ARE YOU ALRIGHT!?!?!

I shake the shoulder of a young monk on the ground and ask, “Are you alright? Are you OK?”

Shoot, his eyes are closed. My right hand gently pushes down on his forehead while I use my left forefinger and thumb to lift his chin as the side of my face almost touches his nose and lips – no breath on my cheek, no sound from his mouth, no rise in his chest.

“Marcela, he’s not breathing. Run across the road and get a doctor. He’s not breathing. RUN!!!!”

Marcela jumps out of her chair and runs out the door.

With intertwined fingers and locked elbows, my body rocks rhythmically – a steady machine delivering firm compressions down into his young chest as I count out loud at a pace of two thrusts a second.

“One, two, three, four, five…twenty-nine, thirty.”

My knees slide up alongside his head, again I tilt his head back and open his mouth.

“Nothing inside.”

Bending down, the fingers of my left hand pinch his nose and I form a tight seal around his mouth. Two hard exhales into his mouth cause his chest to rise.

“Nothing.”

Start again, “One, two, three, four, five…”

“Damn, where is Marcela? Where is the doctor?”

Feelings of anger, desperation, worry, concern, and compassion begin to flow through me. I can’t get lost in those thoughts. I have to keep counting.

“Eighteen, nineteen, twenty, twenty-one…”A small crowd starts to gather around us. Even our two cats stop playing to watch with interest at this strange play between a “sleeping” monk and a sweating white guy in the Saturday afternoon Nepali sun.

“Twenty-eight, twenty-nine, thirty.”

Back to his head. I barely get one breath to pass from my lungs to his when I feel his tightness and he gasps for air. A smile.

Marcela, Ben, and Dayna try to hold back, but they fail not to laugh with the group of twelve monks sitting on the benches watching me and the monk on the ground.

…

A couple weeks ago we met with Phakchok Rinpoche to discuss healthcare, our views, and the needs of the clinic. We suggested a first-aid class for some of the monks who live in the gompa, monastery, next door.

Whenever there is a need for medical attention, the monks cross the yard, enter the clinic, come find one of us, and we provide immediate care for them. Anything beyond our scope, we take across the street to the health facility where more detailed care can be given or they can use their ambulance to transport to a hospital in case of emergencies. This system has been working well, but there are gaps that need to be filled.

The other night we were all at Lela’s having dinner when a monk came to tell us that he needs help. We dropped our card game and ran over to the clinic (just a few meters away). One of the younger boys, 8-10 years old, slipped and hit his face on a step. His lower lip was swollen around a large open wound. Definitely he needed stiches. The young boy, another older monk, Marcela, Dayna, Lee, Ben, Satyamohan and I walked across the road to the healthcare facility and sat and waited. Ben and Dayna comforted the young monk while he was being stitched, Marcela and Satyamohan took care of the paperwork/payment, and Lee and I entertained two dogs while we waited. The tough young guy is going to be alright and he’ll have an interesting story to tell.

Rinpoche really liked the idea of the first aid class, but also wanted us to add a disaster component. With all the recent occurrences in the world, Rinpoche feels strongly that it is important that the boys and men in the monastery are prepared in the event of an earthquake.

The best time for this training is on Saturday and Sunday afternoon. The monks have about two hours of free time on those days – after lunch and before the afternoon/evening puja, prayer. We set out to prepare a rudimentary session that included resuscitation, choking, cuts, burns, shock, concussion, broken bones, heat injury, animal bites, and earthquake preparedness. The more we researched and prepared the earthquake component, the more we realized that we needed help. We reached out to the Nepali Red Cross for more information and guidance, but in the meantime would give what information we could.

The sessions went very well on the terrace of the clinic. Discussions and trainings are always best when held outdoors. On Saturday there were about twelve monks and Marcela, Dayna, Ben, and I had just enough time to demonstrate and explain resuscitation, choking, and shock. Today we had a smaller crowd. Sundays are often spent with visiting family. We were able to cover the remaining material and discuss the actions that need to be taken in the event of an earthquake.

The two afternoons went splendidly. I was out of my element, but the information we shared was important enough to forget about comfort. Thankfully, we all worked as a team and each member proved to be invaluable. Because of that a group of young men are better prepared and much more comfortable dealing with an emergency. I can’t be grateful enough for the opportunity to help them get there.

NAMASTE!!!

Ustai Ustai Tara Farak – Same Same but Different

Sitting on the roof of the clinic watching the sun set-

yellow-orange streaks of light wash the hazed sky

through dark gray clouds rising from behind

ancient Asian green hills loafing,

forming a soft wall to the west of our plateau.

the colors of red and brown clay bricks

shelter people with an uneasy contentment

sitting, casting shadows in their one-room homes

Buddhist and Tibetan flags wave

in a sea of steady warm breezes from the sub-continent.

the certain but soft notes of a distant trumpet player

waft through the valley

complementing the occasional hum of motor-bikes,

the warning song of large black crows,

and the laughter of monks chasing a floating frisbee.

I close my eyes and feel the comfort of home –

wherever it is, whenever it is…

I am here now and nowhere else.

a soft drop of cool rain on my thin warm pants

returns me from my slumber

to watch the tops of trees dance with their waving leaves

open hands grasping each wet gift from the heavens.

a soccer ball being dribbled in the dirt alley below

catches my wandering gaze:

a young boy entices his even younger brother

to guard a make-shift and imaginary goal

as a pack of vagrant dogs choose the victor

with guttural groans and uneasy dancing

a black and red bird sings to 

harmonize with distant packs of homeless dogs

and the melodic tone of an approaching micro.

a cat lazily approaches and joins me on the roof

as the sounds of the Puja rise from the Gompa next door

the horns, drums, and chanting bring me back to the roof

reminding me of tomorrow –

more people to treat, more lessons to teach

and more importantly…

Greater lessons to learn of compassion, kindness, patience

and Love.

Namaste!!!

NO THANK YOU’S – NO APOLOGIES

This morning Joel, Mac, and I were sitting at our dining table in the communal room each doing our own thing. Joel was diligently pouring over international emails and directing the building of the Buddhist shrine, Mac was pounding through an old bi-lingual Kathmandu cookbook she found stashed in the kitchen that was written by the wives of international delegates, and I was staring at the clouds roll over the not so distant mountains after reading the transcript of a recent teaching by Chokyi Nyima Rinpoche. Ben was up on the roof running through his daily yoga practice and Lee was giving Marcela a ride to visit the new location of a satellite clinic. This was kind of a typical Sunday morning. Saturdays we usually spend doing laundry and running around while Sundays are typically dedicated to gathering our minds and bodies, resting our souls, strengthening, and preparing for a new week of treatment, instruction, and fortifying our beds against the merciless nightly attacks of the Kathmandu mosquitoes.

We all have adopted Joel as our cool uncle and good friend. As a Thai-American who has spent the last thirteen years in Nepal, his knowledge and experience is invaluable. Whether it be Buddhism, Nepali culture, or life advice, Joel always stops what he’s doing to listen and share – always with a smile and a laugh. This morning was no different.

Mac and I were sitting across from each other while she was explaining to me the characteristics of ghee and the benefits of cooking with it. We shared a good joke a hearty laugh and changed the subject to culture.

“Hey Joel, how do you say I’m sorry in Nepali.”

Mac and I knew that when Joel closed his laptop to address us, this was going to be a good lesson.  Ahhh, time for class to begin.

As a Westerner, I was raised to always say thank you as a beneficiary of kindness and benevolence. I’m sorry always followed any perceived or actual slight, mistake, and/or offence that I caused. So far I’ve been blessed in my life with countless opportunities and reasons to utter thank you. Unfortunately, I also have had countless reasons to sadly mutter I’m sorry. These two phrases have proven to lose some of their weight and value in my overabundance of their use.

My perceived problem with these two phrases is that, much like the Nepali Rupee, they have become over-inflated. Words, when not backed-up with sincere action, are cheap and cheaply used. A thank you without the sincerest meaning and without the desire or earnest attempt at reciprocation has the danger of becoming another cliché.

The same can be said of I’m sorry. I generally mumble this apology with a lowered head and shrugged shoulders when my speech or action has caused harm or made life even a little more difficult and uncomfortable for another. I’m sorry is always supposed to be followed with an earnest attempt to modify one’s life to ensure that the apology will never again be needed for the same reason. I’d love to say that my thank you’s and I’m sorry’s always meet these standards…hmm, I’d love to say it.

So, now we come to Nepal. Aphsos I’m sorry and Dhanyabaad thank you are rarely uttered.

Do something nice for someone and often you won’t receive a thank you. After a month of dhanyabaads and receiving in return strange looks and even giggles, I started to get a little self-conscious over my pleasant manners. Was this an inside Nepali joke of which I’m not aware? I don’t care…I’m going to force my Western values down their throats until they accept my niceness and courtesy.

“So Joel, how do you say I’m sorry in Nepali? I’d love to know for those occasions that I hit a tender point in the middle of someone’s back a little too aggressively.” After Joel’s quick lesson on the nuances of Nepali culture, I learned that the best way to say I’m sorry is to not have a reason to say it.  

For a month I’ve been focusing my attention in the wrong place – being nice. The most important word in Nepal and one that I hear and exchange constantly is NAMASTE the divine in me greets the divine in you. Namaste is much more powerful than I’m sorry and thank you could ever be. By truly recognizing the divinity and the holiness in each person I meet and greet, there is no need for those overused phrases.

The lesson I learned on a sunny Sunday morning while sitting at a table in Chapagoan and listening to two wise people is that if I truly treat each person as if he/she is a vessel for divinity then there is no need to trouble myself with Thank You and I’m Sorry.

NAMASTE!!!

PS: Hugs and kisses from MollyMac to all her friends and family. She’s doing splendidly and is now cooking dinner for us all.

A Pole and a Mexican Practice Thai in Nepal

This week I expanded my work at Vajra Varahi Clinic: teaching. My assignment in Nepal is not limited to providing massage to the residents of Chapagoan, but to also train the English-Nepali translators in anatomy and bodywork. The plan is that after I leave for my next assignment at Namo Buddha the translators here will be able to sustain the care I’ve been giving.

Monday and Thursday I work with my sister, Manesha; Tuesday and Wednesday my partner is Prajal; and Friday I work with my brother, Satyamohan. This past week the schedule allowed for a formal lesson from 9am to 12:30pm and then we accept patients after lunch from 1:00 to 5:00. Prajal and Satyamohan have some previous training in anatomy where Manesha is new to the world of bodywork. It has been a tough week…not because they can’t handle it, but because they are so motivated and intelligent – I have to be on my game.  I’m really happy that they are also very patient with me.

The sessions have been going splendidly. This first week we spent much of our time learning the parts of the body, the systems of anatomy, directions, and finally movement. After our marathon sessions we were able to put our knowledge to the test on actual patients. Starting this week we are going to change things up a bit to maximize our study time and patient face time. Rather than splitting the day in two, we are going to see patients all day and cover pathology, dysfunction, movement, and treatment while working with patients. My massage section of Vajra Varahi will become a sort of make-shift teaching clinic.

Interestingly, we were given an unexpected day off on Wednesday. An organization of young communists called for a national strike in Nepal. Most shops, busses/ micro’s, schools, health facilities were shut down because of it. We all were able to make the most of it. Joel, a Thai Buddhist and over-all cool guy, is the project manager of a shrine being built just behind the temple and clinic. Because of the work stoppage he had about an hour in is busy schedule to receive some Thai work from me. It was totally my humble pleasure and honor.

Later that night I cooked dinner: we have a cook that comes in and provides lunch, but we are responsible for breakfast and dinner. Breakfast is a sort of free-for-all. I get up at about 5:30 to the horns of the monastery next door and sit with a cup of coffee reading and preparing my lesson for the day. The rest of the staff (Marcela, Mac, Lee, and Ben) filter-in throughout the morning. By 8:00 we’re all usually sitting around the table sharing our experiences of dealing with the midnight barking dogs and our valiant fight against the ear-buzzing mosquitoes. We each take a turn preparing dinner on the 2-burner propane stove, usually with candle light (often there’s no power in the evening). Even though there is no refrigeration, only two burners, and using fresh vegetables locally purchased that day – every dinner we’ve had has been a glorious experience. After dinner Wednesday, I was able to once again practice Thai – this time with Marcela: hence the title of this blog – A Pole and a Mexican Practice Thai in Nepal.

With no television, night-life, or electricity we all end the evening together. Ahhhh, maybe that’s the way it should be – everywhere. We all sit around the table, usually well into the night, playing cards, and exchanging stories and experiences before retiring to our respective rooms to start the battle against the noises and annoyances of the night.

Before we all take-off for Lela’s (a local kitchen next door) to meet Satyamohan for dinner, let me share with you my Sunday. After doing some reading this morning and chatting with Ben and Ariela (an acupuncturist who came to visit from Boudha) I decided to take a little trek. At first it was just going to be a short walk in the woods that lie next door to the temple, but I found a little path. The path led straight down and opened up to an amazing view of wheat fields. Following a little foot path I continued to walk greeting farmers with Namaste and enjoying a light sprinkle of rain. An older gentleman who I caught up with started to chat with me.

I continued to walk when I came upon fields and fields of piles of bricks, brick huts, kilns, and people carrying their handmade red blocks from one location to another.  It was an amazing site to see and experience walking among the rows of huts while dodging mules carrying heavy loads of bricks. After about an hour I decided that maybe I should turn around and try to figure out my way back home. It being Sunday, getting lost was no big deal. Fortunately, there was a red-tailed dragonfly that led me most of the way home. Just in time for lunch.

Later that afternoon, Joel suggested that since the water levels are low in the holding tanks on the roof it may be a good opportunity to clean them out. Without hesitation, Lee jumped on the project. I don’t think that Lee has ever turned down an opportunity to help us all out. He’s a marvelous chap, even though he’s from Birmingham. After sometime I decided to head up to the roof to see how Lee and Mac were doing on this new project. Lee was inside one of the tanks dredging out the silt and handing the buckets to Mac who then dumped the dirty water off the roof. I jumped up and into the other water tank and lent a hand. It turned into a friendly competition between a Brit and an American to see who could get the inside of the water tank cleaner. In the end his was cleaner, but I’m positive that mine was dirtier to start and needed much more scrubbing.

The rain is pouring, the lightning is flashing, the thunder is roaring and I’m off to dinner at Lela’s.

Peace and Love.

Namaste.

----------------------

Pictures will follow later in the week.

My Parents Must be Proud to Have a Son Who’s a Doctor

“Doctor Joe, you have another patient to see you.” I never get tired of hearing this phrase from Prajawl, the front desk attendant. Wearing my white lab coat and a smile on my face, I walk out of my treatment room to the front desk with my interpreter, Ritesh, Maneesha, or Satyamohan.

“Namaste,” with my hands clasped together I give a short bow to my new patient who returns with the same bow and “Namaste”. We escort her to a back room - before we enter she takes off her shoes as a sign of respect for my space – I prefer to think of it as our space.

The three of us sit at a small table where I first read the patient’s chart and try to get an idea of what type of physical issues my client has been troubled with and the treatments she has received.

“How is your back feeling today?”

Although I’m speaking through a translator, it’s important that I talk to my patient and maintain eye contact with her. Neither a person’s nationality nor culture change the fact that being heard and understood are prime signs of respect.

“Doctor, my back hurts.”

“Could you please show me where it hurts?” I ask.

She moves her hands to the lower right part of her back but slightly over the crest of her hip.

“I’ve had massage and acupuncture before but I’ve been working in the fields and the pain has come back. Doctor, can you please help me?”

The trust, faith, hope, and uncertainty in her eyes meet mine and I immediately feel a sense of humility. Here I am a rich foreigner from a wealthy country who has at his fingertips some of the best healthcare in the world, who has running water and 24/7 electricity, who’s notions of farming all arrive from television, books, and riding rural roads on my bike and her eyes are begging me for compassion and relief from her pain. It’s with a complete humble heart that I nod my head and tell her that I will do my best to help.

Treat the patient not the issue.

It’s so easy to get lost in the daily grind back home: massage after massage treating clients who have succumb to the stress of daily life. Here I can’t do that. Every treatment session, usually 45-60 minutes long and up to 8 per day, I have to give all my attention and dig deep to remember all that I have been taught and learned.

With a deep breath, I place my hands on her back and remember the advice of Paul Fowler, one of my Thai instructors, Love, not technique. There is no other way and no massage technique as healing and as powerful as love. I’m learning that with love, compassion, and a conscious breath comes healing. Listening with my hands I start to palpate her back through her clothes (although my patients are on a massage table-except for their feet, are completely clothed) and find a hypertonic QL.

“Dukksha?” I ask using the Nepali word for pain.

In a groan she replies, “Dukksha.”

Throughout the session of compressions, friction, and stretches I mumble “ramro, ramro” – good good, as she breathes and I feel the tissue release its stubborn tension.

Helping her to sit-up on the table, “How does your back feel?” 

“It feels much more relaxed, dhanyabaad – thank you.”

 “When should I come back?”

We go over some simple stretches and the preferred way of rising from a chair and using one’s legs rather than back when reaching for the ground.

“Give it a week and if the pain comes back, please come back to see me – dhanyabaad.”

We exchange Namaste’s and Maneesha, my interpreter for the day, escorts her to the front desk as I sit down to write my notes on her chart.

“Doctor Joe, do you have time to see a monk from the gompa?”

With a humble heart, “Of course, please send him back to see me.”

With love...

Namaste.

Note: I apologize for the slow response to emails. We only have internet access when the power is on and often the power is on while I’m working in the clinic.

Prologue - NAMASTE

Sunday, April 17, 2011, 21:30

After over thirty hours of travel, two hours of customs in Kathmandu airport, and an hour thrill ride in a cab I finally arrived at my location: Vajra Varahi Healthcare Clinic at Vajra Varahi Gompa in Chapagoan, Nepal. When they opened the large gates of the gompa (Buddhist monastery) to allow for the cab, I knew that I arrived at my location and at my new station in life.

Marcella, the clinic manager, was the first person to greet me. After a warm exchange of Namastes she showed me around the building and led me to my living quarters – my new home. Within an hour Macferson, her husband Lee, and Ben arrived. The new clinic team has been assembled: two acupuncturists and a massage therapist.

During and after dinner we were given our orientation: clinic procedures, working with the translators, case loads and scheduling, meal schedule, expectations, and load shedding. Load shedding is an interesting Nepali concept of power delivery. To ensure that the country receives adequate electricity the government has scheduled black outs. Chapagoan, for example, receives about eight hours of electricity a day. Usually we get two four hour blocks of scheduled power. Each day the times are different and the schedule isn’t always accurate.

After an evening of talking, sharing our experiences, and exchanging wide-eyed amazement we all retired to our respective rooms: Macferson and Lee to theirs, Ben and I to ours. After some brief chatting we both decided to turn in for the night. Incredibly, as my heavy eyes began to close, the wildlife (all the stray dogs) awoke. It turned into a night of tossing and turning to the serenade of barking and howling. Ahhhh…glorious.

Saturday morning at breakfast we all decided to head into Boudha with Marcella as our guide. The trip would take about ninety minutes and three busses. Public transportation in the Kathmandu Valley is an adventure. Busses, mini-busses, and tuk tuks make random stops along the road. A barker hangs on the side of the packed vehicle and scans for possible riders. He yells out the destination and when someone shows interest he bangs on the side to let the driver know to come to a stop – or at least slow down enough to let people jump on. This, my friends, is a far cry from the CTA…much more exciting.

Boudha is a spiritual center of Nepal. It is the home of the Great Stupa. Travellers and pilgrims come here to walk around the stupa three times, pray, burn offerings, and heal karma. The mass of humanity is incredible. As a special treat, Marcella suggested that we pay a visit to the White Gompa and offer kata scarves as offerings to Chokling Rinpoche, Chokyi Nima Rinpoche, and our benefactor Phakchok Rinpoche for blessings. This was done during a Drupchen, a nine day holy observance of non-stop mantra chanting. We reverently entered the gompa, walked alongside the left (clockwise) to the back of the altar and then we each presented our katas to the respective rinpochet. Each blessed us and presented us with a book and herbal medicine. Before our departure we were stopped by one of the monks and invited to a back room for an audience with Phakchok Rinpoche.

For over an hour Phakchok Rinpoche talked to us over tea about his experience as a Lama, Buddhist philosophy/theology and his thoughts of and experiences in America. As well, we had a candid and very cordial conversation with him about our lives, experiences as healthcare/body-worker practitioners, our relationships, and expectations. Phakchok Rinpoche shared with me his painful experience with Thai massage. I promised him that when I’m honored to have him on my mat, we will by-pass discomfort and win him back to the honored practice of Nuad Boran.



The following morning we had breakfast at Saturday Café which overlooked the Great Stupa, did some grocery shopping and headed back to Chapagoan. Sunday, the first day of the Nepali work week meant that the streets and all of the busses would be crowded. Our first two connections went without much drama. The third leg of our adventure was a bit more challenging. One packed bus after another passed without stopping. After waiting for almost an hour and no luck, we decided to walk the several kilometers home. Soon after we started walking, like a chariot from heaven, a packed bus pulled over and invited us aboard – on the roof. We scampered up the back of the bus and found places on the roof among other fellow Nepali travellers. Before we reached our destination the driver pulled over and ordered all of us off of the roof. Apparently, it’s against Kathmandu traffic laws to ride the roof of vehicles – blahhhh.

The night is now getting late and we start working in the clinic bright and early tomorrow morning. I still have to pick up my laundry that’s drying outside, do some studying, reading and prepare for a new experience – new life.

Namaste…