Matching Ideals with Systems – an interview with Uday Kshatriya of Possible

by Dr. Stephen Mehanni

“I am a servant of Achhami people.” Uday Kshatriya replies to my question: how do you define yourself as a person? Uday is a senior Health Assistant in his homeland of Achham, a remote district in Far-Western Nepal. He has worked for almost a decade with Possible, a nonprofit healthcare organization delivering high-quality services free of charge in rural Nepal. I sat down with Uday to learn about his life, his motivations, and his experience as a healthcare provider in Achham.

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Uday describes a formative childhood experience which ultimately drove him to pursue a career in healthcare. “When I was small, my friends had grandfathers who used to love them. And I would wonder, why don’t I have a grandfather?”   Uday learned that his grandfather had died of cholera before he was born. He learned from his father that many Achhami people died of cholera, a diarrheal illness, because there were no treatments available. “So that inspired me. Why do people die there? Because they don’t have doctors in Achham. My thought was to become a doctor.”

Uday soon learned that the cost of medical school in Nepal was unaffordable for his family, putting his dream seemingly out of reach. He chose to earn a 1-year diploma in alternative medicine, and gained several years of practical experience working with a physician in Maharashtra, India. He later advanced his training further with a Health Assistant degree. For a brief time afterwards, he joined his brother as a partner in a pharmacy wholesale business, where “business was going well.” In an attempt to help his community during this time, he would frequently make the long drive into Achham to distribute pharmacy supplies at cost. But he knew he wasn’t pursuing his dream.

In 2007 Uday learned of a new organization promising free healthcare in Achham. Possible was at this time a fledgling organization, based in the U.S. but partnered with the Nepali government, with an ambitious goal of creating a sustainable system to deliver free healthcare to Nepal’s poorest communities. The first site was in Achham district. Uday knew that joining would mean hardship for his brother’s pharmacy business, a substantial pay cut, and distance from his family. But for him the decision was easy. “This was my dream coming to a form. So I decided not to continue my business, and to join Possible.”

Over the years Possible has grown. Its services have reached hundreds of thousands in the community. Uday has been with the organization from their earliest years. He has personally cared for thousands of patients, has benefited from professional development opportunities to expand his scope of practice, and has risen to a leadership position as Health Assistant In-Charge.

He describes his experience in those early years. “I was on-call staff after joining here. Within seconds when I would get the information that a patient has arrived, I would to rush to the emergency department. I was ready at any time to provide health services to our patients. Patients have given me lots of blessings.” It hasn’t all been easy for Uday. He recounts conflicts early on between his Achhami community and non-local staff, which placed him in the uncomfortable position as mediator. He continues to be geographically isolated from his wife and two young sons, who live a full day’s travel away in the neighboring Kailali District.

Uday’s concluding reflections on the past decade: “I’m happy. Because what I have gained I have gained from the community. Their blessings. Not more than that. Salary is good. I can take care of my children. So I am satisfied.”

Uday tells the story of someone who wanted to help his community. Wanted to serve. Wanted to make an impact. Prior to joining Possible, he was someone who found himself in a system in which he was only partially achieving these goals. But the idea of a system that could empower him to serve his community in a way that aligned with his ideals: that was strong enough to uproot him from his family and comforts.

In a way, Uday’s story is the story of many of us in global health. Stories of positive intention combined with a sense of inefficacy. Stories in which we are frustrated by the systems that surround us; systems which seemingly impede rather than enable. We are frustrated by the lack of opportunities for growth, as we are increasingly confronted by the limitations of our roles. In these stories, we are drawn towards environments in which our intentions can be harnessed to make an impact. And that is why we feel so empowered, uplifted and enlightened when we find ourselves within a system that can enable us to achieve our goals. One that recognizes what truly motivates people, and aligns with our ideals.

Possible is creating this context for Uday and others in rural Nepal. The HEAL Initiative is creating this context for myself and others, passionate about health equity. For me Uday’s story acts as a reminder of the importance of intentionality as we create our systems. So that we are creating environments in which our ideals are the driving forces, and where inspirational people like Uday are given license to inspire.

 

The HEAL Initiative has partnered with Possible for the past two years. To learn more about Possible and its healthcare system click here.

 

 

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