Lose Your Self

There is something exhilarating, illuminating, and even liberating about leaving all that you’ve ever known behind. Going off the map, getting away from the spheres of influence that have been shaping your identity up to the present, you discover and develop new sides of yourself. You begin feeling profoundly closer to humanity while learning to live like another person. But as you become more in touch with the rest of the world, you may find yourself drifting away from, well, yourself.

Initially, I was very eager to integrate into Nepali culture. During pre-service training, I asked my language and cultural facilitator dozens of questions to help me assimilate. I bought traditional Nepali clothing; I ate weird Nepali dishes; I drank tea whenever offered; at one point, I even tried to grow a Nepali mustache (because all the cool Nepalis are doing it). I tried to be mindful of my every move and action. As a stranger in a strange land, I tiptoed around to avoid upsetting the equilibrium of a conservative culture.

Over time, a few things happened. First, I realized that it’s impossible to be culturally appropriate all the time. Hell, in America I committed taboos all the time. Then, I discovered that I didn’t always want to blend in. How could show Nepalis what Americans are like while trying to act like a Nepali all the time? I’d be a worse than a wet noodle—I’d be a walking contradiction. Also, I take issue with a number of aspects of Nepali culture—attitudes toward Dalits, women, alcohol, marriage, etc. As if these first two realizations weren’t enough, eventually I came to terms with the fact that in trying to conform to Nepali culture, I was playing a role rather than being myself.

This pretending-to-be-someone-you’re-not manifests itself in everyday interactions. In any country they serve, Peace Corps volunteers get pretty accustomed to being asked the same questions over and over. With Nepali strangers, the interview usually includes the following questions:

• Where are you from? Which do you like, America or Nepal?
• How long have you been here? How long will you be here?
• What work are you doing here?
• Will you teach English?
• Will you take me/my family/my baby back with you to America?
• What do Americans eat? Which do you like, American or Nepali food?
• Are you married? Will you marry a Nepali? Which do you like, American or Nepali girls?
• Etc.

For a while, I answered these questions gladly and diplomatically. But repetition gets tedious. Over time, the dialogue grew so monotonous that I could sit through a conversation without paying attention, giving responses as automatically as if reading a script. I became a broken record, only, because the audience was different with each playing, nobody noticed. Like Bill Murray’s character in Groundhog Day, I’ve responded by making my responses more and more absurd with each repetition. Now, when people ask me if I can take them back to America, I tell them I think I have room for them in my bag, or that I’m allowed to take my wife back with me. So far, only one guy has expressed interest in that. Another volunteer, when asked where he’s going (another standard question, although when Nepalis ask it, they literally just inquire “whither?”), has begun responding with “your mom’s house.” I’m not quite there yet, but then he’s been here a year longer than me.

When the truth is offensive, the culturally appropriate answer ends up being a lie. For example, many people are curious as to whether Americans eat beef. Hindus revere cows; in Nepal, killing a cow is punishable with jail time. I used to dodge the question or minimize Americans’ beef-eating habits, but the reality is that that most Americans consume cow several times a week. That’s just the way it is. Our cultures are different, and Nepalis should be aware of that.

Those are largely superficial examples, but many of the compromises run deeper. You conform the way you talk, look, and act to meet peoples’ expectations and preferences. As the singular outsider in a fairly pushy society, the peer pressure can be tremendous. You do things you don’t want to in order to avoid offending others. When you’re under the constant heat of another culture’s magnifying glass, you start acting more like a character than a real person. And soon you start to feel like you’re losing your self.

Some of the time you catch yourself in moments of personal dissociation: participating unfazed in conversations in which your female companions are completely ignored; taking it for granted that women do all the household work; listening politely as your friend brands Dalits as irresponsible and lazy; standing idly by as your sister-in-law beats your nephew because he wouldn’t eat his snack. But most of the time you’re unconscious of the fact that you’ve habituated to things that were once shocking, upsetting, and unfair—that culture you’ve been absorbing molded you into a new person adapted to the environment in which you’re living.

But it’s a temporary acclimatization, not a permanent evolution. It just takes a little time away from village to return to stasis, to remember who you are. Because no matter how much you may feel like a Nepali, a single glance in the mirror is a reminder that you’re not. And even though Nepalis might not understand who you are, they know you’re not one of them. From the laptop to the quick-dry t-shirt, the bank account balance to the college degree—the evidence that you’re an outsider is everywhere. You may need to compromise some of your behaviors in order to assimilate, but you need to draw the line somewhere to ensure your self-preservation.

So, to remind yourself and those around you of your self-sovereignty, you rebel a little bit. Despite the reproaches of your family, you grow out your hair and beard because you feel like it. You don’t clean your room because let’s face it—you’re just not very neat. You enjoy the occasional drink without worrying what people might think. You stop apologizing for being the way you are, because you can’t very well be anyone else.

An Ounce of Prevention

If you’ll look to the top of the page, you’ll notice a new page that says “Get Involved.” If you’ve got a few minutes and a few bucks, I’d really appreciate if you'd check it out and consider supporting some of my work here.

Now for this post. Seeing as health care is still such a hot topic in the states, I thought I’d share a little about a health care system half a world away.

Nepal’s health care system is pretty unique. At the minimum, each village has a health post or sub-health post, staffed with couple of health workers and nurse-midwives. In cities, there are larger government hospitals, mission hospitals, and private hospitals. My primary health center in Shreegaun is somewhere in the middle: it has over 20 staff including a doctor, staff nurse, three health workers, five nurse midwives, two lab assistants, and a psychosocial counselor. The impressive (at least, for rural Nepali standards) building houses a clinic, emergency clinic, psychosocial counseling, a pharmacy, lab testing, antenatal care unit, and birthing center. About 18,000 patients receive services at the center each year, almost all of which are free. In fact, the health center actually gives out money for use of some of its services. For example, women get paid for giving birth in the health center. Patients also receive some money for undergoing family planning procedures like tubal ligation or vasectomy. Of course, a large portion of the funding for these services comes from foreign governments and non-governmental organizations, but it seems to be working quite well.

Nepal also has a unique approach to community health. Two or three women in each village serve as female community health volunteers, whose primary responsibility is to monitor mother-child health. Each organizes a monthly mothers’ group meeting in her village. They deliver trainings (on breastfeeding, HIV/AIDS), distribute tablets (deworming, vitamin A, zinc, iron, folic acid), offer counseling (on family planning, hygiene, nutrition), and encourage visits to the primary health center for checkups. The female community health volunteers are also the primary distributors of medicine for national health campaigns, such as the recent Nepal-wide program to prevent filariasis, the disease that causes elephantiasis. As volunteers, they receive no salary but earn some money by completing reports and often receive an allowance when they attend trainings. Since the program’s conception in 1988, these social servants have had an enormous impact on the health of Nepalis, especially in remote areas.

Still, a wide range of diseases that no longer affect many Americans remain a big problem in Nepal: malnutrition, tuberculosis, hepatitis, typhoid, leprosy, malaria, and many more. In my district, the central health office has programs geared toward the monitoring and reduction of just about every one, and many of them have been successful. For instance, thanks to a national eradication program, Nepal was recently declared polio-free. As another example, NGOs and the government are collaborating to curb the spread of HIV/AIDS through awareness campaigns and condom distribution, in addition to offering free testing, counseling, and treatment. Much of the recent progress in health is remarkable: more babies and mothers are surviving childbirth, more children are reaching adulthood, and more people are living longer. What may not be clear to the average person, however, are the causes of the improvement and the next steps to take. In other words, the public doesn’t always know best.

When I ask local leaders how the community’s health status might be improved, most point to the health center. Recently, the health center held a meeting with community members to hear suggestions for improvement. Those in attendance requested more free medicine, more surgical services, a video x-ray machine, and post-mortem examinations. While these things would indeed improve the treatment of some diseases (except for post-mortem exams—even the hospital staff thought that was a strange suggestion), I found these requests to be indicative of a pervasive, skewed, and unfortunate mindset about community health needs. Because when you consider that most people in my village cook over open flames, drink untreated water straight from ground wells, don’t wash their hands with soap, don’t brush their teeth, and occasionally eat meat that’s been sitting around unrefrigerated for several days, it’s obvious that there are much greater needs than video x-rays. Greater needs even than more medicine.

Let’s take a step back and look at America’s medical history; how have we come to live longer, generally healthier lives? The timeline is marked with countless small innovations that, together, have gradually led developed countries to conquer (or at least control) some pretty substantial challenges to their wellbeing. But the pattern isn’t random; often the earliest, greatest strides have come from social developments, while more recent, biomedical advances have only shown diminishing marginal returns. Take diarrheal disease: whether necessarily or serendipitously, our ability to prevent its spread (through things like sewer systems, water treatment facilities, and flush toilets) preceded our ability to treat it (using antibiotics and other targeted pharmaceuticals). As a result, diseases like typhoid are no longer a major problem in the U.S.; in the rare cases that they do arise, we can treat them. In general, initiatives in public health have had a far greater impact on human health and longevity than have the countless medical innovations of more modern times. Even looking at just the 20^th century, it’s estimated that public health efforts increased the life expectancy of Americans by 25 years, compared to 4 years from medical advances.

In the globalized world, however, there is little order to “new” technologies (comprising hundreds of years of previously unheard of advancements, suddenly made available almost all at once) raining down upon less developed countries. As such, often the quick, shiny fixes look more attractive than the predecessors that made the future innovations possible. In some cases, this is just fine—who needs a landline when cell phones are available? But playing catch-up in fast-forward can be problematic. For a patient, a doctor, or a government health official, providing free care has a more immediate, tangible effect that building latrines or hand washing stations. In most cases, however, medicine alone can’t eliminate a disease.

Some Nepalis still hold to traditional beliefs about health, superstitions that witches can invoke illness that a medicine doctor or an odd home remedy can cure. They may be suspicious of medical care; during the national filariasis campaign, for instance, we encountered a number of people who refused to be immunized, alluding to vague stories of people who’d died after taking the pills. Others (increasingly, it seems) jump straight to biomedicine, looking to medications to keep their blood pressure in check and antibiotics to cure their stomach pain. What is largely missing is the in-between—an understanding that disease comes from how we interact with the natural world, and that, as such, to protect ourselves from disease we need look no further than our own behavior. Sometimes medicines can cure us, but they aren’t a proactive way to deal with disease. Limiting a disease’s spread with more basic solutions, such as encouraging children to wash their hands, training mothers how to treat water, or teaching about nutrition, can have a much greater impact.

In a health center we visited during our pre-service training, someone had left a message in red marker on the white wall of the hallway. Written in English, it read “an ounce of prevention is worth a pound of cure.” Whether it was intended for Nepali or western eyes we’ll never know, but in either case it’s a message we should all take to heart.

Welcome to the Jungle

The word “jungle,” which we tend to think of as an overgrown, untamed wilderness, is derived from Sanskrit. Before coming to Nepal, one of the greatest anxieties among my group of volunteers was the wildlife (scorpions, cobras, tarantulas, leeches, tigers, monkeys, etc.) that we would encounter. In Nepali, however, jungle literally just means “forest.” As I’ve been learning, sometimes the greatest nuisances are the least exotic of all.

I have been waging something of a war these past few months. Each time I think I’ve won, I find my efforts thwarted and back where I started. It’s been largely a quiet battle, the silence broken only by the occasional outburst of an expletive, which being in English goes unnoticed by my Nepali family. I’m talking about my struggle against household pests, namely flies, chickens, and one very pesky goat.

Our kitchen is inhabited by a large extended family of houseflies. The source of the sustenance that maintains their steadily growing population is unknown, but my host family says it’s the same way every year. They swarm around us, coat the walls, and fly around during our meals, provoking us to eat ever more quickly. Some also occupy my bedroom—as I write this post, one is buzzing around my head.

I really dislike flies. I much prefer mosquitos. True, in Nepal the mosquitos carry malaria and Japanese encephalitis, but that just makes it a high-stakes game. If you’re attentive you can kill in the time between when they land and when they pierce your skin. Flies only get under the skin in the figurative sense, with their buzzing, scuttling, and flitting. They are also more touch-and-go—you have to strike with speed and accuracy, correctly anticipating their trajectory as they take off. The back of my Nepali notebook is specked with blood from my success killing flies back in pre-service training (though my sudden assaults never failed to startle my classmates and interrupt our lesson). But that was just a handful each day; here, the challenge is quite overwhelming for a mere man and his notebook.

So you can understand why I was quite thrilled to find that the local market sold sticky traps (although I still don’t know what they’re called in Nepali. I refer to them as the “traps-that-when-flies-come-they-aren’t-able-to-leave-because-it-holds-them”). I bought a half dozen and the next morning placed one on the floor of the kitchen with a little milk and sugar. Here’s what it looked like two hours later.

We were fly-free for a few delightful days, but soon they were back in full force. Despite my family’s wishes, I can’t afford to supply us with a new trap every few days. I’ve thought about introducing spiders to control their population, but I’m afraid that would attract lizards to which would lead to snakes, and I detest snakes way more than flies. I saw my first live one (I’ve seen 8 or 9 dead ones) the other day—it was about 4 feet long and made me very nervous. For now I guess I’ll just tolerate them and try to keep them out of my buffalo milk.

The other, more infuriating annoyance has been the fight with my family’s goat and chickens over my garden. If you’ve read my earlier posts, you may remember how these roving scroungers destroyed my crops while I was at in-service training. I have since reinforced my mosquito net fence with additional wooden stakes, installed sheets of tin along another side and a half, and blocked off the rest with pieces of metal grating. It looks pretty ridiculous, but I’m going for function over fashion. I’ve also been covering the beds with straw after planting to protect the soil from evaporation—a practice that I think many Nepali farmers could benefit from.

But the animals occasionally find a way in. The chickens rake through straw with their feet in search of food, disturbing the soil and displacing the seeds. I came home the other day to the aftermath of a farm animal party—my potatoes had been uprooted, my bean plants decapitated, and the leaves of almost all my nasturtiums devoured. The goat, a cheeky little kid, has been the main problem. I finally asked my family to tie up our baby goat, but his mother freed him by chewing through the rope! The saga may never end.