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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The Obvious Practicalities

 

The other day I came across a dazzling, haunting article in the New York Times. The Lonely Death of George Bell opens with a chaotic photo of George Bell’s apartment. He was a hoarder, and until you look at the photo directly, it meets you more like a cubist painting than a photo of an apartment: an angular, colorful, dump.

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The story follows a public administrator in a bleak office in Queens as he searches for George Bell’s next of kin, distributes George Bell’s assets, makes arrangements for George Bell’s cremation and burial. These tasks unfold in unceremonious anonymity – in fact, a significant amount of procedure is devoted to proving George Bell’s body is George Bell. No friends or relatives come forward to identify him. He was discovered in his apartment only after neighbors called to report the stench of his lonely end. This is the story of thousands of deaths in New York City every year.

To me, the article itself serves to witness and exalt George Bell’s silent passing, as well as what might have been among the most authentic feature of his life: isolation. In a way it is a glorious tribute, nearly impossible to look away from.

As you will see from the letters at the bottom, not everyone agrees.  But I was taken with this rare and unapologetically voyeuristic look at the mechanics of death in its most cold and undignified form.  In Western culture, we rarely visit death undressed. Jobs that in other parts of the world – certainly in Nepal – fall to the community in an old and well-traced set of patterns fall for George Bell to the Queens County Public Administrator.

George Bell’s situation is extreme, but it in other ways it simply exposes a shared fear and denial of death in the West: how the body, sacred in many cultures, is foreign and terrifying to us once it is dead.  It must be managed by professionals, or at the very least, out of sight, and as a society we treat any honoring of the spirit as a bonus round after the paperwork has been completed. We take this for granted, as if it is obvious because it is practical.

When I happened upon The Lonely Death of George Bell this week, I was editing a radio story about young widows in Nepal. The piece is about how widowhood rituals are changing for young women, and features 21-year Bishnu Pande, whose young husband died while working in Qatar. He never met their six month old daughter.

This topic is close to my heart, because historically, young women who lost their husbands have been forced to live out lives of ritual mourning, and Aamaa is a direct result of these traditions. She hasn’t worn the color red in 35 years. There was never any question of remarrying. Her husband’s family didn’t entirely abandon her, but they’ve done little to help her. When I arrived in Aamaa’s life, her daughters were in their early twenties, and her identity as a widow had long since blended in to the larger idea of her. I have always known Aamaa just as who she is, not as a woman bereaved. She has good friends, and people to look out for her, and she goes to weddings and dances.

And yet, for all practical purposes, Aamaa has lived a life of ritual widowhood. She is alone. Dancing is on limits, but ritual celebration – wearing sindur powder, receiving celebratory tikka, red clothing – are forever out. Moving back to the home where she grew up is out. A new marriage is definitely out. Her role in society is that of a woman who lost her husband, and has been since she was a 23 year old girl.

That will not be Bishnu Pande’s story.  But something will be.

So today I come across George Bell while editing a piece about Bishnu, having spent over a decade as part of Aamaa’s life. And it’s clear that what is obvious is not just what is practical. And neither is the ritual discipline that Aamaa observes. The obvious is just what we’re used to. Our treatment of death seems inevitable because it stems directly from our collective, subconscious attitude toward life, toward the nature of existing. Which can span the range of possibilities from Aamaa to the Queens County Public Administrator.

I feel like these hours I am spending with Bishnu Pande in my ear come at a time when  she and I are both somewhere in the middle. We’ve approached this crossroads from opposite sides: I from New York, where George Bell died, and Bishnu from Kaskikot, where Aamaa’s husband died. Her culture is learning to shed ritual, and I feel that mine has lost something vital and is scrambling to get it back. It’s like we’ve bumped in to each other in the middle of some misty dreamscape, each of us missing someone and renegotiating the collective attitude we’ve been taught.

Some letters to the editor have already been posted the article on George Bell. One says:

At first I wondered why “The Lonely Death of George Bell” was on Sunday’s front page above the fold. As I got into the article, I couldn’t put it down…Mr. Bell’s sad experience reinforced for me the importance of reaching out to relatives, friends and all those in a situation similar to Mr. Bell’s so that they have dignity in their final days. He deserved better.

And then another:

What could possibly justify this callous violation of George Bell’s privacy?…Mr. Bell could not have made his wish for privacy any clearer if he had specified it in his will, and no decent purpose is served by inviting us all in to trespass on his home….With this article The New York Times inflicted on Mr. Bell a final indignity.

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George Bell in 1956. / The New York Times

George Bell (L) in 1956. / The New York Times

 

Fall

 

Tiny yellow petals have started collecting in the right angle between the sidewalk and the street. They are huddled there like a paper river, jumping around and changing places ever so slightly as the cars drive by. It is fall.

It was the end of summer before I started to feel like I had arrived here in Connecticut. Even though I’ve been moving between these two very different worlds for twelve years, it has been over a decade since I was abroad for so long at once – nearly seven months, with a brief six weeks back in the U.S. in April, which is when the earthquake hit in Nepal.

I’ve always felt that the gift of living in two worlds, if I am open to it, is the chance to deepen my appreciation of multiple realities. Certain particularities, like the soft muffle of people arriving to temple during the High Holidays, or the rustle of fall and how it smells like apples and makes me think of being outside with my dad, the amazing fact of the New York bagel, a spectacular city skyline twinkling at night, the miraculous convenience of speedy internet – these gifts and many more have been imbued with a resonance that comes only from heightened gratitude. What a tremendous blessing that this is my world, my life, my palette of choices.

Besides being near friends and family, it’s this intensifying of senses that makes me look forward to returning to the States when I’ve been in Nepal. Whatever the tradeoffs, they come with the euphoric feeling of appreciation. Maybe this is why I’ve come to realize that in some way my role on the planet will always be to move between disparate worlds, rather than settle comfortably in one and become stagnant.

This last arrival, however, has been different. It’s been harder for me to access the joys of this plentiful environment. Maybe we are in a new season in America, and maybe I am different, or maybe some of both. I arrived back to the U.S. during the week of Sandra Bland, just as Donald Trump was taking center stage. Everybody seemed so angry and so loud. Among the significant, real outrages and pathologies happening at our doorsteps – Sandra Bland! – precious few were garnering a majority of the words being expended in mainstream discussion. Outside my house, everybody was disconnected from each other, and inside, I couldn’t hear the wind blowing.

It was like being in solitary confinement and being assaulted at the same time.

I’ve started and stopped this post many times, wondering how to write about this season of being between realities without resorting to clichés. I was in rural Nepal working with people to rebuild their houses after an earthquake, sleeping under tin roofs while the early summer monsoon pounded the hills.  Now I’m in Connecticut listening to the Republican debate in my living room. It’s totally cliché.

And yet it’s not these visible differences that constituted the turbulent vacuum between my worlds this summer. Mostly the last two months have been an exercise in putting up barriers. Between myself and the pavement. Between myself and indifferent crowds. Between myself and a certain nothing that creeps in between the activities and compartments of cars and apartments. Between myself and a hailstorm of unmourned and even unacknowledged injury. Between my ears and the fantastic amount of noise, all the talking and procedure that is not about anything.  Between myself and the precious narcissism of our public discourse.

I realize that these barriers have their value. But it feels like a loss. I’m more aware than ever before how many ways American culture forces us to reduce our perceptiveness in order to survive. It’s true that the catastrophe of the earthquake created an especially unique doorway to a productive social consciousness: there was a gigantic and terrible event, but it was fairly concrete – at least on the surface – and I located myself and my community within it. I was one of many people who looked destruction in the face and began rebuilding with patience and humility and a willful connection with others.

But I didn’t really realize how much my sense of my self in the world and in society had swelled out beyond me in these last seven months – even to the earth and its power, to the inevitability of the monsoon, to the practical absurdity of dirt roads going up mountains – until I was back here, and my world became a cacophony of conflicting radio stations, all purporting to be of critical importance.

The summer has been an exercise in shutting down one channel after another, and then re-learning how to decide which ones to turn back on for brief and highly monitored periods of time.

The summer has been an exercise in dodging the frustration, despondency, and aggression that billows about on the street, unchecked, like car exhaust. Then re-learning how to locate and selectively engage sources of collaboration and joy. After all, it is still a blessing to have this palette of choices, whether or not we see it, whether or not anybody sees it. Gratitude is not something that can be faked – it comes directly from a place of knowing.

The summer has been an exercise in observing our political system, our environmental system, and our media, with the surprised naiveté of a newcomer, and hearing the same story repeated in different packages: in how we describe ourselves, our problems, our economic and racial tensions, the rest of the planet.  In the way we talk about the earthquake in Nepal and the victimized people of the third world.  It is a story of detachment, silence, and frustration transmuted in to righteousness.  And yet the power of our systems is tremendous, if only we could see them.  If only we could hear ourselves.

Our narcissism isn’t that we’re a bad society or a bad people.  We just can’t see it.

I have spent a great deal of time sitting quietly in my living room, wondering how we get outside of ourselves without leaving.  I think it is human nature to cling to anything that tells us what we already know about ourselves.  I’m no different than anyone else.  I’ve just spent a lot of time in situations where there wasn’t much to cling to, so there was no choice but to adjust.  We are much more arbitrary than we think we are.

I think about my dear friend Mary every day and I miss her.  I would like to tell her about these things, so she can remind me without saying so that I am just one more well-meaning narcissist, and we are all going to the same place, so we might as well be good to each other and enjoy the scenery.

Now it’s September and the brittle yellow leaves are collecting in the gutter.  They dance around when the cars and people rush by, but they could care less for the hurry that makes them play like that.  It’s just their season to fall from green branches, and become a river in the street.

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On Fractured Temples

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Normally when I leave Nepal, there is an extended process of departure – physical, psychological, emotional. But after being here for most of the last six months, minus six weeks in the middle, I ended up leaving with no procedure at all.

Actually I should amend that a little, since the morning of my flight from Pokhara to Kathmandu, I badgered this hairdresser lady – a friend of a friend – into showing up at 5:30am in her salon to straighten my hair for three and a half hours. That’s right! For two months I’ve been hauling around the hills of Nepal in the hot sun in my flip flops, renting tractors and sleeping under tarps and tin, carrying gurneys of rock with old ladies and filling up rice sacks with dirt to build an earth-bag house, sitting in hot stuffy buses for 5 hours and getting stuck in the mud and walking the last hour in the rain…and the one thing I HAD to do before I suddenly left Nepal to fly home for a funeral was get my hair permanently straightened. Why, you want to know? Because in the U.S. it costs $250 and in Nepal it costs $20. A deal is a deal. And besides, there’s nothing like a good hair day to lift a girl’s spirits.

IMG_5188So in the middle of everything – the whirlwind of our new office setup, the excel sheet full of names and bundles of tin and numbers of people, the scheduling of a planning workshop for our staff, setting up a new financial system – I dropped it all for my last three hours in town and had my hair straightened at 5:30 am. Then I said goodbye to Aidan and Pascal on their way to school, and then to Didi and Bhinaju, who took me to the airport. I didn’t get to say bye to the kids at the children’s home so I bought them some treats and told Ranjita to say how sorry I was I’d missed them, but I’ll be back in 6 months. I’d said goodbye to Aamaa and Hadjur Aama the night before, in Kaski.

And the next thing I knew, I was flying back to Kathmandu, in that reverse warp that happens when I leave Nepal. Except about six times faster. Normally on my way out I have a few days in Kathmandu and they are mostly filled with meetings. This time I had just a few hours between my flight from Pokhara and my flight home.

Everything looks different in Kathmandu than it did when I arrived on May 13, less than 48 hours after the second earthquake (remember the second earthquake???), when the city was filled with bright blue and orange tents clustered at intersections, and all the people were quivering like leaves, waiting for another hit. Things seem to have settled in to a process that is serving as the new norm. IMG_0904And the truth is that if you landed here now, from anywhere, you’d be amazed to find that the apocalyptic situation that’s on the TV is not how things look. That’s because the collapsed buildings that the photographers zoomed in on aren’t the whole story. In fact, they were the tremor after the earthquake of poverty and poor governance, which is too chronic and undramatic to capture our attention, but remains most of the problem.

But the real difference is me.

When I arrived here two months ago, this situation felt vast and unknowable and as tragic as my imagination could make it. Now I can locate myself within it. Our piece, which will ultimately total around 150 homes and piles of stories, was small but meaningful. I have a sense of how people are moving forward with their lives one step at a time (although I should add that during these months, I met only one family that had lost people in the earthquake). Which is not to trivialize what’s been destroyed – only to say that, in the beginning, when everything collapses, it’s impossible to imagine a different future.   All the unseen things are terrible and insurmountable in your mind’s eye, and you can’t conceive of the steps between here and there. I couldn’t even visualize “there.” Now I feel like can at least be at peace with a changing target, because that shifty feeling of uncertainty and failure is a known thing, not a shadow. And so far, we’ve done our part despite it.

My last few hours in Nepal were perfect. I met up with two friends from the U.S., both doing doctoral work in Nepal, both fluent in Nepali. We walked down to Patan Durbar Square, my favorite section of old city, known not only for its temples but also its artisans and craftsmen. Patan is one of the areas that was featured heavily in the days after the earthquake, when the only photos of villages were from the air.

On this last afternoon, the rains held off, making way for a cool golden evening, the light waving in the folds of cloth that ripple along the edges of the temples. We sat high up on the foundation of what used to be a temple, observing the courtyards that were filled with people eating ice cream, buying balloons, whispering on dates, playing. Between the scaffolding that surrounds the damaged buildings, people were busy living in the very space that, I know full well, much of the world sees in its own mind as a pile of dust and despair.

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My thoughts drifted to conversations that Anne and I have had about the beauty and strangeness of Pashupathi Temple, Nepal’s holiest cremation site, where passers-by sit across the river and watch pyres burn during the day and night. Sometimes there are kids playing soccer, or folks out enjoying the sun or the beauty of this thousands-year-old place of pilgrimage. What’s always amazed us about this is that people can play soccer near death. Or go on dates near death. Or just gaze, for no reason at all, at death.

Of course, it’s there anyway, even if you’re not looking at it. And once you get used to the idea that you do not have to avert your gaze from a pyre, or from a mother wailing over a pyre, everything else looks different too. Suddenly that moment belongs, in some way, to everyone.

IMG_0956There is no caution tape around Patan Durbar Square, or even around the base of this foundation that used to have a temple on it. The reconstruction is public and unbashful, but it’s also not desperate. In a courtyard tucked away to the left, bricks are patiently stacked up and a young couple is talking furtively under a tree.

But who would think to take their picture for the news?

I think maybe, in the sterilized West, it is hard to believe in loss unless it looks like something we wouldn’t feel right resting our gaze upon in person. We see the spectacle and only the spectacle, because cracks don’t mean much, but the un-witnessable speaks to our understanding of destruction, and insulates it from the safe and organized world we know. But that’s impossible in this part of the world. Things are lost so often, so publicly, and with so little fanfare. All the falling and building is mixed up together with the balloons and scaffolding; the moment belongs to everyone.  So it is still okay to play.

We sat for two hours with all the other people doing normal things on the bald foundation of this temple, looking out over the square, talking in the warm breeze, and watching the balloons and ice cream and couples and pilgrims swirling around these fractured structures, which are on to the next chapter of their lives with minimal complaint or ceremony.

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When I boarded the plane to come home, my pants still had thorns in them from Tripureswor, Ward #6. These feisty little guys are so hard to get out you have to either pluck them one by one, or have a couple of ladies grooming them off you with a sickle like a baby chimpanzee.  I’ve been groomed a few times in the course of these last weeks, but I just kept walking through the thorns and re-collecting them, and now I’m taking them back to America.

Classy, right?

Hey, my hair looked good.

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