Live From Kathmandu

Deliverance

2008-07-03T01:35:00.005-04:00

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Scenes from the national Maternity Hospital, Kathmandu.

Yesterday all the blood rushed to my head and I thought I was going to pass out. I had to go stick my head out the window and wait for the feeling my face was swelling up to go away. Then for a while I had to fight back tears. "This is not your moment Robin. This is this nice Nepali lady's moment. Do NOT cry." Then when it was all over I just stood there smiling like I was on drugs, peering at the shriven creature whose messy twisting entry into the world I had just audienced. I'm going to be a doctor? Right.

The only childbirth I had ever seen before yesterday was of large farm animals, precisely one lamb and one foal, and the lamb was in kindergarden. Somehow in humans it's different, even though on a nuts and bolts level it's quite the same. There is pushing and resting and wetness and blood and lots of sweating and eyerolling. But that makes it sound beastly, when really, at least to me, in one of my fellow humans it was almost elegant.

I've never been at a delivery in the States, so I didn't have any fast expectations for what would go on at Maternity Hospital, but from my limited experience around American medicine the following I have deduced is different enough to be worth nothing. First, women admitted in early labor all hang out in big hall called the antenatal room, a really tense place with great communal squirming and blanket-clutching, and lots of yelling by nurses and doctors, but mostly silence from the pregnant women themselves. They wait there until things are more or less a go, and then they get wheeled to a bright room full of cabins like office cubicles, open on the side facing the middle, staffed by young nurses wearing baby blue, unless there is some complication like a breach, and then they go to a darker scarier more metallic and wide open room staffed by doctors. To enter either "delivery theater" you have to take off your shoes and put on a pair of communal plastic sandals like a chain-smoking house-coat wearing grandma in Ocean City would wear. The nurses all wield knives and needles and scissors with open-toes, and I even saw a few birthing attendants walking around in bare feet, no lie, among the blood and other liquids on the floor. No one seems to think this is a hygiene issue - no one even made me wash my hands when I came into the delivery room in my street clothes.

Husbands do not stay with their wives during any of it. The women all had a female friend or relative attending them who stayed for the whole thing, but the men wait outside in a cloud of cigarette smoke, sucking on death while their wives are pushing on life. The woman whose delivery I watched start to finish had to have an episiotomy, a really terrible procedure involving a knife, some local anesthetic, lots of blood, and pretty great risk of messing up something important, whose purpose is to open things a bit when the baby is too big. (look it up.) On top of that she had her first child, a boy (a really big deal here), got sewn back up and cleaned up, and hung out with her baby for at least 20 minutes before her husband finally came in to see her. He didn't kiss her or the baby. But he did bring a glass of milk and some cheese crackers. I hoped that that was some kind of specific request - honey all I'm gonna want is to see your face and some cheezits, ok? - but I don't speak Nepali and the wife never stopped smiling so I have no idea how her post-partum snack went over. I do know that during her labor she would look up from time to time and make eye contact with me, the random white stranger who was staring at her crotch for the most important moment of her life. I was usually horrified by half of what what I was seeing or teary eyed or woozy, but if she looked at me I'd smile really huge and nod super encouragingly as if everything were going SO great, and make prayer hands and nod some more - and she always smiled back. I would have kicked me out immediately, so I was really impressed.

I think delivery is handled really well at Maternity Hospital. Of course there is no privacy whatsoever, and there are weird hygiene issues like the bare feet thing, and the fact that they reuse rubber gloves, washing them and hanging them to dry, and then there's the nurse in charge of weighing the new babies who grabs them by the feet and flings them down pretty roughly on a metal scale, a total law suit in the US, but those quirks aside it's a very professionally run show. I guess some part of me expected to leave shaken, pitying the women of Nepal who give birth in squalid conditions (a lot of them do, this is the nicest place you can go) or terrified of ever having a baby myself. But weirdly I felt relieved. It's tough and gross and as gory as I could have imagined, but they make it through ok, and I think I probably could too.

Behind the Gates of NGO Oz

2008-07-01T05:11:00.003-04:00

In the world of international health, all the NGOs, INGOs, volunteers, do-gooders, community groups, and even the government offices of the developing countries themselves - the ones charged with effecting all that meaningful change - are supplicants at the altar of their king and queen, the UN and the WHO, the highest of development royalty. If Bill Gates wanted to give townhall in Banepa, Nepal, $1 billion for universal teeth whitening he would have to get the OK from their court. So when you work for an INGO (international non-government organization) your plan for anti-retroviral donation or cataract surgery or (in my case) cervical cancer screening is little more than a good story for show-and-tell back at home, until you are granted that one important meeting with the great Oz (mythical, not Mehmet), behind the terror-blast-proof gates and through the maze of white-UN-emblazoned SUVs, eyes gleaming with your "escorted visitor" ID. It's totally weird and possibly wrong, but, it is.

So, after all the work put in - a month of meetings with Nepal's reproductive health elite, the 20-page report I just finished drafting, the terrifying bus rides on mountain roads to obscure cancer hospitals in rain forests, and becoming the country expert in a topic I knew zero about when I landed here on June 1 - I am totally un-ironically proud of this picture. Jhpiego has lots of friends in high places, so it's not like it was so hard to get this meeting, but for my project my presence here means go, rather than wallow. Maybe. Hopefully.

A bit about what I've been doing here... Jhpiego is an INGO started by Johns Hopkins that works on women's health and reproductive health projects all over the world, with funding from big donors like Gates and USAID. (www.jhpiego.org.) One of their biggest projects is CECAP, a cervical cancer prevention program that's gone over well so far in a lot of places, including Malawi, Ghana, Thailand, Indonesia, and the Philippines. Cervical cancer is the number one cancer-killer in the world for women (breast is more common, cervical is more deadly) and it mostly affects the developing world. In the US and the UK few women get cervical cancer because we screen for it all the time - if you don't show up for your pap smear in England the government literally calls your mom. In the developing world though, there tend to be more pressing problems, resources are scarce, and getting women to live through childbirth is enough of a challenge - forget prevention, and things like cancer, which you have to be healthy enough to live long enough to get. Except cervical cancer, which kills women in the prime of their lives - usually somewhere in their 40s - because it's caused by an STD called the human papilloma virus (HPV), which 80% of people in the US have and more and more in the developing world have now too. Think warts, but think cervical cancer as well. So, cervical cancer is not your average cancer. It shows up early, it takes a huge socioeconomic toll on communities and families, and oddly enough, it's preventable.

If you screen for cervical cancer using a pap smear or something called Visual Inspection with Acetic Acid -- translation, "looking with vinegar" -- you can catch the transformation of normal cells into cancer cells, and scrape, freeze, burn, or cut them off. It's actually really easy, and in the west we do it all the time. But in places like Nepal, women never see an OBGYN, ever, unless they are having a huge problem, like their uterus has been falling out for the past 15 years because they had a difficult childbirth, and even then, they might not go to a doctor. There is no "culture of prevention," to say it in NGO-speak. Women have it hard here, they do all the farm work and manual labor, and go right back to it the day after having the baby. Seventy-seven percent of the time they can't read. Most of the time their lives are ruled by the mother-in-law they came by through their arranged marriage and the first time they get to choose what they would like to have for dinner is the day she dies. So, they're not running to the doctor every time they have a problem. And even if they wanted to, outside of the Kathmandu Valley there wouldn't really be a doctor to see, at least not without taking 2 days off of farm-work for travel time.

All that said, Nepal isn't a total backwater when it comes to health care. It's way further along than a lot of places in Africa for instance. It has chemo and radiation therapy for cancer, a major cancer hospital, and a functional government hospital in every one of its 72 districts, which are like states. And Nepal is right next to India, which is pretty sophisticated when it comes to medicine; it's not exactly cut off from the modern world. So Nepal is a reasonable place to introduce cervical cancer prevention, or at least more reasonable than Malawi, if less reasonable than Thailand. Which is where I, fledgling med student and former radio lackey come in.

My job here has been to write up a "cervical cancer prevention situational analysis.” This basically means figuring out what they're doing here about cervical cancer now (nothing) and assessing what the obstacles would be to getting a prevention program started in the future (lots). Doing this for the most part has meant lots of tea, because to figure anything out here you have to have lots of in-person visits. People are not big on talking on the phone, even to answer simple questions. Forget email. It's the polar opposite of the PR world orbiting Oprah that I used to inhabit. Publicists agents publishers and magazine editors never actually want to see your face, ever. Here they want to see it, maybe touch it even, and definitely feed it tea, at their place, not yours.

Which all has been great, because I've been sent round to the big offices of Family Health International and the Family Planning Association of Nepal and the Safe Motherhood Network, met with cancer research groups, women's health advocates, former prime minister’s wives, expat Indian doctors, eager government officials, and lifetime developing-world experts, seen remote medical schools and scuzzy ERs and medical records written in pencil on damp log books, and most important for me personally felt like I was actually doing something useful, instead of studying for multiple choice tests.

Today I presented the basics from the report I wrote to the head of reproductive health for the WHO, who “sits,” physically and metaphorically, at the UN offices, hence the picture. On Thursday I have to present it to her again, along with the government people and all of the “stakeholders” – more NGO-speak – meaning people who will play a part in any future prevention effort. After that they are supposedly going to write national guidelines, and someday, with money from the government and people like Bill Gates, implement them. During all of which I will be on a plane – to India, Thailand, Cambodia, Laos, and finally home to New York. No ruby slippers, just a terrible seat in coach and hours of half-sleep half-had under an eye mask.

We’ll have to see of course and it will definitely take a while, but hopefully having been behind the magic curtain for tea wasn’t just the end of a month-long dream. At least I have a picture to prove I was there.

Directed Chaos

2008-07-01T04:58:00.004-04:00

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In Cormac McCarthy's "The Road" a cohort of townmen open the earth in remote country to find a bolus of writhing snakes -- they set kerosene and flames to them, just to watch the mute burning of evil, or its effigy, or its physicality outside of themselves, recognized by its own same slithering energy within. (Most men in history have done the same thing at some point, whether it was the bombing of Dresden or the smashing of a roach on the kitchen floor.)

Feeding the fish at this "holy pond" at Bhaktupur, a town out in the Kath Valley, reminded me of that scene. The human fascination with watching the surfacing fish - an occasional orange coy but mostly brackish brown slick shiny muscular and snakelike - as they suck at rice krispies thrown through their roof and bully each other for position, is somehow as I imagine those snakes in the fictional ground. You throw the rice puffs over and over just to watch them reemerge heaping and thrashing and knocking each other off - a scene going on in every one of our cells, and in euro cup soccer matches, in public swimming pools throughout America in summer, in the crowd at rock concerts, and in every Kathmandu traffic jam. The rising and receding, maybe not of pure evil but of directed chaos. People sit at the edge of the pond and lose themselves in it for hours.

silk worms and cubists

2008-06-30T06:29:00.005-04:00

My friend Raju took me to the school where he teaches tapestry weaving. He is now master where for 11 years he lived as a student, spinning silk for 2years as a 9 and 10 year old when he was too little to do anything else. He took me on the full tour: silk worms in their cocoons, bamboo looms, half-knotted sheets of hemp and scratchy cotton for saris curtains towels and shawls, scales for weighing powdered dyes, the school-wide obsession with Picasso's cubist period, the buddha his student is weaving that is too lovely to be for sale, 9 foot tall metal looms that take 3 months to set up in their intricacy. To him these machines are fingertip-tech like google platforms and facebook applications, instruments of art, yoga for the hands, and the place he is possibly happiest in the world.

"22" in Kathmandu

2008-06-25T02:30:00.004-04:00

Ok, so maybe not exactly 22... but close! I couldn't have asked for a better birthday celebration even though I was on the other side of the world from everyone I love. I somehow collected the loveliest of motley crews in Kath, an Everest climber, an Egyptian musician named Emad who shared my birthday (born in 61 not 81), Masha my Russian salsa-dancer-jewelry-designer friend, DJ Tantrik or Kichaa or Boom depending on who you ask, Bishnu my nepali friend from the Pokhara adventure, Alex the world-traveling expat from NYC, Bob for whom the 60s never died maaaannnn, and Raju artist of woven tapestries and great friend courtesy of my much-missed former roommate Wanda (who called from Canada!) Then of course there were some idealistic NGO workers like me, and numerous expats and professional travelers, not to mention Sudesh the owner of New Orleans who so kindly turned over his restaurant to my party and played the guitar to the tune of "22 in Kathmandu" and doled out enough red wine to keep everyone out very very late by Kath standards.

Alex wrote my horoscope, Bishnu remembered that my favorite Hindu goddess is Saraswati (goddess of poetry, song, wisdom and education) and found me a beautiful statue to take home, Raju wove me one of his famous tapestries, and I'm shipping the 5 latest unreleased DJ Tantrik CDs to NYC for security reasons - get ready.

Better than the presents though and all the Gorka beer and the best apple pie in Asia for dessert, better even than the e-cards from my mom and all the happy birthday messages on facebook that kept me from feeling too lost in the world, is seeing that somehow in 24 days in this place I had reached my tentacles out wide enough to find this awesome assortment of characters that had me laughing and drumming and singing until far past the hour when my birthday was technically over. Gita at my office brought in a chocolate ice-cream cake yesterday to celebrate at work. "I didn't want you to feel lonely so far from home on your birthday," was what she said when she got it out of the fridge. I can probably think of birthdays when I did feel lonely, even if I had no real reason to, or if only because I wasn't actually present enough to enjoy whatever the celebration was because I was lost in my head somewhere dreaming of something else and missing out on everything that was right in front of me. But this was definitely not one of them, and I don't think I'll ever have one like that again. If I do, I'll just have to remember turning 22 in Kathmandu, and unfold my tentacles once again.

"I know you think it's unethical, but..."

2008-06-21T03:42:00.003-04:00

Pic: the OBGYN exam table at the Medical College Hospital, Bharatpur, Nepal. The doctor I interviewed about cervical cancer screening practices there told me that because the women are so uneducated and illiterate (77%), if they have any kind of pre-cancerous lesion he goes ahead and gives them a total hysterectomy. Even though I didn't comment one way or another, he kept saying, "I know you probably think that's unethical. But if we don't just take it out, she'll never follow-up with treatment and she'll get really bad cancer, and we'll have to deal with it later. So if she has had her children we just remove everything." Even though there are easy, cheap treatments for pre-cancerous lesions of every grade. Usually doctors don't call themselves on their own unethical medical practices.

The last place you'd want to go in an emergency... the ER

2008-06-21T03:21:00.005-04:00

You never want to have to go to the ER for any reason, ever. If you have been you know that you'll wait forever, the guy who wants your insurance info is as sympathetic to your problem as the bouncer at Bungalow 8, the doctor charged with dealing with you looks like he hasn't slept in 3 days and couldn't care less that your heart is palpitating/hand is broken/brain is oozing out of your nose/or whatever he has seen a thousand times before, and you totally inherently trust the place to save your life no matter what.

Now imagine that you wouldn't trust the place if your life depended on it, but unfortunately, it does. The ER at the Tribuhvan University Teaching Hospital (TUTH), one of the top hospitals in Kathmandu, is in the pics above. The third pic is of the entry-hall/waiting-room area, which was swimming in dirt, kind of under renovation, and still being used. The last is a view into the ER itself, where they wouldn't let me in even though I kept saying "I'm a doctor!" Can't imagine why in my sundress with camera in hand they didn't buy it.

The first pic is the orthopedic surgeon's office, total swarming chaos. The second is from from another hospital, the Medical College at Bharatpur, of the menu advertising OBGYN services. I mean if it's free...

Full Moon at Boddha

2008-06-21T02:51:00.004-04:00

The night of the full moon at Boddhanath, the most sacred Buddhist temple outside of Tibet. Thousands come to walk clockwise around the stupa in the dusk, tonight even in the rain and mud, some making their way by prostration - literally pressing themselves flat to the ground hands forward, rising back up and stepping along only as far as their fingertips were, then moon-saluting again to the grimy stones, being jostled and stepped over the whole time by the teenagers and monks and tourists and other circling devoted.

My friend Raju and I lit candles in the names of those we love and circled three times ourselves. The air was all storm-electric and incense, Oms and horns and drums coming from the monastery, crying kids being dragged by older brothers and sisters, and mumbling meditations. Three times around gave me the same feeling as a beer on an empty stomach.

Then we motorbiked in the pouring rain to a tiny open air Newari restaurant half of which was roofed by leaky blue tarps and bamboo poles. The Newari are the Nepali tribe of the Kathmandu Valley. Apparently they like Everest beer, french fries, veg momos (dumplings), and these herbed pancakes cooked over a fried egg, like Asian toad-in-a-hole. So did we...

BYOTP and Other Things I Love/Hate/Love Some More about Nepal

2008-06-21T02:28:00.002-04:00

1.BYO Toilet Paper
2. The fact that motor bike drivers and pedestrians wear surgical masks around because the pollution in Kath is that bad
3. The microbus "conductors:" 15-year-old boys who definitely haven't had a bath since their moms last plunged them into the kitchen sink. They hang out of the bus doorways shouting the route name at people on the street and slamming the passenger doors with their fists when they want the driver to stop to let someone on. Then they lean into the bus spraying grease in their wake and scream for the 30 people crammed already into a space for 10 to squeeze harder, so a man in a brown polyester business suit can press in sweating and hunch half-standing in the 3 extra inches of space newly cleared for him.
4. The fact that I have lost my voice from inhaling diesel fumes
5. Nescafe = "Coffee"
6. 100 Rupee surcharge for being white. Which is actually pretty reasonable.
7. Your friendly neighborhood rickshaw driver is a fan of Eminem. Because who isn't!
8. The pounding on your hotel door at 6am that sounds like the inquisition has come for you is just the morning tea-in-a-glass delivery and your totally unrequested wake-up call.
9. Straight men walk around town holding hands and smiling
10. Baby ducks for sale in a basket at the bus station

Shiva is the God of Dance, and Cancelled Flights

2008-06-14T23:54:00.006-04:00

I spent this weekend in Pokhara, not totally by design, but it’s a great case of things going right exactly when you think everything is going totally wrong. I came to Pokhara Thursday, via 7 hours on a prize-winningly grimey bus through rural Nepal – scenery more than beautiful enough to make you forget that your seat is turning your pants black. Friday morning I had planned to fly to Jomsom, a mountain town off the tourist path where I would actually be high enough to see the Himalayas for the first time. From there I was going to hike to Marpa, the village 2 hours south by foot, where my friend Zach’s parents were married by a Buddhist priest on Christmas, 1977. I was even armed with scanned photos to see if there were people around in Marpa who remembered Ken and Jill or who recognized themselves. In Kathmandu everyone kept saying that I should prepare for the worst – it is the beginning of monsoon season and sometimes these flights never take off – but it didn’t really sink in through thick American optimism that they might be right.

Five hours later having gotten up at 4:30 in the morning I was still sitting in the waiting room at the Pokhara airport, where no one tells you anything and everyone just sits staring at grounded aircraft totally patiently. The one thing I had to show for my crazy early wake-up call was that I had finished my copy of Vonnegut’s Slaughterhouse Five and had traded it to the guy running the snack and book kiosk for Krakauer’s Into Thin Air. (Imagine going up to the woman at the Hudson News counter at JFK and bartering your used book for a new one, and her putting your tattered paperback on the shelf for sale.) Even with a new book the airport was getting old, until I met Alex and Marlaine, two American expats in their 40s from New York, who were traveling with their Nepali friend Vishnu and his family. Vishnu was trying to take his parents, grandmother, great aunt and an aunt and uncle to a famous Buddhist temple outside of Jomsom for a pilgrimage. I talked with everyone for a while – about the book Alex is writing about his travels to all 184 or so countries in the world, Marlaine’s apartment by the GW Bridge, and Vishnu’s recent trip to Paris – until I got called outside to board my flight, which then got canceled 10 minutes later. So I was sitting on the floor waiting again, this time to uncheck my bag, and thinking about what I would do that day, and never expecting to see my airport friends again, when Vishnu found me to tell me he had a van and driver for the whole crew and would I come sightseeing with them for the day. Um, awesome.

Vishu’s family did not seem at all weirded out that this random American girl was spending the day with them. They couldn’t directly communicate with me, but they totally accepted my presence. First we went to the lake to take a canoe – all 12 of us – to a Hindu temple on an island in the middle. Then we went to lunch at a Nepali restaurant overlooking the lake where we sat on pillows on a red clay floor watching parasailers land on the lawn below and where everyone ate dal bhat with their hands, except for the 3 “westerners” as we’re called, who used spoons. From there we saw bat caves, king’s caves, hidden caves, waterfalls, Hindu Temples and Buddhist temples, and the famous white river. Vishnu’s grandmother and auntie both come up to my shoulder, and when they weren’t sitting in the back of the van gossiping and laughing like middle-school girls they were scampering over cave rocks and wet stairs in their saris, like kids with gray hair. Vishu made sure at each destination to tell me the history of the site, or explain the political situation in Kath, or fill me in on powers of a temple’s patron god or goddess. His mother loved that I know some of the chants to honor Shiva and Saraswati, although I don’t think they quite got what I meant when I said I’m a yoga teacher and that’s why. At the end of the day they dropped me off at my hotel and Vishnu pronounced that they all felt like they had “known me all their lives.” I paid for every entry ticket I could and said thank you about a million times but felt like only Vishnu and Alex and Marlaine remotely understood how lucky I felt to have been swept up into their family for the day.

My flight to Jomsom got cancelled again on Saturday, but the second time around I got to wait for my flight from my bed in my hotel. The airline will call you it turns out and tell you if things are a go or not. It might have been nice to know that Friday, but I guess sometimes sitting in an airport waiting room for five hours watching the rain is the only way to start a perfect day.

Your guess is as good as mine

2008-06-14T23:47:00.004-04:00

Buildings like these are everywhere. I can never decide whether what was up came down, or what was to be built never got there. There is probably an obvious answer, but I like wondering.

pretty things that hold other things in no short supply

2008-06-14T23:33:00.003-04:00

Banepa, Nepal

Didi and the Rat. Or, Why I Am Living in A Hotel

2008-06-11T01:03:00.003-04:00

This was my apartment. Everything I first said about it was a superficial lie. And now I’m living in the hotel New Orleans.

First there was the problem of the pani (water). The Didi (housekeeper) in the main house claimed there was a water shortage, which is common here at this time of year before the monsoons have really gotten started. Except somehow the main house’s tank was always brimming full, while my sometimes-roommate Wanda and I were becoming experts at showering out of blue plastic buckets. (It’s actually not that bad once you work your strategy out – never rise off your body THEN start on the shampoo in your hair.) I was also getting awesome at water hauling. I could almost see myself living on a remote farm, balancing buckets on a yoke and wearing aprons. But when it came to having to walk next door to the fancy Adreni apartment complex and beg armed guards for access to their taps, because Didi had locked us out of the house pump out of either spite or delirium, I got over my cute anthropological experiment. I will say though that I am good with armed guards. In case you ever face this problem, employ the following: huge smile, lots of bowing with prayered hands and lots of “Namastes.” Thanks yoga.

So Didi. Also Crazy, Crazyface, Crazyeye. The nicknames sound mean but they are comforting when someone who makes no sense has power over your life. My first night she cornered me on the stairs and screamed at me in Nepali for no apparent reason, and I thought I’d really messed up, until Wanda let me know she was straight up “mad.” As in insane mad, on top of angry mad. Another day she unleashed her personal Cyclops, the house attack-kukur (dog) on Wanda when she tried to fill a bucket, making it clear pani would have to be procured elsewhere. The escape was narrow. Frustration with this pani situation made me brave a few nights later when she decided to sweep and mop the concrete stairs outside my bedroom with a stick broom and splashy rag scrubbing. After an hour of this and pleading with her to please be quiet so Wanda and I and our houseguest Daniel could sleep, all yoga failed me, and I snatched her weird archaic handbroom and bucket out of her hands and locked them in the apartment, yelling, “you’re SO coming back as a snail.” Buddhist Daniel watching all this just said, Robin, please find another place to live. After that I felt terrible – getting mad at a senile or possibly schizo old lady is so insensitive and horrible. And as I discovered in the morning not all the namastes in the world were going to get me anywhere with her now.

On what would end up being my final night, she came to my door mime-gesturing for a key to get into my apartment -- the lock system in Kathmandu involves padlocking yourself into your own home and keeping the key in your desk-drawer. I refused to let her in and resolved to just put up with Didi and her antics. I was almost getting fond of her funny little crazy lady! I curled up in bed, finally adjusting to what has to be the most uncomfortable bed in not-America – basically boards and a sheet through which I kept bruising myself with my own bones - and closed my eyes. The rustling that opened them a couple of minutes later revealed a rat’s tail swinging a few inches from my face. My screaming sent him hauling for the door, which I then had to un-padlock so he could graciously leave. Before I realized the crack under the door was a four-lane rat highway and he could come and go at any time. I slept on the couch in the living room, all signs pointing to “get the – out of here immediately.”

So when the landlady’s brother Narang showed up in the morning, the decision had been made, but he helpfully squashed any doubts inertia might have inspired. He came to let me know that Crazyeye had driven away the two teenage kids who had been living in the gardener’s shack and operating as compound security. So, Narang said, were I to continue to live there, I would have to be in by 8pm every night, because at that time the vicious kukur would be unleashed to ward off intruders. If I intended to come home any later, for any reason, I should think about sending in an ap to Dr. 90210.

Down 4 pairs of good underwear thanks to our favorite pervy rat I have cut my losses and am now staying in Wanda’s friend’s hotel until I can come up with a better option. So to anyone I promised could come visit because I had all this space, I still have the key, and you are welcome to take things up with Didi, best before 8.

Dying in Kathmandu

2008-06-09T04:00:00.003-04:00

Pashupatinath Temple, Kathmandu.

Pashupatinath is a Hindu temple straddling the Bagmati river. It is the most sacred temple of Shiva, the destroyer god, in all of Nepal, and the most widely used cremation site. Priests, royals, political officials, and members of every (theoretically banished) caste may have their funerals here on the famous ghats, stone platforms where pyres of sandalwood are allowed to dye out completely before the combined ashes of the dead and the wood are swept into the river.

In the picture on top a priest adds kindling and brush to the pyre of a woman whose funeral rites her four sons performed a few minutes before. Families here prepare the bodies themselves - wrap them, unwrap them, carry them, arrange them, bless them, and set the crematory fire. The first son of this elderly woman put a burning shaft of wood to her mouth, before leading his brothers in prayers, all walking clockwise, three times around the ghat, before the priest took over to do nothing else but tend the flames.

The white building in the second picture is the temple hospice. Here the dying watch the pyres which will soon consume their own bodies, from above the river into which their own ashes will be imminently swept. And on the steps alongside the ghats families come with ceremonial flowers and incense on the anniversary of the death of a relative. They fast for the day and splash water from the river on their faces because it's considered holy.

It's not just that people here are comfortable with the idea of death, because of an esoteric religious belief in reincarnation and karma or what the secular might think of as a cross-your-fingers hope they are soon to be united with the divine. They literally physically handle it, touch it, and live undisturbed breathing its dust. I can't help thinking of the contrast with my American experience - we have put so many layers of plastic between ourselves and death that to even see a corpse is for many nauseating, shocking, or terrifying. Both my and many of my classmates' reactions this past September, when we first cut into our cadavers in gross anatomy, attest to this. Death for us is about hospitals, professionals, morphine, breathing-machines, antiseptics, and law-suits. Death is on television. Death is control. Death is not lighting your mother's body on fire.

I couldn't go into the temple itself because I'm not Hindu, and I couldn't exactly sneak in. Like most days I was the only white person in sight, wandering among mourners, dreadlocked sadhus, priests, mala-vendors and monkeys. It's once place where hiding your map hoping you don't look like a tourist is like standing behind a chainlink fence hoping you are invisible. Which is nice, because everyone wants to help you, direct you, and tell you about this amazing ancient sacred place you've come to visit.

First Take

2008-06-09T03:00:00.000-04:00

A week ago on (6/2/08) when I got here I wrote the following... here is a snapshot of my initial impression of my new home:

"I'm writing from the Jhpiego office in Kathmandu, a small house in the south of the city. I live in the north, which is only about 3 miles away, but in the crazy traffic - motor bikes, buses, rickshaws, taxis, cars, sleepy cows and these trucks-for-hire called tempos, and no street lights or signs or lane lines, or cops doing anything but observing the mayhem - it takes up to an hour to cross town. Yesterday I got a tour of the city on the back of the office assistant Bikas's motorbike who poured some petrol out of a sprite bottle into the tank and took me across town to buy maps. Kath is, well, really dirty. Emissions standards are like the mythical Yeti (the famous abominable snowman of the Himalayas) -- a crazy story from far away no one actually takes seriously. And everything is crumbling as it's being built. There is mud and dust and debris and trash flying everywhere. So far I haven't been to either the touristy area where the trekkers hang, or any of the major temples, but I am seeing the real city, and it's like matchboxes all pasted together to make a winding speeding town that could explode or fall apart any second. There aren't sidewalks and pedestrians just press themselves up against walls and doorways to avoid getting a kneecap grazed off by a motorcycle. And horn honking is the default, it's like stop for more than 10 seconds will get you arrested. Since the Maoists have taken over officially I guess that could be true?

My apartment is adorable. I got there last night after a day of trying to convince the Didi (the housekeeper, but Didi literally means "big sister" and is a term of endearment) to show up and give me the key. It's huge by nyc standards, and on a pretty walled road just off of a main street, and it's somehow totally silent with lots of tiny balconies and lanterns. For $90 a month I have a 2 bedroom and a housekeeper who will clean, do my laundry,and make dhal baht - the traditional nepali staple meal of rice and spicy lentils - every night for dinner unless I tell her not to. NYC people especially understand how otherworldly this sounds.

As for work, I'm definitely excited about the project I've come here to do. I have been assigned a lovely Nepali woman named Jona to help me, and together we will spend the next 2 or 3 weeks meeting with everyone important in women's health in Kathmandu and nationally, along with teaching each other English and Nepali. The goal is to see where Nepal is in terms of cervical cancer prevention and determine if it is ready to implement Jhpiego's program. It is really, really good to feel like I'm doing something totally practical and real after being in school..."

(If you want to know more about Jhpiego, based in Baltimore and operating all over the world, check out www.jhpiego.org. It is affiliated with Johns Hopkins University and mainly focuses on family planning and maternal health.)