year-of-adventure

Bangkok #2

well, posting this from home after a great flight home through NYC and a good night's sleep.  Wanted to get this last post from Bangkok with photos.

OH MY GOSH!  I POSTED THIS ONE FROM HOME AND THE USUAL 4 MINUTE UPLOAD TIME WAS CUT TO A MERE 15 SECONDS!  After i left the internet cafe in the tourist part fo townm, shot this to give aflavor for the crowd in this fast-paced western part of town catering to australian tourists.  Wallked in a nondirection as i was trying to get lost and see the local culture with the goal of getting to the river to experience the river taxis (how can you miss a river that runs right through the north-south parts of town).  Came upon a typical Thai event that i wanted to share.  The people LOVE the king here and he has been good for the population in helping bring them into modern world commerce.  His 80th birthday is in early december and he has had health issues recently - people are concerned. The event was a buddhist devotion of monks constantly chanting for his health and recovery in honor of his birthday - the chant started oct 15 and will continue until dec 15 - 24/7!  I walked in, took off my shoes, and watched the devotion of monks and ordinary people as they read from a prepared chanting book for his health - amazed at the devotion

Walked through flower district, produce markets, street stalls and eventually came to the water taxi stand - waited a few minutes for a tourist boat, and climbed aboard for a nice tour from the river side - good boats, a narrated "guide", and lots of people in "resortwear" with cameras  - aside - another photo like the above one taken from the back of a room - poor technique on my part!

Took the boat back to the start of the skytrain and back to siam square for a shop.  Went to the hightech food court and sampled some thai dishes. The first, a combo of thai noodles in a shrimp sauce with fresh shrimp was great - the last was a thai sweet - sort of flavored tofu the cherry-like things) with other candied fruits in a thick syrup with two scoops of crushed ice on top.  I splurged and went to a movie (Beowulf, in english, digital sound and 3D!) - a great epic  and the 3D added that in-your-face touch- see if it comes to your town (angelina jolie, john malkovitch, anthony hopkins).

Home to hotel, a good sleep and preparing for home.

Last posting on this adventure and will add photo albums for those interested on specific topics.  If anyone wants additional information, please let me know and i'll get you what i can

Thanks for reading and i appreciate all your comments!

dennis

Bangkok #1

Flight uneventful from KTM - late for unknown reasons - as passengers, we never know the issue, but there seemed to be a lot of rushing by crew to get boarding done.  The KTM airport has an interesting strategy of NOT announcing flight departures or gates, so you sort of have to be in the right place to board - luckily there were only 3-4 planes there, so getting on the right one was not a big challenge.  I stood in only 2 wrong lines before i got the right one.

Arrived BKK and passed through customs and passport easily - a great process and they are clearly geared to tourists. The tour limo was there to meet me and swept cleanly into a frantic downtown - a modern large city with lots of traffic - clean, busy and traffic congested. Hotel is central in the shopping district. After i got settled and washed off the sweat of travel, went out for a tour of decadence from high fashion to knock-offs - all young, hip, trendy and expensive.

Great sleep and a wonderful shower, then to a super buffet (Dr Kopila would be shocked) of japanese food, american food, and chinese food, all piled high around a spacious restaurant. I controlled myself after the Bhaktapur experience and had a nice sushi breakfast with fruit - I have another shot at it tomorrow to get the american version with sausage and eggs and stuff.

Decide to take the lonely planet guide book's suggestion and "get lost", so chose a point (the democracy momument) in the center tourist area, about 2 miles or so from my home base, checked with the
tour desk at hotel for directions (lady said it was "too far" to walk), and started out. I'm avoiding the many impressive tourist areas in plans to either do a bus city tour tomorrow or come back at another time. This adventure has been about feeling the culture and i wanted to continue that trend.  I wandered through neighborhoods - an area where they make sewing machines in one shop after another on an entire block - these guys thought it was funny for someone to be taking their photo and tried to look and not look at the same time -  the furniture production area, past food vendors until i hit the tourist area, probably like Thamel in KTM with lots of australians around. This i-net cafe is high end with air conditioning.

Typical garden setting around a low-level government building - the famous wat's are apparently VERY impressive and may get to see some tomorrow on the planned city tour.  After i get these posts done, i plan to wander a bit more towards the most famous wats (temples) here and see if i can sample the river boats on the way home - the river is an important part of new and old bangkok. The cross river ferry system as well as the express boats are local transport essentials.  Maybe i can time it so that there is some day/some sunset .  On this marathon walk several oddities: 7-eleven is VERY BIG here - one on nearly every corner, every fast food place from the states is here, starbucks is second only to 7-eleven. I took a stop for a $3.00 iced coffee as a break with the usual assortment of starbucks people there. 

Time to go...

Farewells

Last internet in Bhouda and so wanted to get some thougths down for posting later in Bangkok.

My "graduation" from Dr Koirala's with a squinty-eyed me in the bright morning sunshine, but wanted to show the people who helped with this introduction to Ayurvedic medicine, Bhupendra, Dr Koirala and Dr Adikari.  Thanks to all of them and to Dr Kopila who managed to keep the camera steady for the photo - she was probably laughing at my squinty smile!

Amala was so special to put together this farewell dinner on my last night at her house - she even hired a friend to cook a carnivore's delight with chicken, fish, goat, buff and meatball (probably buff) appetizers.  They had beer and wine - i know this is such a big event for them since we only had meat maybe twice in the 30 days i was there. Felt badly i could not eat anyof it, but contented myself with a glass of pepsi and a piece of applepie that vidhea broughtand that stayed down well.  Good conversation and promises to keep in touch.  Special family and friends who have helped me make the most of my experience here. Lots of fun good bye's with gifts from Dr Namgyl, Vidhea and Yanik, and Tias and Megan, and Amala and her family - you know how you always say you will email - hope i can stay in contact with them.  I have medical projects continuing with Drs. Koirala and Namgyl that should be fun. 

Got some good photos of Amala's husband in his workshop with artists painting Thangka paintings.

Interesting that Yanik has a car coming soon to pick me up for airport, but nepali's cannot go to the airport for security reasons. Airport trip was easy, streets usual crowded, rutted and polluted.  Airport has the usual group of folks willing to sell/rent you a luggage cart that is free inside. I was swept up by a guy who took the luggage on his cart and guided me through the maze to get to the Thai counter, pay my departure tax (a hefty 1695 rupees!), and get checked in - all within 15 minutes - his charge - 200 rupees - they really know a tourist mark. That is more than i paid for a cab driver to navigate the 60 minutes of traffic back from Dr Koirala's clinic. Well, he has a family to support.

Return to Bhaktapur

I chose to go back here for me "free day" because it is such a peaceful city. You recall from a previous post that we came here for an excursion weeks ago and i'd made a mental note to come back and stay the night.  Vidhea had originally planned a seminar for my last 2 days, but we decided that may not be the best use of resources, so we rescheduled it as a day here and then return to ktm tomorrow for evening dinner at amala's, then flight out monday to bangkok and home nov 29 am if all on time and no flight "issues"

Anyway, Vidhea is a wonder with her connections. We got to spend some time with a most interesting person, Rabindra Puri, a 37 y/o architect born and working in Bhaktapur. We saw his model house that he restored over 18 months using 80% of the original material. He has  fantastic energy about him and is very successful with a crew of 70 doing such renovations on private homes.  He could work an additional 80 crew if he had them. Lacking them, he has started a vocational training institute to produce enough craftsmen for his work and to help the students gain an entry into the world marketplace.  Photo is of the front of his incredible place (he does not live there, but only uses it as a show house).  Interesting fact: in newar  homes the kitchen is on the top floor (3rd in this case) to protect against fire and inhibit the smell
from going through the rest of the house. In this house, the locals believed it was haunted before he started renovation because 3 prepubertal girls had died there over a number of years - the story: in this culture, when a newar girl starts menarche, she is separated from  the rest of the family and no-one comes in/out for a period of time (no pun intended!)  Apparently, other girls starting their periods are similarly sent to one household to go through this passage together.  One theory is that three girls died either from  infection , starvation, or some other malady, and their spirits remain in the haunted house. In this culture, the girls could not be transported down stairs, so a hole is cut in the floor of each floor to lower them to the main floor where the ground is excavated and they are buried today.  Rabindra has not  seen any signs of spirits during the renovation process.  The house is gorgeous with niches, tile floors, and beautiful brass bath soak tubs and shower bases.  He is a bundle of energy and i'm grateful to vidhea for introducing us for a wonderful conversation time.

He noted that this is festival time in Bhaktapur as well - tonight only. This festival is another  based on the full moon, where the people make elborate designs in food at the front of each temple as an offering to the gods, the drinking and celebration for the good harvest.  This is a bit of tourist-preferred town because it is somewhat outside ktm and is clean, historically interesting, and has windows that are unique in the world - all good things to be out looking at instead of typing this blog post!  The tourists all go home and the few that stay in guest houses (like me), share the town with locals. The food drawing and one of the elders with his intense look. Just across town in anothehr square was the 7th annual Bhaktapur night for tourists with native dances and an elaborate system of food stalls and western-style evening.  The dances were nice, but enjoyed the food sculpture more.

Addendum: had a bad piece of chicken/bad vegs this evening and in morning awoke with most severe Gi tract distress yet!  - did not know which end to come into the bathroom with since weakness,fever,and all manner of GI symptoms.  Took ATB and laid in bed until caught the taxi back to KTM. Laid at Vidhea's to recover before the farewell party Amala is throwing tonight, but KNOW i cannot eat anything. 55+ days w/o major symptoms and on the last night I get really sick - go figure!  They swore the vegs were double washed in iodine water for hygiene

Thanksgiving away

Thanksgiving in Nepal - a different experience. Most importantly, no turkey! I went to a splurge place today to feel a bit more like home (had been eating cheaply when i came to thamel) - this one was a thai place and i thought i'd explore a bit of thai food before going to bangkok.  Service was SLOW (maybe it was the holiday shift) and the food, although good, was not outstanding.  My usual lunch is about 1.50 - this was a huge splurge at about 7.50 - paid extra for the rooftop view and lack of crowds - anyway, it was worth it for the big chunks of white meat chicken, rich sauce and variety of  vegs.

The massages:  Dr Koirala scheduled me for 3 treatments (still cheap compared to the states) so that i could experience the difference:

Head massage: pretty good - i would not repeat it - relaxing, but a bit irritating at the same time
Spinal massage: great - relaxing, good pressure, good time length, no toxins or tiredness afterwards or the next day
Siro dhara - the spa crowd reading this may have had this before - sounds odd, but an incredibly relaxing experience and well worth the cost (about $20.00). Picture lying with your head back, plastic under your neck, and warm sesame oil dripped slowly over your forehead - the attendant moves the dripper slowly so the oil goes one way, then another, then straight back. The soft herbal smell and the sesame smell were great additions and the music helped make it a deep relaxing experince for 30 minutes. I'd do this one again even with the messyness.

Happened to be in Thamel (as i've mentioned before, the seat of decadence in KTM) and saw an ad for a thanksgiving buffet!!!  Would not have thought there were that many americans to make it worthwhile.  On closer look, there was no turkey (chicken instead), and heavy on the rice and dal with no mashed potatos or cranberry sauce.

Megan texted me (I've become quite the text messenger wiht the phone system here since connections are problematic for voice, but texts are held and go through - as i've mentioned, there is no voicemail, so text is the only way) to wish me a happy t-day.  They had the usual dal and rice at amala'sand she wa craving turkey and stuffing. A good thankgiving, but missing home more than usual on this holiday where families gather to be together in fellowship!

Winding down and Siro Dhara

Trying different types of treatments to see the experience and how patients may relate to them - refuse to try Basti though (cleansing enemas followed by herbal enemas over several days ) - i'll have to be content with my table-mates' experiences on that one and therapeutic vomiting. To describe vomiting in somewhat more detail for those of you interested; patient is npo from the night before, comes in to center early (5:30ish) and starts drinking a herbal mixture (room temp, not bad tasting) and continues drinking that until their stomach gets distended. That is followed by a concoction of herbs that will produce vomiting on a full stomach. During the vomiting procedure, the patient is supported by a physician in the room, warm towels, gentle back massage, and overall supportive care.  They get warm/cool towels to their head.  Dr Kopila (who is the major physician who gets to support) says she never feels nauseated herself and is able to maintain the appropriate empathy and distance. She says vomiting lasts 3-15 min and then the patient lies down to recover, is given a gentle herbal mix to help settle their stomach, and they go back to their room.  Photo is from a previous post about siro dhara - a relaxation technique where warm sesame oil is lowly dripped onto your forhead in a steady stream and head tilted a bit to make it run straight down and to either side - scheduled for that tomorrow (hopefully you'll get a photo in a later post)

Post foot massage: no toxin-effect like i had with the whole body massage - no particular foot soreness and just a sense of overall comfort from it.

Sunday met with another ayuvedic physician to discuss his practice and how it may be similar to or different from dr Koirala's.   He is a traditional ayuvedic physician and comes from 18 generations (700 years) of continuous physicians in his family with the tradition passed orally and in family notes from one to another. His practice is much different from Dr Koirala in that he is more dominant with his patients (less bedside manner), compounds all of his own medications and uses no diagnostic tests nor western/pharmaceutical products.  He is confident and the bulk of his patients are hepatitis patients (different than we define in the west) - i purchased some patient information books published by his father to share with people at home on various diseases from a traditional ayuvedic standpoint.

Dr Koirala is hosting a group of 7 western doctors (ED docs) - (ED docs from new mexico, western medicine) - Teh ayuveda was a short stop before a 2 week trek into tibet.  Apparently they were booked months before for a 2 hr introductory lecture on ayuveda and this center is a respected, advanced method of treatment, so they would logically come
there for a good overview.

Winding down in these last days with lots yet to do.  Plans for the remainder of the week:
- Cover the 10 most common herbal combinations and uses for ayuveda with Dr. Adikhari; cover recipes and spice use with Dr Kopila; continue morning wide-ranging discussions with dr koirala on ayuveda and western medicine

- Leave health home sat am, got to bahktapur for a guest house stay and a visit with an architect friend of vidhea's who has restored his home there - overnight and wind down.

- Back to amala's for farewell dinner sun night, final shoppnig with yanik sun in thamel; stay at amala's or vidhea's sun night; airport mon am for 1:30 flight to bangkok, 2 days there and arrive rdu i hope 10:45ish nov 30, much jet lagged.

posts will hopefully be from bangkok or another this week if i get back to thamel

Fatima and the market shop

Vidhea is an adventurer and i love it that she shares some measure of her adventure and local contacts with me on this passage. Today we went to see Fatima - a Chinese physician, acupuncturist and reputedly the best foot massage in the country!  I wanted a perspective on chinese alternative medical healing and treatments here.

The building was on a quiet side street, calm, with lots of foot traffic of patients coming and going and a pleasant inviting drive with lots of flowers. She has inexpensive consultations (300 rupees for consultation and first treatment with 200 rupees for subsequent visits) - village and city people, tourists and regular nepali citizens.   She does not advertise and her 42 years of experience go a long way in referring patients.  We met with Dr Fatima, a charming chinese woman who did her training in tibet 42 years ago and feels that she continues to learn every day with new challenges. She often consults her "teachers" - chinese acupuncture books - in spite of her extensive experience.  Her top diagnoses are gastric problems (a recurrent theme among all the physicians i've worked with), the obvious arthritis, but also diabetes, asthma,  and hiccups.  She inserts all needles herself and is a calm and efficient physician. She talks freely with me alone and is busy and yet the exam rooms are full - i feel guilty about disturbing her schedule so keep my usual questions short.  She uses pulse reading and it is somewhat similar to the tibetan approach. Like in Ayuveda, she feels there are mind forces at work that need to be balanced by medication/conversation with the physician, and balancing the mind makes the acupuncture treatments go easier.  She feels she can remove calcium deposits from arthritic joints and prevent recurrence with acupuncture - something no other treatment method i've seen here has claimed.  She says that there are dangers with inexperienced acupuncturists working on the neck or anterior chest, but otherwise less experienced persons only have a lower effectiveness rate or take longer to make the patient better and recovery is not as complete as that with experienced physicians.  I asked her about her personal complications and they are 2 - a rash at the site of a needle, and a person who fainted many years ago because of a fear of needles.  Her length of treatment is geared to patients and she can be effective in a shorter time period with the addition of chinese herbs to supplement the treatments.

The massage: i've never had a foot massage and the soak before in a thick gelatinous mixture in warm water was worth the price alone. Then the vigorous massage with oil - i just sat back and enjoyed.  Mild pain with some points (and he was pressing!), but well worth it. They top it off with some finishing touches - neck, head, arm and leg massages. I walked on air.

Good lunch before with Vidhea with a rare (for me here) ham and pineapple pizza at the roadhouse in thamel - a meat-eaters delight after all this veg food. 

Went with Dr Kopila on a field trip a few days ago to the main market in KTM - the downtown market where all things are available. My challenge to her was to show me the market, to discuss freshness of vegs and fruits, and to choose the spices needed for a well-stocked western kitchen from an ayuvedic standpoint.  We took the microbus and arrived to a crowd (another festival is on) at the peak of shopping time. The sights and smells and crowds were as you might expect in a typical city market in KTM with fresh fruits and vegs from the local and out of valley farmers, fresh fish, dried fish of many varieties, grains, and spices.
The photo is of her negotiating with one of her spice dealer friends to get small amounts of typical spices - photo of our purchases coming with possible uses . 

We were on a quest for good saffron - i have some
really good saffron, but have not used it, so she is giving me insturctions for use in rice.  Real quality
saffron holds color with many dilutions and cheap saffron does not - in the photo she is expressing her
opinion of the quality she was exminaing. the good stuff is about 1500 rupees for a small 10 grams - much cheaper than in the states for such quality - i did not want 10 grams however (would take a LOT of rice for that), so we passed on multiple shops
and she plans to have the cook at the health home who cooks all our meals (she supervises him) get us a small amount from his secret stores and i'll reimburse him. He is always on the lookout fo quality saffron and buys it for the home when he finds it - she thinks it's pretty likely i'll be able to get some in this last week of my time here. The variety of dried fish exceeds anything i'd seen in the largest china-towns of san fanciscoand the fish it
is used as powders and flavoring for a variety of dishes - we don't get fish in the purely veg health home, but the sights and
smells were dazzling!

The moroning tea we get here is a special noncaffineated herbal blend.  Mrs. Koirala has
taken pity on me and brings some special tea for my 7-8 am class and that has some kick to it (still noncaffeinated) with the following: 1 part each: cinnamon, black pepper, cardomom (big), cardamom (little), dry ginger, cloves - one cup of this and you get your taste buds awakened.

We follow this after about 30 min with a cup of typical nepali tea - 1/2 milk, lots of sugar, tea and the above spices - only difference from the other tea is the milk and sugar and it goes down well - every household has it's own recipe and i liked  amala's at the tibetan family, but this is better.

wonder if i can add the same to coffee for that morning zing! - will verify that with her. More on spices and recipes in a future post.

Ayuveda health resources

Walk with Bhupendra today to examine the inpatient Ayuvedic Hospital and the surrounding area of pharmacies.  The hospital is not accedited by the Indian govt for ayuveda training. They cannot train postgraduate staff , nor specialists, but are allowed to have 15 or so nepali ayuvedic students rotate through the hospital to gain experience.  There are 258 physicians in KTM (ayuvedic) with a lower leve of training (about 3 years) and 22 MD in ayuveda, a much higher level of
training and equivalent to our MD (5.5 years of training). They have specialties in GYN and pediactrics at the hospital and average a census of 25-30 inpatients for specialized treatments. The govt funds most IP costs including meals, but if there are
specialized medications required that cannot be compounded in the hospital pharmacy, the patient must purchase them from outside. Families are allowed to stay with the patients, and some limited meals are provided for them. The mean stay for patients is 1-2 weeks with some chronic paralysis patients requiring up to 2 months for treatment.  The photos are of the hospital front with the
sign listing the physicians affiliated with the hospital.  Much different than a western hospital like PCMH with no elaborate lobby or cafeteria. The patient areas are clean and quiet and the patients and families seem comfortable stting in the sunlight.

There are no facilities for ayuvedic nurses (they may not train nurses in ayuveda for inpatient work) and any nursing support required for specialized therapy comes from hiring western nurses.  My impression is that most of the required therapy is done by technical nonnursing staff.  They do very little of the highly specialized treatments such as panchakarma and others done routinely at the health home where i'm staying.

Sample packs of ayuvedic medication combinations - the kind name-patented and produced in pill form (somewhat different that if they were compounded in a traditional ayuvedic pharmacy under a physician's direction) and made available to patients. The variety, easy dosing, tablet formulation and quality control is a plus.  Dr Koirala uses about 30% patented medications (mainly the name is patented, not the formulation) in his busy practice and the remainder is either his own combinations (nonpatented yet), or special mixtures that he feels need to be used for the uniqueness of the patient's case - they are mixed in the adjacent pharmacy and dispensed, usually as powders to be added to tea or milk or made into a paste for topical application.

We walked to a local pharmacy and Bhupendra negotiated with them for a specialized ayuvedic medication i wanted to try  CHAVANPRASH - the best natural source of vitamin c (my vit c has run out and i feel some of this sniffling is due to no vit c).  I'd heard about it in plant medicine course and from dr koirala as the most commonly prescribed medication - i purchased a paste-sort of form for 160 rupees and tried it as a big spoonful in the morning - interesting texture and possible to add it to bread/toast. Those of you who have had vegamite will know the consistency! The photos are of Bhupendra negotiating and comparing products (he chose the green one) and the pharmacy interior.

The mind and ayuveda #2

The mind can help in restoring balance by actively following the more healthy lifestyle of diet and beahvior, but a trained mind, one that is relaxed and lower in stress, will do better in healing than a nontrained mind.  Training can take various forms for different individuals and can be
relaxing walks, music, morning breathing exercises, meditation - something done regularly to relax and discipline the mind.  Photo is of a mantra used in some forms of meditation - focus on the lines and pattern and train your mind to develop a discipline. One who meditates could use color, sound, or such mantras for mental training

There appear to be limits to the effects of a trained mind - the body cannot reverse some changes.  Common examples are calcific arthritis in deformed joints, liver cirrhosis, some neruologic diseases.  Dr Koirala gets a number of cancer survivors for patients and he feels his best results are in those patient able to follow the therapy (usually some form of panchakarma, diet, mental stress reduction, therapeutic massage). He believes that (he is an incredibly experienced ayuvedic physician in such cases in nepal and internationally) trained minds do better. The ideal patient is one who has completed an effective form of western medical treatment and is "disease free" . They can be helped with ayuveda to clear chemotherapy toxins from the system and promote the immune system by ayuvedic practices to maximize their disease free-interval - some pattients will get disease recurrence, but western medicine does not appear to have this form of "immune boosting" in such patients.   

An aside on medications, particularly western medications. Most medications in the west are some sort of purified compund either from a plant base (the active ingrediant synthesised and enhanced), or a synthetic analog of a natural compound that has been targetted to specific receptors for maximum effect.  Dr Adhikari, my medicinal plant teacher maks a good point about this type of synthetic medication.  Western science measures a biologic effect based on a tissue/biologic model they have designed, yet the compund may have other effects that are unmeasured in this model and perhaps undesirable (example: side effects of the drug). Plant medications tend to be combinations of many types of herbal compounds and they may have side effects as well, but the "natural" quality of the compounds because they are derived from plants, may be somewhat more "safe".

He compared this with the exposure of the immune system of the patient to a new compound (say a synthetic western drug) - it is likely that in the thousands of years of human evolution, our genome and immune system have not been exposed to the medication before and some degree of "energy" is required for the body and immune system to process this new compound.  In the plant world however, natural plant remedies have been used for many years of history for a variety of treatments.  His point: the side effects of ayuvedic compounds may be less than western synthetic medication and more predicatable due to lower potency, and plant base - less work for an immune system that is assaulted with millions of foreign antigens/day.  Food for thought.

Diseases resolve differently - an example of diet/behavior effect in healing disease may be a smoker who develops pneumonia. The smoker may/may not have permanent lung damage, but the acute process of pneumonia is his active disesease. His continued smoking will delay his pneumonia resolution, and his emphyzema canot be reversed. In the people who stop smoking, they resolve their pneumonia better/faster, but when they restart smoking at the same rate, they still do not get a recurrent pneumonia. One thougth is that western medical therapy has improved their basic lung function so that they can resist future pneumonia, even still smoking. However, if the patient has a "spiritual awakening" and stops smoking, their lung function will gradually improve.

I asked if that person trained their mind with some form of meditation would the whole process be better for the patient?  Answer: likely, but no studies to "prove that". so, it seems that it comes to the science of common sense.

A different example: in a patient with chronic arthritis, it is felt that an immune system disorder is somehow linked to the disease activity. Specific meds are usually not available, so we use general immunosuppressive meds to decrease arthritis activity (nonsteroidals, oral steroids). These have nonspecific effects, and often side effects. Ayuveda on the other hand uses general medications to enhance immunity.  BY boosting immunity, it is believed that the body decreases inflammation and joint damage in whatever ways it is capable - two different approaches to treatment. Not many would disagree with the patient above having a poorer response to either kind of medication (western or ayuveidc) if they worked in a high stress job, ate excessive foods, and drank excessively.  My point is that there are commonalities between the systems (good habits) and differences  (western - suppress; ayuvedic - enhance normal body systems).  Which is better for the patient - maybe either or more likley both

As i go through the plant medicine course, i'm impressed with the variety of medicinal plants and ocmbinations described in the ancient texts, and their potency (and lower incidence of side effect).  One of the trade-offs in ayuvedic medicine is the patenting of common therapies. The therapies become more expensive to the patient with big pharmaceutical company involvement, but the drug combinations are produced more efficiently, often with rare herbs, and under stricter quality control measures than those used by the average individual ayuvedic physician.

Interesting question: - why don't 100% of people who smoke the same amount and type of cigarettes get permanent lung damage? is there another component at work in the development of disease?

The mind and Ayuveda #1

This is a very simplistic discussion of a complex topic!

I'm trying to work through it with an open mind, even though parts of my "western" mindset find it difficult to accept. All consciousness in the universe operates in an area of unified consciousness that results form that of all living things.  As human individuals, we possess unique higher intelligence that operates at many levels - from the basic common to all living things (cell growth, bodily process coordination, enzymes, hormones, etc) to the complex (thougths, emotions, conscious intelligence/learning, etc).

A disciplined mind promotes order in one's life and helps resist imbalances or disorders. . All individuals are capable of some level of mind discipline; some more than others, with higher forms of meditation. It is felt that the earliest forms of imbalance come from "mistakes of wisdom" where the combined intelligence temporarily loses control of perfect balance. These "mistakes" are usually self-correcting by normal body functions and the person returns to their balanced state (but no-one, even the highest meditators is in a constant balanced state - it'sa goal nto a practical reality). In certain cases, the consciousness permits these "mistakes" to progress - possibly through lack of mind training, bad diet, behavioral excess, stress, or other external factors. The normal clearance of dietary toxins from the body does not happen, or happens less efficiently (more toxins from external sources, poor clearance). This is earliest stage of imbalance that may/may not progress eventually to disease. Continued toxin accumulation results in later phases of imbalance, in some cases leading to symptoms and eventually disease as manifested by overt organ abnormality. The process is reversible at many stages by a combination of correct diet, eliminating excfess behavior, and medications if indicated to
help cleanse the body of toxins.

Running out of time and want to get this part 1 posted.

Photo is of tea each morning with combination of spices - really good!  (cinnamon, cloves, ginger, black pepper, cardamom (especially good for PITTA).

Second photo is of a typical mantra for meditation, more on this in a later post

The massage and festival walk

The massage was EXCELLENT.  My previous massage experience was many years ago by a stout and stern german lady named OLGA.  She worked me over for an hour and left me to ooze under the door and back to my hotel room.  Did it at a conference where i was speaking  and had to give a talk within a few hours of finishing. This experience was totally different.

The Ayuvedic Health home is a separate area adjacent to where i'm staying at the guesthouse. Most of the
long-term patients for the health home stay in my building in the 4 rooms there. I walked across the back area and came to the entry portion (photo) Marliss is the administrator/director of the health home and she and i have talked over dinner - she has a long history of nursing and hopsital administration in Germany and is an excellent organizer.

All of the staff at the facility are recruited from the villages, brought to KTM, and trained in the area needed (various massages or ayuvedic treatments). They pay better than anyone else around so they keep quality people. They are the only such faclity in Nepal. 38% of their visits are from nepali nationals and the remaining from 85 countries. Many repeat visitors who come for 1-2 weeks of cleansing. The cleansing process is a type of phanchkarma (previous post) involving diet and massage to bring toxins to the surface from tissues, then moved out of the body by therapeutic vomiting (more in detail ONLY if someone requests the information!) and therapeutic
enemas (2 kinds, cleansing and nourishing). surpriisingly, my dinner companions feel the treatments (including vomiting and enemas) help them considerably. The man with end stage parkinson's and his wife feel he is somewhat improved, but his treatmet is different and longer, but with similar and additional therapies.

The entryway and checkin is efficent and courteous, tea, slippers. Then i headed to the room with Badhri for 90 min of workover.The warmth of a heat lamp, wam oil, and covering with warm blankets for those parts not being worked on was tremendous!  The pressure wa just right and i left with a totally different relaxed experience than with OLGA for the cost of about $20.00 - high for nepal, but a bargain for the
states.  As the day went on, those evil toxins released by the massage crept into my system and i felt tired, headache - all normal responses to the massage according to my guides.  Super sleep and back with breathing yoga this am feeling less toxic!  But then, what have i done to gain toxins other than eat a few chicken sizlers. 

Did a walk with Bhupendra in the market area at the close of festivcal to see things and the photo is of the temple of shiva which is only open on this one day a year. The crowds were amazing. The day of the festival is for sisters to give their brothers tika as a sign of love and good fortune for the coming year - the temple is for those people who do not have a brother/sister to offer tika and there are volunteers who do the service so that people can continue to have good luck.  We did not go in because of the crowds.

I mentioned about Laxsmi, the goddess of wealth, and the photo is of jewlery stores in the high price part of town that elaborately decorate for the festival to assure good customers (? tourists) that would buy expensive gifts.  All of these decorations come down after tonight and all back to normal business monday morning.

Plan for the week is hopefully to do a shopping market trip with Dr Koepela (my herbal/spice/diet teacher, and the giver of the orange from a past post). Goal is to get some
idea of freshness, explore spices and purchase some (saffron is cheap here, so may get some of that).  Part of Ayuveda is a controlled diet.  She and i have been discussing how to make that more relvant to their patients (they now give nepali recipes and some education about spices) - my suggestion is to
prepare some recipes for common countries of their patients (germany and italy most common) and give those
to patients to let them continue some of the diet guidelines at home.  She has never bee to america, and i had her in stitches as i told her about the concept of an all-you-can eat buffett, and KFC with fried chicken and biscuits. I could see her cringe with shock at the fat, fried, meat excess. 

Hinduism

LET ME PREFACE THIS POST BY SAYING THAT I AM A NOVICE TO HINDU TRADITION - MY KNOWLEDGE COMES FROM MY READING AND LOCAL (NEPALI) KNOWLEDGE SOURCES.  IF I AM INCORRECT, IT IS THROUGH MY OWN  MISUNDERSTANDINGS AND I MEAN NO DISRESPECT TO THOSE WHO PRACTICE THIS RELIGION.  MY GOAL IS TO PROVIDE A BASIC LEVEL OF AWARENESS TO WESTERN READERS.

Hinduism - an ancient religion linked to ayuveda because the creator, Brahma, passed the Veda (books of knowledge to mankind and one of the vedas is said to be a basis for ayuvedic practices.  I can't expect to cover the complexities of the religion so prominent in nepal in this brief post, but wanted to share a small example from a tile outside dr Koirala's top porch where i can look out over ktm each morning . There are three major dieties in Hinduism: Brahma (the creator), Vishnu (the maintainer (stabilizer)) and Shiva (the destroyer). Vishnu and Shiva have many incarnations (thousands) and there are many ways to represent them in art and worship.  A person may worship one or another incarnation, depending on their needs, relevance, and beliefs.

This tile represents a typical example of Shiva. Shiva is shown as havnig 4 arms, blue color, and usually with a trident. His wife Parvati is next to him, on his left side as in most hindu photos. She is nicely adorned. Their son Ganesh is in the center. Ganesh is popular as the problem solver - before you go anywhere or attempt anything, you should make an offering/prayer to Ganesh for good luck.  The family are on white ground because Shiva prefers the snow of the Himalayas. The adults have their hands open in greeting to the people, and shiva's faithful bull, Nandi is beside him. Shiva has water coming out of his head because at some time in the past he had a disagreement with a demon and in response, took all the water from the earth. He has a cobra around his neck because to save mankind he absorbed the venom of a snake in the past and his neck burns still from that venom.  Water flows from his head as he slowly puts it back for the benefit of his people.  In his left hand Shiva holds a musical instrument and wears the skin of a tiger. Ganesh has an interesting history, and is easily recognized by his elephant head. As the problem solver, his life was not always so rosy. It is said that his father, Shiva, was travelling and doing good through the world, fightnig demons, and returned home afert a time to find his lovely wife (Parvati) in bed with a young man. The angry Shiva chopped off the head of the young man (Ganesh, his son who had grown up somewhat during the trip). The angry Parvati forced him to bring their son back to life, but he could only do it by giving him the head of the first living thing he saw, an elephant.  Ganesh has one tusk missing, - he loves sweets and is portly - the moon made fun of his fatness and he threw one tusk at the moon in anger

This tile represents Vishnu, the maintainer. Vishnu has 4 arms and can often be identified by his symbols, a conch, a lotus flower, and a sticklike weapon. Vishnu's vehicle is the man/bird garuda. (not shown in this tile) The monkey god (lower left) , Hanuman, helped Vishnu rescue his lovely wife, Sita (on his left hand, from an evil king. His shakti (companion) is Lakshmi, the previous posts on goddess of wealth, not shown on this tile.  Ganesh is favored every morning with first devotions, and tuesdays are good days for ganesh to help solve particularly difficult problems, or help single women get a good husband.

This photo is of an elaborate rice and bean drawing dnoe on the street in thamel for the festival.  Each part is of a different kind of vegetable in honor of the rich harvest.

A nice sunset photo of the unusually clear closest mountains after a rainstorm.

The week:
- hopefully a massage (relaxation/spinal unknown depending on availability)
- a market shop with Dr Kopila (my diet teacher) after festival when the crowds down to discuss choosnig propoer fruits and vegs for variopus constitutions
- continued morning breathing yoga with Dr Koirala

Ayuveda #2

The two basic forms of "traditional medicine", tibetan and ayuveda, seem to have arisen at about the same time, 2500-3000 years ago and both sprang from similar texts compiled by rulers of the time. Both were based (as was early Western medicine) on plant and herbal therapies (there were no drug companies to sponsor dinners or give pens,  synthesize medications).  Diagram is from a sample Ayuvedic text showing their understanding of the anatomy of the time based on animal sacrifices and tauma victims in war. Maybe this was some of the confusion of the Tibetan students in my lecture!

The differences in the medical practices started with Western medicine in the scientific development of the mechanistic model of the human body (16th-18th century). We are all familiar with concepts of western medicine - each disease has symptoms and these symptoms can generally be traced to a single cause - a disruption of a
critical process that results in disease. The advances of western medicine have been based
on this type of approach - organs have diseases, diseases produce symptoms and illness.  Western medicine has made profound advances in science with surgery, organ transplantation, diagnostic methods; all based on the assumptions of Descartes (briefly summarized here) - all parts of the machine (body) can be explained by breaking down the parts of the machine into the smallest parts and examining which of these may be responsible for broking down to cause disruptions of the machine. Examples are familiar to all of us: bacteria cause disease, kill the bacteria and cure the disease; an organ is diseased (joint/heart/kidney) - remove it and replace it with a new part to make the
"machine" whole again.  This reasoning is effective in single diseases, usually those with bacterial causes, but less effective in chronic diseases that have an unclear cause (osteoarthritis, cardiovascular disease, hypertension, diabetes)

Some exmples of differences between allopathic (western) medicine and ayuvedic medicine:

AY: disease comes about in 6 stages - accumulation of imbalance in the body (bad behavior, diet, infection)--> aggrevation of imbalances--> spreading of imbalances--> localization into tissues and organs-->manifestation of symptoms --> disruption of physiologic function (disease)
West: there is either health or disease. Example: pt goes to their physician with symptoms, the physician does a series of diagnostics, they are negative, the patient is told that nothing is wrong

AY: multiple points of intervention to rebalance the system before symptoms occur with diet, behavior, medications
West: we treat disease/symptoms when they occur, not before

Ay: body and mind are a complex interaction and cannot be separated in health and disease - mind disruptions cause body disruption that results in disease
WEST: mind has some control over disease, but it is hard to believe that a bacterial pneumonia is due to mental causes

Anyway - you get the point.  Photo is of Dr Koirala examining a patient in his clinic - exam is much the same as western with all the same techniques, and no pulse reading (even though pulse reading is a skill taught to ayuvedic physicians, they depend on it much less than tibetan physicians).  His clinic in downtown KTM - open daily except sat from 4-last patient is seen.  Pharmacy on site run by his brother to dispense ayuvedic medications.  Consult visit costs 60 rupees and average medication charge is 100 rupees. Pt can come back free anytime in 15 days after first consult; after 15 days, visit is an additional 40 rupees for another 15 days.  More on specific patients in a later post

Both Ayuvedic and western medicine had their roots in herbal/plant pharmacology, but western diverged with drug companies producing highly potent synthesized compounds that may have been at one time based on less powerful herbals. Example: Dr Koirala believes that PPI (prilosec and it's types) is the most effective treatment for ulcer disease and he either gives it or refers pts to local GI doc for f/u. However, the reasons they got the ulcer to begin with may be infectious (Western belief of helicobacter) or may be more deep-seated with mental stress, bad diet and alchohol, or other things that put the patient's body "out of balance" making him more prone to disease. After the PPI has been given and the ulcer healed, Dr Koirala finds it effective to work on the other aspects of the problem that are more chronic to prevent recurrence of ulcer disease or other diseases. He deals a with a lot of psychological/psychosomatic diseases - those that Western medicine is not very good at treating.

Western medicine uses primarily medications, surgery, and some accessory therapies (physical therapy, etc).  Ayuvedic medicine uses diet, behavior change (yoga, breathing), and herbals in various combinations and bases those combinations on the classical texts for effectiveness - they use a lot more tonics, strengtheners, body balancing-types of medications) - part of my quest is to find the most common and test them out for "balancing" - not that i think i'm in any way out of balance!

Behavior therapy is also important. Dr. Koirala has a strong background and training in western medicine, psychosomatic medicine and behavioral therapy and is a senior ayuvedic physician in nepal
because of his long experience in that field.  It is great to study with someone so well grounded in both fields.

I wanted to cover one type of therapy that is popular in the west, called Panchakarma therapy.  Basically, it is method for cleansing the body of toxins and rebalancing the body. The therapy is
customized to the patient's specific imbalance and can involve many types of therapeutic massage, oil treatments, and various other cleansing techniques. It has been used in a variety of chronic illness and cancer survivors to help decrease recurrence rates. The photo is from a text of oil dripping slowly onto the forehead to allow focused concentration of imbalanced areas to come to the surface for later removal through normal waste channels. The technique is in use in the house I'm staying and involves a patient with end-stage parkinson's disease.  He is having a 28 day program of diet, behavior, exercises and purification techniques. Classical Panchkarma takes place in organized stages of 28 days, 58 days, or 120 days - all very controlled as to the effects induced to maximize the migration of toxins from end organs into the system and purification by removal (the forms of removal are forced vomiting, enemas, or sweating or a combination of all of them). I've heard that several "spas" are offering this type of therapy, but he cautions about the potential danger of doing it incorrectly.  The patient i know has been here before and gets good results with symptomatic improvement and then gradual recurrence of symptoms as disease progresses over months after he leaves.

I'm anxious to hear your commnents on this post - it covers a lot of ground and i hope it's clear about the basic differences between western and ayuvedic medicine.

Festival Time

When Vidhea and I initially discussed the timing for the trip to nepal, she noted that it would be good to come oct-nov because it was festival time. Nepal has more festivals than any other country i've ever been to, but the two biggies, Dashain and Tihar (festival of lights) happened within the last few weeks.  I missed most of Dashain because i was in the tibetan part of town and it is not a tibetan festival, but got a great view of the tradition and excitement of Tihar with Dr Koirala's family.

Tihar is a festival of lights celebrating a good harvest and is the second most important festival in Nepal. 

Families decorate their homes with bright lights during the 5 days of festival - yesterday evening was the peak of the festival with fireworks all around from local homes as boys set of bombs, rockets, and various pyrotechnics.  The rooftop was an excellent place to view them - one of the highest places in the city. A shower during the day left a clear night with no moon.  On the second day of the festival dogs are honored with tikas (plant decorations applied to forehead) because it is believed that dogs guide our spirits across the river of the dead in the afterlife (hence the street dogs are left alone to breed, bark, and generally have a great time).  Lakshmi, the goddess of wealth, was honroed last night.  In the photo, you can see dr. Koirala's wife, Rekha, laying the footprints and offerings from the temple outside the house into the main entrance to guide Lakshmi into the house to allow her to provide wealth and happiness to the household in the coming year. Each morning she offers prayers and offerings to Lakshmi and Ganesh for wealth and solving problems through the day.  Each business in Thamel has their own brand of offering to lakshmi with burning candles/offereings - no-one wants to pass up a good deal wiht this goddess.

The evening was filled with bombs, lights, and traffic!  I could not get a microbus home the other night and had to break down and get a cab  (10 rupees for a micro and 18- rupees for a cab!). In this festival, families stay in town and go downtown to the market to purchase things for their families.  Going to the market tomorrow with Bhupendra to see that event - hopefully the bulk of festival traffic will have finished by then, bu he expects a packed street walk!  Rekha was so kind to provide me with ritual sweets for the festival and as a good mother of the house, blessed everyone including me with her Tika to my forehead.

Ayuveda is going well and one of the prime aspects of it is therapeutic massage. There are multiple massage types offered and i plan to try out one this week (depending on schedule it may be either a spinal massage or a relaxinging massage) - both about an hour or so  The tablemates who eat with me are here for various types of treatment and have several types of massage in their stay of 1-5 weeks for various medical ailments including end-stage parkinson's disease - they claim they are the best they've ever had (both germans). They both were sort of quiet last night at dinner because they missed out on the great pasta and vegs and asparagus soup because they where in day 4 of daily cleansing enemas and were restricted to porridge.

A good birthday

A nice birthday among my nepali friends.  The day started with Dr Koirala and his wife coming to the door at 6:30 with some fresh magnolias (from her garden) and a statue of Ganess (the problem solver).  That was such a nice gesture because when you start praying in the morning, everyone starts with Ganess - more on this coming in a post on hinduism in prep.

Then Dr. Koirala started me on a program that involves morning breathing yoga- he had suggested it  because he does it and it is better to do it in company and i was all for it - interesting techniques of both yoga approach and breathing (yes, it's an alternate nostril breathing technique - more on that as time goes on) - those of you who do yoga likely know the technique - if so, send your comments and i'll post them for others to share.  Then later in the morning, Dr Kopila, my diet/ayuvedic practice teacher came with a beautiful orange.  The story is that the orange came from her parent's village. The village is a special place for orange production with small, extremely sweet oranges.  The village is close to Pokara in north eastern nepal - her parents take a bus the 5-7 hrs on rocky roads, then walk for 2 hrs to the village in the hills. No electricity, good water, no cars and no roads. There are about 1500 houses and 1 family/house unlike ktm with multiple families/house.

Her family have lived there for generations and when her mom comes back to KTM, she brings foods/oranges on pack animal to the bus, then loads it onto the bus and in ktm, takes home with taxi - so... all that work made the orange a special one. I had it that morning and beautiful, small, sweet, intense! The food continues to be outstanding and each soup outdoes the last for flavor and health value.

Enjoying ayuvedic as a study discipline and much different than tibetan - more grounded in and similar to western medicine.  Preparing a clinical blog post for later after the beginner one i posted the other day.

Vidhea and Yanik took me to dinner in Thamel that night with excellent food and wine and conversation with Megan and Kahlil, the other 2 passage students!! 
The place was, like most good places in thamel, tucked on a backstreet behind a wall to hide the nice atmosphere and block the street crowds.  Vidhea knows the owner (and come to think of it, who doesn't she know!) and so we got excellent food with special starters and some prawns in sweet/spicy sauce that were divine - Prawns are extremely rare here, so to have such a delicacy from home was special.  I got a wonderful chicken dish in olives and wine sauce. Vidhea ordered a merlot - another big treat. They gave me two scrolls with gods of ayuveda and the tibetan medicine god as well as a book on tibetan medicine. The photo shows the gods on their scrolls.  Today (nov 7) is the day to make offerings to the Ayuvedic god, Dhanwantri - he is a form of Lord Vishnu who appeared while churning the oceans He has 4 arms, is holding a vase of nectar for healing, a conch (medicines made from animal/coral), a medicinal herb and a wheel of life.

All-in-all, a good day, but missed home as i lay down with my head to the east

Beginners ayuvedic

Ayu (life) vedic (science) - a system of medicine based on observations of scholars about health and disease with earliest written observations recorded in the Veda (one of 4 received directly from the god of creation, Brahma, but written Veda from 1500 BC and before (and earlier observations recorded there were based on oral traditions passed from father to son (no written language) about healthy lifestyles, healing plants, poisons and toxins from about 3000 BC.  The study of poisons was very popular in those days if you were a king or ruler because that was the major route of exiting your kingship - kings collected scholars and scholars studied from local people who lived next to the forests what various plants did to heal human disease. Those observations were recorded in the Veda and subsequent commentaries were written by scholars over the centuries - but a continuous line of treatment and healing for over 3500 years - pretty impressive since western medicine started with the greeks or before, a bit after that, and some portions of western medicine were borrowed from ayuveda as the greeks contacted other peoples in their conquests and travels.

There are 3 basic doshas, or body constitutions, pitta, vata and kapha, and some combinations of these (I am reputed to be a pitta-kapha - we'll see after my survey this week) - these represent the physical constitution; there are 3 additional mental constitutions to add to these.  The basis of personality and intelligence and eventually disease and reactions to environment is dependent on the dosha.  Herbal and other treatments are all based on how they affect the various doshas - example: pitta represents fire - a pitta people have various characteristics and when they become ill, may need to have therapies that focus on things other than fire-based plants or treatments (such as earth, water, air, space-based treatments or plants)

All health is a balance between physical, mental, sensorial, and spiritual health and everything we eat affects those aspects. One develops imbalances through excesses or depletions in what we eat, what we do (excess or no physical activity) and how our eliminations function. Imbalances are maostly self-correcting as the bodsy has a vast ability to self-correct, but frank disease results from accumulation of more "bad stuff" than body can correct. Treatments focus on clearing the toxins by diet and medications and rebalancing the system. much more coming as i become more familiar - seems more akin to western medicine that the tibetan medicine i was studying last month - it was a distant branch off ayuveda with knowledge coming from buddha, who studied ayuveda to learn his medcial training.

Yoga (photo) is a common method for chronic disease. The application of leeches to diseased skin has had good results in gouty arthritis and severe eczema and this home is getting ready to start that form of therapy. Interesting about this facility (Ayuveda Health Home, past post for website) is that it is the only one of it's kind in Nepal, so they see lots of patients from a variety of places (nepal, US, europe) with diseases that have poorly responded to western medical therapies.  Awadh, 10 y/o nephew is an inquisitive buddy.  Just to show how open the household is, he stopped me yesterday and asked - "why do you keep your towl and underwear in your pillow?  As i mentioned, the pillow was rock hard, and i removed the hard part and stuffed whatever clean and soft clothes i had into it. The maid cleans the room, but she must have told the family about this odd american practice of making pillows.  Dr Koirala's wife was kind enough to find me a small soft pillow to replace the hard one. I told her i was sleeping poorly - she told me i was sleeping wrong - i was sleeping to the west - sure enough, i changed ends of the bed and have slept well

Lovers lane and the botanical gardens

The microbus was even more exciting today - excursion was to the southern outskirts of KTM to the National Botanical Garden.  Went with Bhupendra as my guide and the goal was to look at medicinal plants in their natural surroundings.  Good to get out into the country and the event required me to go to thamel by cab, meet him, then two long microbus rides across the city. The record yesterday of 25 people was surpassed today with 28 - all packed chock-a-block into the same type 3 seater van.  There was a bit of a discussion (and i wish i could have had a photo, but the situation did not allow it).  The setup was B and i were sitting in the seat, and had gotten on early, more and more pople were ushered on by the young (? 14y/o) pusher/money collector as we moved along the route so that there were literally no more open spaces.  An elderly man and woman were picked up - the young pusher pointed at me and asked me to move over (not that i understood) - i was crammed in and there was no room to move, so the older lady pushed herself into the only space and settled onto my shoulder (rough, bumpy road) - the pusher got ticked off (? at me, ? at the lady?) and the entire bus started to talk loudly (no-one yells here) at him.  B chimed in and all settled down.  After we got off, i had to know the discussion.  As it turns out, they were mad at the young pusher for taking on the older people when they could have waited for another bus in  just a few mninutes, and mad at him for speaking rudely to me. They told him to please not make that mistake in the future because if he spoke so rudley to tourists, noo one would want to come to nepal!  Some microbus economy: avg take/day 2000 rupees, expenses about 1000 rupees, average take home for driver or pusher for 12 hour shift, 500 rupees or more on a good day  (current conversion - 60 rupess/$1.00)

The garden tour was excellent and got some good photos of ayuvedic plants good as brain tonic for kids - the brain tonic plant shown is cleaned, ground into a paste, and mixed with milk for children and given daily from about age 5 or so for another 10 years or so - less effective for older people and positively NOT effective for ancients.  Some plants/fruits for asthma, not that i'll use them, but interesting to see the average-looking plants and their therapeutic potential.  A small factlet: toilet cleaning lady (2 small outdoor toilets just inside the entrance) has a great business - charges 2 rupees/entry and makes on average 450 rupees on a saturday, 50 on any other day almost better than the microbus driver i mentioned yesterday.  A nice walk back through busy markets in Patan on a saturday (their holiday) topped off by an excellent pizza in thamel with Bhupendra - he considered it expensive, so it was a nice treat for his work touring me around the garden.

Interesting cultural perspective - the garden is apparently the lovers lane of nepal. In nepali society, relationships are very slow and there is no overt physical affection in public.  So, couples who want to do a little "experimenting" have to find a quiet, private place to hold hands or hug - the garden is the place!.  Bhupendra pointed out multiple couples in various stages of becoming acquainted, so we tried to talk loundly when moving along the paths so they had plenty of warning . Photo is of hugging lovers caught in camera as i was shooting the plants in front of them.

A special plant i took for my brother Gary.  Of tremendous significance in nepal and so guarded that it has a barbed wire fency around it.

The microbus experience

Marigolds are in bloom now and used in festivals and offerings. beautiful crop of them on the top balcony of the house.

The language teacher (Bhupendra) (he and i have agreed to just a BIT of language and much more culture), a young 33 y/o guy who has worked as research tech for dr koirala, decided that it may be best to go to thamel using the microbus system.  Picture a standard 3 seat van, pack 23-25 of your best friends into the front and back seats, add a pusher to the railing to find seats, push people into standing positions and collect money, and you have an idea .  fast, regular, and cheap - cab issue last time coming home, the guy did not know where the 5 star hotel was i am close to, took a LONG detour, and tried to charge me more for his phone call to the hotel.  Challenge of microbusses is that the ride back i have to find the right one - there are about 20 that come to that corner - and ask the pusher for the confirmation, then sit back and enjoy the scenery. cost 10 rupees; cab cost 150-200 rupees, time: microbus takes about 20 min, cab 30-35. This bus is unusally empty and no pusher in evidence (likely drumming up business) The photo is of the symbols that i am to look for that tell me the microbus is going where i want it to be going

planning a plant excursion into the surrounding mountains tomorrow as part of the ayuvedic class - looking fo rnatural growth and look of common ayuvedic medicinal plants - suspect there will be lots of climbing!

Major GI distress last night (thursday) after a lunch wed afternoon - knew right away it was not going to do well, and things progressed overnight and flared last night with fever, shaking chills and "gi distress" - atb have helped today along with lomotil - suspect some of it is just changing places - the food is still outstanding and the preparation and presentation are excellent - part of my training in ayuvedic diet is to enjoy the food slowly, think about tastes and textures and spices, chew slowly, pause between courses - all things none of us do in a western diet.

More to come on Bhaktapur and its projects with photos when i get to more leisure i-net time this weekend

Bhaktapur

Had another excellent excursion with anil to a totally different city - bhaktapur - to give an example - the tourists come there to see specific temples listed in the tour books - we spend only a minority of time there and can come back to see them if we wish, but the richness of his history makes that really less interesting than wandering the quiet peaceful streets (almost no cars and very few cycles).  The city has a rich history as the third of the major ancient kingdoms of this valley, and the german govt completed a major restoration project of housing and sewers/water systems in the 1980's. The Germans did a major investment in restoration and revitalization of the sity. Prior to 1980 they had a cholera epidemic every year due to poor water, now it is considered one of the cleanest cities in the WORLD.  It is swept 7times/day and it shows - it is a great place

We were lucky because farming is strong here and the rice has come in and is everywhere in the open spaces with women raking and spreading it to dry in the sun.  they have a lunar cycle (from the last moon, the festival of dashain) to the next moon (the festival of the harvest god....) to get all the rice dried and packed away or sold - this is the time to realize their profit from this crop and everyone is working as hard as they can to assure a good crop.  One of the ladies was raking rice to have it distributed and dry it faster, when her metal rake part flew off just as we walked by - her friends brokew down laughing and i can just imagine they were giving her grief for that while the "tourists" were going by - we were the only tourists in that part of town.  she caught my eye and i smiled - she shyly smiled back, picked up her metal end, and got to raking.

The city has a rich history of resistance to the king, that continues and they are a tough, self reliant people who withstood a siege of the city for 22 year and came through it victorious.  The wood on the doors and balconies - the styles we've seen in the past, dates from 1482, the last time wood was restored in some parts of town - it is is in pretty good shape.

This is a package for a beetle nut - an addictive form of chewed/sucked tobacco-laced nuts that are everywhere - sold in these small packets at 2 rupees. The locals take 20 or more packets/day and it is highly addictive and adds to mouth and throat cancer.  A farmer can grow a single large tree on his land in a 14'x14' plot, supplement with herbs around the bottom, and make a profit of > 80,000 rupees each year.

The photo is of a unique temple in the neighborhoods of bhaktapur - there is not a god or symbol in the temple - you can see all the offerings on the outside - the temple is to the "god of good jokes" - you know how when someone tells a joke, it can be well-done or poorly done - this is a temple to making it well-done. Also used by artists prior to a performance to make it a great one.

Internet withdrawl, a new place

Moved safely to a different part of town - upsides: very nice home of the ayurvedic physician i'm working with, top floor room (his former office), close bathroom, very little smog, GREAT MEALS!!! ayurvedic is partly about food, so the meals are all excellent, all healthy, all vegetarian. Downsides: a hell of a ways away form thamel and fast internet, and with busy class schedule, can only come in for blasts of posting several times/wk - miss that already with no daily email and no daily posting, but...

The hill (what is it with hills you say!) that i walk up to get to this new place.  not as steep as the monestary hill, but hefty one nonetheless.  Photo of my little room - comfortable and airy with no smog this high up and a great view from the upper roof of smoggy ktm downtown.  The mattress is hard, the pillow is hard, and i've managed a make-shift pillow from towel and undershirts and sweatshirt - just the right firmness. My training is with Dr Koirala, a  respected senior ayurvedic physician in KTM who also operates hte ayurvedic health home - a very nice guesthouse that caters to waethy patients who come for a variety of services as day stays or longer stays.
The food is fantastic!  i've gotten a menu plan for the length of my stay with 3 excellent meals/day (except sat) - odd to be called for a meal by a tap on the door and go to the dining room whre i'm the only one there  (there are other guesthouse patients on special stays), but they eat at different times.  The presentation is excellent.  Only regret is no caffeine, so tea is all herbal - we'll see if i feel better.  Odd to be away from the cooking/dining frenzy of amala's house.

Will be seeing some patients wiht Dr. Koirala later in the month and now have classes in ayurvedic theory, medicinal plants, ayurvedic diet, recipes and cooking, and my usual nepali langauge/culture class

Went to Bhakatapur last sat and have many things to post from that visit when i get a free time to get them down.

website for the ayurveda health home - photos of dr koirala and the guesthouse where i'm staying

Into the country

Amala decided that it was time to go on a picnic to the country - to a monestary outside of town. The plan was we would walk the 2-3 hours in the sunshine and have a good picnic at the top.  it was to be a going-away party sort of for me and i appreciated the effort. She was packing a small snack lunch.  We finally got started about 9:30 after many delays mobilizing the walkers. The day was sunny and bright and when we got to the street, it was decided that she did not want us to walk all the way, so we took a cab (2 cabs) and piled in for an exciting ride along KTM main roads and back roads. The roads got more rutted and the cab scraped multiple times - aside - the cabs are all owned by the banks (drivers take a high interest loan) and have to pay the bank 750 rupees/day for the use of the cab, and they have to buy all gas and do all maintenance as if it was their own - gas is available for about 2 hrs throughout the city with long lines - the times vary, so that adds an extra challenge to making money as a cabbie. Quite a few rides before they start to make any money. We rode about 45 minutes, mostly up, then came to the end of the road and she decided we would take it a bit further, new prices were negotiated, and we conitnued up. We took the cabs to nearly the top where the monestary was - beautiful view and we arrived neither hot nor sweaty... The view was incredible and so nice to be up above the smog/pollution w/o dogs barking, cabs honking, cycles winding around us.  The monestary was beautiful with a new and old part - always amazed at the dedication of the monks (about 120 in this one) who may enter at age 5-6 and stay their entire lives in study/prayer and meditation.  In  the buddhist concept this prayer is for all of us.  When you view the photo, imagine if we had walked UP!  A good visit wiht everyone at the top, the kids played nature quiz in english to practice their english and megan read the questions. I ended up winning with 178 correct answers - my momma would be proud.  The question that ran me over the top on my run to victory... what is the only toothless mammal?  (answer at bottom of this post)

The kids loved the food (Amala ended up ordering food from the little buddhist cook area and we feasted on fried rice, fried noodles and french fries - all vegetarian.  She had brought some friend buff mo-mos.  I sprung for something they RARELY get - candy bars and those went fast - just to give a perspective, the entire meal for 9 people was less than the 3 candy bars.  We toured the monestary and the temples (no photos in the temples) and the sense of peace while monks were praying/chanting outside in the sunshine as we toured inside their temple...

It was decided to take the short cut down which ran nearly straight down (see above photo and picture that) - we struggled down to the main road, then hopped a public bus for most of the trip home.  photo is of the kids sitting around after eating waiting to go home - they have on the "alaska" t shirts i brought them - they seemed to love them.  The guy with the straw on his back is a classic - he looked at me just as i shot it and it would be one of those great photos to run in a contest of "add a caption" - his expression is great!

Tomorrow am moving from this buddhist part of town to the hindu part of town and my new homestay family - leaving the world of buddha and entering the world of bramha (the creator), vishnu (the preserver) and shiva (the destroyer).  Hope to be able to post as often, but may be delayed a bit until i find the right place - so much to say...

ANTEATER!!!!!

Leprosy

Leprosy - a name that generates biblical images, thoughts of unclean people/beggars and a severely debilitating chronic incurable and mysterious disease. I'd never seen a case of leprosy.  When i heard from Vidhea about the Women in Music concert and the proceeds going to the leprosy hospital in KTM, i was on board.  Today i got to go to the inpatient facility with a great tour by a truely great humanitarian, Dr. Pradhan, a perky female dermatologist working in this area for 10 years or so.

The stark facts about leprosy are on the website for those interested. Leprosy general information

Nepal,  Myanmar, and Mozambique are still considered endemic sites in the world for leprosy with an incidence of more than 1 per 10000 population.  In the 80's there were > 100,000 cases in the world, now < 3500 worldwide.  The disease is a difficult one to treat because of the chronic doses of antibiotics required, but it is curable, usually over 6-18 months of daily medication depending on severity.  The focus of world health organization efforts is early identification through school programs, outreach clinics and information to remote villages. Early detection allows early treatment and prevents the severe nerve damage that results in lost fingers, toes and facial deformity.  The disease destroys all peripheral nerves in hands and feet, sensory, motor and proprioceptive, so the patient has no feeling and often burns/cuts/destroys their fingers and toes w/o knowing it. Severe chronic ulcers develop on the feet/toes and fingers either auto-amputate or are surgically removed for infection. In severe cases there can be extensive facial deformity and loss of nerve functions in eyelids so the patient cannot close their eyes with eye infections.  Anyway.... enough background

The hospital i visited is in KTM, about a 40 minute walk from my homestay. megan has volunteered there changing sheets and generally helping, so i thought i'd tag along and got to meet the director, dr... who gave us a detailed tour. The facility can support 14 patiens and it is full most of the time. There were 7 pts who require either inpatient (IV) therapy or who are so debilitated that they cannot care for themselves outside.  The remainder of the patients have gone back to their villages for the festival season to be with family.  The patients have a combination of disabilities and their reason for being in the hospital is a place to stay and medication and physical therapy.  Traditional western hospitals routinely refuse leprosy patients in KTM, so specialty care (mainly orthopedic and opthalmologic) becomes a matter of the director pleading with the specialist to do the work, often free.  The photo album has some benign photos of the area and disabilities and the amazing functional results with simple materials.  Medications are provided by Wolrd health Org free of charge, the building is rented and all meals, staff salaries, etc are paid from donations such as the women in music concert.

The main issues for patients:

- cataracts from high dose steroids (from hypersensitivity reactions to medications)

- foot ulcers, finger burns, need for amputation or physical therapy  (smokers burn right through their fingers if not watching cigarettes - so use a bamboo cig holder to help that)

- placement issues - cannot go back to family

Transmission of the disease among family members is not uncommon in villages due to poor sanitation and draining ulcers - recent cases get diagnosed by awareness and the development of characteristic skin patches among family that allows early treatment.

Like many facilities that provide care to a special population, the nurses are dedicated, the staff works hard, patients are uplifting with their acceptance/dealing with their disability, and the place runs on a shoestring, but somehow manages to deliver good, compassionate care.  I came away with a new sense of medicine as a caring profession.  Thanks to Dr. Pradhan and good luck with your work!

The students and tibetan medicine procedures

Had my repeat visit with the students - i could tell form the outset that they were much more at ease, laughing and joking, but also more serious about learning specifics and challenging me.  Megan weas invited by Dr. Namgyl for photos (the previous photographer sis not do a good job and he likes to have all these resource lectures completely taped and videotaped and photgraphed).  I chose to talk about lactose intolerance (i only have a limited time window and limited subject matter w/o having to develop more western concepts, so this seemed pretty benign).  15 minute talk, diagrams on board, and 2 hrs of questions.  These ran the gamut from what are genes, what are the ideal conditions for fertilization, do helicobacter bacteria have anything to do with sperm/ovum formation - as you can tell, a heavy focus on conception.  Their issue is that in tibetan medicine, all the attributes of a human are determined by the male and female pulse at the moment of conception and the content of the sperm and ovum - in other words, all diseases (infectious, physical) that a person will get are determined at the moment of cenception - a vast concept and one in a way foreign from western medicine and in a way similar (gene maps, genetic counselling).  A good visit and good laughs - hard to tell if it was at me or with me, but hope they got a new perspective - i surely did.

Tibetan medicine is primarily focused on treatments by first, changing a patient's diet and behaviuor to allow their body to come back into balance and eliminate the disease.  In those conditions where that doesnot work, is not possible, then they use medication - a complex compounding of secret dried herb mixtures compressed into a waxy pill that is chewed (nasty!!!!!!) usually 4 times/day, but sometimes requiring a tea made during a fell new moon and drunk after filtering.  If that does not work, they move on to the heavy-duty procedures (i've not seen these in my time here).  The first is cupping - in this procedure, a large diameter glass cup is placed over the area of pain/bad humor and suction applied till alarge hicky results, then the skin in that area is lightly scraped wiht a scalpel and suction reapplied to remove the bad blood - the blood is discarded.  Cupping apparatus in photo.  Next most significant procedure is called moxibustion - this involves applying a special wooden tip to the area of abnormality (could be bad blood, could be a painful focus, could be a junction point for many organs).  The wooden stick is heated by rapidly rubbing on the wooden board to generate heat and then placed wiht moderate pressure on the point of interest.  The final one, rarely done because of potential damage to the paitnet is called the golden needle, is used for severe headaches, sinus issues, ear problems, vision issues.  An imaginary line is drawn across the skull as in the photo, a midpoint is identified and a paper hat made to cover the patient's hair.  The golden needle is placed into the scalp at this point till ti touches the skull.  A packet of special herbs (different depending on the condition) is placed on the needle and set afire.  The bers burn and trasnfer heat and healing energy down the golden needle into the skull.  The needle is removed when it cools.

GOLDEN NEEDLE

All very different from endoscopy, but then wheni told dr namgyl about that he was surprised at why we would need to do it to find out what he found out by pulse reading.  Interesting differences betwen western and tibetan medicine!

Popola, patients and pigeons

Lots to talk about with patients and wanted to start with an awkward situation that made me realize more about western medicine and it's limitations.

The typical patient encounter for tibetan medicine involves patient coming in, bowing to the doctor, and sitting in the chair.  99% of the patients i've seen with him are traditional tibetans, all ages. The lady in this story was 50ish and had come before for problems of gas, bloating and was diagnosed as a "lune" disorder, a type of disease classification that is common and treated with specific meds and includes stomach disorders, gb and pancreas disorders.  she had been to western doctors who treated her with unspecified meds that did not help and she was coming for tibetan medicine - this was a followup visit.  She was bettter, but not completely well after 10 days of medications. he talked with her and recommended a slight adjustment in meds.  She asked him what my opinion was of her problem as a western doctor - that had never happened before and i felt unusally ill at ease.  Even though i could get nonspecific symptoms (gas, worse after eating, no pain, no reflux, no changes in weight - possilby GB disease in this type of patient), the symptoms did not fit into any classic western diagnosis and i had no ability to examine the patient (they only sit in a chair and have pulse readings or perhaps BP), no labs, no endoscopy, no xrays - in short, i was dependent on many accessory things to make a diagnosis.  He used very few diagnostics and his pulse reading was the basis of his diagnosis and treatment - a much more portable method.  I had nothing to offer her and smiled and suggested she continue the tibetan medicine if it was helping - interesting perspective for me

In my current homestay family, you saw a photo of the core family, but one member was missing - he is the 87 y/o father of the husband and his affectionate name is popola (grandfather). He is an accomplished Thangka painter (highly detailed paintings on canvas used for meditation focus - examples at Thangka samples) and has made a very successful living at that art.  He cannot paint anymore because his hands are not steady enough, but he is able to draw the complex diagrams required and apprentices paint them to his specifications.  He is an interesting guy - has a chronic cough treated unsuccessfully with western and tibetan medicine, but up each morning to do his meditation and mantras (religious prayers) for about an hour, walks, independent, speaks no english (but he and i smile a lot), loves little kids, and is able to continue his life's work.

The nepali's have long traditions of what works - stuff tested by time.  Pigeons are an example.  A typical buddhist concept is to take no life (even insects) and do not diturb the lives of other beings (barking dogs as an example).  Pigeons are everywhere around temples and stupas and the people encourage them by feeding them. Termites are common here; the structures are very old (in the thousands of years) and cannot be replaced; pigeons eat termites - a sense of balance . The same thing goes for snakes in the sewer systems - they eat frogs and keep the watre flowing because frogs clog the system. The photo is of a temple at is 1500 years old, in daily use, and made of wood with a copper/golden guilding that it laid over detailed carvings. The local people had to decide what to do because someone was stealing the valuable artwork. They decided on a meshwork/grill system that is locked at night - still allows the pigeons to get in - an alarm system would have been disturbed by the pigeons!

Coming - my class and filed trip on wed before the lecture: tibetan medicine compounding (making meds) and other advanced techniques such as cupping, golden needle and moxibustion - photo is of the ingredients in the common medication shown below.

Bye...

Anil's excursion to the real Kathmandu

Anil (who gave such a great excursion at Patan on a previous post) did the excursion to Kathmandu.  We got to go behind the tourist crowds, pollution, and see the Nepali people in their neighborhoods and at worship on this festival.   Nepal was closed to tourists until 1950 and the city has grown rapidly since with too many cars, motorbikes and pollution in spite of the fuel shortage  (gas comes from india and stations are open about 2 hrs a day with 1-4 hr waits for a rationed supply, so motor bikes are the cheapest form of transport - they are everywhere and as chaotic as you can imagine on sidewalks and paths everywhere. This excursion avoided all that stuff.

At this temple (there are hundreds all over KTM that tourists never see), the family brings an offering of food to the god (see lady in the front with her tray of food and family offerings) to bring good fortune to their families for the rest of the year.  I just missed the beheading of a goat at a spot just in front of the photo, but saw the fresh blood and the goat's body being cleaned and gutted just to the right - goats are the preferred sacrifices because the gods favor their meat, but if the neighborhood is poor, chickens are used.  The attached photo album gives a more detailed view of the sights and sounds.

Anil is a historian, a city planner, and a restoration expert.  He has a project called Kathmandu 2020 that is a complete rebuild of the city to modern specifications and has made good progress on the infrastructure with water, digitizing the entire city, sewage improvements and road improvements.  His frustration is with the lack of a central government elected by the people to oversee neighborhoods and projects at the local level (unable to get grant monies if no local place to receive them) and current govt is not a people-elected govt - elections planned for nov.  Interesting to see that progress can be made if the local people are invited and encouraged to take ownership of their spaces and maintain them in traditional manner.  This square is one just an alley away from the tourist masses, but quiet, children playing and people doing their neighborhood duties with cleaning monuments and improving things.  This square will be filled with rice from their fields in 2 weeks as the new rice crop comes in and must be dried in open spaces.  The old rice is used during this festival time to make alcohol (consumed in HUGE qualities) according to anil to celebrate the passing year and the harvest.  Part of the strategy for renewal in Kathmandu is to foster local business ownership - the two that are easiest to do are hotels and restoration.  Here is a website of an excellent example of a high end hotel done by a family with a low interst bank loan and local labor Kantipur Temple house hotel.  I especially liked this one because of their eco-friendly policy in Kathmandu (no use of plastic bags, hotel provides cloth bags for guests to use, no sales of mineral water bottles, but requested to bring your own and hotel provides free mineral water for your use, and hotel has its own wate management and sewage system and encourages purchase and use of local products and food items)

This photo is of a "monument" just outside the dental part of town - dental clinics are clustered here and the tradition is that to assure a painless visit to the dentist, patients nail a coin to the monument.  The people around were asked by Anil if they had just been to the dentist and they said they had and the coin protected them from pain.

After the excursion, went to lunch at an old thamel place, the yak - holly from interim referenced it when she emailed me - yes holly, it's still there, the food is great and the prices are cheap.  I had another chicken sizzler, better than the first one.  The dessert menu for ice cream is posted on the wall .  Any guesses about what "blind love" ice cream may be?

The upload of photos was done in Thamel - the site for getting stuff of any kind and the tourist mecca. Getting back from thamel is a cab ride and negotiating the price is good practice - many cabs sitting around - my opening line "how much to Boudha stupa"; their reply - 600 rupees, my reply - 100 rupees - sorry sir, fixed price of 250 rupees - me: 150 rupees.  if they say yes, i get in for a thrilling 45 min cab ride, if they say no, i move to another cab.  have usually been at 150 rupees (about $2.25) - with the fuel issues above i don't know how they do it.

Lecture to the Tibetan medical Students

  A basket of roasted barley seeds and other traditional Tiebtan snacks - that's what i was offered by Dr. Namgal's mom.  I talke a small amount and it tastes a lot like it looks, like birdseed (aside: yes, i tasted birdseed and catfood as well on a dare in childhood)  She is a traditional Tibetan lady of indeterminate age (no birth certificates in their remote village who smiles broadly at my bow and "tu gee chey" (thank you).  She is in a traditional tibetan long wool dress with a colorful apron called a chupa, worn by married women.  She has comfortable nike's on.  His dad sits proudly next to her with a broad smile - happy people visiting their son from tibet.

The lecture is after clinic and we navigate the road back to his house in a different route than i walked and got lost in an earlier post because he has to pick up a chicken.  The students who live in his house are required to have meat once/week and the chicken is to be their dinner in a stew (all parts are used in tibetan stews, feet, claws, neck, etc, etc).  We get to the house, have barley seeds and tea while the classroom is cleaned for my visit. The students arrive and take their places (8 of them)  and while they come in, i quiz dr namgal about their stories of how they got into this competitive program; 7 are buddhist monks, nuns and one is a tibetan woman of 27 who plans to go back to her tibetan village to practice after her 7 years of training. They stare at me w/o staring as i come into the room.  He starts the class (as each class) with a 5 minute mantra (chant) to the medicine buddha praying for guidance, knowledge, and compassion.  I decided to talk on an easy topic - ulcer disease - and draw a GI tract on the blackboard. They copy everything!.  I stoip every 4 or so sentences so he can translate.  I cover helicobacter, PPI, asa/nsaid ulcer, healing rates, treaments with antibiotics, complications - all without a single slide and with periodic colored chaulk references to my diagram.  After 20 min (it is to be a 30 minute class; they are on holiday, but come to this class because of my visit) i stop, satisfied i've covered it all from a western medicine perspective.

They ask questions - shyly at first and he translates.  what are bacteria, what are antibiotics, they believe the stomach involves more than just the anatonic organ the stomach - do ulcers occur elsewhere.  Where is the pancreas and spleen  ("lun" disorders are those of stomach, spleen and pancreas) - they believe they may be in the lower abdomen somewhere.  I see an anatomic model in the back cabinet, take it apart and show them spleen and pancreas - they are amazed.  The questions get harder - how many capillaries are there between the stomach and the liver and how do nutrients get from stomach to liver (they believe they go through the lung and are purified to get to liver) - my answer - as many capillaries as in a bowl of spaghetti noodles - they laugh loudly and genuinely at the cross-cultural joke.  Why do wonmen have periods, and why periods irregular, what age does menopause occur, how do blood cells get formed, what does the spleen do, what comes first, air in the lungs or red blood cells - 2 hours of questions and they would have kept going (I'm invited back for a repeat session this wed) - he asked me to talk about a disease of the small intestine.  They are grateful and have warmed considerably i think after the spaghetti analogy.  He presents me with a prayer scarf and a tibetan scroll of a prayer to the medicine buddha.  Many photos are taken by his cousin (who with my camera gets them all out of focus

  Dr. Namgal drives me home.  I'm glad i did it

Unexpected rewards

Good days with 70's and cool nights (50) after a rainy spell.  Had one of those moments the other night coming back from a walk w/o flashlight that i plopped right in the middle of huge puddle. Shoes got scrubbed a bit and well worn, but looked clean.  Doing my own laundry after Amala's maid did it the first week - just soak when in shower, rinse, and hang to dry, so just did a bit extra on the shoes

The air is unusually clear after the rain and a walk to the stupa and climb to the top walkways got a great sunset photo and a great view of the annapurna range (from megan's trek).  Her photos are much clearer, but had not seen the mountains from town since i'd been here.  Sort of uplifting though as i'd been missing home and NC sunrises.  One of the thrills described in the nepal lonely plant guide is the ability to ride on roofs of busses (city busses and long distance busses) Going to doctor's office yesterday saw a goat and a kid on the top of a city bus; both looking ragged as they hung on going over the huge ruts, bumps and potholes  (there is never a camera out when you need one!).

Amala cooks well for each meal, but this is festival and she wanted to take a break for lunch. She offered to take our little family out for lunch - her favorite spot was closed for festival, so we went to a place close.  Took this one of them waiting for lunch.  Amala (mother) , her husband (wangji), her 15 y/o son (ngawang) , daughter (Rinzin Diki), and one of the two "annie's" (ane yanki) or nuns who live and work at her home.  Orders went in and no lunch 1.5 hrs later (i had to leave 1 hr after getting there to gwet to my afternoon doctor/patient time).  She was so frustrated that she asked the owner for an explanation.  Apparently, they had only 1 cook during festival time and he was unabel to prepare most dishes (we ordered buff mo-mo's and pizza; not our valiety of pizza, but somewhat similar) and ours were not on his skill list, so he had to send to an adjecent restaurant in town for the order.  Not the lunch we'd expected.

Last night talked to the tibetan medical students at their school.  Photos coming in a later post.  30 min lecture turned to 2 hrs with their questions on western medicine - a good time

Moving to a different part of kathmandu for my ayurvedic medical experience (end of october) and no close internet there, so trying to decide how to post.  May have to be posted in batches when i get to thamel, but may be able to use the doctor's laptop to create text and upload photos later.  Have found this posting to be a good focus for me and a way to "diary" the experience for myself

Megan's annapurna trek

  Megan went on a great trek a week or so ago and her photos were so incredible that i asked if i could share them on this post.  There is also a photo album i uploaded while on fast Thamel connection and her comments are with each photo.  Enjoy and thanks to Megan for sharing!  First photo is early on the trek showing the beautiful scenery.  Second is of a pprter carrying bottles of soda up (and the empties down) for trekkers.  Third photo is one of my favorite types - a path and up!

Megan's start:

The huge, majestic snow covered peeks stand tall and

resilient above the expansive rolling hills, forests, and terraces.

Every step closer to them captivates your very being as you scan your

eyes above you, below you and stretch your neck left to right attempting

to catch every possible vista.  Each day was packed with various landscapes.

We traveled up crumbling weathered stone steps into and out of villages, crossed

over suspension bridges, walked through rice terraces, rhododendron forests,

passed by rivers, through streams and much more.  We sometimes

climbed up for hours, and often down for hours.  But, coincidentally,

just as our feet would be getting ready to send their memo of resignation,

we would enter a village and sit for a cup of buffalo milk tea, hot yogurt/milk,

or, my personal favorite, Nepali tea and biscuits. It was perfect.  Sitting in a small

delicate and simple little hut in the middle of the

Himalayas

; sitting in our fleeces,

sipping our Nepali tea while gazing at the giant mountains feeling humbled

by their vastness and beauty. After hiking from

7am

until about anywhere

between 3 and

5pm

we would enter a village and pick a guest house to sleep in

  All were amazing.  They were very simple with just a bed and a bathroom down

the hall that everyone would share, (the squatting ones of course). All the

houses had either a rooftop or a balcony where you could sit and just stare

at the

Annapurna

range.  A lot of the other trekkers would be eating dinner,

as well and we would chat together until the sun went down. Exhausted from

the day, we usually fell asleep around 8 or 9. The sky would be clear early in

the morning, and all the trekkers would be up and about around 5 or

6 am

shooting photos of the mountains.  We would all mingle more over eggs,

Tibetan bread, and tea at our table outside, still staring out over the ledge.

Then, we would pack up and head out for the new day.

Overall, the trek really was absolutely incredible.  It’s a beautiful place.

The landscape is breathtaking, the village people you pass greet

you with “namaste” and “basnous!” (sit!),  our guides were wonderful,

which was balanced perfectly by his serene eyes and very tender smile,

not to mention his excitement when we said our Nepali phrases correctly!

The

Annapurna

range really is majestic.  I recommend it to anyone who is

on this side of the world.         

Tourist Patan

Mental blessings to all my friends back home from a temple in Durbar square in Patan!

Patan is an old city, maps date it as more than 2000 years old.  It was always a trading city, a stopping point on trade routes through the area and between china and India.  It is filled with temples, like many nepali cities, but the tour by Anil made this city come alive.   Anil is a city planner, visionary, and inventor.  His work in Patan has been world-recognized as retoration that retains the spirit of the area as well as adding functional improvements to reflect how a city began.  I'm going to relate the tourist side in this post and some of his enthusiasm in another one.  Patan and nepal in general are purged about every 100 years by a major earthquake.  That tends to destroy old architecture, wreck temples, but gives an opportunity to rebuild in a better manner.

The city is based on a very logical structure - individual squares with housing on the outer edges of the square (multiple familis in an apartment-like building and services in the more central area (gardens, water, well, compost pile for garbage and garden.  There are central water lines that provide good water (not drinking water) to all areas of the city based on the water table, the drainage patterns, and the weather.  Very efficient and functional.  The romans (great engineers themselves) were not able to reproduce this type of system in any of their cities because of the local geography and reverted stead to the more famous aqueduct system known across europe as Roman. Repairing the water infrastructure in Patan was the first project.  People over the years had dug up, blocked, and tapped into the old clay pipes, so restoring those took time and effort, but when it was completed, the 7 or so public water areas were functioning as they had 2000 years ago to provide plentiful water to citizens for washing, and cooking and as a "push"for a separate sewage system.  The photo is of a group of women using a beautiful public water source for their daily activities.  This water runs the same as it has for 2000 years, 24 hrs a day all year long in a steady stream.  The streets, wells, public faucets and water drainage systems all function together to provide water during dry times and store water during monsoon seasons.

Next in Anil's rebuild of the city with public assitance came restoration of the concept of a square for the basic unit of the city - old buildings that had been destroyed/made unsafe by quakes were restored with modern technology, citizens did most of the work, and local pride and architecture was preserved. In our tour, for about 3 hours we were well away from the touristy part of town and walked through one after another quiet courtyard with children playing, old people talking, and families doing their daily lives.  One such restoration was a bed and breakfast Newa Chen Bed and Breakfast - a low 3% bank loan allowed the owners of the building to restore it and run it as a very upscale B&B, even with no buisiness experience (but lots of hard work).  The place is beautiful and rates are very cheap by american standards  ($45/night including breakfast) for deluxe double room - check out the website if you get a chance.

Great square for public worship with eating places around it - taken from the balcony of the "chicken sizzler"

Went to south asia film festival and Nepali music video showing with Yanik (he was officiating a session on music videos) - really interesting to see films (the documentary was on the fate of young women who are bengladesh garment workers) and music videos (rap is very popular).  Funny to not understand a word, but to feel the beat of contemporary music. Their film technique is good and content good, but male/female relationships are shown much more softly than in american videos.

later this week - photos from megan's trek on the annapurna circuit (told her i'd post them for her folks)

Weekend stuff

Had a GREAT excursion to Patan saturday , the success was because of the enthusiam, optimism, and knowledge of Anil - more to follow on that as i gather background information.

Updates: the wall i referenced in an earlier blog (the guy doing stucco) - now completely covered with grafitti, "i love you" and nasty words.  Discouraging...

Kids playing cricket in an alleyway adjacent to the clinic - the fun part was watching them stop and let passers-by go through - even if folks stopped to talk,  the kids waited.  Their ball was so worn that they had to peel off layers after every 10th pitch or so - felt so bad for them i nearly bought them a new ball , but that seemed so american-touristy - they were just fine with their situation without my interference.

A story of what Nepali's must think of as the ugly american tourist.  A 20's year old woman came to the internet cafe saturday am about 7.  She had an excursion planned and was getting ready to leave.  She stormed in and wanted change for a 1000 rupee note (something no internet cafe would have - that's like asking for change for an american $100 bill - she wanted it in 5 rupee notes (so the owner would have needed 200 notes.  He politely told her he did not have it; she wanted to know why the banks weren't open - he politely told her it was a holiday.  She fussed him out for not having the money/change, and for the banks being closed - why did she need the 5 rupee notes - to give them to poor people on her excursion as a religious offering!  No religious spirit there - I told the owner that i wanted to apologize for her behavior as a fellow american.

I've referenced the great Stupa here in boudha and that many people make rounds of it each day - the custom is for them to touch and spin many of the prayer wheels built into the walls and the much larger ones at entrances.  The buddhist belief is that a prayer wheel contains a paper or many papers with mantras written on them (blessings/prayers) and that by spinning them, the prayers get sent out to the universe and and all people; the more you spin, the more goes out - one of many concepts that makes one believe in the goodness of humanity.  There is a similar custom for prayer flags that are strung from every house  (like on a battleship!) - each prayer flag has a prayer on it and when the wind blows, the prayers go out to humanity.  One photo of the Stupa - note the "compassionate eyes of buddha" at the top when you blow up the photo - no other Stupas in the world have eyes except those in nepal

In closing the neigbors with the noisy dog are moving, BUT, they started the process tis morning at 4:30 AM!.  The process involves hiring 4 coolies to haul all of their stuff down three flights of stairs, strap it on their backs and walk an unknown distance to their new place.  Picture some guy strapping a washing machine, then a stove, the a bedframe on their back.

Good lunch in Patan - a chicken sizzler  (the newaris of patan are big meat eaters) - this was a fajita plate, sizzling, with a chicken breast smothered in brown gravy and mushrooms, spaghetti noodles, and veggies - wonderful!

Catching up

Got a good satellite window yesterday afternoon after it had been down and up all day, so got to upload some photos for this post.  This is my mask photo on a moderately busy main street during afternoon "rush".  On the previous post that showed the two cows waiting for a bus, i was impressed with the guy witht the really big and awkward load - those guys are everywhere and carry anything (Amala said she saw one carrying a washing machine from downtown up 3 flights of stairs to deliver it.

Yesterday was urine day - I came in the morning rather than the afternoon and the patient load was greater, but they had more interesting problems.  One component of Tibetan medicine is urine examination to confirm/support a pulse reading. The patient brings in the urine, pours it into a coffee cup by the window, he comes over, smells it, looks at color, clarity, and stirs it with a small stick to read how the bubbles form (color, size, distribution to the sides of the cup), and then discusses it with me. The patient when cleans up the urine cup and returns it for the next patient - I saw differences in the 6 or so urines we saw yesterday in all of those qualities above that i had never noticed before - his handouts detail pretty well what kinds of disorders the urine and pulse indicate.  I'd be a skeptic if he had not been so accurate in my reading.  We're covering some of the plant compounding theory.  The locals including my homestay family say that tibetan doctors who are good, are really good; my pulse readings are coming along - never going to be a diagnostic whiz, but just interesting to consider the things in a simple observation that we (I) traditionally take for granted and whether they may have some clinical significance.  It's just such a stretch from traditionaly western medicine that my mind has to put the doubting side away for awhile and give it a chance.

I've been bad with my tibetan langauge and Tensin has let me - part of Vidhea's thougths when she sets up these passages are that a student has to immerse themsevles in the culture to get the most of the xperience.  That is fine, but i found myself stressing about langauage practice and that i would never use the langauge other than a few courtesy and survival phrases. So, i changed it from 6 days/wk to 3 and stopped lanaguage, so she is my cultural teacher - I go to her for patient questions, dressing, practices, income, and "stuff" in general about tibetan people in Nepal - working very well for me.  Hope i can work the same deal next month with the nepali langauge teacher...

I mentioned that i would try to get a shot of typical food.  Amala (tibetan courtesy for "mother") cooks three meals a day for we students and her family.  The kitcehen is functional and she uses fresh, healthy  ingredients.  All cooking is done on this 3 burner gas stove, no oven.  A typical lunch plate is rice with dahl (? spelling), a radish, carrot stir-fry with a nonspicy sauce and some potatoes in a mild curry-like sauce.  Water and plain nonsugar yougurt for dessert. Meat is rare and we've had small chicken pieces in s stew and buff mom-mos as mentioned as the only meat.  Nothing too exotic and the food is excellent and just the right amount of filling.

Today - an excursion to patan on a cloudy, coolish day - looking forward to the guide and visiting with yanik, then maybe to a documentary festival for some films this PM.

Thanks for reading and for your comments!

His pulse reading on me

You know how healthcare workers are - nosy about their own health.  While we were practicing pulse reading (from previous post, the most accurate/important aspect of the Tibetan medical system), I asked him what he thought of mine.  His analysis after about 20 seconds on right and equal amount on left

1. You have cervical spine pain - correct - i have had neck pain for the past week or so because of mattress, pillow (he also noted that it would become lower back pain unless i stopped sitting incorrectly - i sit in bed in morning drinking tea and thinking about the river in washington nc)
2. You have breathing problems - correct - the pollution, even with a mask, has given me a slight cough and VERY mild dyspnea going up and down stairs
3. You have stomach problems - correct - new GERD from spicy foods even on medication
4. Your blood is impure (wow - what a hit that one was) - when i inquired - he said that was the cause of all the others above.  Does not imply infection or any of the "bad" things western medicine thinks, just that i have been eating a different diet than used to (correct) and drinking less water than used to (correct) - all of the above can be corrected by adjusting diet and drinking more warm water slowly - no medication required.  I changed morning sitting to include a neck brace from the airplane

Wow - pretty accurate for just pulse reading

we'll see if all that improves, but i feel better knowing (at least form his analysis) that nothing terrbily bad has befallen me yet.

His typical fee for a visit is 20 rupees and medication costs about 100 rupees for about 10 days (current conversion rate makes the visit less than 30 cents). He is doing a great business and notes that he often gets patients who come from other tibetan doctors in town  (whose fees are higher) because of greater patient satisfaction. 

Having a good read with a book from home, Michael Crichton's Travels.  A book he wrote early in his career (1988 publication) during a phase of his life when he had just finished medical school and decided not to continue in medicine, but to travel instead. The world was a different place then, but he has chapters no a number of exotic places and cultures and even though i read the book years ago, it sat on the shelf at home and sort of jumped into my bag to bring.  Maybe it's a comfort about exotic cultures, or maybe it's about just getting out of my comfort zone as i did in alaska and letting a new culture roll over me.  The people here are predominantly extremely poor, happy, take pride in keeping their personal space clean, and extremely dedicated to their buddhist religion.  They live differently than i do, but i have never felt unsafe,  laughed at, treated with anything but common human decency (even when "lost").  Maybe the lesson to be learned from the book is to feel the culture, take the time to think  (a luxury i appreciate more and more)

No photos because the satellite is very slow - redid my mask photo and want to get some of the homestay family

Rearranging Priorities

Eating is very improtant here because we don't have the luxury of a stocked fridge to wander down to, so i'm very considerate of meal times  (7-8 asm, 12-1 PM,  7-8 PM).  Amala is an excellent cook and i will be posting a longer post on this in the future with a typical meal photo, but it is a finely-tuned operation for her to feed us, then feed her family, then do all the other things she has to do.  Yesterday i found out that my doctor wanted me at clinic by 12:30; i didn't tell Amala until 11:45 because i thought i'd just stop at local take away and get something.  She scurried around and made some great buff steamed mo-mos  (a very common lunch, but moderate prep time) which she packed into tinfoil for me to take with me.  I ate half on the road walking to the stares of the poor people all around, and saved half for later when i finished (it's a lnog stretch from 12 to 7!) - well, cold buff mo-mos lose a lot of their flavor and they have less of aan appeal than the hot fresh steamed ones, but i ate them.  I made it to the doctor's about 20 min late, I got a good lunch and i hope met all the social courtesies i needed to.

Photos of me today walking on the main road to get some hair shampoo and socks at the local "department store"  I have anotehr one that did not load of me in mask on the mail street - will get that one up - this one is "two cows waiting for the bus"

Tibetan medicine is going well and i've graduated from merely BP taking to pulse reading. In their belief, the visit si composed of interrogation (asking questions), pulse reading and occasionally urine analysis.  Pulse reading is by far the most Improtant.  The patient is seen while they are sitting, no stethoscope is used except for BP.  The 1616 possible disorders are classified by hot or cold disorder, or by organs (stomach, heart, small intestine, large intestine, lungs, nerves), or by disorders of wind, bile or phlegm.  From the pulse reading one can make a diagnosis.  Urine analysis involves looking at cool urine for colon and sediment and shaking it to see how bulbbles form and what color they are.

More on the patients i've seen  in a later post

Tomorrow:  his pulse reading on me.....

Patients

Spent the first afternoon of the trip seeing patients with my Tibetan doctor.  Up to now we've been covering basic history of medicine and basic concepts.  He's been very helpful at making it relevant to my level of training because most of his handouts and information were created for passages students who are either chiropractic, nursing, or some alternative medical discipline.  His clinic and operation are so unique that i wanted to spend some background time.  His grandfather was a tibetan physician  in Tibet before the chinese invasion in 1959.  He eventually escaped to Kathmandu and started to paractice tibetan medicine for the many tibetans who had fled here from tibet.  He was uncertain if this is what he wanted to do for the remainder of his life, so he consulted the spritual advisor for all tibetans, the Dali Lama.  The dali Lama told heim to remain in kathmandu and continue doing his medical work for tibetan patients, to educate otehr tibet doctors, and provide quality care at fair prices to exiled tibetan citizens.  Amchi (doctor) Lama  (my doctor) followed in his grandfather's path after his younger brother had assumed the business of care and education and he and his younger brother operate a training institute for 9 first year students (7 year program) and they  attend free.   He receives donations to help support their education from tibetan families and patrons.  His clinic has been operational for several years in downtown Bhouda (the tibetan part of Kathmandu); photo coming and he sees patients and charges them reasonable prices for care and medication.  When his grandfather started in the 70's there were 2 tibetan doctors; now there are about 15.  He and his brother  (a monk) staff the clinic; no nurses.  They compound the medications themselves in a large factory  (hope to get to tour that) and they sell meds to patients at lower prices than competing doctors in town.  An average 10 day course of medications will be about 130 rupees (about $2.00) and patients must pay for everything out of pocket as no health insurance in nepal.

A tibetan medical visit is much different than a western medical visit - the patient sits in a chair across fomr the amchi and tells his story. Clothing is never removed, diagnostics are pulse reading, blood pressure, look in the eyes and ears, and perhaps some palpation of the back/spine.  No labs are done.  He gives a prescription for the medication combination (usually tid/bid) and sees the patient back in 10 days.  I will be moving to pulse reading today after doing BP yesterday - an unusually fast progression because of my past medical training.  He is a good teacher and the concepts of disease are totally different than western medicine.  More to follow on that as the blog progresses.

The plan is for me to stay tibetan until the end of october, then move to ayurvedic  (indian/nepali) medicine for the remaining month.  Along the way for this month vidhea has arranged visits to another tibetan doctor, an accupuncturist, message therapist, a tour of the leprosy hospital - a busy month with a lot of variety.  Her local contacts make this type of medical variety possible.  An exciting time for me to be exposed to the many types of medical care delivered to the bulk of the world's population

Clinic front and Amchi Lama

The Concert

The concert, Women in Music, was a big social deal for Kathmandu. It was at the swanky Yak and yeti hotel; the premier hotel in this city and all the social movers and shakers were there.  We were lucky because of Vidhea's involvement we got a close in table.  Megan (the 20 y/o college student here from Boone nc to do volunteering at hospitals and my housemate) and i got to meet the new US ambassador to nepal - her first question to us was whether we'd registered - the embassy as an online registration form for americans abroad so that they can keep track of them in case of some some emergency and of course vihdea had had us do that within 24 hrs of our arrival.  The music was good (loud) with 2 professional women rockers and 8 nonprofessional singers - a heavy selection of american music and some nepali songs.  Good buffet dinner with nepali food (the highlight was fried fish balls in a curry sauce, interesting texture).  All profits go to the local leprosy hospital (megan has been there to volunteer; i have not) and the physician who runs it was at the concert - a very vibrant, enthusiastic and energetic woman).  A brief slide show to highlight what they were doing to help reabilitate and treat all stages of leprosy and more importantly, to help rebuild families who have been disrupted by the disease with educational scholarships.  I look forward to seeing her work.  A good evening and i took a cab home about 11 with speed, sharp turns, darkness and a disagreement with the cab driver (yanik had negotiated 300 rupees for the trip and when we got there he wanted 400, a standard practice - i did what yanik told me; give him the 300 and leave the cab).

Wanted to share a beautiful custom of flower petals in a bowl that is a pretty decoration

Wandering on the streets with MANY street vendorsd taking up every square inch of space - hard to beliefe that so many shops can be selling the same things and still have a customer base.

Power outages are common and regualr (in the pasrt of town I am now, every sun and mon 6-8 PM the power goes out) and at odd times in between for a variety of unknown reasons.  We were at a local restaurant and the power went out in the middle of ordernig - no problem - candles and gas heat/cooking make it a nice dinner - need your flashlight to get home because it is BLACK with no lights. At that dinner had some great buff mo-mos  (cattle are sacred here, so lots of buffolo meat) - these were small, like chinese pot stickers, steamed, with a great filling and nice ketsup-basd dipping sauce - 12 of them for less than a dollar. Lots more vegetarian dishes and that is the usual diet at home.

My language teacher, Tensin has utimate patience with me - as you know, language skills for learning a new language drop rapidly after age 40 and we both know that i only will be using even survival tibetan for 3-4 weeks, so she is patient, easy, does not press me for the previous days lesson too hard, and focuses on easy phrases.  She helps and its a good challenge in the morning.

Lost

Today is a holiday (sat), but start back with language and medicine tomorrow, so have a loafing break.

Getting an airline cold with sniffles, but no fever - my Amyla gave me some strong ginger tea yesterday that helps with the sore throat - rest, vitamin c, yadda, yadda.

Before i came i did a large download of podcasts for my ipod and one of the ones i've enjoyed has been "60 second science" from Scientific American - a minute of funny, serious, thoughtful news from science (60 second science).  If you're into podcasts, give it a try.  A sample: the international robotic competetion for artificial intelligence recently sponsored a conference on robots understanding humor.  The intent is to see if robots/artifical intelligence can understand the unique human quality of humor.  The joke that cracked up the computers there went like this: Johnny's mother saw him at breakfast and said that he'd been in the garden all day yesterday; johnny replied that he teacher had told him to weed a lot, yuk, yuk!  I'm sure they've tried knock-knock jokes....

I had my first solo visit to the Amchi (my medical tutor doctor) at his house. Yanik had taken me once before on the thrill-ride of his motorcycle and i'd tried to follow the directions because i knew i'd be walking there.  I made all the right turns and about 45 min into the walk (up a giant hill), i knew i was lost.  Even though i'd noted carefully the house and surroundings, i could not find it.  My class started at 3 and it was 2:50.  Gathering my wits about me (what else to do) i decided to sit down and wait for megan (my 20 y'o college student housemate) to come down the hill because she was finishing class at 3; she could guide me to the right house.  Photo shows the surroundings .

Never a safety issue , just with no house numbers, no cell phone, no phone numbers...  Cute little kids running around and seeing me as an american, they would yell hello, smile and i almost broke a rule - almost patted them on the head.  Anyway, after about 15 min of waiting an no Megan, i started back down the hill and shortly came to the right house. She was waiting for me and chatting, so....

The housepeople rented a movie that we will be watching today - One Giant Leap (on amazon.com) about a musical project combining music from around the world into various songs; each song using various types of music - check it out or if you've seen it/heard it, give me some feedback.

Last night went to Women in Concert - a big deal musical event that Vidhea started 5 years ago with two friends to highlight wonen's music and the proceeds go to a leprosy hospital in the area that i hope to tour later... more on that concert tomorrow

Alaska flashbacks

readers: got to upload some photos (the slapping monks from "no-no") - let me know if you are having troubel viewing them or if you have trouble enlarging them by clicking on them.  I'd checked those things in alaska, but can't do that here, so depend on your input - thanks

The workers of the world have similar woes and daily irritations.  Those of you who followed the alaska portion of this blog will know how proud i was of my "innovations" to make simple processes easier.  Today i saw a woman who improved markedly on my sand screen . Her screen is larger - better sand sifting, it is tilted so rocks fall out rather than my way of emptying them by hand, and she works better under adverse conditions (heavy clothes and HEAT)

On the walk over i saw a man doing a stucco wall (like brian plans for the front of the house that does not have rocks).  He is applying it over old brick and the owners are trying to spruce up the place.  He did about half of the wall yesterday and overnight some kids had scrawled saying and drawings over his work.  I hope you can see some of the writing and feel his disgust at "those damn kids" as he repairs the wall.

The final alaska memory is that my tibetan doctor lives about a 40 minute walk from here. The last half mile of the walk is up a hill steeper than brian's hill. I'm only going to have to go there for a few more days as he will be moving to seeing patients in the clinic.  My issue is sweat - i will arrive there today drenched!.  Maybe i'll take a spare shirt...

Tonight: women in concert - a dinner and concert by 10 nepali women singers  (2 professional, 8 amateurs) - the organization was started by vidhea, my passage contact and has had successful charity concerts for XXXX years (to be verified tonight).

Next post: concert, sweat and laundry, comments on early exposure to tibetan medicine

Finding a routine

It's good to be settling in a bit and now that i can unpack at my homestay it's less like living out of a suitcase.  The house is great, close to "stuff" and my room is at the top (third floor) with two girls who are staying there and studying at the Tibetan school. My Amyla (house mother) is an excellent cook and her strong Tibetan tea is just the right charge in the morning.  Typical dinner is a flour dumpling about the size of your hand (Te-mo) steamed and served with last night a delicious mixture of spicy clear noodles and vegetables - you add the desired amount of spicy red chili paste, mix it up, and either dip the te-mo or put the vegetables on it.  A variation for those who hgave been here are the ubiquitous Mo-mo's - flour dumplings steamed, fried, stuffed with veg or meat fillings and served by themselves or with a sauce.  I've asked Amyla to help me maintain the slim physique i got in alaska(i can hear the giggles over the satellite connection) because the tradition is that a fat guest is a healthy guest and everyone is encouraged to eat, and eat some more.

Kathmandu has essentially no street names or signs, so wayfinding is an experiment - I've managed at least two routes from the guest house where i was and the homestay where i cam now, walking among hurrying students, workers, or monks/religious persons on their way to the stupa.  The Great Stupa (photo coming) dates for this one from the 14th century and was not damaged/destroyed in any number of natural disasters/invasions over the years. It is a large religious shrine for Buddhist worship. The people are incredibly devout buddhists and each person strives to do a daily routine of prayer/meditation around the stupa (a so-called cora) - They carry beads to mark the number of times around, always walk clockwise, and often touch the 180 or so prayer wheels on the walls for guidance.  The central area of Bouhda is close to guesthouse and so i have to come to the stupa each morning because cafe's are in this area. I enter at a point that requires me to go about half way around to get to the cafe going clockwise.  Yanik pointed out that it is "bad" to go counterclockwise and people may get mad about that, sooooo, clockwise it is.  Trying to match waking at an early time to get to the cafe that opens early (6 am), but is slower, with the i'net fastest time (here 6-7).  There  is a sun disruption at about 8-8:10 that cuts off all satellite connections, so any unsaved work is lost  (this is the third time posting this one, but it gets crisper each time).  My language class starts at 9:30 back at the house and my teacher is great in working on phrases that can make me polite and barely conversational (but it's only been the second class).  Today is the start of the medicine classes and they are to run 3-6 (gets dark at 6) and long walk home in the dark, so my wayfinding will be tested.

Bought a great tibetan meditation cushion from a store adjacent and the material is excellent and colorful and just the right amount of softness for $2.50. In the adjacent supermarket, a pack of digestive cookies is about $4.00 - hand materials are cheap, foods and goods are expensive - luckily wine is about the same as in the states.

Will try photos from this fast(er) connection this evening on the way back from medicine and see if i can get some on from yesterday and today.

Porters (coolies) are day/job laborers who are sturdy guys who carry HUGE loads on their backs by using a strap attached to their forehead for balance and stability. 

This upload try was 8 minutes - we HAVE to do better - will retry anotehr place early tomorrow.  The photos add so much to the story - please bear with me!

no-no's in Nepal

Early in this stay, Yanik gave me the official "no-no" list so that i did not make any major errors, but they are so difficult unless i'm thinking about them, that i have to do an extra bit of concentration

- do not touch anyone on the head - the head is sacred and not to be touched, even children in friendliness

- do not point your feet at anyone- the feet are the lowest part of the body, unclean, and even crossing your legs will inadvertantly point a foot at someone - i've done this several times and caught myself before i got stairs - it's harder to do than i thought

- Do not put your feet on the table, chair, or anywhere off the ground, especially near a shrine - as above - no respect

- do not put books on the floor, and if you see one, pick it up - books are highly valued as symbols of knowledge and learning (even comic books), so keep them off the floor!

- cows are sacred, so they roam freely and can't be injured or even cajoled out of the way

Those are the major ones, but i'm sure i'll learn minor ones

The food lion theme is popular here - it is the theme for a major asian university, but i keep expecting the familiar sign of the food lion (noticed this several days ago as the last TV experience)

There is an interesting daily ritual for the monks at the monestary from my last few days - a form of debating.  Two monks are partners and choose a topic of religious doctrine, one sits lower than the other and argues one side; the other stands and makes his point by slapping his palms together to make a point - picture 50 or so pairs each arguing something different with the raised voices, and periodic slaps.  Apparently it is a senior monk ritual for them to reinforce doctrine. According to my tibetan language teacher there is a winner and a loser.  photo posts extremely slow today, so will post writings to get them out and add photos when i can find a good window 

The value of local contacts is clear - Vidhea and Yanik have been so helpful in having cabs, transport, assuring moves, wayfinding, and many other courtesies that ease the culture shock of the introduction to Nepali life.  Their website for those who may be in the market for a personal passage in this part of the world (Passage: project for Interntional EducationPassage: Project for International Education).  Vidhea's phrase "We have options" is a response to any challenge students give here - she usually gives GREAT options.

The story i heard last night from dinner with my two other students staying at the homestay (beautiful third floor airy rooms with a wonderful family - more on that as internet speed is better with photos) is that i was initially billed as an astrologer (i guess because gastroenterologist does not come across well) and they were so excited that someone could do their astrological charts and give horoscopes and they told a bunch of other students; then there was a correction somewhere that i was an astronomer and the excitement dimmed.  They never told me where GI docs rank in that excitement level. First tibetan language class and i did well with pronunciation of common phrases - good morning, etc, etc; we'll see if can practice enough to make it through the ritual tomorrow

Getting ready to work

The orientation to the chaos of nepal is getting ready to end and my language course in tibetan starts tomorrow (9:30-11) and my tibetan medicine starts tomorrow  (3-7).  Up to now i've been shuffled around by yanik and having a wonderful time of seeing nepal.

Timed photos for the blog upload and each photo takes on average 5 minutes to upload, so I'll be very sleective about those i post to not overwhelm the reader and still try to show the local environment.

The monastery guest house for last night and tonight is a jewel - well away from the traffic and pollution and quiet.  Really good vegetarian restaurant attached.  Miraculously, the dogs and conversation stop at 9:15 and stay totally off until about 6:15, then they start up again.  The garden is peaceful   and a perfect place for that strong nepali coffee.  The room is spartan as you might expect for monks with a hard bed, and a nepali bath - combined commode and shower with no curtain, so that when the shower is on the rest of the bath gets cleaned as well.  Yanik took us to the monkey temple today for a tour by Hubert - a great tibetan scholar with a detailed history that gets better with each telling because of his engaging personality.  Hubert has a complicated travel history, but is one of the preeminent tibetan scholars around.  The history of the country is so incredible not only because of the complexity and devotion to many types of deities, but because objects and artworks that date fromn the 11th century are openly available to the public.  As wth all temples in nepal, it is custom to remove your shoes when you enter.  More on temples and regligious significance as i know more - now i'm just in wide-eyed wonder at the incredbie religious devotion of everyone.  As some of you knew, i used to work with cynomolgus monkeys in my research (totally non harmful for you animal activists!!!).  IN this tmeple, rhesus monkeys roam free and are real tricksters.  One just deftly swiped a little girls' bag of chips (she a\was about 2-3 and devestated) - the monkey sat off to the side and gave a big nanny-nanny as he ate them.  Loved the cute monkey babies 

Nepali's are excellent cleaners - in every place i've been there have been many people working to keep the areas as clean as possible.  The temples are no exceptions.

Food - vegetarian and some periodic chicken.  Pizza for lunch with rare salami.  No snacks and lots of walking (more so than alaska).  My hour of internet time is up.... BYE

First legs of travel

first post from nepal after an uneventful, but long flight.  posting from the slow connection at the hotel to get some thoughts down and may continue this later depending on how late they are open.

all of you know the challenges of long distance travel; and this is the longest route i've taken.  All flights went well, just the right connection time and interesting local food on Thai airways  (3 substantial meals).  On the 16 hr flight i watched 5 movies to about catch up on my missed theater movies and did not sleep at all (i cannot sleep on planes in spite of drugs and a good seat).  Glad i chose to overnight in Bangkok and caught up on a good sleep (the new bangkok airport is about 30 miles outside of town and i could not muster the energy to get transport down there since i'll be much more experienced for the 2 days i stop there on the way back.  airports are a mixtue of sterile and local art -  photo coming of airport detailed art piece depicting the battle over the milk sea in early Thai history (the detail on the figures is what i wanted to show)

Kathmandu is a mixture of poverty, slums, crowds, happy people, honesty, friendliness, smog (my local contact asked if i brought a face mask because of respiratory issues).  Going to a shushi place tonight he recommended and ti turned to be more tempura with no sushi slections - i was the only one there at 6:30 and service was slow (most nepali's eat out between 9-10 pm which will leave me out).

Yanik, Vidhea's son has been my local guide - - a hip, local 25 year old rock disc jockey of american 60-70's music who promises to teach me all the local slang - always good to have a few "choice words" when you hit your finger with a hammer!

out for a walk this am at 6 and saw a different side of the city with hard-working street sweepers cleanign up the debris of a typical night with LOTS of dogs screening the scraps before they get pitched.  Interesting to see smartly-dressed youngmen and women ontheir way to school at 6 - think it's a local college. The breakfast at the hotel was a dieter's nightmare - especially helpful wait staff keeps feeding you more and more and have to physically leave to avoid getting even more food.

Looking for the nepali people's personalities; not the shop keepers selling stuff to trekkers (this is the peak trekking season) and hoping to get some entry into that from the homestay.   Hope to have a faster connection in Bhouda for photo upload, but wanted to get this posted.

Traffic is cut-throat and Yanik and i will be taking on an extreme sport to go to my homestay area on his motor cycle.   Weather hot and sticky at 88.  Time difference is EST + 9.45 hrs  (how the .45 hr gets figured remains to be explained)