New eyes in Thailand!

I didn't realize how familiar Nepal had become until I arrived in Thailand. Sure, I don't speak much Nepali, but I can speak enough to have a little bit of small talk, ask for directions, or buy things at the market (and I can understand some of the responses too!). Of course, I can ask people at length about their medical problems, but that doesn't help much outside of clinic. I can get around by public transport, and know the difference between the local price, tourist price, and rip-off price on just about anything (I don't mind paying the tourist price). I can guess whether or not I want to risk using a bathroom in an establishment after a quick glance around at the workers and setting. I know the culture, and am known at my favorite restaurants, guest houses, and cafes.

While Thailand is more set up for tourists, and the facilities are more familiar (clean bathrooms with TP and 24 hour hot water!!!), it's a totally unfamiliar place to me. The language is so unfamiliar that I can't make heads or tails out of what anyone is saying to me, even with the aid of my phrasebook. I have no idea what things should cost, and have to look in detail at the bills to figure out how much I am handing over. Of course, a day or two is all it really takes to get to know the basics, but it really is a shock to your system to realize that where you are is truly foreign.

It's a great opportunity to look at everything with new eyes, and exercise the ability to do so even in familiar places. It's a muscle that rarely gets exercised as we acclimatize to our surroundings so quickly. When we forget how to use our 'new eyes', it's easy to start to take the good things for granted, or miss out on the little joys in life--and often it's the little joys that create the big joys.

Using our 'new eyes' is what allows us to follow our personal path, "the road less traveled by" instead of the prescribed path. You can see the signs left especially for you rather than following the herd.

I realize that more and more of my posts keep coming back to the same idea; following your path. It seems that nothing else is more important than that. In theory it is such a simple concept, but in practice it is difficult, confusing, and often lonely. For me, the only way to continue resolutely along my path is to continue to find new tools to do so. A daily practice, exercising my 'new eyes', finding a sangha, discussing dharma, all of these help the path be a little clearer and a little less lonely.

Thank you everyone for following me on my journey! I return back to the states very soon, and am so VERY EXCITED for my next chapter.
Love and light,
Ece

Teaching is learning too

Sarita and Saru giving me one last hug in Bhotechaur!

My last days at both the Bhotechaur clinic and Chanauti were truly lovely. At both clinics I was honored in the Nepali tradition, with katas (traditional silk scarves), flower malas, red rice tikkas, and some gifts. I will miss everyone very much! I'm so thankful for modern technology and the ability to at least stay in touch a little bit.

The staff in Chanauti...Nepali people rarely smile.
The pup in front is Kali Bunti, she's teething!
Bonnie, the other volunteer in the picture might be bringing her to the US

I've been spending the last few days in Boudha, Kathmandu with my mom who has come to join me! We have only a few more days here--Monday afternoon we'll be heading over to Thailand for warmer weather before heading back to the US.

Hawk that flies daily over the Bhotechaur clinic...I miss it all already!

Having my mom here has got me thinking more about how exactly it is I travel. I don't just want to show her my favorite places, I want to show her how I travel since so much of why I travel is about Being rather than seeing. It's not exactly 'teaching' but it does have that same effect of causing me to reflect on how, what, and why I do. It feels great to reflect in this way as I will be heading home soon and want to incorporate how I am away with how I am in that thing we call 'daily life' (of course, isn't it all daily life?).

Hanging out with the king and queen (statues)
 in Bhaktapur, the old city

So, how do I travel? I wake up naturally, usually early, and take stock of the day. I sometimes meditate or do tai ji, then find breakfast. This relaxed pace of the morning helps me feel both fed and allows me to part sub-consciously, part consciously decide my direction for the day. I allow the weather and the climactic influences of the day take part in that decision in a natural way, without having to look at the astrological calendar or any number of interpretations. When I start my day this way, everything typically goes smoothly and at the end of the day I feel satisfied and happy.

Some cool graffiti in Thamel, Kathmandu

When I start my day the 'western' way; thinking of all the number of things I 'must' accomplish, skipping my tai ji because "I just don't have time right now", my day ends up being hectic, there are barriers to the things I want to accomplish, and at the end of the day I don't always feel satisfied or happy.

Some ladies in their full Tibetan style clothing
waiting for someone important to arrive!
The kata/scarves are to honor him or her and also to receive blessing.

Of course, back home I don't have the luxury of having every day be totally free; having a job and a career means that there is a certain pace at which things must be accomplished. It's easy to forget, though, that most things don't need to be done on a particular day. Having a system of organization with tasks and their deadlines (thank you Eric Grey!) makes a lot of sense. It allows you to get in tune with the day and pick the tasks that are most suited to your energy and the energy of that day. It also comes back to the importance of having a daily practice in order to become in tune with yourself and allow those decisions to come more naturally, allowing the subconscious to play a role instead of using that crazy monkey mind. Not all decisions can be made rationally!

Boudha stupa
I have way too many photos of this amazing, sacred stupa

I'm happy to say that I've already been on the path to leading my life this way. Reflecting in this way helps me to strengthen my resolve on the path that I've chosen; to have a daily practice, to organize my life in terms of tasks, and to find meaning in everything I do. The exact details are still coming together (I have a feeling that they will for the rest of my life), but it feels good to have more and more direction.

Women In Nepal

My time volunteering has come to a close. I can't believe how fast it's gone and yet I'm very ready to move onward. I'll still be travelling a bit more before starting up my own clinic in Chatham, NY, but I am eager to serve the people, in particular women, there. In preparation to do so, I want to reflect a bit on the women of Nepal.

Some of my non-English speaking lady friends in the village!
The grandma on right is super awesome.

As I've mentioned before, life here is rough. Unfortunately, it's rougher on women than it is on men due to male-preferred culture. Boys are preferred over girls because boys stay in the family home and continue the family business. Girls get married off in an arranged marriage (love marriages are still rare in Nepal) and move into the husband's home. Since the males stay in the family, there is a stronger tendency to put resources into them; namely education. Luckily, things are changing and more and more women are growing up educated, but it is still largely disproportionate. Since boys are busy getting educated, girls are expected to do work around the house from a young age, and are constantly busy. Since the boys spend 6 days a week in school, the are not part of the 'chore wheel' and when they have a day off from school, it's truly a day off.

In a month long festival (not sure of the name),
women and men splash themselves in this 
holy water for blessings. The main purpose 
of this festival is for women to find a good husband.
 Older women dunk themselves in the water,
apparently to find a good husband for their daughters.

In my main clinic in Bhotechaur, all the staff are live-in, so I got to be friends with both the women and men that work there. In Chanaute (the second clinic), though, there is only one live-in staff. It just so happens that all of my friends there are male--since men are the only ones with free time. While men help with the family business and the family farm, women are the ones who do laundry (by hand) and cook--meaning they are busy from dawn until late in the evening since dinner is typically 7 or 8pm. When I ask my educated female friends (in Bhotechaur) what they did on their days off before moving into the clinic, it is always laundry and rest--maybe grabbing some spicy snacks with a friend.

Me and our 'retired' clinic blood pathologist
She still has a full day of work in her home!

Since women are married young, they also have a very long time in which they have to manage their reproductive years. It's great that the general population is being educated on the benefits of having fewer babies, but there aren't a whole lot of options in terms of reproductive control. Most women opt to use Depo shots--which completely stops menstruation--which is donated by the US government. I'm not a huge fan of any of the hormonal reproductive control options, but to stop menstruation by high doses of hormones is the worst of the bunch. Of course, it's better than having 10 or 15 babies.

Ladies cleaning up the big pots after a festival 
where Shiva hangs out around a bonfire
More specifically, women fast all day then gather in the evening
 to eat with the whole village, light a giant bonfire,
 then sing and dance. The festival is to ensure 
the health and long life of the women's husbands.

As a result of all the above factors, I have seen a lot of women with lower abdominal pain, burning urination, vaginal itching, white discharge with odor, and many, many women with uterus prolapse. Insertion of uterine mesh has been increasing, and while it helps in some ways, harms in others. While there are many people both men and women with burning and tingling in their hands, it is disproportionately female since women spend so much time with their hands in cold water washing laundry (in Chinese medicine we call this 'cold damp bi/obstruction'). I'm happy to offer some relief to these women, but a lifetime of hardship is hard to completely undo.

Nepali homes are big; because they house a lot of people!
That means a lot of laundry....

I've also noticed that postpartum Nepali women have significantly more abdominal stretching, even at a young age, than western women. I've discussed this with the other acupuncture volunteer and we suspect that this is due to the low-protein diet--less elastin in the skin. Nepali women often wear long pieces of fabric wrapped around and around their abdomen postpartum onward, possibly to help hold their organs in place!

While most of my patients are older, I feel very fortunate that I've had the opportunity to help some younger women as well, and help them avoid a lifetime of pain. I recently had patient age 23, postpartum with uterus prolapse. While prolapse is rare in someone so young--and rectal prolapse is more common than uterine postpartum--it can occur based on where the baby's head pressed into the vaginal wall on it's way down the birth canal. Some muscles are weakened by the pressure, and then prolapse can occur. She came in not for the prolapse itself, but because the pain in her abdomen was interfering with her ability to do farm work. I was able to do both internal pelvic care (I've been trained by Tami Kent in Portland) and acupuncture with her. I don't know how to assess uterus prolapse, but her pain has been greatly reduced! I'm so happy to have been able to serve her and many other women like her.

Bloodletting in Chinese Medicine

Before getting to the blog post just a quick reminder to put in any orders for things I can get while I'm in Nepal! I'll be making my purchases and packing up very soon...

Cute kiddos!

Fundraising Sales:

Email me at: eceyildirim9@gmail.com to place your order

Yak wool scarf appx 12"/60": $30 donation

Yak wool blanket appx 34"/80" (can about cover a single bed): $37 donation

Handmade ground herb incense by Khachoe Ghakyil Ling Nunnery

Each $7-10 donation, or 3 for $20

     Rhododendron Forest

     Medicine Buddha

     Lotus Blossom

     Tibetan Healing

Prayer flags

     Small: $10

     Large: $12

Prayer flags blessed by Tibetan monks

     Money for blessing will go directly to the monks, give whatever feels right to you

Where does the money go?

Fund raising goal: $4,093

$1000 minimum donation to Mindful Medicine to pay for interpreters, supplies, most living expenses, and administrative expenses

$1800 (appx) in airfare*

$53 Travel insurance (discounted for volunteers)

$140 for Nepali visa and renewal of visa

$700 for additional transportation and living expenses in Nepal for 3+ months

$400 estimated additional expenses (travel supplies, clinic supplies, passport renewal)

*$1800 is approximately the cost of a round trip flight from the US to Nepal in the off-season. I will not be taking a direct round trip flight, but will be instead making a few stop-overs to visit friends and relatives, and will pay additional expenses out-of-pocket.

Came across this picture and several like it around Kathmandu
depicting some kind of energy pathways!

Here in rural Nepal, people have limited accessibility to healthcare. As a result, many minor (and many not-so-minor) health complaints go untreated, and turn into chronic problems. These now deep-seated problems can be difficult to uproot and treat. With the tools and knowledge of Chinese Medicine, myself and the other volunteers are attempting to do just that through Mindful Medicine Worldwide (check out my note below on how to support me)! One of the invaluable tools in treating these chronic diseases is bloodletting therapy.

View in Bhotechaur on my morning walk

Before my immersion into Chinese Medicine, my only prior knowledge of bloodletting therapy was what I learned in history class; that bloodletting was a medieval technique utilized by doctors that killed as many of it’s patients as it helped. Well, turns out that bloodletting therapy is much older than the middle ages, and much more widespread than just Europe. It’s also important to note that modern bloodletting therapy does not involve ‘slicing’ open veins or arteries, instead, an area is simply pricked once or a few times to let out as little as a single drop of blood, but can sometimes let out a few milliliters or more.

Baby goats!!

So what is it used for? In my understanding, bloodletting can be applied to reduce heat (like a high fever), reduce swelling (which is often considered a type of heat), to remove pathological/stagnant blood (one example is varicose veins), or to free the movement of blood and qi in a particular acupuncture meridian or body area. All pathologies can quite literally be diagnosed simply as ‘inhibited blood and qi’, and so when the pathology goes untreated, the inhibited blood and qi becomes stagnant blood and qi. Bloodletting is always indicated in conditions involving blood stagnation, and so we can understand that all chronic pathologies are indicated for bloodletting therapy--as long as you know where and how to apply the technique!

Before you watch this video...

I saw this patient again today, and she strongly requested I do the treatment again on other veins because it was so successful at reducing the burning pain in her vericose veins

Bloodletting has fallen out of favor in most of the Western world, and it is easy to understand why. Practitioners and patients alike tend to get squeamish around blood. Then there’s the fact that much of acupuncture has become synonymous with spa treatments, and many don’t want to face the discomfort that comes with getting pricked with something large enough to cause bleeding (most commonly a simple lancet is used; like the ones used to test blood sugar). Also, many herbal prescriptions can be used to move blood stagnation-but these herbs can sometimes be expensive, or they have to be shipped over long distances (usually from China). Besides, here in Nepal we have a limited herbal supply. Personally, if I am not quite confident that the treatment will help, I am hesitant to try it in fear that I may chase away my patients and be unable to further aid them.

Clouds in Bhotechaur

While my Nepali patients may have deeply rooted problems, they have not had access to healthcare, and so the pathological pattern is still quite simple. I’m still hesitant to do bloodletting within the first one or two treatments to allow them to experience a more typical acupuncture treatment, but I am less hesitant to withhold the technique and more confident in when it should be applied.

Here are two simplified case studies (one acute and one chronic) where bloodletting was applied:

30 yr old female

Common cold with throat swelling and pain

Patient had difficulty swallowing and throat pain as well as typical signs of common cold; runny nose, fatigue, chills, low grade fever. After acupuncture treatment her throat pain was still present, though her energy level was improved and other cold symptoms had been reduced. I massaged (to bring more blood flow) then pricked to bleed LI1, the corner of the nail on the right index finger. Unfortunately, the patient did not allow me to prick the finger of the other hand. As a result the reduction in swelling on the right side of the throat was very apparent when compared to the left. Luckily, the reduction in swelling on one side was enough to allow her more ease in swallowing and less throat pain. The left side remained swollen for 2-3 days then decreased as her cold resolved.

52 yr old male

Disc herniation, L5-S1 vertebra

chief complaint: right leg pain

Patient comes in with report and MRI of disc herniation. Visual inspection and palpation of his lower back revealed a puffy and swollen area at the L5-S1 vertebra, with more puffiness on the right side of the spinal column On the right leg at approximately KD10, there was a big purple stagnant vein. Referred pain mainly went down his GB channel, but it did curve around his leg as well.

Treatment 1-5

I focused mainly on moving the qi in the BL and GB channels, as well as supplementing his underlying KD qi deficiency. Each treatment showed a little bit of improvement in pain. Moxibustion, cupping of the tight erector muscles above the area of herniation, and local needling all played a key role in treatment, though areas immediately around the herniation were too sensitive to do even shallow needling.

Treatment 6

While some of his secondary symptoms improved, there was only a little improvement in his leg pain. I was concerned with the obvious blood stagnation near KD10 on the right leg. After the typical treatment plan, I performed cupping bleeding with a special lancet tool--it holds 3 lancets and completes quick piercing to allowing for minimal pain. Blood that came out into the cup was dark and bubbly.

Treatment 7

Patient reported more pain relief! Local examination of the disc herniation revealed that it was much less swollen! Visual examination of the right KD10 area showed that the vein was still present, but much less purple. I was able to do shallow needling in the hua tuo region directly around the herniation, something that had been too tender in the past.

This gentleman continued to come in for several more treatments. We had one setback around treatment 9 when the swelling increased a little bit, but otherwise he has slow but steady improvement. The biggest leap in pain relief was definitely from the treatment with bleeding cupping.

Purpose

I've been feeling quite homesick. It's inevitable as I've haven't had a stable home since July. I'm thankful for my new Nepali friends as well as the other volunteer at the second clinic (first Ari and Lisa, now Bonnie), but I also appreciate the difficulty of being away from anywhere stable and the opportunity that that little hardship presents.

Clinic staff; goodbye party for Devi (with the scarves, flowers, and red tikka)

As humans, it is through trials that we are transformed. Many people feel this in small ways; they have a fight with a significant other that brings new understanding and deepens the relationship, or someone may struggle to learn a new concept and feel a sense of accomplishment once it is finally grasped. But how often do you peer into your own soul? When do you take time to think about your Purpose? Relationships (romantic and otherwise) may offer a reflection, but it is an altogether different experience to directly peer into your own depths.

Saru (midwife) and I visiting the tea garden

The truth is, I returned back to Nepal because of the emptiness and loneliness I felt when I was last here. At that time, I had spent my 21 years on this planet thinking about the ‘next step’ and waiting for my life to begin, which I referred to as ‘becoming a real adult’. First I have to graduate high school, then college, find a partner, get my career started, be financially stable….subconsciously I believed that achieving these steps would bring about stability, knowing, confidence, and happiness. It took the realization that I choose the wrong career when earning my bachelors degree to start to break that tenuous belief.

Tea flower

Maybe a trip to the other side of the world will clear my head and set me on the right track…

So I came to Nepal, not yet knowing what I was searching for. I learned that accepting uncertainty, instability, and impermanence were what it really means to be an ‘adult’. I suddenly realized that I had unwittingly become a ‘real’ adult’. First came elation, then came pain and loneliness. I understood that there are no series of achievements in life where everything becomes magically perfect. Signing a piece of paper; regardless of if it is for a business contract or a marriage does not automatically make that thing perfect and whole. Life is always challenging and always changing. Even when we are surrounded with people, we are still a discrete, separate unit and have to work to maintain our relationships and continuously strive for happiness.

View from the Chanauti (second) clinic

Even within my profound sense of emptiness I felt more alive than I had ever felt. No longer was I constantly distracted by the ‘next step’. I had stepped off of the prescribed path and was fumbling around in the dark with many more new questions than answers. But this new path felt more right. I had begun my search for my Purpose.

Sunrise in Bhotechaur (main clinic)

Through Chinese Medicine I learned more about the connectivity that exists where we sometimes feel separateness. The cosmos, the planet, and all living things are all interrelated. Humans (and maybe other living things) were given the gift of introspection, and so held a special place between Heaven and Earth with the potential of becoming a Sage (enlightened). The difficulty here existed in that these great teachings were delivered in a more-or-less standard modern teaching style, even with NCNM’s efforts to maintain a Classical approach. This standard model encourages that old ‘next step’ feeling, and leaves that dark, lonely, and oh-so-alive path overgrown with weeds.

View from Bhotechaur

I desired to again return to that path, and was drawn to Nepal where I had first discovered it. Of course, you don’t need to go anywhere to find what is inside yourself, but a complete change in everything familiar lends itself to introspection.

It’s difficult to feel that sense of Purpose and not have any prescribed way to achieve it. There’s no one to walk the path with you, for it is your path and yours alone. We all have teachers that help us along the way, or a friend that walks with us for a while, and if you are listening and watching you will find signs to point you in the right direction. And while I feel confident in my metaphors, I actually have no idea what I’m doing; but something propels me along nonetheless. So, there is the loneliness, the pain, and that amazing, brilliant, profound sense of being really alive.

Nepali Life and an Interesting Case...

Grandma and some kiddos,
mom in the background running the tea shop

Here's a little insight into daily life for all of you as well as a couple interesting cases for you interested Chinese Medicine folk!

Nepali style fire cook kitchen, with an inlaid blessing/prayer design

Life here is rough, so it's understandable that many of my patients look older than they are, and yet they continue their humble daily existence. Nepali people spend their day in the field wearing flipflops or going barefoot, hunched over or squatting down to dig up potatoes by hand or carrying giant bundles of grasses for miles. Their diet consists mainly of rice (which is inexpensive) and a small portion of SPICY vegetables or potatoes with a little bit of lentils. Once in awhile they enjoy a bit of chicken, or if they can afford a buffalo or a cow (buffaloes are more common) they can have a little milk in their tea--which has a TON of sugar. If they happen to attend a wedding (which lasts 2-3 days, see previous post!), they will eat buffalo or goat meat. Meals are often cooked over a fire, indoors, with no proper ventilation. I should mention that the Nepali government is preparing to set up legal guidelines to indoor ventilation, so people are slowly switching over to gas stoves! Electricity is unreliable, so there are no refrigerators and no central heating.

Nepali person carrying a load of grasses, wearing flipflops

The winter here is still pretty warm in the daytime- I often find myself stripping down to just a shirt and skirt with leggings (or the traditional kurta surwal), but nighttime is really quite chilly. Once the sun starts to set, I find myself putting on first one sweater, than a second, then my light coat, and finally wrapping up in a shawl, hat and gloves. After dinner (around 6-7) everyone disperses to get under their bed covers to read or maybe watch tv for a little bit. Rooms are shared; usually 3 single women and 3 single men to a room, or a married couple together in one room. I'm lucky enough to have my own room, though that means I don't have the benefit of body heat to keep the room at least a little warm. I have a hot water bottle for that!

Dipendra and I out for a morning walk before clinic opens

It's interesting to see life truly run by the elements. People wake up before daylight in order to be out in the fields by the time the sun is up. Laundry must be done in the morning so the sun can dry it during the day. You don't take a shower when it is a chilly day, or when you have a cold, or when you are menstruating, and only once a week for the first months (or the first few months) after having a baby. When it is dark, you go indoors and slow down.

The young bride from the previous post
 cutting up vegetables for a meal.
She now lives with her husband's family.

There is certainly a beauty to living by the elements, but it isn't without it's consequences. My patients suffer from a lot of joint pain, coughing, and a myriad of other disorders. I should mention that Nepali people are tough stock-there are many older village people with nothing but minor health complaints. Most of my patients come in complaining of knee pain and lower back pain. I also have several patients who have suffered from stroke, several of which are very young (one young man had a stroke at age 19). Many post menopausal women have uterus prolapse. No one seems all that concerned about their chronic cough (everyone seems to have one) unless it is disturbing their sleep. "Gastric" (acid reflux) is also the norm--due to the combination of ST/SP imbalance/xu and all that spicy food! For you Chinese Medicine folks, common diagnoses are LV and KD yin xu or LU and KD yin xu.

Another typical Nepali house with some farm animals out front

Despite all the hardships, life here is very good. The Nepali people are warm and friendly, and living among the mountains is an unforgettable experience. There certainly is a good reason why foreigners come back again and again; for the spiritual experiences with Buddhism, Hinduism or a blend of the two, for trekking, or for the culture. I'm very happy to be here and humbly offer my novice skills in healing and enjoy the benefits of gaining experience while enjoying Nepal!

Poisoning (?) Case

Patient: male, appears to be age 30-40

hx: alcoholism

Was found unconscious and brought to the clinic. It is suspected that he ate something poisonous, but no one has any proof that this happened, or any idea what the poisonous item might have been.

Patient is brought into the gynecological exam room (it had the only available bed). When I see the patient, he is unconscious but waving his arms and legs around at random and mumbling. The person who brought him in is attempting to constrain him.

Tx: prick and remove HT9 both sides, prick CV26

Patient responds to both HT9 pricks by shouting 'oooooowww!!' and opens his eyes wide. He then closes his eyes again, but is now no longer waving his arms or legs around. No response to CV26. He is still unconscious, but now calm.

Patient is carried from the gynecological exam room to the outdoors (not sure why). At this time he is still unconscious, but rolling a little bit left and right and spitting up foamy saliva.

Tx part two: Moxa at GV20, followed by needle prick towards the front DU20

No response to moxa. With needle prick, the patient becomes semi-conscious. He can not speak, but is coherently gesturing and trying to communicated something. He is propped up and assisted in drinking some water.

The village shaman arrives. At this time I feel that I can not do anything further, so I went back to seeing my patients. A few moments later, after the shaman burns something and chants words (that are not Nepali) the man stands up and walks away.

Breast Abscess

I treated this patient a few weeks ago, and since patients keep their records, this case is to the best of my memory.

Patient: female, appx age 19

hx: Birth of her child one month ago. Swelling and pain in her left breast began one week after birth.

Current: Patient's left breast is now red, hard, and swollen to 3x the size of her right breast. Aerola is red and crusted. She also has a mild fever.

Pulse: thin, rapid

Patient is strongly advised to go to the hospital. Her husband does not want her to go, presumably due to expense. We agree to treat her and ask that she come in first thing in the morning again tomorrow. If there is no change within 24 hours (tomorrow afternoon), she is very strongly advised to get on the bus to KTM and check into the hospital there (by tomorrow night).

Tx: bilateral: LI4, LI11, ST36. left side: GB21, GB43, SP21, ST18

Bleeding to left SI1

Ari, the other acupuncture volunteer, prescribed a huang lian based formula.

Unfortunately, this patient did not return the following morning. I can only hope that she either decided to go to the hospital, or that she was spontaneously cured after only one treatment.

Living the Dharma

Boudha stupa

5 years ago, I began planned a trip to China. Along the path of planning, somehow visiting Nepal became the main purpose of my trip, and visiting China became of much lesser importance. With little to no prior exposure to Buddhism, I decided to begin my trip with a one month Lam Rim course (introduction to the Buddha Dharma) at Kopan Monestary in the Kathmandu Valley of Nepal.

Young monks in front of the gompa at Kopan Monestary (meditation hall)

My stay there has had a profound impact on the course my life has taken, and yet at the time I decided that I took Buddhism "too seriously" to take refuge in the Buddha Dharma and to call myself a Buddhist. I did not want to make a commitment that I could not (or would not) keep. Since then the question of my spirituality faded into the background as I began my study of Chinese Medicine, which is deeply rooted in Daoism (as is Buddhism).

The view from Kopan Monestary

Now that my formal education in Chinese Medicine has ended, I have the time to contemplate the whole picture of my life. My practice of Chinese Medicine remains most important, I am constantly studying ways to better serve my patients (this is the Bodhisattva practice of Buddhism). But more and more I feel the draw to commit to a formal spiritual practice rather than just dabbling in this or that.

Boudha stupa watching over the city

I've begun re-examining Buddhism, which has again been playing a stronger role in my life this past year. Should I take Refuge? Am I Buddhist? By being Buddhist, am I refuting all the other spiritual paths that I believe to be true? I've always strongly held the belief that all the paths are just different ways up the same mountain (or as a kind gentleman phrased today, all are corners of the same bar of chocolate).

Monks hanging out at Kopan monestary

Daily Nepali life is immersed in a type of spiritualism that I have not seen in the US, or many other modern countries. Buddhism and Hinduism are fluid practices between each other, and I've even met Nepali Christians and Muslims! They truly practice, taking time out of their day to go to temple--and not at a prescribed time like Sunday Church. With that example, I find myself examining my daily life. As I am more familiar with Buddhism, I look to that example.

Butter lamps being lit as light offerings

In my understanding of Buddhism, to take Refuge in the Buddha Dharma (to "be" Buddhist) takes 3 vows: to take refuge in the Dharma, the Sangha, and Buddha. I feel the main purpose in this lifetime (and all my other lifetimes) is for spiritual development, which I do through serving my patients and studying from great spiritual teachers; this is the Dharma (Buddhist or otherwise). The Sangha are my Dharma brothers and sisters; other people who are seeking a deeper purpose to life. I already find myself seeking companions and advice from these like-minded people, though they may be from all different walks of life. Buddha is a name for the higher self; mine and that of all sentient beings. The universal consciousness and oneness.

Prayer flags flying in the breeze off of the stupa

And so, I have discovered that it doesn't matter if I "am" Buddhist or not, but what I am is a practitioner of the Dharma. I let go of my attachment to that particular label, and am just allowing myself to be as I am.