If you have spent any time with local Nepalese, you will have heard the phrase “Ke Garne.”  It literally translates to “what to do?”   It is said when life presents you with a difficult situation or a frustrating situation or really anything challenging.

The first time I heard ‘Ke Garne’ was from a patient coming in for knee pain.  She described her daily walk from her home across rolling hills into the forest to gather wood and leaves.  She related that her knee pain was worse when descending an incline, but her daily chores took her up and down hills.  Ke garne.  What to do?  I remember asking her if there was an alternate route she could take or a shorter route to gather wood.  She replied that there was no way to avoid the downhill portions of her walk and she needed the materials she gathered to cook with and to heat her home.  Ke garne.  What to do?

Acupuncture Relief Team walking down a local village trail

I started to ask another question, stammered and faded out as I realized she probably lived way up on the top of one of the hills, or mountains as we would call them here in Walla Walla.  I started to speak again as I gathered my thoughts, still stymied as to whether or not my patient wanted advice or reassurance, when my translator mercifully interjected.  “Ke garne is just a saying we have.  She isn’t looking for an answer.”  When she translated to my patient about my confusion, we all laughed a little.  I explained that my family often says, “Ce la vie” or “such is life”, and a common understanding was established.

One of the less hilly routes around Chapagoan

Ke Garne is spoken frequently in Nepal.  And often, I found many of my patients uttering the phrase.  It was especially frequent when patients were not healing as quickly as they wished, even if they were right on target in their healing progress from my point of view.  The phrase seemed to express a feeling of being in a tight spot or being between a rock and a hard place.  Many of our patients were subsistent farmers, meaning they had to farm to feed themselves and their families.  Chores were not things that could be put off and related to the basics of supplying a meal and gathering heating supplies for the home.  People needed to get back to work no matter where they were in the healing process.

For various reasons, patients would feel significantly better, but would say they had no progress at all, that the degree of pain was the same, and would often be followed up with ke garne.  At times, the ke garne felt like a cry for help and I wanted to respond with help.   It took halfway through my clinical time to respond accordingly.  It seemed that ke garne is a way to accept and respond to the challenges of living off the land, while including your community in the conversation.

In many ways in regards to health care in Nepal, the phrase ke garne seemed applicable.  Since patients could not take rest the way I might ask someone to in the United States.  Paid sick leave or workers comp, while a complicated issue in the West, does not exist in Nepal.  The rhetorical question opened up another perspective and many conversations for me in Nepal.  I would like to believe that it strenghtened my ability to talk about pain management in a language that made such conversations challenging.  It also helped me to find out about the life and overall environment of each of my patients more thoroughly.  Ke garne was also an excellent alert that my patient felt stuck.  It also taught me to allow space for that feeling and to acknowledge that I do not have to have all the answers.  Simply, being physically present  can be support and response enough.