Hope Against Entropy

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Good morning from sunny Pokhara!  I arrived yesterday and enjoyed a nice homecoming tour of all my regular haunts. Since August, Pascal has rigged up a home-made antenna on the roof, Aidan’s other front tooth has finally come in, and the corn has been cut down in the garden in front of our office, replaced with new seedlings.  I absolutely love this season in Nepal – the cold, wide air, the clear mountain skyline which is obscured by fog during the monsoon, the evening snuggles with my nephews under warm blankets.  Tonight I head up to beautiful Kaskikot to see Aamaa.

photoI’m so excited to tell you about our plans for this winter.  After 10 years of chipping away at all this, we are just days away from a two-week collaboration with dentists, researchers, and students from Berkley, UCSF, UConn and the University of Puthisastra in Cambodia. It is a strange and wonderful feeling to be preparing for such a large and qualified group of visitors after so many years of working away with few outside witnesses to our efforts.  There are many great things wrapped up in upcoming this ball of projects.

The first is helping to implement a UCSF/Berkley study of oral health and nutrition in mothers and their children.  Our own JOHC field teams will get to work with the researchers to conduct this study in one of our villages.  The second project is training our technicians in some new techniques, which they’ll incorporate in to their sustainable clinics.  Third, we have the chance to bring dentists to our rural clinics for medical audits.  Believe it or not, after an entire decade, this will be the first time we’ve had foreign dentists come to visit our clinics.  

And finally, we’re going to pilot an evaluation of past patients who’ve been treated by our technicians over the years.  If you don’t think that sounds like Christmas, listen here! This means comparing the outcomes achieved by our local dental technicians to the results produced by fully credentialed dentists in prior studies of the same treatment techniques. img_3285 This is a HUGE step towards our goal of having Nepal’s national health care system adopt rural dental clinics in to all of its health posts. Why? Thank you for asking!  Because the main criticism is that community-level health workers aren’t qualified to perform dental medicine…even though that excludes millions of people from care.  But we’re making the case that, rather than write off local health workers, the medical field must find ways to properly train them to provide the best care possible in their settings.  And that’s what we’re doing!

Ok, so those are the technical points.  Now let’s talk about me organizing for fourteen people to show up next week from California, Connecticut, India and Cambodia.  We have a schedule, a budget, a training plan, hotels, flights, and t-shirts.  We’re doing our best to keep things under control.  But we are up against the entropy of Nepal, people.  THE ENTROPY OF NEPAL.  Pretty much anything could derail our plans and contingency plans: a wedding, a political strike, rain, someone’s grandpa dying, a forestry meeting, a buffalo falling ill.  A buffalo having a baby.  A traffic jam.  A flat tire.  Lost luggage.  Fog on Sunday afternoon.  Somebody decided to drive this point home for me at the recently renovated, lusciously carpeted arrival terminal in the Kathmandu airport, which has a new row of fancy kiosks for visa filing:

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On the plus side, sometimes fate works to your advantage.  Consider our office.  This fall, our landlord’s son got married.  The son received a number of couches by way of dowry.  They don’t fit in our landlord’s apartment, so I arrived to find them in our office, which now looks rather like a furniture store.  If you have any idea how much I have obsessed over the setup of our office, you will especially appreciate this stroke of….er….luck…

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Well, in solidarity, I think I’ll leave you there on the edge of your seat.  Except for sharing a photo of this year’s Race to the Rock, which was one of our best yet.  If you missed it, please consider Jevaia in your end of year giving.  After all, we’ve made it this far – through many political trials combined with road mishaps, fuel strikes, weddings, earthquakes, and baby buffalos – almost exclusively on the wings of individual donors, and here we are entering a very exciting new chapter.  Thank you for being a part of the ride with me and all of us.

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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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