UPAYA ZEN CENTER NEPAL NOMADS CLINIC, DOLPO, 2018 Nepal, with its great mountains and its remarkable people, remains one of the poorest countries in Asia. Over twenty-five percent of the population lives below the poverty line, and in the more remote regions of Nepal, opportunities to thrive are few with an average income below $700 US per year.

Villagers greet the Nomads Clinic and Dolpo Rinpoche in Charkabot.

Upaya’s Nomads Clinic (which began in 1980) has served in the Dolpo region for the past four years. Dolpo has

an extremely high infant and maternal mortality rate. With an average life expectancy of only 50 years,

medical care is sorely lacking or non-existent in many of the villages.

Neurologist Dr. Michael Lobatz examines Dawa, who had a stroke in the first months of his life.

With the support of Dolpo Tulku Rinpoche and the abbot of Shey Monastery, Khenpo Pema Dorje, this year’s Nomads Clinic (NC) team saw over a thousand patients in some of the most rugged, remote, and high altitude villages in the eastern region of Dolpo. Rinpoche and Khenpo were were invited to consecrate and bestow empowerments in Ngagyur Nyingma Dechen Palri Monastery and Ne Chuwopal Ngedon Sherdrub in Taching and Barong villages respectively after their successful completion of renovations in the year 2017.

Dolpo Tulku Rinpoche officiating at Dechen Palri Monastery, Dolpo.

The NC objectives are to: • Deliver direct medical and dental care and health education to people (particularly women and children) in remote, high altitude, rural areas of the Himalayas;. • Train, mentor, and support Nepali clinicians and health care workers who serve in the Himalayan region; • Distribute solar lights (Little Suns), toothbrushes, eye and sunglasses, and other health necessities; • Educate local people in better approaches to hygiene, disease, and health; • Create awareness of menstrual hygiene management and distribute reusable menstrual hygiene kits to all women in the region;. • Distribute birth kits, prenatal vitamins, and birth education to pregnant women; • Educate women and men about birth control and offer contraceptives (implants) to those who wish to use them; • Provide ongoing support for the education of Nepali healthcare workers who join our medical team, a network of young Nepali clinicians from Solu Khumbu (Everest region), Mustang, Gorkha, Humla, and Dolpo; • Provide medical support on a case by case basis throughout the year and ongoing support of the Dolpo Winter Clinic in Kathmandu with menstrual hygiene kits in 2018 and H. Pylori kits in 2017

• Foster knowledge and cultural exchanges between clinicians from Western and non-Western cultures. • Transform the experience of Western clinicians.

Dr. Rob Anderson examines a patient.

The 2018 Nomads Clinic in Dolpo included 23 Western clinicians and Western support team members, partnering with an extraordinary group of Nepali clinicians and health workers, plus a large Nepali logistical team.

Dr. Peter Rice and Pema Gyalpo examines a patient.

In all, over 90 Nepalis and Westerners served for four weeks in Dolpo. They walked over 170 miles across terrain ranging from 6,600' to 18,300' (2000m to 5550m) and saw over 1000 patients in six different clinic locations, and numerous smaller clinics along the way.

Dr. Sonam Lama does an injection.

The clinics included the medical specialties of neurology, cardiology, gynecology, pulmonology, ENT, internal medicine, emergency medicine, dentistry, midwifery, pediatrics, family medicine, and others. Amchi Lhundrup Bista also provided Tibetan diagnosis and treatment to over 350 patients.

Amchi Lhundup examines a patient, using tongue diagnosis.

Dr. Arpels-Josiah shares EKG results with the patient and some team members.

The clinic provided extensive wound care; took care of people suffering from joint pain, gastritis, heart problems, neurological disorders, stroke, diabetes, hypertension, eye problems, skin diseases, and respiratory issues; had a full-service dental clinic and an intensive pediatric clinic that served hundreds of children, including children with congenital deformities.

Nurse/midwife Angel Murdock feeds a baby with breast milk from other women. The infant has a serious face infection, clubfeet and cleft palate.

Nurse/midwife Angel Murdock shows her pregnant patient her fetus.

Dolpo nurse Tsering Wangmo gives a menstrual education class.

Nurse Wangmo puts in implants as Angel Murdock supports.

Nurse Wangmo and Dr. Wendy Lau show a mother how to do “kangaroo mother care.” The infant weighed less than two kilos.

The NC as well provided extensive dental care and education, thanks to Nepali dentist Dr. Phurbu Dorji and his dental assistants Sonam Peldon and nurse Lindsay Brant. Over 216 dental patients were seen and over 251 children received much-needed fluoride applications. Also, 32 patients had impressions taken for dentures to be made in Kathmandu in the winter, and 877 toothbrushes were distributed.

Dr. Phurbu Dorji, Sonam Peldon, Lindsay Brant working with hundreds of patients.

One of our most important new initiatives has been menstrual education and support for Dolpo women. Hundreds of reusable menstrual hygiene kits were given to women, along with self-care education. This project has been made possible through the generous donations of individuals in the USA and Europe. Donated funds supported the purchase of 2,000 hygiene kits, 1,000 for 2018 and another 1,000 for 2019. “Days for Girls,” which employs women from remote areas of Nepal, produced the hygiene kits. 600 kits were delivered during the Nomads Clinic in the field this year, and 400 will be distributed in the upcoming Dolpo Winter Clinic. Noteworthy was the joyous and grateful response of the women who received education and the kits.

Tsering Wangmo giving a menstrual hygiene kit to women of Dolpo.

The NC also provided education in birth control, pregnancy counseling, stretching (yoga) training, and health education. As well, the team did vision testing and distributed 1,000 sunglasses to prevent eye damage from the sun and 600 pairs of reading glasses for vision acuity improvement. There were 1,000 lip balms distributed, half of which were donated by Badger Balm.

Nurse Julie Dubuc with kids and Badger Balm lip protection.

In addition to medical services, the NC team distributed Little Sun solar lights to nearly 1,000 households in Dolpo, where they are invaluable in communities suffering from pollution from yak dung fires (used for interior and tent lighting and cooking) which can cause pulmonary and eye disease. This brings the total count of Little Suns to the Dolpo region in the past four years to over 4,000 units given to a majority of families in this region.

Four thousand Little Suns given to villagers in Dolpo over the past four years.

The NC provides medical help throughout the year, and is supporting follow-up care for a number of patients who came to our clinics this fall, including a young boy with a cleft palate, a young man with untreated seizure disorder, a young woman with serious cardiomyopathy, a young man with recurrent paroxysmal supra-venticular tachycardia, and an elder monk with serious diabetes, among others.

Dr. Burggraaff and nurse Julie Dubuc examining a patient.

Finally, caring for the pack animals, who are essential for carrying food and supplies for the journey, was also a priority this year. There were 75 mule blankets distributed that were sewn by the ROKPA Women’s Workshop in Nepal to help prevent friction wounds for the animals that carried supplies across difficult terrain. This project was headed up by Dr. Barbara Burggraaff, one of NC’s key clinicians. Upaya Zen Center and Roshi Joan Halifax are profoundly grateful for your support of Upaya’s Nomads Clinic. Your generosity, and the dedication of Nepali and Western clinicians, health care providers, and support team members are the heart of this work. For more information about the Nomads Clinic please see: www.upaya.org/social-action/nomads-clinic For more information about the Dolpo Tulku Charitable Foundation: www.dolpotulku.org If you wish to contribute to the Nomads clinic, please give here: www.upaya.org/giving/nepal-nomads-clinic We thank you for your partnership.

The 2018 Nomads Clinic Team

Great gratitude to the clinical coordinators: Dr. Wendy Lau, Tsering Wangmo, Dr. Charles McDonald, Dr. Sonam Lama, Dr. Phurbu Dorji. Thanks to Prem Dorchi Lama, Tenzin Norbu, and Noah Rossetter, the NC logistical coordinators, and Amchi Lhundrup for his tireless efforts. Upaya offers deep gratitude to Abbot of Shey Gompa Khenpo Pema Dorje, Dolpo Tulku Rinpoche and the Dolpo Tulku Trust. Upaya is especially grateful to Little Suns, UCLA Medical, Badger Balm, Patagonia, Skratch Labs, Ova-easy, Jacob Mensurian of Salmon Market (Ketchikan), and our many kind and generous donors, including the Pende Foundation, Briggs Foundation, Be Happy Foundation, the Jennifer Crowell Gilliland Fund, and the Lau family. Special thanks to our Nepali health care workers and medical translators: Pema Gyalpo, Dawa Yangzum Sherpa, Sonam Lama, Sonam Lhamo, Sonam Peldon, and Tenjin. And deep thanks to the whole Nomads Clinic compassionate Western team, including Drs. Rob Anderson, Ray Howe, Barbara Burggraaff, Michael Lobatz, Ranjit Arpels-Josiah, Peter Rice; nurse practitioners Angel Murdock, Lizzie Callard, Coralie Meslin; nurses Lindsay Brant, Julie Dubuc; support team Shawn Andrich, Michael Lyons, Michelle Webster, Dan Pennie, Dan Lin, Amy MacDonald, William DeBuys, and Roshi Joan Halifax. Photo credit: Dan Lin, Roshi Joan Halifax, and Dolpo Tulku Rinpoche.

Offering thanks

Dolpo Tulku Rinpoche on the Trail