Laughter is the Best Medicine

As my time in Nepal comes to a close, the overwhelming emotion I feel is gratitude. In three weeks, I had the opportunity to treat 240 patients and learn many invaluable lessons about health, culture, and life. I worked with amazing, sensitive interpreters and developed a very fulfilling daily routine of eating, sleeping, working, exploring the rice paddies, greeting the street dogs and maintaining a safe distance from the endearing monkeys. On the weekends I traveled to Kathmandu, Bhaktapur, Patan, Boudha, and Swayambhunath to see the ancient temples that are still standing as well as those that are now in ruins.

One of the biggest treats was a visit from Clowns Without Borders, a Spanish performance troupe that strives to offer humor as a means of psychological support to communities that have suffered trauma. They are currently touring Nepal, visiting some of the 586 displacement sites, or tent towns created after the earthquake that range in size from around 200 – 8,000 people and are temporarily housing thousands of vulnerable children.

Although the clowns planned to put on a show for the young monks at the monastery next to the clinic, the courtyard quickly became packed with our interpreters and our patients, as well as throngs of school children, adult passersby, and local shopkeepers. Old and young alike, the audience was captivated with the rare spectacle and eagerly spent the afternoon watching the clowns dance, juggle, walk tightropes, and pull pranks on each other and a few lucky monks.

It made me reflect on how quickly I normally lose interest in such performances. Coming from the jaded Western perspective that I've seen it all or I'm too cool, it is sometimes difficult to freely experience what it in front of me without tainting it with an internal dialogue of skepticism that diminishes life's inherent spontaneity and joy. Yet, for both children and adults whose lives have not been inundated with entertainment and oversaturated with stimulation, their unrestrained ability to appreciate and openly receive the offer in front of them- to laugh- was really very beautiful to witness. As I looked around, I noticed that my patients with chronic pain, severely high blood pressure, Parkinson's disease, and partial paralysis looked happy, comfortable, and free while watching the show.

As I prepare to leave, my hope is that I will carry some of Nepal with me as a means to change the more insidious aspects of the cultural perspective that I have been so rooted in. My existence  needs more compassion, more gratitude, more laughter, and more connection to the inner freedom and dignity that I glimpsed in so many facets of life on a daily basis in Nepal. My experience here has renewed my own internal awareness that nothing is really so bad, as each moment we are given a fresh opportunity to embrace the divine within ourselves as a means to transcend the many ways in which we imprison ourselves with judgment, projection, obsession, self-pity, and isolation.

Thank you for reading, thank you for supporting my trip, thank you for encouraging me on this journey. May you all be happy, peaceful, and loved. May Nepal be happy, peaceful, and loved. Namaste.

Namaste

Being in Nepal has reminded me how important it is to leave our cultural comfort zones and allow ourselves to experience those slight shifts in perspective that pave the way to major insights and life-changing revelations. It is so interesting to realize, again and again, that there is no objectivity- what we believe to be universal truth quickly disintegrates when we are immersed in another culture that has been built upon entirely different universal truths. It is humbling to remember that, no matter how certain we are, our particular perspective of reality represents nothing more than our own cultural indoctrination of what is good, what is bad, what is normal, what is desirable.

In New York, the prevailing cultural doctrine that underlies everyday thought and behavior (in my opinion) is that life is stressful. Satisfaction, inner peace, and personal fulfillment are goals that are constantly pushed farther and farther into the future but rarely achieved right now. Materialism has taught us that we deserve more, that no matter what we have it is never enough, and that something is wrong with us if we are not willing and able to make ourselves sick with stress and exhaustion in the pursuit of health and happiness. We live in a crowded and sometimes hostile environment that requires self-imposed alienation from a very large percentage of the people we cross paths with on a daily basis.

Like the horses that plod through Central Park, we put blinders on as we move around the city, in the form of vacant stares, sunglasses, and unwavering engagement with our iPhones, to most efficiently shield ourselves from the world around us. It is a survival technique meant to conserve energy for interactions that really matter- interactions that we sense will benefit us in some way. An unfortunate con of the New York lifestyle is a pervasive sense of loneliness and mental anguish that stems from feeling unseen, misunderstood, and unfulfilled. Many of us frantically, and unsuccessfully, try to fill this void with drinking, shopping, exercising, yoga, tinder, nostalgia about a glorified past or obsession about a better future.

I have been so surprised that out of the 200 Nepali patients I have treated in the last week, only one has mentioned anxiety and depression. After the horrific earthquake, not to mention decades of imperialism, civil war, Tibetan refugee crises, Maoist terrorist attacks, unstable governments, and limited access to electricity, gas, and water, I had expected to treat mass trauma and PTSD on a regular basis. Instead, the majority of my patients seek treatment for persistent arm or leg or back pain, compounded with other medical disorders, due to poor diet, pollution, and full days of back-breaking labor in the fields. Yet, aside from the pain, or the hypertension, or the gout, or the dizziness, they are happy. They smile easily, they sleep well, they have no issues with ruminating thoughts, grief for the past, or longing for the future.

In contrast to New York, where the dominant cultural message is “life is hard” (even though compared to most places it is really really good), in Nepal, it seems to be “life is good” (even though it is really really hard). In terms of health, it is incredible to think about how drastically that slight difference in perspective impacts physical, mental, and emotional perception of every single life experience. In Nepal, tourists joke about the pervasive Nepali phrase and gesture that signifies, “what to do?” As in, there's a major petrol crisis going on and life is even harder now- what to do? The tourists want action, indignation, rage. Yet, the Nepalis seem to be conserving their energy for actions that really matter- walking for hours or braving the dangerously crowded buses and vans, gathering wood for cooking fires, not freezing to death in the tents or concrete houses that have no heat.

 The dignified acceptance of what is that my Nepali patients so effortlessly carry into the clinic, is the exact medicine that so many of us Westerners seek and crave. The cure for the deep spiritual void that materialism has created in most of us is not accessed through consuming more, as the advertisements would have us believe, nor through numbing behaviors such as drinking, shopping, or exercising, nor through attempts at spiritual by-passing with yoga, meditation, or philosophy. In Nepal, spiritual healing is ingrained in the culture, providing an intrinsic ability to live in the present moment, free from suffering, pining, and longing. It is a survival mechanism that arises as naturally as the impulse to eat or sleep, offering resiliency in coping with the immense hardship, disaster, injustice, and trauma that the Nepali people are, sadly, so accustomed to and continuously subjected to by politicians, natural disasters, and foreign powers.

The essence of this spiritual medicine is found in the most frequently uttered word in Nepal- the simple salutation, namaste,used for both greeting and departing. In New York, namaste is an exotic word said at the end of a yoga class, hands pressed together in prayer form, meant to imply, “Thank you, goodbye, we all just shared a great experience for me.” In Hinduism it means, “I bow to the divine in you.” Or in other words, “The divine in me recognizes itself in the divine in you, and we both acknowledge that sacred bond.” Namaste is a way to say to someone, I see you; I see the goodness, the truth, and the beauty in you and I have faith that you see it in me too.

It is a conscious choice to let go of fear, judgment, and distancing techniques, to embrace the rare opportunity to be free enough to give and receive love spontaneously, without shame and without commitment. Namaste honors the present moment, as an expression of gratitude for glimpsing the divinity carried within each sentient being. Even if only for a second, witnessing that luminosity is profoundly healing. 

Namaste.

Compassion in Action

The acupuncture clinic has been full of patients this week, sometimes with a line out the door. Some walk as much as three hours each way along dusty dirt roads weaving through rice paddies to get here. They come for acupuncture, Chinese herbs, Ayervedic massage, and Tibetan medicine provided by volunteers, in exchange for the price of a cup of tea. Some patients also bring fresh eggs or homebrewed moonshine to give directly to their practitioners as a gesture of gratitude. They come for all sorts of issues- back pain, knee pain, shoulder pain, stroke recovery, digestive upset, loss of appetite. Some of them lost their homes in the earthquake, some of them were injured by their homes in the earthquake. The most surprising thing is that almost none of the patients complain of the stress, anxiety, depression or trouble sleeping, that I am so accustomed to treating in New York.

Beyond offering acupuncture and other forms of medicine, I have noticed that the clinic also provides a community gathering space surrounding health and healing. Most patients come weekly on the same day. They get to know each other, listen to each others’ intakes, and keep track of each others’ problems and progress. They are enthusiastic when someone’s symptoms improve, and supportive when new problems arise. They give each other advice, and even as they receive their treatments with resolve, without complaining about needles or the discomfort of having their bare feet touching the freezing cold floor, they continue to talk and share and participate.

It makes me wonder, at the community clinic where I work in Brooklyn, where the same patients share the same waiting room and treatment rooms on a weekly basis as well- do they ever acknowledge that they have something in common? Or, according to the rigid rules of New York City socializing, do they avoid eye contact, feign lack of recognition, and work hard to maintain the feeling of separation that they have carefully carved out for themselves in such a crowded and overwhelming city? I know I would. It is interesting to think about what it would mean for “community clinic” to signify not just a shared treatment space, but a shared treatment experience. Studies have been done that demonstrate that when a group of people receive acupuncture, people in the same room that do not receive the treatment also show signs of physiological benefit. Perhaps the energetics of healing are contagious, and even synergystic, and the role of community and human connection play a vital role in the journey through sickness and health and personal transformation.

It makes you question, what is HIPPA beyond a lot of paperwork about privacy practices? It is interesting to evaluate how it has shaped our delivery of health care and changed the social fabric of medicine, community, and culture. In the last few decades, individualism and the right to privacy, or in other words, isolation, have become prized above all other communal aspects of life, and even considered a human right whose violation is grounds for a substantial lawsuit. As each individual embarks on their own personally complicated and challenging journey through healing, living, and dying, the coveted privacy that HIPAA aims to protect is preserved at all costs- even at the cost of the type of healing that can be accessed only through human connection itself.

In the amazing novel God's Hotel, Victoria Sweet vividly describes the atmosphere of the old Laguna Honda hospital in San Francisco before it was demoslished. As the last almshouse in the country, it provided open air wards and sunlit community gathering spaces for patients in need of long-term care. The building itself was modeled after Eurpean almshouses for the poor, where nuns offered free nursing care to the old, the sick, and the disabled. Sweet describes the different wards as mini-communities within the larger society of the hospital. There was the little old lady ward, and the little old man ward. Mostly, there were mixed wards whose community was not assembled based on the modern method of clustering by diagnosis, but based on selecting individuals based on mental acuity and nursing needs, which “had been good for the patients because the disabilities in any particular ward were complementary- the physically disabled watching out for the demented; the lame leading the blind, in fact.”

Eventually, in the 1990s, as litigation became the primary factor in establishing medical policies and styles of practice, Laguna Honda was sued, repeatedly, for providing long term care to the disabled instead of releasing them back “to the community” (aka, to the streets, or to debilitated and dangerous SROs on skid row) and for violating patients' rights to privacy by housing them on open wards. Interestly, when most patients were given the chance to be discharged, or to move to private or semi-private rooms, they declined. There was an awareness that isolation is a step on the path to death, that loss of community is synonymous with loss of will to live.

Just like in Laguna Honda, the will to heal, live, and be well in Nepal flourishes through community, mutual support, and compassion. The traditional value of community, not privacy, is ingrained in Nepali culture and serves as a base for strength and resiliency. It is an instinctual social behavior developed for survival in the face of shared suffering, rather than a intellectually developed human right, based on the innate wisdom that as social creatures, human beings cannot thrive in isolation. All around, our distant relatives remind us of this unchanging fact of nature.

Which brings up the question, why, in New York, have we come to believe that we can and should thrive in isolation? Self-reliance, it is called in celebration- the opposite of the dreaded co-dependence, or, the admission that as social creatures human beings cannot escape from relying on one another to survive, thrive, and grow. Perhaps this denial of our true nature is the basis of so much of the self-loathing, anxiety, depression, stress, and insomnia that permeates our culture. Perhaps healing is the recognition that we are all connected, and by embracing that connection without fear we become the human beings we are truly meant to be.

Kathmandu Valley

I have arrived! Towards the end of two full days of flying, layovers, time changes, and a lot of mental disorientation, I awoke from my last plane nap and saw the Himalayas standing before me. Their pure white jagged peaks poked through the clouds on the horizon, towering over the lush green mountains and valleys below.

The Vajra Varahi clinic is outside of Kathmandu, in the much smaller and less chaotic town of Chapagaun. The lower level has a reception area and treatments rooms, and the two upper levels are bedrooms for staff, as well as a common area and shared kitchen. The rooftop terrace is beautiful, with resident feline friends and amazing views across the valley. 

The streets are alive with a ceaseless flow of people, bikes, motorcycles, cats, dogs, goats, chickens, ducks, cows, and the occasional water buffalo. To my surprise, apparently the rooftops are alive as well, with visiting monkeys clambering across the terraces to sample the herb garden, and steal whatever else they can get their hands on. 

Nearby is a Vajra Varahi temple, one of four temples in Nepal built for the Buddhist goddess Vajra Varahi, where I had my first introduction to the style of worship of Nepal's 3300 million gods. 

The dusty narrow streets in the surrounding area are filled with concrete houses intermingled with corrugated tin huts that were constructed after the earthquake. Residential areas quickly give way to sprawling farmland and rice paddies. 

But so far, the most beautiful aspect of being in Nepal is being surrounding by such amazingly resilient and open people. The generous warmth that shines through their radiant smiles truly nourishes the soul. 

I look forward to getting to know them, through the help of my interpreter, and feel very honored to have the opportunity to treat them in the clinic when it opens for business this week.  

Acupuncture Outreach in Nepal

For the month of December, I will be volunteering at Vajravarahi Health Care Clinic outside of Kathmandu, Nepal, treating members of the local community for the price of a cup of tea. Nepal is recovering from a devastating series of earthquakes in April 2015. Millions of people were displaced and continue to struggle. During my trip, I will post to this travel blog, to share with you all the wonder and beauty of Nepal, and the amazing ways that acupuncture and Chinese medicine can be used for stress and trauma in even the most extreme situations.

For more information about the clinic please click here.