Nepali Language Class

Today I finished my last Nepali language class. During my six weeks here in Tansen, I attempted to learn some of the language so I could talk with patients. The hospital has an excellent language teacher (guru), Keela. I had private lessons for an hour three times a week where we covered vocabulary, grammar and some medical phrases. However, I did not try to learn the Nepali script, which is very similar to Hindi.

I love learning new languages, and I think I picked up the basics of Nepali pretty quickly. But it is one thing to speak and do drills in class and quite another to converse in real life. The average Nepali speaks with a lot of slang and informal grammar, not to mention slurring everything together so it is difficult to make out the individual words. I can ask a few simple medical questions, but usually the response is un-interpretable, so I tend to rely on translators most of the time. When listening to Nepali doctors interview the patients or hearing a sermon, I can pick out words and phrases, sometimes even enough to get the gist of the conversation, but usually not much more than that. It is frustrating not to be able to communicate directly with people and say the things I want. It is also humbling – reminding me that I am completely dependent on God for everything.

Although my time in Nepal is almost up and I will likely forget all the Nepali I’ve learned once I get home, I have had fun in the process. I feel grateful and confident that I can still learn a new language should I choose to do some long-term missionary work in the future. Language is an amazing thing when you think about it. Communication is a gift that God has given human beings so that we can relate to one another. To think that we are born with our brains wired to learn language, and that some people can learn several different languages and keep them all straight – it is truly amazing. There are so many languages, dialects and accents, and God understands them all. Now they separate us from others, but one day we will rejoice around the throne of heaven worshipping our king in a multitude of tongues yet as one people.

Here are some of the things the Nepalis will say to God in that day:

• Danyabad Yesu – Thank you, Jesus


• Prasansa hos Prabu – Praise be to the Lord


• Yesu nauko jai hos – Praise the name of Jesus


• Eswarlai maheema hose – Glory be to God


• Aru nauma chaina tyo mukti - There is salvation in no other name


• Hameelai titauchan sarwa sada – he loves us forever
  

Well, that’s enough language lesson for today!

Missionary Life and Fellowship

Since my social calendar has become quite full lately, I thought I would devote this posting to talking about some of the ways missionaries here share their lives and build relationships with Christians and non-Christians. Despite a busy work schedule, the missionary doctors seem to find ample time to interact socially. Here is a glimpse of “missionary life” from my recent calendar:

Tuesday: Dinner with Nepali interns and residents
Manisha, a lovely female intern, cooked some delicious Nepali treats for the medical students – chikauni (potato salad), chicken curry, and khir (rice pudding). We brought fruit salad and veggie salad, which were quite a hit with our Nepali friends. I enjoyed learning more about my Nepali colleagues – their families, culture, education and experiences in medicine. Several of them attended medical school in China, so they know what it is like to live in a foreign country where they don’t speak the language.

Wednesday: Dinner and a movie
I spent my afternoon off with a Norwegian surgeon who is here for a year. She is also single, and I was encouraged by her trust in God to care for her and sustain her as she traveled alone to Nepal for a whole year. We have a lot in common actually and have enjoyed hanging out together and encouraging one another as single gals seeking to serve the Lord in medical missions.

Thursday: Dinner at Nanglo’s
I joined Alice (New Zealand medical student) and her husband Ben at the one nice restaurant in Tansen (called Nanglo's), which serves a selection of Indian, Nepali and Chinese food. Although the price is three times as much as the hospital canteen, you can still eat a very nice meal for less than five dollars.

Friday: Out on the Town
Alice and Ben showed me their favorite place to eat in the bazaar – Mini-Nanglo’s, or also affectionately called the “MoMo Man.” Accompanying us were Hans (a Swedish surgeon) and his wife Anita, and Morag, a Scottish teacher who is teaching English in a local school for a few months. The MoMo Man is a hole in the wall, literally. We sat at a table in the back room, which also serves as a bedroom and wash-room when the diners vacate the premises (the restaurant is also the owners’ home). Occasionally family members came to brush their teeth at the faucet 10 feet from our table.

Saturday: Nepali Church, Bazaar and Lunch, Bideshi Church and Movie Night
I started the day at Nepali church, where I now recognize many familiar faces – Kasi Ram (the tailor) and his family, several members of the hospital pastoral care team and the occupational thearapist, and many of the missionaries and their families. Following the service, I did some shopping and had lunch in the bazaar with Carrie – an Irish gal who used to teach the missionaries’ children – and Yvonne, who is the current missionary school teacher. I arrived back at the hospital guest house just in time for the “bideshi” (English-speaking) church service. Every two weeks, the missionary families gather for worship, prayer and reflection. They take turns leading the service. This week, an Australian family organized things, and it was neat to see the whole family participating. Church was followed by a fellowship meal and then a movie (for anyone interested, the movie was called Caravan – a documentary about the life of a village/tribe who carry their salt on yak-back through the mountains to trade – filmed in Nepal).

Sunday – Dinner with Dr. Lisa and family
I invited myself to Lisa’s house for dinner. Lisa is an American pediatrician who is responsible for supervising the medical student rotations. I really enjoyed working with her on pediatrics and wanted to spend some time hearing about her experiences as a long-term medical missionary. She answered all my questions about preparing for the field, raising support, keeping up with friends and family back home, etc. I hope I was able to encourage her as well.

Often the missionary families organize social activities for the Nepali interns and residents. One night, we joined them for a talk on “How to find your Jiwan saathi” (how to find your lifelong friend or mate). The couple who organized the event talked about the Nepali/Asian approach to marriage (often arranged) and compared the Christian concept of marriage. Then they shared their own story and some of the principles and practices that have made their marriage strong. They asked the interns what they wanted in a husband/wife and what they thought about marriage. It was an interesting time to learn about Nepali ideas of marriage, male/female and husband/wife roles. What a great way to engage the Nepalis on a topic of extreme interest that allowed some exchange of ideas about values and beliefs. Other missionaries open their homes for Bible study, prayer meetings, game nights, and other activities that allow casual interaction and an opportunity for Nepalis to see what a Christian home and family life is like.

As you can see, I have been blessed with wonderful friendships and fellowship here in Tansen, leaving me with little time to be bored or lonely! I am grateful for this glimpse of missionary life.

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.