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From Thich Nhat Hanh:

Contemplate a piece of paper.

Look carefully and you can see a cloud in a piece of paper. Without a cloud there will be no rain; without rain the trees cannot grow; without trees we cannot make paper. The cloud is essential for the paper to exist. There are other essential things for the paper to exist; the sun, the logger who cut down the tree, the wheat that feeds the logger, and on and on.

The essence of the teaching is that if you start with any one thing in the world and think of the things without which it would cease to be, and then branch off from those things and so on, you will eventually get to everything else that exists.

Every object is linked with every other object in the universe. It all inter-exists. If we look deeply we see that the existence of every single thing is possible only because of the existence of everything else.

Maybe one needs to look deeply to see the interdependence of everything in the universe, but sometimes the interconnections can stand out starkly and unexpectedly.

I was just settling into my seat on the flight from Chicago to Abu Dhabi when a man sat down next to me and we began to chat. He was a Shiite Muslim from Saudi Arabia who moved to United Arab Emerites (Abu Dhabi is the capital) because life was hard for him in his predominately Sunni home country. I am usually not very talkative in those settings but I was interested in what he had to say and he was thrilled to have the opportunity to tell me about his personal history, his current situation, and his fiancé, a pretty woman from Lebanon. He was primarily intent on telling me about Islam. I knew only a little about the life of Mohammed and the basic tenants of the faith but he was surprised that I knew anything at all. Once I gave him an opening, the facts and the stories flowed out of his mouth so rapidly that I wasn’t able to take it all in. I could see how important it was for him to share with me what is good about his religion. He told me that “Americans don’t understand Muslims very well, but it is our own fault.” He said that it is the radical, or fringe, elements among its followers who are the most vocal, while the vast majority of reasonable (his word) Muslims are too quiet. He was clearly very devout – three times during the flight he went to the back of the plane to kneel and pray- but when the first meal was served and I asked him if he would be bothered if I drank alcohol he said, “No, no. Feel free.”

The circumstances of his life were clearly very different from my own Midwestern upbringing but,  here is the part about interconnections – he was an Interventional Cardiologist (I am, too, for those who don’t know that). He was returning from a Board Review course put on by the Mayo Clinic, a course that I have taken in the past. I read through the course syllabus on the long flight (maybe I can ask for CME credit) and we talked a lot about our respective medical practices, especially about the challenges and benefits of learning the Radial Artery approach to cardiac catheterization. He told me that he has been seeking an opportunity to do charity work but wasn’t sure how to go about it. He was also interested in learning balloon valvuloplasty but wasn’t sure where to go to get more exposure to that procedure. Because of the prevalence of Rheumatic fever, they do mitral valvuloplasty every day at the hospital in Kathmandu where I happened to be going. It just so happened that I had connections to a heart center that is proficient in valvuloplasty and that has always been appreciative of cardiologists who volunteer to work there. Maybe he could do that.

We exchanged contact information but contact had already taken place between us and in a strangely serendipitous way. They say that everyone in the world is connected by no more than six degrees of separation but sometimes it seems like even less than that.

To be is to inter-be.

The Countryside of Nepal

The road out of the city of Pokhara, a city west of Kathmandu, must have been more more bumpy than it looked from my seat in the back. It was either that or the complete lack of any shock absorption. I could have sworn I was taking a ride in a clothes dryer rather than a minibus.

On the road to Bandipur

We were on our way to Bandipur to view the mountains and visit with Rabbi and Sudha Malla. Sudha was riding along with us while  Rabbi traveled with a team he had  assembled from Gangalal Heart Center in Kathmandu. They held two large free medical clinics whose purpose was to do cardiovascular screening exams on the local population.

Rabi and Sudha Malla




On the way to Bandipur we drove through a lush valley of rolling green foothills doted with mud brick villages and farmhouses, meandering rivers swollen from the recent monsoons, and terraced rice paddies. We arrived just as the clouds began to recede and reveal what was behind them. As the sun set, and again at dawn, we watched expectedly as the grey curtain of mist gradually parted. When it did, there emerged the snow covered summits of Manaklu (Eighth highest in the world) and Annapurna 1 (# 10). A sight like that is difficult to capture in photos and even harder to describe in words, so I won’t try.


There are some strange and unique contraptions that are driven all over Pokhara but nowhere else that I have seen. The could be called a Pokhara-mobiles. Like something out of Mad Max, they look like they were created by some crazed Nepali auto mechanic who assembled things out of whatever spare parts he had available. To me, the vehicles seemed indecisive, in the same way as that Africa animal, the Okapi, which appears to be half giraffe and half zebra. They look like a mix of lawn mower, wheel barrel, and Harley-Davidson Motorcycle. Nan was determined to get a good picture of one but it was hard to do from our moving minibus. Amy kept calling them out to her, as if they were Nepali slug-bugs.

Tech stuff

On the topic of my frustration with blogging from Nepal I was reminded of something I read about Yvon Chouinard , founder of outdoor apparel company Patagonia. He said most of his friends were now emailing each other and he was feeling “excluded.”

To the suggestion that he learn to use mail himself he said “It’s too late.”


Nepal Us

-Me. The city of Pokhara sits at the foot of the Annapurna Range in a picturesque lakeside location with cleaner air and more manageable traffic than Kathmandu. It is a popular holiday destination for Nepalis and expats alike. As with most of the country, it is interesting and colorful, but with a vibe all its own. Pokhara is a mecca for many extreme sports like trekking, climbing, and river rafting, but it also has that Sedona, Az thing going for it, attracting all kinds of “seekers”. Some of it is legitimate but there is also a spirituality-lite element in play.

I was skeptical when as I was standing on a street corner waiting for Carol to come out of a shop when I was approached by a young man with long hair and a goatee, wearing a white robe and lots of beads. At first glance he looked to me like another one of those swami “wanna-bees” and, sure enough, he soon asked me if I would buy one of the book he was selling. The book was the Baghavad Gita , so I told him that I already had a copy at home.

He said, “Oh, have you read it?”

Me, “Some. Not that much.”

Him, “What did you think?

Me, “What do you think? What would you say it is about?”

Him, “It is an instruction manual for your life.”

Me, “What would you say is its main point?”

Him, “What is important is what is on the inside, not the outside.”


I guess my first impression about him was wrong.
World Peace Stupa
“The sacred cannot be approached in a straight line…Pilgrims emulate the path of the sun and circumambulate in a clockwise direction…from the east.”
On our last day in Pokhara we managed to get it all all done despite the fact that everyone but me had a head cold and were feeling variable degrees of sickness. I am becoming convinced that it is not possible to come to Nepal without getting sick; there are too many germs here and our immune systems are not attuned to this onslaught. Nobody seemed interested in gearing back so an hour before sunrise we grabbed taxis and lumbered up the crooked ascent to the trailhead for Sarangkot, the viewing station that has a very front row seat to  the Himalayas. We needed headlamps when we started but by the time we arrived, breathless and a little vertiginous, the sky was glowing in the east and the peaks were emerging behind a shroud of mist.


The gathering



There are few more dramatic or awe inspiring places to be at dawn, or any other time. There were a handful of other people when we arrived but, as more trickled in and the crowd swelled, it remained relatively silent, as if we had all wandered into a grand cathedral just a the prayers had commenced.
Back at the hotel we ate a quick breakfast, then rode to a trailhead leading to another major viewing station, this one with a large Buddhist pagoda, the World Peace Stupa, sitting among a large flower garden on a ridge looking down on the lake and city of Pokhara. The iconic Machupachre (the Fish Tail) and many other snow draped summits acted as backdrop.

Like the earlier trek to Sarangkot, the trail to the Peace Stupa is longer that you first expect and, in the opinion of some, unreasonably vertical. Jim was just emerging from his illness the day before when we really should have just put him to bed but didn’t. He said he didn’t even remember the previous twenty-four hours but here he was trudging upwards. Carol, Amy, and Nan went on ahead while Joan and Rob hung back to offer encouragement to Jim as he climbed the slippery steps, some so tall it was like this was the route designed for basketball players, not normal- legged humans. I bounced back and forth between the two groups, repeating the half-truth that it wasn’t much farther to the top. Jim resisted stopping to get ice cream at the small kiosks along the way and continued with determination. The problem with Nepal, however, is that, wherever you are, there is always some place higher, so we had all worked up a sweat  by the time we emerged onto the open field where sits the Stupa.

The World Peace Stupa is a large structure, gleaming white in the morning sun, with golden statues of Buddha in different mudras facing the four directions on the compass. It reportedly contains important relics of the Buddha himself and is considered a sacred place. It felt sacred to us after we circumambulated, always in a clockwise direction, in the company of an elderly monk rhythmical tapping on a little white drum.

The Stupa and its surrounding grounds are a place where strict silence is enforced, but silence is not Jim’s strong suit. He has a heart as big as one of the Annapurna glaciers but a voice with no volume control. I kept reminding him to try to keep his voice down and he did his best, remarking that he thought their strategy was to get you so tired out on the climb that when you reached the top you couldn’t speak if even if you wanted to.

Carol and I did a few headstands while in Nepal, including at the World Peace Stupa. I thought that it might be inappropriate to do one there-sacred spot and all- but it is one of our routine yoga asanas so it didn’t seem too out of line from that point of view. When Carol did a headstand the monk wasn’t upset at all and just smiled at her in semi-approval.

But when I did one I got busted. I had more difficulty getting up than usual, needing something nearer to focus on than the distant mountains. I even fell over backwards a couple of times. It wasn’t the pose that got me in trouble, though. I never uttered a word but got scolded just the same -not by the monk but someone else – for making noise when I crashed to the ground.

Which of the two pictures above is of a yoga instructor and which one is not?

Earlier, at Sarangkot, Carol did other yoga poses with the mountains in the background. At one point Rob remarked that he knew the downward dog asana. He said, “I used to do downward dog. I didn’t like it. I had another name for it.”


The Gompa
After we “came down” from our mountain immersion experience, and before we flew back to Kathmandu, we took taxis a few kilometers north of town where there is a large community of Tibetan refugees. We walked through the refugee camp and circumambulated the main monastery(Gompa) building. You are expected to take your shoes off even to climb the stairs to the front door and we were not allowed to enter the inner chamber at all. We stood on the threshold to peer in at the various musical instruments sitting next to the tattered red cushions for the monks to sit on during their worship ritual, the colorful mandalas and other murals covering the walls and ceiling, and the large golden Buddha center-stage in the front of the room.

Tibetan refugee


Carol playing with novice monk


Buddhist graffiti- Free Tibet

We hadn’t left much time for lunch so we made a quick stop into a small roadside restaurant close to the monastery that caters more to locals than to people from Missouri. It was clean enough but still only one step up for street food. The fact that nobody gave it a second thought shows how far we have come in the course of a couple of weeks. We were hungry and in the mood for mo-mos and the Everest beer was cold so that was all that mattered.

In the front room I noticed that as the only decoration they had hung on the walls were two posters, one of the Dalai Lama and one of Jimmy Hendrix. Jackie, following her daily lunchtime swig of beer, said, “I’ve been thinking about it and I really think that the Dalai Lama and Jimmy Hendrix would have gotten along.”


Last day with the children

We gathered back at Aashish Church for a “Ripple committee” meeting. We discussed finances, sponsorship, projections for growth of the program; mostly how to help the children in the program now to stay in school and be successful in life as they grow up. It is good to every once in a while meet and talk face to face. I was again reminded of the commitment of Mahendra to the program and how his vision complements our own. On several occasions he has told his Nepali audience that they must be the small pebble that, when dropped into the calm surface of a pond, sends ripples of goodness flowing outward towards others. Everyone has bought into the metaphor that Carol coined years ago.

After the meeting the families gathered and we had one last program together. Because this was a secular gathering of the Ripple families, not the church members, there was no praying or hymn singing but instead everyone stood up and sang the Nepali national anthem. I was impressed with how even the youngest children sang right out with pride and at the top of their lungs. I wouldn’t tell my Nepali friends this but I think their anthem is kind of sweet. Not some rallying cry like most country’s national song, it has a melody that you could more easily dance than march to.

After that, each child was asked to come up to the front, introduce themselves, and give some personal information for all to hear. Public speaking is not something these kids had ever done before but Mahendra thought it would be a good learning experience and only a few appeared to be at all nervous. Some of the mothers, when they spoke, got emotional about how grateful they were that their child was given to this opportunity.

It was emotional for us, as well. Later that day, as we were reflecting on it, I asked everyone to tell at what point had they come closest to choking up? Rob said it was when he pulled out the guitar he had purchased in a small shop earlier in the week-a Nepali knockoff called a “Givson”, as opposed to a Gibson- gave it to a boy whose home he had visited several days earlier and watched as he just delved right into song, not even wanting to stop to eat with the rest of us. This young man had told Rob that he loved to play but didn’t get the chance very often because he didn’t have access to an instrument. Now he does.

For me, it was watching six little girls dressed in native Nepali costumes dancing to traditional music. They were obviously well-rehearsed for the performance and were perfectly synchronized, their expressive hands and faces telling some tale from their country’s folklore. It is a hard life for girls and women in Nepal. On one end of the scale there are the demands made on them based on traditional gender roles. On the farther, but all too common, end lurk the evils of child marriage and human trafficking. They just looked so innocent to me, probably unaware of the dangers that lie ahead for them.

Carol said that what got to her was the steady stream of children and families-mostly single mothers- coming up and telling their stories, some more tragic than others, each with the same themes of perseverance, gratitude and love for their children. Carol’s perspective is one of realization of just how far this thing  has come from the original desire to help just one child go to school. Listening to each of them share their story and their feelings was very touching to all of us. So many people have come together in bring it to this point. We are grateful, too.


” Focus on the person, not the personality. People just want to be loved.”

Carol Sanders


I’ll let Pastor Mahendra have the last word in these dispatches. He told me that when we interview children he listens closely to the questions we ask and sometimes he uses the same format himself. He said that, of all the questions, the one he likes the most is “What do you want to be when you grow up.” We get some great answers, including businesswoman or businessman, singer, doctor, artist,missionary, astronaut, and many others that betray a child’s deep yearning and hopefulness.

Mahendra’s favorite answer came one time when he asked a little boy what he wanted to be when he grew up and the child said simply, “A good man.”

Pastor Mahendra Bhattrai


Thanks to all who have read these dispatches and for your responses.

Shanti, Shanti, Shanti

May all sentient beings be free from suffering

God be with you.

Thanks for contributing photos to the blog to the team members, good photographers, all:


Carol and friend, Nissa

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“Long live the Dalai Lama”

Nepali signs: Left-Reminder of impermanence, Right-View of whose bckside?

Peds ward at Gangalal Hospital- 8 years old, Viral myocarditis/dilated cariomyopathy, EF 15%

“Coffee solves everything”



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“One day this will all be 20 years ago”

“We loved the Earth, but we could not stay.”

Loren Eisely

“These things matter most:

How well did you love?

Did you learn to let go?”


“Invisible threads are the strongest ties.”

Nietzsche, Frederich

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