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5 Considerations for Volunteers

Maximise your impact, minimise your harm.

Apart from the trepidation of my family allowing me to spend three months volunteering in Nepal as a relatively new-graduate physiotherapist (at a time where the country was still searching for political stability), I was met with positive encouragement from teachers and colleagues alike. In reality I was quite unprepared for my adventure. For those considering volunteering in another country, this article is for you.

Are you a Voluntourist?

I wasn’t aware of the phenomenon of ‘voluntourism’ when I left Australia in the build-up to the Australian summer in November 2007 to spend 3 months living and working in Nepal as a Physiotherapist. Voluntourism is a concept I’ve spent many hours thinking about in the years since.

“Voluntourism” describes a volunteer involvement attached to holiday experience in a typically very short term engagement of one or two weeks (Cleaver 2016). The motivation is almost always altruistic, when a person of relative privilege donates their time and skills to help those in need. Unfortunately, due to the structure and short-term nature of these programs, there is often a lack of long-term outcomes and the value for the recipient community is disproportionately low compared with the investment required on behalf of the volunteer.

While I had committed a reasonable about of time (three months), what I didn’t appreciate was that for voluntourism to exist in the first place, there must be an imbalance in privilege and power, usually due to racism and inequity in resources.

Consider a Global Health Perspective

Global health has been defined as “collaborative trans-national research and action for promoting health for all.” (Beaglehole and Bonita 2010, as cited by PhysioPedia ND). Global health is essentially about equity in availability and access to resources. If we continue to think that we can make an impact in a problem simply by providing a temporary workforce then we are missing the point.

How this played out for me is that I thought I was doing the right thing toward sustainable change by selecting a program through an Australian based NGO with a long history in Nepal. While their main programs did not initially include Physiotherapy placements, on further discussion I found they regularly created individualised programs. Great (for me), and my philosophy of “I make a positive change in one person’s life, it will all be worth it”…

But in reality it’s not that simple.

What happens when you leave?

Case in point:

I treated one gentleman daily as an inpatient after a fall out of a tree left him with spinal cord injuries. His accident happened a couple weeks before I was due to leave. We made some good initial progress and he was hopeful of a good recovery, in part because of the care and attention I showed him (he was likely over-optimistic because of this). As my time was drawing to a close, I knew there was no-one to take over. I didn’t have the communication or understanding of the health system to organise a proper handover or long term needs. (My energy and resourcefulness to do this was also being worn down with my own developing gut and health issues, unaccustomed to living in the dirty city of Kathmandu, which along with the tragic sudden death of my host brother had increased my personal mental load). I started to feel growing sense sadness and shame that perhaps I had done little more in the long term than provide him a window into what he is missing out on.

Had his injury happened in Australia, his access to resources and long term support and financial assistance would have been vastly different. I felt (and still do feel) terrible about the situation and how I handled it.

I couldn’t face him. It’s hard to admit it here – but in all honesty, I didn’t even say goodbye.

Voluntourism vs Global Health

VoluntourismGlobal Health
Short term (1-2 weeks)3 – 6 months to years
Engage with community as a tourist or visitorEngage with the community as a citizen
Usually profit drivenNon-profit
Participant largely stays within comfort zone.Challenges the participant outside their comfort zone

(summarized from Cleaver 2016)

Global Health Crises at Home

Where inequity exists, health will suffer. A Global Health approach promotes equity in access and provision of health services to make positive changes. Katjia Ferrera’s presentation (Australian Physiotherapy Conference, Adelaide 2019) described the difference between equity and equality which she illustrated with this image (from the Interaction Institute for Social Change).

Equality vs Equity: If we believe the issues is inequality, we address it by giving everyone the exact same thing, irrespective of their needs. If we recognise inequity is the issue, we will respond to the different circumstances of each individual that require extra or different support for some to reach the same state of health and wellbeing as others in a relative position of advantage.

Inequity Exists Here

There are huge inequalities in health on our doorstep – our indigenous communities, the homeless, refugees and the LGBTIQ suffer poorer health than the wider community.

My study of public health prior to my Physiotherapy degree meant I was aware of these issues before I left for Nepal, but for some reason I chose to ignore them and instead spend time in Nepal. I’m certainly not alone in this. And I reflect now on this over ten years later – why was this?

Perhaps our problems weren’t exotic or glamorous enough. Perhaps I felt that the issues we face at home were so systemic, that a place like Australia should be able to fix it without me. After all, we have an arguably functional government with public health system funding. Australia didn’t need me. Or I didn’t feel I could make a big enough difference at home. Maybe I felt it wasn’t my place to try?

Voluntourism Can Be Damaging

It’s not just a case of bruised ego when you don’t feel you’ve actually been as helpful as you would have liked to have been. It is a case that you can do serious harm through your participation in certain programs.

Tina Rosenberg’s article “The Business of Voluntourism” reveals that over 90% of the children in Orphanages have at least one living parent. She highlights the continued institutionalisation of children through the industry of westerners visiting orphanages when back home, we have pretty well abolished orphanages and institutions. The Australian Government has launched campaigns to address child exploitation and discourages Australians in participating in so called “Orphanage Tourism

Other Ways to Contribute

Depending on your desired location, each physiotherapy community has individual challenges it faces. Connecting with the local physiotherapists to understand their issues is a powerful way to start.

I urge you to consider your own country’s local health challenges and issues of inequity and how you might be able to be involved.

It’s valid to just be a tourist. Travel to the places that interest you – it doesn’t have to be as a volunteer. Save the money on program fees, and instead spend the money on taking more time in the location, attending local language and culture classes (The Lonely Planet books are a fantastic resource for travelers). Contribute money to the local economy through your tourist dollars, choosing sustainable travel practices. You may be able to build contacts and relationships that create ideas for collaboration down the track.

The world is increasingly a global community, connected by the internet and social media in particular. It has never been easier to reach out and connect with like-minded people working in this space. Be informed and inspired by stories from the Global Physio Podcast. Read widely on the Global Health topic.

The value of your ability to contribute meaningfully increases as your expertise and experience does. Expert clinicians can provide skills in a “train the trainer” capacity. Consider that donating your time regularly over a longer period may mean you can contribute to a cause thousands of miles away right here or right now – editing journal article submissions for example.

The World Confederation for Physical Therapy has a list of work and study resources as well as international work opportunities along with the Database of Volunteers and Experts (DOVE) program.

You may have existing relationships which you can use to connect to the right people. Here’s five tips for volunteering:

5 Key Tips for People Considering Volunteering

  1. Consider what financial investment you need to make, and who benefits.
  2. Are you a Voluntourist or taking a Global Health Approach?
  3. Where inequity exists, health will suffer. What inequity is leading to the issue you are trying to address? How is your proposed program addressing this?Consider if you are perpetuating inequality and if your participation is harmful.
  4. Who are you taking over from? What happens when you leave?
  5. Are there other ways to be involved. Connect to the Global Health community.

Uncomfortable Truth

These topics are uncomfortable to discuss, and reveal my own naiveté and prejudice at the time. But I hope by sharing these challenges and concepts that it may help others in their quest to make a difference in the world.

Many great things happened from my time in Nepal: I have a love of the country and I feel a connection to its people. I received so much more out of the experience than I was able to contribute, which continues to fuel my need to ‘pay it back’. Volunteering overseas is not a bad thing – there are many positives that come out of building relationships, collaborations, greater understanding and connections in this world.

What I hope I have done here is to open a discussion and offer an alternative view-point that wasn’t presented to me when I set off. I’m simply suggesting that we need to pause and take an honest look at the situation we are entering into and what we hope to gain out of it. Consider what a ‘successful’ outcome would look like for all parties and build a program around that.

I wish you all the very best in your volunteering adventures!

Note: The planned late 2020 Nepal study tour is under review due to the developing Coronavirus outbreak. This trip aims to connect a global network of physiotherapists to the local physiotherapy community. Join the mailing list or reach me at hello@emilyeglitis.com.au if you’d like to know more about developments. I would love for you to join me. 

Join Emily on a study to to Nepal in 2020. Join the mailing list for more details as they are released.

Resources

Explore these resources for more details.

Australian Volunteers. Australian Government support of locally developed opportunities for skilled Australians. https://www.australianvolunteers.com/

Catherine Hamlin Fistula Association. An example of long-term commitment to making a real change. https://hamlin.org.au/

Cleaver, S (2016) Voluntourism: vlog with Shaun Clever. Global Health Division of the Canadian Physiotherapy Association. Accessed 21st April 2019 from https://www.youtube.com/watch?v=wNFKYdnXU3M

Global Physio Podcast. https://globalphysio.ca/

Illich, I (1968). To Hell With Good Intentions (Speech). Accessed 19/12/2019 from: http://www.uvm.edu/~jashman/CDAE195_ESCI375/To%20Hell%20with%20Good%20Intentions.pdf

Rosenberg, T (2018). The business of voluntourism: do western do-gooders actually do harm? The Guardian. Accessed 19/12/2019. https://www.theguardian.com/news/2018/sep/13/the-business-of-voluntourism-do-western-do-gooders-actually-do-harm

University of South Australia (2017) UniSA pioneers health clinic to help Adelaide’s homeless. Accessed 19/12/2019 from: https://www.unisa.edu.au/Media-Centre/Releases/2017-Media-Releases/UniSA-pioneers-health-clinic-to-help-Adelaides-homeless/

World Confederation of Physical Therapists. Lists many international work, study and volunteering abroad opportunities:

https://www.wcpt.org/working-and-studying-in-another-country

https://www.wcpt.org/international-work-opportunities

https://www.wcpt.org/doves/register

Australian Physiotherapist Perspective: Volunteering in Nepal

This Blog entry is a copy of the article I wrote for the official publication of the Australian Physiotherapy Association ‘InMotion’. Published in 2009, it is a summary of my experiences as a new graduate volunteer to Nepal in 2007/2008.

FEATURE AROUND THE WORLD

Volunteering to the max

In writing about her three-month stint in Nepal, physiotherapist Emily Smith (now Emily Eglitis) ponders the issue of Volunteers maximising their positive impact while minimising the negative consequences for host communities.

Committing your energy, emotions and sometimes even your health and safety to be a volunteer is a big task. It makes sense to find the most beneficial way to spend your time and resources, as it is not just for the duration of your time as a volunteer that you want a positive impact to be felt, but long after as well.

But in our quest to make things better, do we sometimes risk making the overall situation worse? If we help now, does it matter that the change may not last in the long run?

I am by no means expert on the subject of aid work, but while on my own quest to ‘change the world’ as a new-grad physiotherapist, I was confronted by a recurring question: How could I maximize my positive impact and minimise negative side effects from my work? Just as we try to practise physiotherapy holistically, maybe we can consider roles such as volunteering holistically as well.

Emily, client and family at Kanti Children’s hospital Kathmandu

After graduating from the University of South Australia in 2006, I worked for ten months in a private practice in Victor Harbor on the south coast, gaining valuable experience – and money to finance the whole venture. I decided to turn my combined desire to travel developing countries and my curiosity about volunteering into a round-the-world holiday that started in Nepal as a volunteer physiotherapist for three months in Kathmandu.

I worked at Tribhuvan Teaching Hospital (Neurology/Neurosurgery ward), Kanti Children’s Hospital (the only dedicated children’s hospital in the country) and a privately run rehabilitation centre – Sahara Care Home. My placement was organized through a local Australian non-government organisation (NGO).

As can be expected with any developing country, the healthcare system is under strain in Nepal. Delivering services to the estimated 86 per cent of the 29.5 million people who live rurally is a challenge made more difficult by the fact that in addition to Nepali, over 20 other dialects are spoken; even three months of study and practice in the Nepali language did not guarantee effective communication with those Nepalese, usually from smaller remote villages, who spoke another dialect. The sheer number of people is also demanding – population density equates to around 206 people per square kilometre, meaning that there are 5000 people per hospital bed. (By comparison, Australia’s population density is less than three people per square kilometre and an estimated 135 people per hospital bed.) Putting all this on top of a long and convoluted history of instability and corruption, you find a nation in need of assistance in many areas not limited to the healthcare system.

Petrol station nepal

In terms of physiotherapy, there are approximately 150 people working in the field and most are fully qualified. Unfortunately there are even fewer other allied health professionals, especially occupational and speech therapists. I was incredibly fortunate to meet and work under the guidance of the Associate Professor of Neurosurgery at Tribhuvan University Teaching Hospital, Dr. Mohan R. Sharma. Dr. Sharma became a good friend and mentor to me and involved me in the medical and grand-rounds of his neurosurgery interns and registrars. He appreciated that his patients were able to be assessed, treated and mobilised consistently during their stay.

The neurological patients I worked with very rarely received physiotherapy treatment unless they were gravely ill with chest complications. A large part of this was likely due to the under-referral of patients by medical team, which perhaps do not fully appreciate the benefits of physiotherapy in early mobilisation. There is also a lack of resources to treat all cases in need.

While my work was no doubt appreciated by patients and staff alike, Dr. Sharma and I realised that the benefits I was bringing to my patients were not going to last. as the saying goes: ‘Give a man a fish and you feed him for a day, teach a man how to fish and you feed him for a lifetime’.

In a ‘treatment’ role, it was pretty tough to contribute significantly early on. Because of the language barrier, I couldn’t treat patients safely and effectively without the help of someone to translate. I started to feel little useless and that I was absorbing more time and energy from the placement than I was giving back. This is an important consideration to take into account in the planning stage, as you want it to be worth the while of your hosts to orient you and help you settle in. this especially so when language is a barrier, which is why many institutions will strongly recommend a duration of at least three months.

On day I was feeling particularly unconstructive when one of my Nepali colleagues was working with a middle-aged woman with a degenerative brain condition causing severe ataxic gait. The physiotherapist had again tried the standard recipe of ROM exercises and that retraining that consisted mainly of steering the patient awkwardly across the room, accumulating two falls and more than a few near misses.

Nearing the end of the treatment session while giving the patient a rest, the physiotherapist dejectedly declared to me, ‘I just don’t know what to do with her!’ I realised an avenue through which I could really help – the physiotherapist was smart and eager to learn and could obviously communicate in her native tongue to the patient. I was able to jump in and help, brainstorming ideas from my not-so-distant university days for further assessment, outcome measures and goal setting. I helped her to break the treatment session down from the complex task of walking into smaller task components of postural control and stages of the gait.

That day, we all left with a sense of achievement. I realised that encouraging and stimulating physiotherapists already there, and who will stay long after my departure, will benefit the local community the most. Continuity is the key – finding a method to help that will mean your contribution is felt by many more people long after you leave.

As Australian physiotherapists we are privileged to receive such a high standard of training and ongoing support and development from our professional body, the APA. Committing where possible to well-organised projects where there will be support and continuity in your contribution (such as in further training and education of physiotherapists in developing countries) means that we can use our unique skills to immeasurably benefit many other people. If there are no projects of this sort already in progress, you may be able to assist local people at a preparatory level toward this goal. Combining with established aid organisations and researching them well is one method of doing this.

Furthermore, there was a noticeable difference to the multidisciplinary approach to healthcare I have experienced working in Australia compared with Nepal, where doctors seem to be the first and last port of call for health. Advocacy for physiotherapy and its many benefits aimed directly at the medical community might improve service provision of physiotherapy and encourage outlets for professional development. Physiotherapy potentially could have a massive impact in primary and preventative healthcare.

When you arrive in a new community with a quest to make a difference, you want to make sure it is a positive difference you are making and not a negative one. Overall, the task of minimising any negative impact comes down to commitment – being honest with yourself and determining how much time you will need to become autonomous in the role you are playing and then to carry out your duties for a reasonable period thereafter.

Trek through Langtang Village, Rasuwa region Nepal

In a broader sense, being mindful of the unique set of social, environmental, cultural and political circumstances that surrounds the community in which you intend to work can also help when attempting to be holistic in your approach as a volunteer. Working with the local community to identify and tackle issues that are important to them is essential to an effective and enduring project. As Ian Edwards (University of South Australia lecturer and aid worker in Kabul, Afghanistan) points out. ‘The learning process works best when it is genuinely a two way process.’

This principle can also be carried into daily life. There are many disadvantaged groups in the community and how you interact with them is also important. Daily in Nepal I would walk past the homeless beggars, sometimes children who would hang onto my arms as I walked along the street, forcing harsh realities of life at me. To not give a few measly rupees to the beggars feels heartless.

However, children are often pulled out of school because begging is more lucrative. To pay them may mean you perpetuate the problem. What do you do? As part of living and working in a foreign country, you may be in a position to hire locals into employment, as cooks, cleaners, porters or trekking guides. Although you may be able to do the jobs yourself, providing proper working conditions and a fair rate of pay potentially could further your positive impact.

A huge environmental problem in Nepal is waste disposal, and clean drinking water is a luxury sold in plastic bottles that are non-recyclable and clogging rivers and piling up along trekking routes all over the country. It is avoided easily by filtering or boiling your own water. Being culturally sensitive to dress and responses to religious rituals, hand gestures, eating, bathing (and more) is important also. Occasionally, volunteers treat their time as if it is a holiday, neglecting that unpaid work still requires you to show up on time, work well and show respect for co-workers.

Considering how we can best spend our time and effort as physiotherapists will assist those who take the plunge and volunteer, and may even impact on the way we practise right here at home. The process of volunteering should benefit both the volunteer and the hosting community. Finding a way to do this takes considerable awareness of ‘the big picture’ and a consideration of what will happen after you have left. You may not be earning money, but an honest contribution is incredibly valuable and may have benefits beyond those originally expected.

Langtang Region Prayer Flags

Trembling Mountain

At 12.50pm on the 25th April 2015, a major earthquake measuring 7.8 in magnitude shook Nepal for fifty terrifying seconds causing widespread destruction and damage across the country. For context, ten is generally considered to be the upper limit of this scale, with each increasing number indicating double the energy release of the previous number (the highest earthquake ever recorded was 9.5 in Chile in 1950). Nepal is situated in one of the most seismically active regions on earth, with small tremors not uncommon, however major earthquakes such as this occur once every century. On this occasion, an estimated 9,000 people were killed and 22,000 injured across Nepal.

The village of Langtang, north of Kathmandu near the Tibetan Chinese border was completely buried under a landslide triggered by the force of the quake. The earthquake triggered a glacial collapse leading to an avalanche of rock, ice and mud, resulting in an air blast, equal to half the force of the Hiroshima atom bomb which sent shock-waves down the valley

Villages across the entire Rasuwa region were severely affected, with over 250 people killed in the event and many more injured, displaced and traumatized. For an economy based around trekking and tourism, the impact of the earthquake is still felt in these communities.

Nepalese documentary film-maker Kesang Tsetan followed the Langtang people in the weeks and months after the earthquake to document and record the journey of the Langtang people. He created a film that explored what the Earthquake could reveal about the people of this region who have a strong Tibetan Buddhist culture. His film Trembling Mountain shows the personal suffering wrought by the calamity, by ‘story tent’ testimonies interspersed with and serving as thematic and counterpoising elements to the activities of resettlement. This work is also contributing to the Langtang Memory project which aims to create a space for healing through the active process of remembering and documenting in collaboration with the Langtang Community.

It is now four years later and much of the rebuilding has been completed across the country and for Langtang, the infrastructure is restored and trails open for trekking. Emily Eglitis, a local physiotherapist and yoga teacher who has lived in Nepal, now leads yoga-trekking tours to Langtang in an effort to help support the local Langtang economy. “The natural beauty of the region, it’s cultural and spiritual diversity and the kindness and warmth of the people make Nepal the perfect destination to explore the challenges of trekking with the benefits of yoga”. Emily learned about the film whilst leading a group through the Langtang region in March this year and before returning home to Australia, met with the film-maker and to secure a copy of Trembling Mountain. There will be a single screening of Trembling Mountain as a fundraising venture for the Langtang Memory Project and community support on the 27th June 2019 at Wallis Cinema Mount Barker.

Tickets are available through Eventbrite and more details are here on our Events section on the PhysiYoga facebook page. For queries email hello@emilyeglitis.com.au. I hope to see you there!

Gearing Up

Having the right clothes and equipment will make your trekking experience all the more comfortable. But if you’ve not been on a trekking holiday or to a place like Nepal before, deciding what you need to take, what you should get now and what you can get later can be confusing. I hope this overview will help you pack your bags in February.

Here’s an overview of what to expect and what to consider including a detailed packing list.

Buy and Bring vs Buy When There?

Purchasing gear before you leave home affords a certain peace of mind. If you forget to pack something, or don’t realise you need it until you arrive, there are multiple trekking stores in Kathmandu which stock the full range of trekking clothing and equipment specific to the region you are travelling.

You will find the best international brands of good quality and you’ll also find cheap knock offs. My experience is that you get what you pay for – the cheaper items I have tried my luck with have failed in a small way, not a long time after purchasing them which render them useless. For example, a drink bottle that soon doesn’t seal properly and starts to leak. Or a jacket where the zipper broke. Prices are not likely to vary a great deal when you compare the quality brands purchased in Australia versus Nepal.

You will need to be prepared for a variety of activities including of course trekking, sight-seeing and yoga. Hiking boots can get heavy for daily sight-seeing – if you have chunky boots, you might like to take some light sand-shoes for sight seeing.

In my opinion, the minimum that you should purchase a good six to eight weeks before you leave are:

  • Good hiking shoes or boots
  • A few good pairs of socks
  • A comfortable day pack (backpack)

If you can get away with borrowing from a friend, you will likely need a decent Trekking back pack (large one for carrying all your other gear).

Benefits of Buying in Nepal

  • Local knowledge of the region and conditions you are visiting means more likely to get great advice & equipment/clothes to suit
  • Contribute to the local economy
  • Will get a different variety of merchandise to choose from
  • Lighter luggage from home to Nepal

Benefits of Buying in Australia

  • Arrive prepared
  • Don’t have to budget for purchase of gear during your holiday, which effectively spreads the cost out over a longer period
  • You can plan your luggage allowance
  • Save time on your holiday

Specific Items to Consider

  • Sleeping bag: Blankets and bedding is available in tea-houses, but your own sleeping bag is recommended. It can be purchased prior to departure or on arrival from one of the trekking stores in Kathmandu. Personal preference means it is best if you discuss the style and needs with your specialist camping gear shop. General consensus is at least -5C or -10C to be safe if purchased in Australia. Others suggest -20C if purchased in Kathmandu. The Langtang region treks are Tea-House lodges, which are simple rooms but not insulated. A sleeping bag that is warm is essential, but it doesn’t need to be wind-proof. Extra blankets are usually available.
  • Torch: Head lamps are extremely helpful for reading at night but also rummaging around in your room or backpack after the sun goes down. Wind-up (non battery) hand-held torches are a nice light-weight option that won’t go flat.
  • Gloves: Self explanatory.
  • Warm jumper: One or two good quality fleece jumpers to keep warm.
  • Shell Jacket: Waterproof & windproof. Layers are key to keeping warm. They are also really helpful when you are trekking – you can add and subtract layers for your comfort and activity levels. Some people like the quilted “puffy jackets”, but I find you can’t adjust the layers as easily so there is less flexibility in varying the warmth of what you’re wearing so they can become bulky. Your choice.
  • Beanie: Sure you can get it before you go, but then you won’t have as many reasons to get a funky, Nepalese, knitted complete with ear flaps and pom-poms!
  • Walking Poles: I highly recommend walking poles so if you can borrow some, do it. They can improve your balance and really reduce the strain of walking. They can be found at many camping and outdoor shops.
  • Water bottle: Wide-mouthed bottle that can be easily refilled from a boiled kettle. 750ml+. This is good to get on arrival as you want it to have a wide mouth and I haven’t seen a lot locally that fit the bill.

Accommodation

We will be staying in a large range of accommodation options from village home-stays, to simple tea-houses through to 4 star hotels. Thongs or light slip-on shoes are handy for when you head off to the toilet at night or to use in the shower.

Just a heads-up for showers on Trek: some are solar heated, but this is obviously weather dependant. So for the short trek of six days you may decide on a quick body-refresh but may not wash your hair. You can purchase shampoo etc in single sachets from road-side stalls in Kathmandu which means you don’t have to bring lots of bottles with you, but a small bottle of bodywash is helpful.

Weather

February is officially the last month of winter in Nepal and March brings slightly warmer weather and more sunshine. Prepare for generally cool conditions which will get cooler as we ascend through the mountains. Weather snap-shot:

  • Sunshine for about 8 hours per day
  • The daily temperature range is 5C to 26C
  • The evenings and nights get cold
  • Sunny, cloudy or cold days. Sometimes with rain.

The evenings are cool and electricity is unreliable. Warm layers and a good sleeping bag for the trek is advised. A beanie is a great idea – fun designs can be purchased in Nepal for a useful souvenir.

The Trek

  • Walking approximately up to 6 – 8 hours per day (for 5-6 days).
  • Your day pack will likely weigh 5-10 kg – it will be for your extra layers to wear, drink, snacks, camera
  • Up to 12 kg can be given to a porter* to carry
  • The highest altitude is we reach is just under 5000m (Kyanjin Gomba 3850m, with optional extra trek to Kyanjin Ri 4773m).
  • Difficulty level: graded a 2 out of 4 (moderate difficulty). The chance of altitude sickness is low. If you are physically fit and already active, you should be able to manage without too much trouble. It is not recommended for children. It could challenge older people over 65 years old.
  • https://www.uptodate.com/contents/high-altitude-illness-including-mountain-sickness-beyond-the-basics

*We will be using local Porters and Guides for this trek – this provides employment for the local community. We will have one porter for every two trekkers: allow 10kg of extra belongings to be carried by the porter.

The Yoga

You just need something comfortable that you can move and stretch in. The classes will be tailored to suit the individual and will include active or restorative postures to suit the day’s activities. In the evenings or cooler conditions you might like to wear thermal garments under tracksuit pants and a t-shirt. As I can’t guarantee the temperature of the yoga halls (and we may be able to venture outside), it’s best to be prepared with long pants and comfortable long & short sleeve t-shirt options.

You can download a full example packing list here.

And if you have any other tips for packing that have really helped you, I’d love for you to leave a comment and let me know.

7 Problems Trekkers Face & How to Solve Them

Walking is the most popular recreational physical activity in Australia (ABS 2015). Almost half of Australians regularly walk for fitness (Roy Morgan 2018). And there’s good reason for this too – it has amazing health benefits. If there was a pill that could provide half the benefits a good dose of physical activity can, it would be the hottest seller on the market! According to the Australian Department of Health and Human Services, there’s a mountain of benefits that increasing our walking and physical activity can provide:

  • Reducing the risk of heart attack, type 2 diabetes & some cancers
  • Controlling and reducing the risk of osteoporosis
  • Weight management
  • Lowering blood cholesterol & blood pressure
  • Increasing strength of bones, muscles and soft tissues
  • Decreasing the risk of falls
  • Improving mood, energy and sleep

Trekking is a wilderness walk that traverses rougher terrain over the course of hours, days or weeks. Hikes and trails are graded in difficulty according to how physically demanding they are (steepness gradient of the inclines and declines), duration and difficulty (presence or absence of paths, steps, obstacles and access to amenities). There are treks and hikes to suit most fitness levels.

Anyone who has trekked before will tell you the exhilaration and sense of achievement makes a strong trek worth the effort. Walking holidays are a perfect way to really get amongst the nature and environment of a new land, experiencing the culture and history of the landscape as you go.

It’s a good idea to do some preparation before you go in the form of a graduated walking program to increase your fitness and strength and test your gear. As you start to increase your walking or think about preparing for a walking adventure, here’s some of the most common issues Trekkers face and how to tackle them.

1. Blisters

Over two thirds of trekkers (64% according to Boulware et al 2003) experience blisters. Blisters are the result of friction of the foot sliding in the shoe/sock. Moisture, pressure and repetition are the ingredients that make a blister happen. Once you have the blisters, popping them can become an infection risk. It is much MUCH better to avoid getting them in the first place.

It is essential to have shoes that are comfortable and fit properly. Poorly fitting or inapproapriate footwear is the most common cause of blisters. Make sure the laces secure your foot in place and that there is ample room for your toes to slide forward – especially when going down hill. You don’t want your toes hitting the end of your shoe or you’ll end up with unhappy toes – toenails with bruises under them or even missing toenails!

Hiking shoes can be made from a variety of materials depending on whether you need the following factors

  • Waterproofing
  • Light weight
  • Ankle support

There is no “one size fits all” approach. You should consult your physiotherapist, podiatrist or specialist shoe centre to determine the right fit. Consider giving yourself two months to wear them in.

Secondly but just as importantly, consider which socks you wear. Socks need to be comfortable and fit properly – not too big or small. Thickness comes down to your preference and comfort – choose materials that are natural to help the skin breathe and natural materials may reduce odour. Socks made from materials that wick moisture away from the skin surface also help prevent blisters. Fast drying means you can wash them more easily on the trek to wear again in a day or so which will reduce what you have to carry or mean you can change them more frequently.

Many runners and walkers like “toe socks” to reduce friction and improve comfort, but for others, getting your individual toes into each compartment is annoying. Natural fibres breathe well and help your skin condition.  Keep your skin dry; constantly wet feet are not only uncomfortable, but more likely to suffer skin irritations and blisters. I suggest purchasing a few pairs of socks along with your hiking shoes and see which ones you like best as your do your training walks. Then stock up before you go on your favourite pair.

Top: Brown Trekking boot – high top for more ankle support, durable but heavy. Bottom: Black trail-running shoe – sturdier than a regular sneaker and lighter-weight than the boot (but not as water-proof or supportive as the boot).

Although it may rain on our Nepal Trek, our trekking route won’t be particularly wet. You are likely to be fine with one pair of socks per day and one pair of shoes. Some water-proofing is advisable on all footwear, but we won’t likely be wading through streams and mud.

2. Skin Irritation: Chafing, Cuts and Grazes

Chafing can affect a variety of body areas and become really uncomfortable. Common sites are underarms and between the thighs. “Bodyglide” is a topical application that you apply to the skin to reduce friction and rubbing. It’s often an issue of skin rubbing on skin or clothing, so t-shirts  which protect your inner arm from rubbing against your shirt (as opposed to a singlet) might be a good option.

Ill-fitting underwear and bras need to be addressed – spend the time and money on decent, comfortable garments. They will be worth their weight in gold out on the trails. Wear them during your training to test them out.

Backpack straps – consider if you are wearing T-Shirts or singlets as the straps on a backpack can become a source of irritation if rubbing against bare skin. Having a day-pack that fits comfortably and correctly is essential.

Cuts and bruises from slips and stumbles are unavoidable – a small first aid kit with a little antiseptic wash and bandaids is a helpful addition to your day pack.

3. Lower Limb Injuries: Foot Pain (i.e. plantar fasciitis, arch pain) Achilles Tendinopathy, knee pain, hip pain.

Walking obviously places more demand on the bones, joints, muscles and other tissues of the lower limb. So we need to increase our walking and exercise steadily and use appropriate footwear early on – it’s worth the investment and saves on Physio visits later on!

Our body’s tissues are designed to adapt to the stresses and demands placed on them – providing load is applied at the right intensity and duration: too much, too often = the tissues become sore and inflamed. Too little, and we don’t build our strength and endurance.

It is generally accepted that it takes four to six weeks of consistent load for our tissues to show changes in response to training/loading. There needs to be period of load and adequate rest (i.e. rest days as well as adequate sleep and nutrition). Sudden increases in activity without adequate recovery periods can lead to overuse or overload injuries of the lower limbs – hips, knees and feet are especially at risk. The key is to be patient during this period when you are feeling great and want to do more, and not over-do it.

It is a common scenario to see people with injuries about two months after embarking on a new exercise program after starting enthusiastically, to find growing niggles starting to get in our way. The main reason is that the increased stress has just been applied too fast or too much without enough recovery.

Consider increasing only one of the following at a time, and perhaps only by 10% per week.

  • Distance/time walking
  • Difficulty: incline/decline
  • Pace

4. Shoulder, Neck and Back Pain

Carrying a pack puts more compressive forces through your spine. The simple act of carrying a weight will change how you have to recruit your postural muscles.

You can save a lot of back-ache by ensuring your pack fits comfortably with the straps at the right tension so that you are carrying loads more efficiently. So take your time trying different packs with some weight in them (filled with the stuffing in-store makes them look full, but doesn’t replicate how they feel on your back).

I disagree with the recommendation to do all your walking with a pack. This is why:

Muscles have a range in which they are most efficient – somewhere in their mid-range. So if a muscle is lengthened or contracted toward the ends of its range, it is not able to generate forces as efficiently. Poor posture has the effect of putting some muscles outside of their comfort zones: some are less active and may develop weaknesses through lack of use, while others are constantly ‘switched on’ and become tight, tense & strong. This causes imbalances. Attaching a load to our spine (i.e. a backpack) will simply exacerbate these imbalances.

Good posture means that you have the most efficient balance of muscle effort. Doing some exercises that help identify what great posture is for you, improve your posture and strengthen your ability to maintain it is essential, prior to loading it.

Nothing beats Pilates for this purpose. When training for a marathon, I found that after my one weekly Pilates session, my running effort was much less as I moved more efficiently. Develop great posture as you get stronger and more flexible.

For recovery, strengthening and injury prevention Yoga works great too. Stretching and moving our body in all directions is fantastic for reversing some of the stiffness and tension that creeps in over the days. (Which is why we also are incorporating yoga into our trek for those interested).

So use a pack sparingly at the start. Consider a 10 week Yoga or Pilates (or both) program as an adjunct to your walking training. And in the final two months, start to wear a pack gradually building up to the weight you intend to trek with. You could aim for 5-10kg, or weigh what you will carry and replicate that with books or water bottles.

If you are troubled by back pain, see your physio (remember our Trekking Preparation Early Bird Special) to get it sorted early on.

And if you’ve made it to the start line, here’s the most common issues that can make your journey that bit less enjoyable.

5. Diarrhoea

The last thing you want on the trails is diarrhoea.

My wise Grand Pa Don once remarked on his experience with gastro: “You think you’ll die, but you’re afraid you won’t”. Gastro is terrible anyway you look at it, but you will be more comfortable in a hotel room than walking 6 hours a day. So take all precautions to avoid it!

Here’s some tips:

  • Be careful with your water – drink cooled, boiled water (available at all tea-houses) or filtered water
  • Only ever eat cooked vegies (you can try salads if you trust the location is used to catering to Western bellies). They must be washed in filtered, boiled water
  • Consider acclimitazing to the food/country for a few days before heading out to the Trekking route so your body and belly can adjust.
  • Hand-washing: before every meal and after every bathroom break. Soap and water.
  • Consider packing a hand sanitizer when hand-washing is difficult
  • Discuss mediations with your travel Dr when you have your pre-travel vaccinations – if you are bent over a toilet bowel (or not sure which end to aim into it), the last thing you want to have to do is wander the streets to find a chemist
  • Consider packing Hydralyte Sachets for dehydration which can happen with these episodes

Which leads me to…

6. Dehydration

Drink plenty of water during your training and your trek. You have couple options here: bladders or bottles.

Bladders are flexible rubber reservoirs that many day packs can now accommodate with a long rubber straw and mouth piece that is easily reached during your walk. They are really handy and mean you can easily quench your thirst. However in practice, when on the trek you would have to refill with bottled water as they are not easy to clean and you can’t fill with boiled water due to the materials they are made for. So I suggest to keep these for training at home.

Example of a trail-running backpack, complete with bladder and ‘straw’ (left). Metal drink-bottle ideal for trekking.

Metal drink-bottles are the trick and can be purchased on arrival or before leaving (avoid single use plastic bottles due to their environmental impact). The great thing about Metal Drink bottles is that when you arrive at the tea-house in the afternoon, the kitchen can fill your bottle with boiling water to place in your sleeping bag to warm it up. When you go to bed, simply remove it and it will cool overnight ready for the next day. I wouldn’t recommend plastic bottles for this purpose.

While you want to avoid alcohol and caffeine as they can increase dehydration, a few cups of Chia (Nepali tea) or soft-drinks can also supplement both hydration and calorie needs.

7. Sunburn

Sunscreen all the time even if it’s overcast (in this day and age – enough said?). Wear sunglasses to protect your eyes & a Blistex with SPF for your lips.

If you take precautions for these types of issues in the preparation and duration of your trek, not only will you give yourself the best chance of success, but you will make every step even more enjoyable.

Afterall, it’s about the Journey not just the destination.

Happy Trekking!

When Nature Calls, It Won’t Get Lost in Translation

Questions About Trekking in Nepal That You Are Too Afraid to Ask

For some reason, the topics of poo, wee and bottoms seems to be either the subject of childish jokes or only discussed at the Dr’s office. But just for a moment, let’s get serious and talk about something that effects us all – the call of nature. If you like to plan ahead or have travelled to developing countries before, chances are, you’ve already experienced or thought about what the toilets will be like.

If you are thinking of joining us in Nepal, you’re probably especially curious about Out Houses there.
Most of the time, we don’t give much thought to our daily visits to the Lavatory. But habits and expectations surrounding relieving onself can change considerably across countries. Often it’s hard to ask these questions for fear of seeming ignorant, and instead we silently stress about them. BTW, Some poor folk face this fear on a daily basis: parcopresis is a fear of defacating in public places while paruresis is a fear of urinating in public places.

Your Travelling Toileting Profile

Type 1: The Fully Prepared

Those who really care (or worry) about the type, state and shall we say “accessories” of their Water Closet. If this is you, I have included links to each section where you can jump into your detailed research and know all the ins and outs to fully prepare yourself.

Type 2: Go with the Flow

You’re happy to do your business whenever and where-ever is necessary. The smells and sights of the lavatory don’t phase you too much, afterall, we’re all human. If this is you, I hope you pick up some pointers here to make your travels a little more straight forward. For you, I have condensed this blog in to my 4 Top Tips so you can pick the topic of interest to hone in on it.

Type 3: Quietly Interested

Those of us who live somewhere the between the two extremes; we’re not particularly afraid of the foreign rest rooms, but we’ll take any new tips that will help make our travels that much easier.

My 4 Top Tips for Toilets while Trekking

Toilet Types in Nepal

You will come across all types of toilets while in Nepal from the regular western type, to the Asian style squat toilet. Most however are usually the squat variety (especially when travelling overland). Mid to high-end hotels and cafes will likely have Western style toilets.

Regardless of type, one thing that is for sure: DO NOT FLUSH TOILET PAPER! Nepal is an ancient country and the plumbing cannot handle it. It will clog the system. You will need to put the paper in a rubbish bin (if in a hotel or cafe) or a plastic bag and take it with you if there isn’t a bin available.

For an in-depth description of what toilets are like in Nepal, I highly recommend you checkout this article by gogoguano.com – a website dedicated to teaching you how to use toilets while travelling.

https://gogoguano.wordpress.com/2016/10/16/toilet-guide-nepal/

Which brings me to my next tip.

Toilet Paper Vs Water

Many countries in the world prefer to use water over toilet paper as a more hygienic and sustainable approach to toileting than toilet paper. If you don’t think you go paperless, or you find yourself without toilet paper, simply bring a roll of toilet paper with you. I also recommend a few small plastic bags (nappy sacks from the baby aisle work well and they’re usually scented too) and a small tube of hand sanitizer to keep you going.
If you use water, you are expected to let your bottom air-dry. I have to admit, I got a little tired of having a wet bum. So in the colder months my personal preference was to use a combination of water washing and then a little pat-dry from toilet paper.

For a great education on how to toilet yourself using the water method instead of toilet paper, read this article.
https://gogoguano.wordpress.com/2016/09/14/a-guide-to-cleaning-yourself-without-toilet-paper/

And that leads me to the next important subject…

Left hand Vs Right hand

Left hand is for wiping & washing your nether-regions, and the right is for eating and greeting. Before my first visit to Nepal I would stress about using the wrong hand and the wrong time and committing multiple social taboos and horribly offending the locals. I can tell you this – once my left hand was involved in wiping and washing a Number 2, I couldn’t forget it. In fact, I don’t think I looked at my left hand the same way again for months…

Secret Women’s Business

I think it’s safe to say that at the very least, many women find having a period a little inconvenient, especially on trek. But I’m lucky – for many, it can be painful and even debilitating. If this is you, I highly recommend consulting your doctor for solutions as soon as possible to rule out endometriosis or other medical conditions.

Although menstruation is a taboo subject in Nepal and not easily discussed in public (more on that later), I easily found and purchased sanitary products from roadside pharmacy stores, albeit a limited choice. For short visits like ours, it would likely be much more convenient to take your favourite products with you.

Consider that sanitation in Nepal is far from perfect and it would be a good time to consider more sustainable alternatives such as a menstrual cup like the Diva Cup. http://divacup.com/ (this specific product was recently introduced to me by a friend when discussing this very topic, and I have to say it is my new favourite thing in the world – consider it, trekking or not!) So give the Menstrual Cup a thought – they can be purchased online or from an increasing number of Chemists. Not only is it far more sustainable, but it will require less frequent changing and they are becoming more common place in Nepal.

To Illustrate what I mean about typical sanitation;

One night in Kathmadu, I was at a friend’s house when her sister called out “I’m just going to toss the garbage” as she walked out the front door with a bag of household rubbish. I imagined a scenario much like home where we wheel the bins out every Wednesday night (ok, so more realistically, in a mad rush Thursday morning). Except she literally was going to “toss the garbage” into the street. You see, there was a specific spot near an intersection that people tossed their household garbage. Stray dogs would pick through it for morsels of a meal. Rats sporadically scurrying in the background. Occasionally someone would attempt to reduce the pile by setting it on fire. In fact, on a similar garbage pile in another part of town, a dead cow had ended up on one. Eventually it would get big and obtrusive enough, so a truck (I’m assuming government ordered one?) would come and shovel it up and take it away. And the cycle would start again.

Spare a thought for many Nepali women. Even though it was officially outlawed, the traditional practice of Chhaupadi is still common place. This is where menstruating girls and women are banished to small huts outside the family home, sometimes resulting in disastrous consequences for the women.  http://www.abc.net.au/news/2018-03-10/chhaupadi-nepal-menstrual-cup-revolution/9531814

Sometimes their diet is severely restricted during this time and they are also not allowed to touch men or cattle or enter the kitchen. This is more entrenched in religious families and village communities, who think of menstruating women as dirty and unlucky and will blame misfortune on them. I am happy to say I didn’t experience any of this personally when I lived there and attitudes are slowly changing.

Why Retreat to Bali?

October is our first ever PhysiYoga Retreat and we’re going to beautiful Bali.

Why Bali? And why go on a retreat?

I created this retreat is because making change isn’t easy. Serious change that is. Sometimes it requires a kick-start to get momentum in the right direction. After all, a good idea and a good intention need a good dose of motivation to get them off the ground. So maybe you want to go a bit deeper into your yoga practice – to move more and feel stronger.

But perhaps you’re also limited by what your body allows you to do. So this retreat is aiming to combine a therapy stream for those needing some extra support for their aches and pains, as well as a yoga stream for those wanting a deeper challenge.

This short-stay in Bali (family friendly and during the school holidays) will be a time to pause, reset and create some necessary changes in your body to start achieving more. Have a girls week away. Or reconnect with your partner.

Bali is the place to do this as it is now a Yoga haven, recognized as one of the health and wellness destinations of the world. Diverse healthy food, exotic weather and warm welcoming people with a beautiful Hindu influence gently appearing through the art and temples around you. Sure, you might sweat, but chances are you won’t really care. (When I’m there I don’t wear makeup, or just maybe a little for a date night). Don’t take my word for it: Here’s five reasons why Yogi’s love Bali.

The format for this retreat allows us to find a balance for the “me time” with the “we time”: time for ourselves, so take care and look after us. But then valuable time to reconnect with someone important in our lives. If we don’t do this regularly we risk burnout and our relationships and family life suffer. One of the problems with burnout is that we often don’t even  recognize it as burnout – we just feel “funky” or like we’ve lost our Mojo.

And if you’re self employed, it is ESSENTIAL to protect your Business Mojo! Your livelihood and sanity (at the very least) depends on it. Just this year I (finally recognized) I was suffering the beginning of burnout. But not before my health had started to deteriorate and family chaos was enveloping. My husband urged me to look after myself and used this metaphor: “You better not jump off the bus, because if I’m driving, then we’re all going over the cliff!”.

So I did. I looked after myself and I’ve distilled what I did into this retreat to share it with others.

Somethings can’t be put off. Take this advice from the Dalai Lama when he remarked that Man (as in, mankind) is in fact the most surprising thing in this life:

“Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”

It’s important to start NOW. Look after yourself. Protect your mojo.

If you want to get moving more. Reconnect with a dear friend (or the family), now is the time to make a change that you’ll thank yourself for later.

I’ll see you in Bali.

x

Emily

 

Happy New New Year!


This year I discovered that I’m not a fan of the New Year’s Resolution. But I’m not about to throw the champagne out with the party cups. Perhaps we can capture the discontented feelings that arise and trigger us to jump into a New Years Resolution and instead channel the energy to create longer lasting change.

As February starts turning into March, and hot cross buns have been hitting the supermarket shelves for weeks, I’m already wondering where this year has disappeared to. Our New Year Resolutions could may well be a distant memory.

The New Year & Resolutions

Whether you celebrate it or not, love it or loathe it, the New Year is an event that punctuates the Calendar year. Between every other month, we seamlessly (and sometimes unwittingly) transition from one month to the next. December 31 stands out like a sparkler in the night sky, when the fun and frivolity of the “silly season” draws to a crescendo. We take stock of where we are in life and where we want to be.

It just so happens that it is also a time of general overindulgence (food, drink, fun and lack of sleep), which eventually generates feelings of discomfort and discontent. For some of us, we might start considering study, a career change, quitting our job, booking a trip, buying a gym membership, starting Yoga or taking up running. Or all of the above. And perhaps we even make a New Years Resolution to make it happen.

With the chaos, confusion, joy and overindulgence of the season still reverberating through us, is this the best time or head-space to be making serious commitments and long-lasting, successful changes?

Losar

Me wearing the traditional Tibetan Dress for Losar with my Nepali “sisters” – Mingmar (with baby Kesang) and Pasang.

Losar (Tibetan for “New Year”) is a Tibetan Buddhist festival which can last 15 days, celebrating the Lunar New Year. Losar occurs on the first new moon between 21 Jan and 20 Feb and celebrations range from 3 – 15 days. This year, Losar starts on 16th February.

Losar was an ancient winter solstice celebration until perhaps the 16th century when it was moved to coincide with the Mongolian and Chinese New Years, the date of which are calculated by the Lunar Calendar (if you’re wondering about the difference between the Solar and Lunar Calendars, see the notes below. BTW – it’s currently the Tibetan Year 2144).

Losar is celebrated to bring good fortune for the year ahead. Each year is assigned an element (Earth, Fire, Water, Iron, Wood) and an Animal (rat, ox, tiger, rabbit, dragon, snake, horse, goat, monkey, rooster, dog or pig).

To prepare for Losar, families thoroughly clean and declutter their homes and decorate them with flowers. They settle outstanding debts. They sort-out old grudges. And of course there’s prayers, blessings, dancing and drinking Tibetan Tea.

New Year’s Resolutions vs Long Term Change

Sometimes things in our life need to change. And change takes effort. Author and speaker Robin Sharma (ofThe Monk Who Sold His Ferrari books) says “Change is hard at first, messy in the middle and gorgeous at the end”.

Making a reactionary New Years Resolution to what was going in at that moment, when we’re feeling discontented is not likely to help us make the changes we need. In fact, the Trasnstheoretical Model of Change in psychology shows that there are six stages of change, which we move through (forward and backward) at different rates.

1. Precontemplation: we don’t see any problems and there’s nothing we want to change.

2. Contemplation: we start to see a problem that we need to address, but we’re not sure that we want to or how we want to make changes.

3. Preparation: getting ready to change.

4. Action: we make the changes.

5. Maintenance: we keep on going.

6. Relapse (sometimes): we go back to our old behaviours and move through the cycle once again.

The New Year may be a time that triggers us from the precontemplation to contemplation stages where we actually see there is a problem in our life and that we might have to make some changes. This is a good thing. But forcing ourselves to make random changes without giving ourselves the time and space to live in contemplation and preparation is essentially rushing us through stages 3, 4 & 5 and suddenly we’ll be relapsing and giving up.

Losar and Change

Losar is a few weeks after the Solar New Year so it gives a little time and space to work through preparation and action stages. So if your 2018 hasn’t quite gotten off to an ideal start I invite you to start again with a little Tibetan flavour: tidy up, declutter, settle old debts and grudges. Think about what changes you want to make and make some goals of how to get there.

But in all honesty, it is another random date on the calendar. I invite you to start your own Personal New Year on whichever date you choose. Whenever your New Year starts, I hope it’s a great one.

Happy Losar!

x

Emily

Side-note: Lunar vs Solar New Year

The Solar Calendar (that we are used to) is determined by the sun – or rather, the Earth’s revolution around the sun. Because of this, the seasons always fall in particular parts of the year. We know that July 100 years ago in Australia, it was Winter. In contrast, the Lunar Calendar is dictated by the cycles of the moon: the first day of the month is always a new moon, the full moon lands in the middle of the month. The annual lunar calendar is set to 12 rotations of the moon, but this doesn’t quite match with the time it takes the Earth to orbit the sun. Thus, if you stick with just the lunar calendar you will find the seasons fall out of sync and over time, the season start to drift to fall in different months. The solar calendar falls out of sync with the phases of the moon.