Rhymes with Shmashmortion

This weekend my roommate talked to a priest about abortion policy at a wedding. My roommate works on the girls, women and population team at the United Nations Foundation.

They had divergent viewpoints.

Women’s sexual and reproductive health and rights have always been a battlefield — Should sex ed be taught in schools? How should we teach people about consent? Are universities covering up rapes? Should contraception be covered by insurance? Are states putting an undue burden on the right to have a safe abortion? Should the government defund Planned Parenthood? Is a zygote alive? And my favorite, can a woman’s body actually “shut that whole thing down” when raped?

For the amount of air time devoted to discussing women’s bodies, we’ve yet to come up with a way to talk about abortion policy that doesn’t alienate and vilify a portion of the population.

Politicians have been tossing around platitudes about abortion policy to cater to extreme segments of the population without thinking critically about how certain policies affect real lives.

Defining our terms

Before diving in, let’s take a step back to acknowledge our own biases.

We’re all guilty of seeking out news sources, blogs and people that share our view points and confirm the assumptions and attitudes that we’re already predisposed to have. When spending time with like-minded individuals, our opinions tend to get more extreme.

Since the topic of abortion has historically been so intertwined with morality, the arguments that liberals and conservatives make for and against abortion never seem to meet in the middle.


Let’s talk about how we’ve been framing the abortion debate.

The term “pro-life” is a misnomer. All of us are pro-life. Defining a group as “pro-life” misrepresents the opposing viewpoint as “anti-life” or “pro-death.” 

It also creates a false choice between two distinct sides, pitting the extremes of both arguments against one another, when abortion policy is more nuanced than one side or the other – than us against them – and the discussion would benefit from an array of descriptive terms that fall on different parts of a spectrum.

It’s a lot like Orwell’s newspeak in 1984:

“The Ministry of Truth, which concerned itself with news, entertainment, education, and the fine arts. The Ministry of Peace, which concerned itself with war. The Ministry of Love, which maintained law and order. And the Ministry of Plenty, which was responsible for economic affairs. Their names, in Newspeak: Minitrue, Minipax, Miniluv, and Miniplenty. (1.1.8)”

The words we use to define ideas we’re discussing can serve to either clarify or obfuscate the very concept we’re attempting to describe.

Using the terms “pro-life” and “pro-choice” makes it easy to forget that wherever you fall on the moral spectrum of abortion policy, we’re all fighting to save lives.

The difference lies in how we define what it means to save a life and whose lives we’re fighting to save.

Whose Lives are we Saving? The Public Health Argument

Restrictive abortion policies increase women’s chance of death.

Ironically, restrictive abortion policies also increase a fetus’s chance of death due to elective abortion.

According to the World Health Organization, 47,000 women die each year from complications due to unsafe abortions.  This number represents 13% of maternal death.

Evidence suggests that restrictive abortion policy has no influence on the number of women who seek out abortions – in fact, restrictive abortion policies have been shown to increase the number of abortions, most likely due to a lack of access to contraceptives in very restrictive countries.

“Abortion is prohibited in almost all circumstances in Chile and Peru, for example, yet clandestine abortion is common. Indeed, illegal abortion in these countries is estimated to occur more than twice as often as legal abortion does in the United States” (Guttmacher Institute, 2003).

The same report found that subsidized family planning services prevented 9 million abortions over the last 20 years in the United States.

The data tell us that restrictive abortion policies: 1) have no impact on a mother’s decision to have an abortion, and 2) put the mother’s life at risk by not providing her with safe abortion services.

Decreasing abortion has more to do with increasing access to family planning methods than restricting access to abortion.

What Does it Mean to Save a Life? The Social Justice Argument

Since women are the only sex biologically equipped to carry a fetus to term, women are forced to bear the burden of restrictive abortion policies, putting her life – and independence – at risk.

On the 40th anniversary of Roe vs. Wade, Senator Ted Cruz, current presidential candidate and recent victor of the Iowa Caucus said, “No right is more precious and fundamental than the right to life, and any just society should protect that right at every stage, from conception to natural death”

But by fighting to defund Planned Parenthood and other organizations that provide safe abortions, he along with other opponents of abortion aren’t “protecting that right at every stage” because the policy and law that they’re advocating for directly puts women in harms way.

Women around the world are dying because of abortion policies, but even more are losing their ability to complete an education and participate in the labor force.

In the 1992 supreme court ruling Casey vs. Planned Parenthood, the justices wrote “the ability of women to participate equally in the economic and social life of the Nation has been facilitated by their ability to control their reproductive lives.”

Restrictive abortion policy disproportionately affects women over men, poor women over rich women, and marginalized women over women in the majority (read: white).

So when Texas said that abortion centers had to meet the same building, equipment and staffing standards as a surgical center, putting the majority of abortion clinics at risk of shutting down, it wasn’t rich, white women that bore the brunt of this decision – it was poorer, marginalized women that can’t afford to travel to a clinic and can’t afford a private clinic.

The same disproportionate burden that restrictive policies place on poorer women is true throughout the world.

Abortion Policy on a Global Scale

From a public health and social justice perspective, the inequities created by restrictive abortion policy are the crux of the matter. Unfair morbidity, mortality and economic burdens are placed on women who are already marginalized, perpetuating a cycle of gender inequity and disempowering generations of women.

A policy that legalizes abortion and increases access to family planning methods has been proven over and over again to decrease abortions and maternal death.

And yet, 25% of women in the world live in a country that restricts their ability to control their reproductive health.

There are six countries in which abortion is illegal, even in cases of rape, even in cases of incest, and even in cases where the mother’s life is at risk: Chile, El Salvador, Nicaragua, Dominican Republic, Malta, and Vatican City.

If a country’s restrictive abortion policy is grounded in the argument of the sanctity of human life, why isn’t the woman’s life protected under that same law?

Let’s hone in on El Salvador.

In a country that throws women in prison for up to 40 years after suffering from natural miscarriages, they are now faced with a curious moral and ethical quandary:

Due to the zika virus epidemic in Latin America, and the potential correlation between zika in pregnant women and microcephaly in their newborns, the government of El Salvador has requested that Salvadorian women refrain from getting pregnant unit 2018.

In a country where abortion is illegal under any circumstances, there aren’t any clinics where women can go to get a safe abortion. Fear about birth defects caused by zika will cause many women to seek out abortions – and when there are no legal options, their lives will be at risk from undergoing unsafe procedures. 

Discussion around changing abortion policy in response to the zika virus have already begun in Brazil.

The fact remains that women will die as a result of this policy. The most we can hope for is that discussions spark change fast enough to save as many lives as possible.

Looking in the Mirror

It’s easy to look outwardly at countries with restrictive abortion policy, but in many cases, the United States is responsible as well. The Helms Amendment prevents US aid dollars – otherwise dedicated to sexual and reproductive health services and family planning – to be spent on abortion. That means that countries that would otherwise provide safe abortion services for women often can’t afford to without risking funding for other family planning services.

In addition, the barrage of anti-abortion rhetoric that has been surrounding the campaign trail frankly terrifies me. When we know that restrictive abortion policies not only kill women, but also hold women back from reaching their full potential, the idea that some conservative politicians want us to regress to a more restrictive policy makes me question how much they value my rights as a human being.

Not to mention Carly Fiorina crashing a preschool field trip at a botanical garden to talk about the pro-life movement.

Pro move, Carly.

Life is sacred. We all agree that life is inherently valuable and should be protected under law. However, when the data tell us that a restrictive abortion policy causes more death than it saves lives, we need to listen.

We can still have the discussion about when life begins, but it doesn’t belong in the same conversation about abortion policy. The discussion about when life begins is irrelevant when talking about access to abortion – not because it’s not a valid viewpoint – but because restrictive abortion policy doesn’t change abortion-seeking behavior.

The equation is clear: (birth control + safe abortions) = (fewer abortions + fewer maternal deaths.)

It’s public health; not politics.

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To the Man Who Assaulted Me and Walked Away with Nothing

I’ve been on this highway. I can picture her running route. Matagalpa always felt like an escape while I was a Peace Corps Volunteer living in a smaller town outside of the city. I would go to Matagalpa for a sense of normalcy.

My reaction to reading Char’s post about getting assaulted while running in Matagalpa was physical – my muscles clenched and my stomach tightened, my breathing paused. It brought back the rage I used to feel at getting catcalled – “piropod.” It brought back the memory of a stupid, stupid man knocking at my door in the middle of the night after he had stolen my wallet from my house earlier that day. I wasn’t assaulted, but my feeling of safety was.

I know so many women that went through what Char described here during their Peace Corps service and many still suffer from past traumas. Read this to understand. Char – thank you for sharing.


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Guest blog: A city of temples to a city of tents


On April 25, when the deadly earthquake hit Kathmandu, people found themselves running away from what most have spent their lives working towards. Owning a house in Kathmandu means you have attained stability and security in life. I am a resident of Kathmandu, one of Nepal’s worst affected areas. With the death toll and number of injured mounting, the city of over a million came out in the open streets to take refuge under the intermittently rainy skies.

At 11:56 am, the floor of my house started shaking violently. While my family and I were pinned by the tumultuous shaking unable to escape, the whole nation reeled from the destruction, both physically and emotionally. For years, we knew we lived in an earthquake-prone zone, but never thought that a tragedy of this scale would happen in our lifetimes.

The earthquake violated our city, with many of our historical and cultural monuments bitterly and cruelly thrown into a pile of rubble. But the destruction was not uniform. The ancient temples, where generations of city dwellers gathered to pray, crumbled to the ground, while the high rises that have spread rampantly in recent years were largely spared.

With numerous major aftershocks in the first day of the earthquake and many more to follow over the first week, any shake or tremble put us on edge and made us run out to the streets for safety. Fearful, the city of temples turned into a city of make-shift tents.

One strong 6.9 magnitude aftershock caught my sister and I while we were searching for shelter for the night. As we held onto nearby rails, over the distance a couple held in an embrace for support. A panicked woman was consoled by a crowd after escaping from a nearby house while it was still shaking menacingly. It was heart-wrenching to see these glimpses of humanity amidst such chaos and danger.

It was immediately apparent how unprepared the country was to handle a disaster of this magnitude. An utter lack of preparedness and long-term planning revealed the government’s glaring ignorance. Much of the first day of the earthquake went by without much intervention from the state. People were forced to cremate their loved ones near river banks when there was not enough space in the famous Pashupatinath Temple.

Meanwhile it was touching to see how the people came together in the hour of need to take care of themselves and their communities. As people offered to share their make-shift houses with strangers, it reminded me of what it meant to be a Nepali. But when it started raining later in the evening, it seemed like Mother Nature was mocking our collective misery.

Cut off without phone, power or internet, much of Kathmandu was unaware of the devastation outside the city in the rural areas. The rural houses made with mud and rocks could not withstand the violent shaking that came from the earthquake or its aftershocks. The death toll increased exponentially as people ventured into remote villages to help with the rescue effort.

Compounding the tragedy is a glaring disparity- many of our country’s poorest are bearing the brunt of the earthquake. As many lost their family members, the displaced and stranded now also have to build a new shelter. It is going to take my country many years to recover from this.

Nepal as a country has been struggling to come out of a rut that has been inundated with tragedies. After a decade-long conflict, the country was left politically unstable without a constitution or consensus in major parties, and ethnically marginalized groups demanding political identity.

With the deadly avalanche in Everest, a landslide that threatened massive flooding in the Sunkoshi river and most recently, an epidemic of swine flu in the remote district of Jajarkot that claimed over 30 lives, the country’s relief efforts were already under heavy scrutiny as the state struggled to reach out, especially to remote regions.

This also certainly stands to affect tourism, a major economic activity in the country, especially after it had begun to bounce back after the decade-long conflict.

Relief and aid from the international community has flooded the country as the earthquake has received worldwide coverage. Nepal is sandwiched between India and China, two geopolitically divided nations. As a citizen it was frustrating to watch the state’s selectiveness towards relief efforts in such a situation. The public’s growing dissent towards the government was apparent as many affected communities have yet to receive help. Lack of access, the difficulty of mapping the damage in affected areas, and uncoordinated relief teams have severely hindered relief efforts from being delivered on time to the place most in need.

With a history of severe public distrust towards the government due to rampant corruption and political intervention, the government’s strategy to channel all incoming funding and relief through the Prime Minister’s Disaster Relief Fund is facing severe criticism from the nation.

Meanwhile the effort of the army, civil society, several youth groups and individuals who took it upon themselves to reach far flung affected areas is truly commendable. Many of my friends have traveled to places outside Kathmandu, taking with them tents, blankets, water and food to stranded communities and came back with heart-wrenching stories to tell.

As the country looks down a long windy and shaky road to recovery, the road ahead will not be not easy. When social media diverts to other news and the focus shifts elsewhere, we will have to stand alone and recover as a single nation. We will not get much time to mourn.


Subecha Dahal is a resident of Kathmandu, one of the worst affected areas during the tragic earthquake of 7.9 magnitude that hit Nepal.

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3 Ways to Donate to the Nepal Earthquake Relief Effort

If you’re thinking about donating to the relief effort for the ‪#‎NepalEarthquake‬, here are 3 good options:

1. A relief fund set up by RPCVs: One of the hardest hit villages was used for Peace Corps training, so many of the volunteers have lived there and know the families personally. I donated there because I know they’ll work directly with communities to make sure they get what they need and will spend all the money on relief efforts. https://life.indiegogo.com/fundraisers/1245806…

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2. Friends of Maiti Nepal: They protect women and girls from human trafficking. I know and trust them because my student group (Global mHealth Initiative) works closely with them. Their donation page is here: https://donatenow.networkforgood.org/1387022 and you can learn more about the organization here: http://www.maitinepal.org/.  They’ve been keeping their Facebook page updated with their relief efforts.

3. I did a fellowship with Medic Mobile over the summer and learned first hand how wonderful they are. Since starting with VaxTrac, we’ve been collaborating with their Nepal team because they’ve been there for years. They’ve updated their blog with a list of vetted organizations. You can see that list here: http://medicmobile.org/bl…/nepal-earthquake-how-you-can-help

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America, use your words.

Femicide has been in the news lately.

This week a 27-year-old woman named Farkhunda was killed in Kabul, Afghanistan by a mob of angry men for allegedly burning a Quran. After she was killed, her body was thrown off the roof, set on fire, run over by a car and thrown into the river. Her brutal murder has been a rallying point for women’s rights activists in Afghanistan. #JusticeForFarkhunda

Last month in Turkey, 20-year-old Ozgecan Aslan was murdered after resisting rape by a minibus driver while she was traveling home from university. Her murder sparked protests advocating for harsher punishments for gender-based killings.

According to the New York Times, “In hundreds of cases [in Turkey], men who murdered were able to argue that a woman provoked them, or that their dignity was impugned, and they received a reduced sentence, some to just a few years in prison” (NYT, 2015).

Mexico has been called out for having a femicide epidemic, averaging six murders of women each day. These murders are often categorized as “crimes of passion.” According to Al Jazeera, of the nearly 4000 femicides identified in 2012 and 2013, 1.6% led to sentencing (Al Jazeera, 2015).

During my two-year stint of living in a town of ~10,000 in Nicaragua, a young girl was killed by her boyfriend and a woman’s rights activist from the Red de Mujeres Contra la Violencia (Network of Women Against Violence) was attacked with a machete because of her views. She luckily survived.  According to La Prensa, 75 women were killed last year “the majority of whom were killed by their husbands, boyfriends, or partners in their home” (La Prensa, 2015).

I would be remiss if I did not also include examples of femicide in the United States because violence against women in general, and femicide in particular, is a global phenomenon. The UN recently said that no country has achieved equality for women.

According to the WHO, 1:3 women throughout the world will experience physical and/or sexual violence by a partner or sexual violence by a non-partner.

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The WomanStats Project uses data to map gender inequities. Their map on physical security of women throughout the world is especially striking:

Screen Shot 2015-03-24 at 10.08.47 PMNow let’s return to the discussion of femicide in the United States. I googled “woman killed” today and 27,100,000 results popped up in 0.43 seconds. Most of the articles are about women being killed by their significant others, which reflects statistics that say that “between 40-70% of female murder victims in the United States were killed by their intimate partner” (ACUNS, 2013).

Yet when I googled “femicide,” hardly any articles about femicide in the United States appear in the search.

We seem to have a language problem here.

According to a report on femicide by the Academic Council on the United Nations System (ACUNS), the criminal justice system in the United States doesn’t specify these killings as femicides, but rather as homicides or “intimate homicides” (ACUNS, 2013).

An average of 1500 women are killed each year in the United States (ACUNS, 2013). Why are we so far behind the rest of the world in using words like “femicide” to classify these murders?

Maní be like, you guys embarrass me.

Maní be like, you guys embarrass me.

Language is our most powerful tool to enact change.  The words we use to define an issue is the difference between “murder” and “friendly fire;” it’s the difference between “climate change” and the “statewide jacuzzification” of Florida;” it’s the difference between enacting policy on a real issue and pretending that it doesn’t exist.

Brazil understands this. This month Brazil passed a law that will impose harsher punishments for cases of femicide, which they defined as “any crime that involves domestic violence, contempt or discrimination against women.   

The head of United Nations Women in Brazil told Reuters that “it has taken us a long time to say that the killing of a woman is a different phenomenon. Men are killed in the street, women are killed in the home.”

The World Health Organization defines femicide as the “intentional murder of women because they are women” (WHO, 2012). This definition includes intimate femicide (such as by a significant other), honor killings, dowry-related femicide, and non-intimate femicide (like what happened to Farkhunda and Ozgecan).

An organization in the UK called Women’s Aid is working to create a census on femicide to get accurate data on the phenomenon.  It’s amazing to me that there is so little data on femicide, considering the extent to which it happens every day in every part of the globe. 

This blog post is a plea to the United States – as well as the rest of the world – to recognize femicide as a specific category of hate crime.  Only after defining our terms can we hope to collect any meaningful data and legislate policies that work. #Femicide

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But how do you really feel: A self(ie) portrait through haikus

Stye in eye.

Stye. in. eye.

Arrived to Springtime after grueling car ride.

Arriving to Springtime changes one’s outlook on life.

Local government
came and ate all our lunches.
Subtle corruption.

Woke up dark and cold
and there it was: stye. in. eye.
Bodes well for the day.

I slept to survive
the twisting and lurching road.
Thanks, melatonin.

At a rest stop, I
played with a pup in a truck.
Please don’t tell Maní.

Down the hill it’s spring.
Back at home there are blizzards.
Dangerous thinking.

The Himalayas
are encroaching on our plane.
Too close for comfort.

The Himalayas make me slightly uncomfortable.

Hey gurl heyyy!

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A series of haikus about a series of events.

He chose the cafe.
“I cannot work here,” he whined.
A group move ensued.

We began at last.
But when his phone rang he left.
Captive audience.

He watched us standing
by our two heavy boxes.
Thanks for all your help.

Three gals, two boxes
and a stick shift in my thigh.
One long taxi ride.

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When in Benin…

Here is a haiku about my experience at the Ministry of Health today:

They leave one by one.
Soon, we’re sitting there alone.
Successful meeting.

Until next time,

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Young women in the workplace: A timeless story of power.

“Project your personal power” is a phrase I heard often while working towards my Master’s degree last year.  It was usually in the form of well-intentioned advice from a mentor or a colleague.  While well-intentioned, it was also somehow deprecating, prophesy-fulfilling advice.  It made me think about the way people perceive me in a professional setting.  Is there a reason my mentors keep telling me to “project my personal power?”  When I speak, am I not being taken seriously?

I recently presented my research on ChatSalud at the mHealth Summit in Washington, DC.  The panel was about using human-centered design for mobile health (mHealth) projects in low- and middle-income countries. The panel was well-attended and the panelists were engaging and qualified.  We were a panel of young women working in technology for health.

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My panel. I’m the one with the light pink blazer. Meredith, my VaxTrac colleague, is the one speaking at the podium.

Later that day, my friend grabbed my cheek.

–“See, you have them too,” she said.

–“What do I have?”

–“Puffy cheeks. We were talking about how puffy cheeks make us look young.”

She filled me in on the conversation she and a colleague were having.  I should interject by mentioning that both women having this conversation are exceptionally accomplished in their own right- one is finishing her Master’s degree, winning an award along the way that recognized her outstanding commitment to public service, and the other is a registered nurse, computer scientist and PhD.  Both of these very accomplished young women were talking about how difficult it is to be heard during professional meetings.  They said they feel as if they need to get up on their soap box to make sure that their voices are taken into consideration.

Having just finished my panel, I went from feeling confident and strong to feeling self-conscious.  I suddenly became very aware of how I must look to the world– that I had decided to wear my hair down that day, rather than up, and that I had decided to wear a dress, rather than a suit.  All of this makes me look young.  I began to wonder if anyone had heard what I said during the panel at all.  And if they had, did they respect what I had to say as a professional?

The next day I wore my hair up and put on a power suit.  No one will call me young and get away with it.

I’m ultra sensitive to how young women are perceived in the workplace because I’ve encountered this over and over again.  I went through an interview process several months ago with a not-to-be-named organization.  I was told I was one of two finalists and I’d hear back in a couple days.  Two weeks later they told me they were interviewing more candidates.  About a month later I heard through the grapevine from a prominent employee there that I wasn’t hired because HR said I was too young.

Even on my own projects where my male colleague and I call the shots, I’m sometimes left off of e-mails. People sometimes misspeak and say that certain directives come from him rather than from us.  I feel like I’m constantly standing on a hill waving my hands in the air shouting, “Hey guys! I’m here!” What I should be doing is standing on a chair in the conference room, arms folded, power suit on, making it impossible for people to think my opinions matter less than that of my male colleagues.

And this is the image that I try to portray.  I make a conscious effort every day to “project my personal power,” but when I’m undermined, or when I’m called out on looking young, it’s like I’ve gone five steps forward and then am forced to take two steps backwards again.

I have male colleagues that never confront this issue of appearing young. When they talk, people listen.  I don’t know if it’s the height, the tweed jackets, or the confidence they’ve gleaned from growing up male, but I’ve seen it in the same way that I’ve seen young women overlooked and undervalued.

It doesn’t have to be this way.

I read an article yesterday about the 25 most influential Washington women under 35 years old.  I was so happy to read about women who simply don’t give a damn if the world thinks they’re too young. They’re out there running think tanks, passing legislation, and paving the way for more young women to step up and demand the respect they deserve.  There’s no reason to think you’re too young for a task.  If you’re capable, stand up and do it.  Eventually, the world will listen.

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Piecing Together the Nepal Project

I wrote a blog post that was featured on VaxTrac’s website about our work in Nepal. I’m posting it here too because I haven’t yet gone into detail about the work we do at VaxTrac. Enjoy!

Part I: Vial to Child

Many moving parts must come together to execute a project.  Imagine a puzzle in which all the pieces are constantly evolving and changing shape.  How do you put it all together to form a cohesive end product?  How do you know which pieces are the corner pieces—vital for defining what the picture should look like? How do you adapt when some pieces no longer fit within the scope of the puzzle?

Managing a project is a lot like this.

When Meredith, Shawn, Amelia and I traveled to Nepal in November, we were faced with the challenge of filling in a lot of missing puzzle pieces in order to prepare for the launch of our new project called Vial to Child.

sample vial

Vial to Child will use Optical Character Recognition (OCR) technology to link each vaccine vial to the children that receive their dose from that specific vial.  OCR works just like your mobile banking app. Take a picture of your check and the software will capture the words and turn it into text.  Similarly, our OCR app will capture crucial information from each vial, such as the lot number, batch number, and type of vaccine simply by taking a photo of the vial.  The idea of this is that if there is a bad batch, the Nepali Ministry of Health will be able to track it and see which children received a dose from it.

In early 2015, we will train health workers in two districts of Nepal—Nawalparasi and Dadeldhura—to use our Android-based app to register each child that receives a vaccine and to record which vial is used for their vaccine. We will be implementing Vial to Child in 45 health centers between the two districts, serving a population of roughly 36,000 children under five. Since Meredith and Mark visited Nawalparasi in August, this trip focused on finalizing plans with our partners in Kathmandu and doing a site visit to Dadeldhura.

Dadeldhura is located in the Far Western Region of Nepal.  Whereas Nawalparasi is in the terai, a flat area of Nepal, Dadeldhura is located in the hills.  This means that we must account for the difference in access when considering how to roll outVial to Child in each district.  Although the population in Dadeldhura is smaller than in Nawalparasi, people are dispersed throughout the mountains and sometimes must walk several hours to reach the nearest health center.

Part II: Site Visit to Dadeldhura

boarding plane

To get to Dadeldhura, we took a small plane to Nepalgunj where we met up with our UNICEF colleague, Meena Thapa, who works in the region.  From Nepalgunj, we drove for seven hours.  The first four hours were easy because the roads were flat, but the last three hours felt like being in a perpetual roller coaster as our car made its way up the windy mountain roads.

I slept most of the trip, mostly to avoid car sickness, and awoke only to eat at Meena’s favorite spots along the road.  We stopped in one village to eat the typical Nepali dish, Dal Bhat, which is comprised of lentils, rice, spinach, and curried vegetables.  We stopped a second time part way up the mountain to eat rice pudding from a man who cooks it in a giant iron pot on a wood-burning stove, carefully stirring the rice and milk together until they merge into a perfect gooey creation.

Even though we left Kathmandu in the morning, we did not arrive in Dadeldhura until dark.  The next morning we got see how beautiful the town was.  Dadeldhura looks like it’s in layers because it’s built on hills, and is surrounded by white-capped mountains.  The buildings are four or five stories tall and are painted in bright pinks, greens, blues, and yellows.


Meredith and Lauren in Dadeldhura

Our objectives for this site visit were to meet with the District Health Office (DHO) to present the project to them and to coordinate with them to see some of the health centers.  While the DHO was optimistic about the project, within five minutes of talking to them, we learned that they are facing a significant staffing shortage—13 out of the 20 vaccinator posts are unfilled.  This is will present an interesting challenge from a training perspective because we need to train someone from each health center on how to use the Vial to Child system.

meeting with DHO

Luckily, UNICEF is running a pilot project in which they have already trained a number of women to be Auxiliary Nurse Midwives (ANMs).  The ANMs are based in each of the health centers and are sometimes involved in the vaccination clinics.  We will be able to train the ANMs to use the Vial to Child program in the clinics that do not already have a dedicated vaccinator.

We made trips out to three different health centers while we were in Dadeldhura.  At each health center, we interviewed the person in charge, the person responsible for giving the vaccinations, and when available, we also interviewed mothers of children under five as well as Female Community Health Volunteers (FCHVs). There is a FCHV in each of the nine wards served by each health center.  Since they know all of the women and children in their respective communities, they work with the health center staff to notify families of upcoming vaccination sessions.

health center staff

Interviewing staff and patients at the health center helps us understand how the vaccination system works: when and how often there are vaccination sessions, who administers the vaccines, if the health center counsels families on the vaccines, general attitudes towards vaccines, how the cold chain works, what happens when a child misses a vaccination session, etc.  Health workers were generally very excited about the idea of using tablets to register the children.  Their main concerns were not about the technology itself, but about keeping the tablet dry during the rainy season and how to store it so it is safe from theft.  All of this information informs the way we design the Vial to Child app as well as how we implement the project.

demonstrating tablet to health workers

female community health volunteers

Part III: Back in Kathmandu

After Dadeldhura, we returned to Kathmandu for one final week of orchestrating meetings with our project partners, including UNICEF, WHO, the Ministry of Health and local tech companies.  Working with the Ministry of Health is the key to executing a successful project in Nepal.  If Vial to Child works, we want the Ministry of Health to have ownership of the project so they can incorporate it into their national plan.  We are thus relying on them to put together a Technical Advisory Group (TAG) of our key partners to direct and manage the project.

We experienced a slight hiccup with the Ministry of Health just a few days before leaving for Nepal.  Nearly the entire staff of the Child Health Division (CHD) within the Nepal Ministry of Health changed hands suddenly. Thus, a major challenge of this trip was reestablishing contact with CHD.  It was difficult timing-wise because the new CHD director started his post during the second week of our trip.  We were finally able to meet with him and solidify plans on our last day in Nepal, which happened to be his third day of work.

We left it to CHD to organize a TAG meeting between all of the project partners in December.  Our new Nepal Project Coordinator, Amelia, will be moving out to Kathmandu in January to oversee the project, and a small contingent of us will be back in Nepal in February to begin rolling out Vial to Child.

It is going to be a busy and exciting couple months, but to be perfectly frank, I’m happy to leave DC winter behind. Until next time, Namaste!

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Wherever you go, there you are. And so is Peace Corps.

Peace Corps started working in Nepal again in 2012 after a long hiatus.  There haven’t been too many volunteers yet and none of them are currently in the Far Western Region.

And yet Peace Corps kept coming up while we were out there working.  When Meena learned that both Meredith and I had been Peace Corps Volunteers, she began introducing us to local health official as VaxTrac, but also as Returned Peace Corps Volunteers.  One of our UNICEF colleagues said that before Peace Corps left Nepal in 2004, he used to be a Language Culture Facilitator, teaching new Volunteers not only Nepali, but also things like how to slurp up your tea like a local.

When we were meeting with the chief of the District Health Office, he said that he was going into Kathmandu in a few days to meet with Peace Corps staff about putting three Volunteers in his district! How exciting!  I happened to be taking notes with my Peace Corps pen at the time and so I gave it to him.  Peace Corps seems to have a good reputation around here and I think that our experience as Peace Corps Volunteers added to our credibility when working with our local partners.

Chief of District Health Office

Chief of District Health Office

Our first day out in the field we went to a nearby community where one of the Peace Corps volunteers may be sent. It seems like it would be a fantastic site. They are currently building a birthing center next to the health post, though it is still unfinished because they are still looking for funding (hmm, SPA project, perhaps?)

Unfinished birthing center

Unfinished birthing center

The population is small and dispersed throughout the hills, but it’s still a highly organized community with a lot of capacity.  While there, we attended a community meeting led by UNICEF and attended by community leaders from various sectors, including school officials, clinic staff, and female community health volunteers.

You can see people waiting for the meeting to start below.

You can see people waiting for the meeting to start below.

Meena sat next to me translating so I could follow along, which was enormously helpful. The meeting was about how to create a child-friendly environment.  The focus was on schools but the community challenged each other to think more broadly about the topic, discussing how to create child-friendly homes and health facilities as well. 

One of the most interesting points was from a young woman who works in the schools, who was urging the group to consider building separate bathroom facilities for the girls.  Currently, boys and girls use the same bathrooms in the schools, which prevents girls from attending class when they’re on their period.  She was saying that by building separate bathrooms with a way to dispose of pads, it would help with girls’ attendance. 

In a separate conversation Meena added that menstruation is sometimes considered “impure” and when girls and women get their periods, they have to spend the whole time in a separate hut away from their families. She said that this goes back to when modern sanitary products like pads and tampons weren’t available and it was done for hygienic purposes, and argued that the practice is outdated and sometimes dangerous, citing recent deaths that occurred while girls were trying to heat up the hut in the winter, and another incident when a girl got a seizure while she was there alone.

Gender equity is a long road away for everyone, everywhere.  But building a girls bathroom in the school would be a great leap forward.  It’d definitely be an interesting time to serve as Peace Corps Volunteer there!

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Namaste Nepal

Namaste is my first Nepali word.  I first heard it when we arrived at the small airport in Kathmandu and a woman in front of us greeted the immigration officer by putting her two palms together as if in prayer and saying “namaste.” “Namaste” is a greeting.  It literally translates to “bowing to you.”

They say that the sense of smell is directly linked to memory. Once this summer while I was walking to the beach, memories of Nicaragua suddenly flashed into my mind.  I remembered rocking absentmindedly in Doña Petrona’s chair and walking with José Ángel along a dusty road after giving a training session to brigadistas. I almost stopped in place trying to figure out why all the memories were rushing back to me unprovoked. And then I realized that it smelled like Nicaragua. As I tried to place the familiar scent, I looked up and saw the guards were burning a small pile of trash in front of the guard stand. Nicaragua smells of many things, but for reasons unknown, the combination of trash and fire, hot sun and dust will always smell uniquely of Nicaragua to me.

Kathmandu also smells of many things. It smells of dust and of car pollution, of momos and of crowds of people.  But out of all of those smells, it’s the smell of incense that hits me when I venture out onto the main streets. I’m staying in an area of Kathmandu called Patan.  The streets are narrow and lined with old buildings of about three or four stories, with doors and shutters that are painted in deep blues, reds, yellows and greens. The first floor of these buildings are characterized by short entryways– probably about 5 feet high– which open up into various types of shops.

Patan streets

Patan streets

Temples are littered throughout the streets and they are adorned with strings of marigold flowers, candles, Hindu gods and goddesses, and of course, incense. Because of this, the whole neighborhood smells of incense.

marigold flow

marigold flower

In addition to the warm smell of incense, my other first impression of Kathmandu is of the traffic. There are more motos here than I have ever seen in my life.  It is the main form of transportation. Traffic moves in the opposite direction as it does in the States.  Like in England, you drive on the left side of the road.  This is a big adjustment for a foreign pedestrian trying to cross the street. To get to the UN complex where we’ve been taking meetings with our partners at UNICEF, we have to cross a highway without any traffic lights, pedestrian bridges, stop signs, or cross walks. Especially at rush hour, it is hard to find a break in the flow of traffic to dart across to the median, and then to the other side of the street. Usually we wait for a local to cross and follow suite.  Today we literally used a microbus as a shield.  As it cut across traffic to turn right, we walked on the outside of it knowing that cars would need to slow down to let it complete its turn. As jarring are the motos that weave around pedestrians on the narrow streets of Patan.

We’ve been in Nepal for a little over a week. After being so immersed in Nicaraguan culture, it feels odd being in a country where I don’t know the history or the language.  And since we’ve been busy with meetings, I haven’t gotten the chance to dive in and get to know the city.

I need to get my bearings.

Towards the end of this week, right before heading back to the States, we’ll have some time to look around and venture out beyond the 10 minute route between our guest house and the UN complex. Since I’ll be making many more trips to Nepal this year, I know this trip is a mere introduction to all it has to offer.

While this trip is only the beginning, we’ve already accomplished quite a bit. We’re here to prepare for the roll out of a new mobile vaccine registry project in two districts in Nepal. We ventured out to the Far Western Region and caught a glimpse of rural Nepal. We saw some serious access issues, with people needing to walk several hours through the mountains to reach the nearest health facility. We also saw a huge capacity within communities to self-organize and ensure that every child is immunized.

I’m looking forward to continuing to get to know the culture, places, and people as we finish this trip and look on to the next. On Friday we’re going to go to Thamel, a touristy neighborhood in Kathmandu where we’ll get to visit the famous Durbar Square, see big temples, and go shopping for spices, tea, scarves, and jewelry. We’re leaving on Saturday morning.

But after the long journey home, when I get to my room, sit down on my bed, and open my suitcase, I’m anticipating the moment when the smell of incense pours out and floods my room with memories of our time in Nepal.

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