Home again, home again…

Sunday, 13. November 2016 14:19 | Author:

I don’t feel that I have been to a market to buy a fat pig, however the last 3 weeks have been a market of experiences that I am still trying to decipher in my mind. I am writing this in Brisbane airport as a storm rolls in, possibly delaying this evening’s flight home to Cairns. I don’t want to think how long I have been travelling home for, but it feels like days!

I must give a plug for Thai Airways. They were magnificent on every flight. The food was delicious and the standard gin in economy was Bombay Sapphire! Our clearance at Brisbane airport this morning was the quickest I have ever experienced- from landing to clearing customs was 20 minutes. Unfortunately this means I am stuck in Brisbane airport for over 7 hours, but still…

We went to Nepal for a cultural experience and we got one! I said early on that ascribing value to differences was not always helpful, however there was one major difference which still irks me. Nepal is a very patriarchal society. Sons are valued much higher than daughters and as one obstetrician told me, she can tell all her patients that she is a successful doctor and has vowed to take care of her parents as well as her husband’s parents in their old age, she will have patient after patient returning for their fourth, fifth, six or even seventh child in the hope of having a son. Whilst international pressure has been placed on improving the maternal mortality rate in Nepal, it has been left to external agencies and overseas governments to fund this. As a group we were told by our lecturers from the start that we needed to be aware that we were in a patriarchal society and needed to keep our voices lower than normal and remember that it is uncommon for women to drink alcohol so to be careful. I think I have drunk more in the last three weeks than the last 12 months, and that was usually a beer or a cocktail each evening, sometimes more :) I knew that I did not want to take my values holus-bolus and impose them on another culture, but to me, equality of the sexes is one value I could not sit back and ignore. Would me drinking have made any difference to the way men see women in Nepal? Probably not, but to me it was a small stance I could take.

The biggest display of sexism I saw on the trip was at Kathmandu airport as we were leaving. After clearing immigration, we needed to have our hand luggage scanned. We were shown there were two lines for men and one for women. The mens lines moved very quickly and the women’s line dragged. There were not more men travelling than women, but the men did not have the time to wait. Oh and the mens lines had 3-4 tables for the men to arrange their hand luggage into baskets which were readily provided, compared to the women’s line that had one table and you had to ask for baskets. Whilst away I read Clementine Ford’s new book Fight Like a Girl. One of the things Ford argues strongly about is that we as white middle class women living in the west, need to acknowledge our privilege and use it to help women in developing countries, women of colour etc.

I wish I had been able to visit more hospitals in Nepal. We really spent most of our time at one so my experiences are based on this experience in a private hospital, recognising that private hospitals in Nepal are vastly different to those in the developed world. At Fishtail, Florence Nightingale is revered. We were presented with certificates on our last day and these even feature a portrait of Nightingale. As I noted last year in an assignment, Nightingale was a feminist and her values of eschewing marriage for a careers and seeing nurses as more than doctor’s handmaids is often forgotten by some who still see nurses as the handmaids at the beck and call of the doctor. The nursing notes in patient’s charts at Fishtail all followed the same formula- medications given as charted, patient observations as per chart, no abnormal activity this shift. With the families providing so much of the nursing care that nurses in Australia provide, nurses almost had minimal contact with their patients, save for taking vital signs- families often administered medication too, especially oral meds.

One thing that the trip reinforced to me was my desire to be involved in women’s health and to do my midwifery. Whilst I may not work as a midwife, it will give me more options to work in the future.

Being with 21 other people in close proximity for 22 days was a challenge at times, especially for me as I value solitude to regroup, however it was a great group of nurses. Everyone had their own strengths and found ways to add them to the group which was greatly appreciated.

Africa got under my skin the first time I visited, however now Nepal has too. I really want to take MIML™ and the spawns there one day as it was so eye opening. People have asked me about the earthquake and the effect it has had. Some places we drove through between Kathmandu and Pokhara had evidence of the earthquake, but people don’t like to talk about it. People I talked with said that although the death toll was horrendous from the earthquake, it was the downturn in tourism that has had a bigger impact. Tourism is one of the main income streams for people in Nepal and to them they asked that I encourage all my friends to visit. I can tell you that in visiting you will experience a culture so different to Australia’s, or perhaps any other developed country, but you will experience a culture full of the most lovely people.

 

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Farewell Fishtail and Pokhara

Friday, 11. November 2016 22:19 | Author:

Another post with two days in one :) Yesterday we farewelled Fishtail Hospital and today we farewelled Pokhara. Fishtail was very enthusiastic to hear about our experiences in an evaluation session, however it was a little sad when they thought we would be able to tell them where they need to improve. I am not sure if this is because other groups from developed countries come offering suggestions or if they think they need to improve, however we were able to tell them what an amazing time we had had and how it had impacted us. I pointed out that we may do things differently, however that does not necessarily mean that one way is better than another and let them know that I was taking back to Australia the way they involve families in care and how we tend to shut them out a lot of the time.

After lunch I had an hour or so to spare so I was able to spend time doing one of my favourite things in a foreign country- spend time browsing in a local supermarket! It was great seeing the huge range of goods they sold- many similar to Australia, some different. Instead of getting photos of everything, I chose 3 items that I saw that made me smile…

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It was sad to see that a lot of products are aimed at negative body image- slimmers honey and rice for the obese? I can count on one hand the number of obese nepalese I have seen in the last 3 weeks and have fingers left over! Quite a few shops sell ‘chilly’ powder- I think it is just a lost in translation moment :)

We were then farewelled by the Fishtail Nursing College students and staff and hospital staff.

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The students put on a cultural show with dances and we joined in! It was a lot of fun! Last night we had our farewell dinner and said goodbye to two of our in-country hosts. Today we farewelled Pokhara and took the 8 hour bus trip to Kathmandu. It seemed a lot quicker than travelling to Pokhara, however the traffic as we hit Kathmandu was atrocious! The traffic, driving methods and road conditions are not something I will miss! Sadly the bus ride was too bumpy to knit, however I did bit of reading.

Kathmandu is noisy and dusty. It is probably as dusty as Pokhara, however because there is so much traffic, both vehicular and foot, the dust is kicked up a lot more. Tonight I am repacking my suitcase as this was this morning’s effort…

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The next post will probably be from our layover in Bangkok. It is sad to leave this amazing country, but I am ready to head home to my family.

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Kids and mums and bubs

Wednesday, 9. November 2016 23:44 | Author:

Thanks to all for the best wishes for my cold- I am much better today :) I started this morning in the Paediatric ward at Fishtail. 15 kids and their families in a room around the same size as our deck. Three kids had had a cleft palate repair which was closish to home as my brother was born with a cleft palate. A surgeon flew in from Kathmandu last weekend to perform the surgeries and the kids were doing really well! Other children with respiratory illnesses, other infections (including UTIs) and gastro.

We then listened in on a lecture on maternal health in Nepal. Nepal has the highest maternal mortality rate in Asia. In Australia we hear a lot about foreign aid and what it is used for, however today we heard of real examples. UNICEF and the UK’s Department for International Development (DFID) are two organisations who have helped bring about a 50% reduction in maternal mortality in Nepal over the last 20 years. Before the projects funded by overseas aid began 539 women per 100,000 live births died in childbirth. Today that figure is down to 281 deaths per 100,000 live births. In comparison, Australia has 6.8 maternal deaths per 100,000 live births. The projects help fund at least 4 antenatal visits at 4, 6, 8 and 9 months with an incentive program offering 400 rupees for women to travel to these appointments. 10 years ago 90% of Nepalese babies were born at home, however today 48% of women choose institutional delivery, again with incentive payments for delivering in an institution. In more remote communities, Female Community Health Volunteers are trained to be skilled birth attendants which has also helped decrease the maternal mortality rate. Another initiative funded by foreign aid is three post natal visits to the mother at 24 hours, day 3 and day 7. Despite all the efforts of these programs, only 50% of women receive antenatal care.

Other initiatives to help decrease maternal deaths have been promotion of contraception and sex education in schools which has seen the birth rate drop from 3.1 to 2.1 children per woman in 20 years and in 2002 medical abortion was legalised up until 12 weeks gestation. Speaking to an obstetrician last week she did note that often men prevent their wives from having abortions and they ended up having the final say over their wife’s body.

It was great to see a healthy promotion of exclusive breastfeeding for the first 6 months of life, however at Fishtail, women who receive caesarian sections are kept away from their baby for 24 hours because of the pain associated with both the delivery and the spinal anaesthesia. In this time babies are given formula. I spoke to a doctor about this and she said that they have better longterm success with breastfeeding after caesarian with this method than encouraging the mother to put the baby to the breast in the first 24 hours. This is possibly just another difference in health services between Australia and Nepal.

After lunch we visited Western General Hospital, the government hospital for the region. We met the Matron and took a tour of the maternity and gynaecology wards. Women who had delivered vaginally were on wooden beds in corridors and at times it felt like we were being taken through a zoo to look at animals which was rather uncomfortable, however we did see the conditions in the public hospital compared to the private facility we have been working in. Laundry was hung from banisters and walkways outside, families all gathered at the bedsides of patients. In Nepal birthing is women’s business and the father is not present. After a vaginal delivery the mother and baby are discharged after 24 hours if there are no complications, with the postnatal visits outlined in our lecture this morning. It is a shame we couldn’t spend more time there and be more hands on, however we did get to see how things are done and it helped put some of this morning’s lecture in place.

We leave Pokhara on Friday and I managed to finalise my shopping this evening (I think!) I am looking forward to getting home, but in many ways don’t want to leave either. Nepal has gotten under my skin in the same way Africa has.

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No post today

Tuesday, 8. November 2016 21:41 | Author:

No post today- I went down for breakfast at 6.30 and was told I didn’t look well and it was suggested I stay home for the day and not spread my germs. If I had been home I would not have gone to work, so it was sensible I stayed back here. I slept until midday and after 1.30 went for a wander and grabbed a small bite to eat. Looking forward to an early night and hopefully being better tomorrow.

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Peace Stupa, caves and a cold!

Tuesday, 8. November 2016 0:00 | Author:

Today was our day off for this week. I did not sleep well and felt I was coming down with the cold that the rest of our group had last week, however decided to get up and head with a group of people to the Peace Stupa. I am so glad I did. It was a long way up- step after step after step, but once there the view was amazing.

From the bottom carpark, the trek looked ominous…

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This photo was taken about 80% of the way up!

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But once there it was so worth it!

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The Stupa itself was quite serene, even though many tourists didn’t understand the meaning of the word silence!

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The descent was a lot easier! After lunch we organised another small group to head to the Gupteshwor Mahadev Cave as we had been told the architecture was quite spectacular. We did venture inside the cave, but it was so humid and all evidence of stalactites and stalagmites was long gone as souvenirs to tourists before us. The architecture was quite amazing however.

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A group of people were singing and dancing at one stage, although we were not sure if it was a form of worship or celebration. We were invited to take video, however I stuck with a photo!

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Tonight I have been to a local pharmacy where I was offered pseudoephedrine without having to show my drivers licence! I also picked up some Vicks Vaporub and hope after a good night’s sleep I will feel better tomorrow!

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Sisaghat

Monday, 7. November 2016 1:16 | Author:

It is extremely difficult to put into words the last three days. On Friday afternoon we travelled to Sisaghat, a small village around 3 hours drive from Pokhara.

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Sisaghat has a population of around 1600 according to one of the locals we met, however it would not surprise me if this figure included neighbouring villages in the area.

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We went for our major health camp, to provide medical assistance to these people who are fortunate if they see a doctor once per year. There is a bus that comes through to Katmandu and Pokhara at least a few times per week, however most people have hardly ever left their village. The isolation did not mean these people were insular though and although we were a little bit of a novelty being from Australia, there were lots of questions asked and we were able to see so much.

We were greeted with garlands of marigolds and the traditional Nepalese horn.

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For such a small town there was a diverse ethnic mix with a Hindu temple, a mosque and a Christian church. Other houses hung Buddhist prayer flags.

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Our guide, a 21yo lad who was studying science in Pokhara but returned home for our visit, proudly showed us his home and we met his mother. They had goats, chooks and buffalo and we were able to watch the Buffalo being milked.

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The milk was heated over an outside stove and we were offered it to drink. It had a sweetness that was different to cows milk. We walked down paths and met children and our guide introduced us to his other mother and explained that his father took two wives.

We also saw some of the local crops including the millet which was ground and used for breads and also made into a local spirit which was, er, interesting!

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Dinner was back at our host families home and consisted of traditional dal bhat.

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The family had killed one of their chickens especially for us.

Sisaghat is in a valley of the Himalayas and in the morning it was cold and a fog had swept in. The temperature was cold enough for us to see our breath as we breathed out, however once the sun came up from behind the mountains it warmed up and we were hot in our shirts.

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Our host father cooked chapati for breakfast made from the local millet over the outside stove.

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The family kept goats, chickens and pigeons. We heard the goats baa-ing from early morning and eventually they were let out of their pen to graze.

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We were here however for the Health Camp.

 

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Doctors from the Fishtail Hospital travelled out to see over 700 people who had travelled from far and wide. Our job was to take the pulse and blood pressure of those who registered and direct them to the doctors. Many people thought we were doctors from Australia and our local guides had to explain that no, we were nursing students and even though we were white skinned, we didn’t know more than the local doctors! Whereas last week a lot of people had blood pressures that were much lower than we see in Australia (90-100/60-70), this week more people seemed to have higher readings. This was just one test and it could easily have been caused by anxiety at visiting a health camp when there is such little medical assistance usually available to them. We took it in turns taking vital signs and at other times sat with doctors.

I first sat with the doctor conducting ultrasounds. The machine looked like it had come straight from the 70s.


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I learnt later that the majority of people presenting at the health camp came with complaints of lower back or abdominal pain. This was mainly caused by squatting in the fields all day, or at their stoves, or at their toilets. Ultrasounds showed no major abnormalities on most patients, however I was surprised at the incidence of mild to moderate fatty liver that was found. These were fit, healthy people who eat dal bhat most days, eating very little red meat. I wondered if it had anything to do with alcohol consumption which appeared to be rather high amongst the men especially.

I also spent time with the obstetrician/gynaecologist who again reported women with lower abdominal pain from bending all day. She did tell me that in most villages there are trained locals who can assist with delivering babies, however the infant mortality rate is still quite high. The dentist reported pulling over 30 teeth for the day (I did not stay there long!) and the paediatrician comforted parents and grandparents worried about the runny noses and sore ears of their children.

My most interesting time was with the orthopaedic surgeons however. In Australia, MIML™ and I joke that psychiatry is the basket for all the ‘too hard’ cases in the hospital- if the medics can’t work it out they send it to the surgeons, who send it to psych! At this clinic, the orthopods were the dumping ground for the too hard cases. Yes, I did see men and women in their 50s crippled with arthritis from their hard work, and these consults usually took a couple of minutes with the doctors being very forthright and telling people they need to rest for a week or two and the people saying they couldn’t so the doctors telling them there was little they could do. One consultation took a good deal longer. A local came in and spent the consultation looking at the ground. The doctor spoke with them for several minutes. Afterwards the doctor told me that the patient was concerned that some mornings they wake up and want to sit in a corner and not speak to their family and yet other mornings wake up and want to run up and down the street and they can’t explain their behaviour and they thought something must be wrong. The doctor had listened and even though he told me he thought the patient had a classic case of bipolar disorder, he wanted them sent for a cat scan and for some thyroid tests. Although he was not a psychiatrist he did not mind talking to the patient and offering advice.

Over lunch, doctors talked with each other about what they had seen and bounced ideas off each other. The collegiality was really nice to see.

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At the end of the camp we went for a walk around the village. There is a wonderful suspension bridge over the river and we walked across it.

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We also came across some locals who had mixed reactions to having their photos taken.

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Coming into Winter the harvest is in full swing. Rice was being cut and left to dry on the ground before being piled into stacks.

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Corn is also hung around houses ready to be turned into cornmeal.

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This morning we said a tearful goodbye to our family and headed back to Pokhara.

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The self-sufficiency of the villagers really struck me. They almost live off the grid with electricity connected to the homes in order to run a fridge, a few lights and a small television. Water is not plumbed into the homes. The squat toilet is flushed by pouring water from a bucket down it. People bathe by pouring water over themselves, even in the cooler climate, however there was a fire near the water tanks where the water could be heated. The villagers loved having us there and appreciated the health care, but as one doctor told me the doctors feel like they can’t do a lot for people as they are predominantly healthy. In many ways it seemed an idyllic lifestyle- tending the land and feeding your family, however people grow old very quickly.

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I have to include this photo I snapped this evening- I went into a shop to look at scarves and came across this cat who seemed awfully happy with itself!

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Theatre

Friday, 4. November 2016 13:59 | Author:

This is an early post as we are heading out to our major health camp this afternoon and it is doubtful as to whether or not we will have Wifi. I spent this morning in theatre at the Fishtail Hospital. It was a fascinating experience and one that I will no doubt be reflecting upon for some time to come.

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The first case I saw was a total abdominal hysterectomy and bilateral oophorectomy. In Australia, my understanding is the majority of hysterectomies are performed vaginally. Here they have abdominal surgery because they lack the facilities for laparoscopic surgery. In Australia everything is disposable, here it is sterilised and reused. Regardless of the differences however, the patient received the best care available.

There were some minor procedures we also got to observe and then we were told there was to be an emergency caesarian section. Meconium was present so the procedure was rather quick. The father was not present in the room, however when the baby was checked and found to be fine he was taken to his father and grandparents who will care for him for the next 24 hours whilst the mother is in recovery. I will admit I find this a strange practice and as a mother I don’t know how I would cope being separated from my new baby for 24 hours, but this is a different culture and practices are different.

This afternoon we head out to our major health camp. We are camping there for two nights with a family. It should be fascinating, however I know I am rather anxious about it all. No doubt upon our return I will have lots of photos and stories to share :)

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Children of Nepal and TB

Thursday, 3. November 2016 23:52 | Author:

This morning we spent time at Children of Nepal. Here we took some education sessions around hand hygiene, toothbrushing and women’s health. Our group had a group of young women aged 11-22 who were really interested in menstruation and the puberty process. Material I had sourced from Sexual Health Cairns was very helpful in this regard.

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After the education sessions we spent time with the women and some of their young children enjoying tea and biscuits. It was beautiful seeing the children interacting with our group.

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Some of the work Children-Nepal does surrounds empowering women to earn their own money and not be reliant on their husbands. A lot of the work they do is sewing and they sell toys and other sewed items in a small shop and export throughout the world.

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After lunch we heard a really interesting lecture on tuberculosis. One of the main points I took from this was the way the Nepalese government (which changes fairly frequently!) is united in its mission to ensure every patient diagnosed with TB receives and takes appropriate medication. This is done through clinics where patients must attend and sign for their medication each day.

This evening another walk around the town. We saw a graffiti artist completing a new project

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and enjoyed a cocktail overlooking the sunsetting over the Stupa with the newish moon in the background.

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Random Stuff

Wednesday, 2. November 2016 23:02 | Author:

Today we again spent time at Fishtail Hospital. I shadowed a couple of consultants as they conducted outpatient clinics. Unfortunately the Neuropsychiatrist was not consulting this morning, but I had a great chat with one of the obs/gynae consultants. She had seen a patient who, after having two daughters, was desperate to have a son. We talked of the differences in culture and how in Nepal it is still seen as vital having a son as your daughters will marry and look after their husband’s family in their old age and not their parents. She said she tells her patients that she was educated in Nepal, studied Medicine in Nepal and went on to become a consultant in Nepal, married a Nepalese man and still believes she will help look after her parents when they age. Nepal is a rather patriarchal society so it was great to be able to talk to her about some of the differences with Australia. Some people still want children of specific genders, however it is usually not because of perceived gender roles in the family.

I have no photos today- I am conscious not to take any in the hospital as it is not something I would do on placement in Australia. The hospital was quieter than usual today as it was a public holiday as the President of India was visiting. Nepal has a lot of public holidays, however I do not believe workers get paid extra for working on them so a lot of places remain open.

I went for a long walk this afternoon and was able to watch some Nepalese children playing in the street. Since I have been here I have only seen one child watching their mother’s mobile phone whilst she worked- usually the children are gathered out the front of shops playing or talking or singing or encouraging you to enter. Whilst we find the food here relatively inexpensive, for Nepalese people eating out must be a real luxury. A nurse at Fishtail Hospital earns the equivalent of around A$200 per month. On the other hand, over 80 per cent of Nepalese people own their own home. It puts into perspective some of the spending I make at home. The other interesting thing in Nepalese restaurants is that they don’t have children’s menus. Children eat the adults food. We have visited the hospital canteen and always see children there eating Momo. Momos are a dumpling filled with chicken or vegetables usually and most often steamed, although some restaurants will fry them. We were told that for most children a plate of Momo is a real treat.

We are eating a lot of vegetables here. There is usually a plate of beans and carrots for breakfast available to us and the Nepalese diet is full of legumes with a little meat sometimes. On the other hand we have not had a lot of fruit and have to be careful because of the sanitation here. As travellers it is hard to peel apples to eat them and it is easier to skip fruit altogether.

Tomorrow we are off to the Children’s Home which should be a great experience. I have promised MIML™* that I will not bring home an orphan!

 

*MIML™ is the Man In My Life!

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Tibetan refugees and Dipawali Bhai Tika

Tuesday, 1. November 2016 22:25 | Author:

We are almost half way through our trip and I am still having trouble interpreting things I see. As I have said before things are not good or bad, but rather different and at times I really feel like an intruder into someone else’s culture.

This morning we visited the Tibetan Refugee Settlement where our guide and many other Tibetan refugees live. Hearing first hand about the fleeing that started in 1959 and how some people walked weeks and weeks in order to seek refuge in Nepal and how these people live exiled in their own community, however are not Nepalese and do not receive the same rights as Nepalese citizens, even though many were born here was really quite disheartening. I am trying to steer clear of news from home whilst away, and really am trying to avoid politics, however comparing the stories of these Tibetan people and thinking of the dreadful laws Australia has for those seeking asylum really highlighted my privilege in being an Australian citizen.

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We were joined for lunch with over 25 older Tibetan men and women who live at the settlement. For those asking for food pictures…

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After lunch, we distributed some of the woollen items I had collected from around Australia. The smiles and thanks from these people were so beautiful. One of the ladies at our table talked of her 5 children and we were able to give her beanies for each of her children. We will distribute more woollens at the Health Camp this weekend.

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After returning from the Settlement Camp, we dressed in cultural dress in order to attend the Dipawali Bhai Tika festivities put on by the local hotel association at a local orphanage.

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Here is where I am conflicted. I really enjoyed dressing in a Kurta and actually purchased two here and plan to wear them at home. The ceremony of Bhai Tika was something I probably would have preferred to watch rather than take part in as it was not my cultural beliefs. Bhai Tika celebrates one’s brothers as a sister prayed for her brother and gave him flowers and told the god that they could only take him once the flowers wilted and the flowers didn’t wilt. Now sisters venerate their brothers today by annointing their ears and head with oil, giving them a multicoloured tika on their forehead, laying a garland of flowers around the neck and giving them a present. We sat in a circle and participated in the ceremony. Whilst this ceremony was technically a ‘mock’ ceremony it just didn’t sit well participating in it knowing it was not part of my belief system and I question how I am respecting someone else’s beliefs by taking part in it.


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The flowers and shawl they gave us are lovely and the shawl will remind me of my trip. Again I am not sure if because these people were so willing to have us participate (we paid a small fee) we should accept their hospitality. This is something I will continue to reflect upon.

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