Viet Nguyen, MD, MPH, HEAL Fellow 2017 – 2019.
Growing up in rural Nepal, Dharma never thought that one day he would be inviting menstruating women into his home. But the path to being a true agent of change isn’t always what you initially envision. Dharma originally wanted to be a doctor, but due to a lack of time and resources, he studied business and commerce, thinking he could instead work as a banker. Although it was never a goal of his to return to his village in the rural district of Achham, he did so to help care for his elderly parents. Despite limited employment opportunities in Achham, Dharma managed to find some work as an interpreter, which eventually connected him to the non-profit world. He was able to work on HIV anti-stigma campaigns, prevention of maternal to child transmission programs, and enjoyed being involved in partnerships that allowed him to be impactful in healthcare delivery, a passion he had shelved before he even started.
Now, a Partnerships Associate at Possible Health, Dharma spends part of his time producing content for donors and capturing the meaningful work that Possible has done in the community, which is how I first met Dharma, who would sit across from me at work. This works suits him well, as he carries an optimistic demeanor and a confidence to view others in an extraordinary way. His work requires keen observation, and Dharma feels fortunate to be working in health care because he is able to bear witness to how Possible has helped his village and other villages in the district. It is through his work that he realized the importance of understanding the context of whom you are trying to serve.
Despite being from Achham, Dharma is often viewed by his fellow villagers as somewhat of an outsider, “because I am educated and went away to Kathmandu.” But he has been working and living in his village for the last decade since leaving for school, and the reputation of Possible Health as an important presence to the Achhami people has also strengthened over the last decade. “Even though I’m from here,” he explains, “I never knew about the culture in my village.” It is not until he returned and spent time in Achham – working in the villages, interviewing patients – that he learned about the culture of stigma and violence against women. Dharma is referring specifically to the practice of Chhaupadi, which has recently been featured in the global news media.
Defined as the practice of banishing menstruating women to unsafe huts or sheds due to cultural beliefs that surround uncleanliness and unholiness, Chhaupadi has been made punishable by law in Nepal, within recent months. Many villages in rural areas have been declared, “shedless,” suggesting they are entirely free of this custom; however, Dharma has yet to see this being fully practiced. “An international NGO came into some villages and destroyed all the sheds,” he mentions, with a grave look in his eyes. But the beliefs of the people, including the women and girls who are banished, keep the villages from being truly shedless, despite the fact that Chhaupadi has been banned by the Nepali Supreme Court for many years. “They just reconstruct the sheds,” he reports with frustration.
One of Dharma’s projects involves addressing this disastrous example of gender discrimination. He is part of Possible’s Gender Equity Committee to work on this progressive, bold, but necessary mission. It’s one thing to go to your work place and engage in advocacy work, but was Dharma practicing it in all aspects of his life? “I realized, I’m doing all this work, and saying all these things at Possible, but was I living it? I realized, it starts with me.” At a village gathering during a popular Nepali holiday, Dharma had the microphone and was singing a song. I can easily imagine him, his usual gregarious and cheerful self, with matching boyish charm, entertaining the crowd. “I enjoy singing. They enjoyed it. But then I kept the mic and made an announcement.” Dharma told the entire village that he was against the practice of Chhaupadi, and that if women were banished from their homes during menstruation, they were more than welcome to his own home. He told them, “You can come to my home and they will all see that nothing bad will happen.” This resulted in a largely unsupportive response from both men and women. “Most of them were silent. Some asked if I was drunk. I was not.”
Dharma describes this practice as propagated by humans, and not by facts. “I was raised watching my sister go to the shed, because it was what we knew. But we get older, and we learn new things, and we must change. Just because older generations do these things, doesn’t mean we have to do these things.” Since he made the announcement to his village, one woman who had been banished during menstruation, was seen talking with Dharma outside of his home. And despite a few stares, he has yet to see how this will pan out. “She was too scared to come in my home because she can’t even go in her own home.”
Although Dharma realizes that the resistance to his progressive offer to menstruating women will take time to dismantle, he is more than willing to stand up for what he believes is the right thing to do. He is in a unique position of both being from the community he serves, but also working as an outsider. He understands that his privilege of being an educated male working for a non-profit allows him the comforts of avoiding complete ostracization from the community. And he understands the roles that hierarchies of caste, power, and privilege play into his ability to resist Chhaupadi both in name and in practice. However, he remains hopeful that Chhaupadi will eventually become obsolete.
Dharma’s story highlights a few factors that will start to slowly contribute to a cultural shift in practice. It includes being flexible, practicing honest self-reflection, and fully understanding the cultural context and barriers that these women face. This is a concept that has proved difficult even for someone who is from the community he is trying to impact, let alone a group of well-intended outsiders simply destroying all Chhaupadi sheds in a village.
And perhaps, our roles in the global health movement should be more focused on people, like Dharma, who are at the margins of being both an insider and an outsider, in order to be more effective in fostering change. As I’ve learned from Dharma and others like him, change involves truly recognizing the true root causes of a deeply-seated cultural practice in their actual context and not in a vacuum. It involves leverage, patience, and being comfortable with the uncomfortable.
Change is very hard, and doesn’t happen quickly, but Dharma remains optimistic despite many setbacks. “We just need time,” he insists. “Change will come.”