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.