Adding insult to injury

My mother's worst nightmare has come true; I think my bed has bed bugs (she was obsessed with them when there was a minor outbreak in Boston this past fall). I woke up several days in a row with itchy bumps on my arms and right leg, but none when I spent two nights in the spare room of Mark’s flat. At least I hope it's bed bugs, sorta, cause having a biting spider in my room is very unappealing, as is having scabies or measles. I have another bed in my room that's not in use, so I may switch to see what happens.

The other night at Mark's flat I took Benadryl because the itching was maddening, which was actually a godsend because I slept through the 5:30am rooster that usually wakes me when I sleep in that part of town. Yes, there are roosters in Boudha; no they don’t wake me. Perhaps the Hindus’ ceremony at dawn involving bells and a horn aggravate the situation? Not to mention the neighborhood dogs who start yowling in response to the aforementioned horn. No good sleep to be had in that section of town. If it weren't for the electric water heater his apartment has, versus the solar water heater the clinic has, I wouldn't go there!

This early waking almost explains the poor behavior of Nepali drivers. First, they drive on the “wrong” side of the road, which rendered me incapable of crossing the street for the first week I was here. Add to that a lack of lane markers and general driving rules and it is amazing I’ve not witnessed more traffic accidents. And if the haphazard driving behavior isn’t enough, it is accompanied by much honking, which is both a courtesy “Honk! I’m passing you! Honk!” as well as “honk! I’m really annoyed with you! Honk!” The water trucks even have "please honk" painted on the back! However, traffic all but stops once the sun goes down, so honking has not been a cause of loss of sleep for me.

Difficult

Nearly every Nepali I speak with says “life is difficult, very very difficult in Nepal”. Indeed, as I have previously discussed, I find life difficult at times, too, but I have found a new way life is difficult – getting accurate news. I have checked four different sources – The Kathmandu Post, Ekantipur.com, Nepalnews.com, and Mark’s blog and the facts just aren’t lining up about the election situation!

[background] Democracy came to Nepal in 1990, so it’s a relatively new concept ‘round here. Then the son of the king went on a rampage and killed his entire family; this spoiled the democracy. Since I haven’t finished reading the history of Nepal Mark lent to me, I’m not 100% how we got to this point of stubborn political parties… but I do know that there are many many political parties who were not agreeing on the direction of the country until last week when all but one of them decided to cooperate. What we’re left with is the Madhesi party (aka United Democratic Madhesi Front [UDMF]) and everyone else (aka the Seven Party Alliance [SPA]) negotiating about what it would take for the Madhesis to participate in the Constituent Assembly (CA) elections, which will decide who will write the country’s new constitution, 10 April. [/background]

I heard from Mark (who had checked the web – source unknown) this morning that the Madhesi party had again missed the deadline, which had been changed so the party could complete the task of submitting necessary paperwork to participate in the CA elections. A post on his blog reports the same, so no new news there. However, sitting in front of me in the internet store is the Kathmandu Post, whose headline reads “SPA, UDMF finally reach deal”. Who’s a girl to believe?!?

So, I went on a fact-finding mission to the internet; actually, the two Nepali news sites Mark had recommended to me. Ekantipur.com has the same article as The Post. Nepalnews.com reports that the involved parties talked early into Monday morning and reached an agreement, but were having difficulty deciding how to word the agreement. Still, no definitive answer to what’s going on.

I am heartened by the news that the parties have come to an agreement, though I wish I could get more than one source to say so. I’ll just have to continue to wait like the rest of the country until someone sees fit to tell us what’s going on. Waiting, too, is very very difficult.

Home is where the laptop is?

I got word today [which was actually last week] from the medical director that, if I can produce my nurse license from Massachusetts, I can be granted a nurse license in Nepal. This means a shift in responsibility at the clinic, from 90% staff education/10% patient care to 50% staff education/50% patient care. This also means that I’ll have greater responsibility for my work, which right now happens directly under the supervision of a physician but presumably would not were I licensed here. No, I’m not sure of the particulars, except that the clinic is paying for it and it may happen Monday if my parents can get me the required documentation by Sunday (no pressure!). Never fear, you, my loyal reader, will know shortly after it happens. (Update: No, it has not happened yet, though today was the "Monday" to which I referred in the previous sentence. *sigh* such is life in Nepal.)

Perhaps it is this additional layer of complexity to my trip, perhaps a natural course of development regardless of licensure, either way, I am only two weeks into this trip and already I’m not looking forward to going home. Though I’m not quite sure where that is, anyway.

Is home where I am? Where my mail goes? Where my stuff is? If it is the latter, then I have three homes: the Shechen Clinic; 9 Mooney Rd., USA; and McCarthy Self-Service Storage. But defining home according to possessions seems to demean my human life. So the saying goes, ”home is where the heart is”, and that’s certainly not in a storage locker! Nor does it seem right to define home by the United States Postal Service, as trustworthy and reliable as it is. So that leaves personal geographical location.

By that definition, home is Shechen Clinic, Room #1, Boudha, Kathmandu, Nepal. But this presents a new quandary; Friday and Saturday, does home become the spare room in Mark’s apartment? Or does “home” remain in Boudha while I visit elsewhere? Even as I write it, I know this is the case. But why?

Perhaps home does relate to possessions, at least to some degree; if I can literally take my heart with me, but retain the feeling of home in a place, it must, but which possession(s)? Obviously nothing that’s in the storage unit a continent plus an ocean away. Same for those at my parent’s house. So, something in Nepal, then. Of those belonging I have here, I usually tote my laptop around, so that’s not it. My sleeping bag? My large backpack? Not really emotionally connected to either of those. Perhaps, rather than a physical object, it’s actually a sense.

A sense of possession – whether permanent, as in owning a home, or temporary, as in renting a dwelling, may just be the birth of a “home”. Where does one derive such a sense? Come to think of it, what helped me feel grounded and “home” shortly after arriving in Nepal was Mark’s giving me a key to his flat. It didn’t occur to me until I subsequently received a key to my room at the Clinic, but having a key (a possession!) to a place confers ownership; with the receipt of those keys, I claimed not one, but two residences in Nepal. That’s twice the number of homes I have in the US – no wonder I’m sad at the thought of leaving!

Someday I will feel competent

…although today’s not the day. Today (18 February) I had a sit-down-talk-it-out with the medical director and the visiting cardiologist/advising physician. It came about because I was still having doubts about my place in the clinic – NP versus RN – and stopped in to talk to the clinic coordinator about it. Word traveled up, and there I sat with these two docs. Oops.

I didn’t mean to go outside the chain of command, for which I apologized to the medical director afterwards; I was merely looking for some direction. Things between he and I are fine, and I’m feeling much more directed, which I will talk about. However, it’s also led to some professional flailing, which I also want to talk about.

In coming to Nepal I think I’ve taken a professional step backwards. I was feeling comfortable and confident in my work at the prison, and now I’m learning a new system, with new people, in a foreign place, in a language I mostly don’t understand… geeze, how many more hurdles could I have put in my path? Perhaps I should give myself a break, you say? Well, yes. But that’s not my nature. I am feeling inadequate.

For instance, the medical director has identified a skill set in women’s health he would like his nurses to learn from me. And as soon as the word were out of his mouth, I began to wonder if I could meet his expectations, if I have the knowledge he thinks I have. I specialized in women’s health in school. I passed a national certifying exam demonstrating competency in the subject area. My previous job was in women’s health. Anyone have some extra self-confidence I could borrow until I find mine?

So, I will be providing education for the nursing staff in the reproductive health clinic. The medical director would like for me to teach about contraception, antenatal care, and routine screening for cervical cancer. My first didactic is Wednesday at 1500; keep me in your thoughts! Even as I get more nervous, I am looking forward to this new challenge.

Analysis of this self-doubt led to thinking about the connections between self-confidence, job satisfaction, and prior generations. Let’s see if this makes as much sense on the screen as on the page. Workers of prior generations stayed in one job for their entire lives; heck, even my father, after a brief stint in the air force, has been in the same job for 30-odd years. These folks were presumably competent at their work and (hopefully) derived some satisfaction from it. They also tended to get married and have children earlier than folks nowadays. I posit that the competence and satisfaction derived from their life’s work helped them feel more confident in other aspects of their lives, therefore greasing the wheels for marriage and children. Then again, in previous generations, men were the breadwinners, so where does that leave the women?

Women were reared to have different expectations of life. They were not taught to desire a career, they were taught to desire a husband, children, and a house in the suburbs. Therefore, they were much more ready to accept these things when they came their way. Feminists would argue that society has done women a favor by freeing them from such mundane expectations. Others might argue that society has done recent generations of women a disservice by encouraging them to want more than their foremothers. Perhaps. I can understand both sides of it, and can wonder all I want if I would have been happier merely aiming for a husband and not a career, but it would be a shame to throw away all my hard-earned (and expensive!) knowledge. Plus, aspiring to be a competent nurse practitioner is easier than searching for a husband, and I get paid to do it.

Busy, eye-opening weekend

It started with my first attempt at negotiating “public” transportation in Nepal. Public is in quotes because the van/buses and tempos (I’ll post a picture) aren’t run by the government, but they are the least expensive mode of transport around the area and go many places, although with about as much speed as an MBTA bus. So, I stood on the side of the road in a spot of my choosing, there are no “bus stops”. It was a good 30 minutes into these efforts when a very kind Nepali man asked where I was going and I followed him to within 500 meters of my destination, via two buses and lots of busy sidewalks. If it weren’t for my kind Nepali man, I may never have gotten to Thamel (Ta-mel) to meet Mark. And I was early to boot!

We wandered Thamel, the tourist district of Kathmandu, searching for a small, soft cover notebook for my Nepali scribblings, a personal dictionary if you will, all the while trying to get directionally-challenged me oriented (of course Mark had a compass in his bag). We then had dinner at Rum Doodle, which is plastered with good wishes for all those trekking to Everest (like in the grocery store when they have a fund-raising campaign and the walls are plastered with shamrocks or whatnot.). We jetted from Thamel to Patan (20 minutes by M’s motorcycle) to meet Bret, who does something for the United Nations and is interested in Mark’s work on the bicycle generator project. The meeting took place at a westernized hotel where there were at least two United Nations vehicles parked out front and half a dozen shiny SUVs as well. Welcome to the world of global aide.

First impression of this place was that it is at least as warm as my bedroom at home (routinely 68°F) and I needed to shed two of my five layers of clothes. Granted, there was a fire, but I strongly suspect there was also central heating, which I haven’t felt since I stepped off the airplane ten days ago. Second impression was that the only Nepalis around were staff; I was no longer the minority! And not the tallest one ‘round, either. Refreshing not to be the center of attention for a few hours.

It took me most of the weekend, and another encounter with a westernized environment, to realize what was missing – contact with actual Nepalis. See, Mark and I also ended up at a late Mardi Gras party thrown by the US Embassy for its employees and their friends. Again, the only Nepalis present were serving staff and it was on the rooftop of a building designed for Western inhabitants, i.e. water filter on the sink, central heat, signs entirely in English.

There was much talk during both of the aforementioned social situations about the plight of the Nepalis in terms of political instability, petrol and cooking fuel shortage, and load-shedding. And yet these folks live like kings, using all of these resources flagrantly. Disconnect? For me atleast. Then again, none of the talk was about needing to conserve any of these resources; it mainly focused on needing to get more of the resources into the country, which is complicated by the political situation in the Terai (essentially all of the country’s land outside of Kathmandu that is not mountains). So perhaps not as much of a disconnect as I previously thought; must have been my Western, reduce-reuse-recycle mindset poking through. I’ll have to think on that further.

Why does anyone stay here?

Why does anyone stay here? There are seven hours of load shedding per day. The tap water is unpotable. The streets are mostly unpaved and, with rare exception, all filthy. The private schools are expensive and the public schools considered worthless. The air pollution is oppressive and has caused an epidemic of lung disease. There is no central heating anywhere. There is no consistent hot water. And yet, I’m told Nepal offered those who moved here an improvement in living conditions.

The medical director of the clinic where I’m volunteering left his home country of India for medical school in the Ukraine. Then somehow ended up in Nepal, where he has friends, working in a hospital. He took a job at the clinic to work with his friends and now he’s the medical director. Is Nepal an improvement over the Ukraine? From what I hear on the BBC radio, Eastern Europe is experiencing energy shortages worse than those faced in Nepal, with 23 hours of load-shedding per day; seven hours without electricity seems a luxury in comparison.

The story is similar for a fellow nurse. Her parents are Tibetan, but they fled Tibet for India during the conflict with China; my coworker was born in India. The family’s village in India is three hours from the nearest hospital and morbidity and mortality malaria is rampant due to the climate’s hospitality toward mosquitoes. My coworker did a stint in the Indian army where she received her nursing training for free. Financially and logistically I’m not sure how it happened, but her entire family now lives in Nepal and two of her sisters also work at the clinic. So, Nepal, even with all the inconveniences I described in the opening paragraph, is an improvement in living conditions for this family.

If they had the means, why don’t they leave? In the case of the medical director, he had the means to go to medical school in the Ukraine, probably no small feat, why didn’t he keep going? And the nurse – her family made one move to improve their living conditions, why not continue up the ladder?

I’m sure the decision is individual, but can imagine some of the difficulties. In terms of finances, it is much easier to leave one developing nation for another than a developing nation for a developed one; even though the value of the American dollar is falling, the Nepali rupee is still worth only about sixty rupees to the dollar. With the average income around 200$ US, and the cost of airfare probably six- or seven-times more, saving for the cost of travel alone would take a lifetime. Even if one does manage to save to get to his/her adopted home, one must factor in the cost of starting a life in another country, as well as an occasional visit home.

There is also the trouble of procuring a job. Based on the number of signs for schools along the roadside, education seems to be valued. In reality, only the well to do can afford to attend school because the only form of education that is worthwhile is private school. With little or no education, Nepalis have no hope of competing with workers from developed nations for much coveted jobs. Both the medical director and the nurse were educated elsewhere and moved to Nepal in adulthood. Perhaps moving to a developed nation would be easier for them, having been educated elsewhere? The nurse has a daughter who is currently in private school; only time will tell what choices she gets in life, having started in Nepal.

(Un)Sustainable?

Do people in developed countries really want the developing world to have the comforts and, on the flip side, the waste of the developed world? A better question is, can the planet sustain the developing world having the comforts of the developed world? From what I’ve seen, no. Then again, I don’t think the planet can sustain the developing world as it is, either.

One cause of the environmental toll of developing countries on the world is traffic, lots of traffic. Usually stopped for no good reason at all, much like in the US. However, unlike many in the US, Nepali cars don’t have any accommodations for ‘safer’ emissions because they are so cheaply made to be affordable for people whose annual income is 200$ US. So where there is a traffic jam, there is a cloud of gray hovering. And these traffic jams are found on every inch of road in Nepal at some point during the day. Every day. Every week. All year.

And it’s creating a dreadful environmental issue, which isn’t contained to the developing world. Can the developed world ask those in the developing world to stop driving such lousy cars in order to help the worldwide environment? But isn’t advancement of this and other such societies a priority for developed nations? How can this advancement be achieved if these countries do not have access to those technological changes that made the developed nations such?

To add insult to injury, there is no centralized trash disposal. The view out my window is of an empty lot scattered with black plastic shopping bags, plastic bottles, empty snuff packages, articles of clothing, broken flip-flops, scraps of paper, and animal and human feces. The view of the street is just as littered, as are the yards of most homes, as well as the bed of the Bagmati River. There are trashcans in some public areas, but I’ve not seen any outside private homes. And I’ve never seen a garbage truck. Indeed, despite the poverty, conspicuous consumption has come to Nepal along with its cousin, carelessness.

This trash, particularly the feces, has made local water supplies unsafe for drinking due to bacterial contamination. It has also ruined grazing areas for the local cows (thank heavens they’re not eaten!), although the goats are having a grand old time. The litter in the riverbed is not just an eyesore, but during the monsoon season leads to the its being swept out to the Terai and on into India.

Can the world sustain such lack of regard environmental protection? Well, it sustained the developed world’s development, but can it continue to tolerate such abuse, now coming from the other, what? – 75% of countries in the world? I guess that’s what remains to be seen. The cynical pessimist in me predicts that, just as the developing world gets up to speed with the developed world, something tragic, like a second Noah’s Ark, will happen. Or Armageddon. Or we’ll all continue to sit in endless lanes of traffic.

Mero nahm Jennifer ho.

I have a Nepali vocabulary. It's very limited, and terribly mispronounced, but I've got it (on paper at least). Besides learning Nepali, I watched patient encounters led by the doctor, of which I understood little. Then I got to do some teaching of the nurses around pregnancy, as the patient came in on an off day, i.e. the OB doctor isn't in on Tuesdays.

And now for something a little more philosophical...
Talking with a volunteer medical resident today, I started to draw connections between working in Nepal and working in the prison. The patients are poor, although one could argue, not incorrectly, the poor living in America are not as poor as those living in Nepal. Whether as a result of poverty or lack of education leading to poverty, they are often disinterested in their health. They believe medicine (pills) is the way to better health, although medicine a) is not always the solution and b) is very expensive so is not to be used frivolously (about 1/5 the clinic's budget and a good chunk of the correctional health system's).

In Nepal, the patients aren't motivated to do what is asked of them in the way of getting tests because they are too expensive; for instance, a pregnancy test at the clinic in Nepal is Rs. 70, which is a little over a dollar. But when one's annual income is in the $200 range, that's a lot of money. In prison we've worked around that by making medical tests free, although practitioners take heat if they order too many expensive tests. Theoretically, the Nepalis could leave the country if they so desired, whereas those in prison cannot leave the prison, but logistically and financially that seems unlikely. The last commonality I came up with is that, like those in prison, the Nepalis _are_ trapped in their caste, like prisoners are so often trapped by their history of imprisonment. [\philosophy]

Battery's running low, can't charge it because the power's out as part of load-shedding. It should be back on by 2030 and now that I've got an international adapter, I have a prayer of getting the thing charged then. But for now, namaste.

Out and About in Bouddha

It’s official; I have been lost on the other side of the world. Following an abdominal muscle-straining ride on the back of Mark’s motorcycle with my smaller backpack (think acceleration + 20lb back pack and you’ve got Jen gripping Mark and the passenger handle as tightly as possible), I had a tour of the clinic where I’ll be spending the next three months. The compound is slate-tiled, there are gardens, and it’s wonderfully sunny. The staff is all very friendly, although I’m going to have to work on my Nepali to get to know them better. I’ve had a tour of the facilities, talked with the medical director and a visiting cardiologist, and had lunch. And then I was set free on Bouddha.

I confidently strode out the clinic’s gate, through the monastery grounds, and off into the wilds of Bouddha. I received lots of stares, as I got more and more turned’ round, though not necessarily for getting lost. Keep in mind I’m taller and whiter than most everyone else in the city. I ended up in the town next door, down a dead-end street that abuts the local Hyatt; I knew where I was!

I also managed to find a grocery store in which there was a cloche of Germans, one of whom was friendly enough to start chatting about the availability of bottled water; she didn’t want to buy the Pepsi Co. water, but there wasn’t a local option. She’s volunteering at a local school for three months and then traveling in Nepal and India for the remaining three.

Having finally found my way back to the clinic, I met with the deputy manager and the clinic coordinator and have a better idea of their expectations of me. I will meet with the nursing director and the medical director tomorrow; from there it will be decided where I will volunteer. I know, you’re all thinking “you told us you’d be in the reproductive health clinic”, but that’s before I realized that the “hospice” is actually an in-patient hospital for indigent folks. So, it’d kinda be like in-patient nursing, but not in a hospital. We’ll see. As for the reproductive health clinic, though I may see patients, the focus is mainly on teaching the staff additional skills as they have several new nurses right out of school. I like teaching; I have mixed feelings about teaching in a foreign language I don’t know. I still have lots of questions, but am glad to be here starting my mission.

Day 1 + Day 2 + Day 3 = Day 4

Have I explained what I'm doing? I'm volunteering at the Shechen Medical Clinic in Boudha (Boh-dah), Kathmandu, Nepal. It's affiliated with the Shechen Monastary. It offers allopathic medicine, dental care, traditional Tibetan medicine and alternative therapies such as homeopathy and acupuncture [www.shechen.org]. I've got a friend, Mark Jeunnette, who's been living and working here since Fall 2006, so I'm not flying solo.

I arrived safely in Kathmandu Thursday evening. Coming from Western [American] airport security, I was confused by walking _past_ the x-ray machines, but I think I got some sort of special dispensation, as I was the only 5'9" white woman in the airport.

We spent Friday wandering about Mark’s neighborhood, Ekekuntakuna, and Thamel (Tah-mel), the tourist area of downtown Kathmandu. I took frequent breaks in teahouses to get away from the chaos of the city, but managed to stay awake until 2100 before passing out in exhaustion.

Saturday we rode Mark's motorcycle (an American dirt bike, really) an hour to Boudha, which is the town where I’ll be volunteering. We joined in the celebration of Losar, the Tibetan New Year, by walking clockwise around the stupa and admiring the Tibetan ladies’ finery. We found the Shechen monastery and medical clinic, which was a relief to me; I was a bit afraid it wasn’t a real place and all my carefully laid plans were going to be ruined.

I am a little sad to be staring at the end of my vacation (I start at the clinic tomorrow) but I’m going to be certain to negotiate for plenty of time to continue exploring the Kathmandu Valley now that I've gotten accustomed to the craziness of the city. As I said above, on Friday I had to take frequent breaks throughout the day to keep my head from exploding. The lack of traffic laws and lights and the fact that the cars operate on the the "wrong" side of the road, plus jet lag and being short on sleep (and Mark's running me ragged :P ) made for an overwhelmed Jen. I still can't cross the street alone, but I did manage to walk to a cafe by myself the other day.

Ok. Cafe's closing, gotta go.

Folks Who Have A Hard Time Leaving The House

Oh sh*t. I'm going to Nepal. Tomorrow. What if I'm not ready? I don't have all my music loaded on my new iPod (don't even ask!); I might not have enough [insert clothing item here]; I didn't save room in my carry on for the laptop... and on it goes.

I get the worst cold feet before leaving for a trip, mostly for fear of being unprepared. Indeed, I'm not the only one, as I come from a long line of Folks Who Have A Hard Time Leaving The House. I make at least one trip back inside the house before every departure. My mom makes two or three. My grandfather once had to clean the gutters before he could go on vacation (although why he needed the content of the gutter on vacation, rest his soul, we'll never know). It's a wonder we ever leave home at all.

I think my dad's reply to Andrea's and my invitation to my going away party sums it up: "We didn't plan on leaving the country this weekend [to go to Cambridge -- a foreign country -- the People's Republic of Cambridge -- get it? Ha, ha? Okay, Dad.]. We will have ample time to say goodbye to Jen as she lives with us. Nevermind that I'm taking her to the airport. Thanks for the invite."

So, here's to foreign countries, however we may define them, and for knowing when we're out of our element, even if we're just going around the block.

Greetings and explanations

In an attempt to push my sleep schedule closer to that of a person half way 'round the world, where I will be in short order, I'm staying up later than my body would like. Granted, I have a social engagement tomorrow morning at 1100, but sacrifices must be made for good travel. Though hopefully not of the life-ending variety. Or of the dysentery variety. On second thought, may I choose my sacrifices?

One of my sacrifices for good travel will not be losing touch with my state-side friends. Hence this blog; I shall post, as often as I can muster in a developing nation with spotting internet connectivity, my thoughts, impressions, and photos of Nepal. I don't know enough about this blogging thing to know if I can have a place for my readers to comment. If yes, go for it. If no, my email is the same; drop me a line and we can have a spirited debate about what's on your mind.

So, at T-minus three days, here starts the blog.