Nepalese doctor Aditi Giri has spent the last month shadowing several physicians at MIT Medical and gaining first-hand knowledge of the American healthcare system. Of her journey from Katmandu to Cambridge, she says simply, "everything worked out beautifully."
That may be an understatement. Her MIT sponsor, Dr. Carroll Eastman, describes how Giri, who was required to complete an "observership" before applying to medical residency programs in the US, got in touch with her through a series of improbable connections; received speedy approval from MIT Medical's senior administration for the unprecedented visit; and impressed every MIT clinician she met with her medical knowledge, maturity, and determination. "I'd call it 'serendipity,'" Eastman says.
From "sheltered" child to healthcare activist
It's a word that could describe much of Giri's life. The daughter of a hospital administrator and a university lecturer, Giri, now 28, enjoyed what she refers to as a "sheltered childhood" in Nepal's capital. She and her younger brother attended private schools, learned fluent English, and went on to college—in Giri's case, Katmandu University School of Medical Sciences.
But although the school was less than 20 miles outside Katmandu, it might as well have been another country, Giri says. The university-affiliated hospital was the only major medical center serving a population of approximately 1.9 million people in a large rural area. Nearby residents were largely dependent on subsistence farming, suffered from poor nutrition, and had little access to education or even basic services, like sanitation or safe drinking water. "There was terrible poverty all around me in Dhulikhel," Giri recounts. "There were never enough resources. The kind of life I had known in Katmandu did not exist in that part of the country."
Those new experiences were "formative to me, both as a person and as a physician," she says. As Giri immersed herself in her medical studies, she found herself motivated not only by her determination to excel academically, but also, increasingly, by a longing to improve the lives of less fortunate Nepalese.
That opportunity came sooner than she might have imagined. Working as a student volunteer at an international community-health conference in Katmandu resulted in an introduction to Dr. David Egilman, the American director of a non-governmental organization (NGO) that provides primary care services to underserved communities. Egilman offered Giri the opportunity to spearhead a research project investigating how health-related projects in Nepal were funded and managed. And when it was all done , Giri's team had not only uncovered a fragmented system of healthcare delivery influenced more by foreign NGOs than by Nepal's government, they'd also decided to found their own, homegrown NGO, which they called Nidan, a Nepalese word meaning "solution."
Focusing on women's health
Nidan focuses on creating and expanding rural public health practices to improve access to education, water and sanitation, good nutrition, and health services. The group established its first clinic earlier this year in Dhanauji, a small village of mud huts where malnutrition is rampant and most people had never before seen a doctor. There they've focused primarily on women's health concerns—contraception, sexually transmitted diseases (STDs), and treatment for uterine prolapse, in which weakening of the pelvic musculature causes the uterus to drop into the vaginal canal. After multiple pregnancies and births, Giri says, virtually every Dhanauji woman over 50 has the condition. "Most men leave to work elsewhere as laborers, leaving the women to take care of the houses, farms, and children. They come home just long enough to get their wives pregnant and give them HIV or other STDs," she continues. "If we can educate these women and give them more control over their bodies, it will raise the standard of living for the entire village."
From Katmandu to Cambridge
When Egilman invited Giri and her new husband, Prashant—a medical school classmate and Nidan co-founder—to come to the US for a fundraising tour, the two got their first glimpse of the western system of medical education and immediately decided they wanted to further their training here. "Medical education in the US is so much better than in South Asia," Giri says. "What we learn here will allow us to do much more at home."
With her MIT Medical observership under her belt, along with a strong letter of recommendation from Eastman, Giri has started applying for residencies while Prashant continues efforts to expand Nidan's donor base. He hopes to apply for residency programs next year and would also like to complete a Masters in Public Health program before he and Giri return to their work in Nepal.
It's work that will last a lifetime, Giri says. "I will never run out of things to do," she says emphatically. "Changing people's minds, changing their behavior... it's a slow process," she says. "But we have to start somewhere, and maybe our efforts will inspire others to work on these issues as well."
