I'm standing here tonight, brushing my teeth under the almost-full moon. There is a shared sink on the road. It makes me think of a spigot in a campground. This sink is used for everything: washing dishes, laundry, weekly hair treatments and most of our hygiene. All of the neighbors on the street use it and any passerby who feels like washing his face. We fill our tea kettle here and it's where we refill the shower drum. It's made of a concrete pad with a small drain in it and some concrete edging to make it into a little square. An iron pipe comes from the ground, ending in a faucet about three feet from the pad. A small piece of hose hangs down to direct the flow.
Part of me is turned off by the large pool of stagnating water that the sink drains into. It's where we spit our toothpaste out and where all of the animals drink from. Another part of me thinks about how beautiful it is that all of us, ARP volunteers and neighbors, are out here in the cold, brushing our teeth together. The sky tonight is cloudy and the stars can't be seen, but there is enough of a break for the big chunk of white moon to shine down on us. I don't go out into the moonlight enough at home. I brush my teeth in my bathroom, in socks and pajamas. In the US, I am too comfortable to spend this beautiful time underneath the night sky. In the US, a lot of things are different.
I'm thinking over my day and I am exhausted and relieved. I met my 22-year old patient at the local health depot where her Mantoux skin test showed a positive result for tuberculosis. With a high erythrocyte sedimentation rate (ESR) and total lymphocyte count (TLC), I was able to send her on to a hospital in Kathmandu for a spinal biopsy. The skin test is not a conclusive result that she has spinal tuberculosis, but it is now a possibility. A treatable possibility. The treatment is awful, much like chemotherapy, but it is treatment and she would have a chance at living a normal life afterwards.
When the government official measured the swollen red mark on her arm and pronounced a positive result, Ranjana and I smiled at each other. In the back of my mind I thought: How odd is it that we are happy that she may have spinal tuberculosis? I felt a pang of guilt at that, but compared to the other things on the list, it would give her the best outcome. Ankylosing spondylitis, cancer, multiple sclerosis...these are all diseases that are managed. Not cured. They are diseases for life. So we smiled and hugged each other with hope at a positive TB test.
Writing a referral note for her took an hour, as we had to get our letterhead from the clinic, type it out and then walk to the other side of town to have it printed up at one of the shops. She and her father met us. It took them less than an hour to pack all of their things so that they could skip town and head back towards the city hospitals. I was sad to see her go, particularly because it was the first time I'd seen her so happy and hopeful since I'd met her. I had her write down her email for me, though I knew that it would be impossible for us to write since neither of us speaks the other language.
Debbie and I headed back and grabbed our water bottles. Milan, our translator, headed out with us, to cross the scary metal bridge on the way to Kogate. Instead of heading left at the other side, we veered right. We decided to go see the village of Suping, a town only thirty minutes away. Though Milan has lived here his whole life, he's never ventured up into those hills. We arrived to find some mud homes and a large group of goats tended by a sleeping dog. Laundry was hung out near the street, as always, and Debbie pointed out a beautiful banana flower.
As we made our way through the simple houses and appreciated the clean air, we heard a boy calling to us. "Hello!! Hello!! What is your name?!" He was thirteen years old and excited to have some Westerners to practice his English with. We invited him to walk with us and he showed us the hills and terraces near his home. We watched a wedding party cross a deep ravine near us and took pictures of them on the suspension bridge. The cold was too much and we returned the way we came. The boy invited us for some milk tea at his house and his mother was kind enough to serve us masala on their porch. We sat on mudas and the boy told us about his little puppy and how he hopes to save enough money to take her to Hetauda and learn how to train her.
"She is so naughty! She bites the cows. But, she doesn't bite me. I feed her little bits of my food and she is very nice to me."
We said our goodbyes and made our way back to Bhimphedi. Auntie was here cooking dal bhat when we returned and we ate together with the team. I snuck a big spoonful of the chocolate hazelnut butter that's under my bed, virtually all I have left from the large duffle of snacks I brought. In the morning, I'll work at the clinic and leave for Kogate in the afternoon. I'll stay there for two nights to work in the clinic there and return Wednesday. I am excited to go but sad to leave my friends and patients here for two full days....
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