Why did I eat oatmeal with tiny bugs in it this morning?

Why did I eat oatmeal with tiny bugs in it this morning, you may ask yourself. And I would have an unsatisfactory answer for you. Is it a sense of thriftiness that made me resist throwing away a brand new carton of oats? Or perhaps desperation, as I needed to eat quickly to get to work? Maybe tiredness? – I haven’t slept enough all week and it’s finally caught up with me. Is it any better that the boiling water killed them, so at least they weren’t squirming their way down my throat. Or that I also put raisins and a banana in with the bugs? Perhaps what really drove me to eat buggy oatmeal were the starving children in Africa.

Did your mom pull that one out every time you didn’t want to eat your vegetables or drink the milk once the cereal was gone? Mine did so even when I was inclined to throw away the salad dressing bottle before the last dregs were consumed. But I’m not starving, nor am I in Africa. This begs the question; do the starving children in Nepal want my buggy oatmeal?

Judging by the passing of the expiry date (February 2008), I am guessing not many Nepalis eat oatmeal. In fact, this carton was imported from the United States, so that may make it prohibitively expensive for Nepalis. They are more likely to eat sampa (a flour that’s cooked prior to purchase, one just adds water prior to eating), although that’s a Tibetan food, really.. Or just some toast and tea. Or crackers and tea. Lunch is the big meal ‘round here. Anyway… I’ve digressed.

Perhaps you’ve come to the point where you’re asking yourself, self, why doesn’t she return the carton and either ask for a new one or get her money back. Well, hm. I am very conscious of being a Westerner and all the privilege, like returning groceries when they’re sub-par, that implies. I don’t want to seem like I feel entitled to food without… bugs…? and even as I type that, I realize how silly that sounds. Of course one expects new food from the supermarket to be bug-free. Even a Nepali expects her food to be bug-free when she brings it home from the store.

Ok. Here is my oatmeal action plan:
1) Don’t eat any more.
2) Bring it to the store and tell them it’s buggy, and that I bought it recently, so it probably contained bugs from the get-go.
3) Ask for my money back.
4) If refused my money back, ask for another carton of oats, within expiry date.
5) If refused a replacement product, know that at least I tried.

Update: I exchanged the oatmeal carton for a new carton with a current expiry date. crosses fingers for an unbuggy breakfast!

French Yoga

My Tibetan, Nepali yoga instructor reminds me of my high school French teacher. Though I believe in reincarnation, and I think Mazur must be dead – given his age ten years ago and the health issues he faced – the yoga teacher cannot be Mazur in a new body; their lives certainly overlapped. But definitely doppelgangers.

Mazur – as I remember it, he didn’t think us people until our senior year and called on us exclusively by our last names until then, so we responded in like – was just under six feet tall, with dark hair, which he wore in a short pony tail, an medium complexion, and round face. He alternated between two pairs of large-framed, thick-lensed glasses – one for reading, the other for distance, so he was always hunting for one or the other. He claimed to have a daughter of elementary school age, which was fuel for the fires of gossip for every incoming class – how did a man who appeared to be in his sixties have a daughter that young? He drove a red caravan in which he passed my bus stop on his way to school, although not reliably enough that I could call off class before setting foot in the corridor. He boasted about picking up road kill and cooking it for dinner due to having Native American heritage, which added to his mystique, but also the oddity.

My yoga teacher, whose name I do not know, has a similar facial structure, build, and height to the Frenchman, but has a darker complexion. He is probably in his mid-sixties, but everyone looks older than their stated age due to living in Nepal. Despite living in Nepal and teaching yoga, he dresses like Mazur as well: button-down shirt, dress slacks, and dress shoes. Even while teaching yoga. His one concession to his work is sometimes removing the shoes. The yogi, too, has a nontraditional hairstyle – it appears he has a bird’s nest stuck to the back of his head covered in hair. He owns a cosmetology school/ salon and yoga studio with his sister, who is a dour, middle-aged woman who rarely smiles.

Though the yogi doesn’t bark at me in French and Mazur never attempted to teach yoga, the similarities between the men are sure. I suppose I could ask at our next session if he has a brother in the United States, but I think the similarities are due to there being only so many personalities to go ‘round so they get duplicated. The physical similarities aren’t required, though they help in this case, as I may never understand most of either man’s utterances. It is only necessary is to have similar personality energies.

The everyday

As I write (2100 on Tuesday), thunder is rolling over Boudha, though it’s not supposed to. It is months from monsoon season, and yet rain! Good for the hydroelectric plants, good for farmers, good for the flower trees trying their best to give a good show… Not good for the homeless who are getting wet in the chilly evenings. Not good for the sidewalk shop proprietors who literally sit on the sidewalk with their wares; they are losing income due to rain sooner than expected. Not good for Elizabeth’s laundry left on the roof to dry.

Not good for the public works crews that seem to be out in full force now. This weekend, there were two areas of sidewalk in Thamel, which made better gulleys than sidewalks. Yesterday (Monday) half the street from the stupa to the butcher was dug up, with the crew working well into the night. Today (Tuesday) there’s a mound where the hole was, but the diggers have moved on to challenge the faith of the Tibetan Buddhists. Coming ‘round the stupa at 11 o’clock, adjacent to the bricks and rebar from a nearby construction side, sidewalk shops selling Buddist prayer beads, and two women selling baked goods, the diggers have narrowed a four-person path to a two-person path. Question is: what are they digging for? The power lines run (much too close) overhead. The sewage drains are ditches at the side of the road. We can only hope buried treasure is a possibility…

In the not-so-good-news department, we share a border with Tibet, and there’s doin’s there, as I think I mentioned in my blog two posts back. No rally of support in Nepal today, but who knows what tomorrow will bring. According to CNN, the Dali Lama has said he would step down as Tibet’s political leader if his people let things go to violence. Could a change in leadership be what needs to happen to get China to alter its strategy, or will that result in increased violence and threats? Difficult, very difficult.

On a personal note, I have recovered from my viral illness. I am slowly reintroducing foods to my palate, having followed the B-R-A-T diet for a few, bland days. I worked a very busy day in the hospice by myself and everything seemed to happen – an actual hospice patient was admitted, a current patient tried to overdose on medication, the semi-plegic woman wanted to walk to the toilet, one of the patients won’t speak at all… I felt purposeful and (mostly) competent, but it’s a good thing the job is only for one month!

Prabaker is dead

Prabaker has died. He was in a cart versus automobile accident, but the cart was carrying steel beams and these beams came through the windshield and completely severed his jaw from his face. Though the tragic events have been read over and again, I am no less sad to lose my favorite character in the novel I’m reading than if it had been written for my eyes only.

Shantaram is loosely autobiographical, which makes it all the more sad that such a wonderful, loving, happy individual once roamed the Earth, or at least Bombay, India, and does no longer. Prabaker brought to life for me the joy in the head waggle (tilting the head from side-to-side to express happiness or agreement) that I see in Nepal. He is said to have had a grin that competed with the sun. He was known for his generosity and open heart. But more than telling you about Prabaker’s good self, dear readers, I want to talk about why he died.

It seems to me that he would not have met his demise from this accident had he lived in the United States instead of India. And why? Because doctors in the US would have spent many, many healthcare dollars on replacing the man’s jaw and surrounding organs and then nurses would have spend many more dollars restoring his to some sort of his former self. He would have received blood transfusions, donor organs, and hours of surgery. It would have been a miracle, perhaps even written up in a medical journal. The question is, despite how much I like him and think he makes the world a better place, do I agree with the expenditure of so much money on one human being’s health?

I suppose someone must take risks and push the envelope – how else would penicillin and aseptic technique been discovered? But how far should experimentation go and at what cost? I have read that in Canada people die because, due to cost, they cannot have procedures that are routine in the United States. But Canada has socialized medicine, which covers basic health maintenance, therefore theoretically minimizing the need for costly procedures.

But, dying, you say, that’s tragic! No, I say; it’s expected and necessary. You’re heartless and callous, you say! So be it, I say.

I believe that healthcare dollars are best spent treating the basic health needs of many, rather than the extraordinary health needs of one. Now, before you start casting aspersions that I’d feel differently if I had a family member who was gravely ill, etc., I have had such a family member. He had brain cancer; he died. From diagnosis to death was a matter of months. Do I wish his death could have been delayed? Yes. But do I wish he had his life at the expense of other people who may not have received care due to cost had more been spent on his care? No.

Perhaps this is why I’m terrified of working as a nurse in a hospital; to have one’s opinions challenged daily is exhausting. To have to earn a living in a way that goes against one’s beliefs is demoralizing. How to reconcile this? Well, thus far I’ve avoided the hospital. I’ve worked in people’s homes (although not without its belief-challenging moments), in a prison, in hospice in the developing world. But not in an American hospital. But now I face a professional crisis: what do I want to do when I return from Nepal? Can I possibly work in a hospital without finding it exhausting and demoralizing? What kind of nurse do I want to be when I grow up?

Jennifer - 0, Stomach bug - 1

Had a great Saturday wandering around Thamel, the tourist area of Kathmandu. Bought a kurta (pics to follow, mom, once I get it fitted), got lost, found myself, and generally enjoyed the sunny, warm afternoon. Then spent the balance of the weekend at Mark's house, feeling sh*tty after vomiting Saturday night. Prolly wasn't the food; he and I ate the same thing for dinner, which I cooked.

I blame some sort of virus and am hoping it leaves as fast as it came, but it is now Monday and, while I feel much better than I did Sunday (like, I can get out of bed), I'm still not 100%. According to Caroline, an American woman working in Nepal for a year and a half, now is the time of year folks often get sick, as the bugs live a little longer. Great. Not as excited about Spring as I was last week...

On my walk to the clinic from the bus from Mark's this morning, I passed several fellow clinic folk walking *away* from work. Turns out they were on their way to a march in support of Tibet, the day after the 49th anniversary of the Dali Lama's exile to India, and the day after China put the smack down on mountaineers climbing even the Nepalese side of Mount Everest until the Chinese has summited with the Olympic torch. As you, dear reader, saw in the photo in my last post, the "Free Tibet" graffiti has become more prevalent; and even today on my way to the internet store I saw a new schmear: "Boycott the Olympics". Exciting times; I'll keep you posted.

I don't like my job

I don’t like my job. There, I’ve said it. It’s difficult to admit, as I have traveled half way ‘round the world to do it, but it’s boring. In my capacity as registered nurse in the reproductive health clinic, I measure blood pressure, read weight on the scale, clean the examination room, and occasionally talk to English-speaking patients. This is not what I want to do. This is not what I came to do.

I want to give counseling about contraception and antenatal care and sexual dysfunction. But these things are über difficult when one does not speak the language of the majority of one’s patients. So, I must suffice as a nurse practitioner (the practice of which doesn’t even exist in Nepal) on the occasional English-speaking patient with diarrhea.

I feel a bit misled by the clinic, as the explanation of volunteering I read online said they wanted nurse practitioners when in reality the role of nurse practitioner doesn’t exist in this country. Then again, I did not ask questions about my responsibilities, so I am equally culpable. (Note: I have helped to draft a letter to volunteers interested in the reproductive health clinic, so as to save future nurses at least this disappointment).

As I wrote in one of my last posts, I enjoyed working in the “urgent care” department, which they call the “Dressing Room”. However, the usual nurse is back and, well, I don’t know why that should stop me. Well, part of the problem is his limited English. And I don’t want to step on his toes; when I worked in the Dressing Room last week, my friend Kunsang was working in there and it was no problem to work with her. I don’t know how he’d feel about my company. And with my limited Nepali, discussing feelings isn’t easily accomplished.

Today I spent the morning working in the hospice, where there are no dying patients, actually. I felt useful and productive doing dressing changes and giving sponge baths. However, I listened to the usual nurse vent about her frustrations with the work and I’m afraid I have internalized her feelings, as now I am out of sorts (another difficult thing to admit, as I’m half way ‘round the world – aren’t I supposed to be having a great time?).

To boot, I have started having anxiety about what to do when I return to the states in June. Continue with plans to move to Colorado? Stay in Massachusetts? Go elsewhere in the world? I have started to look for jobs in Colorado on my limited internet time (Wi-Fi is Rs. 30 per hour, which is less than $.50, not so expensive, but also not how I want to spend all of my money), but I am feeling discouraged; the job I want isn’t out there yet and the jobs that do exist are suboptimal. Although I’m not exactly sure what the job I want looks like, anyway. To make matters worse, I wasn’t having any luck getting an interview for a job in Colorado while living in Massachusetts – never mind while living in Nepal!

So, dear reader, your assignment today is to please send to me karmic vibes for clear thought. Thanks ☺

Comings and goings

Boudha, where I live, is to the Tribuwan Airport, as South Boston is to Logan; I can hear every plane coming and going. Which means my neighbors, Nepalis with fewer means than I and probably no passports, can also hear every plane coming and going. It’s not so many planes, but still I wonder how they feel about living so close to something so unattainable? Then again, my neighbors may not have access to running water in their homes, a hot shower (although for me that’s a luxury, too), or adequate nutrition, which is all available to me through the clinic. So, the neighbor Nepalis live near much they don’t have themselves.

Here, yes, I am the ‘upper class’, but that cannot be said about me everywhere I go. And even as I start to write the things I live near or see in my daily travels in America that I cannot have, I realize that none of it is so important. None of it is having cooking fuel so I can make dinner for my family. None of it is having water that is safe to drink flow from the tap (or having a tap in the house to being with!). And this is a good lesson to remember.

But before us Westerners go on a binge of verbal self-flagellation for the things we take for granted, I will remind us that there is a ‘spoiled’ upper class here, too. One that shops at the local grocery store where there are twenty varieties of rice cookers for sale. One that keeps the knock-off North Face market alive. One that buys those sweat pants with the words written across the a$$. Are they as well off as the privileged in America? No. They still don’t have clean water flowing from their faucets. And they face the same petrol shortages as the poorer folks. But, when you have pants that broadcast your feelings to the world, sitting in a car would be a shame!

Women's health be damned!

I have discovered urgent care. Unlike most of women’s health, which requires building a patient relationship and then hounding the patient relentlessly about healthy habits, urgent care is a gritty, short-term relationship with immediate gratification at the end. No hounding involved. Granted, some of the skills I have acquired would not be a nurse’s responsibility in the states, but I can still boast about each of my new skills like a Girl Scout with new merit badges.

Two weeks ago it was EKGs (electrocardiogram – but ‘cardio’ begins with a ‘k’ in German). The French radiologist gave me a 10-minute refresher lesson and then I was the go-to girl for EKGs for a week while the usual nurse was out. This included my doing an EKG on a dead woman because the family was skeptical that she was actually dead. Though I’m only marginally passable at actually interpreting the test result, the machine does some of that, so it’s possible to have a ballpark idea of the seriousness of the person’s problem before she even has her clothes back on.

Last week it was lung puncture (bottom of the fifth intercostal space, otherwise you’ll knick the nerve!). In this case, it was to confirm the diagnosis of pulmonary tuberculosis (PTB). The doctors got a kick out of handing the reins over to me, and have initiated me into medical school culture by insisting that I buy them a snack after the procedure, kinda like throwing my own ‘congratulations’ party. Again, very immediately satisfying; hay-colored fluid is enough to confirm PTB; then we send the patient off to discuss TB treatment with the direct observational therapy (DOTS) nurse.

This week, my badge is in assisting with minor surgical procedures. One was a sebaceous cystectomy on the patient’s right pinky finger. The doctor was in charge of cutting and I was the blood mopper. The doc cut the cyst open, gave it a squeeze, and the gunk oozed out – it was gross and fascinating at the same time. It took about 30 minutes of mopping and squeezing, but we got the cyst drained and then sewn back up again.

Probably the most common minor surgical procedure in the clinic is draining abscesses. This usually involves my helping to hold the patient down because he’s writhing in pain, but I aspire to be the one to cause the writhing and subsequent draining of said abscess. These are a bit less quick to resolve, as it can take days to weeks for the infection to respond to antibiotics and then for the body to drain the abscess. However, abscesses have a really good ‘gross’ factor, so that compensates for the delay in gratification.

Future badges include suturing, wound dressing, and venipuncture. And I thought I had come to Nepal to teach!

What is Nepalese society’s obsession?

America’s is looks and beauty and weight and money and, and, and… In Nepal it’s… not getting giardia? Having all one’s children live to adulthood? Living past 50-years-old oneself? Mark has a blog entry about a garish pink house in his neighborhood; perhaps life here is about the color and size of one’s house?

For some who visit the clinic, it seems to be all about health; like in America, they visit for the silliest reasons – the common cold and itching after not taking a shower for 20 days amongst them. But for so many others, healthcare seems to take second place to food, shelter, water… the things one would expect people from a developing country to be concerned with. So how do healthcare practitioners help folks see the importance of their physical well-being?

Maslow’s Hierarchy of Need, comes to mind in this situation. Maslow posited that people cannot worry about higher levels of needs, like education and self-realization until their basic needs of food, shelter, and water are met. If we break it down even further, people can’t worry about their health until their needs for food, shelter, and water are met. But it’s all connected, we say. But we say that from a middle- to upper class background, not from the corrugated steel shack on the side of the road. Thus, basic infrastructure, such as clean water and affordable food, needs to be acquired before people can start worrying about their health.

I’ve said it once, and I’ll say it again, but I’m hoping the elections 10 April go somewhere toward fixing this infrastructure. However, as I get further into Forget Kathmandu, which is a history of Nepal from the early 20th century to today, I lose more and more hope. Nepal has been here before – on the cusp of an election, which promises to finally bring democracy to the country, but ultimately fails and the country returns to a monarchy. It’s been here, oh, eight times, I think, and I’m only on page 141 of 260, so there’s time yet for more failure.

Knowing this, I’m not so sure that my original feeling that Nepali elections are more exciting than American elections is true; it seems both flavors have bad aftertastes no matter the sentiment going into it.

Craptastic week redeemed

After a craptastic week prior, last week was bloody good fun. With fellow volunteer Elizabeth, I wandered out to a new, quiet place in Boudha, the monastery Kopan, where I may take a 10-day course on meditation in a few months. I attended yoga class by myself (i.e. without the five other volunteers from the clinic) and felt very independent. The opportunity arose to perform a pleural effusion needle biopsy, and the doctors had me do it. And I did an EKG on a dead woman.

I could suspect that I was called to do the EKG because no one else wanted to touch her, but I’ve been called on to do every subsequent EKG, too, so it wasn’t just the dead part that freaked them out. As it turns out, the nurse who usually performs the EKG is on holiday, and, of the four physicians, one medical student, and three nurses on the premesis, I was the only on who knew how to do an EKG. And that’s only because the French volunteer doctor had given me a lesson two weeks’ prior. I guess it’s true that on-the-job training is often the way things are learned.

I’ve now given my second teaching on women’s health, although the first was more lively than the second, I think the material about menstruation needed covering in order to continue. Now to choose a topic for next week… I hope to have my women’s health book from home, via California and Bangkok in time to choose a subject; otherwise maybe I’ll have them write down the questions they’re too embarrassed to ask and then pick them out of a hat and answer them. Or something. Any ideas, fair readers? If so, send ‘em along.

In Nepali news, businesses were shut down today in a show of solidarity, and to make a point about needing increased security, after one shop owner was killed and the other wounded Friday night. Oy, just as the bandh on the Terai ends, there's trouble in Kathmandu. Never a moment of peace. But, the hydropower plant has come back on full-force, so load-shedding has been reduced by 1.5 hours each day. Too bad those hours fall when most of us are sleeping. I think we're just been flipped off by the power company!

P.S. – I’ve decided it’s not bed bugs that have bitten me, as I have had no new bites for several days. My latest theory is invisible mosquitoes.