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.
My field experience gave me the opportunity to visualize and understand concepts that had been discussed in class. I was able to perform evaluations, data analysis, and community assessments based on the skills I have gained from my prior coursework. As a doctoral student, leadership is at the core of our curriculum, and we had often discussed different leadership styles and work cultures, this field experience gave me a better perception of just how varied and important this aspect of leadership is to increase work efficiency.
The initial aim of my main project was to review trends and surveillance on Non-communicable diseases (NCD) in Zambia. However, due to the unavailability of an NCD database and the availability of a cancer registry, the project was re-focused to review trends and surveillance on cancers in the country.
Most people would argue that the bare necessities include water, food, and shelter. Everything else is a bonus (well except sleep - I would argue sleep is essential too and hot water also, but I digress). Nonetheless, comparing the resources of the AIC Hospital in Kijabe to my home institution (Vanderbilt Medical Center) would be grossly unfair.
On my first day at work, the WHO-country representative fondly called ‘WR’, received a report of an outbreak on the outskirts of the capital where we situated. The outbreak was reported to have started near an elementary school in the Kanyama district (a slum on the outskirts of the city). The index case was an 11-yr old boy who died 3 weeks prior to the day the WHO received the outbreak notification. The index case was diagnosed post-mortem with Typhoid. Symptoms were: headache, fever, diarrhea and abdominal pains.
As a surgery resident, we encounter patients from many walks of life; a common language and time give us an opportunity to build a bridge, to perhaps not stand in each other's shoes but strive for that, to connect. One of the things that drew me to this career path was not simply the surgery, but the journey of taking a patient pre-op, through their operation, and caring for them as they recover. That journey is built on language, the explanation of their disease, of the operation, of the risks of that operation, and the challenges we face together after their operation. How to overcome that distance here has been a hurdle that I would say I have still not successfully cleared.
“Where’s your team?” the man asked. He was a surprising figure to see on this gray rainy day in Kijabe, standing about my height casually just off the middle of the road, looking onwards at the soccer, or as the rest of the world calls it, football game a few yards away. He was dressed well to be out in such weather, a formal black suit, collared shirt and tie, eyes lighting up as the orange and yellow teams chased the football from one side of the field to another amidst the big juicy rain pellets.