Around the World: In a Nutshell

It is the ninth of May, two-thousand and thirteen, and what a year it has been.  In the past eight months we have circumnavigated the planet, with the majority of that time being spent in the hills and valleys of Far Western Nepal.  We have flown in airplanes of all sizes, traveled on open-air trains, crammed ourselves into buses, jeeps, and vans.  We have been whisked along aboard ocean- and river-going boats.  We have walked, swum, and climbed.  We have slept in huts, houses, and hotels.  We have seen lives begin, and we have watched them end.

Now that we are standing, firmly, back on home soil (insert your own definition of “home” here), it seems apt to ask what this all means.

  • It means that there are things that we will never again take for granted.
  • It means that we have learned to fight battles that we never knew existed.
  • It means hope and ambition, tempered with sorrow and apathy.
  • It means new definitions for more words than I can list.
  • It means things that become newly apparent each day, not least of which is that Health–capital H Health–is something to be thankful for every day, for ourselves and for others.

The next question that seems appropriate, for this “in a nutshell” monologue, is what comes next?

For me personally, or perhaps professionally, the past year has reiterated the importance of long-term commitment and community involvement.  It has solidified my determination to pursue all training necessary to provide a meaningful service to the people of whatever small town we take root in.  It has reinforced the fact that one must always “think outside the box.”

In the next 10 days, not only will I be starting another graduate program, but Ryan and I will be getting married.  Both of these events marking the beginnings of new and exciting adventures, not entirely unlike our around-the-world year.  These adventures are sure to take us to as many exciting, bewildering, and inspiring places as all of the trains, planes, and rickety automobiles have.  My thought is: “Bring it on.”

In the meantime, we’ll be roasting here in the desert of Arizona, riding bicycles and climbing on rocks.

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A huge, heartfelt thank you to everyone who has been there for us along the way.

Bring on the Heat

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So here we are, in the land of tropical weather, humidity, and spicy foods.  We landed in the Bangkok airport only about a half hour late, and found ourselves faced with an amazing array of modern creature comforts.  Moving sidewalks, automated doors, air conditioning, new cars, and consistent electricity all welcomed us to this new and different place.  The process of getting a visa, which we anticipated being a few hours long, took less than five minutes!  When we braced ourselves for the impending haggling session with the taxi driver to leave the airport, we couldn’t have been more surprised to find out that not only was there a taxi stand to arrange for our transport, but that there were also meters in the cabs.  We didn’t even have the chance to haggle, compare prices, pretend to walk away, or utilize any of our other Nepal go-to taxi driver communication tactics.

After a night in a very comfortable hotel, we awoke early to make a 9:15 appointment at the U.S. Embassy, where I had retrieve my official, original United States Government Fingerprint Cards (a background check is just one of the hoops that one must jump through to apply for healthcare work or education programs, and it turns out to be rather complicated when one lives in Asia).  We were inside the Embassy, registered, and back out on the street again before my appointment time had even officially begun.

From there, we took a stroll down the street to the local police department, where I was asked a number of questions by confused law enforcement officials. Apparently the foreign citizens who get fingerprinted in Bangkok police departments do not tend to be hopeful nursing students.  I found that hard to believe…

After some tasty (eye-wateringly spicy) lunch, we decided to take an overnight train to Phuket to meet Uncle Dave for a week of seaside adventure.  The ride was sweaty, but otherwise uneventful, and 16 or so hours later, here we were, in the beautiful seaside town of Rawai Beach, at the very southwestern tip of Thailand.  Commence sequence beach vacation.

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A Man Named Karma

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Having spent a number of days traveling to and from the Kathmandu domestic airport terminal, we have haggled, argued, and conversed with many of the local taxi drivers.  As soon as we enter the waiting area, they swarm; trying to carry bags, offering us rides to all sorts of awful tourist places that we certainly do not want to go to, and doing their very best to extort us in one way or another.

And then there was Karma.  We spotted him, sitting on a concrete wall, uninterested in the heckling scene, picking at the fingernails that remained accessible as a result of his fingerless leather gloves.  One look at him, with his chain wallet, slicked-back hair, and combat boots, and we knew that he was our guy.

Karma drives a mid-70s Toyota sports car, which he takes pride in having personally driven for 36 years.  We asked if this fine ride had a name, and when Karma told us that he had never thought of naming a car.  Ryan promptly named her Melissa.  Sweet Melissa that is.

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Following miles of congested traffic and animated conversation, we had to reroute our excursion, as the rooming house that Karma had recommended turned out to have been closed for 20 years or so.  He took us right to its former site though.

At the end of our ride together, Karma gave us his business card–a business card that depicts him in full business attire.  We of course kept it.

When we flew into the domestic terminal again two days ago, Ryan walked confidently into the crowd of badgering taxi drivers, and asked loudly “Where’s Karma?”  Our man came running, cleared a path through the sea of people, and welcomed us into his waiting chariot.  He and Melissa did get us safely to our destination at a discounted rate, but riding with Karma is priceless.

A Common Preexisting Condition

A healthy sixteen year-old girl passed away yesterday, within a few miles of our hospital.  She had no history of illness or trauma.  Her only preexisting condition was having been born female.  In Achham, and much of Nepal, women of child-bearing age spend their monthly week of menstruation separated from their families, as part of the practice of chhaupadi.  Menstruation is viewed as impure, and women undergoing this biological process are segregated in order to prevent “contamination” of those around them.  Traditionally, menstruating women are sent to sleep in a cow or goat shed outside their house, though some families provide more comfortable spaces for their female members.  They are not allowed to enter the kitchen or use the family’s water source, and are often made to wash their sheets and blankets each day.  This particular young woman had started a small fire to try to stay warm in her chhaupadi shed, and was found by family members the next morning, having suffocated to death.

Hers was the third chhaupadi related death in Achham this year alone and such incidents, unfortunately, are not uncommon, particularly in the winter months.  When trying to decipher some sort of reason behind this needless, completely preventable loss of life, the deep-rooted complexity of such issues becomes apparent.  Perhaps she was cold because she did not have adequate blankets, or because the blankets she had were still damp from having been washed that day.  Perhaps the shed in which she was sleeping was not adequately sealed from the cold winter air.  Her family may not be able to afford adequate blankets for everyone, and she may share a bed or blanket with a sister most other nights.  If these reasons fully explained the issue, it would seem that her death was due to the simple but ever-present dangers of poverty.

The truth of the matter is, however, that poverty is not the only answer.

Education, like poverty, could provide some clarity about how these things happen.  It is very possible that, in the same way that we see countless elderly female chronic obstructive pulmonary disorder (COPD) patients, who have been cooking indoors over open fires their whole lives, this young woman simply did not know the dangers of concentrated smoke inhalation.  Had she known, she may not have built a fire in her small room, or may have left a window open.  This would also be a simple answer; an answer which correlated clearly with poverty and social marginalization.  But these simple answers do not fully explain such a death.

In such a recent post-conflict region, there is a distinct and widespread sense of stoicism, embodied by people of all ages.  Small children come to our emergency room with multiple fractures, their eyes devoid of tears.  Women give birth silently, with no local or other anesthesia.  This quiet yet tangible sense of fierce independence, limited trust, and conflict avoidance, frequently results in a “grin and bear it” mentality.  Perhaps the family did have extra blankets, but the young girl did not think to ask for them or the family did not think to give them.  Perhaps the fact that the tradition of chhaupadi has been practiced for generations contributes to elders believing that “If I did it, so can you.”

Potentially the most difficult contributing factor to address in our effort to make sense of this nonsensical situation, is the fact that a female life is not valued in the same way as a male one.  In this patrilocal culture, daughters are raised with the understanding that they will eventually be “lost.”  Sons are expected to bring wealth upon a family, and to care for their aging parents later in life.  Daughters are raised into their teens or twenties, and are then married and moved into the households and families of their new husbands.  Newborn sons are greeted with open arms, while it is not uncommon to see the new mother of a baby girl in our maternity ward wistful and withdrawn, laying with her back turned to the infant.  Perhaps this young woman would have been offered another blanket, or would have felt comfortable asking, had she been graced with a Y chromosome.

As with all such questions, there are simple answers and there are complex answers.  The problem is that these answers are tightly intertwined, and cannot be logically separated.  We are already conducting menstrual education programs in local schools, in an effort to increase understanding of the biological processes that the female body undergoes.  The local community could join together to distribute blankets to those in need, or could launch an educational campaign about the hazards of indoor fires.  These things would likely help, and may actually reduce the incidence of chhaupadi related deaths.  It is, however, unlikely that these efforts alone would prevent another woman from meeting the same fate.  These are but a few of the deeply entrenched challenges faced by the people of Achham, following the years of war that left no one untouched.  Just as infrastructure is redesigned and rebuilt, so must lives be.

The Day after the World Didn’t End

We awoke this morning around 5:30 a.m., to the standard background of doors opening and closing, people coughing and hacking, and dogs barking.  This particular time, however, the sounds seemed somehow less abrasive—brightened by the humming background of a few hundred Tibetan monks chanting.

While across the continent religious fanatics were seized for distributing doomsday materials (China), and 1000 Russians huddled deep underground in Stalin’s bunker, having paid $1500 each to be protected from the world’s end (Moscow), we sat watching hundreds of Buddhists going calmly about their morning prayers around a giant stupa in Kathmandu.  In Serbia, coal shafts were opened to shelter the masses following the impending emergence of an evil sorcerer inside the mountain, where people could hide as he went on to destroy the world.  Gendarmes blocked access to a peak in the Pyranees, where a giant UFO was expected to beam up gathered devotees (France), and the annual winter solstice celebration at Stonehenge took on larger-than-life dimensions despite declarations by the party’s Druid hosts that they had no end-of-world expectations (United Kingdom).  Another party raged in Cisternino, complete with hot air balloons and sleepless nights (Italy), while the only notable doomsday gathering in Sirence was that of journalists hoping to document “believers,” to the great dismay of local shopkeepers (Turkey).  Perhaps the epicenter of end-of-world festivities, being affiliated with the Mayan prognostication that had spurred all of this ruckus, was Chichen Itza, a Mayan ruin on the Yucutan Peninsula (Mexico). Here, however, people were gathered to celebrate the dawning of a new area.  Presumably, there were countless smaller and less documented ceremonies of celebration, mourning, anticipation, and fear across the globe.  I would hate to think how many disappointed faces left these events, returning to desk jobs, mortgages, and everyday rituals that they had finally forsaken.

What I marvel at is how common these events are.  In my mere 25 years, I have already witnessed the mass-hysteria of Y2K, doomsdays, and the end of civilization “as we know it.”  Is humanity so bored as to need more drama, tragedy, and panic than genocides, guerrilla warfare, action thrillers, and so-called “reality TV” can provide?

While I pondered the humor embodied in these mass demonstrations of some intrinsic human fascination with the absurd, I found great comfort in the calm river of grandmothers, children, and monks alike that circumambulated the stupa, spinning prayer wheels and holding prayer beads.  They all made their way around the circle at their own pace, quietly paying homage before continuing their daily work, studies, or travel.  Just another day.

Traffic Tickets

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December 10, 2012.  City Center, Kathmandu, Nepal.

Judging by the co-mingling of cars, buses, tractors, motorcycles, bicycles, rickshaws, goats, cows, pedestrians, and any other moving body one might feasibly imagine, we had drawn the conclusion that traffic enforcement was nonexistent here.  We were, however, caught off-guard the other day, when we witnessed an actual traffic ticket being issued.

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