I spent the last two days and nights at one of our villager- Bindudidi’s home. She, her 8 year old daughter, and 2 month old son warmly welcomed me into their home. Her husband is working abroad, like most of the husbands in this community, and she takes care of the day to day work on her own.
You cannot come to understand a village until you are truly living in a village (yay participant observation and methodologies of cultural anthropology!) I realized that there were so many amenities at Chisang Clinic that I was taking for granted- shower, gas stove, and bottled water sold by the vendor across the street. So I asked Dr. Karki if I could live in a villager’s home for a few days. It was no problem-I asked Bindudidi at the Sunday bazaar and arrived at her doorstep the next day. Two days of cooking along-side Bindudidi on a firewood stove that filled the room with eye-tearing smoke, and required pushing air through a bamboo rod to keep the fire burning really gave me a completely eye-opening perspective on why respiratory issues are so prominent in this community. To read something in a public health book, and then to experience it in person really changes your frame of reference. I feel so grateful to Bindudidi for opening her home to me. Between my “ali-ali” Nepali- Hindi language combination we had shared lots of laughter and conversations late into the night. Working along-side her while cooking over the fire stove for 3 hours (daal, bhat, takari, achar- super “meeto” yum!) , getting her daughter ready for school (40 minute walk away), washing clothes with a hand pump and hanging them on the branches, and picking “munta” from the backyard has given me a new appreciation and ever-enhanced understanding of the village woman’s work. I am in love with my new family and Bindudidi’s “maya” and warmth.
I am heading out from the Terai Plains to Chisang Clinic Dhankuta in the hills on Friday. I cannot untwine myself from this experience in Bhaunne- the stories, faces and voices that have touched me. I have gained so much and maybe with some more reflection I will be able to put it into words. I certain that this not goodbye- we will meet again! Slash hopefully I will be able to keep this blog going- special shout-out to E-Link Cyber Cafe for their awesome Wi-Fi and welcoming staff! Goodbye Ithari :)
Grandmothers stop us outside the Bazaar in Namje to sing us songs of their childhood.
How fitting- it’s World Breastfeeding Week from August 1-7 woohoo! We just completed interviewing our 20th mother this morning at the clinic. This week has truly been an eye-opening and fulfilling experience for me as a student of anthropology and medicine. Everyday we went out to three interviews in the morning before the scorching afternoon heat set in and completed two more after lunch before sunset. I set out to not only learn what the practices were, but also to gain insights into why they were being practiced- to know what they do and why they do it. Each home visit came with a novel set of conditions and family dynamics. At times it was just our team and the mother on the porch, and at other times it seemed that the whole community had managed to squeeze into the house!
For my next research project I will be sure to make language training a priority for sure. It is easy for the nuances to get lost in translation. I had one particularly exciting experience with a family of two schoolteachers who spoke English so well that I could conduct the interview without the assistance of translators. The interview was so rich and informative for me because I could question further beyond my standard questionnaire interview set. Lots of transcribing to do- and must figure out how to put all of this amazing info into graph format ayaya!
I am sad to see this chapter of my project come to an end. There is something so special about home visits and in-depth interviews with these women. I will be staying at one of the interviewee’s home for the next two days to gain a better understanding of what day-to-day life is really like for these women. I am savoring every moment. I know the next three weeks are going to flash by so quickly. The next leg of this project will be coming up with an ANC breast feeding workshop. Ok our bus is waiting- need to run! Til next time :)
Okay now here is where it get’s really crazy and the puzzle pieces come together. There is an ultrasound that has been sitting in the second patient room as a mantle piece museum artifact since it arrived because the organization that donated it sent neither a trainer user manual nor accompanying information. No one could crack its password, and therefore there was no way to print the ultrasound images/reports. Yesterday out of curiosity Jason (University of British Columbia), Diana (Williams College) and I gave the machine a go. After some time working with the ultrasound guidelines we came out with great news- the ultrasound was finally working! Stuck in a flash drive, worked around the settings, and honestly I just read aloud while my wonderful tech whiz friends did their magic J With the ultrasound we will be able to provide complete ANCs, and move forward as per protocol to the next phase of the Birthing Center. An ultrasound means we can offer complete ANCs, which means we can continue building the center, soon hire a skilled birth attendant, and eventually have a full equipped birthing center with 4 surgery beds! We are currently in the preliminary stages of preparing the clinic to provide complete ANCs for the women in the community. Women in the surrounding districts will no longer have to travel for 3 hours, spend money on transportation, food, extravagant operation/hospital stay fees, and be forced to bed rest in cramped hospital wards. After visiting the closest government and private hospitals in Biratnagar where IVs hung across window sills, and more people lined the floors than beds, I finally gained an adjusted perspective that really helped me understand what made a rural clinic like Chisang indispensable to its servicing communities.
We did not lose a moment. Last night we called four of the pregnant women we had seen earlier that day and tested with the fetal Doppler to come in at 8 am for an ultrasound. They were here by 7 am (that is not how time in Nepal usually works!) The volunteers and I were excited; the staff was ready to go and learn. The room had been cleaned down, the patient table lined, the ultrasound adjusted to the right settings, and the flash drive in place to save the images. The morning ran so smoothly. I took down patient histories/vitals for the ANC report with the aid of Dr. Karki’s translation, and even had the opportunity to locate a fetal heart on the ultrasound. Talk about an eventful morning! I am so excited to be a part of this new chapter in the clinic’s progression and broadening growth. There is so much potential to meet the great needs of the community, and here at the clinic we are all energized and ready to work, work, work!
Just acclimated to the come and go pace of Bhaunne village, and everything has sped up to lightning fast speed in the past two days. I began interviewing mothers with infants up to 6 months of age yesterday morning with our team-Dr. Karki translating, Alka our medical assistant taking down infant vitals, and I note taking/ recording (we inevitably collected an entourage of children as we reached our interviewee’s porch). There is so much richness in a home visit. The family interaction/dynamics and open armed hospitality cannot be reproduced in any other environment. In just a few visits it’s clear that women really do carry good knowledge forward. A few words of nutritional guidance at a government hospital, where most of the women go to give birth, would go a long way for the infant’s health now and into the future. As we go through the questionnaire and survey it’s clear that there is a gap in nutritional knowledge, especially in terms of the importance of exclusive breastfeeding and when to supplement with other foods. However, we do not correct in the middle of the discussion. I am here to learn from them, not to berate and lecture. At the end we have a question and answer session with the mother, elucidating any grey areas, and giving reasons for why such and such should be fed. By the third interview later in the evening, we have a rhythm in our work and the question and answer session goes through smoothly.
I am learning so so much- seeing home made lito made in women’s kitchens, giving information about oral rehydration for infant diarrhea, looking into mother’s eyes and really catching for the first time a glimpse of their perspective. It’s too early to extrapolate conclusions, but it is clear that women here, like most in poverty, are severely limited by the constraints of “dollars and cents”. All practice breastfeeding, which is both the “perfect nutrition” and most economically efficient form of feeding. However when there is “insufficient milk”, which I suspect to be a socio-cultural concept that is usually caused by mother’s malnutrition, lito, Lactogen formula, and animal milk is substituted. Also there is the misconception that other sources of food have “more energy” for the child than breast milk. These are definitely a few points I would like to work to elucidate and offer information about at the clinic’s ANC workshops. It’s coming together so well, and I feel so lucky to be a part of this team here at Chisang Clinic. Hopefully, I can get together enough information to create a infant nutrition pamphlet to distribute at antenatal checkups that will be performed at the clinic.
“You might not change Nepal, but Nepal will forever change you” – Lonely Planet
Starting from the eye of the storm. 18 days in, and it will be a trying effort to trace my steps backwards to where I have come from. I am here, and I cannot turn back. I can only move forward. For the next 5 weeks I am a guest in a home to open to all. Nepal, you are absolutely breathtaking.
Without internet access it’s been difficult to maintain a blog, but from now on I will be making a weekly 2 hour trip to Ithari Cyber Cafe from Bhaunne Chowk to be sure to have this down on record.
I will be working at Chisang Clinic in Bhaunne, Nepal conducting interviews and taking part in participant observation for an anthropological research project concerning the village’s traditional breastfeeding practices. I will start pre-testing my research questions on exclusive breastfeeding and infant nutrition tomorrow- so excited! I will spend the bulk of this two month “yatra” (voyage) at Chisang Clinic Bhaunne in the plains and week or so at Chisang Clinic Dhankuta up in the “hills”- 8,200 ft above sea level. Interspersed will be bungee jumping adventures, treks across mountain ranges and trips to national safaris, tea estates, and surrounding villages. I come with no set agenda, only an expectation of myself to continuously adapt, reflect and grow. The past leg of my journey has given me the opportunity to contextualize and widen my understanding of the project that I have undertaken. I am excited and so humbled.