Newari – Borderless

By Ravi Shankar

The decision to retire was a long, tough, and protracted one. The traditional wisdom always gave out doctors never retire. But we needed time to ourselves. We had long and fulfilling lives and now was the time to take things slow. The body was ageing and required more time to complete various activities. Some tasks were no longer possible.

I still remember the first day I met Rajendra on the orientation day of the Family Medicine residency program in upstate New York. Rajendra was from Jiri in the Himalayan country of Nepal. For a few decades, Jiri was the gateway to the Everest region. Then the hikers and mountaineers started flying to the air strip at Lukla. Roads were also progressing further and further in the country. We grew closer during the residency. We shared many interests including nature, hiking, photography, creative writing, and a strong empathy for the underdog. Our friendship slowly deepened, and by the end of the residency we decided to spend the rest of our life together.

We were also different in so many ways. I was a girl of mixed German and Colombian heritage. My family was well-to-do, and I had a privileged childhood. Raj was from a poor family and had to face many struggles in his life. He went to medical school on a government scholarship. Like most graduates of the Institute of Medicine in Kathmandu he then concentrated on being selected for a residency in the United States. Even in the early eighties this was a long, hard struggle.

He did a few ‘observerships’ and research attachments. He eventually went on to become a chief resident and we both worked for around two years in the Northeast health system after residency. Soon we had to decide on what to do next. I would have liked to continue in the United States. Raj however, was increasingly considering whether we should go back to Nepal. I told him that though I had never even visited Nepal I was OK with whatever he decided.

Though his family had settled in Jiri, Raj was a Newar. His full name was Rajendra Shakya. The religion of the Newars was complex tapestry of Hinduism and Buddhism. His family home was at Bungamati, a Newar village in Lalitpur district at the southern part of the Kathmandu valley. Newar Gods and Goddesses were complex and had both good and more wrathful aspects. Women were considered ritually impure during menstruation and were not allowed into the kitchen during this period, and they could not visit temples. In some rural parts of the country, the Chaupadi system was still followed, and women were banished to a cow shed during their periods. The Newars had their own caste system, and the concept of purity was important. In the Kathmandu valley the Newars had their ritual feasts (bhoj) and the buffalo was the most important animal in Newari cuisine.

The cow was sacred and killing one was a grave sin, but the poor black buffalo was fair game. I often reflected on this injustice. We first worked at the United Missions to Nepal hospital at Tansen at the foothills of the Himalayas. Tansen was a small town with a significant Newari influence and the hospital was the major and often only source of health care for a large population. The hospital was overcrowded, and we had to deal with a variety of patients. The houses for the doctors were lovely and picturesque, and we had a great community of both Nepalese doctors and expats. We stayed in Tansen for nearly a decade. There were delightful walks in the surrounding hills and a rather long hike to the Rani Mahal on the banks of the Kali Gandaki, often called the Taj Mahal of Nepal.

There was an opening for a doctor couple at Khunde hospital in the Everest region and as he was from Jiri, Raj wanted to apply. The hospital was at a height for around 4000 m and was set up by Sir Edmund Hillary. The hospital provides care to local residents, hikers, mountaineers, and porters from the lowlands. Initially it was a very isolated existence. Later a satellite phone was set up and eventually an internet connection followed. We dealt with all kinds of patients. The weather was cold, but I loved the picturesque cottage near the hospital. The region was becoming a popular trekking region and during the peak seasons of autumn and spring several thousand trekkers passed through.

Patan hospital is one of the old and famous hospitals of Nepal located in the city of Lalitpur also known as Patan in the Kathmandu valley. Migration of doctors to developed nations was a major challenge for Nepal and the Institute of Medicine was not very successful in producing doctors for the country as most graduates left for developed nations. The importance of a family medicine/general practice programme was understood by the policy makers and the Patan Academy of Health Sciences (PAHS) was set up. MD was the postgraduate medical qualification in the country and a MD in General Practice and Emergency Medicine (MDGP) was started in this institution.

We were among the faculty for this program, and we were now working at Patan hospital. We had some family land at Bungamati and built a traditional Newari style house. There were smiling mustard fields around though the area was rapidly urbanising. Flowers grew well. In winters, the Himalayas could be seen on a clear day but air pollution and dust made this a rarer phenomenon.

My brother had retired and settled in our family land on the outskirts of Albany, New York. We had a rather large plot of land, and I was thinking of settling near him. We had followed different life trajectories, and it would be nice to spend some together in the autumn of our lives.

Our work at Patan Hospital was hectic. After long conversations we decided to retire from the hospital and offer our expertise to the MDGP program as Emeritus Professors. Raj’s sister and brother had retired and were now living in Bungamati. Patan hospital would have loved for us to stay on.

We decided to divide our time between Albany and Bungamati. Summers in Albany and winters in Bungamati. Winters in upstate New York can be harsh and unforgiving. The long flight between the two locations will be a challenge as we did not handle long flights well. Let us see what fate had in store for us. Our son was a vascular surgeon in New York and we could be near to him. We were happy that we finally decided to retire and spend time with our families and our grandchildren. It was time to explore the road less travelled!

Dr. P Ravi Shankar is a faculty member at the IMU Centre for Education (ICE), International Medical University, Kuala Lumpur, Malaysia. He enjoys traveling and is a creative writer and photographer.

PLEASE NOTE: ARTICLES CAN ONLY BE REPRODUCED IN OTHER SITES WITH DUE ACKNOWLEDGEMENT TO BORDERLESS JOURNAL

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Healing in the Land of the Free

By Ravi Shankar

The wind blowing across the Long Island Sound chilled his bones. The day was cloudless and the sky blue, but the sun lacked warmth. New York. Dr Ram Bahadur had called the big apple home for over three decades. Winters were cold and snowy. There were cold snaps and the dreaded northeaster brought snow and freezing temperatures. Summers could be surprisingly warm. February in New York was the depth of winter.

Long Island was blanketed in snow. He had spent the morning clearing snow from the driveway of his home. The suburb of Woodbury was quiet and peaceful. The trees had lost their foliage and were waiting for the warmth of spring to put on a new coat of green. He had a large house with floor to ceiling picture windows. The house was two storied with an attic. There were two bedrooms on the ground and three on the first floor. He had done well in life and was now prosperous.

He still recalled his first days in the big apple. He had just come to the United States from Nepal after completing his postgraduation in Internal Medicine. The first years were tough. He had some seniors doing their residency in New York city. The state of New York offered the largest number of residencies in the country. He did his residency again in internal medicine and then a fellowship in endocrinology.

All his training was completed in New York. He worked for over two decades in large hospital systems. But, for the last five years he started his own private practice. Compared to most other countries medicine in the States paid well. Private practice was certainly lucrative, though the cost of living in New York was high.

He did sometimes think about his home country of Nepal. The Kathmandu valley was still a beautiful place. His visits were few and far in between. Unplanned urbanisation had made the valley dusty and dirty. Winters in Kathmandu were cold but milder compared to New York. The Institute of Medicine (IOM) was the first medical school established in the country. The original intention was to create doctors for rural Nepal. The selection was tough and competitive. He still remembered his joy on learning that he had been selected for the medical course. During the closing decades of the twentieth century Nepal was in turmoil. The insurgency was ongoing, and blockades were the order of the day. Violence was rife and a lot of blood was spilled.

Most doctors from IOM migrated in search of greener pastures. The others mostly practiced in the valley, the historic heartland of the country. Ram was originally from Gorkha, in the centre of the country but his family had migrated to the capital when he was a few years old. His father was a civil servant while his mother was a housewife. Civil servants did not make much and money was always in short supply. His father was a man of principle and never accepted bribes or tolerated corruption. He still remembered the argument he had with his father when he put forward the plan to migrate to the United States (US) to pursue his residency.

His parents had both passed away and his siblings were also settled in North America. He rarely visited Nepal these days. The insurgency was followed by the overthrow of the monarchy and then a new constitution was promulgated. A federal structure was set up and while this did have benefits, the expenditures also increased. Each state had to set up an entirely new administrative machinery. He married an American academician who taught Spanish literature at the City University of New York. His wife’s family hailed from the country of Colombia.

New York had a substantial Hispanic population these days. He was now fluent in several languages: Nepali, his mother tongue; English, Spanish and Hindi. He also understood Newari, the language of the Newars, the original inhabitants of the Kathmandu valley. He did think on and off about his motherland. Many Nepali doctors left the country. Working conditions were hard and the pay was poor. To advance, you required political patronage. The frequent changes in government required you to be on good terms with several political parties.

He still missed the food of his childhood. New York was a very cosmopolitan place. There were several Indian restaurants and even a few Nepali ones. He was very fond of bara (a spiced lentil patty) and chatamari (Newari pizza), traditional Newari foods. These had earlier not been available in New York. Luckily for him, two years ago a Newari restaurant had opened in Queens. He was also particular to Thakali food. The Thakalis were an ethnic group who lived in the Kali Gandaki valley north of Pokhara. He particularly fancied green dal, sukuti (dried meat), kanchemba (buckwheat fries) and achar (pickle). Anil was a decent cook and had learned to cook a decent Nepali thali[1]and dhido (thick paste usually made from buckwheat or corn). He also made tasty momos (filled dumplings that are either steamed or fried) and these were much in demand among his companions.

Ram loved the professional opportunities that his adopted homeland provided. He had become a US citizen. Working in the US was more rewarding though the paperwork associated with medical care had steadily increased. Many of his batchmates and seniors lived and worked in New York state and across the state border in New Jersey.

Many of them did miss their homeland and had a vague feeling of guilt for not contributing their share to their original homeland. A few of them were working on a proposal of developing a hospital at the outskirts of Mahendranagar in the far west of Nepal. The Sudurpashchim province had a great need for quality medical care. The details were still being worked out. There were about twenty IOM graduates involved and they decided on an initial contribution of a million dollars each. Despite inflation twenty million dollars was still a substantial sum in Nepal.

This group of friends collaborated on different social projects. They were also active in promoting a more liberal America where each citizen and resident had access to quality healthcare. The hospital would be their first project outside the US. A strong community outreach component was also emphasised in their project.

The US had made him wealthy. He was a proud American. However, he also owed a deep debt to his home country for educating him and creating a doctor. Now was the time for him to repay that debt, not wholly or in full measure but substantially to the best of his abilities!

[1] Plate made of a few courses, completing the meal

PLEASE NOTE: ARTICLES CAN ONLY BE REPRODUCED IN OTHER SITES WITH DUE ACKNOWLEDGEMENT TO BORDERLESS JOURNAL

Click here to access the Borderless anthology, Monalisa No Longer Smiles

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