A Nepali Global Health Experience

Dal Bhat Power 24 Hour

Rich in culture and tradition, Nepal is best known for being home of the eight largest mountains in the world, including Mt. Everest. Many villages lie in these mountains, where their narrow roads and rugged terrain make them unreachable during monsoon season. This past month, I had the opportunity to travel to one of those villages as part of a 12-day service learning experience from May 28 to June 8.

Situated in the foothills of the Himalayas, Karmidanda is both stunning with its mountainous views and challenging in its delivery of services like basic health care. Heavily damaged by the 7.8 and 7.3 magnitude earthquakes in 2015, the 70-family village recently finished the completion of a new health post. Our trip was a combination of classroom learning with the setup and execution of a two-day health camp in the village. The village was fertile with medicinal herbs and plant life, making it a prime location for our group to setup health services for the locals.

The trip was organized by Dr. Erin Moore and Nat Willis, co-founders of ParticipAid, a Portland-based project working to build local capacity and community resilience in Nepal. ParticipAid’s third founder, Dr. Kamal Phuyal, provided course instruction along with public health specialist Sangita Kaphul. ParticipAid and their local partner Share Nepal brought together 10 health professionals, with shared experience and knowledge in nursing, medical massage, naturopathic medicine, gynecology, acupuncture, public health, and participatory development. Additionally, we were met in the village by two teams from Kathmandu representing general medicine, gynecology, and dental services. In total, our health team was a group of 20-strong volunteers representing the United States, Taiwan, and Nepal.

 Our team members that traveled from American and Taiwan for this experience. 

Our team members that traveled from American and Taiwan for this experience. 

Upon arriving in Karmidanda, our team was immediately welcomed into the community. The Nepali people are among the most friendly and inviting people I have ever met. “Namaste…Namaste” we heard as we exited the Scorpio jeep that drove us from Kathmandu. The warm majestic scenery around us immediately replaced the feeling of discomfort from the bumpy roads underneath us during our long drive to the village.

Within the first day I felt like I was part of a family. Our days in the village started with chai tea and dal bhat (bhat is rice in Nepali) in the morning with our host families.  Then we spent time in the classroom, on plant walks, and in meetings with local groups including Share Nepal, the area’s female health care workers, and a mother’s group. We learned about things like the impacts of participatory development, the current government and health care structure of Nepal since the 2015 earthquake, and the most common health issues affecting villagers.

Top health concerns included urinary tract infections, uterine prolapse, gastrointestinal problems such as ulcers, and hypertension. This information helped us to better prep the health post for our health camp that was to follow a few days later. Our days leading up to the camp were long, but our host families kept us well fed with so much dal bhat that the tag line “Dal Bhat Power 24 Hour”, ubiquitous among the tourist shops of Kathmandu, quickly became our group’s adopted theme.

As a group we spent the Saturday before the camp setting up the health post.  This included preparing herbal tinctures, prepping examination rooms with tables and medical equipment, and getting the building hooked up with electricity and running water.  We then divided the new health post into two sections one area for the dental group and the other part for our group. The dental group’s area included an examination room, extraction room, and general education room. Our area of the health post included three examination rooms - two for naturopathic medicine and one for gynecological services - a medical massage area, and a pharmacy. A third area was setup in the village’s old health post, where two Kathmandu-based physicians saw general medicine and gynecologic patients.  During the two-day health camp, the three areas worked in tandem with one another, making referrals as needed. We had a triage area setup outside of the new health post where volunteers wrote done patient vitals and chief complaints, and then directed them to the proper service area to be seen by a practitioner. We even had the village dog, referred to as Post, join us by greeting patients as they entered the facility.

At the close of the health camp, our teams were able to treat more than 550 patients in the span of two days. This number far exceeded anyone’s expectation. Initially, we were expecting maybe two hundred patients. And even though each of us was exhausted at the end, we all were pleased with what we had accomplished and the needed services we were able to deliver.

 Our awesome team of healthcare practitioners, support staff, and translators.  

Our awesome team of healthcare practitioners, support staff, and translators.  

Once the health camp completed, we climbed back into the Scorpios that had taken us to the village to make the journey back to Kathmandu. We finished our trip with a full day tour of the world heritage sites Bhaktapur and Boudhanath, and a visit to a disaster recovery site operated by MicroAid International. Our final night was spent at co-founder Kamal Phuyal’s house learning how to make Mo-Mo’s - the Nepali version of dumplings - and sharing our own personal reflections of the past week.

My favorite experiences were in the mountains, living in the village among the locals and being welcomed as part of their family. It was much more of an integrative experience with the community compared to past volunteer experiences I have had. It was an honor to work along side such an amazing group of volunteers and be able to reach so many patients in such a short period of time. By the time our group came back to Kathmandu, news of our health camp had reached surrounding villages, who were eager to have us come back and replicate it in their communities. By far this was the most exciting and satisfying part of the trip.  

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Overall, I found the trip to be an enriching experience, giving me a broader perspective on community and global health. It challenged me as a practitioner to think outside the box, and that unique perspective is something I have been able to bring back with me and apply to my own nursing practice. To encounter a region full of culture and kindness, yet still recovering from a natural disaster, is something that cannot be provided in any textbook or classroom, and thus something I will never forget.

In the words of the late Anthony Bourdain, who passed away during the last days of our trip, "Travel isn’t always pretty. It isn’t always comfortable. Sometimes it hurts it even breaks your heart. But that’s OK. The journey changes you; it should change you... You take something with you. Hopefully, you leave something good behind.”

Mission trips such as this one not only provide us with an opportunity for a hands-on experience in resource-limited areas but they also teach us about the world and ourselves. I hope that everyone is able to have a similar experience to the one I had in Nepal. Dhanyavād!!!

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The Three Universal Medicines in Community Development

Recently I spoke to an undergraduate class about my experience in international community development.  As I was wrapping up, the professor asked if I would give three words that summed up my experience, or ideas that students could keep in mind if they wanted their path to look at all like mine.  I said honesty, community, and kindness, though not so clearly or concisely.  It wasn’t until some days later I realized these concepts had been floating around in my head because I had learned them as the three universal medicines in a self-healing course that I recently took.  I’m quite sure I’ll revisit these “three universal medicines” in terms of human healing in the months to come, but for now I’d like to examine their applications to community development.

Honesty

Often when I tell stories about ParticipAid’s origins and evolution, it sounds like a chronicle of my mistakes and lessons learned.  I’ve written about failure here on the blog in the past because I think it’s such a valuable tool.  In failure there are opportunities to advance your skills, knowledge, experience, and partnerships, but you’ll get none of that if you’re not honest with yourself and others about what you got wrong.  I found this to be really difficult in the beginning, as I was attached to unrealistic expectations of myself and the impact of my work.  I’ve learned, and am continuously learning, to set more accurate expectations.  I hit the mark more often now, but when I inevitably miss it, I know to put my ego aside, search out the reasons, and discuss them with my colleagues.  This helps projects flow with more ease and evolve more organically.     

There is also considerable pressure in this field to sugarcoat or dramatize experiences and frame outcomes in a certain light to please current donors and attract new ones.  I do my best to walk this line with as much integrity as I can muster, but it's tough.  In all honesty if you one day see ParticipAid working as a straightforward for-profit business, this challenge will be one of the reasons why.

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No legacy is so rich as honesty.
— William Shakespeare

Community

By community here I mean relationships.  Community development is not a solo job.  And if approached without respectful trusting relationships, it begins to look more like colonialism.  Best steer clear of that path!  Reliable, heartfelt, and hardworking partners are central to any success I’ve been lucky enough to be a part of in Nepal.  More than actualizing my own dream, my goal at this point is more like weaving pieces of my dream into the work that others are already doing there.

One of the benefits of a few solid relationships is that you don’t need much money to make something cool and helpful to society happen.  The old-fashioned method of blood, sweat, and tears still works reliably well.  And these relationships can be protective of the precious resources that you are able to gather.  Seems no matter what kind of government you’re working with, there is corruption at every turn.  Money is squandered, and once-pure motives are clouded in desires for some degree of wealth or notoriety. It’s hard to know who to trust in that kind of environment, and I would have quit a long time ago if I didn’t have trustworthy allies. 

 We all need to be carried at some point or another.    

We all need to be carried at some point or another.    

Kindness

When all else fails, try kindness.  Not necessarily the giving-of-gifts kind of kindness, but the giving-of-yourself variety.  You could try to speak the local language, help in the kitchen or the farm, play with the kids, belly laugh with someone, pass the time with a local granny.  Acts of kindness show that not matter what else is on your agenda, you care about that single person you are being kind to.  It’s a small gesture and its impact immeasurable, but you can sleep soundly knowing that you made someone’s day better.  

After the earthquake, my local partners and I were distraught about how to respond to the situation.  We had more resources than ever, but it wasn't enough to help everyone.  My friend Jhabraj suggested we go to the houses of everyone we couldn’t help to laugh and cry with them.  When materials goods can’t or won’t do the trick, a little kindness can go a long way.    

 The kitchen, a place where help is always appreciated!

The kitchen, a place where help is always appreciated!

Nepal’s New Prime Minister Brings Hope and History

Nepal’s New Prime Minister Brings Hope and History

The country of Nepal has a new leader.  A landslide victory by the Left Alliance in Nepal has ushered in the appointment of the 38th Prime Minister of Nepal, Khadga Prasad Sharma Oli (KP Oli) on February 15, 2018.  The Left Alliance made up of Oli’s Communist Party of Nepal (Unified Marxist-Leninist) and the country’s other major Communist Party, the Communist Party of Nepal (Maoist Center) swept to victory in the country’s recent elections.  Controlling all centers of power from the federal level all the way down to the provincial and local levels, Oli is viewed to have the best opportunity to lead Nepal into a new era of peace, stability and economic development.

Community and Individual Health

Community and Individual Health

I want to revisit a topic I blogged about a couple years ago exploring the idea of “treating a community like a patient”.  Though I still agree with the philosophy, practice and experience have evolved my opinion on the matter. 

In November 2015 I wrote as general advice (and specific advice to my future self):

“Trust in the innate capacity of the Nepalese people to heal their own communities.  They may have been shaken, but they’re resilient and know what’s best for their families.  Look for obstacles you can help to remove.  Consider what tools and skills they’ll need to support their recovery. Empower them to take control of their own development.”