I recently found myself rushing along with several doctors and nurses to the changing rooms to prep ourselves for an emergency C-section surgery. Dr. Bikash Gauchan was already in the operating room (OR) ready to perform the surgery. The baby’s heart was beating very rapidly; until he could take out the baby, every moment that passed would result in more fetal suffering. The pregnant woman had travelled for at least 4 hours to get to Bayalpata Hospital, built in the middle of green mountains in the Hills region of rural Nepal. Bayalpata sees at least 500 patients a day. Dr. Gauchan managed to take out the baby in record time. When the baby came out, his skin looked blue and his body was covered in meconium, a dark green substance formed from his first feces, which if aspirated can cause breathing difficulties. He was given to the nurses and doctors, who resuscitated him. All of a sudden, the baby was crying. Had the baby stayed longer inside the womb we would be reading a different ending for this story.
While I was in that OR I had the same feeling I constantly have while working in Mexico with my colleagues: that everybody is giving their best, no matter what.
I had the opportunity to visit Possible in Nepal in September 2018 as part of the HEAL fellowship. I became a HEAL fellow in July 2017 because I work in rural Mexico at an organization (Partners in Health Mexico) that fills the gap in healthcare by providing primary care services to marginalized populations in the mountainous and fairly remote areas of Chiapas. We serve people that require antenatal and postnatal care, general medicine consultations and people with non-communicable diseases, including mental health. I serve as the Mental Health Coordinator and when I learned that Possible had a mental health program in rural Nepal I knew I wanted to visit. My goal was to learn from the Possible team and also to share our experience of caring for patients in rural Chiapas. Moreover, two of my class co-fellows are working there: Bikash Gauchan and Pragya Rimal.
My visit to Nepal lasted 12 days. Every day I learned something both from the Nepali culture and from the work at Possible. Pragya was not only very welcoming, but also helped me schedule many meetings with people whose work I could learn from. First of all, I learned that poverty has the same face anywhere you go, of course with its nuances between contexts. For years, people in Bayalpata Valley have had to travel for days to get access to healthcare, but now with the hospital and the community services that Possible helped build, people have a nearby healthcare option. Community health workers (CHW) are also an essential piece to the work, as they visit patients after walking long distances in order to provide them with health prevention information and referrals to health centers. I had the opportunity to shadow one of the CHWs and her supervisor: a community health nurse. We visited houses of people with young children and health problems. There, you could see the magic happening in the middle of a conversation between patients and the CHW; although these interactions were in Nepali, I could still grasp the core part of it, the emotions, the care, the understanding of this woman actively listening to her patients.
During my time in Nepal I also shadowed the consultations in the outpatient unit with the medical officers. I learned about the amazing efforts that Dr. Rekha – another HEAL Fellow – and her team are making to tackle gender based violence. I polished my ultrasound skills in the obstetric ultrasound unit with the most patient nurses who taught me tips to be more effective. I also learned that in Nepal it is illegal to reveal the gender of the baby because parents could abort them depending on their preference. I attended some continuing medical education morning sessions. I met Drs. Barbara Kamholz and Bibhav Acharya, two consultant psychiatrists to Possible and HEAL Advisors. This opportunity, along with what I learned from Pragya about the mental health program, gave me a better sense of the amazing work that the psychosocial counselors, the doctors and researchers were doing; and you could see that mental health was a priority for the staff. Overall, I had the ongoing feeling that I was surrounded by a staff that truly delivered quality care to patients.
One day before I departed back to Kathmandu, we had a small party with staff from Possible in which people cooked traditional Nepali food and paneer and in return I taught them how to dance salsa.
The energy of the way of living in Nepal was quite different from the one I am used to in Western culture. To begin with, people greet each other by saying “namaste”, which means “I honor the divine place within you.” This reveals the overall sense of oneness and spirituality among people and how embedded this world view is in the daily practices. This is the biggest lesson I learned there, a place where nature is respected and there is barely a sense of otherness. This relates to the world we are living in nowadays, where tribute is rendered to what we achieve as individuals and not as a collective, to destruction and fame and not to the sense of humans belonging to something big: humankind. This is one of the roots of why health care is neglected in many places in the world, of why wealth is unequally distributed. This is one of the reasons why I decided to use Medicine as a means for achieving social justice and equity in health. This is my calling, and I am very thankful for the opportunity to be part of something big like CES, where every individual drives their actions for the cause, and a diverse community like HEAL. Our leaders and fellows have dedicated time on the frontlines and some have decided to dedicate their lives for global health for the long-term. And finally, I am thankful for the opportunity to travel to Nepal, and to be welcomed by Possible and by patients, who showed me the urgent needs that still need to be tackled, and also to have seen the kind face that Global Health delivery has on the other side of the world.