I get around
I get around
In this issue we continue our regular 'I get around' series. Every month, younger Association members will tell stories of where they are, what they are doing, who they have met, and why they believe or hope they are doing valuable work. This month it's Seva Khambadkone, just graduated from Ohio State University, on the beginning of her gap year in public health service.
Karnataka and Boston. The idea in social justice is that we are all our brothers' keepers, so that, as members of humanity, we have a responsibility toward each other. This has never more apparent to me than this July, when I visited my family in Karnataka, India. Sitting in the family home first built by his grandparents' grandparents, had awoken nostalgia in my father. I had been busy through the trip writing medical school application essays.
My father's Indian childhood
Family background in Dandeli, India
Here I am (striped top) with my sister and my dad (right) and his uncle, brother, and nephew. The house we stand in front of is my grandmother's family home. My father grew up in Dandeli, a town of Karnataka, India. Karnataka, formerly the state of Mysore, which is coloured yellow in this map, is in the south-west of India
My parents moved to the United States in 1986, where I and my sister were born in 1989 and 1995 respectively. Here is a picture of us taken from last Christmas
Hearing me describe my work in rural Nicaragua, my father began sharing stories about his own childhood in rural India. I had heard many of these stories before, but now he told a new one that struck me. Referring to the paediatric feeding programme my organisation partners with in Nicaragua, he told me that he too had been a participant in a school feeding programme.
I had known that my father's family was poor. When as a (slightly, and admittedly!) spoilt child I would whine about a toy I just had to have, he would tell me about my fortune compared with so much of the world, about the two outfits he owned, and the room he shared with four siblings when he was my age. These lessons of global inequity are partially what led me to apply my interest in science to an aim of social justice. But somehow, despite my undergraduate studies on the relationship between health, nutrition, and socioeconomics, I had never considered the impact of my father's poverty on his own health. I now imagined him without this feeding programme, tired and unable to focus in class due to anaemia, missing days of school due to illness from a weakened immune system and body.
This imagining of my father's childhood may have been exaggerated, but I knew that it fit the lives of hundreds of millions of children in the world. Without the school feeding programme, he, like those hundreds of millions of children, may not have succeeded in school, earned a merit scholarship to college, and achieved the immigrant's 'American Dream'. In which case, I would not now be eating a bagel in my Boston apartment while writing how I 'get around' on my new MacBook.
My time in Ohio
Recent times at university in Ohio, US
Here I am in the front row (left) in June this year, standing in my graduation robes, with some of my closest friends and mentors at Ohio State University. At right (in red) I am being recognised for my undergraduate work in nutrition and development in Nicaragua, together with several distinguished OSU students
The timing of my father's story made it even more special for me. I had graduated from Ohio State University in June, and a week later moved out of Ohio for the first time in my life to Boston, where I'm working as the development assistant for Nyaya Health, a health non-profit serving resource-poor far-western Nepal. This autumn I'll make a bigger move, to Nicaragua. There I will work as country director for Project Nicaragua, a US-based non-profit working toward equitable health in the country, where I will be conducting public health nutrition research with the AMOS Health and Hope community health non-government organisation.
Throughout college I dedicated my extracurricular time and much of my classroom study to issues of social justice in health. I started my university's chapter of a global health non-profit, organising several service trips and long distance projects in rural Nicaragua, and added minors to my science major in public health and international economic development.
But I believe there is a limit to what can be taught through academic minors and limited extracurricular time. Before entering medical and public health nutrition school, and devoting my career to the pursuit of global health equity, I want to develop my understanding of the world. I want to understand the interaction between the social and physical aspects of health, and the breakdown of this interaction that is causing so many of the health challenges facing marginalised populations today. I want to mature beyond good intentions into a more capable partner in the collaborative global effort toward social justice and equitable health.
My work for Nepal
This immersion has begun though my current internship at Nyaya Health. Its belief statement reflects one of my own dearest beliefs: 'Without health there can be no dignity or opportunity'. Though still up-and-coming, it is world-renowned for its transparency, innovation in low-resource health delivery, sustainability, cultural sensitivity, and overall effectiveness. And I'm not just rattling off a list of public health buzz-words here. Working with Nyaya Health I have seen these values of social justice in action. A total of 96 per cent of donated funds go straight to the Nepal programme, nearly unheard of for an organisation with an annual budget of over $US 1 million. A total of 155 Nepali staff are employed by the organisation, with over 80 per cent recruited locally from far-western Nepal. So far, over 101,000 people have been treated at Bayalpata Hospital, all for free.
Nyaya Health is associated with Partners in Health, co-founded by Paul Farmer of Harvard University, who has spent much of his professional life working in rural Haiti. It works to improve health and health systems in the resource-poor Achham district of far-western Nepal. Achham is an extraordinarily under-resourced region with little development or infrastructure and dire medical need. Among the slew of health challenges faced by local communities, high rates of HIV/AIDS and tuberculosis, maternal mortality, and child malnutrition are some of the most pressing.
Nyaya Health has been working in Achham since 2008 to address these immediate problems and to build the necessary infrastructure to reduce future incidence. Since 2009, its prople have run the region's only hospital, Bayalpata Hospital, to provide full inpatient and outpatient services to over 35,000 patients per year, and a parallel female community health worker programme to provide preventive care for 20,000 more patients per year. As the development assistant, I work on partnerships and grants to support our health programmes.
Adding to my father's story are stories of men like Netra Kunwar, who was born in Achham and has returned here after his education to work as Nyaya Health's administrative director, helping bring equitable health care to his childhood community. Or Ashma Baruwal, who realised a passion for grass-roots health work and quit a potentially lucrative career in pharmacy to study community health and lead Nyaya Health's community health worker programme, seeking to be 'part of an organisation that was in a real way making a difference in the lives of the people in this corner of far-west Nepal'.
Then there are the stories of the community health workers themselves, local Nepali women who devote time and energy to reach out into their villages, conducting preventive education services, referring patients to the hospital, and assisting with patient follow-up visits. And then there are the stories of the mentors I work with every day, executive director Mark Arnoldy and physician leaders Duncan Maru, Dan Schwarz, and Ryan Schwarz, who believe in the right of health and further, act to achieve this right in a marginalised, destitute region, who sign e-mails 'onward and upward' and pursue health equity with humility and humour every day.
Nyaya Health in Achham, Nepal
At left a Nyaya Health community health worker measures the mid-upper arm circumference of a child. At right is Bayalpata Hospital, established in 2009
This June Paul Farmer (centre, above) celebrated three years of Bayalpata Hospital, with country director Gregory Karelas and Nepali staff. At right is Nyaya Health co-founder Duncan Maru and us interns with Fahima Aziz and Katsuki Sakai, Vice-Chancellor and associate director of the Asian University for Women
It is these people and so many others on the Nyaya team who have created a culture of efficiency, empowerment, and teamwork, who are dedicating their lives to making these values the standard of social justice health work.
Immersed in this environment, my own approach to global public health is changing, developing in me each day the tools of the social justice trade, and the skills to back the concepts I have always believed in. Writing grants alongside the Nepali health team, I learn first-hand the importance of intercultural collaboration in sustainable community health delivery. Completing finance documentation for the public, I hear stories of partners and donors who were drawn to us for our transparency, and I see beyond the buzz-word of 'transparency' to what it actually means. Developing partnerships, I develop my own skills in interdisciplinary teamwork, in working with others toward a shared purpose.
Nyaya Health hosted global health giant Paul Farmer to come to in Nepal in June, to celebrate the completion of a new surgical centre, and the opening of far-western western Nepal's first microbiology laboratory. It was his first time in Nepal. He said: 'For those who reject cynicism, including those we've been lucky to work with from Haiti to Siberia, from the Navajo Nation to Rwanda, and from Roxbury now to Achham, the dream of global health equity takes root and grows wherever we turn cherished social goals into pragmatic efforts to meet them'.
In the field of global health, I am specifically interested in the relationship between early nutrition and neurodevelopment, within resource-poor communities. I graduated with a BSc in June with a major in molecular neuroscience and minors in public health and international economic development. After this gap year I will go on to medical and public health schools, to earn an MD in paediatric neurology and an MPH in public health nutrition. In my career I plan to combine medicine, clinical research, and policy work, to study the neurocognitive consequences of malnutrition, and to implement effective, research-based programmes to address these consequences in underserved communities.
This gap year, and my father's story that for me began it, will allow me fully to immerse myself into under-served health work, to learn from the stories of the patients and health workers I meet, to work alongside people with backgrounds so different from my own toward a singular aim of justice through health.
As my internship begins to end, I find myself doing a lot of reflecting. Intentions are wonderful. Feel good concepts, of being the keepers of our brothers (and sisters!), of equity and justice and health for all, are necessary. But without developing the skills and partnerships to fight toward these goals, without translating emotion into action, the dream of global health delivery will simply remain a dream. Action is what fed my father, what is building health systems in far-western Nepal, and is what will push my own fight in neurodevelopment and malnutrition.
I'd say my gap year is off to a pretty good start.
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