Today, the rain started on the way to work. By the time we got there, the thunder rolled loudly over the mountains while the lighting cracked the sky apart in horizontal waves. It is our second-to-last day in the clinic and we expected to be busy. Even so, the monster puddles and epic downpour had emptied the streets and the buses held far less passengers than we are used to. We spent more time with our patients, massaging them and saying goodbye to those that we will not see tomorrow.

I put needles in a patient and then ran home to get our headlamps when the power started going in and out. I borrowed Erin's jacket and got drenched before I'd even run a block. I saw one Nepali woman with an umbrella and a few children huddled under an awning. Otherwise, the normally bustling marketplace was happening behind the closed doors of the shops. I got to Auntie's house dripping wet and in soggy shoes. She was in the back, under the coverof the kitchen, cutting red onions with a Nepali floor knife. She sent me back with her lantern and an umbrella that I didn't use because I was scared that the metal pole at the top might attract some of the biggest lightning bolts I've ever seen.

Back at work, I changed out of my wet pants, threw a skirt over my soaked base layer and went in to find my patient. It's her fourth treatment in four days and she's been coming regularly to try and fit half a treatment plan in before we leave. Like many of the patients here, money is the limiting factor around their healthcare. When given the opportunity to have affordable treatment, they travel great distances to come every day or every other day and are compliant in following our directions.

When I first met her, she complained of large and painful breast lumps, burning and smelly leukorrhea and lower abdominal pain. She looked very tired and her pulses agreed that she had no energy. I palpated her breasts to find long, fibrous lumps. When she brought her medical records to me, her ultrasound verified my diagnosis of fibrocystic breast changes.

Like most of my female patients with reproductive complaints, the gynecologist at the hospital did not perform a pelvic exam but instead, just gave her a round of multiple antibiotics and anti-fungals. After four years with these symptoms, it's likely that she has pelvic inflammatory disease or chlamydia. These things are hard to get diagnoses for. Only one doctor followed through with my written referral to do an actual pelvic exam and even with that, he didn't culture what he found. Instead, he diagnosed chlamydia and prescribed the same round of antibiotics and anti-fungals.

My current patient never had the money to buy the medications, since she spent everything she had on the ultrasound and "gynecological exam." No one at the hospital took the time to sit with her and talk about what was going on with her body. Nobody explained to her that she has had a pelvic infection for five years. Four days ago, as she sat in front of me, she thought she had breast cancer because the ultrasound tech never explained to her that the breast lumps were not malignant.

In the first thirty minutes that I had with her, I found as many working metaphors as I could to explain what an infection is. I hope that I was able to help her understand the importance of taking the antibiotics. After this, I worked with the translator to explain fibrocystic breast changes to this patient and help her to understand that she does not have cancer. So much of the patient care here revolves around educating people about their own bodies and their health. They are often confused and scared after having been to any healthcare provider in this country.

Today, the patient reports that almost 100% of the pain in her breasts has been resolved and her lower abdominal pain is 50% better. With the herbal antibiotics we gave her to take until she can afford a round of Western meds, she reports less burning and leukorrhea. But, the pain in her left hip bone, something she's never mentioned before, hasn't been resolved. The clinic is slow, so I lay her on a thin mat on the floor and massage some herbal oil into her back. I do some cranial sacral work and then send her out into the cold and wind to catch the bus. She tells me that she will come back for our last day tomorrow.


I've been here for eight and a half weeks and it barely feels like two. There are so many patients and so much left to do. Yet, tomorrow is our last day. ARP won't have another camp here until September. We leave our patients for six months without the healthcare that they are used to. We leave them in a medical system where very few doctors are willing to take responsibility for coordinating their care. I don't blame them. I know that it takes a lot of courage to take a patient's case on. I've had to dig deep inside to do it myself, but that's what I promised to do when I signed up for this trip.

I haven't been incinerated here. And I haven't run into the wilderness when I was forced to face myself. In fact, as I have spent this time with myself, I am starting to think that it's not so bad to be me. I am made of shadow and light, as we all are. I have my night and day, my sun, stars and moon...and I hope that in going home I have learned not to take so much of that beauty, that is inside of me, for granted.

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