New Year's Reflection

During my quiet times in 2009, I read through the book of Isaiah. Recently, Isaiah 62:6-7 really spoke to me. It reads, "You who put the Lord in remembrance, take no rest, and give him no rest until he establishes Jerusalem and makes it a praise in all the earth."

Those verses were written for the Jewish people centuries ago, but I believe they are still applicable for God's people today. I was particularly struck by the words "take no rest." Since I am a person who loves and craves rest, especially when life gets busy, which seems to be all the time in medical school, I had to stop and think about what that verse means. Surely God wants us to rest and be refreshed. His Sabbath is certainly a day of rest and a time to worship him and refocus and refuel for the week. But I think this verse is talking about a different kind of rest. There are Biblical passages that talk about God's eternal rest, which those who believe in Jesus will enjoy when he comes again and ushers in his kingdom. However, I think this verse calls for a mindset or attitude of perseverance and steadfastness in our pursuit of God's kingdom.

Sometimes I grow weary of life - always adding to my to-do list but never fully completing it. I think I am entitled to some "down time," and I long to just "veg out" with a good movie and ice cream or a long, hot bath. While there's nothing innately wrong with these things, they quickly become idols and stumbling blocks when they take priority over spending time in God's word, calling a friend, or praying. Ephesians 5:15-16 says, "Look carefully then how you walk, not as unwise but as wise, making the most of the time, because the days are evil." And Galatians 6:9 says, "And let us not grow weary of doing good, for in due season we will reap, if we do not give up." Pursuing godliness, doing good, serving God and others, fighting my sinful tendencies to be selfish and lazy - this is a constant battle requiring effort, vigilance and perseverance. Am I really to "take no rest"? Yep. That's the idea. God is always at work (John 5:17), and I want to be like him. So I need to "press on toward the goal to win the prize for which God has called me heavenward in Christ Jesus" (Phil 3:14).

Thankfully, Isaiah doesn't stop there; he goes on to say, "and give him no rest." We are not alone in our labors. God is also working alongside us and in us. And he promises to complete the good work he began in us (Phil 1:6). So when it seems exhausting and useless, and I am overwhelmed with the burdens of everyday life, plus trying to please God and love my neighbor, and when I think I will never change - then I remember that "he who watches over you will not slumber" (Psalm 121), and Jesus bids me come, exchange my burdens for his yoke, which is easy and light, and I will find rest for my soul (Matt 11:28-29). Thank God that even when I choose to "veg out," he continues to work to establish his kingdom.

For that is the endpoint of the verse in Isaiah, what we are to strive for - that God will establish Jerusalem and make it a praise in all the earth. In other words - that God's will be done, his kingdom come, and glory be to him forever and ever, Amen.

2010 promises to be a year of big changes for me. On May 25, I will become an M.D., and shortly after that, I will begin my residency training in family medicine. People will look to me to make decisions about patients' lives. The idea is both humbling and terrifying. I long to be the kind of doctor who can make calm, wise decisions, even under duress and who can inspire trust and hope in my patients whatever the circumstances. But the reality is that I am far from being the doctor, or even the person, I want to be.

So, I think I want Isaiah 62:6-7 to be my theme verse for 2010. This year, I want to press in and pursue God with all my heart, soul, mind and strength. I want to take no rest and give God no rest but make the most of every opportunity to grow and change and pray for God to work in me and do through me the good works he has prepared for me to walk in.

Looking back on 2009, I am thankful for so many blessings.

My family - despite many trials (illnesses, financial struggles), we have a close, loving and supportive family. It is wonderful to be so near my parents and share in their daily lives. They have been a marvelous help and blessing to me during the busy and stressful medical school years. My nieces and nephew are precious and fun - always growing, changing and learning new things. (Photos from Christmas in Washington, DC.) Jenny and Bryan are expecting their second child in February - my nephew John Douglass. This is truly an answer to prayer for a safe, successful pregnancy and a healthy baby!

My church - always a blessing through great, biblical teaching and sound doctrine, worship in spirit and truth, and accountability. Our monthly ladies accountability group meetings are great, and I've started praying regularly with one of the ladies in the group. I wish I had more time to devote to fellowship and serving our church body. Our girls discipleship group is meeting monthly, and it is so encouraging to see what God is doing in the lives of our young ladies.

My roommates - I love having someone to come home to and cook for! But more importantly, having housemates provides ample opportunity to grow in selflessness and humility.

Medicine - I love medical school and am so grateful to be able to pursue such an exciting and fulfilling profession at this stage of life. God has granted me much favor this year, allowing me to win two awards/scholarships for academic excellence and leadership - very humbling and entirely God's doing. Every gift I have is from him, and I hope he will use those gifts to his glory. Spending two months at a mission hospital in Nepal renewed my desire to serve God and the gospel through international medical missions work. Many of the residency programs I am considering have a strong focus on missions. I can't wait to see where God leads next!

Thanks for your prayers and encouragement! I hope to keep up my blog in 2010 with stories from medical school, residency and more.

India - Journey's End

As you may know, I am already back on American soil - glad to be home, but sad to see the end of a wonderful trip. The final leg of my journey took me to India to see some amazing palaces/monuments and some dear friends.

Delhi-Agra

Delhi-Agra
Since my flight to and from Nepal was routed through Delhi, I just had to see the famous Taj Mahal. I must admit, despite my usual adventuresome nature, I found traveling alone in India rather intimidating. I had booked a tour to Agra (where the Taj Mahal is located) via internet and was a little nervous about how things would work out.

I arrived in Delhi at night and was transported to my hotel, which seemed to be in a very busy commercial part of town - not a place I wanted to walk around by myself at night. I didn't have much cash, but I couldn't find an ATM nearby, so I ordered a small snack for dinner and went to bed. The next morning, my driver met me at the hotel for the trip to Agra (about 5 hours from Delhi). It was a long trip with just me and the driver, who asked a lot of personal questions - did I have my own car? a house? was I married? why not? did I have a boyfriend? Understandably, these questions made me rather uncomfortable, but I figured the driver was professional and would never try anything impertinent and risk losing his job. He was probably just making conversation. Still, I would much have preferred either a female driver or to be traveling in a group on a bus. (I could have taken the train to Agra, but then I would have had to figure everything out for myself, and the timing didn't work out as well.)

Anyway, we made it to Agra where I met my guide for the Taj Mahal and Red Fort (the two monuments everyone visits in the area), found an ATM that worked, and had a delicious lunch of veg curry and garlic nan. Then we went to the Taj Mahal, which is really a tomb for Mughal Emperor Shah Jahan's most beloved wife. The gardens and grounds are beautiful and peaceful (even with the hordes of tourists), and the red sandstone and carved white marble with inlaid jewels are amazingly massive and intricate. I can see why so many people from all over the world, including India, visit this place, and I'm glad I came. After the Taj, I went to see another monument - the Red Fort, which lies across the river from the Taj Mahal in perfect symmetry (supposedly). The story has it that one of Shah Jahan's sons took power forcibly and put his father under house arrest in the Red Fort, where he could not visit his wife's tomb but only see it across the river.

As it's name implies, the Red Fort is built mostly of red sandstone. There are various sections of the fort, including palaces for different wives and halls for public and private audiences. As with the Taj Mahal, the sheer size of the fort and the amount of work that went into cutting and carrying all that sandstone and marble are impressive. But the architectural features (arches, turrets, scalloped windows, etc.), symmetry, colors, patterns, and carvings are truly pleasing to the eye. I took hundreds of photos (fortunately, I won't subject you to all of them!). I would have loved to just sit and soak in the peacefulness of the place (after all the tourists left).

After the Red Fort, my guide took me to a shop where I was able to see the process for making the inlaid marble as well as woven carpets. The work is so precise and painstaking, but the result is beautiful. They have to carve the marble images just right and then cut the malakite, lapis lazuli, and other semi-precious stones to just the right shape and size to fit into the marble so that it looks seamless. And the carpets are gorgeous as well. Of course, at the end of the show, I was encouraged to buy something (they could ship it to me anywhere in the world...). Actually, I wish I could buy a marble table top or an Oriental rug. But even the smallest of items was out of my price range.

Finally, I ended my day with a dinner buffet at a five-star hotel (I stayed in a two- or three-star hotel). It was a little weird to eat by myself while my driver waited outside (don't know where he ate), but I thoroughly enjoyed a sumptious Indian buffet (and a glass of wine - the first in a long time). And, though I wouldn't have admitted that I missed it that much, I have to say the vanilla ice cream with hot chocolate sauce was really, really good.

On the way back to Delhi, we stopped at the monument of Fatehpur Sikri, another emperor/shah's palace. Actually, this shah had three wives - one Hindu, one Christian, and one Muslim - and built separate palaces and temples for each of them on the grounds. Like the Red Fort and the Taj, Fatehpur Sikri is all red sandstone and white marble. It's enormous - bigger than either the Taj Mahal or the Red Fort (I guess you need all that room for three wives not to quarrel or get in each other's way). Apparently each wife got one week a month with the king, and the fourth month was for his concubines. Hmm. I wonder what the Christian wife thought of that?

After a long drive back to Delhi, I begged my driver to take me directly to the airport and not to any more shops. He wanted me to "just look" at some marble and carpet factories in Delhi (I am sure he gets a commission or kick-back for bringing tourists to certain stores), but I just couldn't face any more shopping pressure. Everywhere I went in Agra the hawkers badgered me constantly to look and buy - jewelry, animal figurines, religious artifacts, whatever. I kept saying "no thank you," but some of them just wouldn't take no for an answer, pushing things in my face and begging me to consider their poor parents whose sole livelihood was making these fine hand-crafted whatevers. I felt mean saying no and ignoring them, but there's not much else you can do. Boy was I glad to get to the Delhi airport and relax. I was even happier to see my friend Colette waiting for me at the other end, in the Bangalore airport!!

Bangalore-Coorg
Some of you may know the Fraziers - Brian and Colette. They were members of Sovereign Grace Church for a while before heading to India as very non-traditional missionaries. Brian works for an Indian micro-finance company, providing loans for low- to middle-income people (mostly women) to start small businesses as income for their families. So, although he is working in business, he is interacting with Indian and non-Indian people all the time with opportunities to serve God as a witness through his life, work and relationships. Unfortunately, Brian had to leave for a business trip to Delhi the day after I arrived, so I only got to hear a little about his work. But I had a great time hanging out with Colette and the boys, seeing what their life is like in Bangalore. We visited a beautiful park/gardens in the city, ordered Indian take-out food for dinner, had a pedicure (bless you, Colette! My feet sorely needed pampering after my trek in the Himalayas), and took a short but very relaxing vacation to a farm and elephant camp in the hill country around Coorg.

Bangalore

I have to admire Colette for her spunk and courage. She has jumped right into life in a strange land, despite cultural, religious and language barriers. She even manages to drive her own car around the streets of Bangalore. Besides driving on the wrong side of the road, Indians rarely respect lanes, and cars compete with trucks, buses, motorcycles, bicycles, pedestrians and cows, even on "highways". But Colette seems to have a gift for getting around the city. God's grace was abundantly evident on our trip to Coorg, about a five-hour drive from Bangalore.

We stayed on a small farm owned by a couple from Bangalore who decided to give up city life and a high-tech job to live in the country. They have a beautiful farm with animals and agriculture - a vegetable garden, vanilla trees, coffee, and other exotic fruits and spices. To supplement the slow process of making a living from agriculture, they have built a little paradise with comfortable bungalows, sumptious meals and warm hospitality where city folks can get away to the country for a relaxing weekend. There are lots of touristy things to do in the area - the elephant camp, where you can ride and bathe the elephants, jeep safaris in the jungle, the local Buddhist temple and monastery, waterfalls, the river, dam and reservoir (good for rafting, boating and bird-watching). The boys spent hours playing with the puppies and throwing rocks into the water from the top of the dam. Colette and I enjoyed the sunshine and tranquility of the bungalow and beautifully manicured lawn (while the boys were busy with the puppies). And the meals were sooooo good. We were treated to a different Indian dish at every meal, including breakfast, and the owner's wife hovered over the table offering seconds and thirds of every dish, so it was hard to refuse. And of course, on the way to and from Bangalore, we had to stop at the MacDonald's (a highlight for the kids).

What a relaxing and enjoyable way to spend my last days in Asia before heading home. On Sunday morning, I got to attend church with Colette and the boys - all in English!! It was great to sing and hear a message that I could understand, and fun to meet the Frazier's pastor and small group members. Colette - if you are reading this, thank you so much for a wonderful time. I loved seeing you and spending time with the boys!

After that, I got on a plane and spent the next 30 hours traveling back to Houston. I thank God for a safe and smooth trip from start to finish. I miss Nepal and India, but it's so good to be back home in my own bed, to see my parents and roommates again. I think it will take me a while to adapt back to life in the USA, but hopefully the memories of the people and experiences I've had over the last two months will be with me for a long time.

Thanks for keeping up with my blog and for your prayers and encouragement during these last months. I hope you have enjoyed hearing about my travels. I can't wait to see you!

Trekking

Warning: This is a long blog covering my three-day trek in the Annapurna region. There are 94 photos in the album linked below, so beware!

Trekking

Day 1: Pokhara to Landruk
Backpack stuffed to the gills, hiking boots on, I meet my guide, Bhagwati and get into a tiny car to head to the mountains to start my three-day trek. Along the way, the entire Annapurna range is visible in the crystal clear morning sun – snow-capped peaks rising above green rice paddies. It is glorious and I get excited about seeing them up closer.

After an hour’s drive, we arrive in Kande, a pit stop on the road where we will pick up the trail to the village of Landruk, where we will spend the first night – about a five-hour hike. The trail starts at about 1200 meters above sea level. We walk through fields and beside homes and farms, then begin to ascend into more forested terrain. Part of the trail leads through jungle, past many small waterfalls. Much of the trail is lined with stone, creating one long stone stairway. I am surprised at the sheer number of steps. The stone is some sort of slate material, apparently native to the area. But someone must have cut it and moved it and leveled the ground for each step – an amazing feat considering how many miles of trail are so laid out. At one spot, we see a sign attributing a section of the trail to the nearby village. I suppose the villagers benefit from the trails, both for transporting themselves and their goods and for bringing tourists.

Along our path, there are several small villages boasting quaint restaurants and guest houses for weary trekkers. All have flower gardens, sunny patios, and colorfully painted rooms. My guide knows people at many of these spots and exchanges friendly conversation with other guides we pass on the trail. Despite seeing a number of other trekkers, guides and porters, we are often alone on the trail with just the sounds of the jungle and the occasional bells of a goat herd or donkey train. The porters carry baggage for trekkers, as well as all of the food, drinks and supplies for the mountain inns, tied in a bundle or basket and attached by a strap around their foreheads. They walk at an amazing pace – up and down – despite their heavy loads. Once or twice we pass a train of donkeys carrying supplies (especially gas canisters), but the human porters do much of this hard labor.

After hiking for two and a half hours, mainly uphill, we stop at a village called Pothana for lunch. It is windy and cold on my sweaty, tired body. We order hot tea and momos – delicious! Renewed, we set out again. The next hour is almost entirely downhill – again on the beautiful stone staircase that seems to never end. By the time we reach the bottom, my legs are shaky. Only a little more to go, says Bhagwati, mostly flat. She’s right. There are short ups and downs, but my shaky legs get me safely to Landruk. Across the valley – on the opposite hillside, my guide points out the village of Ghandruk, where we will sleep the second night. It is higher in elevation than Landruk, but to get there we must descend to the valley floor and then up again to nearly 2000 meters (Landruk is 1500 meters). I have thoughts of going home – is helicopter evacuation possible?

We check into the Tibet Guest House – cozy but primitive. At least it has a nice hot shower (feels nice on my tired back and legs)! The food and tea are warm and tasty. The daal bhaat comes with a delicious chutney made of home-grown mint, chilis, and tomatoes – and the daal is made with two types of tiny lentils. There is a large French Canadian group staying at the lodge, and they have ordered apple pie; it smells divine.

Our room (Bhagwati shares my room because the inn is full – normally the Nepali guides and porters have separate quarters) is equipped with two twin beds, which appear clean, and very thick, warm-looking duvets. The evening is cloudy, so I don’t know where the mountains are or what kind of view to expect. I pray it doesn’t rain and the clouds clear by morning. When I get up at 3 AM to visit the facilities, the sky is full of stars, so I know my prayers have been answered.

Day 2: Landruk to Ghandruk
Sure enough, when I go out to brush my teeth in the morning I find myself facing these magnificent peaks dominating the landscape – they look so close! Amazing to think that something so huge could have been completely invisible in the clouds the day before.

Breakfast is chiyaa and a banana pancake. Fortified, we pack up and head down, down, down, to the bottom of the valley before ascending up the other side. Our trail consists of about a million stone steps, past fields of rice, millet and mustard. All I can think of is the up, up, up awaiting me on the other side, but I decide not to let it worry me. The descent takes 45 minutes, and my legs are not too shaky.

At the bottom of the valley, we cross a bridge over a raging green-blue river fed by numerous waterfalls on both sides that we see from the trail. Stalling for time before the steep uphill climb, we stop for another cup of tea at a guest house in the village of Kumi. Then off we go up a billion stone steps. We go very slowly, resting frequently to enjoy the scenery. The mountains are visible now and again. At one point, we see a whole flock of monkeys leaping through the trees overhanging a cliff. I envy their agility and easy ascent/descent. We also pass several groups of trekkers, including one family with a young daughter who appears to be counting the steps (do you really want to know?).

Finally, two hours later, we arrive at the top, at the charming village of Ghandruk. Our lodge – the Trekkers Inn – is a three-story building with a beautiful garden. I choose a room on the third floor, which turns out to be quite nice because there is a nice little deck up there with a table and chairs. After a (cold) shower, I bask in the sun on the deck, enjoying the view of the valley and the glorious Himalayan peaks still visible through the clouds. I can hear the sounds of rushing water, crickets, goat bells, children playing. The breeze is chilly, but the sun feels warm and soothing on my shoulders. I could sit here forever. I am so glad I came!!!

Lunch is served on “my” deck (I have the place to myself until a large group of trekkers arrives) – chow mein with veggies, egg, and cheese. I don’t know if I am just really hungry after a rigorous day of trekking, but this I one of the best meals I’ve had in Nepal!

After lunch, Bhagwati takes me on a walk to “Old Ghandruk,” the part of the village where people actually live (as opposed to the part with the guest houses). We stop in a small museum showing how the Gurung people of this region live. Then we wander along stone paths through the village, seeing people harvesting rice in their fields, children playing in the “hay” created by threshing the rice, and others peeling potatoes or washing clothes at communal taps. One of the most charming features of the houses here are their uniquely carved wooden window frames, usually painted in bright colors. Many houses have large straw/bamboo mats spread with rice or corn drying in the sun. There are vegetable gardens and colorful flowers adorning the yards. It really is quite picturesque and idyllic. We wander past the local school (empty for the recent holiday) and health post and eventually make our way back to our inn for a cup of tea and a rest. Dinner is pizza and rice pudding – everything seems to taste better up here. Bedtime is early, as it is dark by 7 PM and there isn’t much to do.

Day 3: Ghandruk to Pokhara
I get up at 5 AM to see the sunrise, counting on the clouds clearing out overnight, leaving the mountains visible. I am not disappointed. It is cold, and my hands are numb by the time the rest of the hotel wakes up. But I enjoy the peaceful quiet of dawn on “my” deck on the third floor, reading Psalms 8 and 19, and meditating on the majesty of God seen in the mountains, yet his grace to one such as me whose life is fleeting and small.

On this last day of my trek, we meet up with another 3 Sisters Trekking guide and her client, who is from British Columbia and turns out to be a veterinarian. We enjoy the company on the trek out to the main road – about five hours of gradual descent and relatively flat trails. Today we share the trail with many other groups, but it doesn’t detract from the beauty of the scenery. The mountains remain visible off and on, and the green-blue Modi River winds its way through the valley, gradually getting nearer as we descend toward the valley floor. Closer to the town where we will be picked up, and almost at river level, we begin to see Nepali families taking a day’s outing to the river or nearby waterfall. Down on the valley floor, the air is warm and humid, and the sun feels stronger somehow. We stop for lunch at a restaurant on the river – only 30 minutes to the end of my trek. My feet are sore, but I am sad to return to civilization. Nayapol is a dirty, commercial little village on the main road, and I find it somewhat ugly after the charm of Ghandruk and the other mountain villages. But soon we are back in Pokhara enjoying a hot shower and cold drinks.

All I can say at the end of my journey is that this was a wonderful, spiritually and physically renewing three days. I am grateful for this time to soak in the beauty of God’s creation and get away from the hustle and bustle of life. And I am especially thankful to have arrived safely with no injuries, heat stroke, frostbite, or any other mishap. I hope you enjoy the photos (there are quite a few, but I had many more).

Pokhara

Pokhara

After playing with the baby elephants yesterday, I traveled to Pokhara, a lakeside town nestled in the hills beneath the shadow of the Himalayas - the Annapurna Range, actually (for those of you who want to locate the place on your maps). To get here, I took the Greenline "luxury" bus from Chitwan. The bus was nice enough - AC, comfortable seats, clean, no one in the aisles or on top. But the road was quite bumpy, and I was in the back, so I did a lot of bouncing around. Still, a very pleasant trip, arriving in Pokhara at about 2 PM.

My hotel is a nice little guest house run by the Chhetri Sisters, an all-women's trekking company. I have booked them for my three-day trek starting tomorrow. Since I'm trekking alone, I wanted to go with a female guide. The people at the hotel are really nice. My guide arrives this afternoon from near Tansen, funnily enough. She has been home on holiday (Dasai and the following festival, Tihar, which ended yesterday) and also because her mother died a few weeks ago. She needs the income, and short treks are good for her because she is in school.

This morning, I took a boat ride across the lake. It was a crystal clear morning, but even by the time we got to the other side of the lake, there were clouds building up and obscuring the mountain peaks. I hired a row boat with a really nice "driver" who spoke English. He showed me the fish farms, big cages in the water where people breed carp to supply the local restaurants. Then we went around a little island temple in the middle of the lake - quite a busy place during the Tihar festival. Worshippers reach the island by ferry. Finally, we went to the World Peace Pagoda. The trailhead is across the lake from my hotel. The boat driver offered to go up with me, since I was told it was dangerous to go alone due to muggings along the trail. The walk was up a huge stone staircase. I didn't count the number of steps - I'm sure it well surpassed Srinigar Hill in Tansen, as it took at least 45 minutes to reach the top. But the view was worth it - you can see the whole valley of Pokhara, the lake and its feeding river, the hills behind Pokhara, and the white-peaked Annapurna range behind that. The sparkling white Peace Pagoda is a Buddhist shrine built by Japanese monks to promote world peace. It is kept immaculate and bright white, so it is easily visible from the lake below.

Coming back across the lake, you can see dozens of tiny paragliders high in the sky. They take off from Sarangkot peak, a hill overlooking the lake. My boat driver said he once took a paragliding trip and stayed up for three continuous hours. It sounds spectacular, and I'm tempted to try it when I get back from my trek. We'll see if my budget will allow it.

Now I am sitting in a cafe on the main street of lakeside Pokhara, at a restaurant called Olive with free wi-fi and mediterranean cuisine. I just finished a plate of tabouli and hummus, and an ice-cold diet coke!! I love Nepali food, but it's nice to have something different once in a while. On the trek, I'm sure I will eat plenty of daal bhaat.

More tails of the trail still to come. See you when I get back to Pokhara on Friday or Saturday.

I Love Elephants!

Chitwan National Park

Saturday I arrived in Chitwan National Park, a national reserve in the lowlands of Nepal. The region is quite hot and grassy, and the main population are the Tharu, who apparently settled and controlled this area from long ago due to some natural resistance to malaria. They grow a variety of crops, including rice, corn, wheat, potatoes, and vegetables, all at different times of the year. This happens to be the season for rice harvest, and villagers are seen carrying huge bundles of rice sheaves. The rice still in the fields is golden brown. Once the grains are threshed from the sheaves, the stalks are saved and used to feed the goats and cows.

My first activity was to take a walk through the village and visit the government elephant stables. (The government uses elephants for patrolling the park against poachers.) It was a hot afternoon, and we walked some distance through tall elephant grass, marshes, and some woody areas, arriving at the river bank to watch the sunset. In the evening, we had delicious daal bhaat and then watched a series of Tharu stick dances, in which the young men beat and twirl sticks in an imitation of self-defense. They were quite energetic, and a couple of times I had to scoot my chair back for fear of getting clobbered. One fraction of a second out of beat, and the dancers would end up with a nasty bump on the head!

Yesterday morning, we took a canoe ride down river, spotting all kinds of birds, monkeys and crocodiles along the way. There are some nine varieties of kingfishers here, and we saw three: a bright red one with a blue back; a bright turquoise one with a white breast; and a speckled black and white one – quite stunning! The river itself is quite calm and quiet – making for a very tranquil trip.

I should mention the canoes themselves, which are quite something. The dug-out canoes are made from tree trunks, somewhat crudely carved out, maybe about a foot and a half deep and two feet wide. Our group of 8 or 10 went in two canoes joined together. Those on the right has to sit as far right as possible, and those on the left to the left. And once all were settled in (on little wooden seats), the canoes sat pretty low in the water – the water level was a few inches below the edge of the canoe. Any sudden movement would tip the balance towards one side or other, and I was worried we would be flooded with water, or capsize. So we all sat very still for the hour ride (a bit sore on the backside). The “driver” steers the canoe with a long pole, as the water is not deep or particularly rapid.

At the end of the canoe trip, we got out and walked back to town through forest, grasslands and marshes. Our guide first told us about all the animals we could potentially see – monkeys, wild boars, wild elephants, sloth bears, rhinoceros, tigers, snakes. The wild elephants, rhinos and bears are very dangerous and unpredictable, so our guide told us how to escape if charged (up a tree for the rhino, into the bush for the elephant, using loud noise and sticks to scare away a bear, and by prayer should we chance to meet a tiger). I did not expect to see much, as it was mid-morning by this time and we made a lot of noise walking through the brush. So when I saw a rhino standing in a clearing in the forest, I was completely taken by surprise. I was walking just behind the head guide, who didn’t even see the rhino until I motioned to him. We were probably within 40 meters of him, and the guide stopped immediately and had us back up very carefully and quietly. We walked around to the other side, where we were more protected by the brush, but we never got as good a view of him as that initial encounter. Unfortunately, I didn’t have time to get a photo, so you will just have to take my word for it that I did in fact see a real rhino on foot, up close, in the wild. It was quite lucky, actually, as yesterday there were 380 visitors to the park and no one saw a rhino.

To top off the morning, we finished our walk at the riverside just in time for elephant bathing. By this time it was quite warm, and I was ready for a cool swim, so I decided to join the elephants (actually, this is one of the tourist attractions). With the help of the elephant trainer, I climbed up on one of the elephants, and he sprayed me with water from his trunk again and again. Then he decided to lay down in the river (in response to a command from the trainer – all part of the show), and dumped me off. How cool!

In the afternoon, I took an elephant safari. In other words, we rode elephants through the forest looking for game. They loaded us up four to an elephant, riding on a saddle with a wood frame. The motion took a little getting used to – rocking from side to side as the elephant lumbered along. They often went right through or over trees, so we had to watch out for overhanging branches. It was a lot of fun, and we spotted two rhinos, lots of deer (two types), monkeys, and wild boar. Not bad for a day’s safari!

Today, before departing from Chitwan, I went to the government elephant breeding center. This is where the female elephants come and wait for some handsome wild male elephant to sweep them off their feet. Seriously, though, they keep the mating far away from the village because the wild males can be very aggressive during mating season. The females carry the babies for two years before giving birth. There were several young-uns in the center, of varying ages. The most famous are the twin males – Ram and Laxman – about a year old. It is rare for elephants to have multiple births where both twins survive. Ram and Laxman are very curious and roam about the center freely, greeting visitors with their trunks searching for cookies. Unfortunately, the shop that sells elephant cookies (still don’t know exactly what they feed them) was closed for the holiday today, so the babies quickly deserted us when we didn’t have anything to offer them.

Community Health 2 and 3: School Clinic and Post-Partum Home Visits

Community Health

Chapter 2: School Clinic
Every Wednesday, the Community Health Program team goes out to a rural school to do health education, screening and physical exams. My trip to Bedbedanga Secondary School in the village of Siddhashwar, was one of the highlights of my time in Nepal. The community is located about two-hours by jeep and half an hour’s walk from Tansen. We traveled in a hired jeep with one intern doctor, Anoud, six nurses, myself and two teachers from the community. What a gorgeous drive! The day was crystal clear and cool, and the Himalayas were visible on the horizon for most of the trip. The road wound along the hills and ridges and up and down green valleys with rice paddies and streams. Half of the road was paved, with winding, hairpin turns down the hills. The other half was gravel/mud/rutted and potholed. By the time we reached the end of the road, I was ready to walk. We crossed over a river on a shaky suspension bridge, then walked through rice paddies and uphill to the school. (Nepali schools are frequently located on hilltops.)

The Bedbedanga Secondary School goes from grade 4 through 10, with 390 students and 12 teachers. Students come from the surrounding villages, some of them walking an hour and a half each way (up some pretty steep hills, too). We were greeted with a formal welcome and introduction to the staff and a huge lunch/brunch of daal bhaat at a teacher’s house. Stuffed to the gills, we then set up clinic in one of the classrooms. The kids lined up by class to get a check-up with one of the doctors or nurses. So for the next several hours, I used my broken Nepali to ask about cough, fever, stomach ache, headache, looked at eyes, ears and throat, checked heart and lungs. Whenever I had a positive response to my simple questions, I got Anoud (the intern) to help explore further – when does you stomach hurt? How long? What makes it hurt more?...
After all the students were seen, several of the teachers and a few community members came with an assortment of problems. Many wanted their blood pressure checked. Others complained of vision problems. It was quite an interesting day. We referred a handful of children to the hospital for further assessment, but most of the kids were pretty healthy. Everyone received a dose of anti-worm medicine.

The drive home was equally beautiful, and I arrived back in Tansen weary but with good memories.

Chapter 3: Post-Partum Home Visits

One day this week, I accompanied a community health nurse and community volunteers to visit several mothers who had recently delivered babies. This was a unique opportunity to see inside the typical Nepali home. I enjoyed the walk and the glimpse of Nepali family life.

The first house we visited belonged to poorer mother. Built on a steep hillside, the climb down was a bit scary. But the view from the patio was amazing. The family, including the toddlers, go up and down the steep hill every day, and they plant rice and vegetables on the terraced hillside. The mother was young but already had one other child, about a year and a half old. She lived with her in-laws, as it is customary in Nepali culture for the woman to move in with her husband’s family after marriage. Judging from the number of children and adults in the house, I would guess there were several sons with their wives and families living under one roof, sharing about three rooms. The mother-in-law was right at the center of activity, proudly showing off her new grandchild.

The nurse and community volunteer examined the mother and baby thoroughly, checking for any signs of infection, malnutrition, or poor sanitation. They asked about breastfeeding, the mother’s diet, and any post-partum complications. The community volunteer then counseled the mother on hygiene, feeding, and signs and symptoms of mother or baby requiring medical attention.

The community volunteers are married women with children who live in the community and have time available and interest in becoming health promotors. They receive training and supervision over a three year period and visit women in the community to give advice about pregnancy, child birth, and post-partum care. One of their tasks is to encourage women to go to the clinic for prenatal care and to have their babies in the hospital. Currently, according to the community health director, 50% of “urban” women and 80% of rural women deliver at home. Maternal mortality is still a leading cause of death for women in Nepal, and the mission hospital sees dozens of cases of obstructed labor, post-partum hemorrhage and maternal and newborn infections from home deliveries each month. That is why it is so important to have volunteers in the community who keep track of the pregnancies and deliveries and check up on women who have given birth to make sure all is well.

One mother we saw on the home visits was having problems with breastfeeding and pain after her cesarean section. The pregnancy had been complicated by typhoid and malaria, and the baby was born small (2.5 kgs) and had trouble latching on to nurse. The mother was anxious and frustrated, not to mention uncomfortable with milk building up and not getting released. Her surgery incision was infected, contributing to her pain. The visiting health team gave her some advice regarding feeding her baby and referred her to the hospital for treatment of the wound infection. When she heard she needed to go to the doctor, she began to cry because there was no one available to help her. Her husband was working in India and had been away for several months, and she had no other family nearby. The community volunteer offered to accompany her to the hospital. Poor mom! She had so many physical problems and was alone at such an emotionally challenging time. But that is why the post-partum visits are so wonderful. I imagine many new mothers have been encouraged and cheered by the company and advice of these friendly health workers. And many potential newborn and post-partum problems have been prevented.

Community Health

Due to my interest and background in public health, I was eager to learn about the Tansen Hospital community health program. During the last two weeks of my time here in Tansen, I have been able to spend several days observing community health activities.

Chapter One: Town Clinic
The Town Clinic is a primary health care center operated jointly by Tansen Mission Hospital Community Health Program and the Nepali Ministry of Health. The clinic is housed in the District Hospital, an old, sturdy-looking building on the far side of the bazaar, in a section of town I had not seen previously. Staffed by nurses, the Town Clinic provides maternal and child health services to families who live in Tansen proper, including well-baby check-ups, immunizations, prenatal care, and family planning.

I was amazed at the number of women who showed up and paid money for preventive care and public health services. The waiting room was packed by 10 AM. I spent the morning seeing babies with Mana, the head nurse – very cute, healthy, happy babies. We did a complete physical exam, and Mana counseled each mother on proper nutrition, hygiene, and immunizations. In the afternoon, I worked with the antenatal team – taking blood pressures, measuring women’s bellies (to check the baby’s size), listening to babies’ hearts with a fetoscope (old fashioned version of our modern day dopplers) and checking for edema or other problems. The nurses also counsel women about contraception and HIV/AIDS and see minor acute childhood illnesses, such as colds and diarrhea. Overall, it was a very pleasant day and quite educational.