It's been twenty-three days since I arrived in Kathmandu and sixteen days since we opened the clinic in Bhimphedi again. I've been posting photos to Facebook, as the internet allows, so that my family knows I'm okay. I've been wanting to write some of my own blog posts but the work days are long and trying to fit in house calls, get laundry washed, do some exercise and occasionally talk with my kids hasn't left me a lot of time. I also needed to get a blog post to ARP so they could put it up on their site. As I'm writing this, the internet has been down for three days and I don't know when it will come back again so that I can post this. I have been keeping a journal about my experience here, but I will try to be better about blogging over the next five weeks that I'm here. Pictures are near impossible to post anywhere but Facebook (why is that?) so I'll try and keep TLH page updated with those as I  caan.

Hetauda
Hetauda

I'm writing this post on the porch where we eat before work. It's Monday for us, the start of a new week, and I'm due at clinic in an hour. Yesterday was our day "off" and Terry okayed Debbie and I to take a trip to Hetauda. This is a bit of a bigger town than we are staying in and we wanted to go there to try and find charcoal pencils for a patient we see on hospice. He has been asking for drawing tools since he is confined to his bed. One of the interpreters was kind enough to chaperone us and so after finishing the tasks that have to be done on our day off, we ventured out to the main road to catch the bus.

The bus was running on Nepali time (so it was 50 minutes late). We didn't know that there was a mela (like a state fair) in Hetauda until we got on the bus and as we ventured down the mountain road, we stopped frequently to pick up passengers. We were packed inside like sardines, I had my arm over Debbie's shoulders to try and give us some extra room as we squished against the windows. The kids piled up by the windshield and stacked themselves on each other. What is usually an hour bus ride took us almost two hours. When we arrived in the town, we were really excited to see a variety of shops and we were hopeful we could find some charcoal.

Laundry
Laundry

The town of Bhimphedi, where we are living, was once the end of the road coming in from India. Some of the folks who lived here would walk these goods into Kathmandu where they would sell them. Now, the road continues all the way there, though it is long and indirect and India is offering to build a new road that would get to the big city in a fraction of the time.

The electricity that comes to Bhimphedi from the dam (about two hours away) is more reliable than it is in Kathmandu. We have only had one power outage since we've been here. The ARP teams last year didn't have internet at Auntie's house, where we stay, but the interpreters found an old router and hooked it up in the bedroom. Though the internet goes out a lot and the router is slow, we are able to get online at least a couple of times a week. I can't upload photos to Flickr or Picasa, but I am able to upload them to Facebook if I set it up before I go to bed and let it upload while I'm sleeping.

Aunties house is four rooms with a hallway between them. She sleeps in one, Terry (our lead) sleeps in another and we use it for a meeting and teaching space and then the five of us split the other two rooms. Erin and I sleep on cots, Tiffany, Debbie and Maggie sleep on wooden beds with thin foam mattresses laid on top of them. We all sleep in our sleeping bags and try to organize our clothing and supplies under the beds or on the window sills. There is no heat in the house, but we've all learned to sleep in sweaters or down jackets. I wear my scarf and sometimes my hat to bed and I find it pretty comfortable. There is a small back yard where Auntie cooks. She makes everything in pressure cookers on a camp-style stove and we boil water in a plug-in kettle. There is a small fridge out there, though I've never looked inside. The eggs and milk are kept in a curio cabinet - I think the milk is raw, it curdles a bit on top but never goes bad. There is a table by the kitchen where the translators eat. There is a small brick structure with two doors and on one side is a squat toilet and on the other is a new shower. There is a large container of water on top of the structure that we have to haul into the front yard and fill up from the main, shared faucet. Gravity pulls the water down and through a low-pressure water heater so we can take a very low-pressure shower. It is heated by a propane tank that is a little fussy but I've learned how to get it between 39 and 43 degrees Celsius and that seems to work out well. We are careful not to take many showers, or to stay in the shower too long because filling the tank can be a huge operation.

The clinic is about ten minutes walk from Auntie's house. We have to be there by 8:30am to get setup and our first patients are scheduled at 9. We are working out of an old community center that the town has loaned to us for this purpose, from September until March. This is comprised of a building with two small, and pretty cold, rooms. We setup plastic yard chairs around the rooms with small foot stools. Each practitioner's area has two mudas to squat on, one for the doc and one for the medical assistant/translator. ARP gave us each a medical kit that we carry to work each day. This kit includes our stethoscope, otoscope, blood pressure cuff, glucose test kit, Babinski hammer, electrical stimulation machine, thermometer and various other medical supplies. The clinic itself is where we keep our needles, herbs, medications, bandages and clean field materials.

We are setup to see four patients an hour, though the clinic has been unusually slow since we've been here. We have been seeing 10-15 patients a day, rather than 20-25 patients. Much of this is due to the fighting over the ratification of the constitution. This has caused a number of outbreaks in Kathmandu and the strikes that have followed have shut down the busses, which prohibits a number of people from reaching us. Most patients who are coming to the clinic right now are walking 15 minutes to four hours to get to us. This is ironic, considering that majority of our patients suffer from debilitating knee and back pain, due to over-stressing these load bearing joints through their daily work.

Patient
Patient

Unlike Portland State University, where I work on a group acupuncture shift - providing acupuncture treatments, ARP runs a primary care clinic. This means that for each patient, we need to be monitoring their vitals, checking for red flags and coordinating care for them. Our Director, Andrew Schlabach, has repeatedly talked to us about the difference between providing care and treatment. We provide care at this clinic, which does not always mean that we are providing acupuncture for our patients. We only do the latter if it is part of the care that they need for their overall health picture. The majority of our patients do not have primary care providers and it is our job to know what is available (in terms of medications, hospitals, etc) and get the patients the treatment that they need. We followup with our patients and monitor their progress and we communicate with their care providers to make sure that they are receiving the medications and treatment that is appropriate for them.

We work Monday through Saturday and sometimes have Sundays off. So far, we have had classes each Sunday we've been here, but this last Sunday was ours! So, Debbie and I trekked to Hetauda and checked out a little bit more of Nepal. Right now, she is in Kogate with our medical assistant/translator, Pawan Thapa. I am missing her, as we've become good friends and partners in crime, but she will be home on Wednesday afternoon. We are rotating through the Kogate clinic. One of us works Monday morning and then takes the 3 hour hike or bus ride up into the mountains. We work there until Wednesday morning and then come back down. Kogate has no electricity or internet, but the translators have cell phones and we can communicate with Terry and the team that way if we have an emergency while we are up there.

It sounds like Auntie is bringing breakfast out to the front porch, where the practitioners eat, so I've got to go, but I will try to be better about updates with our progress now that I've filled you in on the basic details!