Many people I know, both here in Nepal and back in America, ask me why I am drawn to global health and development work, especially in light of the inherent difficulties of such pursuits. My Nepali friends cannot understand why anyone would voluntarily leave what they perceive to be the abundant comforts and riches of the United States in order to work in a country with limited resources, endemic corruption, myriad systemic challenges, and a lack of basic necessities and rights, such as gender equality, accessible healthcare, running water, and effective sanitation. I try to explain to them that I enjoy helping those in need, that I find answers I do not even know I am looking for when traveling, and that America is currently also dealing with a flood of social and political problems, and thus is not the proverbial Promised Land that those in the developing world frequently perceive it to be. But the answer, perhaps, is both much simpler and much more complicated. I am not seeking to escape what some disparagingly call “real life,” as though the possession of car payments, practically useless health insurance, and a mortgage in a white-washed corner of American suburbia is somehow more “real” than life in a tropical Ni-Vanuatu village, a Tibetan monastery in India, or a Nepali municipal hospital in the foothills of the Himalaya. I am not running away from difficulty. Instead, I am running towards new experiences, a better understanding of the complicated, mundane, and frequently unchronicled lives of women all over the world, and a more complete picture of reality, holding out my arms to embrace the many facets of life in all of their messy, challenging, infuriating, and indescribably heart-wrenching glory.

I know that many of the acquaintances who offer their unsolicited opinion on my choice to work in global health truly mean that existence in America, with all the frivolous consumption, instant gratification, and nine-to-five accumulation of titles, prestige, and credit card debt that it typically entails, is fundamentally worth more than the homespun, subsistence lives of those who eke out simple existences from small farms, livestock, and centuries-old handicrafts in the developing and undeveloped world. No words can describe how much this perspective, with its narrow-minded insistence on the inferiority of tradition and the superiority of superficial Western values that are, in the face of ISIS, Brexit, and other post-modern complexities, presently tearing apart at the seams in a dramatic and undeniable fashion, disturbs and frightens me. But when I voice this perspective to those same individuals, they insist that “modernization” – that is to say, democracy, capitalism, nationalism, and secularization – is the inevitable end for all nations and peoples. I do not believe that the values of the West are the only “good” values, nor do I feel that the only way countries can appropriately develop is by becoming like America. I do believe, however, that access to quality healthcare is a fundamental right of all people, and that women and girls around the world should be able to decide when, how, and if they want to give birth. I also believe that those living in developing regions have as much, if not more, to teach foreign aid workers as we have to teach them, and I am eager to soak up that knowledge in Nepal – knowledge not only about medicine and physical health but also about the importance of family, the need to maintain harmony with the land and the rhythms of nature, the peace that can be found in an evening walk, and the wisdom of ancient spiritual traditions that reveal the inability of money and worldly power to secure true happiness. 

Despite all that I constantly learn while providing health care abroad, on some days it is difficult to explain, even to myself, exactly why I continue to seek out the challenges of global health work, why, even when I am filthy and hungry and sunburnt, eaten alive by leeches and mosquitoes while trekking to a remote birthing center only to discover that the health facility is currently closed, I go to bed with an exhausted sense of satisfaction. And it is almost impossible to describe why I continue to open myself up to suffering and despair, why I would rather sit for twelve hours with a laboring woman whose language I barely understand, sweating together in the smothering heat of Nepal’s mid-afternoon sun while encouraging her to push through the agony of a painful stillbirth, than spend my time watching television or attending concerts in the familiar, air-conditioned luxury of my home country.

Part of the answer lies in my deep-seated desire to help others, a value that my parents instilled in me as a young girl growing up in Sacramento, California. As I developed into an adult, I was privileged to receive an excellent liberal arts education, first at a Loretto high school and then at a Jesuit university. I began to study philosophy, religion, and the history of activism, and my sense of social awareness soon expanded to include a wide variety of people living out existences very different from my own – undocumented immigrants in Los Angeles, victims of genocide in Guatemala, women and girls across the world who had been trafficked, raped, and otherwise abused, children in the South Pacific in desperate need of immunizations, quality education, and love. While serving in the archipelago of Vanuatu as a member of the U.S. Peace Corps after college, I had the opportunity to experience firsthand the joy that comes from sharing one’s possessions, skills, and daily life with others, and the sense of genuine contentment, far outweighing the temporary discomforts of squat toilets, bucket baths, and dengue fever, that comes from living in community and truly working with, rather than for, host country partners who slowly morphed from colleagues and students to friends, sisters, adopted parents, and beloved godchildren, to together create a better world.

Another piece of my love of global health is my longing for adventure, my thirst for new experiences, and my endless wonder about the most remote, hidden regions of the planet. Global health work is, indeed, a daily adventure, one that can be simultaneously exhilarating and distressing, annoying and hilarious. I acknowledge that this work is not for everyone. The stress of the unknown, the language barriers, the distance from family and friends, can be extremely difficult. Some people feel called – and rightly so – to help in other ways, to donate money or support various causes through activism, or to provide for their neighbors instead of those who live on the other side of the planet. The world needs all kinds of people and all kinds of service. I think it is great that so many health professionals choose to work with rural, underserved, and otherwise at-risk populations in America. And, as some well-meaning members of my family love to remind me, the rich will always need healthcare services. But so, too, will the very poor, and those who are not American, and those who are not wealthy, Caucasian, male, adult, straight, cisgender, or of any other advantaged, powerful social designation. If I feel called to serve marginalized women and newborns in the developing world, if I cherish the daily struggles and small successes of development work and relish the challenge of fighting alongside underprivileged women in countries like Nepal, working together to assert their fundamental rights to conceive, birth, and control their fertility in the ways that they choose to, why should I not pursue that calling? Why do so many in my society view it as somehow wrong, as though I have an intrinsic failing, an un-American desire to incorporate the views of others and the values of non-Western societies into my life, because I enjoy trekking through the mountains to deliver healthcare, and because I do not believe that the cure for all illness and poverty in the developing world is to become more democratic, capitalistic, and, essentially, “American?” If I cannot help but be more at home in bamboo huts and rice fields than the polished, sanitized clinics and offices of my own country, it must be for a reason. If a wild, essential part of me triumphs every time I navigate Nepal’s incomprehensible bus system on my own, trek soaking wet through the monsoon rains to meet with midwives working in the farthest reaches of the Himalaya, or am able form a connection with a Nepali mother suffering from tuberculosis, eventually utilizing her trust in our relationship to convince her to accept treatment for her condition, then I assume there must be an intrinsic purpose to my calling, even though to some, the pursuit of global health equity seems like insanity.

The final reason for my interest in global health and development lies in my love of stories. Ever since I can remember, I have devoured books, which, to my child’s mind, held the power to transport me to so many different places and times, providing a window into the worlds of people whose lives seemed, at least on the surface, so very different from my own.  This still-insatiable passion for the consumption of stories eventually morphed into the desire to not only read about the lives of others, but also to experience those lives firsthand, to write about them, and to empower women tell their own stories through ownership of their bodies, reclamation of their birth experiences, and control of their reproductive decisions. Working as a nurse-midwife gives me a privileged, intimate look into the lives of diverse women and girls, and I am both fascinated by their lived experiences and deeply honored to be, in some small way, a part of some of the defining moments in their lives, such as birthing their children.

One of the aspects of living and working abroad that I most cherish is the discovery, so startling despite its universal truth, that the stories of lives which seem so exotic in the pages of novels and the covers of National Geographic magazines are not actually all that different from my own. Despite the differences in our material possessions, our educational achievements, and the social expectations and burdens that we carry, I can, in many ways, identify with my SBA students, with the Nepali mothers I labor with, and with the women I meet in Dhulikhel and the surrounding countryside. Like me, they long for acceptance, both by their loved ones and by their larger community. We seek that acceptance by devoting our lives to something greater than ourselves – namely, the well-being of others. Most Nepali women do this by becoming wives and mothers, while I have chosen, at this point in my life, to mother women and newborns through my practice of midwifery. I hold a master’s degree from a prestigious university, while many of the women in Nepal do not even possess a high school education, but fundamentally, we are still the same. We cherish our families, laugh at our follies, make silly faces to provoke the smiles of children, and feel outraged at the injustices that we perceive in our respective lives. We take comfort in the serene splendor of nature, enjoy long chats over steaming cups of tea, worry about measuring up to the expectations of ourselves, our families, and the world, and occasionally like to dress up in exquisitely beautiful clothes and jewelry and dance the night away!

Throughout my time in Nepal thus far, I have been fortunate to hear and bear witness to the stories of so many women and girls. A mother with hemiplegia whose husband lovingly carried her around the labor room before her C-section. A young woman fearfully seeking medical assistance after developing a fever following a home abortion that turned septic. A forty-seven-year-old mother who gave birth to seven children, only to lose three of them in the first years of their lives. A glowing seventeen-year-old primigravida who celebrated her arranged marriage at the tender age of thirteen. A skilled birth attendant who is learning English in order to fulfill her dream of studying nursing in Australia. An internal medicine nurse who competes in beauty pageants and once won the coveted title of Miss Dhulikhel. An energetic thirty-year-old mother who works long, tiring shifts at the bank six days a week, saving up her money so that her thirteen-year-old daughter can achieve her ambition of becoming a doctor. Some of these stories are tragic, some are heartwarming, some are simply a reflection of the way life is, not only in Nepal but all over the world, for so many women. All are an inspiration. A connection, forged in spite of the pervasive, harmful narratives of difference that strive to create tension, competition, and separation. A reminder that what really matters in life cannot possibly be secured through the attainment of material possessions, worldly power, or prestige. A testament to the power of women, and of women’s relationships, to recreate their world. And, for me, the ultimate reason why global health work continues to fuel me, fill me and light a fire in my soul.