On our way to meet research participants in Korak, Chitwan.

Almost all my life, the Nepal I’ve known has mostly been limited to Kathmandu and a few other big, urban cities. This winter break changed that. I had the opportunity to go on field trips to more rural areas in Nepal for academic research with Aashish Jha, Assistant Professor of Biology at NYU Abu Dhabi in the Genetic Heritage Group. One of their major projects based in Nepal is the study of infant and maternal gut microbiomes during pregnancy and the first year of life. The group based at NYUAD has been working with local collaborators in Nepal to conduct this study. This December, a team of about 10 people, including the Professor and myself, conducted field work in some of these locations, like rural Parsa and Chitwan.

During the trip, I met some high school girls in a local school, Shree Nepal Rastriya Madhyamik Bidhyalaya, in a village in Parsa. The principal had arranged for me to meet them to advise them about higher education. I was hoping to share my experiences and offer help with their college application process. I had (naively) expected them to jump at the opportunity — share their aspirations, ask questions and seek help. To my surprise, they didn’t. Instead, they replied that no one had asked them about their post-graduation plans before. “Most girls are married off after high school anyways,” shared one of the girls.

“Still, given that you had the opportunity, what would you want to study?” I asked them again, only to realize that the question lacked relevance. They told me they could only go into either agriculture, accounting or education as these were the subjects offered in high school. A few of them said they wanted to learn how to use computers, but their school didn't have any.

Students from these rural communities face systemic barriers in attaining quality higher education. They do not have access to support structures such as career counselors and academic mentors to guide them through the college application process and often mandatory standardized tests. For many students, the lack of a strong command of the English language becomes a barrier in itself.

Additionally, the principal shared that there was a lack of qualified teachers in the area. Because certain subjects like science are not even offered, students are unable to meet eligibility criteria for many college programs. In addition, the girls carry the burden of everyday household chores more than boys. Most of their families are not supportive of their education. They would rather have their daughters learn and support housework than spend time with schoolwork.

In their communities, they lack role models whose achievements can inspire them. When I asked them whether any of their older siblings had left the village to pursue formal college education, no one responded. As such, they have a deficit of examples of people who have pursued higher education and gone on to occupy positions of influence.

One of the Program Officers (PO) — a Professional Certificate Level (PCL) nurse — shared that she had joined PCL nursing, a three year nursing diploma program students can join after grade 10, instead of trying for medical school because “[she] could not aim that high''. She, who belongs to the Chepang community, one of the most marginalized indigenous ethnic groups of Nepal, further elaborated, “I just could not imagine that people like me could do medicine.”

These conversations were stark reminders of my privilege. Growing up, I was constantly reminded of the importance of education. “Study well first, everything else will follow.” I was always expected to prioritize education to an overwhelming extent. My parents and teachers always offered academic support ranging from choosing a specific major to applying for undergraduate programs. I had access to extra classes after school hours to ensure perfect grades. I had high school seniors, aka role models, who had managed to get into their dream universities around the world. Likewise, I had access to professional opportunities and extracurriculars that helped me establish myself as a “deserving candidate” in my college application. And finally, I never had to deem something impossible because of where I was born, or who I was born to. If not for these privileges, I would most likely not be at NYUAD today, receiving its prestigious liberal arts and sciences education.

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During the trip, we also visited and conversed with a few pregnant women who were research participants in the study. In one of our visits, a participant in Parsa shared that she did not have a lavatory and had to walk 15 minutes into the farm to use the toilet. Lack of toilets in homes, that leads to open defecation and fecal contamination remains one of the leading causes of child mortality, undernutrition and stunting as well as causing adverse outcomes during pregnancy.

Difficult roads on the way to Korak. Photo Courtesy of Arya Gautam

Likewise, during our visit to another participant’s home in Korak, a remote district in Chitwan, we found out that she had gone out to fetch water from the river. In remote areas with no direct water supply, women disproportionately bear the burden of walking long distances to fetch water. Heavy lifting during pregnancy can result in miscarriages, preterm birth and even uterine collapse which is a major reproductive health concern in Nepal. Bimarsh Rana, one of the program managers of the research study, reported that some of our research participants in Korak have indeed had miscarriages.

Additionally, another program officer in Korak shared that most, if not all, pregnant women in the community chose home delivery, which is non sterile and lacks a qualified health professional. This leads to an increased risk of adverse outcomes such as infections, neonatal seizures or serious neonatal dysfunction. “They continue to do it because they’ve done it for generations and it’s very difficult to convince them otherwise,” she elaborated.

A village in Parsa. Photo Courtesy of Arya Gautam

As I first hand witnessed these realities that were just statistics I had read about, they became much more real and urgent in my mind. More crucially, I learnt about these challenges from the people who grapple with them everyday, grounded in their individual experiences and subjectivities. This enabled me to develop a multidimensional perspective on these issues, recognize their nuances and understand how they are not as black and white as I’d previously assumed.

Likewise, another aspect of recognizing the complex nature of these challenges involved understanding how they have persisted despite numerous efforts by NGOs, INGOs and local governments to address them. Many projects have been unsustainable, if not ineffective. For example, the government of Nepal provides monetary incentives for women to undergo four Antenatal Care (ANC) health checkups during pregnancy and opt for institutional delivery. While this policy has significantly reduced maternal and infant mortality rates in Nepal, we were made aware of cases in Korak where women could not access said benefit because they lack the means or resources to visit health centers. Transportation is difficult due to the distance and lack of infrastructure and they often rely on their husbands to take them. Sometimes husbands take the money and spend it themselves, naturally disincentivizing women to make these already strenuous visits to the health center. In addition, health posts in-charges can sometimes either deny women their rightful monetary sum or fail to record their visits to health centers. As such, despite there being strategies in places to improve maternal health care, intricacies underlying the local context can render it unable to produce desired outcomes.

Many development projects in Nepal are unsustainable due to the lack of local participation and expertise. For instance, there was a faulty tap near the home of a research participant. Her partner told us that the tap had stopped working — mud had deposited somewhere along the pipe and was blocking the flow of water, hence the village had stopped using it and reverted back to fetching water from the river downhill. This case exemplifies many developmental efforts in rural communities in Nepal: an external entity receives funds for a development project, builds infrastructure to solve the community’s needs and then leaves. And in the absence of local participation and/or expertise, there is no one to ensure that the infrastructure continues to operate over the long run, and it ceases to exist. In the case of this particular tap, the local community was not involved in its making; consequently, people lacked the expertise or experience to repair or maintain it. Or perhaps there was no incentive — given that it’s mostly women responsible for walking long distances to collect water while men in the community do not bother repairing the damaged tap.

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There were times when I couldn't help but feel a significant divide between our work and the daily lived realities of people in the communities we were working in. How was our work even relevant to these people? I knew that the scientific work we were doing would generate and expand on invaluable knowledge about microbiomes and genetics that would ultimately benefit people, but if our work was not yielding direct and immediate benefits to these communities, what was it worth? Were we instead only invasive and extractive, exploiting already underserved populations?

What, then, is the way forward to create meaningful and long lasting changes? What role can individuals and institutions play to uplift these communities? What I learned, ultimately, is that the seemingly significant dissonance between academia and grassroots can and, in fact, should be bridged. And there are many ways of doing so.

A village in Korak, Chitwan. Photo Courtesy of Arya Gautam

I came to learn that the team had multiple engagements and services to help alleviate some of the most urgent issues faced. For example, health professionals who are hired as program officers by the research team to collect samples from pregnant women and their newborn infants are also raising awareness among women in these rural communities about reproductive health. The officers are encouraging pregnant women to fulfill their regular health checkup requirements, informing them about the importance of institutional delivery, raising awareness about good diet and encouraging women to refrain from consuming alcohol and smoking during pregnancy. They also assist in the local health posts (that are usually understaffed in rural Nepal) in their daily operations. In several locations, some program officers are hired from the local communities. Furthermore, the NGO, Integrated Rural Health and Development Training Center (IRHDTC), that serves as a local collaborator in Nepal for the research study is required to regularly meet research participants, program officers and locals in the community to ensure that the study is properly conducted. The scientific work requires them to immerse themselves in these communities which has made them aware of the realities of maternal and infant health care issues. They are also in communication with the local government and health care service providers in these respective areas, reporting these concerns as well as coming up with collaborative programs aimed at improving reproductive health at the local level.

I witnessed how academic work that, at first, seemed distant from the ground reality was in fact uplifting local communities: it was providing employment at the local level, raising awareness among people on health, and facilitating collaborations between developmental organizations and the government to improve maternal and infant healthcare. This model of engaging in academic work in and with communities really inspired me. I learned how research can be done in ways that are not unidirectional where we simply extract information from places and people to advance our quest for knowledge but multidirectional, such that we use our resources and capital as academics to make meaningful contributions to places and people we are working with.

This, then, bodes the question: if a small academic group from NYUAD was able to contribute as such, what can larger institutions like NYUAD itself do to help empower these communities?

Perhaps it can facilitate engagement of its student body with these communities by means of J-term classes and/or regional seminars. NYUAD’s immersive, global educational experience that fosters meaningful interactions between students and host communities should extend beyond the capital, Kathmandu and into more rural locales. Classes such as ‘Challenges in Global Health' and 'Making Education’ that include field visits to Kathmandu could perhaps reroute to non-urban landscapes that face more pressing challenges. This would not only contribute to a more global-level awareness about challenges in rural Nepal, but also create more economic opportunities in these areas.

More significantly, it is time academic institutions such as NYUAD reevaluate their admission policies and application eligibility criteria. Blanket policies that apply to everyone help create and sustain structural inequities. Institutions like NYUAD that center diversity and inclusion in their mission statement need to actively reach out to students from these underserved and marginalized communities. It needs to recognize the nuances of inequalities even within developing and underrepresented countries such as Nepal, and not simply admit students from private schools of Kathmandu like myself to ensure representation. In tangible terms, this could mean having different evaluation criteria for students who apply from remote and under-resourced schools, as well as expanding NYUAD’s presence beyond admission fairs in private schools of Kathmandu.

These efforts would help create bottom-up changes in these communities. Even if a single student from Shree Nepal Rastriya Madhyamik Bidhyalaya school was admitted to NYUAD, there would perhaps be loud, enthusiastic responses in the room next time anyone asks them about their career aspirations. Upcoming generations in these areas would perhaps, after all, be able to “aim that high.''