[meditation]

Today I will walk up a steep hill to the Kopan Monastery where I will live for the next ten days in dorm-style accommodations. I will take neither computer nor iPod nor PalmPilot; what the hell am I going to do with myself? That has yet to been seen, although if all else fails I have a book and a really tricky knitting pattern for socks. I'll be back 10 May; blog then!

Today was my last day at the hospice

Today was my last day at the Hospice. It’s a bit earlier than originally planned, as I am taking a meditation course that runs 30 April through 9 May. I am looking forward to the class, though I do wish I had a few more days between ending work and beginning the class; I am afraid I will not be fresh to meditate. But, what to do?

My feelings about completing my work here run the gamut (Thanks Kate!) from relief to sadness. I know my work was appreciated, but there is so much more to do; just in preparing my report to the clinic administrators and head nurse and doctor, I thought of additional ideas and programs I would have liked to implement. But that is me working anywhere. That’s the sadness part.

The relief part comes from not having 100% of my heart in my work. That’s the part that made returning to Boudha on Sunday morning difficult. That’s the part that led me to leave some of the “morning duty’s” work (a concept I disagree with, but is certainly the culture here) for the afternoon, despite the disapproval of the afternoon duty nurses. That’s the part that makes me wonder about ever working in a hospital. Sigh And we’re back to that again…

Mish Mash Mentor

I just talked with one of the women my friends recommended as a good resource for helping to puzzle out my future. Indeed, she gave me lots to think about. Here’s an outline of my options:

a) Do I want to provide health care to patients, or not?
1) If not, then what do I want to do and how do I get experience in that?
i) Can I get experience in that without more clinical experience?
2) If yes, in what capacity, and how do I get experience in that?
i) Registered nurse
a) In-patient labor & delivery or antepartum; OB/GYN office
ii) Nurse practitioner
a) In-patient antepartum; OB/GYN office; prison; community clinic

Frankly, providing health care terrifies me; so much could go wrong! But on the other hand, most of it goes right and it’s satisfying to help someone meet her health care goals.

Even if I listen to the part of me that thinks that clinical practice is terrifying, I could still meet my goals in nursing – to ensure women have access to reproductive health care services – through advocacy or education. Granted, jobs in either of those specialties might require clinical experience.

If I choose to continue on with clinical practice, then I need to decide in what setting I want to practice and in what capacity. Questions that arise here include: do I need experience as a registered nurse in order to be an effective nurse practitioner? Do I need in-patient experience, or would out-patient be sufficient? If I choose this option, I need more experience in general, and specifically before trying to take those skills to the developing world (again); the United States is probably the best place for me to get that experience.

Some of these are questions I’ve struggled with since nursing school. And who knows if I made the right decision when I went to Colorado instead of starting on the traditional trajectory of a nursing school student by getting a nursing assistant job that summer. But, as I was just telling my friend Kathy, though it’s difficult to keep in mind, I like to think that everything happens for a reason. At this point, I’m waiting for that reason to become apparent in the form of a job offer!

Psychic map tune-up

I don’t want to write any more. I wonder if this feeling stems from the discipline of the blog or jadedness about Nepal? In the former, tell me, blog writers, what keeps you writing? And for the latter, travelers, how do you keep a place fresh for yourselves, to keep from wanting to maim every non-English speaker that crosses your path?

Yes, yes. Of course I jest. I am not experiencing homicidal ideations (that’s feelings, for the lay-folk). But I am feeling annoyed and frustrated and fed-up with my current situation. The charm of the gaggle of pre-teen boys hanging around the nurses’ office has worn thin. My inability to communicate, except on the most basic level, with most of the people I interact with every day has lost its novelty. And it doesn’t help that I’ve had two bouts of diarrhea in five days.

Mark’s friend Ian bounced ‘round the world for something like 700 days. And I ask myself, ‘Self, how the hell did he keep going? How did he continually adjust to changes in language, food, social norms, and traffic laws? And what affect did those adjustments have on his “psychic map”, that sense of who we are in relation to friends, society, even the geography of home?’ And I wonder if my irritability stems from being full up on adjustments to my psychic map.

Adjustments such as instinctually looking right then left, rather than left then right, before crossing the street; responding to a question first in Nepali and then translating the answer into English to make sure I meant what I said; and not eating in public out of awareness that I have the luxury of eating between meals that many do not. No, I admit, not the most difficult personal changes to execute. But even little stressors, when experienced for, for example the 77 days I have been in Nepal, is exhausting; I sleep nine or ten hours a night and still need a nap in the afternoon.

Perhaps what is needed to balance these Nepali-influenced changes is an anti-Nepali measure. Wearing shorts and a tank top – so much female skin exposed, so not culturally appropriate! Or abandon the culture all together for a night in a Western hotel, as a former fellow volunteer suggested? Or a healthy dose of American macaroni and cheese from a good tourist restaurant. Or maybe all three.

Nargarkot, Kathmandu, Nepal

This weekend Mark, his friends Leisha and Jeff (visiting from Boston), and I went to Nargarkot, which is a town about one hour from Kathmandu on the eastern rim of the Kathmandu Valley. Its main draw is the chance one might see the mountains from 'The Tower' at sunrise. Oy. After rising at 0500, indeed, we saw a mountain (Leisha continues to try to convince herself and Jeff, who was too sick to go with us, that we saw Everest) and I've included a picture here for your viewing pleasure. Can you name that mountain?

I can't speak for the rest of Nargarkot, apparently it's quite the tourist town, with hotels crowding the main street, but somehow we missed all of that. We had very nice accommodations on the road to The Tower and then had to leave town too early Sunday morning to do much sight-seeing. Alas. I'm not all that disappointed, I think we hit the main sight. And really, how many handicrafts can one person look at? Plus, if I haven't said it before, I'll say it now, being a tourist is exhausting!

P.S. - The mountain is in the top left corner of the photo.

Snippets

I've not been on the internet in days, and I've been feeling really cranky too boot, so this is what I've got for you thus far. We'll see how long my patience with the heat in this internet store lasts; you might get more of me, you might not.

ξ ξ ξ

I didn’t realize it until a few weeks back at breakfast with Caroline and Brian at Caroline’s house, but I am seeking a mentor. Trouble is, I’m not entirely sure what I want to do within the field of nursing, so it’s difficult to seek someone in that niche to talk to. Brian and Caroline gave me a few names and I will call them and inquire about conducting informational interviews. I imagine it will happen over the phone, although it would be nice to meet face to face, too. Maybe I'll get a mentor out of the process, maybe not, but it'll be good to bounce some career ideas off of other nurses.

ξ ξ ξ

You know I’ve been studying yoga with the French-teacher doppelganger, but I bet you didn’t know that I have also enrolled in a meditation course. It’s 30 April – 10 May. I’m not sure if there is Internet access, so take note! I might be even more uncommunicative that week than usual.

ξ ξ ξ

Yesterday I observed at a government-funded abortion clinic. It is part of the only exclusively women’s health hospital in the country. The basic procedure is the same as in America, although up to twelve weeks, the only option is manual vacuum evacuation (MVA), as opposed to also having the option to use a vacuum that uses electricity. Medical termination, where the woman takes medication in order to end the pregnancy, is not yet available, but is under consideration, according to the doctor with whom I spoke.

Abortion was legalized in Nepal in 2002, though training for providers wasn’t available until 2004. Now there are trained providers in 71 of 75 districts of Nepal. Given the constraints on women in the realms of citizenship and childbearing (the abortion folks are working on this one, too) and the general lack of respect from society, I am very impressed by the reproductive health choices they have. Dare I say it, but their access to abortion is more secure than women’s in the United States! To boot, registered nurses can be trained in the provision of abortion – I am jealous.

Do you remember the first iPod ads?

Do you remember the first iPod ads, with the people walking down the street, creating their own soundtracks to the world as they went? This was my intention yesterday, walking from Mark’s house to the Ring Road to catch a bus back to Boudha. I was successful until I got on the bus where loud, raucous music was blaring through the speakers. I decided it was futile to try to orchestrate my own soundtrack; so I gave in, removed the ear buds, and hunkered down to tolerate the bus driver’s taste in tunes. Ke garne? [What to do?]

I remember critics wondering about the effect of the iPod on American society: would it further fractionate an already individualistic society? Completely cleave one from another? Drive the final nail into the coffin of ‘community’? I haven’t gotten an update on critics’ perception of American society all these years later, but I know I am a happier traveler in Nepal while taking advantage of these side effects.

You see; so much of life in Nepal is lived in the public eye. And I don’t mean just as the tallest, palest thing walking the streets; I mean as anyone. Poor Nepalis bathe at public waterspouts. Their houses are so close together so as to pass the mustard. The concept of personal space is nonexistent.

I, as an American who was raised in the suburbs, tolerate this poorly. I get cranky and bug-eyed with each additional stimulus. I wander into traffic and potholes.

The music is a form of ambulatory meditation, which helps me tune out the din. Thus I maintain some semblance of personal space and sanity derived therein. I imagine if more people owned such devices here, it could do for Nepal what the suburbs did for America; give us all a little more breathing room. Even if it’s electronic air.

Oh, the wailing

The wailing, oh the wailing… May you never hear this sound. Much unlike sirens to a sailor, the wailing/moaning typically serves to drive away those who surround her. It is brought on without warning, although often it is relieved by feeding her. The wailing belies deep suffering, mental and physical. It is the wail of one who cannot adequately express herself through words; she speaks little, and the little that passes her lips is barely intelligible.

Because of this, most of her history is locked within her, though we’ve had a glimpse. One of the foreigners who gave her food, clothes and blankets through the winter traced her to the Hospice – yes, she lived outside all winter; yes, it is assume she has been raped and otherwise physically abused; no, the woman doesn’t know anything more.

I have a connection with this patient; we play peek-a-boo and she smiles with a radiance that rivals Prabaker. It seems she urinates less often in the bed for me than for the other nurses, so perhaps she favors me, too? It is this thinking, though, that has left me in my current position.

I am angry with her. She is a patient. I am her caregiver. But still I am angry with her. I want to shake her, yell at her, tell her how her behavior is unreasonable and irrational. After the connection I had worked at. After the tolerance I had shown for her crying and urinating in the bed! After I had massaged her skin with lotion and bought her a toothbrush! She threw my kindness, and her afternoon tea, back at me. And subsequently threw my second peace offering, dhal bhaat, across the room, too.

Perhaps, however, the tea wasn’t thrown at me, seeing how the dhal bhaat also went ‘cross the room at nothing in particular. Perhaps it wasn’t meant as a personal affront at all (and even if it were, shouldn’t be taken as such by the nurse from her patient). Perhaps I’ve fallen into the very human trap of taking another person’s actions too seriously?

It is difficult to distinguish the sincere qualities of mental difference (i.e. low intelligence, chemical imbalance, personality disorder) from those of manipulation. And they may not be mutually exclusive, thereby complicating matters. I think I missed the life lesson on distinguishing one from the other, and that is at least one lesson at which I regret my absence.

While I do not know what other life lessons I’ve missed, I do know that I will report for duty tomorrow at 0700 and need to treat this patient with at least the same care and consideration that I offer my other nine patients. I know that I must not take her behavior personally if I am to continue to be her nurse. And I know that she will again throw comestibles and I must be quicker on my feet.

As I started to say in my last post

As I started to say in my last post, when I was so rudely interrupted by a blown fuse, I have been very busy. I didn’t set out to be busy, in fact one of the things I like about Nepal is I have very little to do. Having so little to do has made me wonder how I ever did all the things I did while living in Boston. Guess I’ll find out when I return in June, eh?

I think I mentioned that I hung out with my friend Caroline at her work on Tuesday. It was partially a self-edification mission and part clinic-related. I experienced what Caroline does, and I brought back staff and patient education materials about maternal health for the clinic. Now to pull together a teaching about the materials… (I’ve been slacking and haven’t done a teaching for five weeks – time to make good on my commitment to do a few more before I’ve completed my volunteership at the beginning of May).

ξ ξ ξ

This past weekend I didn’t do a teaching for lack of preparation time because Mark and I went to Bhaktapur Durbar Square Saturday. It’s the former royal palace of the city of Bhaktapur, about 45 minutes by motorbike southeast of Kathmandu. There’s an entrance fee to most of the Durbar Squares, and this one is no exception, so we paid the fee and wandered about. Here more than in Bouhda, or even Thamel (the tourist section of Kathmandu), the beggars and sellers are vicious!

It seemed that every child who approached us wanted to take us to her thanka (predominantly religious paintings of, I think, a Buddhist origins) painting school, where we would have been pressured to buy a painting (and the kid probably would have gotten a commission). The sellers are equally aggressive; if a passer-by (i.e. foreigner) even looks in the direction of her stall, the seller offers products at “lowest price just for you” on “most good [insert name of handicraft here] – other [handicraft] no good.” I can appreciate trying to make a living, but I was exhausted by the end of the day from warding off the onslaught of capitalism.

ξ ξ ξ

Finally, the news you’ve all been waiting for… it seems (at careful glance and from four days in the future) that the first Nepali elections in 10 years are moving forward. As you may have read in Mark’s blog, the involved parties have announced a no-weapons policy; transportation and alcohol consumption have been banned starting Tuesday and Monday, respectively, through Thursday; and government employees have been threatened with termination (job termination, that is) if they don’t show up to their assigned election posts. I’m just sad I can’t vote… this is better than American politics by far!

What happened to this week?

I have no idea where the past 7 days went since my last blog entry. I worked. I visited Caroline at her work to get educational materials for the clinic. I renewed my visa so I can stay in the country (and went shopping at the only place in the country with escalators between the floors!). And now it's Friday again. Oy.

Ok, Mark, here’s your 123 book game (page 123, fifth sentence in, three sentences total) from my current read, Kafka on the Shore by Haruki Murakami:

“I was the teacher in charge of the group of children on a field trip, the ones involved in the incident in which the children all lost consciousness. Afterwards, as you may remember, I had the opportunity to speak with you and your colleagues from the university in Tokyo several times when you visited our town with people from the military to investigate.
In the years following I’ve often seen your name mentioned prominently in the press, and have followed your career and achievements with the deepest admiration.”

And now I’m supposed to list five people who can continue this game on their blogs… hm. Am I allowed to tag Mark back? No? Ok... so, Matt, Luke (that's totally cheating, Mark tagged him and he seems to have no intention of responding), uh... the power just went out unexpectedly making it difficult to type. I'll continue this at a later time.