This is the first article in a short series reflecting upon my clinical experience with the Acupuncture Relief Project in Nepal. When you treat a high volume of patients five and a half days a week, the poignant stories start to stack up. Writing weekly does not begin to overcome the stack.
I am home now in Walla Walla, WA. Sometimes I pause and marvel at the ability to blend a soup without consulting the electricity schedule. I am getting used to the ability to call loved ones whenever without relying on a grainy, spotty Skype connection. I occasionally find myself baffled by the act of picking out an outfit for the day after spending a few months rotating between two sets of clothing. Aside from the minor adjustment period, I find myself mentally processing my time in Nepal.
My volunteer work in Nepal has deepened my understanding of Chinese medicine in many ways. In seven weeks, I treated more patients than I treated during my year-long clinical internship. I was able to follow patients through an entire treatment plan of acupuncture, herbal medicine, and sometimes follow their progress with a referral to the doctors at the health post. I learned a great deal about Tibetan Buddhism from one of our interpreters, and the strength of family in Nepal.
Most of my patients in Nepal live as subsistent farmers. They grow the majority of their own food and raise livestock to suit their animal protein needs. In the Newari village near the clinic, the livestock live on the first floor of each family’s house, and they create beautiful pyramids of drying corn for livestock feed outside of their homes. Life is physically demanding as subsistent farmers. Many of my patients came in for musculoskeletal pain from muscles or from various joint degenerations.
The farmers came in for knee pain, back pain, neck pain, frozen shoulder, wrist pain, and numbness and tingling in their arms from tight neck and upper back muscles. Sometimes the numbness and tingling was due to malnutrition or a complication of diabetes, and other times it was due to cervical disc degeneration or bulging discs. We relied a great deal on orthopedic examinations to try to pin point what was going on. Sometimes we were lucky enough to have patients that could afford or had access to imaging that could clarify their underlying problem.
On my daily walks through the rice fields and neighboring villages, I would often encounter people carrying heavy loads in a basket attached to their heads with a sling. The sling went across the person’s forehead, down their back and cradled the bottom of large baskets. Women would carry firewood gathered in the forest this way. They carried concrete, bricks, dirt, grain, vegetables, and other people this way. It causes a great deal of strain on the muscles of the neck, upper back, and upper spine. I believe this carrying method is responsible for the large number of patients in our Nepal clinic with cervical spine degeneration and cervical disc bulges. And we did have a large number of such patients.
Yet this carrying method is necessary in a country with limited roadways and prohibitive expenses to owning a motor vehicle. I was greatly inspired by a family that carried their mother for 30-45 minutes across their back in order to get to the clinic. Their mother was partially paralyzed in an accident. I will go into her story in a later post, but I walked to their home during my last week of clinical work. They lived a 30 minute’s walk beyond a paved road at the very top of a terraced hill. I am an avid hiker and it felt like we gained 1500 feet of elevation in less than two miles. The ‘road’ was narrow enough to be a treacherous path in places. It switchbacked for a solid twenty of our thirty minute climb. My interpreter Sachyamohan looked back at one point and echoed my thoughts, “Imagine this path during the rainy season. Then imagine carrying a person on it.” My trip to my patient’s home showed me first hand the lengths family in Nepal will go to in order to help each other.
This one patient and her family were not isolated in the great lengths traveled to reach our clinic. We had numerous patients that walked more than 45 minutes one-way to reach us. Patients with knee pain, foot pain, low back pain. They would come in for acupuncture and then immediately walk 45 minutes back home. Normally, an acupuncture physician would ask their patients with joint pain to rest that joint while receiving a course of treatment. For many in Nepal, rest was an impossibility, and yet, most patients reported improvement. Not only did they report improvement, but when we tested range of motion of painful joints before, during, and after the course of acupuncture treatments, many patients measurably improved. There were patients who did not respond to acupuncture for one reason or another, and I will talk about some of those cases in later posts.
I had the privilege of working with individuals recovering from stroke’s, Bell’s Palsy, and going through mourning, as well as a great deal of patients managing hypertension, autoimmune disorders, migraines, and diabetes. Occasionally, the monks next door to our clinic got rambunctious and broke fingers or sprained wrists. Boys will be boys – even when training in Tibetan buddhist monkhood.
Essentially my experience in Nepal granted me a great deal of hands on experience with my medical field. My biggest take aways from Nepal are: 1) having a strong sense of how quickly or slowly we may expect certain ailments to respond to acupuncture 2) a much stronger sense of the universal language of pain, love, and family
I will continue to share more about my experiences and inspiration by individual (anonymous) patients in Nepal, as well as my cultural lessons, and lessons in treating specific ailments with Chinese medicine. Thank you for joining me on this written journey, as I digest the density of volunteering medically in Nepal.