GROW: a : to spring up and develop to
maturity. to have an increasing influence. to promote the development of.
-Merriam Webster Dictionary.
Two months in Achham. Two months a world away from what we
are used to in the United States, yet still, it is only two months. Two months
is hardly enough time to understand, to appreciate, and to develop. Yet time
flows differently in Achham and development, both personal and otherwise, comes
sooner than one expects.
Growing up
Personal development is easy when one is starting from
nothing. Before this summer, the world of international development and global
health was very much a rhetorical one, given life only through articles and
essays. In retrospect, despite nearly a year of campaigning and raising
awareness through Globemed, my view of Bayalpata Hospital was significantly
flawed before I actually got there. With all the rhetoric of ‘grassroots’ and ‘community-based’
I had thrown into my prepared elevator pitch, I was a bit unprepared to see a
respectable looking complex with solar panels, tiled floors, that looked, well,
a lot better than what I was expecting, honestly. My mental image was tied up in
the form of the small community clinic that Nyaya started with, but the
hospital has grown, expanded, developed. Nyaya has changed for the better,
expanding and serving more people and as such it has, without us knowing, left
behind many of the phrases we use to describe it.
Growing Out
Our rhetoric emphasizes that Nyaya is a grassroots
organization. It’s a good word, one that really gets people excited. It invokes
images of strong community backing and involvement, small, local roots, and a
personal touch to healthcare delivery. Does that word still apply when if the
small regional clinic has upgraded to one of two district-level hospitals that
serve patients from hours away? Does it apply to the public-private partnership
that is looking to dramatically increase the amount of government funding it
receives, fighting through the bureaucracy to achieve it? Does that word
describe an organization which has a U.S. team of researchers that receive tens
of thousands of dollars in grants to do research that often seems to fly in the
face of reason for the Nepal side? What does the word “grassroots” mean when
the organization grows?
Growing In
The point of a successful campaign is, in many ways, to
paint the scenario in the best light. The danger of successful campaigning is
that it becomes easy to believe your own elevator pitch. One forgets that
organizations are not purely corrupt and inefficient or transparent and
streamlined. Problems exist. Inefficiencies gum up the works. Communication
lines are often tangled and tensions sometimes run high. That is the reality,
not the campaign. And while it is important to frame the organization and the fundraising
goal in a light that will promote action and involvement, it is essential that
delusion does not become an accepted tradeoff. A realistic assessment of
strengths and weaknesses is necessary for the chapter as a whole, not only to
foster a better understanding of our partner, but to better think of ways to
help strengthen the partnership.
Growing Understanding
It is often difficult to describe the demographic Nyaya
serves to others, whether while giving an elevator pitch, or while campaigning.
“Rural Nepal” is hopelessly inadequate. “Under-served” is difficult to
visualize. “Impoverished” gives a one-sided view of the situation. In reality,
no summary for an elevator pitch can capture the full nuances of the Achhami
populace. What’s a short way of saying “subsistence farmer / migrant worker /
tea shop entrepreneurs / impoverished but not starving / hard working and
generous / indolent and self-serving / caring parents / neglectful parents /
victims/perpetrators of gender inequality / happily married / domestically
abusive when drunk / bearing great burdens, physical and otherwise / mild
hypochondriacs believing that no pills or tests means ineffective treatment” ?
How do you summarize a caste system that segregates and discriminates, and how
do you give an overview of a younger generation who couldn’t care less about
caste? How can you express the changes occurring, from changing age-old
traditions which harmed women to improving overall health through community
investments, and how can you reconcile that with the cold reality that the more
things change, the more things stay the same in the sense that at the end of
the day, you still have to look out for number one. In a society where males
are valued more, there are parents who love and pamper and cherish their
daughters. In a community where most people perform migrant work or subsistence
farming, there are some who dream of studying abroad and pursuing higher
education. No matter how hard one tries, there is really no way of easily
encompassing the population that Bayalpata Hospital serves, who are probably
the most important detail when describing the hospital’s care.
Growing Pains
If a hospital runs out of medicine in rural Nepal, does it
make a sound? Poisonous snakes are, unfortunately, all too common in Achham.
The problem was exacerbated by a country-wide shortage of antivenom. So when,
one night, a member of the Armed Police Force came to the hospital with a snake
bite, what could be done? How must it have felt, knowing that if only there was
this small vial of liquid, everything would be all right? What sort of terror
and anticipation must have filled that officer’s heart when, in the middle of
the night, he was told that there was a chance, a CHANCE, that the other of two
district-level hospitals in Achham MIGHT have antivenom. That is the stuff of
nightmares. Often, donations and campaigns are run for projects that are sexy,
that are popular, that are easy ways to pluck peoples’ heartstrings and their
wallets. But basic issues of supplies and logistics are sometimes more complex
than a single hospital can handle, and sometimes the simplest things are the
ones that need the most attention.
Growing
forward
Growth can be tough, and Nyaya fits all of the descriptions
of growing. It has come to maturity, both scaling up in physical size and also
in scope of services, going from a small clinic in Sanfe to being awarded “Best
Hospital in Nepal”. More and more, Nyaya has increasing influence in both the
region, and also the nation, through its work with the government. Through both
Nyaya Health Nepal’s work with the government and also through Nyaya Health
International’s work in implementation science, Nyaya works to promote its core
values of transparency and efficiency in delivering healthcare to those that
need it most. But growing can be difficult. Growing pains are normal. Nyaya
faces challenges that it must overcome, from communication to employee
retention. But growing also means new opportunities, for both Nyaya’s efforts
in Nepal, and also for Globemed at Tufts to be as useful as we can for our
partner. Whether or not we seize these opportunities and minimize the
associated growing pains is up to us.