Byers Without Borders

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Medical Mission

DOWNtime

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Self-isolating in a hotel room between 12-hour shifts on a COVID ICU is truly DOWNtime. 

While on the unit I’m focused and busy. At the hotel, my mind has too much time on its hands. Its favorite way to while away the hours until the next shift is to torture me with a hyper-awareness of every tight breath, sneeze, or tickle in my throat. It’s back in the hotel when the worry and anxiety show up. Keeping me company while I lay in bed, failing to day-sleep.

Earlier this week, I dragged myself out of bed and went for a jog around Mets Stadium. I read somewhere that making your bed in the morning is somehow good for your mental health. So I did that too and promised myself I wouldn’t get immediately back in it.  

There is a CRNA staying in the room next to me. Joey from Jacksonville. We arrived on the same flight. I can hear him facetime his kids through the walls. I haven’t told him. Having their muted conversations makes my room feel less empty. Like turning on the TV while cleaning the house. It’s nice to just hear their voices. 

I’m trying to learn how to do a handstand. I’m envious of the handstands I see in the online yoga classes I do. They scare me a little, so I use the wall as a backstop. Joey hasn’t complained about that noise yet. 

There is breakfast every day in the ballroom. They’ve set chairs up six feet apart, four per table. Sometimes Joey and I have breakfast together. Loud conversations consistently supported by the same three pillars; personal financial concerns, nurse to patient ratios, and deaths from the previous shift.  Runny scrambled hotel eggs. We put our masks on the table while we eat, like macabre centerpieces. It’s all so surreal. 

We had a shared day off early on here. We ventured to a nearly deserted Times Square. I saw a Grubhub runner on a motorized unicycle zip down Sixth Ave in all black motocross gear. Later that evening I walked past a homeless man playing 99 Red Balloons on a melodica. It’s like being inside Bladerunner. 

I haven’t turned on broadcast TV in days. I can’t handle the news anymore. My Facebook algorithm fills my feed with stuff that either makes my blood boil or makes me cry. I watch a lot of The Great British Bake Off on my laptop. I’m up to season 4 and now know the five basic types of pastry: Shortcrust pastry, Filo pastry, Choux pastry, Flaky pastry, and Puff Pastry.

I find the stress here sneaks up on me. On the unit, there is an air of machismo and detachment. Understable coping mechanisms that no one acknowledges. Even back in the hotel, it doesn’t light up my frontal cortex in a big Hollywood-moment mental health alert! Instead, it is just harder to get out of bed. Harder to work on the handstands. I can’t focus on reading the book I brought. 

All of this proves no matter how hard my conscious cortex tells itself everything is OK, the little reptilian limbic system knows this is fight or flight territory. I picture it deep in there, burrowed into my brainstem, smelling danger. Unable to run.

I’ve found entire new genres of YouTube videos that are the equivalent of staring into a lava lamp. Last week I watched two hours of videos about hand pulling La Mian noodles. Today I spent an equal amount of time watching videos of folks carving wooden spoons. 

My brain must be yearning for something so simple, tactile, and yet fulfilling. 

I want to sit by a fire and carve a spoon. It might be my highest calling. Taking a piece of once-living tree and urging it into a tool that can feed a baby. I can’t really think of a more beautiful act right now.

 

Retching Record

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We’ve been doing this sort of thing for decades, Jen and I. We’ve negotiated transport and driver countless times. You think by now we would have learned to ask if the road is paved the entire way. I guess we’re slow learners.

This weekend’s excursion was to Rwanda’s western border with the Democratic Republic of the Congo. Unlike the flat savannahs of the east, western Rwanda is mountainous. So our five hour, partially-paved trip was overflowing with twists, switchbacks, and hairpin turns. Stella beat her Bhutan record and threw up four times during the ride. What a trooper, she collects airsickness bags from all our flights, knowing that we’re likely going to force some nausea inducing adventure on her.

Not helping matters was our driver’s aggressive acceleration-braking, characteristic of those who drive with two feet. Perhaps a technique for our zealous driver to more effectively overtake and pass every bicycle, car, minibus, and lorry that had the affrontery to occupy the road ahead of us. Through a complex semaphore of horn-honking and turn-signal flashing, he would communicate to the other motorists his desire to pass at the next convenient blind curve. Fatalistic drivers like this one always earn me a seat as shotgun. Jen knows that my life insurance has the higher payout. So instead of watching our driver attempt to squeeze three abreast, between an endless succession of buses and oncoming dump trucks, I focused out the side window, at the passing mountains of western Rwanda.

Around 5000 feet, the topography of western Rwanda reminds me a lot of Appalachia. However, being situated on the equator the curvature of these hills are clothed in a very different flora. In place of the mixed temperate forests of NC or VA, these mountains play host to a more tropical variety. Immediately outside of the capital, the land is parceled in an endless quiltwork of gardens, and small subsistence farms. Broad leaved-banana trees surround homes and run up to plots of corn, peas, sweet potato, melons, cassava. There are stands of bamboo, avocado trees, passion fruit vines. The valley floors are all sectioned into rectangled rice paddies. If any naked earth shows it is the red dirt of my childhood in GA. Shades of green and red are the dominant palate of these hills.

After a while I notice something missing. I’ve not seen any draft animals in Rwanda. There are no oxen tilling those paddies, no donkeys pulling carts of produce. I guess it makes sense. Rwanda is Africa’s most densely populated country. Labor here is cheap. We’re constantly passing bicycles laden down with small mountains of plantains, sweating men and boys pushing them to market.

Tea Plantation

As we get closer to our destination, the patchwork of gardens gives way to industrial-scale tea plantations. The waist high shrubs are so tightly packed, they make entire hillsides into bright green topiary. The only break, the occasional blue-grey stand of eucalyptus, identifiable by its scent as much as its silvery leaves. The plantations are community co-ops. In addition to a source of local income, these fields form natural barriers around Nyungwe Forest National Park.

Colobus Monkey

Nyungwe is Rwanda’s most important area of biodiversity. 1000 plant species, 13 species of primates including chimpanzee and colobus monkeys, 275 species of birds, 120 different types of butterfly. When we cross into the park we enter a world of nature left to its own business. Now the hills are obscured by curtains of green wild rainforest jungle. Blue monkeys eye us from the roadside and hornbills glide along the valleys. There is so much green it makes a racket for the eyes.

Rwandan soldiers also watch us from the roadside. In body armor, with an impressive array of machine guns, they are a reminder that we are on the border of the DRC. From our hotel room, we can look across Lake Kivu and into that no man’s land of civil war and Ebola. It’s like looking into North Korea, Syria, South Sudan, Yemen. Like standing at the edge of the grand canyon or the top of the Sears tower. It gives you the willies. Some travelers (with a poor sense of self-preservation) actually cross that border tracking gorilla, looking for adventure, hits of adrenalin.

For Byers Without Borders, the hotel buffet was adventure enough. Lily and I spent the majority of Monday prostrate on the cool tile floor of our bathroom in Kigali.

Farewell & Thank you!!!

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And just like that it’s over. A decade of wishing, a year’s worth of hard planning and scheming, and here we are looking out at the frighteningly short and narrow runway of the Paro airport, awaiting our departure. None of us want to leave, the time went too quick, evidence that our life here was too perfect.

And it was a perfect community of friends and loved ones who made it all possible. Thank you for supporting us with your insanely generous donations. Thank you Hunt Regional CRNAs for working your VACATIONS! Thank you, to all who didn’t doubt, question, or discourage this dream. It is without a doubt that Jen and I are at this place in our lives because of the myriad interactions we have had with each of you along the way. We are a web of lives, each touching the other, pluck one of us and who knows where the vibration will resound. You have all made this trip with us, you have all helped the people of Bhutan.

Thank you our gracious hosts and new friends.

 

Farewell

Bhutan, Advanced Settings:

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Bhutan, Advanced Settings:

Bhutanese consider it impolite to say no. So they have many different forms of yes ranging from “very unlikely” to “it is certain”. If they say yes three times it’s definitely not happening. 

Bhutanese Ngultrum is the local currency. A one Nu bill is the smallest denomination; there are no coins. So when change of less than one Nu is owed, it is paid in hard candies or throat lozenges.  “Your change sir, 27 Nu and two peppermints”. 

Most Bhutanese parents take their newborns to the temple to receive auspicious names. Unfortunately, the monks don’t concern themselves much with surnames or gender. So Sonam the office girl who helped us with work permits is not Sonam, the boy who took us to Tiger Nest Monastery. Tashi Wangchuck one of my residents is no relation to the royal Wangchucks. 

My typical day starts with a short 20 minute walk to Jigme Dorji Wangchuck National Referral Hospital (JDWNRH). The pinnacle of the Bhutanese healthcare system, and where I will spend the morning in the OT (operating theater), doing hands-on clinical trading with two anesthesia residents. My afternoons are spent lecturing or various anesthesia topics. 

Until very recently Bhutan has been unable to train its own healthcare providers. Instead, doctors were trained in Sri Lanka, Burma, Thailand and Cuba. JDWNRH and the attached Khesar Gyalpo University of Medical Sciences is trying to change this. It is the only teaching institute in the country and it is crawling with students, interns, and residents.


Bhutan Basics

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Bhutan basics:

National Bird- Raven

Favorite Food- Anything with chilies 

Fridge settings-Winter, Summer, Monsoon

Toilets- squat (bring paper unless adept at the Asian bidet, water bucket and a scoop)

They drive on the left, so step off a curb and look RIGHT not left (that lesson comes quickly).

At day 23, life here is starting to feel normal. Everyone is settled into a pleasant routine. 

With only three sets of clothes each (one for wearing, one for washing, and one backup) Jen’s day usually starts with some laundry. You have to hang it out early, so it will dry before the afternoon weather rolls in (cold fingers hanging up wet clothes in 30 degree temps). Our little washer is on the balcony with the clothes line. It took some practice figuring out what the “fuzzy” cycle was about. Also, to power the washer Jen has to unplug the microwave, and run the extension cord from the electric blanket through an open kitchen window, but the chore no longer produces the profanity it did early on. 

On teaching days her and the kids bundle into a taxi and head across town to the school where they teach English Literacy and Yoga. 

Without the rush to make morning assembly, they usually choose to walk back home, picking up ingredients for the evening’s dinner on their meandering. Back at the apartment, Jen is still the teacher, and it is time for the girls to do their own schoolwork. 

On non-teaching days, the girls all head straight to the pine forest above the apartment. Schoolwork is still on their schedule, only now their classroom comes with a view. They always seem to negotiate time to build a fort or play among the prayer flags at the end of their lessons. After, it’s back down into the valley for the day’s shopping, a visit to the telecom office, or perhaps a coffee with another volunteer. 

I normally catch up with the gang around 3:00. After snacks and snuggles, we try to go out on some adventure together in town. A trip to the National Library, Tashi Dzong, the archery grounds, or just a taxi ride up to the telecom reflector tower. 

Evenings… the same dinner, bath, hair-combing, teeth-brushing routine as home. Except it is Indian cable that provides the background chatter instead of DirecTV. Occasionally a power outage triggers some flashlight games. And a game of Uno is never far from reach. 

We certainly are lacking many of the comforts of home here. We’re cold a lot, and we haven’t yet found a decent slice of bread. But there is something to the simple life here. It’s like the difference between those diabetic desserts and those made with real sugar and lard. One is richer and more satisfying.

Lunch with Lamas

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The snows held off. This past weekend we finally made it out of Thimphu, our guide, OR nurse Sonam. 

I couldn’t be more proud of the girls. They stoically endured hours of vomit inducing mountain roads (Jen and Lily were the only ones to avoid a purge) in a tiny car that smelled oddly of lemon Pledge. 

In Phobjika valley, winter migration grounds for the blacked neck crane, the kids politely sat on the floor of a farmhouse and ate red rice, fried fresh cheese, and pork belly. While they didn’t clean their plates, they also did not balk or turn up their noses to our host’s meager offerings. 

In Punakha we visited the city’s Dzong (a mixture fortress, monastery, government offices, and court house). The Lama of the Dzong was impressed that we made the children wear Kira as a sign of respect. So he invited us to celebrate one of his junior monk’s recognition as master mandala maker. Mandalas are the highly symbolic art pieces that are painted on buildings, and canvas throughout the Buddhist world. In some ceremonies, the artists spend weeks creating mandalas of colored sand only to sweep it away in an acknowledgment of the impermanence of reality. 

photo by worldreligionnews.com

For our hosts, the party we joined was bit like an office event, celebrating a promotion. The celebrant’s family was present, and naturally, they insisted we partake of the food. Again, the girls rose to the occasion. Taking cues from the monks, they balled up rice and ate with their hands, in local fashion. They sipped at tea I know they dislike, and Lily sampled an egg of unknown vintage that even I avoided. If diplomacy can survive our current administration, my girls may have a future in it. 

Shangri-La 2.0

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In Dzongkha, Druk Yul is the name Bhutanese give their country. It translates to Land of the Thunder  Dragon. They should call it Land of the Thunder Dog. Packs of stray dogs infest Thimphu. To my torment, they sleep all day and bark all night. The four that camp out at our apartment entrance have become de facto pets for the girls. Gi-gi, Noodles, Grumpy Dog, and Russell. 

Despite difficulties sleeping, Bhutan continues to confound and delight us. In Delhi, Bangkok, Tokyo, or Hong Kong it was easy to find a 7-11, Kentucky Fried Chicken, or Starbucks. Not so here. There are no chain stores, no billboards (other than pictures of the king), and no 6-lane highways. So we buy our produce at the weekend market, fast food is a street vendor selling Tibetan Momos (steamed dumplings), and our coffee is the instant crystal type.  

Unlike other Asian countries we have visited, Bhutan is not rushing headlong into the modern/globalized world. They’ve seen the result such actions have taken on neighboring countries (deforestation, pollution, urban sprawl, crime) and politely said no thank you. Bhutan chooses to enter the modern age in its own time. 

And so, as recent as 60 years ago there were no paved roads connecting this landlocked country with the outside world. The first television signals were not received until the late 90’s. In 1989, as a way to preserve Bhutanese traditions, the government began actively promoting Driglam Namzha, a code of conduct that specifies how to behave like a civilized Bhutanese. The most visible sign of this commitment is the requirement to wear traditional dress (Gho for men, Kira for women) at school, in the office, or when visiting temples. 

The ethos of mindful-modernization permeates the entire culture. As part of its constitution, Bhutan maintains 60% of its land under forest cover. New construction must conform to traditional Bhutanese design. Even traffic lights are an object of scrutiny. When one was installed in the capital, the residents of Thimphu complained that it was too impersonal. After it was dismantled their city became the only world capital without traffic lights, leaving us to decode the movements of their traffic police. 

In tourist brochures and travel shows, Bhutan is often compared to Shangri-La, that fictional Himalayan paradise first described in the 1933 book Lost Horizon. Having seen maroon clad monks with smart phones, in a country that jealously guards its forests despite their economical potential, Shangri-La 2.0 is a more apt description. 

Himalayan Adventure: Our First Few Days

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98% of a big fat Himalayan adventure is figuring out the mundane. How do you charge a laptop, make a local call, find bathroom cleaner. 

Our first days in Bhutan are behind us and we’re starting to get our sea legs. 

The kids have learned to sleep with vests over their PJs and everyone congregates on the electric blanket when reading. There’s no insulation or central heating so our apartment (at 8600 feet) is pretty chilly. 

We’re slowly getting the hang of making meals for five on an electric hot plate. And no one needs to be reminded not to brush their teeth with tap water (we have a gravity filter the size of a mini-keg that constantly needs refilling). 

It was a pretty productive weekend setting up our home here. We got local phone numbers, internet for the apartment, and made it to the weekend market (the only place to get fresh vegetables). And all of this in a blend of English and Dzongkha, a language similar to Tibetan and heavy with Z and Shu sounds. 

It wasn’t all chores, though. Yesterday we hiked up to Taktshang Goemba (Tiger’s Nest Monastery). This ancient structure clings to the side of a cliff 2700 feet above the floor of Paro valley.

Guru Rinpoche (an aspect of the second Buddha, Padmasambava) is said to have flown to the site on the back of a tigress to subdue a local demon. As such we shared the arduous climb with Bhutanese pilgrims. 

The site of so many blond heads scampering through the rhododendron forest was quite the spectacle for many of these locals, who were all smiles. 

In fact, we’re always a bit of a spectacle when we leave the apartment. There are so few westerners here. And even fewer western children. And I’m sure we’re traveling with the only western twins in the country. Which explains why the second word we learned in Dzongkha, after Hello, was the word for twins… Nima Dauwa. 

Let our Himalayan Adventure continue…….