Another Room in Heaven

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

The Way to Muktinath

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Night falls at last.

 

*

 

Fleeced and Ready

 

So we’re in the final countdown before 20 of our field staff and 12 dentists, public health specialists, and students arrive here on Monday night.  As I’ve previously explained, we are trying very hard to steel ourselves against the persistent unraveling of planning that seems to occur despite all efforts to the contrary in this neck of the woods.

This steeling involves checking and rechecking that hundreds of people will show up in rural locations for dental screenings, and that our own field staff will make it here by Monday night (our best hope that everyone will be on img_0886time for the start of training on Tuesday morning…very crafty).  We’ve combed through a detailed inventory of supplies – mind you, none of us are dentists, yet we are in charge of the 2% Chlorhexidine solution – and we still have to shop for 50 teaspoons (don’t ask, this is my life, it’s real).  We found a training hall and a bus for forty people, and there are currently no political strikes or holidays scheduled.  I reviewed the whole thing with Dr. Sokal on skype and drew a layout of our workflow complete with the number of chairs and tables we need.  We booked nine people on one flight from Kathmandu to Pokhara, and hopefully, the flight will not be cancelled.

So this week it snowed in Connecticut, and with the bad weather, Dr. Discepolo, a pediatric dentist coming from UConn, missed her flight.  Because even Connecticut starts going haywire when Nepal gets involved.  Fortunately, Dr. Discepolo was scheduled to come in a day early, and will be here Monday instead, so we are ALL SET.

Today while Aamod and Gaurab were in Puranchaur meeting with people in the local health ministry about the upcoming project, and visiting primary schools (again) to make sure they’ll be sending mother/child pairs for screening, Muna and I were at the office fielding other essentials.  Among which was printing jackets for everybody, which we need by tomorrow night.  But after the Nepal Health Research Council and the 10-tab spreadsheet of budgets and reservations?  Jackets – no sweat!

We’d picked out a few samples on friday, and Muna called the printing press this morning to ask if we could send photos to inquire which jackets could be silkscreened.  The printer told us he had to physically see them.  So we went to the shop to get the jackets, and while Muna took a taxi to the printer to show them a puffy vest and a fleece, I commandeered basically everyone in the store to help me take 40 more puffy vests out of little stuffing bags so I could check off sizes on a spreadsheet.  Then we finished that and I tried on option two, the fleece number, so I’d know what sizes of those we’d need if the vests didn’t work.

Muna texted: “They said they can’t print on either type.  I am coming back.”

We put everything away again.

Muna returned.  “They told me, even if someone says they can print on this vest or this fleece, don’t let them.  It will be ruined.”  Ok then.  Back to the drawing board.  We tooled around looking for something else that could be printed on.

The store owner came in.  “I can bring this vest to my Son-in-Law,” he announced. “He has a factory, and I’m sure he can print this.”

“But the other printer said–”

“My  Son-in-Law can do it,” the owner declared.  “Even if we have to stay up all night, we will print your jackets by tomorrow evening.”

We considered.  It was decided that I would go with the store owner to visit the son-in-law’s factory to review the case.  But only after lunch.  The store owner had not eaten since early in the day.

Muna returned to the office to call all 20 of our field staff, again, to remind them when and where to appear tomorrow night, and I took my computer next door to the jacket shop to work on a Welcome Packet during lunch.  (I say it’s Welcome Packet, but in point of fact, I think I just need the list of 40 participants and the screening layout and the schedule where I can see it at all times.  It’s for me, forty times.)  After lunch, the store owner pulled up in a car and took me to his son in law’s factory.  We presented the vest option and the fleece option.  The vest proved unprintable, but the fleece was a definite.  Definitely a definite doable printing job.  I poked my head in to the “factory,” which was, in top Nepali style, basically a living room.

“I will take you to the printing shop to arrange the logos on the computer,” said the Son-in-Law. “We have to wait for my colleague to go ahead on his bicycle.”  Courteously, we waited for the colleague to get a ways ahead on the bicycle, and then we caught up on a motorbike.

We entered the printing shop and presented a sketch of the layout to be arranged for the jacket.

“Yes, I have this pattern,” said the printer.   He pulled up our jacket on his computer.  “This, right?”

Me: “…?”

“The young woman was in here earlier,” he explained.

I texted Muna.  “I’m back at the same printer you took the sample to this morning.”

Muna: “WHAT?  They said they couldn’t do it.”

Me: “…? …I know, right?”

It takes about an hour an a half to arrange the logos, mainly because one of our visiting dentists teaches for a Cambodian University, and their logo has Khmer lettering that won’t come out right.  The printer guy painstakingly recreates each picture of the Khmer lettering in the logo for the Cambodian University.  He arranges all the pieces of the printing for our jacket and prints it out on laminate.  The son in law comes back and gets me and the laminate on his bike.  He deposits me on the main road so I can take a bus back to the store to get the rest of the jackets out while he prints a sample at the “factory.” I seriously have no idea how this day would have turned out if not for the shop owner and his son-in-law, who basically saved our butts.

It’s now 4pm.  I take out my spreadsheet again.  The entire staff of the store that Muna and I entered at 11:30am today begins taking out fleece jackets from various unpredictable locations.  Fleece jackets appear from every heap and rack of mountain-wear, and they are sorted in to piles while I read from my spreadsheet, again.  Everyone is concerned that the men are not to wear hot pink fleece jackets, and this must be accounted for.  The floor is is covered in fleece jackets.

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I leave for an hour and a half to go do an interview with a local paper, and come back at 8pm.  The son in law has brought a sample jacket with him.  The only problem with it is that the whole thing is too high, and the hood falls over the printing.  Also, while putting the print on, they accidentally melted off one of the drawstrings at the hood and pressed it in to the shoulder of the jacket.  This too must be corrected.  They promise not to melt any parts of any of the other 39 jackets, which I send off in 4 oversize plastic bags.

At 8:45pm I head home for dinner.  Among the things I did not do as planned today: write a training schedule; print referral tickets; send an abstract to UCSF.

Why are you so late? Bhinaju asks.

*

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Hopeful in Sarangkot

 

Yesterday we met with the Sarangkot Health Post Chairman and a committee of local leaders.  Our goal is to advocate for Sarangkot to invest government funding in their dental clinic, our longest-running one.  This is part of a larger strategy of bringing rural dentistry into Nepal’s nation-wide Health Post network, which we’re only really beginning to dive in to deeply now that we’ve sorted out the clinic model itself.

A normal meeting in Nepal will begin, at best, 30 to 60 minutes after the stated starting time.  In villages, it is not unusual for this to be doubled: our Oral Health Coordinator trainings, which involve teachers from all over the village, frequently start at least two hours late.  It’s just a given, and if you’re Nepali you are pretty down with the long waiting period prior to your carefully planned program.  If you’re me, you basically never get used to the feeling of dread that nobody has shown up, all is lost, nobody cares about anything, and you were way overly optimistic to be in this line of work anyway.  Inevitably, just when you’ve chewed your nails down as far as they will go, people show up and casually take their seats.

Amazingly, however, when the four of us arrived at the Sarangkot Health Post on two motorbikes at 1:25pm for a 1:30pm meeting, about 10 local leaders were seated and waiting patiently for us in the chairman’s office.  I think I’ve seen that happen…maybe never.

It’s important to know that Nepal has not held elections at the local level since the early 2000’s. Instead of an elected local government, most villages have a handful of people – probably 95% men – who are socially (or self) appointed to make decisions, plus a village chairman and a Health Post chairman, who are both appointed by the district government.  These village Committees have power over spending but have no direct obligation to represent the needs or desires of local residents.  For us, that means convincing a committee of influential people and two all-powerful officials that the dental clinic is not only worthwhile, but should be a spending priority. If there’s a code to crack on getting village residents to apply pressure, we haven’t found it yet.

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Our meeting with Sarangkot went amazingly.  Aamod and I had invited the Health Post chairman for coffee a few days earlier and he received us with some expected concerns and doubts, but with an open mind.  A few days later, we found the committee gathered in his office to be genuinely interested in talking with us and quick to acknowledge that, notwithstanding the flush torrent of external funds in to Nepal, any new health service for rural people is not truly stable unless it can be incorporated in to the government health care system.  Our proposal was that we would invest $1000 in new supplies and training for the Sarangkot clinic, upgrading it to our current infection control standards, if the government agreed to pay the salaries of the technician and assistant.

They said yes.

Not to the amount we’d hoped for – $1000 per year – but to a lesser amount that is reasonable (our original hope was a serious long shot, given that the district and central levels do not recognize oral health as a funding priority, and they finance village budgets).  After a lot of discussion, we came to a decision that was duly recorded in the meeting minute book and signed by everyone present.  This involves a commitment for the local Committee to include oral health in their requested budget for the next fiscal year starting in July 2017 (which gets submitted in November), and for the intervening year between this July and next, to submit a proposal to the municipality for an emergency amount that will help bridge the gap.  They are also preparing to move the dental clinic in to another room that is bigger, cleaner and more secure.

There are still many unknowns – meeting minutes definitely aren’t action, and they definitely aren’t funding.  Some critical steps are up to people higher up, where we are also moving in to advocacy.  It will be important for us to monitor and collaborate in this process, following up on the agreed timeline, offering support to Sarangkot’s funding proposals.  There are lots of places where things could fall through.  BUT, we got through an important step one more successfully than any of us expected, which is that everyone appears to have agreed it’s worth trying.

In the short term, the new room is to be ready in two weeks.  We supplied paint and set some other requirements: secure doors and windows, removal of storage that is not related to the dental clinic.  After that, we will provide various supplies and training in stages, at pace with the progress of Sarangkot’s investment in the people.

Good start.  Now, on to Bharat Pokhari!

*

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Dipendra and a vigilant mom at the Sarangkot Clinic in 2016.

Sindure Signs

 

Sindure village is one of the old feudal capitals of Nepal, where a king once ruled over Lamjung district before unification in the mid 1700s. The drive from Pokhara takes about 6-7 hours…the last three are very bouncy.

IMG_3007Our day began in a downpour at 6:30am, with the usual wakeup activity: loading a dental chair on to the top of a Landcruiser. We packed in various boxes of medicines, adjustable stools, plastic goggles, and this fancy Hello Kitty timer. Because Virex disinfecting soak is 20 minutes, exactly, and one must have a proper timer.

Also, we had an extra passenger and her little boy who were headed home to their village. They set up in the front seat, and the little boy kept arranging himself with his knees splayed out and the bottoms of his feet together, so Neha quickly named him Laughing Buddha. Mean time, we squashed ourselves in the back of the cruiser and set off in the rain, picking up our senior technician Megnath on the way. And then we were off to our first ever clinic opening in the district of Lamjung.

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We settled in and the cruiser bounced joyously along. It was strange to be headed off to Lamjung again, where we spent many long hot days after the earthquake at this time last year. I was apprehensive about how our clinic setup would go, if the whether would clear, if the road would be passable, if a lot of things. And it was Sunday the 26th, exactly one year after my beloved friend Mary passed away on another rainy and pregnant day last summer. I stared out at the passing rain and fog, thinking about each moment I’d spent on this morning last June, checking my phone for updates from the other side of the world, stunned and devastated by a sudden change of events.

Then again, the bracing car ride left minimal opportunity for rumination. A few hours in, we stopped for tea, and shortly afterwards, Laughing Buddha barfed all over Gaurab in the front seat.

Well, the best part is yet to come.

We arrived at the Health Post in Sindure at 2pm to find that, while work had been done on the clinic room, such as making sure it had a roof over the entryway, the room itself was filthy. To give you a frame of reference, here are pictures from main room of the Health Post, which sees patients regularly to distribute medicine and make referrals. Unlike our dental clinic, the Health Post is not performing surgical-type procedures—nevertheless, setting up a dental clinic with rigorous infection control is, well, basically up to us.

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Still, there’s a reason we rely on rooms provided by the community instead of building ourselves new facilities. I’ve seen how that can be the difference between imposing new resources haphazardly, and mobilizing existing capacities to raise things to the next level first.  Then it’s a good time to push the boundary, which in this case as in many others, has not yet been approached. After all, with some sweeping and a few buckets of water and phenol, our dreary clinic room started looking a lot better.  There’s no water source at this Health Post, so Dilmaya, Neha, and the Health Post Assistant good-naturedly hauled buckets of water from a “nearby” house at least a quarter mile away.

A few hours of washing, drying, and setup, and things are improving already. This room will need a nice bright coat of paint on its stained walls – we provide the paint, the team does the labor – but for now, here is JOHC Technician Jagat Dura in his new office!  And we’re not even at the best part yet.


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During our pre-opening day, a veteran technician and our medical field officer go over everything from top to bottom with the new technician (who’s already had weeks of training before this) and clinic assistant.  It was awesome watching Megnath Adhikari, who started with us in 2013 and now runs the Puranchaur clinic, reviewing with the new clinic team everything from how to put the top on the autoclave to how to fill out the patient forms to when to change their gloves. Our infection control protocol, when followed, is stricter than that observed by many field teams and local hospitals. The new teams always look so new and wide-eyed that it throws me off every time. To be fair, imagine if you took a few weeks of training in dental medicine, and then, say, your congressman came in and asked you to pull their tooth out?!  But then, as the months go by, inevitably these green clinical teams turn in to people like Megnath, who started out with sagging jeans and a quizzical look, too. This growth in skill and confidence, which I’ve witnessed over and over, is one of the coolest things about this program. It inspires me to believe that this is a system that could be deployed widely by the government with the right investment in training and resources.

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Senior technician Megnath Adhikari reviewing use of the autoclave with the Sindure team

In the evening we stayed at the home of our technician, Jagat. His mother cooked heaps of food and poured us one cup of local moonshine after the next. I was so tired I kept falling asleep and had to get out of bed for each succeeding round of dinner.  And still…the best part is yet to come.

Sindure is a predominantly Gurung area with different traditions of respect than many of the other areas where we’ve worked. The local President had spent the evening with us, and after everyone was overfed, it was time to sit around and sing for a while. I’m not a very good traditional Nepali folk singer, but I’m a decent self-taught drummer and chime-player. So, having secured an empty plastic bottle and a set of tin cups, I am confident saying my role in this process was solid, although you can’t hear it in this video cause I was filming.

The next morning dawned in a downpour, which cleared as we made our way to the clinic for opening day. The clouds nestled down in to the hills like cotton and we climbed up over them. Sindure was too beautiful to leave out a scenic photo.

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In an opening ceremony, we were each given gifts, and I received the finest one, a magnificent Gurung-style ornament made by our technician’s grandmother. These shiny dangles are made from cracker and candy wrappers! I love this thing.

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The door to the clinic was officially opened by the Singing President, who had apparently recovered from last night’s revelry and lay down honorably as the first patient.  Jagat performed his inaugural checkup, supervisor standing by, with a crowd peering in the door and looking very enthusiastic about this whole thing.  Who knew dentistry could be this entertaining?!  And we’re still not at the best part yet.

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Now then…nothing like showing off your new filling!

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It is currently the busy rice planting season, which is about the worst time of year to open a dental clinic because everybody is in their fields. Nevertheless, we had a pretty solid attendance from a fleet of Female Community Health Volunteers (official women’s health workers trained by the government) and some other folks here and there.

We plucked various people off the road, such as one man walking by on his way to plant rice. All in all, the new clinic was inaugurated with about 25 patients, with Megnath carefully supervising the new team, and seeing that was especially gratifying.

As our day was coming to an end, I happened to look up at the sky. And for only the second time in my life – the first time being on the sacred day thirteen after Mary passed away – I saw the following sight:

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Look! I cried, look! Everyone turned their faces up and let out a collective breath of delight. I ran over to a clear patch of ground to try to get a picture, but my camera was having trouble focusing while pointed directly in to the sun.

“It looks just like a roti!” exclaimed the man who had stopped by on his way to plant rice.

Now then, my mind chirped, this must happen a lot. Weather patterns are repetitive; I mean, I know where to find all the rainbows in Kaskikot, and in what sort of light. It’s so predictable that I’ve usually climbed a hill and pointed my camera already by the time a rainbow is emerging. Still, I consigned, how lucky for me to receive this lovely gift today in a brand new place.

“Do you see this kind of rainbow often?” I casually asked the man who had stopped by on his way to plant rice. To confirm my suspicions.

“I see rainbows all the time,” he said, “bent sideways like this. But I’ve never seen this kind of round rainbow in my life!”

I clicked and clicked in to the sun, and the shutter went off only one time. Almost immediately, the clouds moved back in and the wonderful roti faded away.

Later that night, after a long, bouncy and exhausting ride home, back in bed in Pokhara, I lay in the dark and pulled the photo up on my phone. I turned it this way and that, looking for something. I kept thinking of Mary saying trying to show me the big hand in the sky, and how I couldn’t find a thing until much later. I zoomed the photo in and out and scoured for clues. Then, tired and lonely for her, I held the phone back and sighed. And there, right where I couldn’t miss it, was a perfect Buddha, the sun shining from its heart.

Once I saw it, I couldn’t not see it.

 

 

 

 

 

 

 

As a little extra flourish, an unmistakable smiley face, etched off to the right hand side, grinned at me as if to say: how obvious do you want me to get, you little shit? I clicked my phone off and fell asleep with it lying near me on the bed.

Welcome to Sindure, world.

*

A Life of Love

A Life of Love

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.

Dec. '03

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.”

 

 

 

Waiting Out Rain

 

I’ve just arrived in Nepal, and the dust and diesel is shining on the streets of Kathmandu, stilled by summer rain.  Honestly for a whole decade I didn’t want to be here during the hot and buggy monsoon, but last summer I discovered that of course, like any season, the rainy time has a unique and indispensible magic.  The water clatters and pounds, washing everything and making us wait.  It comes down too hard to walk around or do anything.

Just wait.

It’s strange to re-enter this season which was so intense last year, when I arrived to a stunned and grieving city dotted with blue and yellow tents.  It seems that this country has basically just plugged on, absorbing the earthquake on to its pile of other messes, the unlucky people who lost the most – possessions, limbs, relatives – doing what people do: surviving.  The next day just keeps coming, and for anyone whose life wasn’t irreparably altered, that catastrophe isn’t the topic of conversation any more.

Things for me, however, have changed a lot.  When the earthquake threw us in to the ring with the big multinational agencies, it helped show our tiny staff the value of our community-level expertise.  This spring we launched our dental project in Lamjung district where we did earthquake relief.  

In the fall I also started a Master’s Degree in social work, and I’ve been able to incorporate a lot of what I’m learning in to our program right away.  Guys, seriously, a lot of this stuff I’ve been trying to explain has an entire body of theory and practice associated with it called human rights!  People are doing rights-based health care at the United Nations!  I found out I am basically an expert on rights-based dental health care in rural Nepal…WHO KNEW?!  (Who becomes an expert in that by accident?)

Ok, just wait.

Also, a few years ago, we thought we should do some baseline surveys in our villages.  Not too focused on the concept of sample sets, we thought we’d survey ALL the households…3,374 of them distributed over various hills and more hills, actually.  Because as long as you’re doing it, do it, right?  I wrote a survey with input from various people, we trained some high school students as surveyors, and just last week – 2 years later – we completed a 58-page report on this survey (thanks, Sarah Diamond!).  Come to find out there’s very little current research of this kind in Nepal, and this report is a thing.  I am taking it around like my visiting cousin and introducing it to everyone.  Here is a picture of our report.  Let’s call her Cousin Mae.  She’s in color, with pie charts and clones and everything.
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All this has come together in a very cool way.  Over the course of this year, three major U.S. Universities have developed a potential interest in partnering with us for research or medical collaboration.  It feels awesome!

So with all that in mind, this summer, I’ll be doing a few things:

  1. Visiting each of our ten clinic locations (past and present).
  2. Establishing a Rural Dentistry Coalition in Nepal to advocate for policy level recognition of our model, so that rural dental clinics can be established systemically for all villages through the national health care system (eventually).
  3. Laying groundwork for future research partnerships (hey, positive thinking!)
  4. Revisiting some of the places we did earthquake relief  (unforgettable)
  5. Planting rice with Aamaa and getting myself in to as many embarrassing situations as possible (inevitable, really).

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I am very ready for all of this following knee surgery in February.  At physical therapy, I do a warm-up each day where I put the treadmill on “maximum incline” of about 20 degrees and walk for 10 minutes.  Yay!  Now I am here and our newly launched Sindure Clinic is reached by a 5 hour hike.  That means physical therapy + dental clinic supervision at the same time.  This is not a deal you can find just anywhere, people.  Take note.  It’s not even a limited-time offer.

I’ll sign off with a few lines from a recent article in the Guardian that I really appreciated.  It can be very hard to stay motivated doing this this kind of thing, even though it’s true I sometimes get to pretend my iPhone is a grain-sifting woven pan and put it on my head, and we can reliably say it’s not a cubicle job.  But the pervasive story of the American (Social) Entrepreneur is hard to see past, with its celebration of saviorism, speed, and simplicity…as if there’s an equation to solve or a prize at the end.  But society doesn’t work that way, and often building things is just hard work.  You only stick out when you screw up; most of your ideas are 78% wrong the first 8 times, but there’s something good in there; when you disappear, that means it’s working.  If being humbled isn’t exalting, you’re in the wrong business.  I decided to tape this bit up on my door:

“I understand the attraction of working outside of the US. But don’t go because you’ve fallen in love with solvability. Go because you’ve fallen in love with complexity. Don’t go because you want to do something virtuous. Go because you want to do something difficult. Don’t go because you want to talk. Go because you want to listen.”

And then…just wait.

*

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Moving Still

 

An exciting week of office work led up to this year’s Maghe Sakranti, which always seems to coincide with some travel experience, astrological event or, in this case, Aidan’s 8th birthday, IMG_3858which, if you think about it, is the same thing.

The main topic of my conversation with Aidan and Pascal since I arrived two weeks ago has been black forest cake. Birthday cake came in vogue in Nepal about five or six years ago – as far as I can tell, it was discovered on TV, and has been translated in to an epic mashup of east-west-birthday-wedding-puja sort of candle-lighting experience that is not to be missed. Anyway, after a hectic week of office meetings and shopping for light fixtures, I caught the last bus up to Kaskikot on Thursday to head home for Maghe Sakranti with birthday cake for Aidan.

Because of Maghe Sakranti, the bus was packed with people heading home to Kaskikot. “Kaskikot packed” means that there is no standing room left inside the bus, and additionally, the people with poor tactical skills who’ve sat in aisle seats have someone’s butt in their ribs or armpit or smushed directly onto their faces. Most definitely, all people with seats are holding either a random package, bag of tomatoes, or someone else’s child on their lap.

As a master bus-rider, I possess a hierarchical mental catalogue of exactly which nooks and crannies make for a tolerable ride relative to a shifting set of variables. I approach “Kaskikot packed” with the focus of a honing pigeon.

IMG_4380It is immediately obvious that today is a top-of-the-bus day. Air is high on my list of prioritized variables, and all of the strategically located nooks and crannies inside the bus are taken or have been invaded by the limbs and odd angles of people who are technically not using these spaces. It’s a total free-for-all. For some reason, Nepalis have an awe-inspiring tolerance for this kind of physical disarray; I on the other hand, while happy to fit myself in to a pretty small nook, need it to be evenly balanced on all sides and protected from random entry, no matter how small my zone is.

Never fear, this is situation is accounted for. I hand Aidan’s cake to the Ticket Bro – all the guys who collect money on buses are Bros of the first degree, with wiry bodies and saggy pants – and clamber up a metal frame to the roof of the bus. The Ticket Bro, who knows me well (ok, I stick out, and besides I’ve provided many unreasonable entertainment opportunities for the general bus-riding public), hands Aidan’s black forest cake up to the top of the bus. I wedge it in flat between a box of beer bottles and a floppy sack of mystery items that’s soft enough to sit on. Soon I too am wedged in evenly on all sides by other passengers, which is exactly the way I want to be. I bend my knees protectively over the cake and we lurch away. The climb to Kaskikot isn’t a long distance in miles, but it’s all up, one switchback whipping around to the next.

The air begins to rush past and in settles a familiar, soothing reeling. The bus is climbing and honking, people are sticking out every which way, we are ducking the occasional branch – FWAP! – as the trees whoosh by. A wave of exhilarating calm envelops me, soft and malleable.

There have been three accidents on this bus route since in the thirteen years I have been riding it. Each time there is a bus accident, everyone including me swears off this road, these good-for-nothing-regulations, these drivers. The police crack down on the rules; buses are improved and added to reduce passenger load. The new bus I am on today looks like a greyhound, with upholstered reclining seats. But inevitably, the people turn this bus in to a wild beast. It’s inertia.

IMG_8687It just can’t be avoided.

Which, in a way that’s hard to explain, is why it’s so calming. Like in many poor countries, there is no illusory order here: everything is paint splatter all the time, and nobody’s pretending it’s something different. Everyone is hanging on to the spinning planet with one finger, and it is still working, at least until it’s not. Over time you realize that you too are paint splatter. You might think you aren’t now. But when order falls away, all of us are wilderness.

After the tragedies that have happened on this road, I know I shouldn’t admit it’s thrilling to catch the bus just in time, climb up to the roof, and duck branches while people talk on their phones and sway side to side eating peanuts like we are on Amtrak. But it isn’t a thrill because it’s dangerous (for the record, in purely statistical terms, driving on the beltway is just as dangerous)… it’s a thrill because it doesn’t feel dangerous. It makes sense. Because we are all flying through the trees together; because chaos and order have switched places, and everything fits despite the appearance of anarchy, and we are not dead yet.

In the mean time, some racing tiger inside of me catches the trees dashing by. I can feel the grumbling pavement even from up on the roof of the bus, and the Ticket Bro heedlessly climbs up and down the side of the bus like a chimpanzee while it is whirling around a corner. The valley below us recedes, and that wild thing in me, with a racing companion to match its speed, is still.

I’ve found this pocket of tranquility in other fast places.  When I catch a seat on the back of a motorbike and take off, zipping up my jacket. When I’m flying down a path in the trees with a sickle and rope in my hand, my flip flops smacking tap-tap-tap-tap on the rocks. Occasionally I have whirled into this thing when jumping on to the subway in New York, snagging a tread of some larger tapestry in the crush of a ten-million-person city with a trillion little shards of disorder that still fit in to something bigger.

In the subway, this is a private knowing. But on this bus, the miracle is out in the open for everyone to see: unruly, electric, FWAP! It’s still working.

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As we climb the lone road up through Sarangkot and closer to Kaski, people filter out at their homes, lugging their bags and boxes and children. The Ticket Bro clambers up and tosses bags off the top of the bus, and our resting props are gradually removed. My stop is the last stop. Soon all the other passengers decide to move down inside the bus, but because I am a honing pigeon I know that none of my approved nooks inside are available yet, and I stay on top of the bus, alone with Aidan’s black forest cake. I lie down so I don’t have to worry about oncoming branches, and crowd myself in with boxes and sacks to block the breeze, and float up the road on my back, watching the night sky roll by. My thoughts spiral in and out, moving still.

Of course, I can’t see where we’re going from this position. No problem. This road only leads to one place.

*

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The Walk Home

 

There’s nothing like my first visit to Kaskikot after having recently arrived in Nepal. Granted, sometimes there’s a year in between visits, and in this case I was here just last summer after a long winter stay. But still – today did not disappoint.

I woke up to the charming experience of Pascal throwing his arm on my head. Let’s face it: this room where Didi and Bhinaju live is too small for all of us now, but we are persevering while the house is being built. It is the nights when I share a bed with Aidan and Pascal that I question my judgment in teaching them taekwondo while they are awake.

While Didi made tea, we all lay in bed debating whose fault it was that we’d all spent the night practicing kickball rather than sleeping. Then we documented our morning in selfies.

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Late morning, I met up with some of our graduated Gaky’s Light Fellows for lunch. It was so great to see everyone and hear what they are doing. Sandip is marketing for an online news outlet. Ramesh is deciding where to apply for his bachelor’s in journalism. Nirajan is in Kathmandu, working for Teach for Nepal, and Nischal is entering his second year of bachelor’s. Umesh and Narayan have a solid paid gig singing traditional music each night, and Narayan has his own radio show. Bhagwan is a residential supervisor in a school hostel. When Puja and Asmita finally got there a few hours late, we all made plans to go boating later this week.

Next was getting up to Kaski. With the fuel shortages, this is more challenging than it’s been, as the bus is running infrequently. Not to worry!  I caught the back of a motorcycle ride and then secured a taxi to the bottom of “the jungle path” that climbs straight up from the valley to the house. Forget the bus, man.

So first of all, at the beginning of this path you have to cross over the Gandaki river, which is usually dry at this time of year, but swells in the summer and fall. We used to wade through it, but a few years back it got this nice concrete bridge. So I’m crossing the bridge, and…it just stops in midair. The last half of the bridge is suddenly no longer there.

It takes me a few minutes to negotiate the drop over the ledge of the bridge with a torn ACL in my right knee that won’t let me jump down on to the rocky bed five or six feet below. I make my way over, progress to the bank a short way away, and there at the bottom of the path up to Kaskikot is this leathery guy resting next to a bundle of wood. He looks kind of resigned. I chat with him for a minute and then he asks for help lifting the bundle of wood.

“My son is really strong, he can carry this kind of load,” the man says woefully. “It’s just pretty heavy.”

Nevertheless, the bundle must be lifted, so we give it a try- fortunately I am more qualified than your average random American to hoist a bundle of wood on to someone’s back so it can be slung from their head and carried across a dry riverbed – but it is too heavy, he can’t get upright under the weight. He sets it back down, resumes his seat in the road, and looks resigned again.

“What’s with this bridge?” I ask. “Half of the bridge is missing.”

“I know!” He says. “The other night, I drank up a full belly and came here and fell right off of it.” He points to his forehead and says, “I got a bit of a bump right here.”

IMG_6126“I hear you,” I reply. “I’m not even drunk, and I nearly fell off the bridge too.”

“Just went right over,” he recalls.

“Should we try this bundle of wood again?” I ask.

“Ok, but you have to come around the front and give me a hand.”

I heave the wood on to his back again and this time give him a hand to brace against as a counter balance, and he stands up.

“Thanks, bye,” he says, as if it makes sense that I appeared for this interaction.  Off he goes.

Partway up the jungle path I run in to two kids coming down.  They stop me.

“Where are you from?” they ask me in English.

“America. Where are you from?”

“Puranchaur,” the little boy answers.

“Oh, I’m going to Puranchaur on Tuesday,” I say. It’s one of the villages where we launched last year. I ask what grades they are in: four and eight. “So,” I say to the fourth grader, “do you brush your teeth at school?”

“Yep,” he answers.

“Huh. For about a year, right?”

“A little less than a year,” he says.

“Cool,” I answer, and down the path they go.

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Finally I come out the top of the jungle path and emerge at the water tap in Kaskikot.

“LAURIEEEE!” the ladies cry. “Here you are, just in time for wood cutting to start tomorrow! Last year you came to cut wood, and this year you’re here to cut wood!”

YES. This is the gold medal of the Welcome Olympics. And yes, when I go to cut wood, I understand that it is a memorable experience for all of us.

On my way to the house, a few other people – completely independently – express their approval that I have arrived just in time for wood chopping. I am winning at Nepal.

At last, I drop over the spine of the ridge and there is home. Baby O’Neil is tethered outside, her wet nose pointed quizzically my way; she has grown some brown fur.  The hillside is dotted with jubilant yellow mustard flowers.  There is the familiar line of the Annapurnas rising in to the dusky sky, distant and close. No matter the path that brings me to this piece of land, it always appears the same way, luminous and inevitable.

*

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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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