ma3003

Mehreen Arif
FSB Nepal and HealthRight International
Kathmandu, Nepal

In order to interview young Tibetans, Rinchen and I had to go to the Tibetan settlement in Jorpati. All of them finished their +2 (high school) and bachelors degrees and were working in offices at a prominent Tibetan carpet factory in the Tibetan settlement. Because of their jobs they could not travel to FSB clinic so we requested permission to interview them at the factory.

The settlement was a very tranquil place with buildings and prayer flags hung throughout the community. It was tucked behind the main Boudha-Jorpati road on an uphill incline. The dirt, construction and ceaseless traffic of the main road presented a stark contrast to this area.

On our walk there we crossed many magnificent monasteries and Tibetan clothes and souvenir shops.

Overall, the young Tibetans reciprocated much of the apprehension Ms. P and Mr. R voiced (refer to my previous blog post). I also met participants who are half-Nepalese, half-Tibetan who brought to light an issue that I was not even aware of.

One participant exclaimed, “My grandparents moved from Tibet in 1960. My father was born in Nepal. My mother is Nepali. Technically, I should get Nepali citizenship but it is difficult to get it through the mother. Once, I applied and I got rejected. They never disclosed the reason for rejection. I think they needed some extra money or some sort of a bribe. So it’s very difficult to get Nepali citizen even if you are half-Nepali and half-Tibetan.”

I also encountered Tibetans born in India who were able to obtain Indian refugee status and Indian RC (refugee cards). One such participant said, “In Nepal, there are lesser opportunities. India is much better for jobs and education. In Nepal, there is not enough freedom as a Tibetan. My family and I have Indian refugee cards, so I can compare living in India to living in Nepal. We are now settled in Nepal because our business is based here. And business is better here now. I have been working at factory since the past three years. I work in the order processing unit and I make contacts with clients and provide information.

“Attaining refugee status in India is also very hard. In Nepal, it’s a whole separate issue because it is completely banned. But to get a refugee card in India, both of the individuals’ parents need to have refugee status first. Also, people who come straight to India can also get a refugee card by registering themselves as new Tibetan refugees at Tibetan administration and refugee offices in India. In the future, I see myself moving to Bangalore, India. I have some relatives in India as well.”

Another participant shared, “In Nepal, getting a job as Tibetan is very hard. In India, you just have to make a bankcard and show it to you employer as proof of residency. In Nepal, there is nothing to show here. We don’t even have citizenship or residency despite being born here. In order to be eligible for any good or higher ranking jobs, we need ID documents.”

I met one Tibetan who was very lucky to actually have obtained Nepalese citizenship. He shared, “The area over there [pointing to houses in the distance] is the Tibetan settlement that you can see with prayer flags. Years ago, that settlement was given to Tibetan refugees by the Nepalese royal family’s king. With that, he also granted the refugees Nepalese citizenship.

“My father was one of the lucky ones to have obtained Nepali citizenship, so to be honest, I also have Nepalese citizenship. When an individual turns 16 and the father has Nepalese citizenship, the individual can apply to citizenship as well. My siblings and the whole family have acquired citizenship naturally.”

Talking in particular about mental health, another participant shared, “I have not received mental health services because I really don’t know where to go, and for a country like Nepal, no one really talks about mental health services. There is no awareness about this issue. Like, I don’t know whom to talk to or reach out about therapy or counseling.”

Mehreen Arif
FSB Nepal and HealthRight International
Kathmandu, Nepal

A lot has happened since my last blog post. I started my research project and finally began interviewing Tibetan refugees! A Tibetan community healthcare worker, Ms. Recho Dolma brought in patients from the Tibetan settlement in Jorpati and FSB doctors and nurses also identified Tibetan patients during consultations.
Mr. Sanjaya Basnyat, the Executive director of FSB, kindly requested the director at the Tibetan settlement camp office, Mr. Kalsang Dhundup, to instruct Ms. Recho Dolma and some other Tibetan nurses to bring Tibetan patients to FSB clinic for interviewing. The patients who agreed to be interviewed and take part in the research were thus brought in.

I interviewed 5 patients on the first day! I was so excited. Although it was a very time consuming process because despite anticipating that translation would take time I did not anticipate that it would take almost 50 to 55 minutes per patient. My research protocol says that interviews would take less than an hour and I thought I would be able to conduct one interview in about 30 to 40 minutes. However, when I actually interviewed the patients I realized that most patients needed the answer choices repeated to them at least twice per question. In the beginning the patients who came in were in their 60s and 70s, and hence required extra attention to detail and repetition.

I still remember feeling quite nervous during my first interview because I knew that the term “mental health” in South Asia carries a lot of stigma and seemingly denotes that someone is mentally unfit or has psychiatric issues.

But I made it a point to educate each participant and inform them that mental health services like therapy, talking to a psychologist/psychiatrist or receiving one-on-one/group counseling is not just for patients with severe mental disorders. Every person goes through a stressful experience in life or possesses some feelings of sadness or depression at some point during their lifetime. Therefore, seeking mental health services or help should not be frowned upon because it is as crucial and important as seeking help during an accident or when someone has a fever or is in need of any other physical health relief.

And slowly but surely as the interviews progressed I realized that overall the participants were very honest and open about their feelings while being interviewed and by the end of the interview almost all of them stated that they would definitely want to receive mental health services in the future.

Interviewing Tibetans in Kathmandu has been a cathartic journey for myself personally as well. I have interacted with so many different and beautiful people – each with their own story to tell and their own struggles but one thing that always binds and defines all of the participants I have interviewed is their status as a Tibetan refugee in Nepal.

Two patients left a mark on me and reminded me of the value of this fellowship and project. My interaction with them heightened my faith in pursuing global public health at NYU and being a human rights advocate. They were both very warm and friendly and had suffered a lot in their lives. The lady was 76 years old and the gentleman was 75 years old.
Interviewing them was almost bittersweet because while they were remorseful of the conditions of Tibetans in Tibet and Nepal they both respectively acknowledged that they have lived their lives and now were not pessimistic but had some hope that the future generations of Tibetans will get educated and fight for the rights of Tibetan refugees.
I will refrain from using their names for privacy issues but I want to share some of their quotes. I will address the lady as Ms. P and the gentleman as Mr. R.

Ms. P was very proud of Rinchen for getting an education, becoming a nurse and being able to interpret for her. After the interview was over she turned to Rinchen and said, “I am very proud of you. You got a good education because of which you can communicate with others and speak whatever you want to say. Unlike me… because I have a lot to say but I cant communicate due to the language barrier. So you are lucky.”

She turned to me and said, “I thank you for your concern for Tibetans. Tibetans are suffering because we do not have our country, we are happy that other people are helping us. And you are helping document our struggles.” She further added, “Due to the greatness of the Dalai Lama, Tibetans are getting educated. I am hoping that future generations (of Tibetans) will improve because of His Holiness and His Blessings.”

Mr. R was a retired army veteran. On one instance he exclaimed, “My parents were captured by Chinese forces. I don’t know what happened to them and that disturbs me all the time, till this very day. I remember it like yesterday. When the war started we (my siblings and I) ran out of our house in Kham, Tibet but my parents stayed inside and were taken away by the Chinese.”

He further revealed, “After a lot of miserable times I eventually moved to Nepal. Here I served in the Tibetan army for 14 years, at the border of Nepal and Tibet. Although I was in Nepal I represented Tibet and lived in difficult circumstances in tents near mountains. I feel I have done so much but now what more can I do…

“I feel so dejected because conditions in Nepal are very complicated and expensive for Tibetans. It is difficult to generate money and jobs.”

Mr. R spoke quite passionately about Tibet and was hopeful like Ms. P that future generations of educated Tibetans in Nepal could be the harbinger of peace and justice that all Tibetans anxiously await.

Another elderly participant exclaimed, “Thank you for this interview… if this research helps the Tibetan community it would be great so sacrificing one day to come here is not a problem at all. What you are doing is very admirable.”

In my next blog post I will share my experience about interviewing young Tibetans and their thoughts on mental health and their status as Tibetan refugee in Nepal. Stay tuned!

Mehreen Arif
FSB Nepal and HealthRight International
Kathmandu, Nepal

It occurred to me that I did not write about my experience visiting the Nepalese Health Research Council office to obtain my research approval. Mr. Anil (the Administrator at FSB) kindly took me to the NHRC office. The NHRC office was located about 40-45 minutes from FSB (northeast Kathmandu) in the heart of the city.

Little did I know that it was in the same compound as the Ministry of Health (MOH) which was a huge brick building that houses three departments – Department of Drug Administration, Department of Health Services and the Department of Ayurveda. The Department of Health Services (DoHS) is further divided into Management, Family Health, Child Health, Primary Health Service Revitalization, Logistic Management and Epidemiology and Diseases Control. The DoHS also includes three sections namely – Leprosy control program section, Personnel Administration Section and the Finance Administration Section. The NHRC started as a committee under the MoH in 1982. In 1991 it became a statutory and autonomous body under the Nepal Health Research Council Act No. 129.

The NHRC collaborates with the WHO, UNICEF and USAID in order to facilitate and promote research in non/communicable diseases, environmental health, health systems, traditional health and mental health. To conduct any type of research in Nepal a researcher has to submit their proposal for ethical review to the NHRC.
While I was waiting for NHRC approval (because that took longer than American research approval) I shadowed doctors at FSB (refer to prior posts) and also had sometime to sightsee and explore Kathmandu.

I had a lovely time with Ms. Ishwori and her family exploring Patan (Lalitpur) – a historic city only 45 minutes from Kathmandu, that first came into being in 745 AD. Patan boasts beautiful ancient art, stone carvings, Buddhist and Hindu temples and statues and a plethora of cultural UNESCO heritage that I had the pleasure of exploring.

Going back to research, the video below is a snippet of my journey to the NHRC. Behind me is the MoH. I am wearing a mask on my face as is customary for everyone in Kathmandu given the amount of dust in the city. You can catch a glimpse of the busy road and the abundance of “scooties” (scooters) that both men and women gallantly navigate.

While at the NHRC office I met an officer who assured me that because I came in person she will process the proposal and contact senior reviewers to expedite the review. Moreover, in order to conduct any type of formal research domestically or internationally through an institution in the U.S., researchers need American research approval i.e. they have to submit their proposal to their universities Institutional review board (IRB).

It was certainly an arduous waiting game that finally came to an end a few days ago! I received IRB approval last week and my research is off to a hectic yet great start. More soon on my experience interviewing Tibetan refugees at FSB clinic.

Mehreen Arif
FSB Nepal and HealthRight International
Kathmandu, Nepal

Living in Nepal has evoked a myriad of latent emotions within me that I or rather my surroundings had aided in suppressing. Having studied identity and race discourse in depth during college as part of my English degree curriculum I read works by esteemed historians and authors and wrote numerous papers on the caricaturization of identities and the premise of a nebulous nationalism when it comes to immigrants and first generation immigrants reconnecting or connecting (for the first time) with feelings of American or their native patriotism. I revisited those papers today and entered into a deep rumination and an eventual realization that moving to Nepal for two months is gradually making me relive my yesteryears in Pakistan. It has enabled me to connect with my roots on a more spiritual level that I had been yearning for the past 5 years.

My time here is rekindling my memories of the beauty of South Asia and South Asian life. And oh how I missed this.

1) The splendor of speaking in my native language and reconnecting with rare and authentic Urdu (اردو)
words extracted from literature that are not usually spoken in conversational language…

2) The divine taste of the mangoes – and one of the most popular varieties cultivated in South Asia since centuries is known as “the King of the mangoes” because Pakistani and Indian mangoes (imported to other parts of South Asia including Nepal) are known to be the sweetest mangoes across the globe. If you haven’t tasted a Pakistani or an Indian mango (whether it is a Langra, Chaunsa, Sindhri or an Anwar Ratol) you haven’t lived…

3) The beauty of wearing shalwar kameez and embroidered cotton kurtis (South Asian short blouses) with abandon…

4) The delight upon seeing stationery shops (with Oxford mathematical tools like compasses and dividers reminding me of my O-level geometry classes), map houses (where geography books and maps are sold), the odd khokas (roadside food stalls) and paan shops (a betel leaf wrapped delight), the churiyaan (bangles) and mehndi stalls (henna), the incessant traffic, the beautiful terrain and ancient banyan trees to even the species of crows in South Asia that I have yet to encounter anywhere else…

5) The Nescafe gold instant coffee jars, the Cadbury silk bars, Spout gum, UHU sticks (glue), Surf excel (detergent), guava and mango pulp drinks, mithai (South Asian desserts), digestive biscuits, sarsoun ka taail in it’s most pure and organic form (mustard seed oil) and South Asian food… all types of Nepali food – fairly reminiscent of Pakistani and Indian cuisine as well…

6) Playing mesmerizing Bollywood songs and movies and watching invigorating Pakistani and Indian talk shows – usually accessible online only in South Asia…

7) The euphoria and sheer excitement of watching a Pakistan v.s. India Final Cricket World cup Championship match and failing to conceal my uninhibited jubilation when it culminated in Pakistan’s historic ICC (International Cricket Council) win since 1992…

8) The adroit craftsmen selling handicrafts, artifacts and souvenirs around places of worship or at museums…

9) Being greeted by a cacophony of sounds from the numbing noise of construction drills or honking horns when walking on the occasional unpaved road alongside a sewer redolent of animal excrement or rubbish discarded by shop owners… (okay maybe I didn’t miss #9 all that much)

10) The affable people all around who are ever willing to lend a helping hand and the circle of mutual respect often missing from Western cultures that binds the South Asian populous – whether it is showing respect in the form of greetings like “Namaste/Namashkar” and the joining of hands, or saying “Salaam” with a gesture of raising the hand to the forehead, or letting elders walk in front of you and addressing family members with their distinct titles highlighting and appreciating their familial roles, from Didi (sister), Bhai (brother), Bhabi (sister-in-law), Jeeja (brother-in-law), Uncle, Aunty etc….

I can keep writing and adding to this list but that will take too much time and space. This was just an attempt at sharing a portion of a huge piece of what South Asia means to me and how I take pride in calling myself a South Asian American.

 

Moreover, June was the month of fasting (Ramzan) for Muslims all over the world and in Nepal. After fasting we celebrate Eid-ul-Fitr. Eid is a time of celebration and festivity spent with family and friends marking the end Ramzan. We fast to get closer to God, to understand the suffering of those less fortunate than us and those who cannot afford to have three meals a day. It teaches us patience, perseverance and resilience. Ramzan was a bit more special for me this year because I am in South Asia for one and secondly it overlapped with the Tibetan holy month of Saka Dawa. The video above shows a Tibetan prayer service that I observed at the Swayambhunath temple and I understood how Tibetan Buddhists also share the same core principles of a holy month with giving thanks in order to receive blessings. And with this I wish you Happy Saka Dawa and Eid Mubarik from Nepal.

Mehreen Arif
FSB Nepal and HealthRight International
Kathmandu, Nepal

Hello everyone, I come bearing glad tidings. I have received Nepalese Health Research Council (NHRC) approval for my project. However, I am also in dire straits, because I am still waiting on American (IRB) approval, and that will take some more time. But I keep telling myself that everything will hopefully fall into place soon enough and that patience is pivotal for me.

The good thing is that however frustrated I get about approval proceedings, my patience is far from wearing out because the approval proceedings has offered me a unique opportunity to get to know the people of The Friends of Shanta Bhawan (FSB) clinic.

I have been shadowing Dr. Laxmi Luitel (one of the three physicians at FSB). Dr. Laxmi grew up in a rural part of Nepal and moved to Kathmandu to become a Health Assistant (paramedic). Soon she got married and had a baby boy, but decided she wanted to do more. And hence started her pursuit of becoming a doctor. With the support of her family who took care of her baby in Nepal, she set off with her husband to China where they both pursued medicine for 4.5 years. Dr. Laxmi is a primary care physician but hopes to one day specialize in gynecology because of the dearth and demand of female doctors in the country and her passion for helping women.

Empowering the girl child in South Asia and Africa is a big feat and one that is often accomplished by social workers or NGOs but seldom thought of as a doctor’s or public health professional’s job. But I have realized that is very much a doctor’s and a public health professional’s job.

A few days ago I had the unique opportunity of meeting three amazing first year medical students from UC Davis who were on an observational placement also shadowing doctors and nurses at FSB. These three individuals became my friends in only a few hours and we hung out for the three days they were at FSB, then had a farewell dinner (for them) together on Saturday.

Much like Dr. Laxmi, Alejandra, David and Margie taught me the meaning of service and commitment to bettering peoples’ lives as they shadowed at FSB, served and raised awareness at health camps in villages, and taught local school children about medicine and health.

Going back to Dr. Laxmi again: she owns a hospital in the ancient Newar town of Sankhu (outside of Kathmandu) with her husband, but she is committed to her service at FSB clinic as well, so she works here from 9 am to 3 pm everyday (besides Saturdays) and then works at her hospital from 4-5 pm till nighttime.

My shadowing experience with Dr. Laxmi was extraordinary.

Not only did I get to observe physical exams, pelvic exams (pap smears), patients with diabetes, uric acid, hypertension, piles, UTIs, gastro-intestinal issues, chest infections, pneumonia, pulmonary tuberculosis, jaundice, thyroid problems, constipation, pregnancy issues, vitamin deficiency and infertility; but I also got to see the smile, heartening responsiveness and sheer concern with which Dr. Laxmi treats her patients. This is something that I have read a lot about in my public health curricula at university but had never really experienced first hand: the importance of empathy, bedside manner and trauma informed care principles in medical practice.

It should also be noted that due to the dust, pollution and unhygienic conditions of the Jorpati and Boudha area many patients come in with pulmonary tuberculosis, gastrointestinal diseases and UTIs. And during the physician visits Dr. Laxmi not only told her patients about their diagnosis but what stood out to me was that she would make an extra effort to educate her female patients about hygiene and sickness. She drew diagrams to explain the position of the urethra, vagina and anus and how clean wiping and safe sex measures should be implemented in order to avoid UTIs and pelvic inflammatory diseases.

As I shadowed Dr. Laxmi we saw all types of patients from infants, to children, to adults (including Nepalese ethnic minorities and Tibetan refugees).

I also recognized that the Nepalese ethnic minorities or Tibetans usually came in with a family member who had a better command of the Nepali language because the Nepalese ethnic minorities were comfortable speaking their regional/tribal languages and the Tibetans were comfortable speaking Tibetan. Language plays a huge part in access—access not just to healthcare or education but to a sense of identity and belonging.

Furthermore, I observed that the doctors (Dr. Laxmi, Dr. Shyam and Dr. Bhumi Upreti) at FSB see on average 45 to 48 patients a day and on busier days – almost 80 to 88 patients per day.

What was more noteworthy was that after a physician visit if a patient was prescribed to get X-rays, EKGs, ultrasounds, abdominal scans or blood drawn for testing – they can do so at the clinic there and then and wait on their reports and refer back to the physician again – all within the span of one visit. Additionally, the set fees for physician visits are NPR 50 for previous patients (US $0.49 = 49 cents) and NPR 60 for new patients (US $0.58 = 58 cents). Ultrasounds, scans and X-rays all range from NPR 250 to NPR 600 (US $2.50 to $6.00).

One of the physicians Dr. Sam (Dr. Shyam Shrestha) also serves as the ultrasonologist, thereby curbing additional expenses for the clinic so that the clinic continues to provide subsidized care for its patients while also providing free tuberculosis medication.

The clinic also offers free lunch everyday at 11:30 am sharp for all of its staff prepared by Mona ji, Mina ji, and Babita ji. They are extremely hardworking and contribute to the well oiled (food) and structure of FSB.

At FSB I have enjoyed copious amounts of chawaal (rice), daal (lentils), masala, vegetables, fried potatoes, tea, and the list continues; all thanks to the ladies who work in the kitchen and feed about 27 people daily and now graciously feed me as the 28^th person.

At the end of the day they leave the kitchen spick and span with pans, plates and utensils neatly stacked.

Moreover, I sit next to Ms. Ishwori Shah the Finance and Admin Chief of the clinic and adjacent to Ms. Sarita Basnyat the Finance and store assistant (who has worked at FSB since 1992). Both women handle the finances, revenue and external communication with donors/suppliers of FSB clinic. Ms. Ishwori continues to help and support me during my time at FSB clinic.

 

 

 

These people (along with many others who are not mentioned in this post) constitute the staff of the Friends of Shanta Bhawan clinic under the guidance of Sir Sanjaya Basnyat (the Chief Executive Director of FSB). Sir Basnyat is very inviting towards volunteers, international physicians, NGOs, researchers, and donors who could contribute to the enrichment and prosperity of the clinic. He has also helped me tremendously in preparing for my project in Nepal.

In addition, Sir Basnyat is a strong advocate for the health and wellness of the people of Jorpati and Boudha and the importance this clinic holds for the community. For example, in the year 2016 FSB succeeded in providing care to 19,326 previous patients, 12,040 new patients, and 11,296 patients under 5 years old. In the previous year FSB administered roughly 4,414 ultrasounds and X-rays, 65 ECGs and 15,455 pathology (blood, urine, stool, HIV, immunology and vaginal smear) analysis reports.  A comprehensive patient census is collected each month and divided by old/new patients, patients under 5, pathology reports, patients for each doctor and even a patient census by caste (Janajati, Dalit, Muslim, Brahmin and Chhetri, Madheshi, and Tibetan refugees). Furthermore, FSB is facing a lot of hurdles with the government’s plan on demolishing the buildings on either side of the Boudha road (including FSB clinic) in order to expand the road.

Due to the subsidized nature of FSB’s clinical services the clinic urgently requires funding and donations after incurring a heavy yearly loss (with an average deficit of NPR 1,00,000/ US $1,000 a month).

Despite all the hardships, Sir Basnyat and the FSB team have a future plan for FSB that includes first and foremost its relocation (which comes with caveats such as losing their present patient influx and generating additional revenue for relocation), providing extensive pediatric and gynecology services, developing a birthing center, establishing an automated registration system, and procuring advanced medical equipment for the clinic.

And hopefully, my research with Tibetan refugees will help FSB in providing counseling and mental health services for Tibetan refugees and expanding services to include Nepalese ethnic minorities as well.

In conclusion, the FSB clinic has benevolently opened their arms and accepted me into their friendly family. I hope to return their heartwarming hospitality through my research and raising awareness not only about Tibetan refugees but about the Friends of Shanta Bhawan clinic alongside HealthRight International and the vital work and much needed care they provide to people in the region.

Mehreen Arif
FSB Nepal and HealthRight International
Kathmandu, Nepal

The transformative power of travel never ceases to amaze me and I continually express my gratitude to the NYU Gallatin Fellowship in Human Rights for providing me with the platform to further my passion to be a global citizen advocating for refugee and migrant health . This is my second blog post for the site but my first blog in a country of rich history, expansive Himalayan landscapes and inviting people: Nepal. Upon arriving  in the capital and the bustling metropolis that is Kathmandu city, I was greeted by bright sunny skies and a whiff of dust that I thought was due to some construction going on at the Tribhuvan airport. However, during my ride to the hotel I realized that most of Kathmandu was engulfed in clouds of dust owing to the construction and rehabilitation projects going on due to the 2015 earthquake.

My residence Green Hotel is a four-minute walk to FSB clinic, which is extremely convenient. However, the main road to the clinic is very underdeveloped, and the government plans on expanding it by demolishing many buildings on either side that have flourished as businesses including FSB clinic that provides much needed healthcare services to the community of Jorpati and Boudha.

My first day at the clinic was the first day that I arrived in Kathmandu on Wednesday, May 24, 2017. I was graciously welcomed by the Executive Director of FSB Mr. Sanjaya Singh Basnyat and the entire staff. I was shown around the clinic, which is a 4 story building that provides vaccinations, maternal and antenatal child care, family planning services, primary care physician consultations, blood workups, X-ray and EKG services and medicines to the local community (mainly Nepalese ethnic minorities and Tibetan refugees).

The Jorpati and Boudha area is of significant importance to Buddhists (mainly Tibetan refugees) due to the presence of the great Boudhanath Stupa. Due to the great location of Green Hotel the Boudhanath is also a four-minute walk but in the opposite direction from FSB clinic.

After the clinic hours (9am to 3pm), I venture out to Boudhanath to take in the essence of spirituality, to observe Buddhists monks and Tibetan Llamas perform prayers and incantations due to the holy month of Saka Dawa (honoring the Buddha’s life), and just blend in the atmosphere like a local (which isn’t really that hard because I have been told I “do not look American” and that I look Nepalese… up until I speak English that is). Fun fact: they charge a fee for foreigners at the Stupa but I have yet to be asked to pay up because I usually just walk right in with my back pack and my surgical mask (which is imperative to wear when outside because of the dust) and give a confident nod to any security guard present. Overall, I am getting by just fine because everyone here understands Urdu/Hindi with ease and even if I don’t speak Nepalese, speaking the other two languages has certainly bridged any communication gaps with everyone that I interact with.

I go to the clinic from Monday to Sunday (with Saturdays being the day off). The whole FSB staff has made me feel so at home at the clinic and I am so happy I chose FSB and HealthRight International for my Gallatin Human Rights fellowship. The only disconcerting issue is that I am waiting for research approval from the Nepalese research council and the NYU IRB board, after which I can formally start my research. Until then I am preparing everything for the project, helping around the clinic and volunteering as much as I can.

Just yesterday Ms. Rinchen Paldon (a former nurse at FSB and my Tibetan interpreter for the project) and I went over the whole interview script in English and Tibetan.

Ms. Rinchen was born in Tibet and left the country when she was very young to be with her aunt and uncle in Kathmandu. Her parents sent her here in order to have a better life but Ms. Rinchen has never been able to meet her parents and her whole family who are still in Tibet ever since she came to Nepal at the age of 8. She is a Tibetan refugee herself and finished her nursing education in India. My conversations with Ms. Rinchen certainly made me cognizant of the immense dearth of mental health services for Tibetans in Nepal.

Moreover, it is extremely hard for Tibetans in Nepal to secure jobs due to the lack of identity documentation and their refugee status.

This all makes one think: what really constitutes identity discourse? We can identify ourselves in many ways but the truth of the matter is that our identity is documented by what passport we have or what country’s residency we obtain or whatever piece of paper we possess that states which country we essentially belong to—or rather, don’t belong to.

This is my parting thought of the day with which I leave you with. I hope to gain more clarity during my frequent rumination on refugee/migrant identity, mental health and human rights through the course of my time in Nepal. I will be writing again soon, hopefully after securing research approval!

Mehreen Arif
HealthRight International
Nepal

I am a first-year master’s student at the NYU College of Global Public Health pursuing my MPH degree in Global Public Health, and I am extremely grateful and honored to be amongst the growing community of distinguished Gallatin Global Human Rights fellows.

My project is based in Kathmandu, Nepal, and I will be working with a health NGO called HealthRight International, which operates from within a human rights framework, and the local FSB (Friends of Shanta Bhawan) clinic. HealthRight and FSB Nepal work together to provide care to local Nepalese ethnic minorities and Tibetan refugees in the Boudha and Jorpati area of Kathmandu.

Health is a human right that, in an ideal world, would most certainly be available to all. Mental health, moreover, is a crucial part of people’s overall well-being. Unfortunately, mental health is a subject that is often eschewed or not even discussed in low- and middle-income countries, especially in South Asia. My research will focus on assessing the burden of mental health issues (specifically, the prevalence of depression, trauma, PTSD, and discrimination) on the Nepalese ethnic minorities and Tibetan refugees in Kathmandu, as well as understanding the barriers impeding Tibetan refugees’ access to mental health services in Kathmandu.

Tibetans have sustained numerous human rights abuses, including torture, in Tibet under Chinese authority, and they have faced obstructions to their religious and cultural daily lives as refugees in their adoptive nations as well.

I chose to do my project in Nepal as opposed to Dharamsala, India, and its surroundings (where the majority of Tibetan refugees reside in proximity to His Holiness the Dalai Llama). Nepal, while a beautiful country, has been riddled with civil unrest and is prone to natural disasters, so support and awareness has been needed to highlight the plight of Tibetan refugees within its borders.

I anticipate some challenges for my project this summer. For one, I must obtain approval from the Nepal Health Research Council board, and it will be a long process. Further, I don’t know how the interview process will pan out. I will be working with a Tibetan language interpreter, and there are a lot of elements to take into consideration, mainly bias and trying to provide a safe environment for the refugees to open up about their mental health stressors. Alongside all of that, I must survive the monsoon season!

But ultimately, my goal is to understand and help Tibetan refugees, a rapidly diminishing and often overlooked faction of Nepalese society.