Tag Archives: economics

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

A House of Mirrors

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

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

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

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

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

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

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

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

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At the Base of a Tree

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

At five cicadas were interesting, like figs.

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

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

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

 

 

 

Reflections

Everest Prelude: Pemba

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During the hot summer of 2001, I was drawn to Nepal by the Mountain. Also, the mountains–these grand Himalayas where the world places so much of its imagination–but mostly, the Mountain itself. At some point in young adulthood I began reading books about Everest, and I simply knew I would go. It was never about climbing it, but about following it. Because, as my mom would say, it was there. 

I never could have understood nineteen years ago that the road to the Mountain would be so much longer and more magnificent than I had imagined. I originally visited Nepal with an international group that was studying medicinal plants, and during that muggy August week in Kathmandu, I optimistically rented a bike and made a 36 hour journey into the unknown that foretold something of the road ahead. I didn’t know what a vast constellation of adventures lay before me in the decades to come, or about the family and community that would adopt me as a daughter, or the public health project I would unintentionally co-found to address an issue about which I had no expertise. So many cut fingers and thunderstorms and shelled peas and paint-splattered clothes lay between me and Mt. Everest. But in recent years, my heart has wandered back to that horizon, which has remained an untouchable idea, visible in the real world only from a distance. 

This winter I knew, with the same certainty that first brought me to Nepal, that it was time to visit Everest at last. So I called up my oldest (by time, not age) Nepali friend Pemba Sherpa, who was on the cook and porter staff of the medicinal plant study group back in 2001, when we were both in our early twenties. Pemba has since become an extremely successful tour guide, and at a hotel in Kathmandu he produced for me a backpack, a pile of gear, and instructions to take on my journey. We played with the oximeter and found my oxygen sats to be 95 while sitting in Kathmandu. I downloaded an offline map and purchased a plane ticket to Lukla. 

I’ve decided to post my eight day trip to Everest Base Camp as a separate travel journal. But before it starts, let’s begin at Fire and Ice Pizzera in Thamel, where Pemba and I reminisced over dinner the night before my trip began. We jumped back to August 2001, when we met, and from there travelled backward through the chapters of his incredible life. 

Pemba in me in 2001

Pemba and me in 2001

Pemba was born in a village in Solukhumbu called Soloban. In the 1980s there was no school in Soloban and Pemba spent his days herding, even during the snowy winter months.  I remember him telling me once, “my feet were like rocks!” His herds used to take him from time to time to Lukla. Once, Pemba stayed a hotel for a some days while his goats grazed there, and the hotel owner told him that if he wanted to, he could consider getting hired as a porter for tour groups coming to trek in the Everest region.

Soon after, fifteen year old Pemba decided to leave Soloban without telling anyone. He went to the hotel and said he was ready to work. It was the mid 1990s and there were no phones or regular means of remote communication. It would be six years before he saw his family again.

With the lights of Fire and Ice Pizzera bouncing off wine glasses, Pemba recounted how the hotel owner assigned him to porter on a fifteen day tour with a Spanish group. 

His wage was two dollars a day. Among Pemba’s jobs was to bring tea to the guests in their tents each morning. There was one guest who didn’t drink tea, but every day when Pemba presented this guest with the tea tray through the opening of the tent, the man would put a 200 rupee tip–about two dollars–in the teacup. This continued for the whole trek: the guest never drank tea, but every day he tipped Pemba two dollars. Four dollars a day for fifteen days was more money than Pemba had ever seen in his life. 

At the end of the trip, the tour group produced a tip for the entire trek staff, and part of that went to Pemba. But in addition, he had made a special impression on the guests, and they pooled an extra $100 for him. And finally, he was gifted with several expensive branded down jackets that, at that time, were almost impossible to get in Nepal. He took that stuff all back to Lukla and sold it off and made another $300. He ended the two week trip with an unimaginable seven hundred dollars in cash. 

“‘Well,” Pemba laughed over our pizzas, “I said, ‘this is what I’m going to do!’” 

Pemba in 2001

Pemba on our trip in 2001

He ended up taking a bus to the city, living with a relative of the hotel owner, and working his way through the tourism industry. He began studying languages – English, Japanese, German. He had no way to contact his family back home, and his aunt was living relatively nearby in Boudanath, but there weren’t many people from Soloban in Kathmandu during those years and there was no way for the two of them to discover each other. One day a customer at the mountaineering supply shop where he was employed asked if he wanted to join the cook and porter staff of a plant study expedition for foreigners.

That was the trip where we met in 2001.

Pemba’s career took off in the following years. He speaks seven languages proficiently and has still never had any formal schooling. He runs a massively successful trekking business and has travelled to over forty countries. He has poured resources back into his home village of Soloban, rebuilding a school and helping to organize health care services. He was recently nominated to run for local political office. When I hiked to Soloban from Jiri Bazaar with Pemba and Prem in 2008 (the week our Aidan decided to show up twenty days early…), Pemba was received like a prince. 

“Call me if you have any trouble,” Pemba said, as we bid goodnight. “The path is easy to follow. It has always been your dream.”

–> Read Part 1: The Height

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Headed to Everest Base Camp, 2020

Aamaa, Aidan and Pascal, Family, Kaskikot, Nepal Life

Water Works

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It used to be that, in the winter, we’d sometimes get up at four AM to fetch water. When the tap nearby in Deurali would dry out due to the dry weather, or the tenuously protected pipe sourcing it would breaksomewhere along its many kilometers between Dhampus and Kaskikot, we’d have to go further downhill to the natural spring in Rotepani.

Deurali

In the summer, Rotepani was so rich with water that people filled their tin water jugs freely under gushing, splashing geysers while others bathed and did laundry and on the surrounding rocks, submerged up to the knees, cooled in the August heat. But in the dry season, sometimes even Rotepani would slow to a trickle from two out of three pipes that protruded from a cemented tap. The gushing natural spring that pours directly over the rocks would evaporate. Sometimes the line for water took half the day.

During those times, Saano didi and Neru would wake up before dawn and come up the path to our house. Aamaa and I, and Bishnu while she was still here, would join them with baskets slung from our heads and loaded with every jug and bottle in the house. We’d pick up Maya Bouju as we passed her house and walk single file along the edge of Gita Bouju’s wheat field. With the hills still shadowy along the southern horizon we’d cross the dirt motor road, make our way down a steep stone walking path to arrive at Rotepani in the dark, and help each other fill all the containers trickle by trickle. Then we’d walk back up the hill, pour the water in to slightly larger vessels in each of our homes, and turn around to do it again. Each trip took about 45 minutes, and we’d make three or four visits before the sky stretched open its arms to deliver another morning.

There have been times when water takes up the majority focus of attention in the household functioning. When pipes break in Deurali, when the weather is dry, when the buffalo is ill, when there many guests, or when there are very few residents to share labor; all of these lead to an immediate and exacting calculation of how much water is in the house, how long it will last, and what amount of physical labor is required to replenish it.  Sometimes it’s one person’s job to ferry water for hours at a time. When I’m here, I tend to gravitate toward the water carrying—a fairly straightforward, essential, and never-finished chore.

Over the last year or so, recent changes in the government have led to mumblings about piping water to the yard of each individual home. In sixteen years, I’ve seen many changes come through Kaskikot…new two-story cinderblock houses, paved road, the occasional wifi connection, a completely transformed economy from subsistence to remmittance. Cellphones, Facebook, TVs, hotels, cars.  Many of the houses around us in Kaskikot have already rigged up pipes that they can attach to the Deurali tap when it’s not in use, offering a continuous stream of water that passively fills an enormous polypropylene tank in the yard. But water still lords great power over us.

In our case, we’ve had a tank for years, but like the enclave of about four houses near us—including Saano Didi’s and Mahendra’s houses—we still have to carry water to it, the regular way. Our water situation remains basically unchanged. We still take baskets five minutes up the road to fetch our water from the tap in Deurali. When Deurali is dry, we still go to Rotepani, 15 minutes away. On occasion, when Rotepani is too busy or the flow of water is almost dried out, we walk winding footpaths half an hour down to the fields in Dadapari and use a cup to lift water from a natural pool under the rocks.  A few times, I’ve accompanied Aamaa to do a household of laundry on flat stones there.

Aamaa, of course, is sixty-two and lives alone most of the time. So by “we,” I mean Aamaa.

Last summer as I was leaving in August, somebody rigged up a pipe that had been brought from Deurali up to the crest of the ridge by our house. Its mouth wasn’t in our yard, but it was only a up on the ridge, about seventy-five yards away instead of all the way in Deurali. The day I was leaving for the U.S. was the same morning that this new pipe was first hooked up, and all our closest neighbors clamored about filling buckets and oil gallons and jugs while Mahendra’s father presided over the fray. Whenever the pipe was unattended, it sprayed wild streams of water that swirled into muddy rivulets, spilling down the side of the hill and into Khemraj sir’s corn field. Little Narayan and Amrit were ecstatic with the newfound responsibility of presiding over a line of eager adults and aiming the unruly three-headed pipe head as it washed dirt off the footpath and over the terrace.

When I arrived back this week in January, I discovered this setup slightly relocated but similarly conceived. With water more spare in the winter, each household has been assigned to use the pipe on alternating days. Today was our assigned day; Aamaa began fretting about it last night. I assured her that I would take water duties in the morning, which is pretty straightforward, but the problem is that for reasons I couldn’t determine, Aamaa wanted to get cracking at dawn…and one thing that’s changed in the last ten years is that I am no longer so interested in proving something that I’m motivated to get up before dawn. I am happy to prove my value during daylight hours.

Lucky for both of us, for some reason the water didn’t become available this morning until 9am. Having slept until American hours and had my tea, I dutifully began the water retrieval process. Pascal helped me bring all the water jugs and bottles and even buckets up the hill, where we set them down beside Maya Bouju’s house to wait our turn.

Saraswoti was there of course, and Jivan’s young wife Bal Kumari, and Mahendra’s father. Everyone had brought literally any item in their house that could hold liquid. The issue–and the thing is, I’m American, I’m trained to spot potential matters of inefficiency and to fret about them–was that the pipe itself was barely producing a trickle. So filling the army of receptacles from our three households was a phenomenally lengthy task that quite literally involved watching water drip for long, yawning minutes. And minutes. And more minutes.

I squatted down next to my pals Saraswoti and Bal Kumari. They were perfectly happy with the distraction, the pace of the task, the opportunity to sit on a hill and chat or not chat and pick at blades of grass. I was like, “Yo you guys, it’s going to take me approximately one million years to fill all this stuff.” My gaze drifted to the footpath.  Four minutes away was a perfectly functional, largely unmanned water tap.

I calculated that in the time it would take Saraswoti and Bal Kumari’s water jugs and buckets and bottles and gallons to fill in front of mine, I could easily take a jug to Derail, fill it, bring it home, and bring it back here for a second filling.

“Just wait, Laura, it won’t take too long,” Saraswoti assured me, despite the fact that this was plainly inaccurate advice.

“I’m just going to go…um, fill this jug and come back,” I said. I did. When I came back, my other six jugs and buckets and bottles were still waiting in line. Bal Kumari had left and Saraswoti was taking her turn.

“Have a seat, Laura,” Saraswoti said. I sat. Saraswoti and I watched the water drip lazily, its splashy pitch changing as the surface level crept up the inside of the tin jug. The winter mountains pierced the entire panorama of the northward sky, and to the south the hills were clear and fresh. When it was my turn, I filled our jugs, took them home, dumped them in to the tank, and began the whole process again.

Of course, Bal Kumari was back.

“Laura didi, it won’t take long,” she and Saraswoti assured me. Given that the water hadn’t become more abundant, this statement had also not become less untrue. I couldn’t take it. I took one jug off to Deurali, repeating the entire process as before.

As my trips accumulated, so did the various filled containers in the yard. The tank filled. Aamaa has recently installed a recycled oil barrel that comes to my chest; it was filled. At intervals, Pascal was reluctantly cajoled in to retrieving filled bottles and buckets from and dumping them out at home and returning them to our muddy hill. The tubs and emptied kerosene gallons were filled. Each time I thought I was done getting water, Aamaa would find another centimeter of space inside some container or another and make an entire four liter tin jug of water disappear in to it. I started to get annoyed, and then I started to giggle. The teapot, after all, was still empty.

I couldn’t help but think of when our only containers were two tin jugs, a leaky plastic box, and two small lotos. By comparison, there was now enough water in the house for all of us to bathe five times and do a midnight water puja under the moon. But Aamaa kept finding more spaces to add water and sending me back to the maddeningly dripping pipe by Maya Bouju’s house.

“Aamaa, I think–” I wanted to point out that the tap in Deurali was currently available daily. Why was I an indentured servant to the drippy pipe by Maya bouju’s house, today, just because it…existed?

“It’s so much closer,” Aamaa said. “If the tap dries up, I’ll be without water,” she explained. I found this both entirely logical and entirely illogical at the same time. It couldn’t be solved. It reminded me of the time that Bishnu and I had dozed off in the middle of the afternoon with Pascal lying between us when he was a baby, and we woke up to find the lights on in broad daylight amidst the ruthless load shedding schedule; Bishnu yawned groggily, “Hey when the electricity is available, we have to utilize it.” This immediately launched me in to fits of hysterical laughter for the next ten minutes and I would lose it every time I thought about it for years. Now, I also knew the only thing to do was keep getting more water from the pipe on this, our assigned day. The opportunity was not to be missed, irrespective of any broader analysis about overall benefit. And while I claim to have nothing left to prove in Kaskikot, let’s face it: where the rubber meets the road, I still have too much pride to throw in the towel early.

The only way out was to prove this labor was unwarranted.

“Aamaa, are you gonna take the cups out of the kitchen and have me fill them up too?!” I cried, half joking and half serious. Truthfully, I wanted to sit around and read. I resented this unreasonable purgatory, even though I not only signed up for it voluntarily, but also understood that it technically started and ended far away from the pipe by Maya Bouju’s house. I didn’t want Aamaa to have to haul water tomorrow or really ever. It just seemed to me, like, you know, we totally had lots of water.

Finally, when our entire yard was ringed with anything that could be turned in to a basin or pitcher, each brimming so high that the act of dipping a cup in it would spill a few steps worth of hauled water, I put the basket and rope down on the porch.

The buffalo honked lazily. It was mid-morning, and the day stretched bright and clear in front of us.

“They say,” Aamaa mused to nobody in particular, “that we’re each going to have our own water tap. I brought the pipe here already. But I’m not allowed to connect it up to the yard.”

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Around Town, Nepal Life, Oral Health Care Project, Work

Politics and Poets

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With the Nepal government undergoing a major restructuring, a big goal for us this summer is to figure out how the newly formed provincial government works and establish relationships with influential decision-makers.  We’re just getting started, and as I’ve described elsewhere, so is the government: most of the province-level officials are quite new to their desks, and in many cases the scope and processes of their jobs are still being decided.

So let me give you an idea of how this works.  Honestly, this is my real life.  I begin with a friend of mine in Kathmandu, who I was introduced to through an organization that gave us a grant a few years ago.  This friend refers me to a colleague of hers, who I’ll call Sam, who works inside the new Province #4 government office in Pokhara as a representative of a big nonprofit doing policy work on another topic.  So Sam is not exactly a government employee, but he’s connected to people in the Province office because he works in the building, and most happily, he is someone I can ring on his cell phone.  I set up an appointment.  It’s our first trip to the Province offices and we’ll just have to go meet Sam and see where we get.

Are you with me so far?

Muna and I walk about a mile from our office in burning July sun, and meet Sam in his office at the new Province building. Sam is a friendly, energetic and smart guy, and he begins to orient us to the structure of the Province government (we tried to google it–maybe you’ll have better luck). He combs through our present bureaucratic challenge: obtaining official endorsement for a workshop we want to host to train new dental technicians (who will of course work in Government Health Posts).   In the absence of clear procedures, we mull over who best to take this to next.  Sam makes a call to the Province Health Coordinator, an obvious choice, but the Health Coordinator is out today.

Eventually – and this is only possible because Sam is helping us, and because we’ve made a satisfactory case to him – he gets us an invite upstairs to meet direclty with the Minister of Social Development, who holds the highest office in the Province, something like a governor.  This is great news.  Muna and I follow Sam out of his office, and by this act Sam is adopted into our quest and ordained as our guide.  Without him Muna and I are just random people in the hallway. We stroll through the almost-finished government building, which like most government offices outside Kathmandu has a concrete austerity produced by minimalist decoration and a building style that leaves stairwells in the open air.  Even the walls look somehow unfinished, expectant.

At the top of the stairs we move down an echoey corridor and come to the mouth of a room crowded with men.  Peering through the door frame, I see a tall, lean Official sitting at the other end of the narrow office, the throng of visitors clamboring for his attention.  Sam and Muna and I are directed to the room across the hall to wait.

We wait.  It is very hot.

After some time, we are brought back across the hall to the Minister’s office.  It is stuffed with as many black faux-leather couches as the room will allow, and as per standard Important Office decorating style, they are situated perpendicular rather than parallel to the desk where the Official in question is seated. I can’t explain this, but it’s the set up of almost every Important Office I’ve been to in Nepal.  The halls are empty and the offices are packed with extreme quantities of couches, which are almost always lined up along one wall so that visitors find themselves talking to the Official they’ve come to see at an angle, while the Official gazes past their knees at empty space.  A perk of today’s office is that, with the July heat pawing at the walls, the ceiling fan is turned on to the highest setting.  I am seated directly under it.  It feels wonderful for about ten seconds, and then I realize I am doomed to suffer in a singularized typhoon for the length of our Important Meeting.

The last of the previous visitors is just leaving as we get seated, and when the previous callers have cleared out, Sam introduces us to the Official.  Muna and I – mostly Muna – describe Jevaia and explain the authorization letter we are looking for.  We say are “seeking suggestions on how to properly coordinate and align with the new government.”  We don’t say we are already pretty sure that these procedures are not defined yet; in fact, the inquiry itself is probably the best formal step available.

After some time, the Official falls silent. In my opinion, the Official Silent Phase is one of the great tests of mettle in this line of work, particularly for impatient foreigners.  From a western sensibility it’s completely perplexing: for about five mintues, the Official taps on his laptop and gazes past our knees without saying anything. The fan blasts the top of my head and wooshes through my ears, and I command my self to sit properly through the Official Silent Phase, like Sam and Muna are doing, without fidgeting or asking to turn the fan off.  Take note, impatient American Person With An Agenda.  If you come here on a schedule, it will be silently and inexorably bled out of you. The people on the faux-leather couches don’t own this timetable no matter how bombastic and fantastic their ideas are, and let me tell you right now that nobody else is in a hurry.  It never occurred to me I might need a jacket to get through our first Province government visit in the dead middle of the summer, but I surely wish it had.

Suddenly, the door flies open and an elderly man in traditional daura-suruwal dress walks through the door.  He waves his walking stick at the foot of the couch.

I don’t have a picture of the Poet, so here’s an internet photo of a man in a daura surulwar.

“Son, get up and move over there, I’m just gonna have a seat,” the old man says to Sam, who graciously leaps up from the seat closest to the Official desk, and moves down the line of couches to a spot near the door.  The old man sits down and leans in to the corner of the Minister’s desk with a twinkle in his eye. He begins reciting a legnthy poem.

The Official is, by old man terms, a junior “son” like Sam. In an instant, the hierarchy of the room is reorganized. The Official leans back in his chair with a grin and sets to listening to the poem. All of a sudden, we are all in school.

For forty five minutes–no, I’m not exaggerating–the Official and the Old Man engage in philosophical conversation while the fan hammers my head, Muna waits politely and Sam cycles through expressions of interest.  I won’t find this out until after the meeting, but the old man is the son of a famous poet, and himself a reknowned scholar. More men–all men, Muna and are I the only women for miles around, it seems–wander in to the room to listen while he holds court.  The poet leans dramatically forward and back on the faux-black leather couch, swaying to his recitations, swiveling his attention from the Official to us to other would-be meeting-seekers near the door, and unleashes a reverent Islamic lyric.

“So tell me,” our Official says, with somber studiousness. “I want to know something.  You’re a Hindu man.  But you speak eleven languages and you’ve studied Islamic poetry extensively.  How do you reconcile those who eat cow meat?”

I shiver and try to casually hold my hair out of my eyes.  I look enviously at a corner door, where more men are periodically filing in and out of the room, and notice that Sam seems distracted by the door too.  Why can’t the Minister just tell us whether we can have a letter, or what we have to do to get it?  Why can’t he release us from bondage, and THEN listen to poetry?

“Let’s have another poem,” the old man says. He turns to Muna, who, following Sam’s relocation, has ended up on the couch seat beside the Poet.  Leaning toward her, the old man brightens, saying, “Would you like to hear a Hindi Poem?”

“Nobody properly understands Hindi,” the Official interjects, boldly. “How about a Nepali poem.” I am well aware that we will need to hear all the poems if we want to find out about our letter.

Another gaggle of men comes out of the corner door, and suddenly Sam says, “let’s go.”  Go where? I chatter.  The Minister hasn’t answered our question yet.  I’m confused.

“This way,” Sam says, motioning toward the corner door.  Why are we leaving?  But with no choice, I get up and follow Sam and Muna through the mystery door.  We enter the next room, and there, in a grand office, behind a hefty wooden desk flanked by the National flag, sits the actual Minister of Social Development.  She rotates on her chair, adjusts her sari over her shoulder, and waves us to sit down on two spacious couches where she can examine us directly from across the carpet.

Who was that guy? I whisper to Muna. Suddenly I am afraid I’m about to start giggling uncontrollably.

“The Secretary,” Muna mutters.

“So,” the Minister of Social Development commands, wasting no time and leaning forward on her clasped hands.  “Who are you?”

 

 

Aamaa, Around Town, Family, Nepal Life

The Other Skies

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The first thing I have to do is convince Aamaa to wear one of her new kurta salwaars. She has spent 60 years wearing a more dignified sari and she’s shy to dress like a girl. I insist she will be a lot more comfortable on our 24 hour journey with trousers on.

Bhinaju and our cousin Laxu come to the airport with us. As we stand outside the door to the airport, again there seems to be a strange inversion of everything. We say goodbye and move in to the 24-hour netherworld of air travel, but the moment when I detach like a raft in to the sea, alone and timeless until landing back in the rest of my life, never comes. Instead, all my focus is on Aamaa while we pass through various inexplicable passages and security checks, making goodbye phone calls along the way.

We end up seated with Chandrakala, a charming woman probably in her mid-forties leaving Nepal for the first time to go be a maid in Greece. I explain everything from the seatbelt to how to order drinks and use the bathroom. I set up their personal TVs with films for them to watch. They both look disapprovingly at the glass of wine I ask for, so I make a point of asking each of them repeatedly if they would like some wine during the flight. Aamaa has a million questions. Is it night or day? Can I put my passport away yet? Are mom and dad awake now? I don’t know. I’m used to not thinking about any of these things.

We spend the flight talking with Chandrakala didi and when we get off the plane in Doha in the middle of the night, the three of us stick together. The Doha airport will be the first thing we encounter that is a developed country version of the comparable thing in Nepal; Tribhuvan International Airport in Kathmandu only supplemented its two small departure terminals a few years ago and the waiting area is decorated with rows of cheap, attached metal chairs that can be dragged about in units of three. The Doha airport is a dazzling maze of high ceilings, moving walkways, shiny things, monitors, duty free shops where beautiful women are illuminated by fluorescent lights, and of course, the enormous random nauseous teddy bear that is taking up space at the center because space needs to be taken up. It occurs to me how strange it is that in modern times, the first thing an immigrant from a developing country will see in a wealthy country is an airport, which is one of the weirdest environments modernity has to offer.  For example, Aamaa couldn’t even think of a question about the following dinosaur under a passageway in the airport:

I lead Aamaa and Chandrakala didi to the sleeping room and we all try unsuccessfully to doze off. Aamaa and I both end up stretched out on the floor instead of the awkward lounge chairs, and I appreciate how we must look, sprawled out on the ground in a room full of disciplined travelers using the chairs.

We go to the bathroom and use an automatic hand dryer.

By now we are all aware that we’re going to have to abandon Chandrakala didi to the Doha airport when our flight leaves for New York. I take us out to the nauseous teddy bear where a bank of monitors will show Chandrakala’s departure gate when the time gets closer, and explain to her three or four times how she’ll navigate the list of English symbols. Chandrakala didi is literate but uncomfortable with English, and if you don’t know what a gate is or how an airport works, reading the monitors is just one obstacle (how do you even know you’re supposed to read a monitor?). There are many Nepalis working in the Doha airport and we chat some of them.  Chandrakala didi will be able to ask someone if she needs help, but it still feels wrong to leave her alone in the glowing Doha airport with its mysterious halls and signs and statues. Eventually we have to say goodbye, and she sits outside our gate watching us go.

Every time Aamaa and I have to pass through a checkpoint or security screen, the international airport staff first assume that we aren’t traveling together, and then want to know what in the world is going on. Aamaa has all the looks of a first-time traveler from a traditional part of Nepal, and in addition to the fact that I have all the looks of a private-school educated white suburban yuppie from Connecticut, I tower over Aamaa by about eight inches.  Since she doesn’t speak English, I usually have to translate instructions.  After figuring out that we go together, most people assume I am her daughter in law, which would explain how I know Nepali and why I’m the one shepherding her on an overseas journey. “This is my daughter!” Aamaa giggles as she corrects enthralled security guards and airline attendants. We make our way from counter to counter and checkpoint to checkpoint, crossing the globe in a little bubble of delight that we make no sense.

Finally we board our fourteen-hour flight to JFK. We get incredibly lucky with an empty middle seat on a mostly full flight, so we’re able to take turns properly sleeping. I was worried about how Aamaa would handle strange food made by unknown people, but she mostly exclaimed over amount of it, approaching each tray with curiosity and then asking me if I wanted to eat her pats of butter because she was full from the continuous flow of food.

“That goes on the roti Aamaa, you don’t eat it by itself. It’s like ghee.”

And then the next tray would come and she’d ask me if I wanted the butter again.

We peered out the window at the rolling white puffs lolling off to infinity and Aamaa asked if the clouds were the ground or the sky.

“The sky,” I said.

“Does this plane also go to the other skies?” Aamaa asks, long after we’ve lost track of night and day.

“Other skies?”

“They say there is this sky, and then a sky above this, and then a sky below this one,” Aamaa says. “I don’t really know much about it. But I was wondering if this plane goes to the other skies.”

I gaze at her.

“I don’t really know,” I say. “I don’t know much about it either.”

Many trays and questions and naps and pats of butter later, we break through this sky and New York comes in to view. Aamaa reaches behind her for my hand as she stares out the window, and with a dramatic rumble, the plane sets us down on the ground.

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Oral Health Care Project, Work

Technician Training

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Last winter, for the first time ever, we had foreign dentists meet our technicians, supervise them treating patients in the field, and assess their treatment outcomes. This has been an enormous opportunity for us as an organization and for our technicians who are working hard to provide the only dental care in their villages. This week, we had Dr. Keri back for a second training based on findings from last winter.

Our refresher training included two days of classroom work and a one-day treatment camp at a school. Keri covered topics related to infection control, pain diagnosis, pediatric behavior management, informed consent, treatment planning, and charting. Based on the results of our study of treatment outcomes in fillings placed by our technicians, we introduced a new instrument used to prepare a tooth for a restoration.  On day two, we had a few patients come in for practicals, including Aidan and Pascal.

 

 

 

 

 

 

 

 

 

 

 

 

On day three, we treated about 100 children and adults with supervision from Keri and from Dr. Kafle from our referral hospital, Kantipur Dental Hospital. This gave the technicians and assistants a whole day to apply the concepts from the classroom training to many different types of patients.  I was worried we might not have enough patients during summer vacation…but that was definitely not a problem.

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Over this last year, I’ve realized how far JOHC has moved in to new territory in the oral health care world in Nepal, and really, in to the health care world generally. I’ve come to appreciate that our technicians are true specialists in low-resource dentistry, with training and institutional support that has allowed them to venture in to realms of sophistication not typically expected of providers serving the rural poor. I’ve always been committed to making sure their scope of practice remains safe and appropriate, and at the same time, I recognize that there’s been far less time and money invested in identifying how safe and how good a service can be when the customers are millions of people who cannot rely on reaching a conventional health care setting. Such questions are asked only from the perspective of established institutions and well-funded people in power; that this leads to widespread, unnecessary suffering for the vulnerable is very obvious.

The other side of the same coin is that it inadequate services can be easily excused because they fit a conventional mold.  While Keri was here, we took time to visit the dental section of the public hospital.  We met some great doctors, many of whom are only one or two steps removed from hospitals or people we work with.  But they are working in an underfunded environment with rusted instruments; we observed numerous breaches of infection control in our short 20 minute visit.  The sanitation and safety measures used in our rural clinics are significantly stronger than those we saw in the dental ward of the hospital, even though we are working in a much simpler setting.  Why?

Something else that’s magical about this newfound opportunity for more training and collaboration is getting to know our field staff better, and as a group.  Our clinic assistants – all women (also, on all of our teams, either the technician or team leader must be female) – are these incredible women who tend to listen quietly and then, with very little fanfare, make everything run smoothly.  Without them our infection control protocol would be hash.  They are always the first people to show up at a training or field program.  Biju is raising four children and managed to complete the rice planting in her fields the day before she made the six hour trip to Pokhara from Sindure with her nine year old in tow.  Renuka and Pabitra are always smiling, never miss a thing, and both have put in long stretches of work without pay while we straighten out agreements with their local governments. Sita is upbeat, diligent and ready to toggle between different roles without being asked.  They are just SO AWESOME.

It was a good week.

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Family, Nepal Life, Oral Health Care Project, Work

Nooks and a Little Sauce

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Over the course of 13 years in Nepal, I’ve spent almost all my time in villages. My whole understanding of Nepal, and all my friends, routines, the food I eat, the places I sleep, even the way I speak the language and therefore the way I think, have been organized around my adopted family and rural life, or its popular sister, the cramped and thankless circumstance of recent urban migration.

But this summer, I’m full-time supervising a city-based office with four people and a field staff of 16; getting a latte each morning; diving in to health care policy and human rights frameworks. I schedule coffee meetings and visit offices. All told, it’s only in the last 1-2 years that I’ve started getting to know some of the other long-term foreigners and NGO founders living in Pokhara, who all pretty much know each other, because they all live in the city, which for me has always been just a place to visit for work. And when I’m here, my non-work life is completely centered around my (recent urban migrant) Nepali family.

There’s a vague sense of discovery about this new routine. For example, I’ve been sleeping in a room in the office, and – this is going to sound weird, but – slowly realizing I can put things there to make the bed and little space around it mine. Like: a new blanket. Or: a hook on the wall. This is an especially weird feeling. In all the time I’ve lived in Nepal, the only space that’s been mine-ish is the small house in Kaski, with its two beds and one dresser that I share with the rest of the family. A single bed and little shelf of clothes for me alone, that I can modify to my liking, is a bizarre amount of freedom that I’m only even noticing bit by bit. (Mind you, we’re talking about a bed in the finance and admin room of our office.)

Obviously, I have no trouble with this in the rest of my life. But in Nepal, well, it’s just not the way I’ve learned exist here.

IMG_9195The other night, I had Pascal and Aidan for a sleepover at the office, with its main attraction, the Internet. We watched movies and ate treats. We’ve also been out for boating and out for dinner, because it’s fun, and we live in the city. And yet these are activities that have never remotely crossed my mind in the past, because they are more similar to how I live in the U.S. It actually never occurred to me I could do them here because the communities I spend my time with mostly don’t.

Today I went to a salon and got my hair done. A salon.

When I was a kid, I was literally the pickiest eater the world has ever seen. I know you think your kid is pickier, but trust me on this one. I was okay with a short list of simple foods, and I would gladly sit and watch everyone else eat rather than be forced to alter this known quantity. Once, I went to my best friend Katie Schultz’s house, and they made me pasta with butter while the rest of the family enjoyed a normal meal. It wasn’t till I put the pasta in my mouth and a terrifying and unfamiliar taste exploded on my tongue, that I found out that butter doesn’t taste like margarine, which is what we had in my house. The feeling of shame and fear sitting at the dinner table, hoping nobody would notice if I didn’t eat, is still with me almost 30 years later.

It wasn’t until eighth grade, on a school trip to Smith Island where I was stuck in an adolescent group eating situation, that I tried tomato sauce for the first time. For a few years – ok, until college – I’d put a little blob of tomato sauce on the side of my plate, and kind of dip my fork in it. Eventually I worked my way up to normal pasta, but to this very day, when I make my own meals, every component sits side by side so I can mix as I go. I’m no longer alarmed by new foods like I was as a child, but I don’t adventure much. I eat the same reliable items almost every day.

What, you ask, does this have to do with Nepal?

I’m not sure, but all I can say is it kind of feels the same. I’ve spent a long time in this environment adjusting to the absence of almost everything I was accustomed to before I came. I found my nook and I’m comfortable there. Rural life in particular, while not materially complex, runs miles deep, and each iteration, each day, each season and year, enriches and returns itself to the last one with a sense of familiarity and certainty: the next one will come too, even if we are not here to see it. I haven’t made a life of travel. I plopped down in one place and snuggled in. Altering its fundamentals even in small ways creates a whole orchestra of funny tastes on my tongue.

Also, FYI, we eat the exact same thing for every meal in this country. PHEW.

Mean time, I do like this blanket though. How do you like my office nook?

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Oral Health Care Project, Work

Getting Schooled in Vendor Outreach

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The only question I get asked more often than if we need dentists (answer: YES! as mentors and teachers for Nepali technicians) is if we need donations of toothbrushes or paste. While that’s a conservative yes, because we provide a limited number of those supplies to schools, most of the time, the answer is, not really, unless they are donations of something purchasable in Nepal. Because, if you think about it for a second, it’s pretty obvious that going to some village and handing out a bunch of disposable hygiene products once might make for good photos, but it doesn’t do much for anyone who needs to use these items every day forever.

Instead, one of the four core activities in JOHC is called Vendor Outreach, where we work with village shopkeepers to make sure that dental hygiene products are locally available and affordable, the same way sugar, salt, incense, and laundry soap are.

In the past, vendor outreach has mainly consisted of having local JOHC teams – i.e. residents – visit the shops in their villages, look at products, talk to vendors about fluoridated toothpaste, and sometimes put up posters or stickers that help people identify toothpaste with fluoride. But this summer we’re working on stepping it up. The main reason is that schools need supplies to run their school brushing programs. For that, we provide brushes and paste on a declining schedule, but by the end of two years, either students or the schools have to finance $1 per student per year to run their brushing programs permanently. Even though this is extremely inexpensive, our experience has been that when supplies run out, often schools just don’t replace them. If we want schools to buy brushes and paste, they need to be extremely easy to get.

Therefore, in June, we started Vendor Outreach 2.0 by looking for the best-priced wholesale distributors in Pokhara, with the idea of setting up a direct link between village shopkeepers and the best possible deal on dental care products. But when we approached our first shopkeeper with this idea he told us he already buys his supplies from a wholesale truck that comes through his village on a regular schedule.

P1000170 copyOk, we said, could we get the truck to go to the best-priced wholesale places? We showed the vendor the prices. The vendor showed them to his truck guy. The truck guy offered a better rate.

So that was over.

Onward, then, to Salyan, one of our harder-to-access regions, where Gaurab was organizing a vendor outreach program for the following week. He had a list of about 25 shopkeepers and their phone numbers. It occurred to us that we should invite school teachers also, since the point was for the teachers who run the brushing programs to connect with the vendors who supply the products they need. This stroke of insight made us feel brilliant. Actually, that was a really good idea.

Before the Gaurab’s trip out to Salyan for Vendor Outreach 2.0, I suggested that he print out little slips of paper with the location and contact info of the best wholesalers we’d found in Pokhara. That way we’d make sure all Salyan’s shopkeepers had this info in a nice tidy fashion. For the best deal.

“So how’d it go?” I asked Gaurab back in the office on Tuesday.

“Great,” he says. “We had over 20 vendors and a lot of the teachers running their school brushing programs came too. We made visits to a number of shops, and I brought the poster with the fluoridated toothpaste packages.”

Vendor Outreach in Salyan

“Awesome, did you give out the contact info for the wholesalers?”

“Yes but…”

“What?”

“I mean, they said they already get brushes and paste at that rate from their wholesale trucks.”

“Are you serious?”

“They said they can totally visit the wholesalers we found if they happen to come to Pokhara,” he consoled me.

“So basically, we’ve spent the whole summer on this, and what you’re saying is…village shopkeepers already get brushes and paste at wholesale prices from trucks that deliver right to them.”

“Yes.”

“All these schools already have vendors down the street with access to these products at the cheapest prices we can find.”

“Yes.”

“…So Vendor Outreach is basically just…getting the teachers up the street together with vendors, and convincing them to purchase supplies down the street.”

“Yes.”

“Like all we have to do is get everyone together and talk about it.  Maybe assign a specific shop to each school.”

“Pretty much,” Dilmaya chimes in.

“Guys,” I said.

“I mean, they can use the wholesalers we found if they come to Pokhara,” Gaurab reminded me comfortingly.

“Why is everyone going around handing out free dental supplies?” I demanded to nobody.

Back to the drawing board.

We find this over and over. Our complicated ideas for fixing things are 99% irrelevant, with a critical 1% of something that is missing: information, a tool, a little encouragement, some social integration, a familiarizing element or formality. Vendor outreach will continue to involve oral health education for shopkeepers, because most people are not aware of the importance of fluoridated toothpaste in preventative care. But then it’s mostly a matter of building relationships between vendors and purchasers–especially between schools and specific local shops to source the supplies for their very affordable brushing programs.

In other words, we need tea parties more than we need supply chains, more than we need products, more than we need anything that’s not already there.

In conclusion, we’ll enthusiastically be taking donations of items such as art supplies for oral health games in schools, certificates of achievement for Oral Health Coordinators, funds we can spend on having local tailors sew brush holders, holding workshops, lobbying local leaders, creating teaching materials; and actually, if anyone wants to offer rides to our field officers out to Sindure and Rupakot and Salyan so they don’t have to spend so many hours walking or stuck on buses, that’d be great.  Also, snacks.  Help us out – there are many things we need to do our part well, and lots of opportunities to support communities in Nepal.

As far as brushes and paste though, I think local shopkeepers figured this out quite some time ago.  Duh.

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Vendor Outreach in Sardikhola with technician Megnath Adhikari

Vendor Outreach in Sardikhola with technician Megnath Adhikari

Earthquake, Nepal Life, Work

A Bamboo Village

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I am so excited about this post. I started hoping I’d get to write that title a few weeks ago, and now here it is.

We went back to Archalbot today to see how things had progressed since our tin delivery about a week ago. In contrast to our first shelter outreach effort, where we left not knowing how many heads we’d actually covered, in Archalbot we found a village of new bamboo houses. Some of them are still in progress, for a few reasons. One is that the houses in Archalbot didn’t fall completely; most people still have homes that are dangerous, but not technically unlivable, which slows down the shelter construction. The second is that it’s planting season, so people kind of got something up as quick as they could, and plan to do their plastering and finishing in about a month.

Still…this was a pretty great sight to see. Let’s start with the earthbag house. It’s been covered in a bamboo frame and turned in to a pretty sweet little cottage with electricity and everything hooked up, and a neighboring home built right next to it, much like the attached houses they are temporarily replacing.

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Next up, remember Kushal? Here is a photo from the tour he gave me of his original house, and here he is in his new bamboo home.

 

 

 

 

 

 

 

The site we glamped at in Kripa’s yard, which was previously the buffalo shed, is now a bamboo outdoor hotel (which unfortunately, I seem not to have taken photo of!) And this lady, Kripa’s neighbor, was seriously so happy about her bamboo cabin that she absolutely insisted we come back again after the planting season, when it’s all plastered and everything, to stay the night.

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I could post another load of these photos. They were just great, one after another.

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For the sake of transparency, I should admit that there was one woman who hadn’t built a thing; her tin was sitting on the buffalo shed waiting to be used. In the end, we didn’t pre-check all the frames or original houses in Archalbot, because we’d spent so much time there and the homes were so concentrated that we relied on the community to police itself (and in fact, it was a neighbor who brought us over there). This house is one of those that is ambigiously unsafe; cracks in the walls, but generally a more appealing place to live than a temporary house, so it’s kind of up to the owner whether or when they’re going to bit the bullet, move out, and rebuild.

We had an awkward interaction where I politely explained that she didn’t really need a roof – which I could see from looking in her house – so we’d be giving it to another family in the morning. I said we’d welcome do our best to provide anything else she could think of for something she actually needed. That was at 7:30pm. When we came to pick up the tin the next morning at 9:30am, we found the following:

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Well, that worked. For something.

So we have the successful, the more successful than we actually we wanted…and Uttam. Of all the houses in Archalbot, Uttam’s family’s are my favorite. Unfortunately they’re on borrowed land and in the last week and a half, the landowner said they can’t stay, so in theory they’re going to have to relocate this whole operation to their own land, where their ruined house is still taking up a lot of space. As a result they didn’t bother building the front wall. But I still give this house an A- overall, and an A+ for improvement from starting point.

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However the trophy goes to Uttam’s older brother, whose home is quite smaller. Remember when I this family didn’t want to go cut bamboo because they said nobody would help them? When Uttam’s older brother and his wife left for the woods with their tape measure, and when he showed me where he’d planned the guest area? This guy and his wife looked so proud of their house and so grateful that something in this world hadn’t proved to be a sham.

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When I took this photo of Uttam’s brother outside his house with his grandson, he called me over and pointed to the camera, and I knew he was going to say what people always say: “Please send me a copy of this picture.”

But he wanted something else.

“Show this photo to the world, ok?” he said. ”You know, something for people out there to remember me by.”

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