Posted by Gregory Karelas
Friday was indeed a triumph. Of course the program started forty five minutes late. But as I told the Local District Officer while we waited alone for the first invitee to join us, “It’s ok, Sir. In Achham, everyone is right on time.” In other words, forty five minutes late was no stress to local chronometers, their bearers or to me.
The meeting’s purpose was to rally formal support for Nyaya Health’s new funding request to the Ministry of Health and Population. Its primary tool was a presentation that explained our services and expansion plans, highlighting Nyaya Health’s unique contributions to healthcare in Achham and specific features like the free care it provides to 26,000 patients every year. The team included Bayalpata Hospital’s Medical Director, Community Health Director, Accounts Officer, Data and Technology Officer and me. The invitation list included twenty five of the leading government, political party, media and community leaders in the region, as well as the Regional Health Officer and a representative from the National Planning Council in Kathmandu via speaker phone. The plan was to begin with introductions. I would give the presentation. Our team would host a Q & A together. And then the big moment : we would ask each attendee to sign a letter of recommendation advocating for a tripling of Nyaya’s government funding from thirty lakhs (approximately $37,500) to one karod ($125,000). The letter would accompany our request to the Ministry. And we would personify persistent advocacy until the Ministry reached a decision.
The program took a solid but reliably turbulent beginning. Almost all invitees had arrived. The presentation went well and met loud applause upon conclusion. The first question came from a local journalist, asking about allegations of corrupt purchases at Bayalpata Hospital before my time in Achham. As explained in a previous publication on this site (please see The Road to Healing), our hospital had been accused of illegal supply purchases roughly 9 months prior, resulting in a staff strike and the ultimate dismissal of almost all of Bayalpata Hospital’s senior leadership personnel. The reporter wanted to know why the government’s formal Investigation Report on the matter had not yet been released and what it said. The scandal at our hospital had left virile rumors in the community and questions like these on the tip of every reporter’s tongue. I thanked him. And then answered with every ounce of information I could, as recent dealings with the press had taught me that holding back any detail would generally herald more headache. All parties seemed satisfied. We moved on.
From there, the questions turned to the subjects of strategy, funding logistics, and similar groundball queries amidst welcome platitudes and thanks for providing necessary care to Nepal’s poorest of the poor. Our team welcomed audience questions, vacillating between Nepali and English replies, and seized every moment to praise Nyaya Health’s audacious model of free care amidst the resource deprivation of Far Western Nepal. Our answers matured to monologues; and Nyaya’s vision found the limelight. Our momentum could only build. Until, Mr. Arjun (name changed to respect privacy), a prominent member of the Bageshwor Water Committee, raised his hand to speak.
Almost two years ago, Nyaya Health made an agreement with the Bageshwor Water Committee to provide certain priority services to residents of the Bageshwor community in return for use of a water pipeline that ran through Bagheswor property lines to Bayalpata Hospital. Among them was the agreement to provide special consideration to Bageshwor citizens applying for Hospital job vacancies within a specific stratum of staff qualification. At 11pm on Christmas day this past year, a Bageshwor resident visited my office to wish me a happy holiday and inform me that his community would cut the Hospital’s water supply in eight days for alleged non-adherence to our hiring agreement during a recent round of staff recruitment. In defense of our hiring practices, I met with Mr. Arjun and other Bageshwor leaders in the days to follow, receiving speedy reassurance at a dinner chez- Monsieur Arjun that our talks had clarified all misunderstandings and created a reinvigorated partnership between all parties.
Thus, when Mr. Arjun began his thirty minute diatribe regarding the same issue, I was surprised. But knowing how things often happen in Achham, I wasn’t surprised at all. With the attention of a newfound audience, he began to condemn the hiring practices of our Hospital and then criticize its lack of willingness to provide Bageshwor residents services such as free helicopter travel and all-expenses paid treatment in Kathmandu. His rhetoric quickly turned to ranting, and his vehemence seemed to take a tone of reproach. Our team looked annoyed. Many guests looked confused. Mr. Arjun continued.
From the podium where I stood, I took the liberty of recounting my Christmas-time meetings with Mr. Arjun and the Water Committee, specifically noting the evening when we buried the hatchet over a handshake and rice dinner. My response was simple, yet thankfully effective enough to quell Mr. Arjun’s concerns and satisfy our audience. He quieted quickly. The crowd seemed satisfied. I continued. Yet my broken trust and questions surrounding Mr. Arjun’s impetus hovered. Our Q&A session progressed. And our conclusion ultimately found crescendo in my promise that Nyaya Health would continue to create a model hospital, redefining healthcare delivery and its systems for all of South Asia. All participants signed our letter of recommendation, and smiles became the room.
There is little more to tell from that point forward, except that Mr. Arjun became remarkably car sick during the 90 minute jeep ride that he asked of us on the return from our presentation to the Hospital. I do not believe in karma, especially when it comes to the suffering of others. But I did find the coincidence of Mr. Arjun’s perceived sabotage and his patent illness thought provoking.
My experiences in Achham have taught me that there are no rules here. As in many parts of the world, and surely in those most destitute, there is no need for them. Days are hard. Life is a struggle. And nothing is guaranteed—especially not support for anything outside of immediate individual gain. Yet we persist. I often find it difficult to understand the connection between the poles of selflessness and villainy that the people we serve use to define us. But we persevere. We were not invited by this community to serve it. Yet we have treated over 80,000 of its members in four years. The answer is grit. We’re not perfect. And our product is far from it. But with compassion as fuel and temperance as a mantram, we greet the challenges we never expect to see, especially when they come from the sources we expect the least.
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Gregory Karelas is the Country Director of Nyaya Health. He graduated with an MSc in Medical Anthropology.
Tags: Achham, collaboration, Far West, global development, global health, global health delivery, Government, Gregory Karelas, Health, Health equity, healthcare, Logistics, management, meetings, Nepal, NGO, Nyaya, Nyaya Health, partnership, rural life, Stories from the Fog, transparency
When I first joined the Nyaya family in late 2008, our annual revenue was $76,631. After all calculations were tallied earlier this year, our annual revenue for 2011 turned out to be $552,333 — quite the jump. But what was even more obvious than our growth thus far, was still how large the gap in health services is that we aim to fill, and how much our budget will continue to grow. Rough calculations at the beginning of 2012 suggest we have approximately a 1 million USD funding gap for the next 18 months.
Since mid-2011, when Nyaya brought on our first full-time Executive Director, our team has grown immensely. While there is always a lag in growth of programs after a growth in organizational resources, we plan for 2012 to bring an equally large growth of services for our patients. And with that growth comes the need for a similar, if not larger, growth in our development (fundraising). Over the last few months I’ve had the privilege of working with several members of our team in Nyaya’s Boston office to rethink our approach to development, and to determine how we plan to raise $1 million USD in the next year and many more after that.
including, for example, a Director of Development. Thus, much of our work in these domains is conducted virtually via online communication. Creating more formalized processes like these will help us to remain lean, continuing to collaborate across a broad and largely volunteer team.
