Clinical 1

Today was my first day doing clinical observation with Dr. Koirala at his second clinic in Putalisadak. Yesterday was an amazing tour with Anil. Saturday my dad arrived. The last week or so has been constant action...

Starting with the tour, which was maybe the fourth one I've been on with Anil: we went to two towns just outside of the city, one where most of the traditional woodwork is produced, the other where mustard seed oil used to be produced for the whole country. While the details of the tour were beyond fascinating, I would be doing him an injustice by trying to recreate the experience, so I won't; however, a few of the basic ideas he emphasizes in all his tours are finally so drilled into my head that I can put them down here. Since he's an engineer and an urban planning expert, he often speaks about how to make a city a functional, successful place for its inhabitants. There are four pillars of such a place. First, he says, you want a place to be livable, so that the people living there have what they need and some of what they want. In order to make a place livable, it needs to be managed. If the management is going to be effective, the people in charge need to be accountable. And the only way to get people who will be honestly accountable is to ensure that the place has something competitive to make it bankable.

So, say a place has a competitive product, like wood, and craftsmanship to work with it, making it bankable. There is the question of how to ensure that the artisans--who are the fundamental link in the chain--earn enough money from the natural resources to sustain their lives. Assuming they sell, for example, some pieces to Anil directly for his restoration work, they receive payment for that: P1. But that alone can't sustain their family, so they also do work making windows and decorations for hotels and commercial enterprises, which brings in a second income: P2. In addition, Anil and his wife run an organization called Crafted in Kathmandu, wherein artists' work is exported to Manhattan and sold through catalogues in small numbers, bringing in P3. With P1, P2, and P3 together, the families can support themselves and continue their work authentically. Authenticity is something Anil takes very seriously, and every craftsman learns about the history and reasoning behind the details of what it is they do. For example, they know why in the final scene on the wheel depicting the 12 scenes of the Buddha's life, the food shown is mushroom instead of pork; though there is debate about whether he was poisoned by one or the other, it is likely that he abstained from eating meat (especially pork) and thus it was mushrooms. The debate is cause by the fact that the word in the text from which the art is derived can translate as either food. This is the level of knowledge each artisan has....it's astounding.

He also speaks a great deal on the iconography of the Buddha, and one fundamental aspect of Buddhist iconography is the lotus. For those who aren't familiar, the symbolism of the lotus is the following; the roots of the lotus begin in the earth, which is material form. It then grows through the water, which represents illusion, in order to blossom in the air, or emptiness. This is the same path that the Buddha followed. Similarly, the symbols on the Nepali coin are meant to represent the attributes of a leader. On each side of the square mandala on the coin is a symbol, including a knife (ability to defeat enemies), wheat grain (provide for the people), staff (diplomacy for negotiation), and a conch shell (mobilizing the people).

So those are just a few tiny snippets of what Anil teaches us on the tours. I admire him immensely.

Clinical study today was a totally different experience than taking class, of course. It's hard to describe when I know I'll be leaving out so much essential and fascinating information. Dr. Koirala's clinic was a little hard to find because it's in an area of town I haven't been to before, so I accidentally wound up visiting the Nepal Health Society. It sounds official and has a large office space in a big modern new building, but when I walked through the doorway, I found it empty but for a single desk and some wooden standing dividers. A young woman and a young man were sitting on two chairs in the unlit apartment, doing nothing, as there was absolutely nothing to be done in such a space. However, there was a phone, and the woman helped me to get directions going to the right place. She seemed very sharp, and I left wondering why the place was so deserted: alive but defunct at the same time.

When I arrived at Dr. Koirala's clinic, more of a storefront with a room in the back, it was already almost 5PM and the place was very busy. A Nepali boy in the front asked me if I was American and then led me to the back room, where Dr. K was in consultation with two men already. I watched him go through three or four patients, with intermittent translation or explanation. I caught a tiny bit of what was going just from my scarce understanding of Nepali--negligible from a medical or academic perspective, certainly, but something nonetheless. I also felt a patient's pulse for the first time, which was interesting. The whole perception of the room, the patient, myself changed when I was in the position of having to interact physically with the patient. I'm sure the nerve-wracking aspect would or will change over time, but it was definitely an experience this time. Then another girl came in, a Nepali medical student doing an internship with Dr. K as well (just clinical observation). We shared notes and she translated conversation for me, and generally it was a helpful situation.

The room itself was very small, painted white but not pristine, let alone sterile, like clinics in the States. The examining table had a cloth covering, which naturally wasn't changed between patients, as the average time he spent with each person was around 15-20 minutes and there were countless people waiting to be seen. When I left at a little after 7PM he was still going strong. The other girl said that he usually stays until 8PM or later, every day. He examined each patient in much the same way; feeling their legs, checking the knee joint movement, prodding the abdominal area, sometimes checking the throat, eyes, or tongue, or a specific area if someone complained. One difference I noticed about the way he examined men and women was that while he felt around the ribs and chest area, even with the stethoscope, he would ask the women about their children. Inevitably they had something like four children, with various situations, and it was always at the same moment that he invited them to tell him briefly about their situation. In discussing this with my dad after, we deduced that it was a deflective measure he took so that their emotional attachment to the topic would allow them to relax while he was feeling a perhaps sensitive part of the body, at least for a conservative culture like Nepal's. Maybe I will ask him about this specifically at some point.

Again, there's just too much to say. It's quite late so I'm off for now...hopefully will get enough sleep to wake up and do yoga.