Tag Archives: Nepal

Dispatches from Nepal: A drop in the bucket

By Bethany Bray May 27, 2015

The 10 days that Jeffrey Kottler spent in earthquake-ravaged Nepal this month were exhausting and painful but also some of the most worthwhile work of his career, he says.

Kottler served in a medical team with Empower Nepali Girls (ENG), the nonprofit he founded 15

Jeffrey Kottler plays with some Nepali youngsters near an Empower Nepali Girls medical tent.

Jeffrey Kottler plays with some Nepali youngsters moments before a 7.3-magnitude quake hit on May 12. (Click on photos to see full size)

years ago. The help the team members provided, including treating both physical and mental wounds and distributing donated supplies such as tents, is just a “drop in the bucket” toward what is needed, says Kottler, an American Counseling Association member and professor of counseling at California State University Fullerton.

Over the course of 10 days, the ENG team treated more than 500 people, including some in the hardest-hit areas of the country that had yet to see international aid. A 7.8-magnitude quake left much of Nepal in ruins on April 25; the destruction was made worse by a 7.3-magnitude quake on May 12.

Kottler is CEO of ENG, a nonprofit that develops mentoring and supportive relationships with children at greatest risk of being forced into early marriage or sex slavery.

Kottler and an ENG translator wait for their next patient in the "counseling corner" of a makeshift ENG medical center setup in a school.

Kottler and an ENG translator have their counseling tools ready as they wait for the next patient in an ENG medical center setup in a school.

Counseling Today has posted a series of online articles about the conditions in Nepal via Kottler’s travel journals. This journal entry from May 19 is the final installment.

Find more photos and information in earlier articles here and here.

Jeffrey Kottler’s travel journal: May 19

Mount Everest area

I had already seen four families in a row without a break, and my energy was faltering. Many cases are similar: One or more of the children has a headache or stomachache or sleep problem, and the parents are worried; or an adult is hypervigilant and overreactive to any noise or movement, unable to sleep or eat; or some preexisting medical condition like hypertension or heart problems are now far more serious. With such a long line of people waiting to be seen, most of our sessions are 20

Kottler and one of his students (far left) in the middle of a counseling session with a Nepali family.

minutes. During that time my team of students and I have to figure out what’s going on and attempt some form of reassurance or intervention. I’ve been teaching deep breathing, a simplified form of self-talk, but mostly explaining and normalizing their reactions as typical of trauma symptoms and chronic, unrelenting fear.

One mother brought in her boy after seeing our doctor because of an eating disorder. She had taken him to hospitals trying to figure out why he wouldn’t eat and complained of stomachaches when he did eat. The doctors recommended giving him vitamins and energy drinks to maintain his nutrition. But the mother was beside herself with worry and didn’t know what to do, especially since the earthquakes, when the boy had become even more unwilling to eat at the family meals.

I asked the social work students to do an assessment while I worked with an older girl, one of our [ENG] scholarship students who wanted to attend medical school next year but whose father thought that it was time for her to be married now that she was 18. He insisted girls didn’t belong in school and tried to sabotage her studies as much as he could. What should she do? Can she disobey her father and pursue her studies? Or should she follow her dreams and risk being disowned? I had spoken to her a few months earlier when I was in Nepal with several of my counseling students and had told her that the choice was hers and promised her that if she wanted to continue medical training, we would provide alternative housing and support her. I had directed my counseling students (after only one semester) to talk to her, and one student, Karla, shared her own story of immigrating from Mexico when she was 12, unable to speak English, leaving everything behind, and also showing resolve to be the first in her family to ever attend university, much less graduate school. This seemed to strongly impact the girl, and now I was following up with her.

I returned to our therapy room to find the social work students still trying to engage the boy who would not speak and deferred all questions to his mother. Yes, in other ways he is normal and happy, although since the earthquakes his eating problems have worsened. Yes, the family is intact and they are all healthy. Yes, their home had been damaged and they were living outside, but they planned to move back inside if there were no further quakes in the next few days. The students looked at me and shrugged, unsure what to do next. They are smart and capable and awesome, but this was really confusing, and I was also puzzled. Time was running short, and we had barricaded the door against the crowd fighting to get their turn.

I told the boy I had a test for him and wondered if he would pass. He looked intrigued, so I told him that I bet I could find something that he would eat. He barely looked at me, but I could see the beginning of a smile. I pulled out a Snickers bar and handed it to him. Out of pure obstinacy, he

Two Empower Nepali Girls scholarship children stand in front of their damaged house near Lukla in the Mount Everest region of Nepal.

shrugged and passed it to his mother, pretending he wasn’t interested. He looked back at me defiantly, the glimpse of a smile now gone.

“What DO you like to eat?” I asked him. “Smoothies?”

He nodded his head affirmative, or rather waggled it back and forth in that characteristic Nepali way.

“KFC?”

Another nod.

“Kabobs?”

Again, a nod.

“So, what don’t you like to eat?”

He whispered something I couldn’t hear. “Say that again,” I asked him.

“Dahl baht.”

“I see.” And now I did see. Most Nepalis eat rice and lentils for both meals of the day, every day, even when they are given other choices. It is perhaps the single most nutritious meal that the human body can metabolize and provides a cheap and efficient source of protein and energy. It turned out he really didn’t have an eating disorder; he just didn’t like dahl baht. But he LOVED fast food.

My head hurt with concentration. I desperately needed a break and to use the restroom. Before I could get out of my chair, a tiny girl was carried into the room by a man, accompanied by what I assumed was the girl’s mother. They were followed by the principal of the school we were using as our clinic, and Pasang Sherpa, the president of our (ENG) foundation in Nepal.

Because confusion was my usual state of mind, I just sat and waited for the drama to unfold. I wondered what could possibly surprise me next.

“This is Pramisa,” Pasang said to me, pointing to this absolutely adorable girl who was looking around the room, studying all of us carefully. “She is 3 years old.”

I nodded, waiting. Pasang and the principal explained to me that these were her aunt and uncle.

“Where are her parents?” I asked.

Everyone looked at one another after the translation. Her mother was at the hospital. “She is dressed in white,” the uncle said.

“She is dressed in white?” I repeated, now completely confused.

“Yes,” Pasang agreed. “Her husband, the girl’s father, died yesterday. He was hit on the head during the last earthquake. He was in the hospital and he died. The mother is with the body, dressed in white as she is [culturally] required. This girl, she doesn’t have a father, and we haven’t told her yet.”

I looked at this little girl, Pramisa, and she was smiling and playing with a stuffed animal I had just given her. My heart just broke. I could feel myself losing control, tears running down my cheeks, and so excused myself for a moment and walked out of the room to regain my composure. Were we now going to tell this 3-year-old that her father was never coming home? I had already seen and done so much, but this I could not do. But I knew I had to go back in the room.

Once I was back in my chair, Pasang asked if we might offer this girl a scholarship, support her now that she had lost her father and her home. They had no money, no place to live, no way to earn an income. The mother would spend a year in mourning, and that would be her job.

I thought to myself how fate had put me in this place, at this moment in time. My chest hurt. I felt so flooded with emotion from all the accumulated stress, all the stories I had heard and all the people I

had seen. I had felt so helpless at times, so inadequate to provide the help and support that everyone needed. And now I was given this gift: I could save this child — literally save her life and give her a future — by agreeing to provide her with a scholarship so she could have an education and a future.

I could barely speak, but I nodded my head, once, twice, then up and down so vigorously that everyone looked at me curiously. “Yes, of course,” I finally spoke aloud. I looked at the aunt and uncle and told them that although this was a terrible tragedy, I would do everything in my power to make certain that Pramisa was provided an education, to go as far as she could in life, maybe even to become a doctor or an engineer, professions that were rarely possible for girls in Nepal.

Then I fled the room, went into the restroom, shut the door and started sobbing. In fact, I am crying now as I try to tell this story.

Kottler (upper right) with his ENG medical team.

We are now heading home after 10 days of exhausting, overwhelming work. During this time, we have treated more than 500 patients, as well as distributed and prescribed $30,000 worth of medications and medical supplies that have been donated by doctors and hospitals in the U.S. We reached areas that have still not received any government help or assistance by any nongovernmental organization three weeks after the first earthquake.

It has been among the most painful and yet the most interesting experiences of my professional life. I have known many of our ENG scholarship girls for over 10 years, some for almost 15 years. During that time I have spent time with their families, shared tea in their homes, visited with them at school and walked on the trails, listened to the stories of their lives and the daily challenges they face. Now many of their homes are destroyed. Their schools are gone and their teachers have disappeared.

My heart still hurts. I can barely sleep. I’ve probably lost 10 pounds in the last week. I can’t tighten my belt any farther. I know this is the result of compassion fatigue or vicarious trauma, as well as primary trauma of surviving two major earthquakes and dozens of smaller ones. I know it is the result of working insane hours and seeing so many people compressed in a day. I know it is the result of seeing so much devastation and despair, so much sickness.

I know that what we have done is just a drop in the bucket compared to the millions of people who still need help, need tents and food and water, need support. But after a life devoted to service, a life dedicated to teaching and helping others, I am certain that everything I have ever done, everything I have ever prepared for, was to be here now.

Kottler walks along a trail in the Mount Everest region with a nurse, Pema. They took the walk to take a break and talk about the trauma and flashbacks they had been experiencing themselves. "Pema is a nurse who was at ground zero after the first earthquake. She saw headless bodies, saw hundreds of corpses crushed and listened to the wails of desperate mothers begging her to save their injured children. We talked about secondary trauma and how so many health professionals will experience problems once they fully metabolize everything they’ve witnessed," Kottler says.

Jeffrey Kottler walks along a trail in the Mount Everest region with a nurse, Pema. They took the walk to take a break and talk about the trauma and flashbacks they had been experiencing themselves. “Pema is a nurse who was at ground zero after the first earthquake. She saw headless bodies, saw hundreds of corpses crushed and listened to the wails of desperate mothers begging her to save their injured children. We talked about secondary trauma and how so many health professionals will experience problems once they fully metabolize everything they’ve witnessed,” Kottler says.

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For more information on Empower Nepali Girls, see empowernepaligirls.org

See recent photos and updates from Nepal at ENG’s Facebook page

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

Dispatches from Nepal: Sharing stories, normalizing fears

By Bethany Bray May 21, 2015

In the aftermath of the recent earthquakes that have devastated Nepal, Jeffrey Kottler has found that some of the most effective counseling tools available are empathy and a listening ear.

Kottler, a professor of counseling at California State University Fullerton, is in Nepal to join the earthquake relief efforts of Empower Nepali Girls (ENG), the nonprofit he founded 15 years ago.

Empathy comes easily, Kottler says, because he’s just as afraid and stressed by the constant

Jeffery Kottler pictured at an ENG medical camp.

aftershocks that shake the South Asian country as its native residents are. A 7.8-magnitude quake left much of Nepal in ruins on April 25; the destruction was made worse by a 7.3-magnitude quake on May 12.

Kottler has set up a “counseling corner” in the medical tents organized by ENG. People have been standing in line for hours to be treated, he says.

Counseling Today is posting a series of online articles about the conditions in Nepal as Kottler sends in his travel journals from the field. More photos and information is in our first article here.

Jeffrey Kottler’s travel journal: May 14

Kathmandu area

I used to think seeing 10 clients a day was a busy day, but we treated 158 medical and 41 counseling cases at the medical/trauma clinic we set up in two school classrooms. This was the first of five that we plan for the hardest hit areas. People from all around the area lined up patiently outside our “offices.” While Matt, our medic, Monet, our triage specialist, and two of our ENG scholarship girls who are now nurses worked furiously in room to treat broken bones, abrasions, infections, wounds and all kinds of trauma-related symptoms, I worked with various families, children, adults and couples. At one point, there were so many people lined up at the door toward the end of the day I just invited them all in for a group session.

With 17-year-old Chhusang Sherpa acting as my interpreter and assistant, I talked to people about their nightmares, insomnia, hypervigilance and struggles losing their homes. The few in the region who were willing to talk about their fears felt isolated and alone, as if they were the ones who were weak. One woman told me her husband and children accused her of being “cowardly” because she startled so easily and refused to enter their house, preferring to sleep outside.

I saw two 70-year-old friends together presenting various chronic medical complaints for which our medic and nurses had no treatments. They were both extremely hard of hearing, so I kept yelling (through Chhusang) that their symptoms became worse because of the stress they were under.

I saw a family concerned about their 5-year-old son who had been trapped in a building during the first earthquake and was now mute.

I saw two young mothers, with their children, who wanted to talk about their fears because they said nobody else would listen. They reported that most of their neighbors and family were acting as if things were normal, making it difficult to tell their stories.

I saw a political leader who, because of his position, was not able to admit to anyone that he was terrified all the time. He couldn’t sleep. He could barely function. I told him that because he was a leader, it was his responsibility to help others talk about their fears and concerns.

I saw an older woman who couldn’t get in to see our doctor, so instead she came into my office to hold my hands and look into my eyes. We sat like that for several minutes until she smiled, thanked me and walked out. I turned to Chhusang to ask her what that was about, and she just shrugged.

I saw a 96-year-old man who was in remarkably good health but felt he was going to die soon. It seemed important to him that he tell me about his life. He must have enjoyed our time because he returned later in the afternoon for another session.

Then there were cases when I was so far out of my usual standards of care that I could only shake my head. One man complained of vertigo, which made perfect sense to me, because I have also been dizzy since the earthquake, feeling as if the ground is constantly moving (which it is!). I reassured him the symptoms would go away, but he insisted on some medication to make him feel better. So I “prescribed” some little orange pills, one in the morning before breakfast and one in the evening before dinner, and he’d feel better. They were aspirin.

I saw a 6-year-old boy and his family because of their concern that he wasn’t “normal” since the earthquake. I tried to engage the fellow, but he just kept hugging his mother. Once I offered him a chocolate mint energy bar as a bribe, he started talking about his fears to me and his family, reassuring them that his reactions were absolutely and perfectly normal, given the circumstances.

I saw a mother who broke her arm saving her child from a collapsed building during yesterday’s earthquake (a 7.3-magnitude quake May 12), and she had refused to go to the hospital to get it X-rayed and fixed. Matt (the medic) sent her to me to persuade her to go or she might lose the function of her arm. I tried to be gentle, but during the translation, Chhusang scolded her and told her she owed it to her child to take care of herself.

I looked at Chhusang with awe and admiration. In the time we’d spent together, this high school girl was becoming quite the counselor herself.

I tried all kinds of things during the sessions: normalizing their fears, explaining about trauma and its symptoms, inviting them to share their stories, teaching deep breathing and relaxation strategies, introducing a little self-talk, encouraging them to talk to others and literally holding them.

But I found what often worked best, especially with the children, was sharing with them that I felt much the same way they did: out of control, scared and overreacting to any sound or movement. We mostly laughed about that together.

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For more information on Empower Nepali Girls, see empowernepaligirls.org

See recent photos and updates from Nepal at ENG’s facebook page

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

Dispatches from Nepal: Aftershocks heighten trauma, grief

By Bethany Bray May 14, 2015

The people of Nepal are focusing on basic needs right now – finding shelter, food and water; staying safe; and caring for family. Anything else, including processing the trauma that comes from

One of the girls in the Empower Nepali Girls program, standing with her family in front of what used to be her home. They are now living in a tent.

One of the girls in the Empower Nepali Girls program, standing with her family in front of what used to be their home. They are now living in a tent.

experiencing a 7.8-magnitude earthquake, will come later, says Jeffrey Kottler.

Kottler, an American Counseling Association member and professor of counseling at California State University Fullerton, traveled to Nepal this week to join in the work of Empower Nepali Girls, the nonprofit organization he founded 15 years ago.

“We [have] provided tents for people living outside, treated 20 patients for a variety of medical problems and tried to soothe the children, many of whom are a wreck,” he wrote in his travel journal May 12. “I feel so helpless, trying to hold them, reassure them and ease their fears, when what they really need is a safe place to live and a place to go to school.”

Empower Nepali Girls develops mentoring and supportive relationships with children at greatest risk of being forced into early marriage or sex slavery. Since the April 25 earthquake that devastated Nepal, however, ENG staff and volunteers have been helping with sanitation efforts, distributing supplies such as tents, food and water, and providing medical care to the injured.

Jeffrey Kottler, top center, plays a game to soothe and distract children in the Empower Nepali Girls program.

Jeffrey Kottler (top center) with children in one of the tents Empower Nepali Girls has set up since the earthquake. The children were drawing pictures and talking about where they were and what they were doing when the first earthquake hit, he says.

One of the ways Kottler’s team has tried to soothe the children in their program – and distract them from the ongoing aftershocks – is by encouraging them to draw and then hanging their artwork on the tent walls. The ENG team is also using and distributing an ACA fact sheet on trauma, Kottler says.

The initial 7.8-magnitude quake left much of Nepal in ruins, without electricity, safe drinking water, food and other basic supplies. On the day of the earthquake, an Empower Nepali Girls team member, Sara, was in the middle of her quest to climb Mount Everest to plant an Empower Nepali Girls flag on top of the world’s highest peak. She was trapped by an avalanche and stranded for three days, but she was eventually rescued, Kottler reports.

Aftershocks have rattled Kathmandu and the surrounding area since April 25, including another 7.3-magnitude earthquake this week. More than 8,000 people have died, while countless more have been injured.

Kottler experienced the 7.3-magnitude quake shortly after he arrived in Nepal.

“We were playing games with the children — ‘duck, duck, goose’ — when a huge earthquake hit, knocking many people to the ground, collapsing buildings and terrorizing the children who are already so fragile from the constant turmoil beneath the earth,” Kottler writes. “… The aftershocks continue to literally rock our world. I don’t feel haunted as much by the terrible shaking as I do by the sounds of the children crying and screaming and the glazed looks in their eyes. I couldn’t sleep last night very well because the aftershocks kept rocking the bed. I slept with my clothes on and flashlight nearby in case I had to bolt quickly.”

Many Nepalese have been sleeping outside out of fear of more aftershocks.

“Although it is early for major trauma symptoms to take hold, many of the children are having nightmares and many people refuse to go into their homes at all,” Kottler says. “I kept trying to reassure them that we would do all we could to help them rebuild their lives — and their homes and schools. It feels to them as if so many of their dreams are now gone.”

ENG families huddle in a tent to wait out an aftershock.

ENG families huddle together in a tent during an aftershock.

During his two-week trip to Nepal, Kottler will travel with an Empower Nepali Girls team to Namche, near Mount Everest, where the epicenter of this week’s earthquake was. Landslides and avalanches have washed away entire villages, he says.

“We are setting up medical camps in various regions to provide basic health care, distribute antibiotics to those with respiratory infections and distribute medical supplies to clinics in the areas. We’ve prepared simple treatment manuals for responding to the most acute trauma symptoms and the more severe cases that will start appearing in a few months when we return with another team,” Kottler writes in his travel journal.

“… Our team consists of a special forces medic, a hospital administrator and a friend acting as a ‘mule’ to help get all our medical supplies through customs at the airport. I saw so many supplies piled up at the airport, so little getting to the people who need them. We have to operate very quietly, under the radar, because the government has been making it very difficult for relief agencies to function. Riots have broken out with people trying to escape the capital or they are protesting the government inaction. Politicians are afraid to show their faces for fear they will be killed by everyone who is so furious at the chaos and incompetence of the government.”

This map, courtesy of Empower Nepali Girls, shows the areas where the nonprofit operates. (Click to enlarge)

Empower Nepali Girls operates in 15 different locales throughout Nepal, including remote regions where children are the most at risk.

Kottler has traveled to Nepal more than 20 times since founding Empower Nepali Girls and working as the organization’s CEO. Numerous counselors and counseling students have traveled with Kottler to Nepal during the past decade, helping organization provide mentoring and mental health training, conduct home visits and teach in local schools.

Kottler spoke briefly about his work in Nepal when he co-presented a keynote address in March at the 2015 ACA Conference & Expo in Orlando.

Jeffery Kottler pictured at an ENG medical camp this week.

Jeffery Kottler pictured at an ENG medical camp on May 13.

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CT Online will post more articles in the coming weeks as Kottler continues to send in his travel journals from the field.

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For more information on Empower Nepali Girls, see empowernepaligirls.org

See recent photos and updates from Nepal at ENG’s facebook page

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday