Spontaneous? Me? Sure...

I am a city girl. Most of my family here lives in the capital city of Kathmandu. In my short visits in the past, I have never left the city even though everyone tells me you have to never seen beauty until you have visited Nepal’s countryside. This time, I have made it a personal goal of mine to get out of the city.

Chitwan and Pokhara are two places that are definitely on my list. Chitwan is known for its safaris and jungle wildlife, and Pokhara is a smaller city about 5 hours from the capital, famous for its beautiful views of the Annapurna mountain range. And if there’s time, Lumbini, the birthplace of Buddha.

Originally, I had planned on traveling and sightseeing with my mom in September while there was nice weather. Turns out, it was still rainy season, and staying in the jungle when it’s raining isn’t all that pleasant. The humidity and rain alone would be awful but as my cousin joked, it might rain leeches. Frankly, I wouldn’t be too surprised if that was literal. My mom got bit by a leech in Kathmandu in the winter. Going to the jungle in the rainy season when the trees are chock full of leeches… that’s just asking for it.

The bugs are out. Mosquitoes are especially dangerous. Malaria and Japanese Encephalitis are fairly common mosquito-born diseases in the Terai region, especially during rainy season. No thanks. I told my doctor I only plan to spend a few days max in Terai, but he gave me antimalarials in case I change my mind – or decide to go to India on a whim. By far my biggest weapon was bug spray, lots and lots of bug spray.

I was really hoping to be able to experience this with my mom which is the biggest reason why I had planned to go in September. Tomorrow is the first day of October. My mom leaves next week. I have to say I was a little disappointed.

Then,

I’m not really sure how it all happened, but a few phone calls later, we were somehow canceling all of our plans, dropping everything to leave tomorrow morning, rain or shine, 7am sharp for the countryside.

As I rush to pack and worry about waking up at 4am, I’m still in shock.

My life is on fire and I love it.

keep your eyes and mind open

My experience so far has been both challenging and phenomenal. Nepal is amazing but I have never such truly real desperation as I have here. I am not naïve enough to think that it doesn’t exist in the states but I have also been asked for money by homeless men with blackberries and new kicks in the states. I still have gym sneakers from high school and am rocking a not so smart slide phone. True story.

baby crawling around on dirt covered sidewalk
with no pants
parents watching from afar

In all seriousness, there are a lot more facilities and outlets to get help in the U.S. Here, in broad daylight on a crowded street, I saw a girl with skin dark, worn and toughened, wearing tattered clothes, barefoot, not begging others for money but digging through piles of garbage for scrapes of food to eat. There are thousands just like her, families sleeping on the side of the street, others working day and night for virtually no money to try and feed their starving families.

And still others resort to theft. My aunt and uncle tell me to always keep my bedroom locked and for good reason. There has been things stolen from this room at least twice before, thieves go in and out without the homeowners knowing, even when they’re right upstairs. Valuables are a given, but my uncle told me people will steal anything and everything. More than once people have drained all the water from tanks by stealing faucet knobs to sell for a few rupees. At my cousin’s weddings, a thief posed as a wedding guest and stole people’s shoes.

Theft and crime is more prevalent around the holidays (coming up!). Dashain is traditionally a time for new things. People are compelled to buy new clothing and gifts, as well as host a feast. The price of gold has skyrocketed. Traditionally, married women must not leave the house unadorned. Back in the day, women could walk around with thousands of dollars of gold jewelry on her, now it’s dangerous to have anything of value on you at all. Gold necklaces and earrings are yanked off of women (even off babies!) walking on the sidewalk by thieves on motorcycles. I heard that a thief yanked a necklace off of a girl and then came back, smacked her, threw the necklace back in her face and screamed at her for wearing fake jewelry… I don’t think I would have believed that story a few months ago, but now I don’t doubt it one bit. I’m not too sure who I feel worse for, the person who has things to be stolen or the person who has to steal to put food in his kid’s mouth. Again, my view would have been drastically different if someone asked me a few months ago, but now… I’m not so sure.

check out the background and foreground

In a world where you truly can’t move up no matter how hard you work, theft and crime will always be prevalent. Hopefully things will be different one day, but then again, you see the same problems in developed countries with rigid class structures and large socioeconomic gaps. There are people that are just lazy, but then there are people that are truly hard working but struggling to get anywhere. Younger generations are jumping through hoops to go abroad for a shot at a good education/job, but more importantly to get out of this rut they find themselves stuck in.

For anyone traveling abroad, the best piece of advice is to ALWAYS be aware of your surroundings, keep your eyes and mind open. 

Broken Record

People always ask me why didn’t I just volunteer or work in the states for my last co-op. People from the states, people from here… it’s always the same question, my answer is usually something short and simple along the lines of learning about the culture and different health care systems. But sometimes I wonder that myself. Whenever I’m going through a rough patch (no, it’s not all fun and easy), I think why did I make things so much harder for myself, why am I here. Technology wise, I would learn a lot more in the U.S. I’d also learn more about the healthcare system I will one day be a part of. I would get to stay at home comfortably. It would be a lot easier, more convenient, more comfortable, less expensive, a lot less grant/scholarship writing…

I have already volunteered and worked in hospitals in the U.S. I have shadowed doctors, been a part of incredible research teams, got a chance to help patients and see what clinical care is like in the U.S. More experience is always better; however, I felt like something was missing.

I have this distinct memory of when I was younger in Nepal. We were going to the airport and there was a man lying in the street, visibly ill, jaundiced. I was quite young but I remember thinking, why is he yellow, he’s sick - why won’t anyone help him, shouldn’t someone call an ambulance? A policeman eventually took him away. I was in no position to help but couldn’t look away, wondering what would happen, if he would be okay, why didn’t anyone come rushing to help or call “911.” Whenever someone asks where my interest in tropical/third world medicine comes from, I think back to that moment. Even though I did not decide I was going to be a doctor until last year that vivid moment of curiosity stuck with me.

 

In my memory, I have never been exposed to anything less than the immaculate halls of Massachusetts General Hospital and Brigham & Women’s Hospital before now. BUT as a baby, I was admitted to Kanti Children’s Hospital, sick with pneumonia. It’s no less than amazing to be able to work in that same hospital. Sitting at the clinic, I imagine my mother frantically talking to the doctors trying to figure out what was wrong…

It was a very personal decision to do my last co-op here. Cultural immersion and exploration of my roots played a big role in my decision but I also needed to see what healthcare was like here. There is an enormous disparity between the states and developing countries and that is what I came here to see. As much as I might moan and groan about how easy it would’ve been to stay at home or maybe go to a nice tropical English speaking country with standards as pristine as its beaches, I continually remind myself that is not why I came here. I didn’t come here to be comfortable. I came here to challenge myself and hopefully learn a little something about my own culture and global health.

Who needs the tropics when you live on Long Island :)

Language Barrier

One of the biggest hurdles of living abroad is language differences. Language is incredibly important, not only in getting ideas across but in making connections. People underestimate the value of connectedness until you’re surrounded by the senseless twangs and twitters of a language you don’t understand. It’s incredibly frustrating, not to mention lonely. When you finally come across someone that speaks your language, it’s like a sigh of relief, an immediate feeling of closeness.

My first official day at the hospital, I met two Australian medical students and instantly felt relieved like letting out a breath I didn’t 

know I was holding. “YES! There are foreigners to experience this with me, AND I can speak English, thank god.” Even though I can understand Nepali, it’s still foreign to me, a completely different phoneme set. I never learned it in school, and I haven’t used it extensively in over a decade. It takes an extra second and some mental work before the message relays. Even though I had just met them, I felt an instant sense of comfort. I know they can understand me. Ashleigh & Heidi were my saviors my first few days at Kanti Children’s Hospital. They showed me around and gave me a proper orientation. They had already been at Kanti for three weeks and are almost done with medical school so I had a lot to learn from them. I could translate for them, and they could explain the medical cases to me when the doctors were too busy. Ashleigh mentioned that explaining cases and treatments to me was a nice refresher for her. I’d say the three of us made a pretty good team. Unfortunately, the next week they were off to a different department, different team. Alone again, but this time I am a lot more confident…

Although at the time it was frustrating, I’m really grateful that I grew up multilingual. When I was young I hated attending ESL (English as a Second Language – yes, I only learned English when I was 3 or 4 in case you were wondering) and being confused about what language to use. Now, I can’t imagine not being able to understand my own family. Looking back, I laugh because my Nepali only ever comes out when I need to speak about something in private. When I’m out shopping with my mom in the U.S. and we’re being hounded by pushy salesman, I can talk freely without worrying about them cleverly twisting my words. I chuckle thinking about how my aunts and uncles seamlessly go back and forth among three or four languages all in one conversation without missing a beat. Sometimes I wonder if they even notice it. The words are arbitrary. They translate into meaning no matter what language is spoken.

At the hospital, I see how hard it is for other foreign students who have to sit and wait for someone to translate for them. Even then, sometimes thick accents can block any sort of understanding. However, it is nice to know that people here WILL try to communicate and translate for you. All the doctors speak English and Nepali. Most can also speak Hindi, and some of the surrounding dialects. With a little hand waving/pointing, and writing, the point gets across.  

Hopefully.

Earthquake!

Background:

When choosing to go abroad for my last co-op, I was not afraid to take on the challenges of cultural and language immersion in a developing country like the rest of my peers; I was immensely afraid of natural disasters. It sounds silly when you say it out-loud but realistically, I am an adaptable, independent woman with the enormous advantage of having family to help me. I can handle culture shock. I can handle the day-to-day challenges of living in a third world country. What I can’t handle is a building collapsing on top of me, a flood sweeping me away, or being caught in the middle of a mudslide.

Nepal ranks number one on the top earthquake risk list. About every 75yrs, there is a major earthquake near the Nepal-India border. In 1934 an 8.4 Reichter scale earthquake shattered the city of Kathmandu. My grandma used to tell stories about how she ran outside as buildings collapsed around her. After about 80 yrs, Nepal is long overdue. A force that created the highest peak in the world could easily come back to topple it back down.

danger written all over it

If another major earthquake strikes, Kathmandu valley is especially in danger. The vastly overpopulated city is built on soft sediment rather than solid bedrock. Trying to save money, people cut corners by watering down concrete, using lower quality materials, and not following the building code. Poorly constructed buildings have sprung up in every nook and cranny of the city. There are dozens of high voltage power lines lining every street and alley. If “the big one” ever hits near the valley, hundreds of thousands of people would die or be severely injured; the entire city would be flattened.

More info

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Sunday, September 18, 2011:

It was a typical Sunday. We visited relatives in the morning and then made our way to a mela (festival) later in the afternoon. It was pouring so hard that the rain leaked through my umbrella. I was slightly concerned the sky might be falling. We were soaked. Eventually it stopped raining and we jumped in the car to drive home.

The regular bumpy ride home seemed normal… until we saw people lining the street, dozens more running outside screaming, staring up at the sky. We stopped the car to look around and see what was going on. We thought maybe a power line went down. There was a cloud of dust and smoke in the sky, was that always there? I couldn’t remember. What if there was a riot and a bomb went off? What was going on? My mind raced with questions as my mom said to the driver to go home, it wasn’t safe to stay put.

As we continued to drive home, my cousin called home to see if anyone knew what happened. The lines were jammed. Almost home… we finally get a phone call. There was an earthquake, with at least two tremors so far. Panic sets in. We tell the driver to drive to a large open parking lot near our house.

When we get out of the car, everyone is standing outside waiting for the aftershock. I am shivering partly from the cold, partly out of fear. We try to call our house but the lines are still jammed. My mom’s brother and oldest sister are still in the house. My mom’s sister is 73 and has trouble walking and climbing stairs. We frantically keep trying the house number. My cousin walks over and rings the doorbell just as I finally get them on the phone. We tell them to come outside with us, stay together. Everyone discusses what we should do, we can’t wait outside all night, can we?

We decide to go back into the house together. To say that I was utterly terrified does not even begin to describe the feeling at the pit of my stomach. I go into emergency preparedness mode, fearing that my worst nightmare, my one fear about traveling abroad, has come to realization. I started throwing all the absolute essentials, important documents, my passport, a change of clothes, and water into my backpack and instructing my mother to do the same. I threw on a sweatshirt and sneakers and was ready to run if anything were to happen. Our family designated an open space to go to in case of an emergency.

My uncle tells us about how the entire floor shook for what seemed like eternity. The light fixtures swung back and forth. How could we not have felt anything? Are the roads THAT rocky that we didn’t even notice an earthquake? In retrospect, it was probably for the best.

We nervously wait, turning on the news to see what happened. The power goes in and out a few times. A wall collapsed not too far from here, killing three people. The entire valley waits for news about if an aftershock is coming, or if the worst is yet to come…

That night we quickly ate together and watched the news, with our shoes on, just in case. I couldn’t sleep, woke up every hour or so. In the morning we learned that a small aftershock came around 2am, but not strong enough to feel. The city returned to normal. I still watched the news everyday as the death toll rose in Sikkim, India and wondered if I should be relieved that some pressure was released and another earthquake won’t come any time soon, or if this was just antecedent to “the big one.”

Culture Shock: Part II – The inevitable

At some point you start to notice differences, whether slowly or all at once, after or simultaneously with the good parts—it is inevitable. Even slight differences eventually create a rift between you and your host country, making you realize just how far you are from home.

One of my good friends asked me, “So what ISN’T in Nepal that we have in the U.S.?”

The answer is complicated. The short version: nothing. If you look in the right place, you can pretty much find everything here that you would in the states. It’s just …different.

• Sometimes, it’s not that Nepal doesn’t have something, but that people don’t know how to use it and instead revert back to old ways. I have seen refrigerators sitting around unplugged, and laundry machines gathering dust while girls vigorously scrub and hand wash their entire extended family’s clothes. Most houses don’t have microwaves (?!) even if they are readily available in stores. It’s somewhat amusing to see bathrooms fitted with bathtubs but then another shower/faucet set on the wall outside of the tub. I have not once seen any of those tubs put to good use. Everyone showers in the bathroom, outside of the tub, just out there in the open, no curtains, getting everything wet… it just does not make sense to me. I guess everyone tends to get stuck in their old ways, including myself. Like Lily Aldrin, I hate things being moist, even the word itself bothers me. I hate squishy wet flipflops/shoes. I hate wet clothes that cling to you. I hate slipping on wet floors. I hate moist walls and countertops. I hate mold. I hate the idea of not having toilet paper. Everything should be neat, clean, and DRY. Unfortunately, since it is rainy season that is never the case inside or out. So far everyday it has rained (on my parade ha ha)

• Other times, it is the case that standards are not enforced. Only now is quality control starting to come into place. Every night on the news, another atrocious crime of integrity is shown. Most times it is food related.  Grocers injecting produce with chemicals to make more money. Bakers and pastry makers use old rotting materials to make treats. Milk swirled with bits of melted plastic to make it look whiter and creamier, delicious right?

My first few days at Kanti Children’s Hospital were a real eye-opener. As a government funded hospital in a third world country where the government changes every six months, they do the best they can. However, for me, it was a drastic change from working in one of the best hospitals in the U.S. (Yay Mass General!) to this… After a 2-3 hour extensive lecture on the history of/lack of funding and stories of what efforts were trying to be made, we begun the tour. I literally felt nauseous, not from seeing any gory procedures, but from seeing (and smelling) the state of the hospital. The halls reeked of urine and were lined with overflowing troughs of garbage. People stared as we passed by, occasionally spitting on the floor (inside). I asked to use the restroom, they let me use the super special locked up staff toilet. There was no running water in neither the toilet nor the faucet, but the entire floor was sopping wet. I don’t think my stomach could have handled stumbling upon regular patient toilets. You’re lucky if you find a clean flushing toilet, extremely lucky if there’s toilet paper, most are literally holes in the ground. After meticulously sanitizing my hands with the alcohol sanitizer I brought from home, we continued the tour. In the NICU, the water in the faucets comes out brown. The OPD clinic was swarming with flustered parents and sick children, often 3-4 families crammed into a tiny cubicle. There is no such thing as patient privacy or confidentiality. It’s a race to shove your child’s chart into the doctor’s hands first as he’s finishing up with another patient.

                                     

Prescriptions don’t exist here. You can get almost anything over the counter. Pharmacists dole out medical advice and strong drugs without ever having to study medicine. Working in the health care field, this was a huge shock to me. The doctors at Kanti frequently yell at parents for giving their children adult drugs or inappropriate doses. I look up drugs before taking anything because half of them are not FDA approved for use in the US/Europe, usually for good reason.

the pollution, no exaggeration.

Outside near main roads, the pollution is horrendous. It is hard to breathe without a mask, even for locals. There are supposedly car inspections, but throw in some money and your car will pass no matter how disastrous it is to the environment (and our respiratory systems). Not only car fumes, but dirt and dust in general rule the air. A few days ago, I saw an old woman sweeping dirt off of dirt path which really only makes sense in baseball.

• The last scenario: they have it, just not enough. There are frequent electricity and water shortages. Most people have large water tanks that they fill up when water is available. In certain areas, they only get a little water for one hour a week, and even that isn’t clean water. It is not enough to last a family for a whole week of cooking, drinking, and bathing. I’m staying with family in Lazimpat, which is both near a river and lot of big hotels so luckily we usually have clean running water. With all the waterborne diseases, finding safe potable water is a must. Tap water generally isn’t safe to drink. Bottled mineral water isn’t always trustworthy either. My family filters the water, sets it out in the sun for 7 or 8 hrs (Solar water Disinfection), and filters it again before it is ready to drink.

Electricity shortages, called load shedding, are more frequent in the dry winter where the hydropower plants cannot meet demand. So far it’s only been for a few hours a day, a few days a week, but later on it can be up to 16 or 17hrs per day every day. My family has generators so it has not been a problem thus far but I remember that the last time I was in Nepal we used candles every time there was an electricity shortage.

There’s a lot more to be said about differences and challenges to overcome, too much for one post. Language, family & culture will have their own dedicated posts coming soon.

Culture Shock: Part I - Beginnings

Culture Shock is real kids. You hear the stories and never think it will happen to you.
Rest assured, it will.

My first few days were full of meeting new people, seeing new places, eating amazing food, and sleeping like rock (thank you jet lag). With getting settled, sightseeing, visiting relatives, shopping, and getting everything ready for work, the days were jam packed and flew by.

My aunt took us to see the last night of Indrajatra, which is an 8 day long festival in a very old part of the city, 

Kasthamandap
temple made entirely from a
single  tree without any iron
nails or supports,
the capital Kathmandu
is named after it.
(Kath means wood)

Hanuman Dhoka, the Kathmandu Durbar Square.

Kathmandu

Durbar Square

We walked around as she told us all the legends behind the festival. 

Later that night, we saw the living goddess, Kumari, being pulled by chariot (yes, an actual chariot, pulled by people) to the Kumari Ghar. She is preceeded by the other living deities, Ganesh and Kumar.

(Kumari House aka house of god: 261 Layaku St)

The legend of the Kumari and how she is chosen is fascinating but I won’t go too far into it. (If you’re interested, there’s more about it online or you can watch the 2008 documentary Living Goddess.) The little girl is treated as a living deity and commands the utmost respect. Thousands come to watch, hoping for even a glimpse of her. During the festival of Dashain, hundreds of people line up every day to be given a tikka by her hand. A tikka is a blessing placed on the forehead, symbolizing opening up the third eye, which gives one wisdom, concentration, spirituality, and luck.

Chariot pulled by Nepalis

Ganesh

My first sari

Everything felt new, exciting, and interesting. I was captivated by the legends behind the structures and festival, like having a story unfold in front of me. I really enjoy history and mythology.

I bought my first ever saris and kurta salwars to wear during the holidays coming up.

The short time we spent at home was spent meeting relatives and playing with my cousins’ adorable kids. My family would not let us help out with any housework because we still felt like guests to them. As my mom put it, “Life here is a vacation.”

Woke up in Kathmandu yesterday

After a red eye flight, we finally arrived Friday morning. It’s a hot morning in the valley. We got off the plane using one of those movable stairs and took a bus to customs. I was already pouring in sweat, slightly relieved they made me check my handbag at Doha. No more air conditioning, oh boy here we go...

My mom and I had barely touched our bags when someone came rushing to help (for a few bucks of course). We were met at the arrival gate by a few uncles and cousins who loaded up the car and bickered about whose house we should go to first.

The drive to my aunt’s house was completely unfamiliar. I gazed out the window, eyes wide open. I giggle as a see a sign for an Irish Pub in Nepal, mentally noting that I must take a picture of it later. A lot has changed in the last decade. Houses, apartment buildings, and shops have sprung up everywhere in the city. There aren’t very many empty lots anymore. It’s a little strange to see huge new department stores in the background and little shanty shacks barely standing up in the foreground. Certain sections are really nice whereas others are rundown with heaps of garbage strewn along the road.

The roads are a mess. With potholes and cracks every couple feet, it is definitely a rocky drive to get anywhere. And that’s speaking about the paved roads, some are just dirt paths, others rock and gravel. The rules are: drive on the left side, when you feel like it; drive as close to the vehicle in front of you as you can; and honk your horn if anyone is slightly in your way. Motorcycles rule the road here. It takes an hour to get anywhere in the valley, unless you’re on a motorcycle and can zip through traffic. The traffic jams are horrendous. Traffic laws are not enforced; hell most laws in general are not enforced. I heard they tried traffic lights and it completely failed, especially with the common electricity outages. At large intersections, police direct traffic, but otherwise it is mostly a free-for-all. If a vehicle can squeeze through, it will. Pedestrians and turning vehicles have to forcibly cut traffic or they will literally stand there all day. No one will let you go. It is a tangled obstacle course of maneuvering around cars, motorcycles, pedestrians, stray animals, and the rocky roads themselves. Driving is only for the very skilled here.

Upon arriving at my new home, we unpacked a little, chatted with family, and ate until our stomachs were ready to burst. Relatives dropped in throughout the day to welcome us. The first question is always, do you remember me?

Around 4 or 5pm, I started feeling the jetlag and was in bed by 7pm serenaded by the sounds of strays outside and the live music of the restaurant across the gully (alley, small street). I was up by 4am to the sound of roosters, birds, and cows. I did a little early morning yoga and went upstairs. I walked around the roof terrace with a cup of tea admiring the sunrise in the mountain sky as shops began to open, street venders started shouting names of produce for sale, and the city began-a-bustling. 

I could get used to this.

             

Life in Transit

Cannot believe I am on an airplane to my birthplace in a land far far away. It all seems so surreal. I just moved back to NY from Boston and then moved my baby brother cross-country to Claremont, CA for his first year at Harvey Mudd College. 

Our flight back to NY was cancelled due to the impending doom of terrible awful Hurricane Irene. What was supposed to be a quick trip turned into a week of repeatedly being put on hold with US airways. 

It was the first time I felt physically stranded, albeit being stranded in paradise. California is beautiful. 

Instead of the busy stressful NY life with hurricane warnings, I had sun, surf, friendly and relaxed people. Normally, I would kill for that type of vacation. Nevertheless, being told I can’t go home makes me uneasy. 

By the time I finally got back to NY, I had less than a week to get ready, pack, and mentally prepare for this trip. The endless to-do lists were hopelessly daunting. And yet, here I am, all packed, on my way, but not quite ready. It just has not hit me yet.

 

As I sit here in Doha, taking in my surroundings, I feel as though I’m still in NY sitting in the terminal at JFK. There is an eclectic mix of people spanning all ages and cultures. I hear the familiar tongue of Nepal and I know I am close. Only 7 hrs to go.