Taking the Leap

Kathmandu welcomed me in. Arriving from India and spending my first two days at Wanderlust hostel was amazing. Finally a fun hostel situation which i felt I had been depriving myself of thus far. The city felt easy compared to where I had traveled in India. The intersections not nearly as noisy and the people were friendly! I spent the first two days investigating trecking options (guided vs non guided) and visiting Buddhist sites. Meditating on compassion, wisdom and service, all the while preparing for the medical mission that had brought me here. 

I met the Global First Responders Team on 12/5 and we boarded a bus for Manthali. As we left the urban sprawl of Kathmandu, I could never have guessed what I was in store for. 

We picked up Dr. Suman Karmacharya on the way out. He is the selfless physician who brought healthcare to the Manthali area and surrounding villages usually by walking multiple days at a time, to areas where roads did not yet exist. Next we pick up Shanta, the woman, Dr. Suman had invited to serve as our translator for the trip and someone I would get to know more deeply. 

The first thing notable were the roads. The further we got from Kathmandu, the worse the road conditions became. The area had been plagued by landslides, the worst of which had been brought on by rain, a year and a half prior. Despite ongoing efforts, the area had never recovered. Houses had fallen off ledges and the road had crumbled into the river bank for miles. It was destruction to point that it was unclear where the road had been. We bumped along a makeshift dirt path that had been forged on the river bed and it was clear that infrastructure was a major issue here. This stretch was challenging with low water levels and likely impassable during the rains. 

We arrived in Manthali well after dark, and were greeted with floral garlads at Hotel Kasthamansar. We had a team meeting to discuss objectives for how to set up our triage, pharmacy and provider stations for the clinic the following day, then off to bed for an early wake. 

Day one began as I rushed to familiarize myself with the Medication list which appeared foreign because of the different names in Nepal, and because of my inexperience as a general practitioner. Coming from a cardiothoracic surgery world- i feel ready to combat bleeding and blood pressure, but COPD and pelvic pain are a different story. 

We take the bus up to Dhobi village, which lies isolated, deeper into the hills. Multiple rock slides delay our journey, and an excavator works to clear the dirt road. I now have a new bench mark for the worst road of my life and I realize this is the best bus driver that I have ever met. 

We arrive to a rural hilltop clinic where people have already lined up for our arrival. I watch as the GFR team pulls together desks and chairs in an outdoor courtyard to create the mobile clinic. Patients are triaged with vitals and chief complaints and assigned to a provider. I anxiously await my first medical patient in nearly 8 years. I see villagers with issues ranging from osteoarthritis to hemmrhoids, anginal chest pain to ring worm. Did I mention GERD.. everyone has GERD, so much so that I beginning to feel GERD myself. 

The woman of the village were proud and well put together. They adorned layers of clothing that made joint examination feel like unwrapping a blanket. The older women had gorgeous golden nasal piercings that shined like ornaments. I begin to understand that while most of the villagers come from poor farming backgrounds, they carry with them an immense pride in their culture. 

We head back to Manthali as the golden hour turns to dark. The ride back is uneventful, except that the path is obstructed with rocks at one point and it’s now up to us to clear them. We make progress towards our hotel, and I sit next to Shanta. I am feeling proud of my day- I’ve seen 15 or so patients and have done my very best! At the same time, she has translated for the villagers in a way that enables them to receive care. 

She begins to confide with me, about her journey with a seizure disorder and how it has impacted her life. We share our experiences with anxiety – about how it has affected my ability to trust myself and about how it has affected her ability to venture out. Sharing these vulnerabilities, next to her, I realize how open I’ve become in my travels thus far. It feels good to share and connect and something in me wants to open. 

The next day, we board the bus and travel to Laligras community hospital, due north of Manthali. As we set clinic up, I see the preparations that some of the other providers have made for this trip. I see bags of surgical supplies and otoscopes. I begin to compare myself, and feel ill equip and frustrated. Clinic begins and the sun beats down on the entire team. With a hospital setting, there are X-ray and basic lab test capabilities but today is a struggle. While again most of my diagnosis involve arthritis and GERD, I catch a 9 year old with new onset knee pain. His blood work comes back positive for rheumatic fever ASO and we start him on penicillin. I find another woman with pain in her small joints- blood results reveal rheumatoid arthritis and we begin steroids. 

That night, we tour Dr. Sumans medical center in Manthali. A place that brought medical care to the surrounding area. He again reiterates multi-day treks into villages, where he would carry medical supplies for patients. With pride, he showed us the new eye center under construction where patients would come for their cataract surgeries from surrounding villages. Medical care is affordable and targeted to provide the maximum value to the local communities. 

Afterwards, we are blessed with music from Dr. Sumans son- Shawshank who plays guitar songs on demand from Beatles, to Oasis, to Nepali classics- Resham! As we sing and celebrate, our 3 guides show off their dance skills and we all get up to join! It’s a fun night of celebration and im feeling the love! 

The week reaches its mid point, we head to the rural village where Dr. Sumans grew up; Saghutar. The road is narrow unprotected switchbacks and ridgeline. We visit a hillside shiva temple where we honor Aurelia’s recent  loss of her daughter. A GFR alumni whom was supposed to join the trip had she not passed away at the young age of 35, just a month prior. I am speechless and something clicks; I am here because she is not. I am a last minute addition to the team, who was invited a month prior. I feel grateful, guilty, honored, sad. Im standing in a special place; I’m stepping into my own power, my own love and gratitude. And all in relation to a loss. 

From the temple, we walk across the hanging bridge that connects the hillsides. The long and loosely suspended bridge is a beautiful symbol of life. I sit with the idea of birth, death, rebirth. A bridge that represents transcending fear. A bridge that represents stepping into our own power. Letting the past go and taking an unprotected leap of faith. A place of surrender to life- to the best possible outcomes. 

We arrived to the clinic and found it to be fairly well equipt. We set tables in the shade and got to work. I rembember taking my time and going intentionally slow, with purpose. I saw patients with severe arthritis, COPD, hypertension. I counciled smokers from a place of love for their beautiful community and simple life. Their wisdom and joy was becoming evident. I wanted them to live longer and healthier but not at the cost of complicating their lives. The brunt of the patients were for the dental team and midwive team (who managed the GYN issues). This allowed me the grace to sit in with the dentists and assist while they preformed tooth extractions by the dozen. The bus ride back to Manthali was thankfully as uneventful as the remainder of the night. 

The next morning we awoke early for a long trip to the Janakpur community. These were among the worst roads of the trip and I remember not feeling well- largely due to eating too much dal bhat the night prior. We came to a rural farming community where the closest pharmacy was a 5 hour walk away and there was no medical care. We set up in the school courtyard with a panoramic view of the surrounding mountains and were greeted with gorgeous ceremonial hand knit scarves. I began to feel better as the day flowed. My translator and I, saw villagers with back pain, knee pain, GERD… Something in the air here caused ear wax to build up and people were complaining of hearing loss. I did my first cerumen removal, and then proceeded to do several more. It was most satisfying when they would report better hearing immediately, but this wasn’t always the case. 

The day wrapped up as the sun tucked over the hills. This creating gorgeous photo ops while the dental team finished. We played with kids who were staying late in the school yard and relaxed before heading to the bus. The roads felt even more dangerous in the dark, and for whatever reason, mortality hit me all at once. As I sat next to Shanta, she realized my discomfort on display and began coaching me to slow down and deepen my breath. We synchronized our breathing and locked eyes. something in me felt like this wouldn’t be such a bad way to die. 

The long ride continued as we shared my Spotify playlist and without intending, the feeling went from connection to distant. My playful teasing struck a chord. I felt confused because i didn’t know where the line was crossed. As we exited the bus that night, I pulled her aside and express my perspective. My feeling of openness, the lack of concern for the future and the connection I felt to her. And at the same time, I understood her reservation and certainty that investing emotions into me could only lead to pain. I felt resigned, that space would be most respectful option. 

Day 6 of medical mission work begins. Our final day of clinic. We have breakfast, pack onto the bus and head off for a beautiful Himalayan viewpoint before heading to our final clinic day. 

On the bus and inspite of our dialogue the night prior, I sit next to Shanta. She tells me abit about her family. How they live together at home. What’s hers, is her families and vice versa. I look around at the beautiful landscapes of the hills, which I have been admiring the entire trip. I realize that this is a culture that takes care of what’s important. They do not turn their back on family and have immense pride in their homes. They take care of  eachother and that creates impenetrable family. 

I understand Shanta’s reservation. The home that I have left is so different. The self serving culture of the United States. We are pushed out at 18 and expected to individuate. To contribute to our society and provide for ourselves. I realize, that never once, have I sent home a paycheck to my family and rarely do I consider what is the best for my family prior to making decisions. Again, I’m tearing thinking about my parents and sense of loneliness they must feel in my absence. What is the purpose of striving to be more. It has taken me so far from family. We pass a mustard field and I reflect on the biblical parable of “faith the size of a mustard seed” Mt.17:20.  Perhaps faith is about trusting that things will work out, even when the outcome isn’t guaranteed.

We arrive for the final clinic day at Kurhot hospital. Another warm scarf greeting as we set up our tables and chair and prepare. My translator is Dr. Shankar- a medical officer who is responsible for most of the patients at the clinic. We cruise through patients with complains of back pain, shoulder pain, epigastric pain. The villagers are well taken care of and the follow up plan is excellent. We see 25 to 30 patients over the course of 5 hours and drain the pharmacy of most medications. In celebration of the final clinic day, we are served instant coffee and given red dhotis. After more photos with people that I’ve nevermeet, it’s back to the bus for a final night at the “Kwality resort”. 

I’ve never seen so many patients in a day and I’m exhausted. As we arrive, I create some space to be alone and reflect. Im feeling so powerful. I just completed my first medical mission. I’ve given my best, and learned so much from the people. I’ve got feeling for a someone and want things to continue despite the trip concluding. 

We are served an Indian/ Nepali buffet of food and gather around the fire. I want nothing more than to rest, and retire to the room early, so I do. After what feels like a restless and sleepless night, the alarm goes off it’s time to get up and board the bus to Kathmandu. I feel anxious because it’s over but my feelings remain. I think if I can express myself articulately, I can change things, but I’m too tired for that and I fall asleep. As the bus bumps on, I feel waves of sadness that could be confused with happiness. It has been a long time since I’ve let my guard down and im grateful to be open, raw, vulnerable.  We pass through the familiar makeshift riverbed and return to bumpy asphalt. 

The bus pulls over on the side of a busy highway so Shanta could get off. As she collects her things I think i see a tear. We have a tentative plan to meet for church in the morning. 

We arrive back to the moonlight hotel for rest and final dinner with the GFR team on the rooftop overlooking Thamel district. Surrounded by our guides, laughter and shared memories, the medical mission finds its natural close. Before I leave Nepal, I will step in the mountains for a guided treck to Marti Himel basecamp. Seeking reflection in the mountains and internalizing the lessons of the mission trip.