About coffee, um, I mean water....

The coffee blog post was conceptualized over nine months ago when a long awaited Moka pot arrived with a visitor from the US. Since then we've done multiple taste tests with various brewing techniques and probably (definitely) consumed more than 1,000 cups of coffee in our home. But lest we get ahead of ourselves, this time of year reminds us just how precious the water is that's required to brew said coffee. So as a prerequisite to writing about coffee, we'll explain how the water gets to us in the first place.

Nepal's climate (and just about every other aspect of life) is dependent on the South Asian monsoon. Rains arrive predictably in June and stay till September, driving the annual agricultural cycles. April and May, however, are the hottest, driest months of the year, bringing with them often severe water shortages throughout the region. Furthermore, due to contamination of surface and ground water by things we'd rather not mention, safe water is even scarcer. Add to this our weak foreign stomaches and, well, lets just say a clean glass of water has become one of our most precious, appreciated commodities. (So is albendazole, but that's a different post all together.)

So how does a household get clean drinking water? There are a few options, really. But since our necks are as weak as our stomachs, we don't carry our own water up from the local tap. Rather, we've learned how to truck it in. And pump it. And filter it.

Step 1: Call the water truck. Pray that they have both water to fill their tanker and fuel to reach your house. (The tanker's hose runs down our driveway, into our ground tank.)

Step 2: Wait as 7,000 liters of water fill your ground tank.

Step 3: Pump water up to the roof, where 2000 liters can (and should) be stored.

Step 4: Turn on the tap -- but don't drink it! (And please don't judge our dishes.)

Step 5: Again, multiple options here that include boiling, bleach, UV light, and others. We prefer a simple carbon filter to make our water safe for drinking.

Step 6: Finally! Poor clean, drinkable water into your coffee brewing mechanism of choice. More on this step soon....

Ke Garne? (What to do?)

In my Nepali language classes, we are currently studying the Nepal wilderness. We learn about the forest, animals, bugs, etc. The community assignment for this chapter includes a trip to the zoo. However, I am learning even more about Nepal's wilderness in my own home.

While tackling the usual suspects (e.g. mosquitoes, geckos), I noticed a bug on our table. After killing and disposing of it, I noticed another... and another. Soon, it became very clear that the bugs were coming out of the table, boring holes through the wood. What?!? Not knowing what to do... I videotaped it. 

Afterwards, I sprayed insecticide in the holes. One little creature got caught halfway with his head at the hole opening. I couldn't quite live with him still in there but wasn't sure how to get him out. No worries, I remembered the good ol' scotch tape test for worms in med school and... voila! To all my medical friends, I promise the worm came from the table. =) 

After some consultation with Christine, our carpenter who built the table, and the internet, it appears these little creatures are powderpost beetles. Thankfully, they can cause some cosmetic damage, but not any extensive damage or further infestation. We're hoping their presence adds to the "distressed wood" look, rather than discourages future dinner guests. Ke garne? 

Disasters - Ready or Not...

This small, beautiful country of Nepal has seen more than its fair share of natural disasters. Year after year, monsoon rains bring floods and landslides. And after the devastating earthquakes, the country has been looking to improve their disaster preparedness. Patan Hospital has led the country in developing and implementing a disaster plan. As a result, other hospitals have asked Patan for assistance to develop a similar, site-specific disaster plan.

Over the past month, Patan Emergency Department has worked with another hospital, Spinal Injury Rehabilitation Centre (SIRC), to improve their disaster preparedness. Recently, we ran a disaster drill to evaluate their response and implementation. Can I just say - this was a blast! We bused 50 medical students, make-up artists, videographers, and photographers an hour away to this hospital. Additionally, officials from the Ministry of Health, World Health Organization, and Army attended as participants, observers and evaluators.

SIRC did a great job. It was good learning experience for all of us. With the fresh memories from the recent earthquake, everyone understands all to well the critical nature of this preparation. Overall, this was a sweet day of watching hospitals and organizations work together to build the emergency response system in Nepal.

Make-up artists did a great job making wounds/injuries realistic.

One of the Emergency Medicine Fellows gives instructions to the army for the disaster drill. 

"Patients" being dropped off at the hospital. The hospital did a great job of triaging and managing all of the patients.

The medical students did an awesome job acting as patients injured in a building collapse.

The Restock

What would you do with 200 pounds? I'm not talking about the spendable pound sterling, but rather the precious and often pricey luggage weight allotted to air travelers. Thankfully we were two individuals flying internationally, so these pounds cost us nothing extra at all. (Until you consider the airfare itself.)

While I almost always avoid checking bags, preferring to travel light and avoid lost luggage, that rule definitely does not apply when it comes to the restock. That is, the glorious opportunity to fill our bags with favorite commodities from the US.

It won't take you long to notice the themes of this year's restock.

1. Coffee. By far our most regularly imported item. Customs officers must think we're running an illegal cafe out of our home. The post office may think the same, as we have amazing friends that send us regular supplies. Thankfully, the value-to-ounce ratio is--in our caffeinated opinion--quite high.

2. Canning supplies? We'll concede that neither of us is your typical canner. But seasonal produce includes exotic lychees and amazing mangoes, such that we'd even risk botulism to preserve them. (Hopefully there won't be any blog posts about that in the near future. But then, who would be able to type it?!)

3. Wool anything. This past month it was socks, but the last restock included long underwear. Unlike standard fabric blends, you can go for months without washing wool and it doesn't stink. Not that we've tried....

4. Emergency gear. Whether it's a large-scale disaster or a power outage due to shortages, camping stoves and backup batteries are our MVPs.

5. Shoes. Mainly because our 'merican-sized feet can't fit into anything here. That, and the trails tear through them quickly.

6. Chocolate. A perennial favorite. The high temperatures in South Asia require increased paraffin content to keep chocolate from melting. So while the wrapper may say "Hershey's," if it comes from Delhi it's just not the same. We love sharing real Hershey's s'mores and baked treats with expat and Nepali friends alike.

Before I get carried away, an essential clarification: I would much rather spend these pounds on people if I could, missing them a thousand times more than anything listed above.

But TSA frowns upon that practice, so for the time being, I'll enjoy baking Nestle Toll House chocolate chip cookies. If only I could find some cooking fuel....

Modified Life

Life in Nepal requires lots of modifications. Creativity is a must! To begin, here are just a few ways in which life is a little different:

• Unike in the US, we can’t buy everything we could possibly want in the grocery store. If you want it, you often need to figure out how to make it. Some of our favorite homemade things we would normally just buy are yogurt, ricotta cheese, crackers, english muffins, granola, pasta, and of course, ice cream.
• Doing laundry by hand.
• When there’s no gas and no hot plate, apparently you can use an iron to heat water?!? 
• My pretty strong stomach is no match for the invisible bacteria found in the water. We are constantly filtering or boiling water and/or contemplating our chances when eating out in Nepal.
• Monkeys. They are all around the city. In certain areas, including the baggage claim in the airport's domestic terminal, you need to conceal all food and/or beverages. Otherwise, they'll soon belong to the monkeys.
• New bugs. Especially land leeches during the monsoons make daily walks more adventuresome, requiring regular bug spray and even soaking socks in permethrin to keep them away. And just when leech season finally ended...tick season began.

Of course, we expect that foreigners would and should adapt to their new surroundings. But now, in light of the ongoing border blockade between Nepal and India, even Nepalis are being forced to make modifications to their daily routine. Without cooking gas, we are revisiting how to make favorite foods with the one electrical appliance that we have. Did you know you can make almost anything in a rice cooker? Bread – check! Soup – check! Molten Lava Cake – you bet! Even restaurants are now advertising a “Modi”fied menu, emphasizing the frustration with Prime Minister Modi in India who is believed to be playing a large role in keeping needed supplies from coming into Nepal.

But as the dry winter season begins here in Nepal, electricity is also becoming scarce. Nepal relies on hydroelectricity for power so without consistent rain, we have a limited supply. Many of the rural areas have no electricity at all and in the city, we have to share the supply. This means that during a good portion of the day any given house has no electricity. Below is our current schedule of when electricity is out each day:

            Power is out during the intervals listed.

No sector is immune to the shortages. Domestic flights have been cancelled. Public transportation has been drastically cut. (Christine's commute, as a result, went from $0.20/day to $20.00/day.) Hospitals are short on supplies and in terms of cooking for patients they've even had to resort to open fires. 

Resourceful employees at the Spinal Injury Rehabilitation Centre

Economists are predicting that the border blockade will have a larger negative impact on the country than even the major earthquakes this past spring. But while foreign aid (from India, even) poured in to help Nepal respond to that crisis, most in the world aren't even aware of the blockade, which is now into its 5th month. And so, for the unforeseeable future, it looks like we--along with the rest of the country--won't be traveling. May not be working. And will continue to cook creatively. Between the hours of noon and 4:00 p.m., that is. 

Mountains (The Perfect Wordless Wednesday Theme)

Makalu, 27,825 ft.

Langtang Region: Dorje Lhakpa, 22,854 ft.

Mountains are so elusive! This was five minutes after the above photo was taken. Bye-bye Dorje.

Annapurna South, peaking out at sunrise. 23,684 ft.

Machhapuchhre or "Fishtail" (for obvious reasons), 22,943 ft.

You may already recognize this shot, but we have to include Sagarmaathaa, also known as everest Everest. 29,029 ft.
(In the center with it's characteristic plume.)

For the first six months, we thought these were mountains, as this was our only view during the monsoon rains.
We now know that these are just hills. :)

Nepal Continues to Struggle Post Earthquake

Months after the earthquake, we still see evidence of its destruction on our daily walks. With the end of the monsoons, rebuilding was expected to begin. However, this is currently impossible with the lack of fuel and other resources due to the continued blockade at the Nepal-India border. Even the World Food Programme, a branch of the United Nations, has been unable to overcome this obstacle. They were delivering food via helicopter to many of these affected villages but are now grounded due to the fuel shortages. Many families affected by the earthquake are living in tents or temporary homes made of tin, which provided adequate shelter during the rains but are not as suitable for the cold winter months.

Here are just a few pictures of the homes we pass walking around Kathmandu.

House destroyed on the left with temporary corrugated tin house on right.

Tent cities for earthquake victims remain scattered throughout Kathmandu.

Children playing in one of the tent cities where earthquake victims continue to be housed.

When leaving a research conference at the Hyatt this week, one of the nicest hotels in Kathmandu, these tent cities pictured above were visible from the walkway. While contemplating this disparity and in the midst of subsequent guilt and grief, I just wanted to get them all rooms at the hotel. Although it's not a sustainable solution, I wrestle with hard questions: what is the answer? And how do we get there, especially when the entire country is in survival mode and the rest of the world, and honestly even some of us in Nepal, have moved on from the earthquake? While I don't have answers, we need to continue to seek ways to practically help while living here alongside the people of Nepal. Please continue to pray for Nepal, an end to the blockade, and a renewed focus to rebuild and restore these communities affected by the earthquake. 

Trekking 101

A few lessons learned while trekking through the Himalayas last month:

1. Just keep walking. 

2. Water is your friend. And Red Bull is your best friend. We'll choose that over Gatorade any day!

3. We'll never be truly "local." While in our own estimation a 20-lb. pack between the two of us equaled traveling light, you should've seen the laughs we inspired each evening as we pulled out sleeping bags, down jackets, and water filters. 

4. Beware the flying squirrel! (Click here if you missed it.)

5. Nepalis are, without a doubt, the strongest people in the world. We were constantly passed by teenagers running up and down the trails in flip flops, carrying 100+ lbs. strapped to their heads.

6. There's a common t-shirt in Nepal that says, "Daal Bhaat 24-Hour Power." We now know why--and we agree! The local rice and lentil combo kept us going.

7. If you're not sure which path is the main trail (i.e. the road to/from China), just follow the mule poop.

8. Trekking poles = knee-savers. And quite possibly life-savers. 

9. In addition to being the strongest people in the world, Nepalis are the most hospitable as well. We were regularly given yak cheese, tea, and beds to sleep in, simply because we were guests.

10. Speaking of those beds: I need to shrink a few inches (and I'm only 5'4"). The average height of Nepali men is 5'4" and women, 4’11½". The beds were made for exactly that. So learning to curl up, sleep diagonally with legs hanging off the bed or over the footboard made even lying down a little more interesting.

11. Ramen noodles become increasingly delicious the more miles you trek.

12. Just keep walking. It's worth repeating. The days can be long and the trail difficult, but just keep walking. One step at a time.

Logistically speaking, the lessons really were as simple as 1-2-12. But the deeper reality is that many Nepalis have no choice but to walk for hours--sometimes days--just to obtain basic necessities like firewood, clothing, food, and medical care. Not a single Nepali we met along the way was trekking. They were simply living. We're incredibly grateful for the privilege to walk alongside so many.

Perhaps these pictures will tell a bit more of the story as we trekked from Lingam to Num, where we subsequently took a jeep followed by an airplane to get back to Kathmandu.

All smiles in the beginning. This was the start of our trek with the first "up" seen in the background.
Too bad we had to go down first. 

Up. Down. Cross the river. Repeat.

This was one of five new (since April) landslides we walked over. We're thankful for safety and great weather.

Daal bhaat, our trail MVP. Nepal's twice-daily meal of lentils, rice, and veggies.

Finished!

What's next? A return trip? Planning on it. Everest Base Camp? Perhaps. Stay tuned... and please send Gatorade Chews!

Flying Squirrel - What?!?

During our time on the Himalayan trails, we are always on the lookout for hazards as the path is narrow and the terrain is difficult. Interestingly, some of these hazards are animals. The typical encounters are with mules, cows, and goats as they are herded from one village to another. These encounters can be potentially dangerous on the narrow trail as often only one animal fits (you or the 2000-pound livestock), making it necessary to stay on the inside hugging the mountain. While trekking, I often wondered how many livestock fall off the edge and subsequently prayed that I wouldn’t. On rare occasion, we saw the infamous yak, which we would love to adopt but will have to wait as they don’t do well in Kathmandu's lower altitude.

The trail (aka Road to China)

 Mules carrying goods from China

 The Yak

I think my biggest fear has been the possibility of encountering a snake, especially as many are poisonous. Anti-venom in Nepal? I don’t think so. We can’t even get fuel or cooking gas. Two of our teammates encountered one of these deadly snakes on the trail, but thankfully, our Nepali colleague has some impressive snake-slaying skills and came back with pictures of said snake in his bare hands.

So, when you are finally off the trail for the day and enjoying dinner, one would expect to be done with the hazardous animal lookout, right? This was not the case on one of our nights trekking home. Having just sat down on the floor to enjoy some daal bhaat (lentils and rice), we heard a commotion. We were suddenly face-to-face with a large, cat-sized something possessing a long tail, red eyes, red hair, and the temper to go with it. I wasn’t sure what to do – I wanted to run, but wasn't sure I could get up with my sore knees after a full day of trekking. And our gracious hosts kept telling us to keep calm and keep eating. So we watched as they tried to catch this thing.... What ensued reminded me of the Great Outdoors movie clip when they tried to catch the bat in the cabin:

All I kept thinking about was rabies. Despite the hissing and frightening claws of this animal, the Nepalis were able to stab it in the eye causing it to fall to the ground. I thought it was dead, so of course, got closer to look at this thing and take a picture. The locals were picking it up and stretching out it’s wings/legs – A Himalayan Flying Squirrel – a rare sighting in the mountains. While trying to take a picture in the dark, I noticed it was breathing. Quickly we insisted they take it outside while we tried to keep our distance. Although they "trapped" it under a basket, sometime in the middle of the night this flying squirrel escaped. Somewhere in the Himalayas is now a one-eyed flying squirrel. Hope his depth perception is okay, otherwise, some dangerous Himalayan mountain flights may await him.

The Himalayan flying squirrel

What the animal looked like when sprawled out

Despite the hazards and introduction to new animals (i.e. Himalayan Flying Squirrel), we had a great time on the trail making new friends. Definitely looking forward to being back in the mountains again.

Out of Gas

While these days often end in exhaustion with the increasing difficulty of accomplishing even the simplest of tasks, I am not talking about my own “gas” or energy. Instead, all of us in Nepal are experiencing the hardship of no petrol or cooking gas. Since the promulgation of the constitution on September 20^th, political unrest and shut down of the border with India has prevented these needed supplies and other goods from getting to this landlocked country. And currently, there is no end in sight.

Lines of vehicles for the last bit of fuel

As a result, the roads are virtually empty and lines of vehicles are seen waiting for petrol that likely will not come. Restaurants and many businesses are closed due to lack of cooking gas and difficulty for employees trying to travel to work. Hospitals are struggling with the same issues as well with the addition of difficulty getting medicines. In a country that has electricity only a portion of the day, many places then depend on fuel-run generators - uh oh! It’s amazing how much we can take these things for granted. 

For us, we are also nearly out of gas. We no longer have gas for our shower/water heater and are left with only a small amount for cooking. No worries, it makes for some fun as we begin exploring other options, including our camping stove. Cooking outside is a nice change of scenery, especially when the Himalayan Mountains are in view.

Americanizing the Momo

India has samosas. Italy has ravioli. The US has cream-filled donuts. Nepal? The momo.

This past Saturday we found ourselves elbow-deep in ground chicken, cilantro, ginger, garlic, and Magic Momo Masala. Our language teacher Sama had invited us for a lesson in making Nepal’s most popular snack food. Two billion per year popular! Within minutes it was clear that we were there for the entertainment factor more than our efficiency in the kitchen. (Though just for the record, this bahini made one or two more momos than my didi. J)

While the most traditional momo in Nepal is filled with buffalo meat (in Tibet it’s yak), we think there just may be room to expand the momo’s horizons: do I hear Nutella? Mushroom and brie?

Apparently momo-making inspires a common facial expression. Can someone please help Rose finish her name?

Enter now the ulterior motive behind this blog post. Coming to a table near (those of) you (in Indiana) this winter is the opportunity of a lifetime: to create your own signature momo. Suggest your filling combination of choice… and be prepared to make it a reality. You might just find your name on a menu this Christmas.

Of course, Sama thinks Ghirardelli brownies might be the best way to Americanize the momo.

Juka (aka leeches)

Land leeches (juka in Nepali) are very common during the monsoons and make trekking quite the adventure. Juka is a name I find fitting for these fast, furious, and unrelenting creatures. When I see one scurrying up my boot for the next blood meal, I feel like Jerry Seinfeld, responding to his annoying sworn enemy, Newman. Grimacing with teeth together, I grumble: "Juka!" At that point, my heart starts racing and I begin jabbing my hiking pole at my boot, trying to fling it off. The problem here is that this requires me to stand still, leaving me vulnerable to the many other juka that have now spotted me. Here they come...

They can attack from all sides, coming from the front, behind and even from branches or leaves hanging above. Once they attach and you know it (most of the time you can't feel them due to an anesthetic they inject at the site), the question becomes - what to do? Some would say to just leave it there and once it feeds for about 20 minutes, they will fall off - for me, that's a little bit harder to stomach. Others recommend sprinkling some salt on the juka to get them to fall off on their own. Of course, you need to remember salt for the journey. Most don't recommend pulling them off as sometimes they may leave behind some of their mouth parts in the wound which could get infected. Often you just find a blood spot on your sock as evidence that they got you.

Sneaky juka on my boot

I have come to believe that it is best to be the first one on the trail instead of the last, at least in regards to avoiding juka. The heat and vibration from the first person alert the juka, who then begin to make their move just as subsequent trekkers are crossing their path. I don't know about you, but sounds like the perfect position for my bahini. =)

There's still so much to live for....

**This was written previously, but posting was delayed while awaiting official paperwork. Just for the record, my job in Indianapolis had much longer delays due to paperwork. :)

Mode of Injury: Compressed by house.  I’ve written these words more than 100 times in the last few weeks. The census at the Spinal Injury Rehabilitation Centre (SIRC) continues to rise as patients are brought here from acute hospitals to begin the long, difficult journey called rehabilitation. Many have lost more than just the ability to walk. Yesterday before seeing a patient I read this in his chart: “Lost wife, daughter. Home destroyed." He has no other family. Words can’t describe the degree of grief collectively represented at SIRC right now. And this is just one small fraction of the entire country.

But things are changing. Aftershocks are diminishing. Communities are rebuilding. Just today I sat in on a peer counseling session where one young man encouraged his fellow patients, “We may not have our legs, but we have our hands and our minds. There’s a lot we can still do.” This perspective has not come easily, but he’s determined, persevering to make new plans for the future. Watching his resilience in action, I see it fuel not only his own efforts in therapy, but those of other patients and staff members, as well. Myself included.

As a researcher/educator at SIRC, I have the privilege of spending time with people like Manoj. He's a Nepali doctor volunteering at SIRC. He's also currently applying for residency in my field, physical medicine and rehabilitation.

While nothing short of heaven itself will take away the depths of loss here, there are bright spots lighting the way. For the past 14 years SIRC has been fighting an uphill battle to bring awareness to the need for rehabilitation services in Nepal. Those efforts, which have shown brilliantly in these post-earthquake months, have finally paid off. The government recently asked them to be a national leader, expanding their services beyond spinal cord injury to other kinds of patients, as well as training healthcare workers throughout the country. SIRC is poised and ready to run, bolstered by this newfound support, a committed Nepali staff team, and patients who don’t quit.

“It feels like we’ve lost everything,” explains one younger woman, “but I can still cook. I can still feed and take care of my children, even from my wheelchair. There’s still so much to live for.” 

I couldn’t agree more.