of high mountain forest and then got distracted with a sandwich. In the end, aside from knuckles white from clinging to the seat in front of me as if that can save me from a long descent in to the Kali Gandaki – one of the deepest gorges in the world – I come out fine. Prem and I arrive in Jomsom at 7:30pm.

I know I’m in Nepal, but Jomsom looks like a ski town and I have to keep reminding myself that this is Mustang. We clomp along a stone-laid main street with quaint local shops and hills rising up behind them. In the U.S. we’d call the hills mountains, but in Nepal, the mountains are the sheared white rocks twice as tall that are currently lost in monsoon cotton one row further back on the horizon.  It is hard to believe anything could tower over the already looming hills – I remember thinking the same thing at Ground Zero, knowing that Lower Manhattan’s massive skyscrapers had been dwarfed by the Twin Towers.  It is impossible to imagine land up in the middle of the sky, but I know Diligiri is there, behind the clouds, a thousand stories high.  We settle in at a hotel.  Local plum wine.

Our walk to Muktinath starts the next morning and takes two days, one long day up and one long day back. We walk along the Kali Gandaki in a landscape created contradictorily by the upward smashing of tectonic plates and the downward gouging of receding glaciers. The result is a desolate, heaving geometry, eons of history piled atop one another and laid bare straight from river to the sky. Dwellings impossibly carved out by people who once migrated southward from Tibet are clustered in the sweeping rock face, and the occasional modern village is a patch of irrigated greenery in a borderless expanse of brown. This should be the province of giants, but we are just tiny people, our feet sliding over bazillions of even tinier rocks, where fossils casually present themselves because nobody has owned them yet. They were once underwater and they have been here forever and ever and ever.

The climb starts. No houses, no villages, no ancient dwellings for hours. Prem Bhinaju finds a fossilized creature with gold flecks in it. Uncharacteristically , I haven’t exercised in weeks and my legs feel like playdough, but it’s cool. I have an actual fossil in my pocket.

We arrive in Muktinath around five, eat something, and rest for a while. Then, because tomorrow will be a long day and we’ll be pressed for time, we go out to explore the area around the outside of temple complex.  That will leave us time to go to the temple itself in the morning.  I leave most of my things behind except for my SLR camera and rain jacket. Now that it’s evening a slight mist is drifting downwards, uncommitted to getting us fully wet. Dusk turns dreamlike and enchanted.

Prem says we’ll walk up to the place where the path to Thorong-La pass starts. We would need a whole extra day to get to the 5,416m pass, but there is time, at least, to lay eyes on its direction. We circle the wall of the temple complex, and two nuns are just leaving, one wearing hot pink sneakers. I ask if the nuns if they were born here in Muktinath and they say yes, and even though that is a completely unremarkable fact, to me it seems incredible because I am so far away from the world I know. They bustle off to the nunnery.

We climb quietly past parts of the complex wall that have cracked and broken in the earthquake two years ago, and emerge in a widening field that slopes upward and disappears in to a fog. “The way to Thorong-La,” Prem says. He says we are at 2800m. I say, obviously, we should walk up another 200m, so even though evening is turning denser, up we go in to the haze.

Some ways ahead, a walking bridge is slung across the gorge to our left and we climb until we reach the concrete block anchoring the bridge to the ground on our side of the river. Without any comment, Prem sits and I follow, and then I lie back and stare in to the unremitting white sky. No variations in density or color, no dragons or bears or wizard faces, just an endless, depthless white.   Further up the green rocky slope, on the other side of the embankment of fog, is the path to Thorong-La; below us is everything we’ve come from.

Quiet.  I am filled with a profound gratitude for Prem’s company, his silence, the easy way we can walk up to this concrete block and sit on it at dusk and do nothing at all.

After fifteen minutes, I decide to cross the bridge, for much the same reason we walked up 200 meters. We’re on one side of a bridge, so it should be crossed.  The first step out over the edge ofthe gorge sends a thrill through my nerves, and then out I plod out over the wires, which undulate a little with my steps, until I am standing directly over the water gushing down from the high mountains.  A thunderous cloud of sound rises up through my bones and engulfs my senses; I can barely hear my own breath. It feels like the river is running right through me, and when I shout or chant the water picks up the sound and rumbles away with it taking my voice down down down down to all the places we were.

The instant I step back on to the concrete block the mountain silence envelopes me again; magically, the roar of all that water is audible only between the walls of the gorge. Prem takes a turn on the suspension bridge, and then we head back down the green slope and circle around the other side of the giant temple complex.  Night is creeping in slowly, as if stalling a little to give us just enough time to see one more wonderful thing.

We come to an area of the hill I have been viewing from below in the mist: rows and rows and rows and rows of prayer flags strung behind small white structures scattered high up on a hill. I studied Tibetan Buddhist funerary rituals for a course I took this year, and throughout the evening, my sights have been trained here. When we passed the nun in the hot pink shoes, I pointed this way and asked if it was okay to pay a visit. She said yes. Prem and I make our way over the hill toward the fluttering prayer flags.  He walks down toward the road, and with barely a word, I go up.

I’m expecting to see signs of sky burial, but I realize quickly that this is a land burial site. Everything feels unified and still, but also light and high. There are small cairns everywhere, placed for passed spirits to find refuge to heaven, and as I walk between the grave sites, it suddenly occurs to me to ask Prem, still at an audible distance, if he thinks I could build a cairn. Why not, he says, and sits down on a rock facing out over the endless prehistoric topography while I climb higher up and find a patch of ground abutting the faded squares of color calling tut-tut-tut as the wind tugs them from their strings.

Prem never asks why. He just waits.  And when I have built it, a stack of stones among all the stones and fossils, another room in heaven, and when I have sat over it and cried for some minutes, I walk down the hill and we leave.

Night falls at last.

 

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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.”

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Wanderlust, with “Trespassing!”

 

So the other day, a friend posted a Luftansa ad on Facebook with the caption, “this is the Nepal I love!” The post popped up in my feed, although it had nothing to do with me.

I clicked on it. The ad follows a Nepali fashion designer from New York back to Nepal as part of a “wanderlust” ad series by the airline. She goes to familiar places in Kathmandu, and then poses in front of the Annapurna mountains. And then, she eats a meal with some women who start to look very familiar – so familiar that I don’t recognize them in this context. And then, a teenage boy runs off of the roof of a house. His feet patter over the corrugated tin over our kitchen, which I had installed last summer to fix a leak over our cooking fire.

THAT’S MY HOUSE!!!! I start yelling. Luftansa decided to make an ad about wanderlust, and out of the ENTIRE GLOBE, they picked MY HOUSE IN NEPAL!!! I watch again. You can see Aamaa sitting right there on the porch with a white towel on her head. Have a look for yourself:

The colors of home – LUFTHANSA?!  I don’t think so!  Aamaa and Bishnu and I painted those colors!!  As my friend Bess says…trespassing!  You guys, this video has well over 3 million views.  Now, next question: who has a friend at Luftansa?  I think we should look in to a new corporate partner, no?

Go ahead and send your ideas my way…laura@jevaia.org.

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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Meticulous Serendipity

I’m already in the last week of my visit, and as usual things have flown by too fast.  This monsoon has been more spirited than last year’s, blanketing us in torrential downpours every night and through each morning.  Finally this week the weather seems to have calmed down, but I’m missing the cool and comforting feeling of the rain closing us in with its clattering and clanging.

The main focus of our summer has been a new foray into the world of health care advocacy.  We have a model for rural dental medicine, and we want Nepal’s government to fund dental clinics in all of its village Health Posts.  Our idea is that if the government would set a standard at which it will finance rural dental services in the national health care system, then the global development industry will start doing what we’ve doing: training, mentoring, supervising and auditing rural dental technicians so they meet the standard (which we can help define).  As far as I know, we’re the only organization in Nepal working on this particular topic in this way.

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Salyan Dental Clinic at the Salyan Health Post

Like many developing world countries, there’s a complicated and often mutually distrustful relationship between the aid sector and the government of Nepal.  This largely results in aid agencies privatizing their projects as much as possible; I’ve done this myself, because it’s easier to just do something right yourself than manage a hassle of hectic and sometimes exploitative bureaucracy.  Mean time, weak governments spin out more and more self-serving regulations against a flood of foreign funding that is trying to silo itself.  Ultimately, it’s development itself that suffers, as decades-old aid industries, still chasing down base level poverty, make apparent.  So something that excites me about what we’re doing now is that, setting aside dental medicine itself, I see the process we’re in, if it works, as a strong example of effective collaboration between the private sector, which is great at risk-taking, innovation, and raising money, and a developing-world government, which, at least in Nepal, is by far the best option for scale and stability. I like to think this is a version of life where we all do what we’re good at, with respect for the reality that we need everybody if we’re going to think big and get somewhere.

Now then.  Should you choose to work on rights-based health care policy in the developing world, which you might have been considering, here is your primer on how to get started (after refining your particular service of choice for 10 years).

Our advocacy happens at three levels, beginning with the village level, where we’ve been pushing for permanent local government funding.  This is not for the faint of heart and best suited for people with a good sense of humor.  You’d better be down for a ride that’s 90% culture and 10% policy, and heavily focused on navigating relationships, social dynamics, and weather.  The village level is where we’ve focused most in the past, so we’re reasonably adept at this…except that the reality is that institutional services just aren’t very stable at this level.

Next is the district government, where we’ve previously had only very simplistic coordination, such as required letters to required people.  But it’s the district government that sanctions and distributes village budgets, so without support here, it’s a lot harder to get anywhere at the local level. The other day we had a District Coordination Meeting where our program director and I presented (in Nepali!) on the role of the government in extending our oral health care model to its predominately rural population, filling a gaping hole in the primary health care system. This meeting exceeded our expectations – we received a lot of positive feedback and useful criticism.  I was lavishly complemented, of course, on my village accent.

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Lastly, the day before I leave Nepal, we’ll have our first workshop at the central level in Kathmandu, and with this, we’re leaping in to completely new territory.  But this is ultimately where it’s at: it’s the central government that fixes funding priorities and distributes earmarked budgets through the national health care system.  Recognition of our model at this level would set up a standardized place for rural technicians in Health Posts, providing a framework for agencies with a lot more money to invest in creating rural dental technicians who can then be permanently staffed by Nepal’s own government.

We’re feeling emboldened and encouraged after learning a lot from each and every meeting we’ve had so far.  Despite my own resistance in the past to clunky public systems, at this stage of the game, I’m finding some of the cumbersome government procedures to be oddly reassuring.  They give us steps to take.  We’ve met some very decent and hardworking public officials over the summer, even if they receive us with skepticism and give us some hard knocks. I think this has actually grown our confidence.  We can wait for the meetings, answer the questions, submit the documents, do all the things, because we have confidence in our product.  There’s also the humbling reality that the government has plenty of reasons to be cynical of the social work sector, so if we have to prove ourselves, that’s fair.  It’s forcing us to be both meticulous and more adaptable…eventually, we’re responsible for creating our own good luck.

Besides that, rice planting season concludes with a wonderful festival where everyone puts on green bangles and paints their hands with henna.  Kaskikot’s premier henna-drawer has become none other than yours truly.  What did you expect with an activity where people let you doodle on them with temporarily-staining plants?!  Govinda’s porch had an hour long wait for these skillz on Saun 1.

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The best thing about the henna designs is that you start with an idea, and then it becomes a meditation that designs itself, following a pattern in the creases and borders of someone’s palm, incorporating smudges and wayward marks in to unexpected flowers and vines.  You just can’t say before you start exactly what you’re gonna make.

Doodle doodle doodle…

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Saun Sakranti

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Each year, at the end of the rice planting season, on the first of the month of Saun, we submit to the explosion of greenery, the ebullience of the insects and heat and unrelenting rain. On Saun Sakranti, women slide green bangles onto their tan arms and people spend the day decorating their hands in henna patterns. Didi says this is because it’s supposed to keep snakes away in the fields. (Therefore I’m thinking of petitioning to make this practice a more regular public service?)

In case I haven’t made it clear that I’ve gotten really in to henna drawing, it’s one of my favorite things ever. I don’t know why I didn’t discover it sooner, but last year our Gaky’s Light Fellows introduced me to this awesome activity during some of our evening hangouts. Since then, I’ve practiced my henna doodles on anyone who will let me.  Plus anyone who can be convinced.

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Which makes Saun Sakranti pretty much the greatest festival ever, although I realize I say that about almost every festival and celebration in Nepal because so many of them are colorful, awe-inspiring, or loud and joyous.

On my way up to Kaski for Sakranti I collected up some green bangles and a few packets of henna. I had a date with Sulochana, Govinda’s 13 year old daughter, who pleads with me to put henna on her every single week. With such a fast rotation of new designs she’s become a IMG_8914walking advertisement, and some of her friends have been waiting their turn for a few weeks now. So when I got to Govinda’s house mid-afternoon on Saun Sakranti, there were some eager customers waiting already.

Once I started though, more people just kept coming. Mostly kids, but a handful of adults too – one sweet auntie waited for an hour and a half. I ended up doing this for almost three hours! It
was so much fun! And, I must add that 99% of the things I try to do in Nepal are initially met with unwitting displeasure at my incompetence – unfortunately, my skills at cutting grass and sifting grain and plastering houses and planting millet, and a few other things, were not well practiced at age 22 when I started trying them in public – so being received as the uncontested henna queen of Kaskikot was, I admit, a hard-earned affirmation of ego.

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And it’s pretty.

Happy Saun Sakranti, everyone!

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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.

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A Life of Love

A Life of Love

The Video Nepal’s Been Waiting For

 

In thirteen years, I have spent at least one of every season here.  I’ve cut rice and planted millet.  I’ve harvested wood.  I’ve cut wheat, and planted corn and churned milk the old fashioned way.  I’ve chased the chicken around and painted the house for Dashain.  Most of these things I’ve done multiple times, and believe me, I received plenty of impassioned feedback as I tried them out.  These are all activities people in rural Nepal learn from toddlerhood.  Seeing a grown woman who can’t flip a pan of rice grain properly is basically impossible not to comment on.

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I’ve pretty much learned a lot of these things because I absolutely insisted on doing them terribly while I figured them out.  In some cases, I’ve really earned my stripes.  In others, let’s just say that people have become happy with the American version of, for example, collecting water.

But there’s one season I’ve purposefully avoided, and it’s the rice planting one.  Even tasks I don’t much enjoy, such as those involving fertilizer (i.e. buffalo poop), are things I have determined to throw myself in to.  It’s like how, when I used to take winter diving lessons, we had a “fun day” where we got to use all of the diving platforms at Montgomery Aquatic Center, and that meant that, for fun, I had to make myself jump off the petrifying 10-meter platform that was level with the third-floor spectator section.  I absolutely hated fun day.  But it never remotely crossed my mind that, if the 10 meter platform was available, I wouldn’t jump off it.

This brings us to the topic of the hot, buggy, wet rice planting season.  I think you get my point.  I stayed in the U.S.  No fun day.

It’s not like this was very clever and nobody noticed.  Every year I am asked when I will come to plant rice.  People will list all of my accomplishments to date, and exclaim as to how I have never participated in this one activity that is so central to the culture and basic survival of Nepal.

Ok, so here it is.  I determined to jump off the 10-meter platform this summer.  Partially because as you get taller, it doesn’t look as high.  I over came my distaste for the idea of the monsoon last summer, and this summer, I appreciate the torrential rain tremendously.

So last weekend I joined Saano Didi’s family in their rice paddies.  Govinda’s daughter Sulojana came with me.  And the amazing thing about waiting 13 years to do this: not one person cried out at how terrible I was at planting rice.

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“You have to teach her, sikaunu parchha, you have to teach her,” all the ladies cooed.

Silky mud, bright clothes, plants in your hands.

“Laura, you’ll be back in November, right?” Neru asked.

“Yep.”

“Because that’s when we can eat this rice.  Make sure you’re back.”

 

 

 

Puranchaur Clinic

 

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

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

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

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

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

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

See for yourself:

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

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

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

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

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

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

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

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

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