Pastoral Care

Tansen Mission Hospital (TMH), as its name indicates, is a hospital with a mission. The hospital logo states, “We Serve, Jesus Heals.” One of ways TMH serves is through the Pastoral Care Team, a group of dedicated Christians who provide prayer, counseling, and financial assistance to patients and families. I had the privilege of spending two days with the pastoral care team, possibly the best two days I have had here in Tansen.

The team starts their day with worship and prayer in the hospital chapel. Then they make rounds on the wards. I joined Silas as he visited patients who were due to have surgery that day. Silas asks patients how they are feeling, tells them that the doctors in the hospital serve Jesus and believe that ultimately he is the one who heals the patients, and explains that we pray in Jesus’ name, knowing that God hears our prayers and will grant us the peace and joy that only he can give. He then asks the patient if they will let him pray for them, that their operation would go well and that they will have peace in their hearts. Most patients accept prayer, with varying attitudes - some grateful, others skeptical.

We visited one little girl, about 10 years old, who had fallen from the roof of her house and needed surgery to set her broken arm. Her father was with her, an older man of very humble background by appearances. He told us that this was the youngest of his ten children, and as he spoke, he got choked up and turned his face away to hide his tears. Silas was able to talk with him and pray for him. I think he was worried about his daughter, about the costs of the surgery and hospitalization and about his family back home. The prayer seemed to have a calming effect, and who knows what seeds were planted in this man’s heart regarding Jesus’ love for him and his family.

Next Silas counseled a young lady who had attempted suicide by swallowing agricultural pesticides. She explained that she had been angry with her father because he beat her when he was drunk. Silas talked with her about the perils of anger, shared some verses from the Bible and talked about God’s power to help us control our anger. Then he called her parents in and talked with them, explaining that their daughter’s suicide attempt was a cry for help – she longed for a close and loving relationship with her father. He pointed out that the father’s drinking was hurting the family and could have (almost had) tragic consequences. Silas encouraged the girl to tell her father how she felt about his drinking, and he admitted to having a problem with alcohol. Finally, Silas invited the family to the hospital prayer service (held at noon daily in the chapel), where he gave a message about how Jesus provides a better way of dealing with anger and stress than liquor or other vices. I don’t know if the message made any impact on the family, but they came and heard, and now at least the father knows there is someone who can help him stop drinking.

In the afternoon, I joined Seti, another pastoral care team member, as he interviewed patients to assess their financial need. The hospital has a charity fund to help patients who cannot afford to pay for the care they receive. The pastoral care team is responsible for deciding who is eligible for social services. They ask patients about the number of family/household members, employment and income, land holdings, number of oxen, goats and other animals, debt burden, and other possible sources of assistance (e.g., from relatives or community members). When patients are approved for charity funds, the pastoral care team explains to them that the funds come from Christians around the world who support the hospital and pray for the doctors and patients because they love Jesus. So everyone hears about the love of Christ before they leave the hospital.

During my time with Seti, we visited an elderly woman, 78 years old, who was admitted for heart failure and emphysema. She told us that her husband died 10 years ago, though in fact he had married a second wife 30 years earlier and had not provided well for her since that time. Her only son left her three or four years back and she has not heard from him since. Although she has land, it lies uncultivated because she has no one to help her farm it. She works as a day laborer when she can get work, carrying loads of firewood or other supplies for 50 Rupees a day - about 80 US cents. However, for the past month, she has been unable to work due to worsening heart failure and difficulty breathing. Currently, she lives with neighbors and depends on them for food. She does get a small “old age” pension from the government – 500 Rupees a month, about $US 80. As it turns out, she is a Christian and goes to church in her village. When we prayed with her, she literally wept with joy.

As I walked through the hospital wards with the pastoral care team, I saw the patients and families with new eyes. Sometimes on medical rounds, we focus on the physical problems – vital signs, wound infections, how the lungs sound – and don’t see the spiritual pain and sickness written in the faces of patients and their loved ones. These past few days, I have been more aware of the spiritual side. When I look around the wards, I see curiosity in the eyes of onlookers as they see us pray with patients. (Side Note: the hospital wards are very open with up to ten beds per room and little privacy. Everyone knows everyone else’s business. At times this is a good thing – parents in neighboring beds can look after each other’s children and encourage one another. But when doctors are visiting with one family, the entire room listens and watches, which is a little awkward.) Sometimes I see desperation and despair, weariness, depression, loneliness, pain, and longing. A kind word (even if I don’t speak Nepali), a gentle touch, even a smile can bring comfort to a patient who is alone and scared. I pray I never lose sight of the importance of this ministry and that I will never be afraid to enter into the spiritual side of my patients’ lives.

The Pastoral Care ministry at Tansen Hospital is special. Few hospitals in Nepal have a pastoral care department and even fewer have such a devoted Christian staff to carry out the vital task of bringing spiritual healing to the patients. It is a tremendous witness to patients, families and even the Nepali doctors and nurses.

Rain, Rain and more Rain

Today is the third day of rain in a row. I thought the monsoon season was over, but apparently it is having one last hurrah before the nice weather arrives. For the first time since arriving, I have needed my sweater – I only brought one – and wished I’d brought a rain coat. The water is desperately needed, as Nepal depends on hydroelectric power. In the dry season, the water shortage means hours a day without electricity, as well as limited water for household use. Unfortunately, the heavy rains have caused flash floods and landslides throughout Western Nepal, killing at least 36 people and injuring and displacing many others. Houses have been swept away or buried in mud and debris, and overflowing rivers have flooded crops and villages.

Today, we had a road vehicle accident arrive at the emergency room with nearly 60 injuries - most likely due to the slippery roads and poor visibility. Please pray for those affected!

In the morning doctors' meeting, we heard how the entire hospital staff worked together with great commitment and compassion to triage and care for all of the injured from the accident. Even the custodial and security staff helped by handing out blankets and comforting injured and scared children separated from their parents. This is truly a wonderful hospital to work for!

Reflections at Half-way Point

Actually, I am more than half-way through my clinical rotation here in Nepal, and many of you have asked me what I like most about Nepal, what I miss most about home, what challenges I've faced, and what I’m learning. So I thought it was time to take a few minutes to reflect on my experience thus far. I’ll start with the easiest question:

What do I like most about Nepal?
The people, the culture, the food, the natural beauty. Nepali people are extremely friendly, hospitable and gracious. The women dress in the most colorful saris and khurtas, so walking down the street is a feast for the eyes! Then, no matter where I walk, children run after me shouting “Namaste! How are you? What is your name? Where you from?” Nepali culture is rich in little niceties – greeting people on the street with a slight bow and hands clasped together, always asking about friends and family, offering tea to visitors. Nepalis also love to share their food, no matter how humble. In fact, I have been surprised several times when one of the Nepali interns invites me to try a bite of whatever he or she is eating at tea, right off their plate (if my brothers-in-law are reading this, take note!). I know we do these things too, but it seems more significant when you are a stranger in a foreign land to be the recipient of these small blessings.

Nepali food is amazing – a blend of Indian and Chinese really. I already described some of it in a previous entry. At about 10:00 each morning, after morning rounds, the interns and doctors head to the hospital canteen for chiyaa (tea). The chiya is made with milk, spices and sugar, much like what we call chai back home. For Nepalis, this is their breakfast, and they eat any of a number of tasty treats with tea:

• samosas - fried, triangular shaped “hot pockets” filled with spicy potatoes and veggies
• parartha - a cross between a tortilla and a pancake, sometimes filled with spicy potato
• chole - something like a spicy chick pea stew
• aalu achar - potatoes with tangy cucumbers
• pakota - vegetable fritters
• and momos - steamed dumplings filled with meat or veggies

And the scenery – well, Tansen is absolutely beautiful. The hospital complex is up on hill overlooking a valley planted with rice paddies – very green and lush this time of the year. In the morning, the valley is usually filled with mist or clouds. So I look out my window and see the green hills around a carpet of white - wow! Behind the green hills around Tansen, on a clear day, you can sometimes see the majestic, jagged, snow-capped peaks of the Himalayas. We are too far west to see Mount Everest, but some of the western peaks are nearly as tall. I’m told that any day now the weather will clear up and we will see the peaks every day. Can’t wait! I have enjoyed exploring the area on short and long walks. There are many trails and paths that lead to incredible vistas, forested hills and beautiful flowers.

What do I miss most from home? Not much really - Diet Coke, friends and family.

What are the biggest challenges?
Apart from the challenges I described in my previous post dealing with patients dying, I guess the biggest challenges are simply physical inconveniences – heat and humidity, travel and critters. Surprisingly, at 4000 feet above sea level, the weather has been much like Houston. The humidity plus strong sun light make for a rather uncomfortable stickiness most of the time. Fortunately, it does cool down at night, and I'm told that the cooler weather will arrive any day now.

Travel is always an adventure, as in any developing country. Buses only take off when they are over-full with people on the roof, in the aisle and hanging out the door. And they stop every two seconds to let someone on or off. The winding mountain roads are narrow with minimal shoulders, so passing other vehicles is frightening whether you are on the side looking straight down the steep cliff, or the side where your bus comes withing millimeters of the bus going hte other direction.

And then there are the bugs - little ones, big ones, biting ones, singing ones (cicadas). . . The ants are a constant, and not just in the kitchen - there is always a column of ants coming and going down my wall near the window. They clean up the dead bugs, crumbs, and other things I don’t even see, so I don't mind much, as long as they keep away from my bed. The spiders are my least favorites – big, long-legged, creepy looking spiders that come in the cracks of the windows or ceiling. I hate squishing them, but I just can’t bring myself to turn off the lights at night knowing there is a spider on the ceiling waiting to parachute down into my bed while I sleep. Oh, and last night, the guest house manager called me outside to see a snake he had killed right outside the guest house door (my room is right by the door). It looked like an innocent green grass snake to me, but I was told it was rather poisonous. Supposedly they don’t like to come inside – small consolation! I will definitely think twice before taking my laundry off the line at night, as the clothes lines are in a grassy area near the guest house.

What am I learning?
That is the most difficult question of all. I am not sure I can truly answer it now – it may take some time after I get back to Houston to discover the ways God has used my time and experiences here. I suppose I am learning about myself mainly. Am I willing and able to live and serve in a place like this? Could I ignore the inconveniences and discomforts for long-term? Would I be able to learn a new language and develop relationships with people from an entirely different culture? Would I be able to sustain my relationship with God? Would I find people to pray with and be accountable to?

The answer to all of these questions so far is YES. From past experience, though, I know that the first weeks in any new place are always fresh and exciting. It usually takes about six months for loneliness and homesickness to set in. So far, I haven’t really felt homesick or lonely, and I doubt I will get to that point before I leave. But even now I can see how God has provided encouragement, friendship, and even little tastes of home (movies, Skype video calls, even chocolate!). And I have “connected” with missionary doctors, Nepali interns, patients, and shopkeepers in the short time I have been here – perhaps not deeply, but enough to feel that I could build deeper relationships here if I had time. I do not know if I will come back to Nepal for short- or long-term work. I hope so. This time has certainly confirmed my desire to serve somewhere, somehow in a poor country like Nepal. I can see how God is using the missionary doctors here to further his kingdom, encourage the Nepali church, and share his love with people who are poor, sick and needy. And I know I want to be a part of something like this.

My Patients and My Patience

As my Nepali improves, and my knowledge of the hospital routine, I have had some really good experiences taking care of patients. Kalpana is an 8-year-old girl who came in with meningitis/encephalitis – an infection of the brain that can be caused by bacteria or viruses (some of them mosquito-borne). When she arrived, she was unconscious and paralyzed on the right side. During her two weeks in the hospital, she made very slow but significant recovery. She woke up, responded to commands, was able to move her right arm and leg a bit, eat, and sit up (with assistance). However, she still isn’t talking and has not recovered full strength in her limbs yet, so her prognosis is guarded. The occupational and physical therapy team worked with her and her parents, showing them exercises to do with her to re-teach her brain to coordinate movement and hopefully strengthen her muscles. I enjoyed being a part of her care team and learned a lot about encephalitis and meningitis in the process. It was great to write her discharge and see her parents take her home. Please pray that she recovers fully. A child with physical handicaps is a tremendous burden on a rural Nepalese family.

Sisir is a 5-year-old boy who presented with a huge lump under his right jaw. It looked like mumps, but mumps is generally on both sides of the face. He had a low-grade fever and tenderness in the area. It could have been an enlarged lymph node or a developing abscess. The lump measured 7 x 5 cm on admission, but quickly shrunk to less than 2 x 2 with IV antibiotics. He was very happy to be able to go home for Dasai! Sisir’s dad spoke a little English, which made my daily interview and exam much easier. And I heard Sisir counting to ten in English on one occasion, so I entertained him by trying to count to ten in Nepali.

Bikram is a 3-year-old boy who came in with 15 days of fever, decreased appetite, and general malaise. He had a huge liver and spleen and was diagnosed with typhoid or enteric fever (caused by Salmonella typhi – not the same Salmonella that causes food poisoning, but related). His mother was beside herself because day after day, Bikram kept spiking really high fevers and not eating well. One day she was in tears with worry and asking why he wasn’t getting better. Typhoid is like that – it can go on for days or weeks, even with antibiotics. I told her in very bad Nepali that I was praying for her – no idea if she understood or not – and asked the pastoral care team to visit and pray with her (I don’t know how it was received or what effect it had). However, the next day, mom was all smiles and reported that Bikram was better, the fever was much less, and he was eating well. They went home the next day, very grateful for a good recovery. I hope that somehow they experienced the love and healing of God during their short stay here.

Other stories are not so happy. I have seen so many children die the past four weeks – of meningitis, overwhelming infection, and respiratory failure. This week, I was taking care of a preemie born at 31 weeks (about two months early) weighing 1700 grams (normal 3000-3500). He was jaundiced and had to be placed under a special lamp. And he had a heart murmur from a patent ductus arteriosus (a shunt between the aorta, which pumps blood to the body, and the pulmonary artery, that channels blood to the lungs to pick up oxygen). A PDA is normal and useful before birth, and it usually closes within hours to days after birth. But this baby’s stayed open for some reason, causing his little heart to work harder, pumping more blood through his lungs, and decreasing flow to the rest of his body. Then, unfortunately, he developed necrotizing enterocolitis (NEC) – a condition in which portions of the intestine become injured and die, causing bleeding in the stool and even perforation of the intestines at times. Premature babies are at higher risk of NEC and are less likely to recover. This poor little guy just couldn’t overcome all of the problems he faced. He started having trouble breathing and finally just stopped. It was really hard to see him in the end, but it was even harder to see his mother’s reaction. She was beside herself with grief from the moment he began to go downhill, sobbing, wailing and even falling (or throwing herself) on the floor in agony.

Perhaps even more troubling to me, though, is the lack of emotion from parents. One night in the emergency room, a 2-week old baby was brought in blue and not breathing. We tried to resuscitate him unsuccessfully, and he was pronounced dead on arrival. The parents did not show any sign of distress. They simply signed the paperwork and took the body home. Some people say that parents here don’t get “attached” to their babies too soon because death in infancy and early childhood is so common. In fact, many babies are not given a name until some days or weeks after birth. It is hard for me to believe this is truly the case. Surely any woman who has carried a child in her womb for nine months and nursed him at her breast for even a short time would feel some grief if the child died. Perhaps those parents who don’t appear to grieve are simply hiding their pain deep inside until they can express it in private. I suppose doctors do the same thing. I certainly felt like weeping and wailing for that baby – so cute and chubby like all babies are, but lifeless – and yet I simply went on with my work.

Seeing children die is a challenge to my spiritual and emotional equilibrium. I am forced to grapple with the reality of death and disease while attempting to show empathy, compassion and love to my patients and their families. How do I feel their pain without succumbing to it? It is such a joy to see a child get well, to see a baby smile and coo or a 5-year-old running down the hall of the pediatric ward. But to see a child in pain, gasping for breath or delirious with fever defies everything that is good and right and beautiful. I am so thankful that we have medicines and procedures that make people better, and that God in his mercy has given us bodies that have remarkable healing capacity and the knowledge and ability to harness that capacity to speed or assist the healing process. Ultimately, however, life is not ours to give or take, and even as a doctor I can only wait on God and plead for his mercy. It’s humbling. But I have been meditating on his promise that one day he will wipe away every tear, and there will be no more sickness, no more death, no more pain or grief. In the meantime, I find I need to go to him every day to renew my capacity to love and show compassion.

Hindu Festival

Dasai is a major Hindu festival in Nepal, sort of like our Christmas. The festival lasts for 10 days and commemorates the mythical victory of Lord Rama over Ravana, the demon king of Sri Lanka. Dasai is a family holiday, so Nepalis travel home to gather with relatives for feasting and worshipping various gods with prayer, offerings and sacrifices (goats mainly). There are special blessings for family members, homes, vehicles, etc., and everyone gets new clothes. Children and younger family members receive special blessings from elders, which are bestowed with a tika (red spot) on the forehead. One source told me that on one of the days of Dasai, people worship dogs, so they put tikas and bangles on their dogs and treat them nicely for a day. On the two main days of the festival, people take their goats to the temple to sacrifice to one of the Hindu gods. They also build huge bamboo swing sets, and I heard there was a ferris wheel in the bazaar. (No wonder there were so many broken arms in the hospital over Dasai!)

I managed to have a good conversation with one of the pediatric interns before he left for the holiday. I asked him what Dasai meant to him, and he said it was pretty much just a cultural thing, a time to be with family and friends. He does not believe in any god and hasn’t since he was a small child. Although he will receive a tika from his parents and grandparents at Dasai, he does not plan to worship at the temple. I hope to have more conversations with others over the next few weeks, as it is a good way to start conversations about faith and beliefs.

Things at the hospital were really busy despite the holiday. Other area hospitals were closed, so the mission hospital here in Tansen received many referrals of critically ill/injured/pregnant patients. Half of the interns and residents were on holiday, so I actually felt useful helping on rounds and in the Emergency Room.

Bagnas

Bagnas

This Saturday (Shanibaar in Nepali), I walked to a house church in Bagnas, a village about one hour’s walk from Tansen. The church was started when Meena, a young lady who cares for one of the missionary children, became a Christian. She heard the gospel from the missionaries she worked for and eventually gave her life to Jesus. Her family wasn’t happy with her at first, but soon they also converted. The family faced ostracism from the community for a time, but many others have now become Christians and others are at least accepting of their new faith. The small church (about 30-40 people) now meets in their house. Pastors from Tansen take turns preaching on Sundays.

The service was simple but really beautiful. The music was simple – a guitar and tambourine. Then they had a great time of prayer, with people sharing prayer requests and others praying for them. I was moved by their passion and love for the Lord. I wish I could learn each of their stories, as I am sure they all have an amazing testimony to how they heard and responded to the gospel and what it has meant to be a Christian in Nepal. There were lots of children present, and I just kept thinking how awesome it is to see the next generation of Nepalis growing up in Christ. The sermon was in Nepali, so I can’t really say much about it. With my Nepali lessons, I can pick out every fifth or sixth word, but not enough to put it all together. Still it was cool to listen and watch. I am going to try to find some time to study my Nepali/English song book and learn the words for Lord, Jesus, prayer, praise, salvation, cross, gospel, etc. I might even try to get my Nepali teacher to go over some Christian terms with me. He’s not a Christian, so it could lead to a good opportunity to share the gospel with him.

After the service, Meena and her family invited us for a “snack” in their house upstairs from the church. It was so-o-o-o-o-o-o-oooooo delicious (mito). They served some kind of roasted chick peas that were really nicely seasoned, fresh cucumber slices from their garden, fried potatoes, and beaten rice. I don’t know how the rice is made, and I’ve never eaten anything like it – it’s toasted, crunchy and yummy. It was so humbling to receive such warm hospitality from people I don’t even know!

The walk to Bagnas follows the ridge between Tansen and the highest point of the area where there is a radio tower (see photo). Compared to my last walk (death march, really), this was quite pleasant – a bit of uphill on the way, but mostly flat and downhill on the way back. Saturday was an absolutely beautiful day for a walk – crystal clear with the Himalayas visible on the horizon and cool (at least in the morning). The views over the Tansen valley were amazing. Along the way, there are several little communities (clusters of houses really), and everyone was out walking or just working or visiting outside their houses due to the Hindu festival this week, Dasai. We got lots of “hellos” and “namastes” (Nepali greeting). The children especially love to chat with foreigners and practice their English, “How are you?” “Where are you from?” (imagine this said in strong Nepali/Indian accent). Everyone paints their houses for Dasai, so it was really colorful and festive.

My traveling companions were two Australians – Graham and Elaine – and an English medical student, Kat. Graham is a surgeon, and Elaine (his wife) is a nurse. They retired with the specific goal of spending several months a year doing medical missionary work. Now they spend three months a year in Nepal and two to three months elsewhere (Africa, Papua New Guinea). They’ve been to Nepal several times already and know many people, including Meena and her family. Kat is finishing her last year of medical school and leaves Tansen this week. She is really lovely, and I’ve enjoyed getting to know her.

Nepali Hospitality

Wednesday night I had the honor of being the invited guest at the home of Kasi Ram and Nirmala. Kasi Ram is a tailor who makes clothes for many of the missionary doctors and medical students (I’ve already had him make me four Nepali outfits!). While waiting for him to finish my outfits, I have sat in his shop visiting with him and his wife for a couple of afternoons. This is their story: Three years ago, Nirmala was very sick and almost died. In fact, her heart stopped for a time and she had to be resuscitated. During this time, some missionary doctors and local church members prayed for Nirmala’s healing and shared with Kasi Ram about Jesus. When Nirmala recovered, Kasi Ram started going to church. Soon he and his entire family became Christians and were baptized. They faced persecution from friends and family but have persevered in their faith and are very involved in the local church. Their son, Bikram (22 years old), attended Bible college for two years in Kathmandu and hopes to become a pastor eventually. He is helping to organize a youth retreat for next month and asked me if I would like to give a talk on purity if I am still in Tansen. His two sisters, Eleni and MonaLisa (like the painting), are 17 and 20 years old and attend college in Tansen, both studying commerce. Bikram speaks English pretty well, as does Kasi Ram, so I was able to converse with the family and have Bikram translate so I wouldn’t leave the women out. Otherwise, with my limited Nepali, we would have had a very quiet dinner!

Kasi Ram lives in a house that was his grandfather’s grandfather’s. It is a two or three story structure with the kitchen and family room on the second floor. We sat on the floor to eat dinner, which is the traditional way, I think. Dinner was quite a feast. For those who are not familiar with Nepali food (similar to Indian food mostly), I will describe the dishes in detail.

Daalbhaat is the main meal here – rice and lentils. Picture a plate heaped with rice and a bowl of lentils (of varying liquid content). The lentils (daal) are poured over the rice and the two are eaten together. It is not particularly seasoned or spicy. It is the side dishes that make the feast. Vegetables (tarkari) of some sort are stir-fried and seasoned with curry or other spices and served on the side. At Kasi Ram and Nirmala’s, we had a squash/pumpkin/potato-like vegetable side, AND green beans (simi). She also made chikauni (see below) and crisp rothi (bread) and chicken!!

Pictured: Clockwise from top left - chole (chick peas), daal (lentils), tarkari, more veggies, rice (bhaat), chili sauce or other veggies.

Chikauni is a potato salad made with yogurt, onions, and various spices and other veggies. Apparently it is specific to the Tansen region of Nepal. And it is quite tasty! Fortunately, Nirmala sent me home with some, which I enjoyed for lunch today. I am guessing it is healthier than our potato salad with mayonnaise. Oh, I forgot to mention that the milk products here are generally from buffalo, not from cows. It has a distinct taste and smell, though I’m not sure if that’s because of the animal species or just the way the animals are raised and grazed here. The yogurt is definitely tangier than what we have back home!

After I had stuffed myself on the delicious dinner, Nirmala served dessert – yogurt with banana and pomengranate. I didn’t think Nepalis ate dessert, but apparently I was wrong. I managed to finish off my plate (it was really good) and a cup of chiya (spiced milk tea).

After dinner, the family sung a song From the Rising of the Sun. Of course they sung in Nepali, but I managed to make out a few words. Then they asked me to read a passage from the Bible. I read from John 15 in English and Kasi Ram then read in Nepali. I recognized the word fruit (phalphul) as he read, so I felt like I was following along! Then he asked me to pray for his family and he closed in prayer. It was really awesome to worship with this wonderful Christian family. I thank God for them and for their faith. Please pray for them if you think about it. I think it would really encourage them to know that other people in my country are praying for them and for their small church.