Last week, I traveled from Dhulikhel to Dhadingbesi, the center of one of Nepal’s more remote districts, Dhading. One Heart Worldwide has supported the upgrading of many of the health facilities and birthing centers in this area and has also funded training for many local birth attendants, nurses, and other healthcare providers in the region. With the assistance of One Heart’s talented, good-humored field training officer, Malati Shrestha, who gamely put up with my love of walking despite her preference for the bus, I spent the week visiting many of these health centers, observing the physical buildings, performing needs assessments and quality of care analyses, meeting with the skilled birth attendants, auxiliary nurse-midwives, and nurses who provide maternal care, and assisting with skill development as well as providing hands-on patient care.
Many people I know, both here in Nepal and back in America, ask me why I am drawn to global health and development work, especially in light of the inherent difficulties of such pursuits. My Nepali friends cannot understand why anyone would voluntarily leave what they perceive to be the abundant comforts and riches of the United States in order to work in a country with limited resources, endemic corruption, myriad systemic challenges, and a lack of basic necessities and rights, such as gender equality, accessible healthcare, running water, and effective sanitation.I try to explain to them that I enjoy helping those in need, that I find answers I do not even know I am looking for when traveling, and that America is currently also dealing with a flood of social and political problems, and thus is not the proverbial Promised Land that those in the developing world frequently perceive it to be.
Women are, by and large, second-class citizens in Nepal. In some families, they rank more on the level of third-class citizens, as they are valued below both the men and the livestock. Simply being female here seems to mean that you are supposed to give up your seat on the bus to any man who wants it, keep your legs crossed, your eyes downcast, and your behavior in check in order to avoid stirring up male lust, demurely apologize should you dare to voice an opinion (or even to state a proven fact) that goes against the beliefs of any man in authority, and dutifully pray every morning for the blessing of sons and the long life of your husband.
When labor pains started for Anjana, 20, she had no idea her life was at stake. She was 36 weeks into her first pregnancy and felt contractions for a full day before her family called for the midwife. By then, she was well into an obstructed labor – a potentially fatal condition for both her and the baby.
For most of the two-hour flight from Geneva to Dublin — as soon as the seatbelt light blinks out — Mark Dybul does not sit. He stands in the aisle, flush against his own armrest, thumbing at his smartphone, while flight attendants and passengers squeeze past. He’s wearing a crisp gray suit, white shirt, and white pocket square. His side swept blonde bangs are thinning but cut across a youthful face. A multicolored United Nations pin clings to his lapel.
At a Senate Committee on Appropriations hearing in June, Sen. Lindsey Graham (R-S.C.) made the case for continued U.S. investment in programs like the President’s Emergency Plan for AIDS Relief (PEPFAR) to end pandemic diseases. “As a Republican, I’m proud of President Bush, who came up with a program called PEPFAR,” he said. “The return on the dollar for the PEPFAR program has been absolutely astounding.”
This week, I’m in London to mark an important milestone. Five years ago, leaders from all over the world came together to insist on making family planning a global priority. Together, we made a promise to enable 120 million more women and girls to use modern contraceptives by 2020 with the goal of achieving universal access to contraceptives for everyone, everywhere.

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