Sweet home NepalI saw my future here in the US, and I never thought a kidney would pull me back
My family moved to the US in October 2005, a few weeks after our last Dashain together with the family. I was 10, old enough to understand our decision, but too young to understand the gravity and finality of it. Over the years, we settled into this new world, leading manageable lives. I attended high school, finished my undergraduate studies, and saw my future here in the US. But I never thought a kidney would pull me back to Nepal for good.
In 2017, Baba was diagnosed with end stage renal disease or kidney failure after suffering from diabetes for many years. He was forced to leave his job in order to better manage his health and attend the doctors’ visits. My parents also lacked the social and emotional support they craved. Eventually, based on the language and cultural barriers, the exorbitant price tag, and the wait time for surgery, we started discussing transplant options in Nepal. So without knowing if or when we would come back, we left our home once again, deciding to dive head first into the confusing world of Nepali healthcare.
I vividly remember our first visit to the Human Organ Transplant Centre in Bhaktapur. My heart sank as we entered the unfinished parking lot, the gravel and pebbles crackling beneath the tires of our car. Puddles of stale brown water led up to the entrance. The air carried a faint smell of drywall or cement, and the beep-beep-beep of dialysis machines punctuated the noise inside the hospital. To our left was a small hospital pharmacy and guards lounging at their station. To the right was a large open interior with people chasing doctors and nurses, milling about and waiting. All the sights, sounds, and smells overwhelmed me.
We went to the transplant centre many times after that first visit. We also visited various other hospitals and clinics in the Kathmandu area. Over time, I acclimated to the hustle and bustle of these environments and even welcomed them as familiar. I got used to walking the local streets to retrieve lab results, making an appointment at the Civil Service Hospital, bargaining for lower prices at pharmacies, and, of course, always carrying a hand sanitiser and a roll of toilet paper with me.
In order for a transplant to occur, both the donor and recipient undergo rigorous medical tests to ensure the safety and compatibility of the transplant. After months of doctor’s visits, lab tests, imaging tests, and other medical procedures, Mamu was determined to be a good match for Baba. And on March 15, 2018, Dr Pukar Chandra Shrestha and his medical team successfully transplanted Mamu’s left kidney into my Baba. Witnessing the transplant and recovery was an extremely humbling experience for me. I was humbled by Mamu’s strength in risking her life without hesitation to save another. Not only did she give life to me and my sister, she also gave life back to Baba, and there is no greater gift than that.
I was also humbled by the outpouring of love and support we received from family and friends from all over the world. They drove us around to all our tests and hospital visits, made food for us, got our medications, and shared in our joys and sorrows. Some stayed overnight at the hospital in less than ideal sleeping conditions. Others still showed their support from a distance through texts and phone calls. The days and nights following the transplant, we also got to know other families at the transplant centre and shared our stories over juju dhau.
I would like to think this sense of community is universal, that I can find similar support systems anywhere in the world. But it is precisely in this regard that the Nepali people are extraordinarily unique. We are a proud, resilient, and impulsive people, but we are also friendly, welcoming, and respectful. Our rich cultures, religions, languages, customs, morals, and community values tie us together across oceans and continents. This unique bond got my family through the transplant process, for which I am immensely grateful. Finally, I was humbled by the triumphs of the surgical and clinical team in Nepal. The country has made major strides in the past 20 years in the public health and medical field. Transplantation was also introduced recently in Nepal, with the government largely supporting renal treatment.
These promising trends, however, don’t obscure the reality of low quality of medical care in most parts of Nepal. There are only about 30 hospitals in Nepal to serve its 30 million people. That equals just 0.3 hospital beds and 0.6 physicians per 1,000 people, according to the most recent World Bank data. These statistics translate into long wait times for a simple doctor’s visit where many patients are unable to pay for quality care and treatment. Mental health facilities and professionals are especially lacking. In comparison, the US has 2.9 hospital beds and 2.6 physicians per 1,000 people.
Corruption also rears its ugly head in every industry and field, including medicine and public health. Power and greed drives many decisions (or lack thereof) and hampers the development of a nation. Nepal is also plagued by its pervasive culture of disparity in gender, caste, sexuality and income. Regardless, Nepal continues to inch in the right direction and might blossom beautifully if nurtured.
For many years now, Mamu has tried to convince me to move back to Nepal after completing my education here in the US. And for just as many years, I have disregarded her suggestion as wishful thinking. However, this transplant journey has shifted my idea of where I belong, and what I wish to contribute to society. In just a few months, I will be starting an MD/PhD programme to become a doctor and conduct transplant research. I now join the medical field with a sense of purpose and a goal of returning to my homeland to serve the people. Ultimately, I will always remember that when I needed my country, it was there for me. And when my country needs me, I will make sure I am there for it.
Dahal is currently working in Washington, DC. She can be reached at firstname.lastname@example.org.