Expat speaks
Every success has room for improvement
SEWA BHATTARAI
Dr. Lin Aung is the World Health Organisation (WHO) Representative to Nepal. Hailing from the neighboring country of Myanmar, Dr. Aung’s has been in Nepal for four years now. This is his second stint in Nepal as he was here previously from 2003-2005 as deputy to the then WHO Head of Mission in Nepal.
Sewa Bhattarai met up with Dr. Aung in his office at Pulchowk for a conversation about the strides Nepal has made in the health sector where a little about his personal life was also divulged as an added bonus.
How do you like working in Nepal?
Nepal and Myanmar are very similar in terms of peoples, cultures, ways of working, respect for elders, and a lot of other things. The staple food of Myanmar is similar to Nepal’s, rice with dal and maybe different kinds of spices. Also, there are a lot of Nepali people in Myanmar, and we have a Nepal-Myanmar Friendship Association here. So I feel that I’m not in a strange place. There hasn’t been much cultural shock at all.
Dinesh Gole
What are WHO’s activities in Nepal?
WHO works mainly on disease control, health system strengthening, health policy and strategy development, and environment and health issues. Maternal, child and neo-natal health are some of our priorities. We are also working on primal healthcare and universal health coverage. The Ministry of Health alone cannot accomplish everything, so it’s important to have Health In All Policies (HIAP). We are also helping the Ministry of Health develop new health policies after 2015.
What are Nepal’s most critical public health problems right now?
Like most developing nations, communicable diseases are a big challenge for Nepal. But at the same time, non-communicable diseases like diabetes, cardiovascular diseases and cancer are rising. So we’re making a two-pronged approach where prevention of diseases is the priority. It’s very costly to treat diseases, especially non-communicable ones. Raising awareness to prevent them is the key.
How can the challenge of communicable diseases be addressed?
Diseases can spread from one person to another, especially from water. It’s not enough to treat the person because the person is going to go back to the same environment and get infected again. So to improve health, it’s also important to improve infrastructure and environment. The most important key is education, especially of children. We have to work with the education sector because these health changes can be sustainable if children know about them early on.
Where is Nepal in terms of achieving its health-related Millennium Development Goals (MDGs)?
Nepal has progressed very well on MDG4, which concerns infant mortality, and MDG5 which concerns maternal mortality. The spread of TB and HIV have also reduced. Recently Nepal held a high-level regional meeting on how to sustain health momentum after the MDG deadline of 2015, which is next year. And one of the reasons Nepal was chosen to host it was because of its noted progress in MDGs despite being such a resource-constrained country. But every success always has room to improve, and we mustn’t be complacent if we’re to sustain the improvement.
On a personal note, how does someone as busy as you spend your free time?
Earlier, I used to spend a lot of time with family. But now my children are grown up. My daughter is studying abroad and my two sons have finished studies and are working in Myanmar. So I spend a lot of time reading online about health, international politics, and global health diplomacy. I try not to spend too much time on Facebook because it’s very time-consuming. I’m also involved in religious pursuits: I pray, go to Buddhist shrines.
As a Buddhist, how does it feel to be in Nepal, the birthplace of Lord Buddha?
I must say I feel blessed that my duty stations have alternated between India and Nepal, both of which are important for Buddhists. The Buddha was born in Nepal, attained Enlightenment and passed away in India. I’ve visited all these places, and also Swoyambhunath and Boudhanath in Nepal. Besides, I believe all religions have something good to give. So I’ve visited churches, the Sai Baba Temple in India, and the Lotus Temple in India which incorporates all religions.
3
Women and the Beautiful Game
NITYA PANDEY
The fairer sex has eventually conjured ways to be a part of this magic.
As the world watches the Argentinean captain play for his jersey thousands of miles away, somebody from Mugu is christened “the Messi of the Himalayas.” One might wonder who the fortunate boy is to be honored with such a title. And that is right where you are wrong. This is not a boy but a girl!
Sunkali, a young lady from one of the remotest parts of Nepal, has displayed a great passion and dedication for the beautiful game which rivals that of her male counterparts.
There used to be a time when football was solely a man’s game. Women either remained completely disinterested in this “men’s affair” or would be content putting on short skirts and waving huge pompoms to cheer for their favorite men on the field.
Times, however, have changed. Today, women have not just started viewing football with great energy and passion but have also begun to step onto the field themselves that once used to be an all-men’s territory.
Top: After she started playing football, Princi Koirala is filled with even more respect for those who participate in international tournaments.
Left: Samani Subedi wears a jersey to support her team during the World Cup. She grew up playing football and is still crazy about it. (Photo courtesy: Princi Koirala)
And Sunkali is not the only one to join the brigade.
“I grew up playing football and am still crazy about it though I don’t play anymore,” says Samani Subedi, a student, who absolutely loves watching the Premier League matches whenever she has free time. She even recalls an incident from her childhood when she and her best friend stopped speaking for eight years just because they had a spat during a match.
“We always took football pretty seriously. For us, it was like a matter of life and death.”
However, unlike Samani, there are plenty of other women who watch the game only during the World Cup. This is a month-long football fiesta that occurs once every four years. There are colors, carnivals, smiles, tears, and most importantly, football. It is the time when the world becomes a stadium where fans and footballers from across the globe witness histories being created and recreated within the traditionally allotted ninety minutes plus a few minutes of play to yield the win-lose results.
“Yes, the World Cup is quite different,” agrees Ranjita Pokharel, a student who is currently supporting the Netherlands.
“It’s a bigger platform and there’s a lot more at stake. But if you’re already familiar with the players by watching the club matches and are able to understand their strategies and techniques, it gets even more fascinating.”
So what is it about football that has all these women losing their sleep over countries that they don’t have the remotest connection with? Is it the good-looking players? Is it something about the game itself? Or is it simply the coolest phenomenon to be a part of at the moment?
“For me, it’s the beauty of the game itself,” shares Samani. “Just look at the way in which the Brazilians and the Croatians exchanged their jerseys after Brazil defeated Croatia. That was pure magnanimity, respect and passion. And that’s football for you,” she says.
Ranjita adds that the players’ good looks do matter to some extent but that is not the only reason to stay glued to your television at three in the morning. “I love Robben but I don’t find him handsome. I watch him because he’s a great player,” she says.
For many diehard fans in the world, football is not just a game played between twenty two players. It is also not limited to the charm of a particular trophy or achievement. It is a cult, a religion, something to live and fight for. And this spirit of football is felt as much by women as it is by men, irrespective of their gender.
But there are still many people who express astonishment at the fact that females can be so enthusiastic about a “male” sport.
“Football was something that I lived for while I was in school,” says Bhawana Pokharel, an ex-ANFA player. She was primarily a midfielder but also played as a striker and defender whenever the need arose. She, who is currently studying medicine at Bhairahawa, however, often faces a raised eyebrow or a gasp of surprise whenever she mentions that she used to be a footballer.
“I don’t know what it’s like in Kathmandu. But in Bhairahawa, it’s still difficult for most people to believe that I played the game for so many years despite being a girl.”
There are plenty of reasons behind people reacting about the matter the way they do. Other than the traditional way of thinking that always regards men as being the more knowledgeable beings when it comes to anything and everything related to sports, it is also the fact that this is the kind of game that demands a lot of stamina and vigor. Sometimes, a tackle may get too rough, leaving a player severely injured. And girls, who, according to the conventional notions, are supposed to be weaker than men attract looks of disbelief when they mention that they like watching or playing football.
Princi Koirala, an engineer who also used to be a midfielder in her university, admits that football was not something that came naturally to her. Although she had always loved watching the game from afar, she had not even imagined how difficult it would be to actually play on the field. Initially, she was overwhelmed by the pressure to perform well and the strict discipline that was required for every player to stay in form and maintain the stamina. But gradually, she got used to everything that came as a part of being a footballer.
“After getting a taste of what it feels like to be a footballer, I’m filled with even more respect for those who perform in the international tournaments,” says Princi who is supporting Argentina in the ongoing World Cup and is ecstatic that it has made it to the finals. “But I also believe that women can fare equally well in those similar kind of competitions, provided they are given proper opportunities and training.”
For those who play the game or have played it at some point in their lives, watching football is almost like living it. Every dribble, every pass, every goal, every card and every whistle holds a lot of meaning for them. Gone are the days when men would chat about goals, referees and players and women would daintily sip sherry under wide brimmed hats. Nowadays, women speak as confidently and analytically about the game as any man. If you check the social networking sites, women are commenting just as enthusiastically about the World Cup as men are. Perhaps the game is too beautiful to stay restricted within the masculine realms and the fairer sex has eventually conjured ways to be a part of this magic, in terms of playing as well as viewing.
4 How I became the smartest person in the world.
How wonderful it would be to know everything, with the world, literally, at your tongue-tip. It is possible; I am a living proof. Or so I would like to think, rather gainfully, as I discover. Unlike what you have been taught at school, a touch of smugness actually pays. My tendency to drop useless facts in the middle of serious conversations has already earned me a solid book: AJ Jacobs’ Know-It-All, aka “One man´s humble quest to become the smartest person in the world." I get the message. But the person who gifted me the book clearly doesn’t.
Forever troubled by the huge gaps in his knowledge, Jacobs, the editor at large at Esquire, sets for himself the unenviable task of reading all 32 volumes of Encyclopedia Britannica, coast to coast. That is 33,000 pages, 44 million words! Beset by recurrent pangs of severe knowledge deficit myself, I understand perfectly why Jacobs had to do something so drastic to make amends. It’s not our fault that the less gifted don’t get that we must do what we do.
Since I was a little kid, I have always wanted to be a know-it-all. So much easier said than done, I know. But just because it’s difficult, it’s not impossible. There are ways to do it. For instance, whenever I am at some acquaintance’s and getting bored by the Kangress-EE-Malay-Maobadi-jo-aayepani-ustai talk, I make a quick detour to see if there are any books about the house.
In this manner, I have over the years gained secret access to books on political science, electronic engineering, gynecology (ah, the in-depth illustrations!), modern physics, organic chemistry, palmistry, manicure, toilet cleaning, you name it. Even when my mind was lost in a welter of facts, even when I didn’t get 90 percent of the material at hand, I have plodded on and on and on. Persistence is another hallmark of genius, I am told.
This quest to imbibe all the knowledge in the world can sometimes send you on the verge of insanity (remember the ragged-looking Einstein photo?), but it can also be highly entertaining at other times. Like that time long-long ago when I was idly scanning the shelves of a popular bookshop in Kupondol. Hopping and skipping between the shelves, I arrive at this humongous volume of Kama Sutra, with ‘complete illustrations.’ I look around. No one close by. I am about to plunge right into the vast sacred sea when something else catches my eyes.
The red jacket of Andrew Bryant & Michelle Lia Lewis’ The Street Guide To Flirting—which could have been pulled out of a Phantom comics—is at once arresting. I am dumbstruck. I didn’t know flirting was something that could be learnt. You either had the talent or you didn’t. But then I start thinking: Could this really be my manna, god-sent to help me finally overcome my crippling anxiety in talking to the opposite sex? I decide to give it a shot.
But it just so happens that the person at the tills is a gharelu middle-aged lady. There was no way in the world I could take the book to her. What would she think of me? Here she was, allowing me in her shop thinking I was a ‘nice’ guy who dutifully read his Carnegie and Dickens, and here I was, shamefully eyeing a guide to flirting. Conscience calls, and for the very first time in my life I decide to do the right thing: stuff the damn book into my inners.
The hard-earned guide was an entertaining read, but not much help. It was filled with tips on how to offer girls well-timed compliments and where to take them on first dates. Bakery, I learnt, is the perfect place, the smell of baking bread acting as a strong aphrodisiac. All fine and dandy, but how do I first open my mouth before a girl? And when it’s open, how do I proceed to close it?
To be honest, the more I try to ‘broaden my horizon’ the more confused I get. But that is missing the point, you see. According to Friedrich Nietzsche (warning: name dropping is a telltale feature of a know-it-all), “Arrogance on the part of the meritorious is even more offensive to us than the arrogance of those without merit: for merit itself is offensive.” Jesus-Hare-Ram-Christ! Now I know exactly why I don´t know everything! Because then I will be merit-worthy, which is offensive.
Thus I will stick to the time-honored ritual of presenting Google searches as proof of infinite personal knowledge. Did you know that lightning strikes earth 6,000 times a minute? Why don’t we harvest it? Imagine all the mega-wattage to light up all our Godavari villages, all free of cost! And had you heard about couvade, which, according to AJ Jacobs, is a Basque custom “wherein the father goes to bed during the birth of his child and stimulates the symptoms of childbirth.” Think about what its adoption could do for the cause of gender equality in Nepal.
Homer Simpson, the Archduke of Springfield, says, “Facts are meaningless. You could use facts to prove anything that´s even remotely true.” I just used them to prove that I am the smartest person in the world. Of course, you disagree, you dunce!
5 Infertility: Curse or curable?
ROSHANI DHAMALA
While most causes of infertility are curable, each one demands its own kind of treatment.
Buddha Laxmi, 44, was childless for the first 10 years of her marriage. Married off to a farmer in her early teens, she couldn’t conceive even after taking several medications on various doctors’ advice. Disheartened, she was convinced that no new life could be born of her. But life had something else in store for her.
“My husband insisted that I see a doctor for the last time, and thankfully, I agreed,” she grins as she ecstatically explains that three children were born to them – two sons and a daughter, all of whom are doing well in their studies now – after she underwent hormonal therapy for infertility.
Infertility – the inability to conceive an offspring or to carry a full-term pregnancy– is a grave problem many couples face worldwide. It is defined by World Health Organization as a condition of couples where the female is unable to conceive after two years of regular trying, where the underlying causes can be infection in either the male or female, or in both. According to one of its reports, one in every four couples in developing countries has been found to be affected by infertility.
Dr. Uma Shrivastava counseling a patient at Infertility Center, Bijuli Bazaar. Factors such as psychology, diet, stress level, drug usage, and lifestyle contribute to infertility. (Pratik Rayamajhi)
“Infertility is a vast area, and factors affecting it can be more than one,” says Dr. Uma Shrivastava, reproductive endocrinologist at Infertility Center, Bijuli Bazaar Kathmandu. Hormonal causes, leading to problem in release and development of egg or sperm in male or female, or damage to the fallopian tube, cyst or tumor in uterine cavity, infection of pelvic cavity, tuberculosis of uterus, and sexually transmitted diseases are some of the frequently found causes of infertility in men and women. The most common and frequently found cause in Nepal is polycystic ovary syndrome (PCOS) in women, informs Dr. Shrivastava. This is again an endocrine (hormonal) condition in females, leading to infertility, and accompanied by signs like irregular menstrual cycle, burning hands and feet, intense restlessness, acne and a horde of other symptoms.
While most of these causative factors of infertility are curable, each one demands its own kind of treatment, adds Dr. Shrivastava. Of the many means, In Vitro Fertilization (IVF), the process by which an egg is fertilized by sperm outside the body leading, most likely, to the birth of a test-tube baby, is one means that’s growing increasingly popular and accessible in recent times.
Dr. Shrivastava, however, explains that IVF is not the sole, let alone sure, answer to the problem. Determining the precise cause of the problem, which can be many, is the right place to begin at while treating infertility, she explains.
Diagnosing correctly to find the root cause of infertility, nonetheless, involves a long and meticulous process, explains Dr. Shrivastava, who has been handling and treating such cases for twenty years. Of the many stages, counseling is the first. Many times, factors such as a person’s psychology, diet, stress level, drug usage, and lifestyle are contributing to infertility in the person. These are the factors that can be understood and corrected through right counseling, thereby ruling out the necessity of any serious medication or surgery for cure.
But a lot of other people have to go through other advanced stages of diagnosis, and the causes discovered may vary from hormonal to anatomical.
Laxmi Chhetri, 38, from Pokhara, was diagnosed for poor ovulation, a hormonal condition that, nevertheless, was cured by a few doses of medication. Laxmi now has one son, whom she gave birth at the age of 36, after spending 13 years of her married life unable to conceive.
“Many cases can be cured, and we try that it’s accomplished with minimum invasion, intervention or drug usage,” says Dr. Shrivastava who attends to patients of all age groups starting from the 20s to late 30s and early 40s.
Infertility is more than a mere physiological or anatomical condition; it is often laden with serious social and psychological overtones. Apart from social stigma and shame infertility brings to couples, it also seems to eat into their sense of self-worth and meaning in life.
For Laxmi, spending 13 childless years was both socially and emotionally taxing. During the year, she frequently faced harsh comments and queries from friends, family, and neighbors, starting right after the third year of her marriage. There are many other women like Laxmi who encounter this expectation of giving birth soon after they get married, and upon failure to do so are tagged sick, infertile, and thus incomplete. Seema Paudyal (name changed) from Syangja, who is now just two years into her marriage, has been visiting the infertility center to understand the cause of her perceived infertility and treat it.
Experiences are as many as there are people.
“I wasn’t tortured by my family. Yet I always felt a nagging sense of lack from within because of my condition,” Buddha Laxmi shares, recalling the days, and years she spent, unable to conceive or give birth. But now, as she feels enormously blessed to have three children, no amount of hardships and struggles she faced to raise them up appears to have tired her. “I did everything for my children happily and will continue doing so. I’m totally satisfied with my life,” says she who runs a grocery shop at Panauti to support her family.
In Buddha Laxmi’s case, her fallopian tube blockage had to be corrected to cure her infertility. But sometimes, the causes for infertility can be as simple as one’s age and lifestyle. According to Dr. Shrivastava, for female the chances of fertility ranges from 30-40% till their late twenties, after which it decreases steeply by 10 to 20 % every passing decade. For men, while age affects less in their sperm production, habits like smoking, drinking and drug use gradually kill their fertility.
“‘I already have a child. So how come I can’t procreate now?’ Some men react when they are informed about their infertility,” explains Dr. Shrivastav, adding that unhealthy lifestyle can be one reason behind such infertility at a later stage of life.
But not all cases of infertility have been unfailingly cured. The rule of natural selection – according to which there is only 25 percent of success chance – comes in the way of all medical attempts to treat infertility, explains Dr. Shrivastava. “Yet, keeping the hope up is the key while treating infertility,” she adds.
And apart from severely complicated cases like tuberculosis and serious infection of the uterus or pelvic cavity, many cases have been found to be successfully cured – some quickly while some in a longer period.
It took two years of regular visits to the infertility center for Laxmi before she got pregnant and delivered a healthy child, and everything cost her about two hundred thousand Rupees in total.
Costs vary according to the kind of treatment – starting from just five thousand to more than hundred thousand Rupees, depending on the kind and duration of treatment. And while the presently most popular IVF mode of treatment is comparatively expensive, other different kinds of infertility treatments exist that begin from a cheaper range, informs Dr. Shrivastava.
For Laxmi, who comes from a peasant family from outside of Kathmandu Valley, the two hundred thousand Rupees probably was a significant amount.
“Yet the joy of being a mother is nothing comparable to money,” she shares as she sits patiently waiting for her turn in the lobby of the Infertility Center she has been visiting for the second time in the hope of becoming mother again. And there are many others like her, with similar hopes, giving her company since gone are those days when infertility was a curse. Now there is cure.
5
img
Values Matter in International Relations
As debate continues whether a military intervention is imminent to deter Syria from using poison weapons in its grisly civil war, the world community seems confused about the outcome of so called limited use of force by America. Civil war in Syria has been going on for about two years with attendant fatalities of more than 100000 deaths and its regional implications are too serious to ignore.
While none is sure about the outcome of armed intervention in Syria, which the Obama administration is almost set to launch, should the U.S. Congress gives blessing, experts are busy analyzing the legality of such use of force against the background of lack of UN Security Council authorization.
Unsurprisingly though the State Department legal advisors may cite the past precedents, in particular, the Kosovo intervention in 1999, which then was not backed by the resolution of the UN Security Council to justify the proposed military intervention in Syria. Nevertheless, they should not be unaware of the loss of credibility which the armed intervention in Iraq by former president George W. Bush in 2003 brought to the U.S. leadership, when the UN was bypassed.
A parallel exists between Iraqi situation of 2003 when its former president Saddam Hussein was accused of possessing Weapons of Mass Destruction (WMD) and now in Syria where its beleaguered president Bashar al-Assad has been blamed for gassing its own citizens on August 21. Then Iraq was alleged to have violated the international norm by breaching the UN Security Council resolution (687), which had obliged it as one of the UN members to disarm in the wake of 1990-91 Gulf War.
U.S. invasion of Iraq in 2003 on the suspicion of hiding nuclear, biological and chemical weapons categorized as WMD, was launched even before the UN inspectors team had verified the existence of such horrific weapons and coincidentally American administration under Barack Obama, who is known as a anti-war president based on his previous stands, is moving towards armed intervention in Syria before the UN inspectors have submitted their reports, let alone their confirmation of use of chemical weapons by Assad.
How determined is the current U.S. leadership in attacking Syrian military targets is evidenced not only by its decision to move aircraft carriers with Tomahawk cruise missiles to the Mediterranean Sea but also by presidents speech which he gave recently blaming Assad for using chemical weapons. Roger Cohen, an op-ed columnist of the New York Times in his piece Make Assad Pay has quoted Obama who said We have concluded that the Syrian government in fact carried these out. And if that is so, then there need to be international consequences. His Secretary of State John Kerry has repeated the same version emboldening the suspicion that military attack is likely on that ground.
Doubtless that there is international taboo against chemical weapons that include harmful gases like sarin, nerve gas etc. because 189 members of the UN have abjured the scourge of such weapons by becoming parties to the 1993 Chemical Weapons Convention. The use of these gases must be condemned and the perpetrators of the same must also be brought to justice , however, in the name of doing justice can we throw the existing architecture of enforcing rule of law that governs inter-state relations into a waste paper basket.
Shouldnt we adhere to the UN Charter, the central treaty of modern era is the question asked by international law expert David Kaye, in his Foreign Affairs feature The Legal Consequences of Illegal Wars. If the U.S. as a self-declared worlds policeman, finally decides to launch military intervention in Syria on the ground that it believes president Assad has used chemical weapons against the Syrians, it should, as advised by David Kaye, think coolly about what the legal and institutional consequences of law-breaking might be.
Some advocate that the use of force by the U.S. in Syria in absence of UN blessing is justifiable citing the examples of former presidents Ronald Reagan and Bill Clinton. They conducted unilateral military campaigns in Libya (1986) and Afghanistan and the Sudan (1998) respectively without seeking international endorsement, which means UN Security Council resolution. But lets not forget that both presidents then defended their action claiming self-defense.
A look at the relevant Article of the UN Charter on member states right to use force would be in order. It says States are generally prohibited from using force against other states unless they are acting in individual or collective self-defense or pursuant to an authorization of the UN Security Council. Many are skeptical if the American leadership can invoke this provision in Syrian intervention as there is no direct threat to the security of the Americans.
Smart lawyers may advise the president that they can rely on the doctrine of Responsibility to Protect (R2P) to craft an exception to the above UN Charter requirements. But one should not turn a blind eye to the vital point that R2P, even though endorsed from the UN Summit in 2005 (commemoration of 60th anniversary of the UN), would be illegal if not backed by Security Council authorization.
A former Australian Foreign Minister and Chancellor of Australian National University, Gareth Evans in his Project-Syndicate essay Diplomacy and Double Standards has argued that R2P is inherently flawed, because the major powers will always be immune from intervention, not only because five (China, France, Russia, UK, and U.S.) of them exercise Security Council veto, but also because of their inherent military strength. Viewed from this perspective the frequent invocation of such controversial principle in managing international affairs puts a small country like Nepal at a greater advantage.
In his opinion the U.S. eagerness to punish Assad on his alleged use of prohibitive weapons even without UN sanction and cool response to the military suppression of Muslim Brotherhood supporters in Egypt is akin to Americas espousal of double standards.
At a time when the region of Middle East is burning fueled by Shitte-Sunni divide and continuous struggle for regional leadership, it would be unwise to undertake a military campaign in Syria enlisting support from the Coalition of the Willing rather than focus on comprehensive diplomacy. Such diplomacy should aim at resolving the wave of sectarian strife building across the Middle East, which is a bigger threat to world peace according to David Brooks, whose thoughts have appeared in his latest New York Times piece One Great Big War.
The present world may be American-led and American-protected as opined by Roger Cohen but values matter a lot in international relations. America should be able to erase the growing perception around the world that some lives are more important than others. Continuing to offer billions of dollars to the military that kills the citizens because the latter oppose their policies in one country and leading the military campaign in another in the same region only because Syria has been alleged to have used banned weapons will always question the credibility of the leadership
Every success has room for improvement
SEWA BHATTARAI
Dr. Lin Aung is the World Health Organisation (WHO) Representative to Nepal. Hailing from the neighboring country of Myanmar, Dr. Aung’s has been in Nepal for four years now. This is his second stint in Nepal as he was here previously from 2003-2005 as deputy to the then WHO Head of Mission in Nepal.
Sewa Bhattarai met up with Dr. Aung in his office at Pulchowk for a conversation about the strides Nepal has made in the health sector where a little about his personal life was also divulged as an added bonus.
How do you like working in Nepal?
Nepal and Myanmar are very similar in terms of peoples, cultures, ways of working, respect for elders, and a lot of other things. The staple food of Myanmar is similar to Nepal’s, rice with dal and maybe different kinds of spices. Also, there are a lot of Nepali people in Myanmar, and we have a Nepal-Myanmar Friendship Association here. So I feel that I’m not in a strange place. There hasn’t been much cultural shock at all.
Dinesh Gole
What are WHO’s activities in Nepal?
WHO works mainly on disease control, health system strengthening, health policy and strategy development, and environment and health issues. Maternal, child and neo-natal health are some of our priorities. We are also working on primal healthcare and universal health coverage. The Ministry of Health alone cannot accomplish everything, so it’s important to have Health In All Policies (HIAP). We are also helping the Ministry of Health develop new health policies after 2015.
What are Nepal’s most critical public health problems right now?
Like most developing nations, communicable diseases are a big challenge for Nepal. But at the same time, non-communicable diseases like diabetes, cardiovascular diseases and cancer are rising. So we’re making a two-pronged approach where prevention of diseases is the priority. It’s very costly to treat diseases, especially non-communicable ones. Raising awareness to prevent them is the key.
How can the challenge of communicable diseases be addressed?
Diseases can spread from one person to another, especially from water. It’s not enough to treat the person because the person is going to go back to the same environment and get infected again. So to improve health, it’s also important to improve infrastructure and environment. The most important key is education, especially of children. We have to work with the education sector because these health changes can be sustainable if children know about them early on.
Where is Nepal in terms of achieving its health-related Millennium Development Goals (MDGs)?
Nepal has progressed very well on MDG4, which concerns infant mortality, and MDG5 which concerns maternal mortality. The spread of TB and HIV have also reduced. Recently Nepal held a high-level regional meeting on how to sustain health momentum after the MDG deadline of 2015, which is next year. And one of the reasons Nepal was chosen to host it was because of its noted progress in MDGs despite being such a resource-constrained country. But every success always has room to improve, and we mustn’t be complacent if we’re to sustain the improvement.
On a personal note, how does someone as busy as you spend your free time?
Earlier, I used to spend a lot of time with family. But now my children are grown up. My daughter is studying abroad and my two sons have finished studies and are working in Myanmar. So I spend a lot of time reading online about health, international politics, and global health diplomacy. I try not to spend too much time on Facebook because it’s very time-consuming. I’m also involved in religious pursuits: I pray, go to Buddhist shrines.
As a Buddhist, how does it feel to be in Nepal, the birthplace of Lord Buddha?
I must say I feel blessed that my duty stations have alternated between India and Nepal, both of which are important for Buddhists. The Buddha was born in Nepal, attained Enlightenment and passed away in India. I’ve visited all these places, and also Swoyambhunath and Boudhanath in Nepal. Besides, I believe all religions have something good to give. So I’ve visited churches, the Sai Baba Temple in India, and the Lotus Temple in India which incorporates all religions.
3
Women and the Beautiful Game
NITYA PANDEY
The fairer sex has eventually conjured ways to be a part of this magic.
As the world watches the Argentinean captain play for his jersey thousands of miles away, somebody from Mugu is christened “the Messi of the Himalayas.” One might wonder who the fortunate boy is to be honored with such a title. And that is right where you are wrong. This is not a boy but a girl!
Sunkali, a young lady from one of the remotest parts of Nepal, has displayed a great passion and dedication for the beautiful game which rivals that of her male counterparts.
There used to be a time when football was solely a man’s game. Women either remained completely disinterested in this “men’s affair” or would be content putting on short skirts and waving huge pompoms to cheer for their favorite men on the field.
Times, however, have changed. Today, women have not just started viewing football with great energy and passion but have also begun to step onto the field themselves that once used to be an all-men’s territory.
Top: After she started playing football, Princi Koirala is filled with even more respect for those who participate in international tournaments.
Left: Samani Subedi wears a jersey to support her team during the World Cup. She grew up playing football and is still crazy about it. (Photo courtesy: Princi Koirala)
And Sunkali is not the only one to join the brigade.
“I grew up playing football and am still crazy about it though I don’t play anymore,” says Samani Subedi, a student, who absolutely loves watching the Premier League matches whenever she has free time. She even recalls an incident from her childhood when she and her best friend stopped speaking for eight years just because they had a spat during a match.
“We always took football pretty seriously. For us, it was like a matter of life and death.”
However, unlike Samani, there are plenty of other women who watch the game only during the World Cup. This is a month-long football fiesta that occurs once every four years. There are colors, carnivals, smiles, tears, and most importantly, football. It is the time when the world becomes a stadium where fans and footballers from across the globe witness histories being created and recreated within the traditionally allotted ninety minutes plus a few minutes of play to yield the win-lose results.
“Yes, the World Cup is quite different,” agrees Ranjita Pokharel, a student who is currently supporting the Netherlands.
“It’s a bigger platform and there’s a lot more at stake. But if you’re already familiar with the players by watching the club matches and are able to understand their strategies and techniques, it gets even more fascinating.”
So what is it about football that has all these women losing their sleep over countries that they don’t have the remotest connection with? Is it the good-looking players? Is it something about the game itself? Or is it simply the coolest phenomenon to be a part of at the moment?
“For me, it’s the beauty of the game itself,” shares Samani. “Just look at the way in which the Brazilians and the Croatians exchanged their jerseys after Brazil defeated Croatia. That was pure magnanimity, respect and passion. And that’s football for you,” she says.
Ranjita adds that the players’ good looks do matter to some extent but that is not the only reason to stay glued to your television at three in the morning. “I love Robben but I don’t find him handsome. I watch him because he’s a great player,” she says.
For many diehard fans in the world, football is not just a game played between twenty two players. It is also not limited to the charm of a particular trophy or achievement. It is a cult, a religion, something to live and fight for. And this spirit of football is felt as much by women as it is by men, irrespective of their gender.
But there are still many people who express astonishment at the fact that females can be so enthusiastic about a “male” sport.
“Football was something that I lived for while I was in school,” says Bhawana Pokharel, an ex-ANFA player. She was primarily a midfielder but also played as a striker and defender whenever the need arose. She, who is currently studying medicine at Bhairahawa, however, often faces a raised eyebrow or a gasp of surprise whenever she mentions that she used to be a footballer.
“I don’t know what it’s like in Kathmandu. But in Bhairahawa, it’s still difficult for most people to believe that I played the game for so many years despite being a girl.”
There are plenty of reasons behind people reacting about the matter the way they do. Other than the traditional way of thinking that always regards men as being the more knowledgeable beings when it comes to anything and everything related to sports, it is also the fact that this is the kind of game that demands a lot of stamina and vigor. Sometimes, a tackle may get too rough, leaving a player severely injured. And girls, who, according to the conventional notions, are supposed to be weaker than men attract looks of disbelief when they mention that they like watching or playing football.
Princi Koirala, an engineer who also used to be a midfielder in her university, admits that football was not something that came naturally to her. Although she had always loved watching the game from afar, she had not even imagined how difficult it would be to actually play on the field. Initially, she was overwhelmed by the pressure to perform well and the strict discipline that was required for every player to stay in form and maintain the stamina. But gradually, she got used to everything that came as a part of being a footballer.
“After getting a taste of what it feels like to be a footballer, I’m filled with even more respect for those who perform in the international tournaments,” says Princi who is supporting Argentina in the ongoing World Cup and is ecstatic that it has made it to the finals. “But I also believe that women can fare equally well in those similar kind of competitions, provided they are given proper opportunities and training.”
For those who play the game or have played it at some point in their lives, watching football is almost like living it. Every dribble, every pass, every goal, every card and every whistle holds a lot of meaning for them. Gone are the days when men would chat about goals, referees and players and women would daintily sip sherry under wide brimmed hats. Nowadays, women speak as confidently and analytically about the game as any man. If you check the social networking sites, women are commenting just as enthusiastically about the World Cup as men are. Perhaps the game is too beautiful to stay restricted within the masculine realms and the fairer sex has eventually conjured ways to be a part of this magic, in terms of playing as well as viewing.
4 How I became the smartest person in the world.
How wonderful it would be to know everything, with the world, literally, at your tongue-tip. It is possible; I am a living proof. Or so I would like to think, rather gainfully, as I discover. Unlike what you have been taught at school, a touch of smugness actually pays. My tendency to drop useless facts in the middle of serious conversations has already earned me a solid book: AJ Jacobs’ Know-It-All, aka “One man´s humble quest to become the smartest person in the world." I get the message. But the person who gifted me the book clearly doesn’t.
Forever troubled by the huge gaps in his knowledge, Jacobs, the editor at large at Esquire, sets for himself the unenviable task of reading all 32 volumes of Encyclopedia Britannica, coast to coast. That is 33,000 pages, 44 million words! Beset by recurrent pangs of severe knowledge deficit myself, I understand perfectly why Jacobs had to do something so drastic to make amends. It’s not our fault that the less gifted don’t get that we must do what we do.
Since I was a little kid, I have always wanted to be a know-it-all. So much easier said than done, I know. But just because it’s difficult, it’s not impossible. There are ways to do it. For instance, whenever I am at some acquaintance’s and getting bored by the Kangress-EE-Malay-Maobadi-jo-aayepani-ustai talk, I make a quick detour to see if there are any books about the house.
In this manner, I have over the years gained secret access to books on political science, electronic engineering, gynecology (ah, the in-depth illustrations!), modern physics, organic chemistry, palmistry, manicure, toilet cleaning, you name it. Even when my mind was lost in a welter of facts, even when I didn’t get 90 percent of the material at hand, I have plodded on and on and on. Persistence is another hallmark of genius, I am told.
This quest to imbibe all the knowledge in the world can sometimes send you on the verge of insanity (remember the ragged-looking Einstein photo?), but it can also be highly entertaining at other times. Like that time long-long ago when I was idly scanning the shelves of a popular bookshop in Kupondol. Hopping and skipping between the shelves, I arrive at this humongous volume of Kama Sutra, with ‘complete illustrations.’ I look around. No one close by. I am about to plunge right into the vast sacred sea when something else catches my eyes.
The red jacket of Andrew Bryant & Michelle Lia Lewis’ The Street Guide To Flirting—which could have been pulled out of a Phantom comics—is at once arresting. I am dumbstruck. I didn’t know flirting was something that could be learnt. You either had the talent or you didn’t. But then I start thinking: Could this really be my manna, god-sent to help me finally overcome my crippling anxiety in talking to the opposite sex? I decide to give it a shot.
But it just so happens that the person at the tills is a gharelu middle-aged lady. There was no way in the world I could take the book to her. What would she think of me? Here she was, allowing me in her shop thinking I was a ‘nice’ guy who dutifully read his Carnegie and Dickens, and here I was, shamefully eyeing a guide to flirting. Conscience calls, and for the very first time in my life I decide to do the right thing: stuff the damn book into my inners.
The hard-earned guide was an entertaining read, but not much help. It was filled with tips on how to offer girls well-timed compliments and where to take them on first dates. Bakery, I learnt, is the perfect place, the smell of baking bread acting as a strong aphrodisiac. All fine and dandy, but how do I first open my mouth before a girl? And when it’s open, how do I proceed to close it?
To be honest, the more I try to ‘broaden my horizon’ the more confused I get. But that is missing the point, you see. According to Friedrich Nietzsche (warning: name dropping is a telltale feature of a know-it-all), “Arrogance on the part of the meritorious is even more offensive to us than the arrogance of those without merit: for merit itself is offensive.” Jesus-Hare-Ram-Christ! Now I know exactly why I don´t know everything! Because then I will be merit-worthy, which is offensive.
Thus I will stick to the time-honored ritual of presenting Google searches as proof of infinite personal knowledge. Did you know that lightning strikes earth 6,000 times a minute? Why don’t we harvest it? Imagine all the mega-wattage to light up all our Godavari villages, all free of cost! And had you heard about couvade, which, according to AJ Jacobs, is a Basque custom “wherein the father goes to bed during the birth of his child and stimulates the symptoms of childbirth.” Think about what its adoption could do for the cause of gender equality in Nepal.
Homer Simpson, the Archduke of Springfield, says, “Facts are meaningless. You could use facts to prove anything that´s even remotely true.” I just used them to prove that I am the smartest person in the world. Of course, you disagree, you dunce!
5 Infertility: Curse or curable?
ROSHANI DHAMALA
While most causes of infertility are curable, each one demands its own kind of treatment.
Buddha Laxmi, 44, was childless for the first 10 years of her marriage. Married off to a farmer in her early teens, she couldn’t conceive even after taking several medications on various doctors’ advice. Disheartened, she was convinced that no new life could be born of her. But life had something else in store for her.
“My husband insisted that I see a doctor for the last time, and thankfully, I agreed,” she grins as she ecstatically explains that three children were born to them – two sons and a daughter, all of whom are doing well in their studies now – after she underwent hormonal therapy for infertility.
Infertility – the inability to conceive an offspring or to carry a full-term pregnancy– is a grave problem many couples face worldwide. It is defined by World Health Organization as a condition of couples where the female is unable to conceive after two years of regular trying, where the underlying causes can be infection in either the male or female, or in both. According to one of its reports, one in every four couples in developing countries has been found to be affected by infertility.
Dr. Uma Shrivastava counseling a patient at Infertility Center, Bijuli Bazaar. Factors such as psychology, diet, stress level, drug usage, and lifestyle contribute to infertility. (Pratik Rayamajhi)
“Infertility is a vast area, and factors affecting it can be more than one,” says Dr. Uma Shrivastava, reproductive endocrinologist at Infertility Center, Bijuli Bazaar Kathmandu. Hormonal causes, leading to problem in release and development of egg or sperm in male or female, or damage to the fallopian tube, cyst or tumor in uterine cavity, infection of pelvic cavity, tuberculosis of uterus, and sexually transmitted diseases are some of the frequently found causes of infertility in men and women. The most common and frequently found cause in Nepal is polycystic ovary syndrome (PCOS) in women, informs Dr. Shrivastava. This is again an endocrine (hormonal) condition in females, leading to infertility, and accompanied by signs like irregular menstrual cycle, burning hands and feet, intense restlessness, acne and a horde of other symptoms.
While most of these causative factors of infertility are curable, each one demands its own kind of treatment, adds Dr. Shrivastava. Of the many means, In Vitro Fertilization (IVF), the process by which an egg is fertilized by sperm outside the body leading, most likely, to the birth of a test-tube baby, is one means that’s growing increasingly popular and accessible in recent times.
Dr. Shrivastava, however, explains that IVF is not the sole, let alone sure, answer to the problem. Determining the precise cause of the problem, which can be many, is the right place to begin at while treating infertility, she explains.
Diagnosing correctly to find the root cause of infertility, nonetheless, involves a long and meticulous process, explains Dr. Shrivastava, who has been handling and treating such cases for twenty years. Of the many stages, counseling is the first. Many times, factors such as a person’s psychology, diet, stress level, drug usage, and lifestyle are contributing to infertility in the person. These are the factors that can be understood and corrected through right counseling, thereby ruling out the necessity of any serious medication or surgery for cure.
But a lot of other people have to go through other advanced stages of diagnosis, and the causes discovered may vary from hormonal to anatomical.
Laxmi Chhetri, 38, from Pokhara, was diagnosed for poor ovulation, a hormonal condition that, nevertheless, was cured by a few doses of medication. Laxmi now has one son, whom she gave birth at the age of 36, after spending 13 years of her married life unable to conceive.
“Many cases can be cured, and we try that it’s accomplished with minimum invasion, intervention or drug usage,” says Dr. Shrivastava who attends to patients of all age groups starting from the 20s to late 30s and early 40s.
Infertility is more than a mere physiological or anatomical condition; it is often laden with serious social and psychological overtones. Apart from social stigma and shame infertility brings to couples, it also seems to eat into their sense of self-worth and meaning in life.
For Laxmi, spending 13 childless years was both socially and emotionally taxing. During the year, she frequently faced harsh comments and queries from friends, family, and neighbors, starting right after the third year of her marriage. There are many other women like Laxmi who encounter this expectation of giving birth soon after they get married, and upon failure to do so are tagged sick, infertile, and thus incomplete. Seema Paudyal (name changed) from Syangja, who is now just two years into her marriage, has been visiting the infertility center to understand the cause of her perceived infertility and treat it.
Experiences are as many as there are people.
“I wasn’t tortured by my family. Yet I always felt a nagging sense of lack from within because of my condition,” Buddha Laxmi shares, recalling the days, and years she spent, unable to conceive or give birth. But now, as she feels enormously blessed to have three children, no amount of hardships and struggles she faced to raise them up appears to have tired her. “I did everything for my children happily and will continue doing so. I’m totally satisfied with my life,” says she who runs a grocery shop at Panauti to support her family.
In Buddha Laxmi’s case, her fallopian tube blockage had to be corrected to cure her infertility. But sometimes, the causes for infertility can be as simple as one’s age and lifestyle. According to Dr. Shrivastava, for female the chances of fertility ranges from 30-40% till their late twenties, after which it decreases steeply by 10 to 20 % every passing decade. For men, while age affects less in their sperm production, habits like smoking, drinking and drug use gradually kill their fertility.
“‘I already have a child. So how come I can’t procreate now?’ Some men react when they are informed about their infertility,” explains Dr. Shrivastav, adding that unhealthy lifestyle can be one reason behind such infertility at a later stage of life.
But not all cases of infertility have been unfailingly cured. The rule of natural selection – according to which there is only 25 percent of success chance – comes in the way of all medical attempts to treat infertility, explains Dr. Shrivastava. “Yet, keeping the hope up is the key while treating infertility,” she adds.
And apart from severely complicated cases like tuberculosis and serious infection of the uterus or pelvic cavity, many cases have been found to be successfully cured – some quickly while some in a longer period.
It took two years of regular visits to the infertility center for Laxmi before she got pregnant and delivered a healthy child, and everything cost her about two hundred thousand Rupees in total.
Costs vary according to the kind of treatment – starting from just five thousand to more than hundred thousand Rupees, depending on the kind and duration of treatment. And while the presently most popular IVF mode of treatment is comparatively expensive, other different kinds of infertility treatments exist that begin from a cheaper range, informs Dr. Shrivastava.
For Laxmi, who comes from a peasant family from outside of Kathmandu Valley, the two hundred thousand Rupees probably was a significant amount.
“Yet the joy of being a mother is nothing comparable to money,” she shares as she sits patiently waiting for her turn in the lobby of the Infertility Center she has been visiting for the second time in the hope of becoming mother again. And there are many others like her, with similar hopes, giving her company since gone are those days when infertility was a curse. Now there is cure.
5
img
Values Matter in International Relations
As debate continues whether a military intervention is imminent to deter Syria from using poison weapons in its grisly civil war, the world community seems confused about the outcome of so called limited use of force by America. Civil war in Syria has been going on for about two years with attendant fatalities of more than 100000 deaths and its regional implications are too serious to ignore.
While none is sure about the outcome of armed intervention in Syria, which the Obama administration is almost set to launch, should the U.S. Congress gives blessing, experts are busy analyzing the legality of such use of force against the background of lack of UN Security Council authorization.
Unsurprisingly though the State Department legal advisors may cite the past precedents, in particular, the Kosovo intervention in 1999, which then was not backed by the resolution of the UN Security Council to justify the proposed military intervention in Syria. Nevertheless, they should not be unaware of the loss of credibility which the armed intervention in Iraq by former president George W. Bush in 2003 brought to the U.S. leadership, when the UN was bypassed.
A parallel exists between Iraqi situation of 2003 when its former president Saddam Hussein was accused of possessing Weapons of Mass Destruction (WMD) and now in Syria where its beleaguered president Bashar al-Assad has been blamed for gassing its own citizens on August 21. Then Iraq was alleged to have violated the international norm by breaching the UN Security Council resolution (687), which had obliged it as one of the UN members to disarm in the wake of 1990-91 Gulf War.
U.S. invasion of Iraq in 2003 on the suspicion of hiding nuclear, biological and chemical weapons categorized as WMD, was launched even before the UN inspectors team had verified the existence of such horrific weapons and coincidentally American administration under Barack Obama, who is known as a anti-war president based on his previous stands, is moving towards armed intervention in Syria before the UN inspectors have submitted their reports, let alone their confirmation of use of chemical weapons by Assad.
How determined is the current U.S. leadership in attacking Syrian military targets is evidenced not only by its decision to move aircraft carriers with Tomahawk cruise missiles to the Mediterranean Sea but also by presidents speech which he gave recently blaming Assad for using chemical weapons. Roger Cohen, an op-ed columnist of the New York Times in his piece Make Assad Pay has quoted Obama who said We have concluded that the Syrian government in fact carried these out. And if that is so, then there need to be international consequences. His Secretary of State John Kerry has repeated the same version emboldening the suspicion that military attack is likely on that ground.
Doubtless that there is international taboo against chemical weapons that include harmful gases like sarin, nerve gas etc. because 189 members of the UN have abjured the scourge of such weapons by becoming parties to the 1993 Chemical Weapons Convention. The use of these gases must be condemned and the perpetrators of the same must also be brought to justice , however, in the name of doing justice can we throw the existing architecture of enforcing rule of law that governs inter-state relations into a waste paper basket.
Shouldnt we adhere to the UN Charter, the central treaty of modern era is the question asked by international law expert David Kaye, in his Foreign Affairs feature The Legal Consequences of Illegal Wars. If the U.S. as a self-declared worlds policeman, finally decides to launch military intervention in Syria on the ground that it believes president Assad has used chemical weapons against the Syrians, it should, as advised by David Kaye, think coolly about what the legal and institutional consequences of law-breaking might be.
Some advocate that the use of force by the U.S. in Syria in absence of UN blessing is justifiable citing the examples of former presidents Ronald Reagan and Bill Clinton. They conducted unilateral military campaigns in Libya (1986) and Afghanistan and the Sudan (1998) respectively without seeking international endorsement, which means UN Security Council resolution. But lets not forget that both presidents then defended their action claiming self-defense.
A look at the relevant Article of the UN Charter on member states right to use force would be in order. It says States are generally prohibited from using force against other states unless they are acting in individual or collective self-defense or pursuant to an authorization of the UN Security Council. Many are skeptical if the American leadership can invoke this provision in Syrian intervention as there is no direct threat to the security of the Americans.
Smart lawyers may advise the president that they can rely on the doctrine of Responsibility to Protect (R2P) to craft an exception to the above UN Charter requirements. But one should not turn a blind eye to the vital point that R2P, even though endorsed from the UN Summit in 2005 (commemoration of 60th anniversary of the UN), would be illegal if not backed by Security Council authorization.
A former Australian Foreign Minister and Chancellor of Australian National University, Gareth Evans in his Project-Syndicate essay Diplomacy and Double Standards has argued that R2P is inherently flawed, because the major powers will always be immune from intervention, not only because five (China, France, Russia, UK, and U.S.) of them exercise Security Council veto, but also because of their inherent military strength. Viewed from this perspective the frequent invocation of such controversial principle in managing international affairs puts a small country like Nepal at a greater advantage.
In his opinion the U.S. eagerness to punish Assad on his alleged use of prohibitive weapons even without UN sanction and cool response to the military suppression of Muslim Brotherhood supporters in Egypt is akin to Americas espousal of double standards.
At a time when the region of Middle East is burning fueled by Shitte-Sunni divide and continuous struggle for regional leadership, it would be unwise to undertake a military campaign in Syria enlisting support from the Coalition of the Willing rather than focus on comprehensive diplomacy. Such diplomacy should aim at resolving the wave of sectarian strife building across the Middle East, which is a bigger threat to world peace according to David Brooks, whose thoughts have appeared in his latest New York Times piece One Great Big War.
The present world may be American-led and American-protected as opined by Roger Cohen but values matter a lot in international relations. America should be able to erase the growing perception around the world that some lives are more important than others. Continuing to offer billions of dollars to the military that kills the citizens because the latter oppose their policies in one country and leading the military campaign in another in the same region only because Syria has been alleged to have used banned weapons will always question the credibility of the leadership