Posted by Jeffrey Kaplan
As I sit in the airport on my way home, I can only reflect on how randomly fortunate those of us who just happened to hit the “lucky dog club” (being born in a 1st world country) are. Our personal commitment to sharing our fortune of high quality, readily available healthcare and the directly related overall safety is often only reinforced by bearing witness to the efforts of those who courageously step into the ring day after day in extremely challenging environments to save lives and in turn combat the inequity that exists outside the comfortable walls of our homes.
It took 28 hours to get from JFK to my hotel room in Kathmandu. A long journey by some standards, but in reality, a relatively comfortable one which includes shelter, safety, nourishment, and healthcare if needed. After a short hiatus in KTM, we headed to Achham, which took another 28 hours including stopping for the night. Those same comforts from my prior trip were not as evident if somehow things went wrong on this 2nd leg.
Fortunately we arrived safely, and all seemed in order. Nyaya’s Bayalpata Hospital was not the typical rural poor hospital that I had seen in the past in other under-served countries. No, it wasn’t NYU Medical Center and even without a medical background I could see that there was much to be done at this young oasis, but there were seemingly adequate staff, basic supplies, pharmaceuticals, a strong sense of hygiene, a commitment of growth (to bring a full toolbox of basic health needs to the citizens) and an unwavering standard of a dignified approach of providing healthcare to its patients and their families regardless of the seemingly impossible circumstances for both provider and patient. Some or all of these are almost always lacking at rural health facilities in Nepal and elsewhere. And all of this under the position that healthcare is a human right and that unpayable user fees will only serve to deter patients who have no other options from seeking medical assistance when they need it most. Everyone is welcome here, and no fees apply. Although some may argue that user fees are the only way to build long-term, sustainable healthcare facilities (and they may be correct), with the average income in Achham district at about $0.50 USD per day, user fees today will only result in one thing at this time – no healthcare at all for those in need. The region would return to the same situation that existed before Nyaya Health, and that would continue to exist today without it. Say it with me…unacceptable.
I was looking forward to watching the hospital run for the next 4 days, to see for myself how the different departments ran, how the staff handled the long hot days, who showed up for treatment, how important this facility was to the community, what Bayalpata could handle capacity-wise, what needed to be referred out and how difficult those referrals would be to actually implement, etc.
But as it turned out, things took a turn for me and my aspirations. After about 3 hours in Achham, I started to feel ill. Some bug left me with heavy sweats, weakness, and upper gastric symptoms. Then the massive heat, combined with no electricity and a respectable case of diarrhea led to a dehydrating state. The combination of the virus and the dehydration resulted in a bed-ridden me. In our world, this is a temporary inconvenience. Under the worst case, you hit the Emergency Room at your local hospital, get hooked up to an IV, and then move on with your life often within a day. Lucky for me, I was at a hospital with adequate care when this happened. But for those billions of people without access to Bayalpata or another adequate facility, the results can be much worse. 2.2 million people die each year due to diarrhea, almost all in developing countries. If it weren’t me, if I hadn’t been at that hospital, if the team from Nyaya Health had never embarked on this venture, I had could have actually died from it. People all around the world are suffering from and dying of preventable and treatable disease. Say it with me …unacceptable.
And then there are the heroes. Personally I felt honored to get a glimpse. I wasn’t going to die, and because I had adequate care, my condition was considered minor in nature. But I watched the team in action and I was one of the beneficiaries. In my room late at night, in complete darkness (no electricity) were 7 Nepalis, all working to change my IV. A simple task, maybe, but we are always at our greatest risk when we are most confident, and in the dark in another language without optimal equipment and without light, there is always risk. And without this hospital, without these workers (95%+ of the full-time workers are Nepali, I might add), the risk is much higher.
And then there was the rest of the Nyaya Health team – Duncan, Ryan, Gregory, Mark, and Sindhya, who all sacrificed their own comforts for that of the visitors and the patients – all of whom made sure to care for me not only under their respective oaths, but also in the spirit of accompaniment that we have all been taught by our sensei, Dr. Paul Farmer. Dr. Farmer made this journey with us to see Nyaya’s successes and challenges, and was also part of my medical care, bringing his expertise and wisdom, his love, and his humor as he always does.
It was a site to see Duncan and Gregory (both 6 foot+ tall) sleeping together side by side on a thin twin-sized blanket (no mattress) in my room to make room for others, and so that Duncan and Ryan could check on me multiple times during the night after their typical 18 hour workday. These are educated, highly seasoned professionals (Duncan and Ryan being residents at Harvard Medical School), choosing to spend every one of their waking moments completely dedicated to these people on the opposite side of the world. Trying, failing, learning, trying, failing, and learning over and over again. Taking punch after punch and never wavering. Not for money, not for power, not for fame, but to put justice into action – for “Nyaya.” We can only hope that our children grow up to have the strength, love, and dedication of these young people.
On the second morning of our visit, Dr. Maru told me of an 8 year-old boy that had come in with what seemed to be a bowel obstruction. They were doing more tests including a simple enema to see if maybe it was just a bad case of constipation, but if he needed surgery he would have to be referred to a hospital 16 hours away via jeep. In this case, there would be a low chance of this boy surviving. After some more tests, it turned out that he had a severe case of intestinal worms, an affliction that is both preventable (for pennies, I might add) and easily treatable if caught early, but a late stage case also calls for surgery which would require referral to that same hospital. I’ve thought about that boy and his family since. And of course, due to the dedication of the Nyaya Health team, the surgery center at Bayalpata is opening and hopefully one day soon will provide surgeries like this one. What is more important? I cannot think of it.
It has always been clear to me that that even if a single life is saved, it’s all worth it.
And then there is the spirit of the Nepalis themselves. I didn’t get to spend enough time with them due to my bedrest, but I got the distinct feeling that these are people who see life as a privilege as opposed to a right. Such wisdom from the East should be taken with us every day.
I left hopeful. The people of Achham have a dedicated group of young people from both the East and West who won’t stop until they have set in motion a sustainable system for those who need it most. We came across powerful Nepalis, some of whom are working hard to improve things for their fellow citizens, and are welcoming this group into their country with open arms. Another set of ideals that could be better called on in our home country.
With excruciating need, internal local support, and an outside group of deeply dedicated experts that have adopted this region as their own, it seems clear that capital – both financial and intellectual – will continue to flow in. All we can hope is that it happens fast enough to save that single innocent life.
As my 14 year-old daughter Andrea recently told me, “it will all work out well in the end – and if it hasn’t worked out yet – that just means that it isn’t yet the end.”
Jeffrey Kaplan is a Partner at Deerfield Management, an investment firm with a focus on healthcare that manages money for foundations, endowments and others. Jeffrey joined Nyaya’s Board of Directors in March, 2012.