Sunday, May 11, 2008

Damauli and Thimi

After scanning the last few entries I'm dismayed at how little has been captured of the past weeks. The short list itself is long, and lengthier narratives would fill a book...agh! I'll start with yesterday, which was spent in a town called Damauli, 150km out of Kathmandu. I went there with Dr. Koirala, Dr. Kopila, and one of her peers, Dr. Namruta, also a young woman. They were going to do a full check-up of about 30 cases of uterine prolapse (varying degrees), all of which are part of a study they're doing on the efficacy of Ayurvedic treatment for the problem, which includes oils and exercises (yoga). Only 17 of the cases showed up, for various reasons (one woman got very bad jaundice; others were unable to be contacted, etc.) but almost all of them had improved significantly. It was my task to take photographs ("snaps") of each case. Obviously this kind of thing would be impossible to see in the States, let alone in the manner I got to see it...but strangely, what I thought I'd find a little much for my unprepared eyes did not arouse any disgust, only empathy.

Most of the cases are the result of inadequate or improper post-natal care. The women in the hills work extremely hard, including physical labor, and have little or no time to rest after giving birth before they resume their various chores. On the drive to Damauli, I saw three generations of women in one family--a bent-backed grandmother, pretty young mother and her daughters, maybe 9 and 12--walking along the road with huge loads of vegetables on their backs. Given that this kind of toil is part of maintaining their livelihoods, it's no wonder that they'd sacrifice rest in order to keep food on the table. There are other further exceptional cases: one of the cases we saw was a woman whose children are grown and husband is paralyzed. She had total prolapse, meaning the uterus was completely outside the vagina, and had ulcerations and other complications...the only solution was to send her for an operation, but she wouldn't go, because somebody had to care for her husband. It is a real struggle for the doctors.

For the most part the women were relatively open, but some were quite shy (especially those whose prolapse was not severe) and didn't want Dr. Koirala in the room. Of course, the preference women have for female doctors, particularly gynecologists, makes perfect sense. It was an intense day. After the last case Namruta and I walked down to the river and checked out a cave where a yogi supposedly meditated thousands of years ago (in fact Damauli is the site of a few caves where the writers of the Vedas meditated), but it was absurdly hot and we headed back up quickly for the five hour drive home. On both the ride there and back we stopped at a few stands where they sell plates of tiny hot fried fish. They were basically all there was to eat, so I partook; and in fact they were delicious, as was all the fresh produce we bought on the way back--bananas, papayas, endless greens. I bought a small rack of the fish for Ama-la, but when I presented it to her at home she literally screamed and jumped backwards. Hahaha! Turns out Tibetans have a "thing" about fish, but I won't call it an aversion, because that's so un-Buddhist, haha. It was very funny. Now I have a rack of fish sitting in my room and nothing to do with it, but dry or not, I'm sure they'll start smelling. Hopefully Vidhea and Yanik like fish; it would be a shame if such a tasty snack went to waste.

After an evening flying along the bumpy highways gazing out at trucks with painted slogans like "God...Halp Me" [sic] and advertisements for brands like "Lacto Fun", it was great to just hang out all night and rest. It's been about a week since Rupesh came, but the sleep has been sorely needed. And I check to make sure I can still touch my toes every morning and every night, even if I don't do much other stretching. Tsk tsk...lack of discipline. But my discipline is needed for other things: like schoolwork.

Today was the last tour with Anil. His genius has really illuminated the last five months here. This time we went to Thimi, also outside the city, to check out the vegetables, ceramics (which they're famous for) and general entrepreneurship that's popped up around the town. Thimi has other claims to fame, though, including the complex which manufactures textbooks for every school in Nepal, which means about 7.8 million children. The buildings were built by US aid a long time ago. We whizzed by the complex and into the town, where we disembarked from the van and wandered for several hours. The first stop was a traditional mask-making shop and studio where a young girl, high school-aged, was deftly working with black clay (which is kneaded with cotton, because it can't be fired). She showed us the process of mask-making, and the red and white clay as well, while Anil gave us cultural background. He pointed out that in many cultures around the world, creation myths describe that sentient beings were shaped out of clay and life was then blown into them. Because of this the designation for potters has usually had some connotation of being creators; in Nepali this is "prathapati" or "creators of people." This is part of why it's so important for the young people who are reviving and maintaining these traditional arts to take pride in this part of their identity, and not to feel that the amazing work they do is somehow inferior to the overly-intellectual work of others. As Anil said, at the end of the day, it's not just economy.

It's also worth noting that the Nepali designation is one of the 64 surnames that automatically inform the informed listener of the occupation or trade of the person named. For example, "Tamrakar" means coppersmith, and Anil's own surname, "Chitrakar" means image-maker, and his family is traditionally involved in photography, though painting preceded that. He himself used to do some mask-making as a child, and told us some details about them, like how to tell the masks that are used for display; they have the headdresses shaped and painted in clay, whereas those used for actual dances and ceremonies would have real headdresses of jewelry and flowers and the face only for the mask, so it is lighter for the dancer. They're lined with lhota (?) paper from the hills and with cloth inside, and use rice flour glue or a strange concoction of buffalo hide and ground bones, which smells powerful and disgusting. The original paints are made of ground rock. This clay is used not only for mask-making but also for vats and vases, which are painted and used in family rituals to store rice, water, alcohol, and other "divine" substances. Some of the rituals they're used for are really fascinating, like celebrating when a person has seen their 1,000th full moon or turns 77 years, 7 months, and 7 days old. Thimi's particular culture is derived from the period of Nepal's history prior to 1482, when Bhaktapur was the capital instead of Kathmandu, and its strength as a city was supported by 7 small surrounding towns each with a specific function and product, of which Thimi's was ceramics.

Walking around the town I saw quite a few sacrificial goats tied up awaiting their demise around the temples, but one particular Buddhist bahal (Gusi Bahal or the Yellow Jasmine Bahal), open to the public but privately owned by a family, was devoid not only of animals but also any visitors. The family had moved to Patan and left the bahal to fall into disrepair, but we did peek at the Buddha statue, sitting forgotten but looking just as serene as ever, behind the locked wooden gates that were nearly decrepit. Though the wood was nearly destroyed, we could make out the figures of the Buddha's two main disciples, Ananda and Sariputra, adorning the doors leading to his inner chamber. The smaller stone stupa in the center of the courtyard, however, was carved so beautifully that the fineness and subtlety of the work was still not only observable but remarkably obvious. It's a treasure of the world, this city with these places, and it's really "God's work" that Anil is doing in making so much preservation possible.

Afterwards we visited a Thimi ceramics business and thoroughly enjoyed exploring the shop and the workshop, seeing the kilns and raw products, unshaped and unfired clay baking in the sun, and funny little completed products, like a clay foot-scrubber with a little glazed frog on its back. Tuesday, Caitlyn and I are going back to pick up some final gifts, because I saw some things there that my grandparents will love. As we drove back into the city, the fragrant smell of massage oil overpowered the van as we passed a factory responsible for supplying the myriad massage parlors in Thamel with their lubricants. Even more interestingly we passed over a bridge where on either side could be seen long stretches of land occupied by tents and lean-to shacks. When I asked Anil what the story was, he explained that during the election campaign the Maoists had promised scores of people land if they voted for them. Now the masses had appeared at the government's doorstep, in a way, demanding their land and occupying the public's in the meantime. Quite a sight...I wish I'd had my camera.

Alright, it's been two days since I showered (running all about and lacking water at home), so it's off to the Hyatt to wash up. Tomorrow is the second round of hunger strike for me and Caitlyn's first, so I'd better smell alright for the press.

Wednesday, May 7, 2008

Hunger strike + more

So many things have happened since the last time I blogged that I'm overwhelmed and don't know where to start...but if I don't update now, I'll forget 90% instead of 50% of all the little noteworthy things.

On Saturday I went with Sapna, the Nepalese medical student doing a clinical internship with Dr. Koirala at the Putali sadak clinic, to the hospital where she studies. It's an Ayurvedic hospital known best for its care of jaundice patients. I don't want to exaggerate, but the experience was kind of harrowing. First of all, the complex wasn't built to be a hospital; the property was bought by government and turned into a public hospital later on. The buildings are essentially huge and residential, almost like hotels. They're not even clean, let alone as close to immaculate as humanly possible like American hospitals. We first went into the men's ward (it goes without saying that we climbed several flights of stairs-elevator is unheard of)...the first floor had three patients in a huge room with about twelve empty beds. One man was belligerent and wouldn't talk, so we didn't go over to him. We spent the most time with a wizened old man who had chronic obstructive pulmonary disease, and I practiced taking blood pressure (which I still can't do properly) and using the arguably obscure stethoscope (which I can) to hear how lungs shouldn't sound. Then we went upstairs to the jaundice floor, where there were maybe twenty-five or thirty patients whose problems ranged from mild to very severe. I should note that there were not even curtains to divide the beds, let alone separate rooms for the patients...I practiced taking patient history and palpation (with Sapna's translating assistance and patient instruction) and we spent some with with a few of the patients, though not much. We went back downstairs and took a full patient history from a new patient in the non-jaundice ward, who happened to be a classic example of a vata constitution and had problems directly resulting from the behaviors and imbalances associated with that dosha. It was exciting.

We walked out and across the dusty courtyard to the women's building, where there was a grand total of five patients. One was a woman with some kind of menstrual trouble, three I don't know about (one was hooked up to the lone IV in the entire hospital) and the last, quarantined in a corner of the immense single room (maybe fifty beds total) was a seven-year-old girl who had TB meningitis. The entire time we were in the hospital--maybe 2-3 hours--I didn't see a single nurse, and there was a doctor coming in to make rounds in the men's ward as we left. This little girl couldn't speak and was covered with a blanket. I initially thought the old woman lying on the bed was the patient, but as we approached she sat up and rolled back the covers to reveal this tiny figure on the bed, chewing her lip, eyes rolled up, arms and legs folded. She had been in the ward for two days, having come from another hospital in Kathmandu that Sapna said was in "worse condition" than this one. As we left, she began to cry, and her grandmother and mother were trying to massage her legs and pacify whatever discomfort she was in.

After all that, we walked around the courtyard and looked at some of the medicinal plants growing around the complex. None of them are processed or used at the hospital. Still, it was nice to see them: guduchi, amla, and marijuana among others. I took some pictures and then we wandered around Durbar Marg for a while as the sun set. It was wonderful to talk to Sapna about all kinds of things, not only related to medical studies but also about Nepali versus American society, and our personal experiences of various expectations and silent (or not so silent) pressures on women in our respective worlds. On Friday we're going to spend some time going through a fantastic book I have based on polarity therapy, which itself is essentially an adaptation of Ayurveda.

Sunday was the 24th consecutive day of a hunger strike that Tibetans in Kathmandu have been holding. Earlier in the week Ama-la had mentioned that she, Pa-la, and Tsering Dolma were going to be there on Sunday, and invited anyone else in the family to come, and I decided to go as well. Popo-la got so excited about me going that I was almost startled, and everyone in the family was so grateful and kept saying how much it was helping that I was going and supporting them, and how much it meant to everyone. So on Sunday we headed over to Swoyambhu and settled in under the giant tent of Tibetan fabric. We waited for about an hour on the hill outside while the previous group finished chanting and had some thukpa (the strike runs in 24-hour cycles), and then went in and sat down. Almost immediately the man running the affair came over to me and asked me to come sit in the front and center, next to the one other Western girl there, Lorena Rodriguez from Spain. He made some introductory remarks in Tibetan, including introducing me and Lorena, and then we embarked upon our 24 hours of fasting. Most of the time was spent praying, though there were about five or six hours that I was just sitting and looking around, or talking to Lorena. We got water at 3PM, but other than that, there was nothing whatsoever to break the rhythm of just sitting. On Friday I'd gone with Tais to get a mala at the stupa, and I was really happy that she showed me how to use it, because it was a very intense and new experience to use the mala beads and chant mantra (om mani padme hung). The Tibetan momo-las (grandmothers) were thrilled to see me with the mala...it made me feel very good to make them so happy just by being there, and wish that I could do more. Vans of tourists heading to the stupa drove by, and each time they would pull to a stop and stare at us and take photographs, and all of us would flash the peace sign and they would respond in kind and then drive off. It was great to spread the message. I almost got attacked by a monkey when I got up to use the bathroom one time, but aside from that, it was a very peaceful day.

To make things simple, I'll just copy and paste the little article I wrote on Facebook:

The uprising that started in Tibet on March 10th is still spreading worldwide.

Though the protests at the Chinese embassy here in Kathmandu usuallywind up with demonstrators in tears and often with violence (freelyavailable photographs now attest to the force used by Nepali police)many Tibetans, including monks and nuns, continue to fight against the Chinese crackdown in Lhasa and other regions of the country. However, it's equally important to note that aside from these unfortunate incidents, there are peaceful means of protesting as well.These passive methods are also widely used, especially here in Nepal.There are many candlelight vigils held for the monks and nuns who arebeing killed in Tibet and to show solidarity with them.

I spent this weekend at a hunger strike by the Swoyambhunath stupa, with more than fifty Tibetans, and one other Westerner (Lorena Rodriguez, from Spain). These gatherings receive less attention from the media than active protests that quickly become provocative and violent. The people present there were about half from the monastic community and half laymen, and of the laymen, most were Momo-las (grandmothers). The strike has been going on for 24 consecutive days and will go on indefinitely, at least until the Olympics. The strike consisted of refraining from eating or drinking (besides one water break) for 24 hours, sitting together in a large tent, praying, chanting, and so forth.

There were a multitude of signs and banners in several languages:Nepali, Tibetan, English. They called for a UN fact-finding mission,for immediate provision of emergency medical services in Tibet, and forthe international community to press China to allow free movement ofpeople and provide access to daily needs for Tibetans. Aside from theinherency of the situation, there was nothing overtly political aboutthe state of Tibet's state, so to speak: no mention of autonomy,independence, or the like.

Everybody there supported the struggle of Tibetans against the Chinese occupation of Tibet, but perhaps more relevant, they also act as representatives of the true strength of the Tibetan people and Tibetan Buddhism. They condemn violence, whether perpetrated by Chinese or Tibetans, not condemning the perpetrators themselves; at the same time, they recognize and want it to be known that there is a clear imbalance of power in this conflict. There is a definite oppressor and oppressed, a definite victim, though any can be villains. I was there because I do believe justice is on the side of the oppressed.

Please check out the following link to photographs of the hunger strike, as well as other recent protests in Kathmandu:


Now, if you scroll far enough along in that slideshow, you will find a picture of Lorena and myself at the hunger strike. A Reuters news agent came over to interview us sometime in the morning, and gave a short interview; naturally this hasn't been used anywhere. I'm hoping that when I go again on Monday, this time with Caitlyn and hopefully Tais, some of our words might find publicity as well as our pictures. Anyhow, after the protest, we all drank thukpa (which apparently has a very flexible meaning, because in this case it refers not to noodles but to rice soup with cashews, paneer, and Tibetan cheese in it...under other circumstances I might have been sick from it, but it tasted positively delicious) and butter tea, and Ama-la and Pa-la and Tsering Dolma and I went up to the stupa for a couple of hours. First we got watermelon (a monkey stole mine, and Pa-la's) but we made it up unscathed, and it was beautiful and sunny and we had a lovely time. In fact, we also happened to see a very interesting thing almost as soon as we got up there: two nearly white snakes were mating near the temples. They were braided together like the caduceus.

When we got home Tais and Phuntsok had made us lunch, which was very sweet and also thoroughly appreciated, since we were all pretty hungry by then--after the stupa we had gone to sit in Buddha Park, which is this fantastic place with three ENORMOUS gold statues of Avalokiteshvara, Shakyamuni Buddha, and Guru Rinpoche (Padmasambhava). It was ludicrously sunny and hot, so the hunger caught up with us quickly, and even the chili in the tofu didn't bother me at lunch. Of course, Phuntsok readily admitted that his basic reason for cooking was what I'll call "karma by association"--if he and Tais made us food, they would automatically get some of the merit we got for participating in the strike, as Ama-la said, "without asking." Haha! Either way, lunch was good, and I'm bound and determined to get them to accompany us when we go again on Monday.

There's much more, but this entry is getting super long, so I'll write it in fieldnotes form (haha). Met a brilliant artist, Pasang, who uses old pangtes (chuba aprons) to make beautiful mandalas and designs. His cousin Tashi runs the store, and he was telling me about how his parents suffered discrimination when they first came to Nepal from Tibet; because they ate meat and the Hindus didn't, they weren't allowed to touch vegetables in the supermarkets, and they were poor and not socially mobile because they didn't speak Nepali. Now it's enormously different...the population of Tibetans in Boudha has grown so much that even the Nepalese owners of Gemini Supermarket speak fluent Tibetan, and any shopowners who learn the language do much better business. Still, there is a division, and I can sense discomfort even at home sometimes when self-conscious upper-class Nepalese people come over.

On that note, I will end this entry and go on with various other items of interest later on!

Friday, May 2, 2008

Strange encounters

The streets of Kathmandu most definitely belong to the people. Coming home from the clinic in Putali sadak tonight was crazy; there were swarms of people around the cars and bikes, and vehicles could hardly move...the honking was an endless wail of converging horns coming from a ton of trucks and taxis fighting their way through the pedestrian mess. Today the first follow-up since I've started clinical came in, and it was a particularly interesting case (some demyelinating disease, but not MS). Interestingly, the treatment Dr. K prescribed has had an effect in only 8 days--this after a chronic problem for years and being on tons of immunosuppressant and other medications...Dr. K said that when something so mild has an effect like this it indicates an error in the original diagnosis.

It's good that the clinic was busy and distracting today, because I saw an upsetting thing on the way there this afternoon. Stuck in traffic, I happened to look out the window and observe that the entire street was surreptitiously watching a man strong-arm his wife across the street. She tried to get free of his grip, but he was having none of it; we started moving just as they rounded the corner of a building. I may have slight tendency to paranoia, but this man's face and body language--and the woman's--along with the reactions of everyone around them--signaled that a beating or some kind of typical abuse was about to take place. It bothered me very much. The rank injustice of domestic abuse sickens me.

We also had a strange incident this morning. Tais and I were sitting at the table outside our bedrooms when a shabbily-dressed older middle-aged man appeared on the stairs. He started mumbling something, repeating "maathi, maathi" and asking for "tato pani" (hot water)...when we told him there was none and to go downstairs he didn't respond at all, just kept repeating the same thing. "Maathi kehipani chainna" ("there's nothing upstairs") didn't mean anything to him, so finally I just told him to come with me ("ma sanga aunnus") and directed him to Ama-la. Turns out he was a beggar who decided it was fully within reason for him to open the gate and hike the steps into the house and ask for food. Ama-la had already given him something to eat (after which he asked for bread instead, and then demanded tea as well), and then he had headed up to where Tais and I were. Guess his stomach was still rumbling...or his mind was just skewed. Either way it was unsettling that he just came right on up there and it made me thankful for the locks on our doors. Of course, I also realized how different and unfeeling my reaction was; I was uneasy, while Ama-la was generous and kind. It made me a little ashamed.

Tais and I spent some of the morning at the stupa, which was wonderful. I'm going to make it a point to go there every day until I leave and do kora for at least half an hour. There's something ritually comforting (or comfortably ritualistic) about rolling the mala beads through my fingers, reciting a mantra in my head, just going step by step around the imposing white structure.

I wouldn't mind musing a bit more, but many essays are waiting to be written, so there's no time!

Thursday, May 1, 2008

Short list

Today and yesterday have both been mega-storms...thunder, lightning, wrath of the gods, the whole deal. Still, it's a nice break from the sweltering heat during the day. I've been spending way too much time indoors as a result of the weather and all the work that still has to be done for Lehman classes. Classes with Dr. Adhikari and Dr. Lakshmi have finished just today, so I have a notebook nearly full of information on the basics of Ayurvedic pharmacology and clinical examination. At first I wasn't sure how effective classes would be with multiple teachers, but it's turned out that their mini-curricula coincided beautifully. The details of rasa, vipaka, pravada, karma, and so on are probably too detailed to be of interest in a blog, so I'll leave them out. The various laws (Law of Homogeneity, Law of Natural Order, Law of Suppression, Law of Existence) were fascinating as well. They have philosophical names, but the laws are applied to pharmacology. Instead of going into that side of things, I'll post here a tiny part of one lesson on etiology, having to do with wrong use of the will, called volitional transgression.

There is an error known as pragyaparatha, the failure of intelligence by which we resort to substances even after we have experienced them to be harmful. This kind of volitional action can appear to have no effects for a long time, but it also leads to conditions like alcoholism and other addictions, in addition to generally unhealthy and indulgent behavior, which indicates an inability to control or direct the will. This factor relates to causes in our psyche which result in excess perverted, or deficient actions of the body, speech, or mind.

Misuse of our bodily functions either related to misuse of the senses or through either suppression or forced excitation of our natural urges. We should not suppress these urges, but rather attend to them as they naturally arise. The 13 noted urges are listed as follows:

Belching or flatulence
Defecation
Micturition (urination)
Sneezing
Thirst
Hunger
Sleep
Coughing
Breathing caused by overexertion
Yawning
Lacrimation (crying)
Vomiting
Ejaculation

According to Ayurveda, it weakens our life force to suppress these natural impulses. At the same time, it is important not to artificially excite them (for example with laxatives). Without going further into misuse of the senses, we assume that there are four ways the environment or outside world comes into contact with ourselves; minimal, in excess, perverted, or optimal. Of course there are many other things related to the whole sensorial dimension of health, so skip that for now (and a good three more classes' worth of information) and on to the pathogenesis of specific disease!

Actually, maybe not. Lights just went out randomly (though load-shedding hours were not set for this time)...I guess it will have to wait.