Namaste from Nepal!

I’m bringing this blog out from hibernation to post some pictures from my time in Nepal.  Here’s an update from the last few months:

Dear friends,

I am two-thirds through my global health rotation in Nepal and have been enjoying the medical and cultural aspects of life here.  Because I may not have had a chance to see you before I left (especially since the January polar vortex cut short my layover in Beer Sheva), I’ll start with a quick update from last semester:

I spent the fall in the US to study for board exams, apply for residency in the US, and rotate through hospitals in Harlem, Memphis, Manhattan, and Minnesota.  This was also time to decide a specialty.  I have loved family medicine since high school, particularly the behavioral health aspects after studying psychology in college.  After psychiatry rotations this year, I decided to pursue psychiatry instead since it is more focused on my interests and aptitudes.  I am excited for its challenges as a young field in global health and its relationship with theology and faith communities.

Since being in Nepal, it has been a joy to get to know some Nepalis and ex-pats here. I’ve been blessed with the acquaintance of several people doing inspiring work, including long-time medical missionary heroes, my Nepali landlord who is a leader in community mental health in the country, and a woman working in counseling training with the local church.

For our two-month global health rotation, five classmates and I are at the large government-run Patan Hospital.  I spent three weeks in the pediatrics department, which was full of adorable kids and supportive families, but a bit sparse on teaching.  The last three weeks in the psychiatry department have been fantastic.  I joined Nepali medical students for their basic clinical rotation in psychiatry; they have been warm and welcoming and the teacher is an inspiring educator and clinician.  The psychiatric diseases are similar to those in the US, but people with depression and anxiety tend to come to the doctor for physical complaints like back ache, pain in the hand, or chest pain.  The pain is real, involving a mysterious intertwining of the physical and the immaterial–and often responds to antidepressants.

I’ve also had the chance to explore the Kathmandu area a bit, including a large temple and the local palace in Patan.  The Kathmandu Valley is an enormous, diverse urban area–not a wandering collection of sherpas, farmers, and tourists.  Attached are a few pictures from around town: a large Buddhist temple site, students from psychiatry, and hiking scenery.  I’m looking forward to staying in a rural area for the next two weeks before returning to Israel for a few short rotations and graduation.

Let me know how you’re doing; I’m looking forward to seeing you again whenever that may be!

Grace and peace,

Lisa

Mom

This month marks a milestone in my family.  My mom, Anne Crystal, was diagnosed with pancreatic cancer two years ago.  Next week marks the two-year anniversary of her enormous Whipple surgery, at which point she will beat the survival odds.  Her CT scan last week showed no new growth since this spring.

Some of you have never had the chance to meet my mother, so here is a quick sketch.  If you find anything admirable in me, my mom likely had something to do with it.  She has been–and continues to be–a wise mother; we always knew we were loved, and her discipline was firm, yet gentle.  She encouraged and modeled kindness and goodness.  Likewise, my mom is the paragon of hard work and persistence.  When my sister and I were toddlers, she trained for triathlons and marathons, including the Boston Marathon.  At age forty, she went back to school (after earning a teaching degree before we were born) for a competitive physical therapy program, passing classes like physics and chemistry with pre-meds after a twenty-year hiatus from studying math and science.  Furthermore, she knows how to have fun. In her twenties, Mom and a friend bought motorcycles and drove from Colorado through California.  Somehow, my sister and I just found out about this last year :)

Mom has lived her life intentionally, showing us how to balance compassion, prudence, and pleasure, especially in the last two years.  As a part of her mission to “seize the day,”she recently returned from a trip to the Grand Canyon with my dad, which has been a dream of hers since she was young.

Thank you all for your valuable support, especially my sister Katie, who has been faithfully caring for Mom since she graduated from college two years ago, and my dad.  Through all the pain, God has given us so much to be thankful about.  If you have a minute, please visit http://www.caringbridge.org/visit/anne_crystal/guestbook and leave Mom a little congratulatory note on her Caring Bridge site, even if you’ve never met her.  Although we still have a tough road ahead, we have much to celebrate.

We love you and we’re always proud of you, Brave One!

Marathon Mom
Congrats, grad!

Congrats, grad!

Easter 2011

A Little Excitement

As one might guess from the length of time since my last (Christmas) post, school has kept me busy and life has been relatively quiet.  Lots of studying, some time with friends, some cooking adventures — and final exams are already in full swing!  While the politics in this region have been volatile, Israel has been calm in comparison.  One glaring exception is the rockets that have hit some towns in the south of the country, including a few in Beer Sheva.  Don’t worry, I’m fine, and the chance that I would actually get injured is extremely low.  The bomb shelters are quite safe and easily accessible, including one on each floor of my apartment building.  A siren always sounds with at least a minute to reach a shelter.  The “Iron Dome” counter-rocket defense system was recently implemented and yesterday it intercepted a rocket before it hit the city; this could change the situation significantly.

Despite the unpredictability inherent in this part of the world, I still feel strongly called to be here.  Although my school is not perfect, I still feel that this will be a good preparation for my future career in medical missions overseas (I certainly am learning a lot!) and that this is exactly where God wants me.  I was aware of the risks when I decided to come.  I also feel extremely blessed that I have a warning siren, shelter, and overall, very little violence in my city.   As I watch the reactions to the violence — toward and from both Palestinians and Israelis — I am seeing how easily political conflict can cultivate hate; feeling like a victim can make you less discerning about who the real enemy is.

On a happier note, I have been enjoying the clinical rotations we have several times a month.   To practicing interviewing and to start developing clinical skills, we have visited a wide variety of locations in small groups.  Here are some highlights:

Bedouin* village: a Jewish nurse took us to visit a family she knew well.  She interviewed the head of the household (who had two wives and over twenty children), interspersing explanations in English for us, as we sipped three courses of tea and coffee served by his second wife.  The nurse shared about the discrimination many Bedouin face and health factors connected to their culture, like an early marriage age for women.  Surprisingly, she had a greater influence as an outsider, compared with a Bedouin woman, who would not have had the ear of the men (the decision-makers) in that community.  Her mantra was, “You must be clever” — clever about how you motivate people to change, which comes more effectively through understanding what they value, and ultimately their worldview.

Child development center: Under the supervision of the social worker, I conducted an entrance interview of a family who had previously been clients at the center. I was inspired by the social worker’s attention to detail that helped piece together the probable root of the problem (the mother likely had depression and little social support, which contributed to her misinterpretation of her daughter’s normal activity level).  However, due to beliefs about mental health in the family’s conservative religious community, professional support for the mother would likely be difficult.

Kibbutz**: One of the directors in my program also works as the family doctor at his 800-member kibbutz.  He was an integral part of kibbutz life and had known his patients for many years.  His patients repeatedly said that they trusted and respected him deeply as a physician and a friend.  I was refreshed by this example of what I am working toward.

I will be going home to spend time with my family over Passover break, which unfortunately is sandwiched by final exams in microbiology and pharmacology.  My mom has continued with chemo treatments and the last CT scan showed no new growth, which we are extremely thankful for.  We appreciate your prayers since we still have a tough road ahead.

As Passover and Easter near and we remember God’s deliverance of his people from slavery in Egypt and from slavery to sin, I pray that the sacrifice and resurrection of the Lamb will fill you with life and peace.

—–

*Bedouins are Arabs, mostly Muslim, who have been nomads in the Negev desert for many generations.  Today, more live in small villages or even in Beer Sheva.  My hospital sees many Bedouin patients, especially in the maternity wards (the average births per woman is around seven). See Wikipedia article on the Negev Bedouin


**A kibbutz is a group committed to equality and living communally, often (historically) working the land.  They were a significant part of the society and economy in the years leading up to and following  the formation of the political state of Israel.   Interestingly, our professor said that many of the aspects of the kibbutz arose first out of necessity, later out of philosophy. See: Israeli Kibbutz article.

Advent

I have a confession to make.  I have been listening to Christmas music since August.  I have always loved Christmas music (my sister and I were an unbeatable team in our high school band’s annual name-that-Christmas-song competition), but I will usually wait until mid-November to start listening to it.  This year felt different.  I am surrounded by a people who are in a constant state of anticipation (some more than others) of the first advent of Christ.  They are still praying, “O come, o come, Emmanuel,” and the carol replies, “Rejoice! Rejoice!  Emmanuel has come to thee, O Israel.”  I can feel the excitement of the shepherds and the angels announcing, “Joy to the world, the Lord is come!”  The Messiah you have been anticipating since he was promised to you, the great Son of David, who will rule forever with justice, peace, and love, has come!  It feels like it’s Christmas all the time.

Living in such a society makes me celebrate the privilege of knowing the promised one.  I am in awe of how prophecies have been fulfilled in such rich ways–some ways that can only be understood after the life, death, and resurrection of Jesus.  I can experience how the Messiah brings peace, both with God and with man.  I know the nearness of what “Emmanuel,” God with us, means (and not just what it means in Hebrew).

In this advent season, we also look forward to the second coming of Christ: we anticipate the new and rich ways God will reveal himself and continue to bring about justice and love.  I wish you all a very merry Christmas!

Back in School

I am now feeling like I am really in medical school, not just on a trip to Israel.  The craziness of living in a completely foreign place, being essentially illiterate in a new language, and furnishing an apartment from scratch has kept me busy.  Now, I’m getting used to the culture (like becoming more assertive in “waiting in line”), my apartment is starting to feel like home, and classes are in full swing.

Most of our courses are in the basic medical sciences like biochemistry, immunology, and molecular biology, plus clinical and global medicine.  Since I majored in psychology, most of the subjects are new to me.  Some of the classes are taught poorly, which adds to what I must teach myself. While I envy the classmates who have already taken some of these classes already, I know that I will probably, eventually, learn what I need to know. I trust that the extra time I put into the liberal arts will help me understand my patients and their contexts in the future.  I certainly am learning a lot, but because we don’t have exams coming up I am not feeling too stressed yet.  However, December is approaching rapidly!

Learning in medical school is a different game from my undergraduate education. Here, we have more freedom in the way we learn the large volumes of information. We only have quizzes for one course, periodic exams for another, and rarely write papers or give presentations. Essentially, everything rests upon the final exams — and the board exams in two years. Many students draw from a larger pool of textbooks, depending on how they learn best. We are encouraged to attend lectures, of course, but since most are not required, we can study independently if we choose. Unfortunately, the feedback on how I am studying doesn’t really start to come back until after finals!

Update on Mom

Dear friends,

I am sorry for the delay in reporting my mom’s results — the news was sad and my coursework continues to be heavy.  After hearing the results from a CT scan and subsequent lung biopsy, this is what Mom and my sister wrote on the CaringBridge site (http://www.caringbridge.org/visit/anne_crystal – feel free to leave a note for Mom if you’d like):

“We heard from the oncologist today [Oct 4].  We did not get the news we were hoping to hear: the nodule on Mom’s lung is cancer metastasized from her pancreas. Mom has several options at this point: do nothing, re-start the same chemotherapy drug she had last year, or begin an ongoing aggressive chemo involving three different drugs [which she will begin in late October]….The doctor says she is free to go to France with her friend Lora next week, so that’s exactly what she plans to do.  Mom is feeling great and looking even better….

Find rest, O my soul, in God alone;

my hope comes from Him.

He alone is my rock and my salvation;

He is my fortress, I will not be shaken.

-Psalm 62:5-6”

——

I am very sad about this news, but am feeling at peace.  God has been so good to us throughout this tragedy.  Both my sister and I could be home last year, which was a miracle in and of itself.  Mom has literally had the best medical care in the world at Mayo (all covered under our health insurance), which will likely be a stark contrast to my future patients, who may not even have access to a simple blood test.  She has the option of a more aggressive chemo, which makes the prognosis better than I expected – it could mean Mom and I still have a wonderful summer to look forward to.  This is just the start of the list of things we’re thankful for.

Please join us in praying for a miraculous healing and that Mom would continue to feel good for a long time.  I hear she’s having a wonderful time in Paris (her favorite city) with her friend.  Our motto last year, modified from “seize the day” in Latin, was “carpe the living daylights out of the diem.”  None of us know which day will be our last, so it’s a good reminder to us all.

A Land Flowing with Yogurt and Date Syrup

Sabra, green plum, dates, banana, and nectarine

One of my favorite parts about living in Israel is the food.  I love fresh fruit, bread, cheese, and yogurt.  In Be’er Sheva, fresh produce stands and bakeries are abundant and the last grocery store I went to had around 50 types of cheese.  Yogurt is sold by the gallon.  I have been trying new fruits, vegetables, and cheeses every time I shop.  These have included the sabra cactus fruit, persimmons, mangos, apple guava, kohlrabi, dates (did you know date honey, silan, may have been the honey of “land of milk and honey”?), figs, laban cheese, and Safed (Tsafit) cheese.

Sabra cactus fruit

Sweet Pomegranate

I have also learned to cook differently here.  Although I can find most ingredients, some new foods are more abundant–and less expensive–than in Minnesota.  One such food is the eggplant.  Before I came to Israel, I borrowed an Israeli cookbook from the library and discovered that Israelis take their eggplants seriously.  I tried to flame-broil an eggplant, which was moderately successful and extremely messy.

Since moving here, I learned a much easier way to cook eggplant.  Imagine it as the Israeli equivalent of a baked potato.  Pop it in the oven until tender, usually around an hour an in the toaster oven, then drizzle with tahini sauce.  To prepare the sauce, start with raw tahini (the sesame seed equivalent of peanut butter, available in the U.S.) and add lemon juice, salt, pepper, paprika, and garlic.  Easy and delicious!  I also made an eggplant soup last week, which added a little variety to the baked eggplant.  Ingredients like chives and mint leaves gave me something to talk to the vegetable man about.

Eggplant soup

Another common Israeli dish is a vegetable salad of finely chopped tomatoes, cucumbers, onion, and parsley, in a light dressing of lemon juice and olive oil.  Falafel in pita and schwarma (similar to a gyro, but different flavors and meat) are common street foods.  Delicious, but not so nutritious.

Shakshuka: eggs poached in a thick tomato sauce, not scrambled in a thin sauce like mine

Traditional Iraqi breakfast (brunch on Sabbath), prepared by a classmate

On a more serious note, I’d like to ask for your prayers for my mom.  As some of you know, over the last year she conquered pancreatic cancer through an enormous surgery, chemo, and radiation.  At today’s check-up, her CT scan showed a spot on her lung.  The doctor said it didn’t have the usual appearance of pancreatic cancer spreading, but we won’t know anything definitive we see the results of a biopsy and further scans early next week.  Please, please pray that this is completely harmless.  Regardless of the outcome, we can still say that God has been extremely good to us over the past year.  I am so thankful He gave my family the time together, as unexpected as it was.

The Holiday Season

Note: there is now an option to receive updates from the site via email (look to the left).  Or I can put you on my list (email auney.o@gmail.com); then, when you receive an email,  you’ll be a short click away from replying to me with an update from you!

Rosh HaShanah (the Jewish New Year) and Yom Kippur have come and gone, and Succoth is now upon us.  In the midst of all the holidays, we’ve also had our first full week of class.  I will write more about classes in the next post, but I wanted to report on my surprisingly eventful Rosh Ha’shanah break.  I apologize that this is so long, but I hope you’ll bear with me.  I won’t be offended if you skip to the photos when you get bored.

Before I go on to the excitement of a last-minute road trip, I want to remind you that this was three days worth of fun; the rest of my time is spent in boring old Be’er Sheva.  The pictures don’t show that I also brought my microbiology textbook and that we quizzed each other on biochemistry in the car.  In addition to being an interesting little trip, the weekend made me reflect on the place where I will be living for the next three years.

A. Good ol' Be'er Sheva B. Ein Gedi/Dead Sea D. Organic Goat Farm E. Tiberias on Sea of Galilee F. Mount of Beatitudes G. Nazareth H. Tel Aviv

My roommate Claire rented a car decided to rent a car at the last minute (partially to move the last of our furniture purchases) and started the weekend off with a day trip to the Dead Sea and Ein Gedi.

Road Trip!

I have always lived in places renowned for their cold temperatures, so driving through the wild, open Negev desert is still a little thrilling.  We enjoyed a refreshing hike at the ancient oasis of Ein Gedi and a not-so-refreshing dip in the warm Dead Sea.  Between the shrinking shoreline of the Dead Sea and the preciousness of an oasis in the desert, I was reminded of the region’s delicate environmental, political, and economic situation.  My best response was to try to take shorter showers.

We returned from the Dead Sea with enough time to join about half our class for a New Year’s dinner hosted by another classmate.

Rosh Ha'shana feast at Emmanuel's

The next evening, after a three-hour tour of the Israeli countryside, we arrived at an organic goat farm in the verdant Galilee region, where we spent the night in large geodesic dome tents. The owner of the goat farm produced her own cheese, milk, and yogurt — and gave us several samples.

We had planned on buying dinner in town and only brought a few pitas with us, but ended up with a gourmet meal.  It felt like the miracle of the multiplication of the loaves and fishes, which originally took place only a few miles away.  We picked and grilled organic bell peppers stuffed with home-made cheese, fresh-picked herbs, and the humble pita, then flame-broiled an eggplant picked from an organic vine.  To that, another family donated an array of steak, chicken, and sausage leftover from their grilling.  What more could we ask for?

Caitlin, grilling our feast...with her bare (clean) hands!

The Sea of Galilee was a short drive away.  We drove through Tiberias, on the Western shore, which has long been a major city in the Galilee region.  It now has resorts, beaches, and burial sites of famous Israelis, all of which are frequented by vacationing Israelis.  As we descended to the Sea of Galilee itself in the evening, I was taken by its beauty and relatively small size.  Jesus’ public ministry began here; it is hard to believe that a world religion could take off from this little lake.  On The next morning, we drove to the Sea of Galilee and hiked around scenic Mount Arbel, which overlooks the lake and has ruins from a fortress in its cliffs and caves.

Our last Sea of Galilee stop was the Mount of Beatitudes, where Jesus is said to have preached a famous set of sermons to curious crowds in the natural amphitheater of the hillside.  After climbing in the hills alongside the Sea of Galilee, the tourist destination seemed fake and romanticized.  It was covered with unnaturally lush grass, tropical flowers, and a big snack bar (from which, I’ll admit, I enjoyed a passionfruit icee).  I wanted to tell all the tourists to drive back to Mount Arbel and walk around there to recreate the more humble original ambiance.

From peaceful Galilee, we headed to Nazareth, which the guidebooks warned was sometimes a disappointment.  It is a busy little city and as far as historical sites go, only has a few traditional commemorative churches (my favorite name was “The Basilica of Jesus the Adolescent”).  The town almost seemed irreverent; people went about their everyday business as if they didn’t care that this place was revered around the world.  Claire’s heroic driving was put to the test by twisty streets, a dearth of road signs, and Israeli drivers.  We got lost and just ended up stopping at an overlook of the sprawling city.

Nazareth

I felt like modern Nazareth gave me a taste of Jesus’ Nazareth: it was not terribly prosperous and had a bad reputation with the tourists (“can anything good come out of Nazareth?” – John 1:46).  However, Nazareth’s fame has skyrocketed since Jesus’ time; Tzippori (a.k.a. Sepphoris) was the big city and Nazareth was an insignificant suburb.  Now half the world has heard of Nazareth and the map’s font size for Tzippori is about half that of Nazareth.  It’s a good reminder of the fleeting nature of this world.

On the way back to Be’er Sheva, we stopped by the beach in Tel Aviv to dip our feet in the Mediterranean.  Since we just can’t escape med school, we practiced writing amino acid structures in the sand.  We were quiet as we neared the end of our whirlwind road trip — returning to Be’er Sheva is a little depressing.  It’s is hot, dry, sandy, dirty, and run-down.  There are certainly more depressing cities in the world, but Be’er Sheva is so close to so many exciting places (like glamorous Tel Aviv or historical Jerusalem), which people envision when I say I’m studying in Israel.  My new goal is to find the beauty that must exist here.

One such source is the people.  Be’er Sheva is the modern anthropologist’s dream city.  There are large immigrant populations from Russia and Ethiopia, mixed with Ashkenazi and Sephardic Jews who have been in the city for a few generations,  and Bedouin Arabs whose ancestors have roamed the Negev for thousands of years.  Sitting in Soroka Hospital’s courtyard, it is not unusual to simultaneously see a Haredi Jewish man in a black suit and top hat, an Arab woman in a Burka, a young woman in tight jeans and heels, and a Bedouin man in a long white robe and desert head wear a la Lawrence of Arabia.  And these people mostly get along: I’m told that Be’er Sheva is one of the most ethnically integrated cities in Israel.  Add a technologically advanced hospital that serves over 60% of the land area of Israel, and it’s a fantastic place to learn global medicine.

Video of goat farm:

Immigrant

This will also be posted on a blog from first-year MSIH students: http://firstyearmsih.blogspot.com/ (set up by the MSIH admissions office).  You can check out thoughts from another classmate, John, the previous “blogger of the month.”  Unfortunately for me, he was also a professional journalist…it’s not quite fair that he got to go first.  Alas.  Finally, stay tuned for photos/stories from travels through Israel over Rosh HaShanah last weekend.

Two weeks of real medical school under my belt, plus a month of orientation classes.  I don’t quite feel like a real medical student yet (although I officially passed my first course!), but it’s getting closer.  Right now, I just feel like an immigrant.  It’s tough.  Before coming to Israel, I knew I was choosing a challenging path in attending medical school in a foreign culture.  Older MSIH students had also warned me of this.  I chose to go here so I could learn how to live and heal in new cultures — and I do not regret my choice.  However, expecting difficulty won’t necessarily ease the pain when you are experiencing it.

Think about setting up your own wireless router; in the U.S., it can easily bring out the worst in people.  Then, when the internet still doesn’t connect, try calling tech support and pressing every single number on several automatic phone menus because you don’t understand any of the options and just want to talk to a human being who might possibly speak English.  Then you get transferred to five different people before being told that someone will call you back in five minutes.  He never does.  I will never complain about pressing “1 for English” again.

I could give you a discouraging list of the frustrations, but that would not be entirely representative of my first few weeks here.  Some problems simply take a time investment that I would make if I were in the U.S.  Anyone needs to learn how to turn the key just right in a finicky lock.  Furnishing an apartment takes time, even when you have more than two suitcases worth of belongings or own a car.  Thankfully, we also have resources that ease the burden of living in a foreign country.  There are the Israeli “student liaisons” who have helped us find apartments and overcome some language barriers.  The second- and third-year students have advice (sometimes an overabundance) since they struggled through the same things.  Techies in my class finally got the wireless internet working in my apartment — after the internet company said the modem was broken.

Since life in Be’er Sheva does not end with frustration, I’ll mention some victories.

I am learning how wait in line like an Israeli.  “Waiting in line” is a bit of a misnomer as Israelis don’t stand in lines.  From my Minnesotan perspective, when I go to the bank, I see a sea of people and watch them push to get the next opening.  Cute old women cut in line at the grocery store.  However, I have discovered that Israelis usually have a sense of who is ahead of them in line.  I even heard them ask who is last in line when I went to the post office yesterday.  If I know approximately what place I am in line, then confidently and swiftly move forward when it is my turn, I can generally get through the line quickly, fairly, and with only a small amount of yelling and pushing.

My roommate and I have a washing machine!  To give a context for that victory, here’s how you find a used washer in Be’er Sheva based on our experience:

  1. Track used washing machine prices and find a few possibilities.
  2. E-mail a seller, translate her e-mail into English, call her, get vague directions from her friend since she doesn’t really speak English, and walk thirty minutes to the market across from her apartment.
  3. Spend an hour trying to find her apartment.  Look for a building number that does not appear to be displayed anywhere (Israelis somehow don’t believe in consistently labeling buildings).  Stumble through conversations in Hebrew with people on the street and with the seller.
  4. Keep wandering until you find her.  Follow her through a narrow path to her apartment building and find that her washing machine looks great.
  5. Discover that she will be returning her keys to her landlord at 4 pm the following day.
  6. Head home since you have class from 8 am to 5pm tomorrow, have no car, can’t find a professional mover with such short notice, and have not been lifting enough weights to wrangle a washing machine all by yourself tonight.
  7. Go to bed.  Repeat.

Eventually, we ended up finding a good washing machine and hired a mover to transport it for a reasonable price.  Of course, it involved another night of absolutely no studying, but classes are pretty slow right now.  Apparently things don’t really get going in Israel until after the fall holidays, so we have some grace during the move-in period.

Life really is getting easier as we settle in.  My roommate and I have acquired most of the furniture we need.   My classmates continue to be great sources of inspiration and laughter.  I am getting oriented to my new neighborhood and am developing some running routes.  And, after I had a long conversation with the vegetable man over soup ingredients, he gave me a good deal — a sign that I may be moving beyond the tourist phase.