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Statistics and thoughts on changes in Tansen

Les wrote this about 2 weeks ago – but then we got busy with work and helping Hannah get ready to move away from Nepal. (More on that later). Hope it is interesting still!

This is the busy season at Tansen hospital. Monsoon is not yet fully established, so there is no rice to plant. The roads are still mostly passable, before some of them get washed out with the rains again. The people from along the Indian border, who are used to warm weather, are no longer afraid to come up where the temps are now usually in the mid 80s. This is not bad for sitting at home in the breeze with a cold drink, but it makes the clinics very hot, with short tempered visitors all anxious to get seen quickly and get out of the building. Ceiling fans help a little, but we are all sweaty and grumpy in the heat of the day. (The only air conditioning is in the operating rooms.)

After a string of very busy hot days last week, I (Les) was told that we had set an all-time record for our outpatient department, seeing 510 clinic patients in one day. This inspired me to go look at the annual statistics on how work volume at the hospital has changed in the past decades. Some of this is showing the changes in the country of Nepal and the environment the hospital is working in. Some of the change is due to improved services that we are now able to provide.
  Dates of stats          1990-91                              2015-16
Total Admissions:          5663                                      12728
Bed Capacity:                   102                                         169
Overall mortality rate:   5.65%                                   2.43%
Total deliveries:               536                                        2295
Caesarean Sections:       12.5%                                   14.2%
Outpatient visits:           100,218                               98,338
Full time Nepali staff:     255                                      396
Expatriate Staff:               16                                            12

There has been some population increase in our area, but most of the increase in patient load is from the building of roads and increased access to vehicles to carry patients from the villages to Tansen. There is also more awareness that doctors can help with illness. I hear a lot less now days about visits to the witch doctor, or illness being causes by spirit possessions.

Another change these days is that a patient quite often presents with a condition which needs a consultation with a specialist. When the family has the means to pay for the trip into a medical college, we refer them from Tansen to Kathmandu or another city. However, there are also more services we can provide in Tansen: a High dependency Unit with ventilator support, many more lab tests (especially biochemistry), endoscopy, echo-cardiograms, and CPAP for babies. Most orthopedic cases are managed operatively rather than by prolonged admission and traction. Broken legs usually go home in less than a week. Laparoscopic surgery has been started on most types of cases, which also has a shorter recovery time.

I am not sure why the mortality rate has gone down. Maybe we are able to save more people, or maybe we are admitting some “less sick” people. And many of us believe that the continued prayers from around the world affect the work here as well.

Deliveries in this district are now happening in a hospital 90% of the time. This has caused an explosion of our maternity case load. (Just last night while on call I attended a breech delivery, a forceps delivery, and a complicated obstetrical tear that needed repair. All of the women and babies are doing well this morning.) Cesarean sections have not increased very much. Both of these are good statistics for pregnant women in this district, who now expect to survive the delivery and have a healthy baby. (I still have a very vivid recollection of a woman in labor during our first few years in Tansen. She cried through the first hour she was with us about how she was going to die. I thought she was just afraid of labor pains, until she finally looked at us and said, “Are you saying that I’m not going to die?!?”)

The most important statistic though, in my opinion, is the last one. We continue to move towards a facility fully run by Nepali staff. We are able to recruit more local people who have the basic qualifications we need (doctor, nurse, accountant, etc.), even if they do need some additional training after we get them. And we have a large group of interns and residents working to learn at our hospital, some of them Christian. I see a future where the missionaries come in fewer numbers to not just “be the doctors” at Tansen hospital – but to train and encourage the Nepali doctors and staff in their work. In the meantime, we continue to covet your prayers and gifts for the work at Tansen hospital.

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South Africa

We’ve been away from Tansen for a couple of weeks now – part of our time away was in a country we’ve never visited before!  We saw many differences to Nepal – and also similarities – during our time in South Africa.

We were asked by the Global Health Unit of the Methodist Church to attend the Pan-African Health conference in Johannesburg, S.A.  Les and another colleague from Kathmandu both gave short presentations on the work that has been and is being done at the hospitals here in Nepal, and how that can help some of the hospitals in different places in Africa.  There were good connections made and lots of ideas shared, and it was very encouraging to be reminded that God’s work is being done all around the world – not just in Nepal!  Sometimes it is easy to get so busy with the constant needs where we are that we forget that there are needs everywhere.  And that God is working everywhere!

We also realized what a blessing it is to work at Tansen Hospital.  Many of the Methodist mission hospitals in Africa struggle for funding, have difficulty raising local income, face government restrictions on charging patient fees, and are expected to participate in very poorly managed government health programs.  We are grateful for the programs the Nepali government is running, like TB, HIV, and maternity care.  And we are grateful for our donors who have generously supported our free care for poor patients program, as well as the many building and equipment purchases over the years.

We decided we couldn’t travel to Africa and not see some animals!  So – we went on a short safari – overnight at Pilanesberg National Park (about 2 hours’ drive outside of Johannesburg).  It was great – a beautiful lodge, wonderful food, and lots of animals!  Lions, giraffes, rhinos, zebras, buffalo, water bucks, antelope, and elephants (Oh, My!)…. so amazing.

Then, we flew on South African Airlines down to Cape Town.  It was a beautiful place – we enjoyed walking on the beach, seeing Table Mountain, enjoying the beautiful flowers at Kirstenbosch gardens, and seeing the penguins at Boulder Beach.  We only had 2 days, but a friend of one of our friends in Tansen showed us around and made us so very welcome.

The differences between life in Nepal and in South Africa were interesting.  South Africa had much more development: expressways for driving, industries, well managed parks, large clean houses, and a lot less dirt and dust.  But all the houses were surrounded by high walls, razor wire, and often electrical fencing.  People are very scared about burglary, armed robbery, and violence.  Our host said it was better not to walk alone, even during the day, and definitely not to go out at night.  Even though Nepal is beset by just as much poverty and civil unrest, if not more, we are grateful that we have never had any fear for our personal safety in Nepal.  (Except while driving along the roads!)

Having said that – there are elections coming up here, and there have been rallies and strikes again.  There are also continuing difficulties with increased government rules and restrictions.  Thanks for your prayers.

Now, we are back in Kathmandu – and Les is so excited to be singing in Hannah’s final Kathmandu Chorale Concert on Saturday.  We have no opportunities to participate in high level Western choral or instrumental music in Tansen.  Hannah didn’t have enough basses, so Les is getting to sing – I (Debbie) do confess to being jealous.  Why are there always enough altos?  🙂  But – I’ll enjoy listening to the concerts and being proud of Hannah’s conducting skills.

Thanks to all of you who write to us and pray for us.  We think of you often and appreciate your support so much.  God Bless!

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Feeling Humbled – again

It was five years ago this past week that we arrived back in Nepal – just the two of us that time! Sunday (March 5) was the birthday celebration of the United Mission to Nepal – 63 years of serving in Nepal. We got to be part of the celebration in Kathmandu 5 years ago and still remember the feeling of being part of something that started before us and will (God willing) continue after we leave. It’s quite humbling, and also inspiring!

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Speaking of being humbled, a couple of weeks ago our househelper brought us up to date about her sister in law who has been quite ill with cancer. She has been traveling to a hospital several hours away monthly for chemo treatments. Each time, the family members go around to relatives, friends, and neighbors to ask for the money that she needs for the medicines. They are getting very deeply into debt.  (We wrote some about this 3 years ago.)

So – the family came to our helper, and asked, “Do you have any money you could let us have?” That happened to be the day that we paid her for the month – so she felt that she couldn’t say no. She gave  half her monthly salary to help this woman go for her treatment this month.

Giving half your month’s salary is a big thing – but it is even bigger when you know that this money is all that she will get for the month – and that she is the only wage earner in the household (which currently includes her son and daughter in law, her grand daughter, and a relative of the daughter in law.)

Les has been invited to give a presentation about Tansen hospital in South Africa!  We have been considering this – and wondering whether or not we should both go.  (Only Les’s way will be paid).  We shared this with one of our friends here.  He encouraged us to go – that it was a wonderful opportunity and that we should go together.  Later, he told us that he wanted to give us some money to help towards the trip.  This is a Nepali friend who doesn’t make that much – and doesn’t have extra money to give for things like this!  We were very touched.

This all reminded me of Jesus’ story about the widow giving her two mites – I continue to stand in awe of the generosity and faith of people like this.

One final note on humility….today I (Debbie) took the test that is required at the end of each bible study book I am doing with a couple of Nepali ladies.  Each time it reminds me of how much of the language I still need to learn – and how much more about Jesus and the bible I can learn – especially when studying it in a different language and different culture.  It often brings out things I would never have considered while living in the U.S.

Deb’s bible study….

For example, we see all around us the kinds of roads and trails that Joseph and Mary must have traveled on to Bethlehem.  We walk and ride on those roads – and can better imagine the long trip on a donkey while pregnant!  We also feel more urgently what Jesus means when he commands us to care for widows and orphans, since we see that they are often left without help or support.  They live on the edges of society and struggle with daily physical needs as well as trying to survive without much love and encouragement.

We so appreciate your love and support. Love to you all!

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Little Miracles Bring Hope

Back when I was in college, someone gave me a short piece of rope with a knot tied in it. They said that I should keep it with me as a reminder that when it seemed that I had reached the end of my rope that I should tie a knot and hang on!

Last Wednesday (Dec 21), I felt I had reached the end of my rope. Hannah (youngest daughter) and Nathan (her fiancé) were in KTM – and were scheduled to come to Tansen on the mission bus the following day. While I was meeting with a group of friends, I heard the news that there was a strike being called in KTM for the day they were to come. I was devastated….. I knew having them come a day later wouldn’t have been the end of the world, but it was one of those times when I had been looking forward to it so much that the thought of the plans not working out was the final straw! I was thankful for my friends who promised to pray for me, and who encouraged me.

Hannah and Nathan did, in fact, arrive on the mission bus on Thursday as planned. They actually had quite a good trip for these days – only 11 hours! (Much better than the 18 Hannah had experienced a couple of months ago.) We have been enjoying having the two of them here with us over the Christmas holidays, and I’ve been thinking about the small miracles and answers to prayer that God so graciously provides for us to keep us from becoming hopeless.

There are several instances which I can think of in just the past few weeks. The first involved me returning from Kathmandu after staying to see Hannah’s Christmas programs. (Les had flown from KTM to near Butwal on Monday (Dec 12), and had gotten a jeep up the hill to Tansen that evening. I stayed on in KTM until Friday (Dec 16.)  I realize that the last blog I wrote was about strikes – and we did, in fact, travel from Tansen to KTM (via Pokhara) leaving at 5 am to get to KTM on Dec. 7.  We really enjoyed our visit in KTM and loved seeing Hannah and watching her performances.

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Hannah directing the KTM Chorale in their Christmas concert

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Hannah’s school performance

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So – back to Dec. 16…. I caught the flight to Pokhara mid-morning that day, and was able to view the mountains for the entire 25 minute flight. It was so beautiful. A taxi met me at the airport, and we had lunch and then started driving towards Tansen. I had decided to fly to Pokhara instead of the closer Bhairahawa airport because that day a 3 day strike started in Palpa district, along with the other districts around the Bhairahawa airport. We drove for about 3.5 hours, and arrived at the border of the Palpa district about 10 minutes before 5 pm. Now – usually these days in a strike, they open in the evenings to let night buses and other vehicles get through. Not this time. This time the plan was to have a continuous bandh (strike) from Friday morning through Sunday night.

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Arrival at Pokhara airport

Views from the road

Views from the road

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River on the border of Palpa district

Well – the taxi driver and I walked over to where the road was blockaded – and he started asking if we could be let through because I was a foreign doctor who needed to get to the mission hospital! (Well – a doctor’s wife is close enough, I guess?) Anyway – I was praying, and I know many others were as well, because after an hour or so, they let us go through! All other vehicles had been turned back – and I was starting to contemplate having to spend a night in the village….

Anyway – one miracle – we arrived to Tansen safely and without any troubles – in the midst of a 3 day strike (which did last the 3 days!)

The second miracle was that the strike which would have affected Hannah and Nathan was cancelled – an answer to prayers, again, I’m sure.

Finally, the other day we were invited to walk down to eat at a friend’s home in the village. After walking down the back of Srinagar Hill for about 45 minutes, I noticed that I was missing my right contact lens. I knew I had put it in my eye because the left one was in, and I always start with the right. But – I hadn’t felt it fall out, and I had no idea where it was. So – after a lovely lunch and visit, we walked back up the hill, and when we went into the house, I went to the bathroom where I put my contacts in in the mornings. I looked on the counter – and then on the floor – and just under the corner of the floor rag was my lens! Amazing! Not only that I found it, but that it was in one piece after others had used the bathroom after I had dropped it and hadn’t noticed. I still am not sure what happened, but I was very thankful for that miracle! (And I was amazed at how my brain compensated for the missing lens…. mono-vision!)

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Hannah and Nathan with Laxmi before lunch. (I could still see well enough to take the photo!)

I know there are many prayers that are apparently not answered – or the answers are very slow in coming. We have prayed for some of our friends here for over 25 years – and they still are not following The Way. We know that people are hurting and that it often feels that God is far away or uncaring.

But – for the moment – when I put my contacts in in the mornings, and when I enjoy the time with Hannah and Nathan, I am thankful for a God who cares for some of the smallest details of my life and sometimes intervenes to give me fresh hope.

May your New Year be filled with that Hope.

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Strikes again. Looking for Peace on Earth!

We’ve been enjoying sitting in our back garden and admiring some of the most beautiful scenery in the world.  It all looks so peaceful – like there should be no worries, cares or problems.  However, we are once again in the midst of a political struggle and we’re not sure how it will all end.

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We first became aware of difficulties last Wednesday when all the staff were talking about a strike starting at 1 pm.  Of course we wanted to know why, and found out it is due to the possible new state lines being drawn in a constitutional amendment proposed to change the originally approved state lines in the new constitution.  Our district would be affected (most people believe in adverse ways) if the new states were implemented.  So – people out here decided to call an indefinite strike.

For us, the first hurdle to overcome was the fact that Les had plane tickets to fly to KTM on Thursday afternoon for a meeting on Friday.  Now, the planes do fly during strikes, but first you have to get to the airport!  And it wasn’t going to be possible by car – which causes a bit of a problem when the airport is approximately 60 kilometers from where we live.

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Never fear!  Les hopped on his trusty bicycle (still in working condition even after various accidents in the past) and started down the hill towards Butwal.  The best thing is that it is almost all downhill (literally) from here to Butwal.  As Les was nearing the last hill into Butwal, his chain broke!  So, he coasted in to town and slowly went along until he found a bicycle repair shop that was closed – but the owner was inside working.  (During the strikes, stores are forced to close, but some people open doors or shutters part way and watch for possible customers.)  He agreed to repair Les’s bike – and they only had to close the door once when a group of protesters came by.  (He also turned off the radio, and turned down the lights until it was “all clear”.)

After getting a new chain, Les continued on down the road to the airport in Bhairawa.  He was able to lock up his bike in the nearby shed of a friendly guard and had a couple hours to spare before getting his flight.  He brought a change of clothes and his computer in the backpack, as well as water, snacks, pajamas, toothbrush, and money. (Good thing  he didn’t have to carry a suit.)

Les enjoyed an evening meal with Hannah, and spent some time with her the next morning, as well.  He attended his meeting – which was mostly to show the people there that Tansen Hospital is very serious about continuing to train anesthesia assistants. (One of the training programs we run here)  After the meeting, Les had another nice meal and visit with Hannah.  (Kathmandu wasn’t under the strike restrictions.  No one there is quite so upset about the proposed state line amendment.)

Saturday morning, the strike in our area was continuing on.  Les got to the airport in KTM about 7:30, and saw the notice that the airport in Bhairawa was closed due to bad weather.  (Mist and fog)  The flight was scheduled for 9 – at 10:30 it was delayed to 11:30, then to 1.  They finally boarded the plane around 1:15, and sat on the runway for another hour!  So, Les arrived in Bhairawa airport just before 3, where he collected his bicycle and began riding – this time UP the hill!

The first part of the ride was rather uneventful.   No cars out, and most shops closed.  Major intersections had people sitting across the road in chairs, making sure no motorcycles or cars were going through, but bicycles and rickshaws seemed to be exempt, and there were plenty of them out.  (The other exemptions are milk trucks, ambulances, and wedding parties!)  But coming into Butwal, there was a huge crowd of protesters blocking the road, facing off with riot police, so Les found a side street and went around to avoid the crowd and the stone throwing which was also happening.

Because it gets dark here soon after 5 pm, we had arranged for a taxi from here to go down to meet him partway.  (During strikes, the roads are usually only closed between 6 am and 5 pm).  Les and the taxi actually passed each other without noticing, but they did find each other and he was able to throw the bicycle on the top of the taxi and get up to Tansen before 8 pm.

This is now Tuesday afternoon, and the strike goes on.  The shops all open at 5 pm and are absolutely jammed with people getting food and necessities.  It is getting difficult for shop owners to replenish supplies as it all has to be done at night.

Tomorrow, Les and I have planned to go into KTM to be with Hannah as she has several performances coming up this next week.  The current arrangement is to go on the hospital bus – leaving at 5 am, and going the long way around via Pokhara.  Because our district of Palpa is the one on strike, and the district of Syangja (Pokhara) is not, we hope to get out of Palpa before 6 am when the strike begins again.  Should be possible – but we have learned that nothing is a certain and sure thing here!

We are thankful that we can be sure of Jesus and His love for us.  As we are celebrating advent here at church and with our missionary team, we are glad to again remember the amazing sacrifice God made in leaving Heaven to come here to earth as a baby.  Merry Christmas!

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Thoughts on Tihar

The season has changed, the rains have stopped, and the views of the mountains have been spectacular.  The daytime temperatures in the sun are still quite warm, but the evenings are getting chilly.  Even though we miss the autumn season in Ohio, this season in Nepal is one of the nicest.

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During this time from the end of monsoon into this cooler season, there are multiple holidays celebrated by the followers of the Hindu religion.  The festival that just ended is called Tihar – also known as Deepawali.  We went out walking on the night of Laxmi Puja.  Laxmi is considered to be the goddess of wealth and prosperity.  On the evening/night of Laxmi puja (worship of Laxmi) everyone who wants to have more riches and prosperity lights the way into their home so that Laxmi will not pass them by.  People also make colorful designs in front of their homes and businesses and small footprints leading into the house so that Laxmi will feel welcomed and be able to find her way in to bless them.  There is much singing and dancing, and also eating of special kinds of treats made only at this time of year.

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As we walked through the streets brightly lit by the candles, sparklers, and lights, I was musing about the difference between Laxmi and Jesus.  Once a year, people here spend much time, money and energy preparing their homes for Laxmi puja.  Their goal – to gain the attention of this goddess, Laxmi,  in hopes of having a more prosperous and easy life.  “Notice me!  Make me rich!  Pay attention!”

On the other hand, we have a savior named Jesus who stands at the doors of our hearts – whether we have prepared, hung lights, or called to Him.  He comes searching for us – to give us the most precious gift of all – forgiveness of our sins because of His great love for us.  And an offer of a relationship with the God who created the universe, but who wants to be part of our lives.  Amazing!

Let’s notice Him!  And may our lives here continue to shine His light into the dark places of the world.

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Kriya (Ritual Hindu mourning)

We returned to Tansen on Sept. 29.  As we were on the bus that day, I got a text from Ganesh (my assistant and the guest house host) that his father was ill.  We met him that evening, and even though he was still feeling weak, he was planning to walk back down to his home in the village (with the help of his son and grandson.)  We were happy to see that he seemed better.  Ganesh’s dad had struggled for many years with alcoholism, and his body was starting to wear out.

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The next day, Ganesh left for a trip to India.  Before he returned, he was getting calls from his family urging him to hurry back as his father was more seriously ill.  The family finally hired a vehicle to bring his dad up to the hospital again and he was admitted with severe pneumonia.  This was on Tuesday – and Ganesh returned that evening from his trip.

Even though his father was quite ill, he seemed to rally after being in the hospital and being on oxygen and medication.  However, by the end of the week he had reached a plateau and didn’t seem to improve any further.

On Monday morning, Ganesh came to our door quite early and asked Les to come down to check on his father.  Within a few minutes, Ganesh was back at our door, asking me to come with him to the guest house so that he could show me where his keys and important information was located – because he knew that his father’s death was imminent.  He also knew that once his father died, he would not be able to return to his home or to work until the 13 days of required mourning was finished.

Ganesh’s dad died at 6:30 am on Monday, October 10.  He, along with his 2 younger brothers, were all there with their father.  One was crying softly, but it wasn’t until Les pulled the sheet up over his father’s face that Ganesh broke into loud sobs.

Things went quickly after that.  They found a jeep, and along with the body (wrapped in a sheet) and the rest of the family, they rode down to the village where Ganesh’s mom and older brother were waiting.  The other relatives and neighbors soon gathered, and they soon had a full bus, a jeep and about 20 motorcycles (all men) who traveled with Ganesh and his father’s body down to the river at Ramdi.  This is the Kali Gandaki River – which eventually flows into the Ganges River.  It is considered a holy place, and is where people take their loved ones for cremation.

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While there by the river, Ganesh and his 3 brothers all had to remove their regular clothes, and wrap in a long white cloth.  They also had their heads shaved – except for one tuft of hair which is left on the back of the head.  After that, the body was burned, and the ashes were thrown into the river.

For the next 12 days, Ganesh, his brothers, Ganesh’s mom, and the wives of Ganesh and his brothers, all have to observe what is called Kriya.  It is a time of mourning which is directed by the Hindu priests.  Because Ganesh and his family are Brahmin (high caste) the rules are often more strict.  Ganesh’s mom (the widow) has to remain isolated in the sense that no one is allowed to touch her.  She has to prepare her one meal a day on her own – after doing a ritual washing.  The meal can only consist of rice, ghee, cucumbers, white radish, lemon pieces or juice, and some sugar if desired.  No salt is allowed for the entire time of mourning.  This meal has to be cooked over an open fire.

We went to the village house on Wednesday to pay our respects.  The widow was by herself at her little place to cook.

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The 4 sons (Ganesh and brothers) were at their place to prepare their food.  They also were being directed to do a specific “puja” (worship) in order to help their father’s spirit get into heaven.  There is a priest who comes daily to the house in order to make sure all these things are followed properly.  Neighbors and more distant family members stay nearby to help – giving tea to guests, and doing the things needed to help the family in mourning.

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The 3 daughter in laws also have their own place to make their fire and cook their food.  They all have the same restrictions on what they can and cannot eat.

To our western eyes – this seems like a punishment for the family who are already mourning the loss of their husband and father.  Is there any purpose to following all these rather empty seeming rituals?

For me, the most difficult part of this to understand is the isolation.  If I had just lost my husband or my father, I would want to be able to touch the rest of my family – to both get and receive comfort.  Hugging isn’t a big part of the culture here, but even just giving someone a hand squeeze or shoulder pat would be helpful.

Even at the end of the 13 days, life will never be the same again for Ganesh’s mom.  She will never be able to wear any red clothes again – and wouldn’t be able to marry again, either.  Life for widows is quite hard in the Hindu religion.

One interesting note about how life is different in KTM from the rest of Nepal – even when it comes to Kriya.  Wealthy businessmen and govt officials in KTM have somehow arranged for their kriya to last only 13 hours instead of 13 days – they don’t have the time to spend on this, so have gotten permission to shorten it significantly.

The hospital here in Tansen actually allows people to have leave (with pay) for the required kriya they have to do.  It would be very difficult if they didn’t do this.

Please keep Ganesh and his family in your prayers as they head into another week of doing this mourning.

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