Water Works

 

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 three baskets slung from our heads 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 reveal 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.

We have a tank, 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. Our water situation remains basically unchanged. We still take baskets to fetch our water from the tap in Deurali five minutes away. 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 windy 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 arranged to rig up a pipe that had been brought from Deurali up to the crest of the ridge by our house. Its location wasn’t in our yard, but it was only a up on the ridge, about seventy-five yards away instead of five minutes in each direction. 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 BAA! presided over the fray. Any moment that the pipe was unattended, it sprayed wild streams of water that swirled in to muddy rivulets down the side of the hill and in to 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 down the hill.

When I arrived back this week in January, I discovered this setup slightly relocated but similarly conceived. With water much more spare in the winter, each household has been assigned to use it on alternating days. When we got up this morning, it 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 fine, but the problem is that for reasons I couldn’t determine, she wanted to get cracking at dawn, and one thing that’s changed in the last ten years: I am no longer so interested in proving something that I am am 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 BAA!, and 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 bijou’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.”

*

 

 

 

 

 

 

 

 

Aging

The second half of our winter professional development is focused on treatment of older adults. Even though a lot of treatment that dental technicians do is in schools, during the weekly dental clinic at the Health Post, they mostly get adult patients. And since most rural adults have had little or no dental care, and likely weren’t exposed to fluoride toothpastes or other preventative measures for their first few decades of life, some of the conditions that present in our rural clinics are pretty extreme. Besides that, tooth loss in older age is common enough that it’s more or less expected.

Of course, our technicians can refer older patients to higher care, and they do. But following up on referrals isn’t always that easy, especially for older folks with reduced mobility. Not to mention that rehabilitation of many mouths we see in elderly patients would require months of ongoing, expensive, complex treatment even in a state-of-the-art dental hospital–something that’s simply is not feasible for the majority population even in a first-world city. So here we are in rural Nepal working in primary care, which is about disease prevention and improving quality of life. But save for the occasional extraction, older adults are mostly left out of the process when it comes to primary oral health care: directly related to the ability to eat, sleep, and participate socially. If we can relieve pain and preserve teeth longer, that seems like a solid contribution.

With this in mind, we wanted to develop a professional development workshop on how the simple techniques that we’re already using – glass ionomer, silver diamine fluoride – can be used to help relieve the diseases experienced in older populations in Nepal. By “we” I mean Bethy since she’s the one obviously who did this because I write stories about teeth and she is a public health dentist. And even if you’re not a dentist or especially interested in cariology, I have to say that how this turned out is really pretty cool.

A few years ago, Bethy and Keri took photos of about 65 people who’d had restorations done in our clinics, and we used these as the basis for a quality-of-care assessment. It resulted in a few different things. One was adding some missing instruments. Another was noticing an apparent pattern among older adults where, around middle adulthood, adult teeth begin to wear rather than decay. It might be caused by anything from an acidic diet, to abrasive brushing with spices, to a lifestyle change like a new medication. The lower part of the tooth near the gums wears down and become loose, causing sensitivity and difficulty eating, and gradually, the teeth simply fall out. These are the adults who, right now, are getting no care at all besides the occasional extraction.  They were the focus of our training.

Our technicians practiced placing glass ionomer restorations on the root-surface lesions, near the gums, that so often lead to tooth loss in older adults. Bethy explained how an event in the life of a middle-aged adult, such as an illness, can cause a simple change like dry mouth that alters the whole environment and leads to deterioration of a previously resilient set of teeth over the next period of years.

I loved this workshop. For the first two hours, instead of looking at teeth, Bethy brought in pictures of older people and the clinical teams simply talked about aging. What makes people old? Are all old people the same? Do they have the same priorities and daily demands and ideas of self? What do we assume when we see someone who we think is “old”? How does a person’s identity factor in to how we work with them to improve their lives? What is our responsibility to someone’s dignity?

In preparing for the workshop, Bethy and I mined our respective photo archives for pictures of elderly people in Nepal and Cambodia. One by one their faces stared out at our group of clinicians, suddenly daring: Who do you think I am?

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In the beginning, most participants had a sort of default position that older people are weaker and less capable of handling dental treatment. But as we went through the photos for well over an hour, stories blossomed. In some cases, they were people whose backgrounds we knew- my neighbors in Kaskikot, steely women I’d photographed during our work after the earthquake in 2015, caretakers and weavers and shopkeepers who’d given interviews in Bethy’s surveys in Cambodia. Bethy used a clever framework called “Go-go, go-slow, no-go” to talk about what each of these people might be expecting or hoping for from a medical professional. I got to laugh about how Hadjur Aamaa has basically no teeth left and gets around pretty slow, but she’ll put one foot in front of the other to get to the house and then frets the entire day, every day, about the dishes or the peas that need to be shelled; it is absolutely vital to her human essence to be busy with something useful. By the end, our clinical teams were musing over what their patients might be thinking about, who they depended on, and who relied on them, what made them human and alive in the world. This was probably a go-slow patient, like Hadjur Aamaa; this one likely a go-go patient ready to sit there all day and get her teeth fixed; this patient probably wasn’t really about treatment, and mainly needed to have his discomfort acknowledged.

The next day, we returned to the same school in Kaskikot to treat patients age 45 and over. (We’re in rural Nepal, 45 is approaching the pre-elderly group…60 is safely considered “aged” and the point is to catch people BEFORE their teeth are gone.) It was exciting to see the same situations we’d learned about the previous day in the real lives of real people and to be able to offer simple treatments that have the potential to forestall tooth loss for years. The teams continued using the App, entering patient data digitally along side the paper forms.

While patients were waiting outside, the father in law of our local Channeler came by for a checkup. I’ve been to see our Channeler a few times – she lives down near Laushidunga, in the direction of Sada Shiva where I taught primary school for a year.  The story that’s told about the Channeler is that she suffered terribly from a kind of delirium for a period of time. She was treated in a hospital, but nothing helped. Then she began to channel spirits. She rebalanced. People travel from all over to see her; I’ve brought a handful of visitors there to connect with people they’ve lost.  Before Bishnu left for the U.S. in 2008, she went to see the Channeler to connect with her father. The Channeler’s husband has a bum knee, and once I gave him my knee brace from CVS, and he always greets me with an old familiarity when we meet in the road up in Deurali.

Anyway, at some point in the afternoon I couldn’t find our technician K.P., and I walked outside to find he was having his palm read in the waiting area. The Channeler’s father in law spent about an hour reading almost everyone’s palm for fifty rupees each. Everyone–our office staff, the field teams, the schoolteachers and other patients–exclaimed over the things he knew: who’s father had died young, who was still to be married, who was destined to successfully stay with one line of work for a long time (one of our clinic assistants! yay!). I didn’t get a turn because by the time I was ready – I’d had my 50 rupees in my pocket for like an hour – he’d had enough with palm reading. Palm reading was over.

Still, my most favorite patient of the day was a 93 year old woman who arrived alone. She was frail, used a walking stick, and barely spoke to anyone even to ask them to move out of the way as she plodded through clusters of people like Moses parting the sea. She wore a jaunty white knit cap that stuck up boisterously on her head. Her entire mouth was completely empty except for one jutting molar with an expanse of exposed root.

“How can we help you?” Hira, the Deurali technician, asked.

“This tooth hurts,” the woman said simply.

 

Hira treated the one tooth with silver diamine fluoride, a completely painless procedure that will hopefully preserve it a while longer and ease her suffering. Then the woman stood up, picked up her walking stick, parted the seas and went home without a word.

*

 

Airport Gymnastics

Bethy and I are on our way to Thailand to present at the International Association of Dental Research Conference in Da Nang, Vietnam.  We are on a panel about “Behavioral Science and Health Sciences,” me to present about Jevaia as a social justice project and Bethy to talk about a system she developed for school-based health care in Cambodia.  Between us, let’s call Bethy the scientist. She plans ahead. She calculates things such as time and has an external battery pack with every configuration of port imaginable and a rubberized exterior that could withstand a nuclear attack, and she brings it with her almost everywhere.  Bethy is a prepared and organized kind of person. I’m what we could call…the artist. I hit snooze 4 times and borrow chargers from nice people along the way. I don’t travel without chocolate.

We meet in Thailand, the mutual transit point on our respective journeys from Nepal and Cambodia to Vietnam.  The next afternoon, at Bethy’s urging we’ve arrived at the airport a solid two hours before our short international flight from Bangkok to Da Nang.  How planny of us. As we are checking in, the clerk asks us to display our visas for Vietnam.

We are both surprised.  Even the scientist! With our American and New Zeland passports, we thought we could purchase visas on arrival in Vietnam.  This is somewhat true, the airline agent tells us. However, there is a new process that requires visitors to submit an online application ahead of time and bring an electronic visa approval to immigration upon landing.  Without the approval, we aren’t allowed on plane.

Well then.  This is awkward.

The Airline Agent informs us politely that we have 47 minutes before check in closes.  I get my phone connected to the WiFi and start googling around for how to apply for a visa to Vietnam.  I find a website called Vietnam Visa Online (lovely name, quite to the point) that says this can be done with approval rushed to one hour, for a fee of only $500.

While I’m poking at my phone looking for a less pricey extortion option, Bethy assures the Airline Agent that we’ll definitely have no problem completing the required process in 47 minutes or less.  I tap madly at my phone screen, and we decide to go for a rush fee that’s only $100 and might or might not get us the visas in time. I click send. Bethy stalls with the Airline Agent. The check-in line shrinks, I hit refresh on my phone, and by now our window has diminished to 13 minutes.

…Tick tick tick…check in closes.

But not before Bethy casually softens the Airline Agent in to printing out a document that shows we arrived on time, and woos her in to walking us over to another desk where we can stare at my email waiting for the visa approval to arrive on the basis of our $100 rushfee. A new Airline Agent looks delighted that our problem has been moved over to her counter, where I set down my phone and Bethy and I peer deeply in to its icons.  We wait.  Airline Agent #2 waits.

An email!  Is it our visa approvals?  No. It’s a reply stating that due to the fact of today being Saturday, urgent processing isn’t possible.  However, we do have an attractive option to pay another $300 to get the visa approval today, or we can certainly wait in Thailand until Monday.

We kind of have no choice but to do the extra-special saturday rush fee, which has been specifically designed, after all, for suckers like us.  So we pay the fee, and then the screen freezes, and we can’t tell if we’ve paid $300 or not. I get an email saying that we can call an office in Vietnam with questions. But honestly, who has questions?   

Calling Vietnam would be a fine idea except that neither of us has phone cards that work in Thailand, so I ask Airline Agent #2 if she can call the Vietnam Visa Online from a land line.  She says the airline has no way to make international calls.  “But you’re an airline,” I point out. This doesn’t change anything, since apparently Asia Air actually cannot make an international call to a mysterious Visa processing office in Vietnam. I deduce this because eventually, Airline Agent #2 takes pity on us and gives us her personal cell phone.  We call Vietnam Visa Online and induct a fourth person in to our lair of chaos.

Mean time, I still can’t tell whether the payment has gone through on my credit card, and my credit card password isn’t working (or theoretically it’s possible I haven’t used it in a few months and I can’t remember it) so I can’t log in and check. For the next twenty minutes, the clock ticks down to our departure while I toggle between my phone and tablet trying to figure out if I’ve paid the fee, and Bethy toggles between Airline Agent #2 and the newly inducted lady from Vietnam Visa Online, whom we have to keep calling from the Airline Agent #2’s personal cell phone.  The voice in Vietnam talks us calmly and assuredly through various steps, which I tap out on my phone, as if we are diffusing a bomb.

Eventually, all three of us–Airline Agent #2 is all in now—are leaning anxiously over my phone, hitting refresh, waiting for the document with our visa approval to show up from the Helpful Voice in Vietnam.  Whose name turns out to be Selina.

Is it there?

How about now?

We may have to carry on our bags.

…Should we call again?

……Is it there yet?

……..How about now??

TADA!

The email arrives.  All three of us bounce up from my tablet screen and give a shout.  Airline Agent #2 triumphantly passes our boarding passes over the counter and we run to the gate.  I won’t see it until we’ve already arrived in Vietnam, but another email has popped up from Selina at Vietnam Visa Online.  It is highlighted in an alarming fluorescent yellow the color of a radioactive duck.

HAVE YOU RECIEVED YOUR VISA YET? IS EVERYTHING OKAY NOW? PLEASE ADVISE!

I write Selina back after we land in Da Nang.

We are here in Vietnam and everything is fine! I didn’t get your mail until we landed. Thank you for all your help today!

We’re aware that it would be responsible, at this stage, to be upset about the insane amount of money our visas just cost, but instead we are delighted with the exchanges of the day, the managing and wooing and reassuring and eventual co-conquership with strangers of our last-minute visas. In fact, we were so irresponsibly pleased by this accomplishment that Airline Agent #2 didn’t even seem bothered when I wanted to take our picture, regardless of the fact that we were holding up an otherwise orderly process of reasonable people getting on a flight from Bangkok to Da Nang.  

And we were able to recharge our tired devices on the fly.   

*

Farmer vs. Medic: Mountain Carry

 

I consider myself something of a carrying specialist.  I have carried water, I have carried wood, I have carried grass, I have carried stinky buffalo-poop fertilizer in a basket and I have carried straw.  I have dropped sacks of rice and recovered and soldiered on with other sacks of rice.  I know carrying, and I know the hills of Nepal.

Relatedly, Bethy is here doing summer-session professional development with our clinical staff, and it just so happens that she spent 10 years as a medic in the New Zealand army.  Recently, we got to talking about the topic of carrying.  It turns out a core skill of army medics is the “fireman’s carry,” and also that this skill may be used either in an emergency with an unconscious or wounded individual or in situations such as on a dance floor, at a bar with friends, or in the middle of the road in Pokhara.

Now Bethy and I are both what you might call competitive individuals–in an entirely healthy and reasonable way, of course.  Out of pure scientific curiosity and in pursuit of expanding human knowledge generally, we got to discussing who could carry whom from the house to the water tap in Kaski.  As Bethy is a scientist and published researcher, and I am a self-made live-in-Nepal-and-start-dental-projects-and-write-stories-er, it became imperative to deploy a proper study on the matter.

Our publication follows herewith.  It is my deep hope that this work will contribute to a deeper understanding of the world and serve as a basis for future investigation.

Phase 1

Phase 2

 

 

 

It’s Not a Problem to Deliver Your Underwear

My friend Ann is here in Pokhara for the summer. She is an IMT therapist and has begun volunteering at the Kaskikot health post, working with the Health Assistant to treat patients using integrative manual therapy. Whenever somebody comes to visit me in Nepal for the first time, I briefly have a renewed sense of chaos, of how from a western sensibility, there is an unnerving feeling of inefficiency and an opacity around how problems get solved. For the most part you don’t rely here on public services, or even private businesses, to pop up with specialized solutions or knowledge in a pinch. You rely on someone’s cousin. To the uninitiated, it’s unclear what people do when things need fixing, and this leaves one with a sinister feeling that small irresolvable inconveniences will accumulate until everything is a hopeless mess and all is lost forever. Therefore, in the presence of first-time visitors I can’t help feeling as though I need to account for a mild but pervasive sense of anarchy that they cannot describe but which, I know, they feel. I don’t know how to explain that there is a different kind of intuitive coherence with other rules.

As for Ann’s visit, everything is basically going great, but one hitch happened early on when she left the bag that contained all her underwear at a hotel in Kathmandu. Also, Ann said it was perfectly fine if I wrote a blog post about her lost underwear. The underwear, while inconvenient but replaceable, was not as much of an issue as the bras that were in the forgotten bag: Ann said her bra size is not that easy to find, and she also said that it’s fine if I write about her bra size too. Replacement of the odd size bras in this environment is one of those opaque things that appears to have no viable solution. The bag needed to be retrieved.

We called Ann’s hotel in Boudanath and determined that they had located the bag of underwear and put it in storage. This was a positive start, however, the next opacity was how the bag would get moved to our district when the mail system exists but doesn’t work according to any particularly obvious or accessible processes. Happily, I was scheduled to go to Kathmandu about a week later. So we rang up Ann’s hotel again and I asked Dorje, the proprietor, if he could hire a taxi to send the underwear to the hotel where I would be staying in Kathmandu. Regarding my hotel, I had previously stayed at the Tibet Peace Guest House only once, but last week after I had called a few times in the process of reserving a room, the hotel clerk and I were officially pals, and when I would call he would answer, “Hello, didi.” I asked the Tibet Peace hotel clerk if he would mind fronting the taxi fare for Ann’s underwear, so that I wouldn’t have to coordinate an exact meeting time with the driver. He said, “Sure didi, no problem.”

“Ann, I have hired a chauffeur for your underwear and the clerk will receive it at my hotel,” I told Ann. She was so excited. Especially for the bras.

I got to Kathmandu and had my meetings and Dr. Bethy arrived and the next day we boarded the plane to Pokhara.

“AH, SHOOT!!” I cried, bonking my forehead against the inside of the double-paned window. A French tourist sitting behind us, who was playing her ukulele in the airplane, became alarmed. She stopped playing her ukulele and leaned forward with her eyes wide.

“Is everything okay?” She asked luxuriously, concerned.

“I forgot Ann’s underwear!” I cried. “Shoot shoot shoot!” Now how would we get it?

The French tourist leaned back and resumed her ukulele playing, and also some singing. The plane was very small, and luckily she was quite a good singer.

Once we’d landed, I called up Ann’s hotel again. Had they forgotten to transport the underwear, I needed to know, or had I left it orphaned for a second time, now at the Tibet Peace Guest House?

“Hello Dorje sir, do you still have my friend’s underwear?” I asked. Dorje revealed that he had planned to send it a day later, today, because the hotel was located in Bouda, a bit of a hike from downtown Thamel where my hotel was, and today they had a driver making an outing anyway. “Oh, I am back in Pokhara now,” I said. “Now what?”

Dorje sir and I pondered the problem for a moment.

“If you know anyone who can bring it to Pokhara, I’ll get your friend’s things to them,” Dorje sir promised. “I will deliver it myself!”

“Ok, I have an idea,” I said. I hung up and walked over to Adam Travel in Lakeside, where we are friends with the owner. Prem often hangs out here in his free time and they book all my tickets. Once, I got to attend a travel agency exhibition in the U.S. with the owner Basu sir.

“Hello Laura didi,” the Adam Travel guys said when Bethy and I walked in. “Ah! Bethy! Hello!” They naturally always know who is traveling with me; the same guys had booked Bethy’s tickets a day earlier, too.

“Hi guys, I was wondering if your Kathmandu office could arrange to have my friend’s underwear sent over. She left all of her underwear at her hotel in Bouda.”

The Adam Travel guys told me that their Kathmandu office is now closed, but the people who used to work at there now work at the Sacred Peace Hotel. Those guys would arrange it. Adam travel proceeded to call Surjet at the Sacred Peace hotel. Surjet said he had some friends at a bus company.

“So,” Adam Travel told me, “They need to bring the items to the Sacred Peace hotel, and you’ll pick it up here. It’s going to be $5 for the cab to the hotel and $5 for the bus to Pokhara. You pay $10.” Where would this be paid? I asked. We’d pay Adam Travel, they said; other people would pay other people in the middle and the debt would accumulate and then we’d pay it off here. No problem.

Sold! I put Adam travel on the phone with Dorje and they discussed all the intermediary checkpoints where someone knows someone who will help reunite the lost underwear bag from Bouda with Ann in Pokhara by Wednesday. We’ve solved the matter within 8 minutes. I wondered why I hadn’t just done this before.

“So there’s bad news, and there’s good news,” I announced that evening to Ann. “The good news is that your underwear will be at Adam Travel in 48 hours. The bad news is I forgot it in Kathmandu.”

“How’s it going to get here?” Ann asked.

“…FedEx.”

*

Confidence Under Construction

 

For about a year now, the Government of Nepal has been undergoing a decentralization of power. The country has been divided in to five provinces and outfitted with new government employees at the state level. It’s an exciting moment for a project like ours, which is aimed at capacity building in the government health system. Right now entire tier of government in Nepal is literally undergoing construction for the first time.

In the mean time, a large number of essential items are not yet decided even as the new government is deploying its duties. The desks are purchased and people have been assigned to sit behind them – literally – but exactly what these people are responsible for and how their responsibilities are to be executed is still a work in progress. Many operational policies are still not in place, and decision-making power isn’t yet clearly defined between different levels of government. Basically, we are in a car that is being built while rolling down the highway. You’ve probably been there too, right? And I accept that many people would find this alarming.

These people, however, find it AWESOME.

This a great time to be a grassroots organization in Nepal that has been working on health care with previously less-empowered leaders in villages. Oddly enough, Jevaia Foundation now has a lot of specialized knowledge on a key primary health issue that few if any other organizations are working on in Nepal. We have policy ideas that we’ve already modeled in multiple health posts, and there are elected officials in lower levels of government with an interest in getting this model supported by the ministry of health. And right around the corner from us in the capital of Province #4, the policies, budgetary headings, and guidelines that will decide these matters are currently being created.

Our hope is that in coming months, we’ll be able to play a role in influencing some of the new health policy. Currently oral health care in Nepal is available almost exclusively in private practice. The ministry of health doesn’t even have a budget heading for oral health at the primary care level, and in the villages where we work, leaders have cobbled funds from other budget categories to run dental clinics in their Health Posts. In the new provincial system, we’re hoping to organize local officials and communities to demand the creation of oral health budgets from the Ministry of Health at the province level.  Cool, right?

So even though everything’s a bit weird here at the moment, a time of change and uncertainty is of course always, potentially, a time of heightened opportunity. It is certainly a million times better than an unyielding stasis, as anyone who has been in one of those surely knows.

Now let’s bring this all back down to the ground for a second, in my home village of Kaskikot, where the newly elected village leaders reopened the dental clinic we started…which had been closed for SIX YEARS. (Here’s the Washington Post story about our handover of the Kaskikot clinic in 2013.) The new Kaskikot clinic is fully integrated in to the Health Post and financed by the village government. Patients register in the main building and then take a registration ticket to the dental room. Data on patient flow and treatments provided is maintained just like all other primary care services delivered in the government Health Post. Our job is now confined to monitoring quality of care and technical support. It’s AMAZING.

In order to garner backing for this example and its variations in other villages, we’ve been hard at work over the last few weeks meeting people behind desks in the new province government, and then meeting with other people they suggest we meet with. It’s so refreshing to talk with these newly appointed officials and to brainstorm with folks outside government who, like us, have been chipping away at sticky issues for a long time and are trying to sort out what the new system means for these bigger goals. The confusion of the moment is offset by what feels to us like a sense of possibility and movement.  At the same time, it’s important that everyone carry on with a grand performance of confidence, even though nobody is sure what is going on. So, ok, we’re doing that.

For example, recently I thought to invite a couple folks we’d met up to Kaskikot to see the dental clinic one Sunday. They agreed to come. I immediately began worrying over how to make sure that they’d be there on a busy day. The Kaskikot clinic is generally seeing about 8-15 patients a day, which is getting close to full capacity…but it’s also the busy planting season, and it’s raining, and….and anyway, it would just be a bummer if we invited Important People to our clinic and there were not a lot of patients when they arrived.  Maintaining confidence under construction means pulling out all the stops.

Fortunately, the Kaskikot clinic runs on Sundays, and I spend Saturdays at home in Kaskikot. I decided to invest in some advertising. Here’s where we move this story from Important Offices to Aamaa’s Kitchen.

“We’re going to the clinic tomorrow morning,” I informed Didi and Aidan and Pascal over dinner. They were in Kaski last week for school vacation. Didi protested that she needed to leave early morning to cut grass for the buffalo because Aamaa’s leg has been sore. Also, she pointed out, What if it rains later in the day? I told her I was 100% certain that it never rains on Sundays and that, in conclusion, we were all to leave for dental exams at 9:30am sharp.

On Sunday morning I started my rounds early, at Saano Didi and Saraswoti’s houses. Nobody looked like they’d been planning on a dental checkup after breakfast. “C’mon guys, we’ll go together, it will be fun. Malika Didi is coming,” I begged. With dignity, of course. For the greater good.  Then, walking down the ridge toward Deurali, I ran in to Mahendra sauntering home.

“I need you to come to get a dental checkup today,” I said.

“A dental checkup?”

“At the health post. There are some important people coming to see it.”

“Ok Laura didi.”

“Really? You wouldn’t lie to me.”

“I wouldn’t lie to you Laura didi.”

“Hey and bring some of your friends,” I added, testing my luck. Mahendra has a posse of bros that move as a pack.

“Ok Laura didi.”

Mahendra and Saila

“Really?” It seemed suspicious.

“I’ll be there Laura didi.”

“Around 11,“ I said, and continued down the ridge.

I came to the yard of Saili Bouju, who’s married to our local shaman, Bauta Dai, our local shaman. Since I pass  their front yard every time I walk home from the main road, we check in pretty regularly. When I’d arrived on Friday, we had already made a plan to go to the dental clinic Sunday morning.

“Saili Bouju, we’re going for a dental checkup today, right?”

“Yes, yes Laura,” she assured me in her deep raspy voice.

“I’ll be by at 9:45,” I said. “With Malika didi.”

I continued up the walk to the the next two houses, where I made my pitch to Barat’s two sisters-in-law and their families over tea. Ambika Bouju happened to stop by as I was rinsing my teacup.

“Ambika Bouju, come for a dental checkup today.”

“Hey, I’ve been meaning to do that,” she replied, to my great happiness. “I need to take my son in.”

“Today’s the day! There are some Important People coming from Pokhara to see it. We need a crowd.”

“Ok, I’ll be there,” Ambika Bouju agreed.

Out at the main road I came upon Amadev bouju in her yard. She can’t hear very well. “Bouju, let’s go to the health post today,” I said. She smiled and nodded and said, “Sure, Laura.” She’s an overall positive person.

“Really?”

“Ok, ok,” Amadev Bouju said.

“To get your teeth checked.”

“Yep!”

I had a feeling we might not be talking about the same thing, so I hopped down in to the yard to discuss the matter at a shorter distance.  “COME TO THE HEALTH POST WITH ME TO GET A DENTAL EXAM,” I repeated.

“Oh! Dental exam? My teeth don’t hurt.”

“A checkup is important!” I proclaimed. Amadev Bouju rolled over fairly easily. She said she’d meet us at the clinic.

I made my way toward Butu bouju’s house.  Back in the day, when her daughters were younger, we used to have sleepovers and make chocolate chip pancakes over the fire.  Butu bouju was out in the yard and tried to impose more tea upon my already full-of-tea stomach. I was delighted to find out that she’d been thinking to bring her grandkids to the health post for a dental checkup at some point. “I’ll be by with Malika didi to pick you up,” I said, making sure that Didi would have no out now that I’d advertised her all over the village, and headed home.

“I’ve rounded up most of the people in Deurali,” I announced over breakfast. Didi replied that she was going to cut grass. I countered withthe importance of oral hygeine, and of my schemes, and how she loves me. And so on.

We set off mid-morning. Narayan and Amrit, who over to play with Aidan and Pascal, were rounded up and I shuttled the whole gaggle along the edge of the cornfield. They disappeared in to the tall stalks and I turned around to make sure that Didi was following close behind.

Somehow, by the time we got to Govinda Dai’s house, I was already alone again. Didi had peeled off to go retrieve Butu Bouju. Saili Bouju said she had a headache and would go another time, and only after much cajoling said that she’d meet us there in a little while, which I was pretty sure was a way of pacifying me and sending me on my way. When I passed Ambika Bouju’s house, she was nowhere to be found, and even though her daughter said she’d be up the road shortly, it seemed improbable. All four boys—Pascal, Aidan, Narayan and Amrit—had taken off ahead of me down the road while I was trying to recapture our patients, and by the time I reached Govinda’s house in Dophare they were nowhere in sight. I walked in to Govinda’s yard alone, not seven minutes after mission launch.

“Ok Dai, let’s go,” I resigned.  I’d been in this moment at least a thousand times before: everything looks static and bleak. There are no people. It is foggy or rainy or dark or something else that generally conveys that you are all alone. Well, something would work out, or it wouldn’t.

As Govinda dai readied his umbrella, I looked in the road and saw that Mahendra had appeared out of thin air, with a friend. They were carelessly posted by the side of the road, sullen and awesome as usual.

“I told you I was coming, Laura didi,” Mahendra said with casual authority. “You guys go ahead. We’ll be along.”

Near Maula, we caught up with Aidan and Narayan. “Where are Pascal and Amrit?” I asked. “THEY WENT HOME,” Aidan declared triumphantly, beaming. I sighed. Oh well. “I’m going to call your mom,” I said, and took out my phone to dial Didi, who was missing in action. “I HAVE MOMMY’S PHONE,” Aidan proclaimed ecstatically. “IF YOU CALL MOMMY IT WILL RING RIGHT HERE!”

I thought morosely that Didi and Butu Bouju most likely got to chatting and weren’t coming along.

We arrived at the Health Post in a thick fog. The previous night’s rain had left everything squishy and slick. Durga, the clinic assistant, was just getting through the morning disinfection and setup process. The technician Dipendra was nowhere to be found. It was 10:40 and our visitors where scheduled to arrive at 11.

10:50. Dipendra rolled up on his bike.

10:53. Pascal and Amrit came tumbling out of the fog through the gate to the Health Post complex. They tore across the lawn, jumped over the wall, and went back out in to the road to play by the pond until called for their exams.

10:57. Didi materialized from the fog at the gate. Behind her, Butu Bouju was walking and chatting with her grandkids, like spirits emerging out of a cloud. I blinked. There was Saili Bouju behind them.

11:10. A line of non-recruited folks had taken tickets and were awaiting appointments. The bench outside was full, not just with my neighbors, but with the natural flow of weekly patients.

11:15. Ambika Bouju arrived with her son.

11:20. Mahendra and his bros sauntered in to the yard.

11:30. Our two visitors showed up to find a full clinic with a long line of adults, children and elderly patients sitting out a roughly 40 minute wait. Inside the clinic room, Dipendra demonstrated the treatment planning form that was developed during our last professional development in December. I pointed out our infection control protocol on the wall and other features of the clinic protocol that we’ve added to the Health Post setting, like floor coverings, dress, tray numbers and documentation.

We retreated to the local government building next door to talk about our next steps at the province level. By the time we came back outside to get in a car back to Pokhara, it was about 12:00, and the line outside the clinic has grown even further.

“Saili Bouju!” I call across the lawn.

“I told you I was coming!” Saili Bouju shouted back.

*

(p.s. I have no idea what’s going on with my weird knome-hairdo in this photo)

Aamaa-Rama

 

Ice cream cone practice

If the Guiness Book of Records took entries for Aamaas who had rarely left their villages in Nepal and had the most friends living in the U.S., our Aamaa would win by a landslide. I don’t even know how many people have been to Kaskikot to eat in Aamaa’s kitchen in the last decade and a half, but it’s an impressive cohort of my friends and family, even if you don’t count all the tourists that Prem bhinaju brings by. We wanted Aamaa to get to see as many of them as possible here in their natural habitat. I put out a call for visitors.

My friend Jackie drove all the way down from Maine to meet Aamaa in Connecticut. We went to a hot air balloon festival and ate ice cream.

“We should go. It will be dark soon,” Aamaa clucked.

“The whole point is to see the balloons lit up in the dark!” Bishnu and I objected.

“It’s night,” Aamaa countered logically. The fact that everyone isn’t basically inside by dark is one of the features of American life that Aamaa seems to find continually alarming. As a side note, she has been busting my chops for being out after dark in Kaski for fifteen years.

We had dinner (after dark) with my friends Heather and Abigail and their son Teddy. Heather was in Nepal with a group of my friends in 2010 for a big hiking trip. I took Aamaa to my IMT clinic, where she was received like a celebrity by all of the therapists. Of course, Aamaa knows all about IMT because in 2013 we did a major manual therapy project in Kaskikot based on the model we use in our oral health program, and three of my IMT therapist friends spent a few weeks in Nepal.

For the weekend, we went shopping in a grocery store (what?), got our nails done, did our hair, cooked an insane amount of Nepali food, and had an all day Aamaa-Rama party. Will, Lissa and Catherine, the therapists who’d come for the IMT project in 2013, came in from Boston and D.C. Dr. Keri, my cousins Robert and Audrey, and my friends Mona and Todd all made long drives to meet Aamaa. I set up a slideshow to play through photos and we sat around all afternoon seeing friends.

The next morning, Bishnu and Aamaa packed their things to drive down to D.C. to stay with Bishnu and my parents.  Will and Lissa came over for breakfast, and then we put everything in Catherine’s Mini Coop and I stood on the sidewalk.  Aamaa got in the car an buckled her own seatbelt.

At last, it came…that withdrawing feeling that I am used to having in the front yard of our gentle orange house in Kaski. Like a fishnet has been tied around my insides and is being pulled away by the force of a world that cannot come with me.  The thing is that usually I am on the other side of it, moving away from an anchor and feeling that world slip away as I leave.

This morning, I was the one standing on the porch, watching the color and sound move out in to the road.

“This is no fun,” I mumbled.  I would be going down to Maryland down to my family in a week.  But suddenly it felt like I couldn’t remember the last time I’d been alone.

“No kidding,” said Aamaa in her matter of fact, unsentimental way.  “That’s what I do.  Everyone leaves and it’s not fun and I sit and cry.”  And it’s true.  Every time a group of us come to Kaski, we leave.

“Nice job with the seatbelt,” I noted.  “See you guys next week.”

They pulled off in Catherine’s car, and I waved, like Aamaa always does, and went back in to my house to think of something to do.

*

 

 

Wanderlust, with “Trespassing!”

 

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

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

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

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

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

The Ritual of Goodbye

 

I decided to take the jungle path up to Kaski, which I normally travel multiple times during any visit, but haven’t been up or down yet during this hectic winter. I set off late and as I climbed up, the scramble of things fell away and I was alone on the stone path.  Where there is time to climb and think.

It’s been a few years since the forest was cut here (for grass, firewood) so the way is lush and clustered with greenery.  I always wear flip flops and the contours of the rocks feel close under my feet, even in winter.  At intervals, I came upon dustings of red powder laying bright on the rocks, a trail I suspected had been left by a recent funeral procession headed in the other direction down to the river.  Midway up the path there is a natural spring that has been organized with laid stones, and one large flat rock with a groove in the middle serves as a ledge channeling a steady stream of water for drinking. When I come this way with the kids, they cup their hands under the trickle and funnel the water between their lips, like something out of the Secret Garden. The spring always feels like a sacred place, a steady tributary of water that started who knows where, up high in the mountains, probably, and falls there at our feet as we pass.

As I made my way up from the valley to the ridge, I had that granular awareness of time passing behind me, and it seemed so strange that at any moment I was on one stone, and then I would be on the next one, and just that way the whole path would be behind me and I would be up in Kaski, the secret water tap and everything far below where I’d just been.

img_1031By the time I climbed up the last step to the ridge top, I was a combination of chilly and sweaty in the January dusk. I walked the spine of the ridge, which curves along our cubby of village as if along the top row of a stadium. Little Narayan caught sight of me up along the ridgetop, and yelled out from way down in the first row where he was visiting a neighbor, LAURA DIDIIIIIIIIIIIIIIIIIII!!!!! before launching in to a sprint and leaping up over terraces to come walk the last bit of the way by my side. We made a right turn at our row in the top section of the stadium, and strolled out to the house sitting in the wings, where the fire was lit and Aamaa and Hadjur Aamaa were waiting.

We had some popcorn and hot tea as sunset approached. Narayan’s brother Amrit came over and in the yard we practiced taekwondo and played chungi, which is basically Nepali hackey sack using a ball of rubber bands, while Aamaa cried out at us to calm it down and I riled everyone up. Govinda dai came over and we sat with Aamaa in the kitchen while she made anadi paste, a rice dough with ghee that is healing for sore muscles and bones, and then we ate it and it made our hands sticky with ghee. Saano didi came over, and then Mahendra’s mother came over. We transferred to the big room with all the beds, and while our visitors took seats around the room to hang out, I jumped under the blankets with Hadjur Aamaa, and with us both lying down, my long limbs rested against the soft jumbled folds of her sari.

Aside from ritualized procedures and ceremonies – tikka-giving, astrology-reading, mala-making — goodbyes are wholly unfashionable around here. So what usually happens on my last day or last morning in Kaski is our closest neighbors come over to chat, but nobody talks about the fact that I am leaving, going to another world, and won’t be back for a long time. If we do, it is in the form of asking about the trajectory of my flight, how long I’ll be in the air, what they give us to eat during such a long journey, and whether or not it is colder where I’m going than where we are. We discuss what season it will be when I come back (summer), and what fieldwork we’ll all do together (millet planting and rice planting), and this leads us to reminisce about what a klutz I was when I first arrived, and how many things I know how to do now. At some point, people wander out mid-conversation. Because the course of events is set, both the leaving and the returning, and since there is nothing to be done, there is no point in becoming uncomfortable. I understand this ritual of goodbye, and have become grateful for it.

churning milkAfter most people had left, Govinda stayed while I churned milk so I could bring buttermilk to Pokhara tomorrow for the family. Govinda took photos of me, which is kind of nice because I don’t have many photos of myself since I’m always the one taking them – but then, people, he posted them on Facebook and two days later I would discover that this photo album is wildly more popular than anything I’ve ever posted of myself trying to be useful or worthy. What does it all mean?

When the milk was churned, Govinda dai left to go home and Aamaa and Hadjur Aamaa and I got ready for bed. It’s always been a nightly habit of mine to go out after everything is quiet and look at the stars, across the village stadium at Kali with her arms stretched out under her cloak, and study the positions of the constellations amassed around her. I usually walk out along the garden, and sometimes I climb halfway up the hill to the ridge and look back at the house with its golden porch light, a warm square in the broad, cold darkness. Even when I am far away from Kaski, I often feel my self located there, outside in the silence, looking back at the still, lit house in its expansive darkness. That spot is a place of gratitude and wonder, of tiny-ness and huge-ness at the same time: my little self, with coordinates in the galaxy.

It was another January night, clear and chilly, the stars laid out overhead like dust. I went out to the yard to brush my teeth, and for whatever reason, instead of going out along the terrace, I stood in the square of light cast off the porch and looked out in to the dark. In the summer, the yard is hemmed in by towering corn stalks, but in January, there are no walls against the yawning night.  I stared out in to the blackness, past the edge of the yard, and all I could see was the outline of trees under the stars, and an opening in the blackness at the top of the hill where the path gives way to the ridge.

It occurred to me that in all this time, I’ve never looked at it this way. I studied the inscrutable night, brushed my teeth, and threw my eyes up to the sky for a moment to make sure Orien was where I expected him.  Then I went back in to the house, placed the wooden bar across the inside of the door, got under the warm covers, and drifted off to sleep, safe against the morning.

*

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