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Apr 16, 2017

Review and update: Worm hole, Passion and Future (Post 12/24)

I have not entered monthly blog posts since December 2016. It was tough time for me to settle leaving Seoul in search of new but meaningful jobs. Finally, I am now all the way here in Kigali, a beautiful and clean capital of Rwanda via Karachi, Pakistan, where temperature reached the highest up to 50 degree centigrade !! It was a long trip with layover for few weeks in Sacramento, California, where my youngest sister and her family are working hard to fulfil their American dream. In this difficult yet transient transition testing our resilience - I left my infant son, who was just exploring the world, with his mother for few months in Sacramento. That was too hard for me as a father and husband to be away from them for almost 6 months. Even now I have been away from them. Our temporary "post - IVI situation" demanded that I take risky and short term consultant job with Polio Eradication Initiative (PEI) at WHO, Pakistan. After months of hard work in Sindh province supporting the provincial polio surveillance team, I was lucky to be working with PIH, Rwanda office as Monitoring and Evaluation (M & E) specialist. The other hat that I also wear here in Rwanda is as "a master student pursuing 2 years course in Global Health Delivery with equity and social justice as its core principle" in University of Global Health and Equity (UGHE).

Here in this post, I would like to write what I observed, did and learnt post IVI departure. One of the reason that I left Seoul was that I was worried that if I continue the same kind of job in repetition for next couple of years (having served IVI for 5 years) lacking creativity, innovation and lively work atmosphere, I would be like a "robot" disconnected from the everyday reality. Somewhere, we can imagine a hyper city like Seoul as a "worm hole", which can literally transform or influence your behaviour in such a way that we sometime fail to realise our roots and sometime fail to understand what you want and dampens your "child like" passion. There is a danger in this, while I am not talking in terms of space and time travel but literal or else at psychological horizon. For me, I am a Nepali health professional, who landed in IVI with dream to excel in research capability, so I would be able to translate those knowledge, skills and tools into our context. Our context is very different to hyper cities like Seoul. So, the whole 5 years of IVI experience was like a travel through "worm hole" of differential treatment, which means that when you travel through "worm hole" of space - time reality then, you are bound to get influence of "radiation, magnetic energies". For me likewise, the influences of differential treatment of such magnetic nature was (may be) not by design but by default. In this context, we (privileged ones) may talk about poor people and sympathise their suffering of those living with poverty. In contrast, we sometime fail or forget what needs to be done is at the community level and that is where we will be able to serve people the best and better. Sometime, we live in virtual reality or in "worm hole" influence and we may write poems about others suffering by passing your everyday chores in a palace like shiny buildings, without a faintest idea of what suffering means to be living with poverty. Sometime, people criticise such tendencies as "crocodile's tear" in others suffering. I may also criticise in the same way. Somewhere someone great said that "it is only through dirtying your hands helping people in need and being with them in their company that we can be more useful to the communities in need." So, now I realise if anyone of you is thinking hard about your career and of course work life balance, then we need to definitely ask ourselves the following questions:

  1. What am I deeply passionate about?
  2. What taps my talent and passion?
  3. What meets a significant need in your work area?

Somehow I now realise that I was struggling to find out the professional niche suitable for myself. Enough has been written in my previous post and in the previous paragraph - the reason why I could not or able to fully achieve the goals which I was determined while at IVI. This is partly me and equally organisational culture and "inside" practices, which were subtle in nature. Somewhere in sarcasm, I have written in similar thought process in Jan 2016 post "After all - it is the truest analysis and understanding of poverty that will help us deal with "real" public health challenges that we face and have to solve in coming years to come. Here, I also urge all those national and international staffs, who perceive and claim to work for the upliftment of people in the developing countries, have to understand poverty and visit those places to understand in real sense "what is suffering, as a result of poverty,  means?", otherwise we need to question the very work ethics of developmental works in the name of poverty !! So I would ask you - "have you seen very closely what is poverty? Have you seen children die because the nearest health post is 2 hours walk uphill? Have you dealt with a situation that family does not want to vaccinate their child because they do not know or have an idea what vaccine is and for?"

In search of my passion and channeling professional competencies for right cause, my brief experience in Karachi, the provincial headquarter of Sindh province of Pakistan was meaningful working in extreme heat and security challenges. You can read the details of thoughts in August 2016 post titled "From Karachi: the final battle against Polio" and also June 2016 post titled "From the field: Using tweeter feeds to share polio eradication activities from the field" Persistence and hard work pays and this is an universal principle which all of us believe. This happened when I was in Karachi, when I was offered a seat at UGHE to pursue master in global health delivery, which is related with my passion in evolution. Along with UGHE came an opportunity of profound significance, this was a chance to serve Partners in Health (PIH), Rwanda, which was an organisation cofounded by Prof. Paul Farmer, Harvard University and Dr. Jim Kim, World Bank President.

15 April, 2017

Nov 7, 2016

Relationship between Population Health and Development Post 11/24

The whole period of 19th century was characterized by colonialization of Latin American, African, and Asian subcontinents, while the early 20th century saw the epochal changes through two world wars. These wars led to the shift of military might from Europe to the United States of America. As a result, Europe had to struggle with the politico – economic restructuring with change in power dynamics. The United States of America (USA) was also pulled into this European affair. This engagement in a decisive role to end the war led the USA undoubtedly becoming a new superpower in global political leadership and principal advocate for neoliberalism in global affairs. This essay explains the dynamic relationship between population health and development with some examples of its advantage and disadvantage.

First, let us explore and try to understand the advantage in considering population health and development together. Although there was continuous shift in understanding the relationship between development and health in academia and developmental sector, all the discourses were heavily influenced by ideological divide that exist between socialism and capitalism. In the midst of these changes, the movement of comprehensive Primary Health Care (CPHC) lead to the Alma Ata Declaration by the World Health Assembly (WHA) in 1978. This CPHC movement brought an overwhelming shift in the thought process dealing with health of the community and its link with socio – economic development. One of the key principle that was enshrined in the declaration was that health is basic human right (Basilico, Weigel, Motgi, Jacob, & Keshavjee, 2013). The Alma Ata declaration also recognized that the investment in health strengthen the local health infrastructure and improve access to essential health care services with community participation. This meant that health was treated as an end, while socio – economic development was the means to address the challenge of poverty and disease in the community through community participation. One of the legacies of such though process that started with CPHV movement today would be Millennium Developmental Goals (MDG) which have now streamlined as sustainable developmental goals (SDG).

Although the CPHC movement brought enthusiasm in health and developmental sector, it was short lived with the rising influence of neoliberalism, which considered health as commodity to be bought and paid in contrast to health being basic human right. However, on positive side, the world witnessed the birth of numerous international institutions like the United Nations (UN), the World Bank (WB), the International Monetary Fund (IMF), the World Health Organization (WHO), UNICEF (for children’s safety and health) and several rich governments funded overseas development agencies like USAID. Majority of these organizations were harbinger of colonial legacies like the Pan American Health Organization (PAHO). All of these new organizations were also headquartered in Europe and few in the USA became the powerhouse for providing policy direction on the subject of development and health across the world. With complex bureaucratic processes (Kleinman, 2010) and its ramifications within the organizations, the discourse on population health and socio economic development in low income countries were influenced by rapid changes in the socio political and economic landscape of the world. There was also parallel rise in independence movements all across Africa and Asia. All previous colonial states like India were exercising their self-determination rights for freedom and sovereignty. However, there political and economic situation was very fragile in post-colonial period. (Basilico et al., 2013) Sadly, all key international developmental organizations like World Bank, IMF, UNICEF and other bilateral donors were dictated favoring neoliberal ideas and principles against the basic needs of the population in low income countries. All these organizations also used this international platform as means to exercise their political and economic interests. This meant that all those countries in Africa or Asia, who received huge development loans from WB and IMF, were heavily influenced in the framing of their national policy and its implementation. All of these practices were clearly against the spirit of Alma Ata Declaration. The outcome of these neo liberal ideas and principles dictated the development and health related policies, resulting into failure or poor performance of health care delivery in targeted countries in the long run. (Basilico et al., 2013)

In summary, the start of debate in considering the role of population health in the socio economic development brought serious discourse among world leaders, policy makers, planners, and funders. As a result of this discourse, there is a serious academic and policy interest in the relationship of poverty and diseases and socio economic development in low-income countries. Also, we need to acknowledge that there is always the push and pull between different socio – political ideologies, which play important role in dictating the course of population health in a community through their influence on the policies and its implementation.


Basilico, M., Weigel, J., Motgi, A., Jacob, B., & Keshavjee, S. (2013). Health for All? Competing Theories and Geopolitics. In Reimagining Global Health: An Introduction (pp. 74–110).
Kleinman, A. (2010). Four social theories for global health. Lancet, 375(9725), 1518–1519.

Anuj in Himalayas

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