Healthcare in the Himalayas; a Nepalese Note-taker
Sudip Pokhrel is a healthcare expert from Nepal who has worked with many international agencies and NGOs including the WHO and UNICEF.
He reveals the new challenges Nepal’s healthcare system is facing and how better communication is helping him make an impact.
Living in Kathmandu, a city that sits 1400m up on a Himalayan plateau, it’s apt that Sudip has an eye on the sky.
“My dream was to be a pilot. I didn’t pursue that, but aviation remains a strong hobby of mine. You could say I’m a bit of a plane nerd.”
He has spent many hours in flight simulators, can identify aircraft from their shape, and can hold his own in conversations with pilots. Sudip explains that his country’s challenging Himalayan landscape makes aviation in Nepal even more interesting.
“I think we have some of the most challenging airspace and dangerous airports in the world. People fly in just to experience the landings.”
Health Projects and a Hilux
Despite his passion for planes, Sudip’s professional expertise lies in public healthcare systems and policy.
With 20 years of experience, he’s worked with the WHO, UNICEF, the Foreign, Commonwealth & Development Office of the UK government, and various other international aid agencies and NGOs. Sudip’s mission is to improve the healthcare system of his homeland, as well as that of other developing countries.
Sudip works to formulate effective public health policies and strengthen national health systems. This could entail, for example, strategies to improve drugs and medicine supply in a country, interventions to strengthen maternal and child health, fostering public-private partnerships in public health, or designing complex public health projects.
Sudip’s days are dominated by creating. He writes reports, papers, and proposals for clients, and spends considerable time collaborating across different time zones. The job also entails a hands-on element; for about 45 days each year, Sudip is out in the field, visiting villages and townships outside of Kathmandu. A welcome byproduct of these trips is the chance for Sudip to indulge his love for off-road driving.
“While visiting remote communities, I have to negotiate rough terrain, so part of my work itself is an off-road adventure. I drive a modified Toyota Hilux, the preferred mode of transport among humanitarian aid workers and militias worldwide!”
Nepal’s New Healthcare Challenges
Focussed on top level policy, Sudip explains that Nepal’s healthcare needs are changing.
“As Nepal has got richer, the challenges to our healthcare system have evolved.”
The trend for urbanization – as seen in much of the Global South – is dramatically changing the average Nepali’s lifestyle. Large numbers of people have migrated from rural areas, leaving behind a subsistence lifestyle and adopting an urban one.
That typically means exchanging a physically active life and homegrown foods, for a more sedentary lifestyle, where food of all sorts is freely available. This is changing the ‘disease burden’ of Nepal, Sudip says, with conditions that are typically associated with the developed world, now on the rise.
The country is seeing increases in the rates of ‘expensive diseases’ like cancer, heart disease, diabetes, and hypertension, and this is one of the new challenges Sudip is focused on. From an economic standpoint, it’s cheaper to put budget into stopping such diseases before they happen.
“You can spend relatively few dollars per person to prevent these diseases in the first place, or have to spend much, much more trying to treat them once they occur. So the focus should always be on prevention”.
A Lust For Life
Sudip has also spent much of his career working to improve maternal and child survival in Nepal. His intimate knowledge of the area has given him an increased appreciation for his own life.
Born in the 1970s, Sudip was delivered into the world via a home birth in Rumjatar, a hill village in the east of the country. It was a place with little in the way of medical facilities and a time when 300 of every 1000 children born in Nepal would die before their 5th birthday.
“The child survival rate was so low, I’m kind of amazed I made it, so I don’t take my life for granted.”
He still visits from time to time, though notes that many from his village have long since left and nature is reclaiming the abandoned parts of the settlement.
When he was a child Sudip’s family moved to Kathmandu. His father worked for the Nepali government and later the UN, advising different countries around the world on agricultural policy. Sudip grew up in a house of NGO-speak so says it felt natural to take a similar path.
For six years he worked for a German non-profit, largely involved in information management. He steadily grew his knowledge and skills, before moving over to policy planning in the health sector.
“I was fascinated by the complexity of healthcare, the challenge it offered, and also the importance of it.”
Two years ago, Sudip went freelance and continues to work with agencies and governments around the world.
The Communication Conundrum
One of the big challenges Sudip faces is taking complex health information, full of reports, trends, and recommendations, and making it easy to understand for policymakers who do not necessarily have deep knowledge of the domain.
“Communication and knowledge in the health sector are often very esoteric, with experts and academics freely throwing around jargon and tech-speak, which precludes policymakers and concerned citizens from understanding pertinent healthcare issues. It’s the tyranny of experts.”
Tech-savvy, Sudip is continually looking for ways he can better present information, and share his ideas, which is how he discovered Craft.
“I’ve tried to overcome this problem by writing as simply as possible, and communicating my recommendations in a very easy-to-understand and attractive format.”
Sudip emphasizes that most people in his sector still use legacy software to trade ideas. His use of Craft has been well-received and has helped him make a bigger impact with his work.
Another challenge is the cultural crossroad that Sudip finds himself at. He has to balance the expectations of large, western-orientated organizations, with the reality of slow-moving bureaucracy and a more ‘relaxed’ attitude to life, found when dealing with some countries.
“I love the culture of Nepal; it’s very laid back. But sometimes so laid back that nothing happens.”
A Rough Road To The Future
Sudip is hopeful for the future of his country. But as with his off-road journeys, the path ahead is bumpy. Sudip says that Nepal has made good progress over the years in reducing certain burdens of diseases. However, it still faces challenging obstacles in securing quality healthcare for all citizens.
“The government, to date, has failed to guarantee the health of its citizens. Unless there is significant reform in the government apparatus and how the health sector is organized, the Nepalese people will continue to be barred from attaining high-quality healthcare.”
Sudip explains that the healthcare divide between the poor and the rich is alarming. While the richer echelon has access to world-class privatized care, the poor cannot afford it but are often forced to use it, as government-provided care has gaps and is unreliable.
“The sad thing is that many low-income families are further driven into abject poverty because of the high expenses they are forced to incur for healthcare. This is often catastrophic for the families involved.”
Health professionals like Sudip are pushing for reforms, but ultimately they require strong political will, which Sudip laments is currently lacking.
“I’m not happy with the present direction. But I’m hopeful that we will overhaul our health systems in the future and that there will be champion politicians who will spearhead reform.”
More Than Mountains
Like any country, Nepal has its problems, Sudip says. Kathmandu is getting crowded, urban planning isn’t well regulated (leading to sprawl), and the traffic is ‘horrendous’. But Sudip loves the city and his homeland and is keen to point out that Nepal is more than just mountains.
“The topography and biology are very diverse. We have a wide range of different environments, from Himalayan peaks and high plateaus to tropical jungles and scrublands. There are rhinos, elephants, tigers, leopards, and wolves. I’ve recently got into bird watching, although I’m not proud to admit that I’m yet to spot Nepal’s national bird – the Himalayan Monal.”
The strikingly colorful bird lives between 2000m and 5000m of altitude. But Sudip counters that he has had success with another of Nepal’s native avians: the Crested Serpent Eagle, a majestic raptor of the lowlands.
Sudip has photographed the same female on the outskirts of Chitwan National Park over the last three years. He visits her whenever he’s there, a ‘relationship’ that has not gone unnoticed by Sudip’s companions.
“My friends joke that my girlfriend is waiting for me.”
Whether it’s airplanes, avians, or advanced healthcare policies, Sudip continues to look up and aim high.
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