Possible: A Surprising Health Care Model for Nepal

mother and childI generally have a policy to say yes whenever it makes sense. In the last week this led to my serving as an auctioneer for a breast cancer fundraiser, and also a guest at a dinner discussing health care experiences.

The dinner was hosted by Possible, a non-profit that is offering high quality care to the world’s poorest populations. If this sounds too good to be true, it isn’t, but it is complex work. If you’re wondering why others haven’t done it before, perhaps it’s because they don’t have the passion you see shimmering in the eyes of Possible’s staff, including CEO Mark Arnoldy, who is among Forbes magazine’s 30 under 30 list of global changers.

Here’s some information about the amazing impact Possible is having in Nepal. I am going to make them my holiday charity for 2014: instead of gifts, I’ll ask people to consider making a donation. Consider doing the same this holiday season as a way to engage your friends/family in being a blessing to causes you care about.

1. Why Nepal?

Nepal has some of the most progressive healthcare policies in the world; the constitution guarantees the right to health and universal healthcare for the poor. But executing on those policies remains a challenge in rural areas, and millions don’t get the care they need from the traditional private, public, and charity approaches to healthcare. Our model of durable healthcare enables us to be paid by the government to deliver healthcare within their infrastructure, and allows us to solve for the patient while aligning revenue with care.
Secondly, we were repeatedly told our vision for healthcare might work in some places, but not in Nepal. Which is precisely why we embraced the challenge, and charged forward determined to defy expectations. We knew that if we could create a healthcare model that worked fully for the poor in a region labeled impossible, our innovations and proof would be more powerful.
2. How many people have you reached? With what services? 
To date, we’ve treated over 218K patients who make less than $2 a day and walk on average five hours to reach our hospital. We treat an array of medical issues, including: TB, HIV, safe births, fractures, malnutrition, dental, and mental health. We treat patients at our hospital, our surrounding clinics, and through our referral care program (with partner hospitals and our crowdfunding partner Watsi) for advanced treatments.3. How can we get involved?
You can directly invest in our work here. You can also follow us on Facebook and Twitter for updates, and sign up for our email to receive patient stories, impact data, and more. 

4. What’s the future look like for this program?
For the next five years, we are committed to improving and expanding our durable healthcare model in Nepal. We are going through a 2-year hospital expansion project to turn our hospital into the first rural, accredited teaching hospital in Nepal. We also plan to expand our number of health clinics to 72, and employ over 900 community healthcare workers to cover the entire Achham District, a population of over 250,000 people.

Haters Going to Hate …. Especially on 17 Year Old Female Pakistani Nobel Laureates

The whole world was not rejoicing with Malal Yousafzai. In fact, people in her country, Pakistan, were amongst the most virulent opposers. Here’s an example from the Twittersphere: “Many girls out there who suffer/suffered far more than Malala but their fathers aren’t CIA agents like Malala’s. ?#?MalalaNobelPeacePrize?“. I worry about a young person bearing the brunt of so much scrutiny; this is what many in Islamic culture would consider “the evil eye” or bad luck raised from jealousy. Blessings on Malala and her family. If teenagers, like Ms. Britney Spears, found fame difficult to handle in their 20s, then I can’t help but wonder what Malala will encounter in her own 20s (may she live long, as people would say in Islam as a blessing).

The audacity of a teenager, standing up to the Taliban, gaining the international community’s attention, and being undeterred throughout, has brought out the conspiracy theorists in full force.

She’s a puppet of India, America, both, or the CIA. Her father is a salesman; she dances to the tune of the West.

In addition to her long list of accomplishments, Ms. Yousafzai can add exposing the misogyny, fear, and envy to her list.

What No One Tells You About Domestic Violence


Grandville : Cent Proverbes

 (Photo credit: Wikipedia)



The recent suspension of star Baltimore Ravens running back, Ray Rice, has caused a furor both on and off the Internet. Rice was suspended for 2 games before a video was made public by none other than the gossip outlet TMZ. I watched the video. I have skipped over the ISIS beheading ones, not wanting to give an audience to terror. Domestic violence, however is closer to home. After seeing for myself an intimate fight between a husband and wife, I was shocked that the video was still allowed online, and chagrined I had participated in a voyeurism. His wife, Janay Palmer has since spoken to the media, defending her husband and a private moment. There’s much we could say, and has been said, about the abused protecting her abuser. At the very least we have empathy for a wife trying to save her husband’s career.


Ray Rice isn’t the only man in America – or the world for that matter – who could knock his partner out during an argument. Like Rihanna’s infamous fight with Chris Brown, during which he bruised the pop star, the fight is one part of the puzzle. What happens after the fight and our reaction to it are others.


Take for example my friend from high school. In a close knit Indian community she couldn’t come forward about the dangers in her home. When she was persuaded to go to the adults, on more than one occasion she was told that the problem was culture.



Indian men beat Indian women was the message she received from her Caucasian teachers.


“I believe her father is abusing her,” a chemistry teacher said.


No one, even we her friends, did anything. We pretended that she was like the rest of us.


My friend suffered in silence, partly to save her mother (and the rest of the family, including herself) the humiliation the Rices are undergoing in the international media.


She pretended because that’s what everyone needed her to do. Because blaming culture or overlooking abuse was easier for everyone than confronting the deep sadness and possibility of mental illness that drove her father into a blinding rage.


Easier on everyone except for her.


I’m sad for the Rices but also for the rest of us that we continue to pretend that this type of behavior is rare or surprising. Or that we think shame is the solution.








Don’t Let Cyber Bullying Win in Qatar: #ISupportQatarFirsts

QatarLast week I wrote about the criticism a group of Qatari youth received for traveling to Brazil. To be more precise, traveling to Brazil, in a mixed group of men and women, where the females were photographed without veils or wearing traditional dress. On Wednesday I invited us to ruminate on who defined Islam: the masses or the individual?

This week, the company that was sponsoring the trip, Vodafone Qatar, has pulled their support of the trip and by association, the group. Yes, you read that right. A corporate entity, who sent young people to a remote village in the Amazon, where they are currently in basic conditions and far away from their families, disavowed the project midstream.

What’s more important is the psychic effect this has on the participants, particularly the female members of the group. In a traditional, tribal society like Qatar, a person’s reputation is a stand-in for him or her. While the participants were being abandoned abroad, the girls’ families at home were being chastised in a Friday sermon at the mosque; their parents’ actions were being questioned on social media.

The countries in the Arabian Gulf have long walked a fine line between their traditional values and a space at the global table. Westerns may not realize that consumption – iPods, Cadillac, and Coke – do not alleviate conservatism. In fact, for most consumers in the GCC, consumption is an economic activity that does not effect their personal choices (expect perhaps in the case of the BDS movement against Israel). People may stay up all night watching episodes of the sex filled scenes of popular HBO shows but in public they behave appropriately.

A long held practice has been that what happens outside of Qatar is the prerogative of the traveler and his/her family. You would find the bathrooms occupied on flights descending into Qatar as women went to robe themselves in preparation for the Doha International Airport. What the criticism and abandonment of the #qatarfirsts campaign has shown, however, is in a world with social media, this limited space of freedom may no longer be the case. Qatari women’s (and men) right to choose how they conduct themselves while abroad may now be at end.

This is a #qatarfirst but perhaps not in the way the original organizers intended. The first time cyber bullying has gone unchecked. The first time women were publicly shamed for a private choice. Given the plans for the country’s rapid development, and the oft repeated, now synonymous with modernity, the 2022 World Cup.

Let it not be the first time we in the community allow a group to dictate the actions of individuals.

Here’s what you can do:

Reach Vodafone Qatar and tell them their action has been ill advised.

Reach Vodafone’s global office in the UK and let them know their brand is behaving irresponsibly locally.

Use the hashtag #isupportqatarfirsts or #istandwithqatarfirsts on social media to let the team know they are have our support.


How to Help Gaza in 1 Easy Step

The news is rife with atrocities in Syria, Iraq, and Palestine, among other places. We clamor against death tolls and rightly so. But the public can grow weary of these images, preferring to turn back to their more comfortable programming.

I am particularly touched by the Gaza crisis because I’m watching how it has polarized friends around the world through social media. Perhaps people misunderstand the Palestinian cause because of the myths about this historical conflict. Perhaps because they don’t know any Palestinians either personally or culturally.

Artists, writers, musicians, friends: each have a role in building our world view of a people group. Sadly for most places in the Arab world, the people are represented by their politicians.

Unlike people in Arab countries, the rest of us can’t as easily make distinctions between people and their leaders. My Iranian friends love me though I’m American. My Pakistani research assistants write down notes from our sessions though I’m Indian. The world thinks of Gaza as being ruled by Hamas because that’s the predominate talking point.

Instead of death tolls or media soundbites, how about we think for ourselves? Can we see people for what they are: humans like us who have passions, desires, needs?

Let me share with you an artist, Mona Hatoum, who I learned about during the exhibit Turbulence at Mathaf: Arab Museum of Modern Art. I live in the Middle East and this certainly allows me to gauge the messages the media feeds us about this part of the world. As a writer much of my recent work has been set here because I see it was part of my role to contribute to a wider group of stories about this place. I’m still an expat writing about a place that is not my origin but after nearly 10 years here I write with the other perspective in mind.

Do you have other suggestions of how we can combat media saturation?

Anatomy of a Deportation

Screen Shot 2014-06-25 at 3.12.07 PM

Photo by FitOut

Nothing ranks as high on an expat’s list of fears as being deported. Maybe death of a loved one while you’re abroad. Not your own death, because like the average teenager, you think your charmed expat life is immortal. Those who have lived overseas know all too well both death and deportation are likely scenarios. Neither is polite to discuss in public.

I wrote about both in The Dohmestics, my most recent paperback release, based on observations as an expat for nearly a decade. The novel explores the lives of six women: three employers and three housemaids who live in the same compound, or walled neighborhood. I found out how difficult the employer-housemaid relationship was to describe in the process of trying to get interviews as background research. Even friends were reluctant to let me speak to their helpers.

Then fact and fiction collided when we were told that a nanny in the neighborhood’s sister was in the detention facility.

That’s how we learned there’s something worse than being deported. Detention.

The sister, also a nanny had runaway from her employer who had her working at several homes in the extended family with little sleep or food. Yes, for some reason, we use the word “runaway” to describe a grown woman who has no other recourse to end her employment. Runaway: a word that has been to describe willful teenagers and slaves, those beings treated as human chattel.

She left her employer one day, walking out while the family was upstairs. She worked for a series of other families in various conditions: sometimes sleeping on the floor on the kitchen because the maid’s room was used a storage. Waking up at 4:30 a.m. to iron and cook for her landlord who also charged her rent. Bouncing from family to family, a few years went by. An ailing mother, a maturing daughter: she wanted to go home.

She got an airline ticket – hard to come by at the tune of thousands of riyals – and went with her luggage to the embassy. They turned her over  to CID or the criminal investigation department. She called, hysterical, because she was being held in a facility with hundreds of other women, some of whom had been there for a month, others for three.

The line was scratchy: they were default fasting because no one was being given food during Ramadan.

Despite being a women’s area, there were no sanitary supplies.

Anything you received, you had to get from someone on the outside.

We assembled a care package, the contents what you might take your daughter’s dorm room: peanut butter, bread, jam, Kotex, chocolate, laundry detergent.

More calls, from random numbers, from borrowed phones (hers had been confiscated) of other long timers. Rushed conversations to exchange file numbers and any updates.

She has a good chance of eventually going home. She has a ticket, no debt, no pending charges. Someone has to take interest in her to distinguish her case from the hundreds of others who are much, much worse. They are waiting on sponsors to pay fines for having a runaway (that word again), waiting for family to raise money to bring them home, waiting for a miracle to clear their debts.

“That’s the place people take their maids when they want to punish them,” a friend told me. “If they don’t want them any more, they leave them there.”

As you may recall, my first book was banned for being about Qatar and Qataris. I had no idea that love was a sensitive subject.

Maids, though, housemaids, I knew were controversial. They are the invisible army without the glamour (or indignation) of the 2022 World Cup stadiums to galvanize the international media to their cause. There is no country named in The Dohmestics because I hope it makes it into the hands of readers in Doha. But also because the treatment of these women, who sacrifice their lives for their children, fund unfaithful husbands, and prop up their home economies (personal and national), is commonly archaic across the Middle East – whether Lebanon, the GCC, or Egypt – and extends into Asia where high rise suicide jumpers in Singapore are so commonplace, they only make the news if they take a young child with them.

“I am not a housemaid,” I said enunciating the vowels for the embassy official who had missed my American dress, accent and husband. “I am here for a friend.”

Is the deportation facility in the novel? You’ll have to read it to find out. This is one instance when real life is worse than fiction.


What’s Your Bias?

In my research team we focus on three areas: race, writing or gender. We’re trying to gauge how aware we are of gender biases. See how you do on this five question series.

Leave your reactions in the comments!

When Your Friend is a Trafficker

Last week’s New York Times article about labor abuse in the construction of the NYU Abu Dhabi facilities brought new light to the dangerous of doing business in the Arabian Gulf. For the laborers, the complaints were much the same: addition to unsanitary accommodations, low or no wages, and harsh working conditions, the men who tried to protest were rounded up by police, beaten, and deported.

I was shocked by the images of men in bunk beds, not only several to a room, but three to a structure: one on top, one on the bottom, and creating a third floor to the structure, by sleeping under the bed. How you have to be the guy on the floor is something that I can’t fathom but a metaphor of the intricate hierarchy even within the Olympics of the oppressed.

Lately the talk of the kafala (or sponsorship) system in Qatar involves highlight all the laws by which workers have their rights assured. The government isn’t the issue, many people argue, it’s the sponsors. There are hotlines where laborers can report their abuses, people often say if they’re feeling generous. This is the tack NYU’s management took, issuing statements that they can’t guarantee that contractors would uphold their fair labor agreement – an agreement they made sure to put in place before construction began. A day after the article was published, however, they did an about face and apologized. On the Internet. To workers who don’t have bathrooms with running water. The NYU response is standard of the CYA moves that an entire range of institutions are using to duck around the abuse. Instead of changing the system, they are becoming part of the problem. None of us, not even American universities, it seems, knows how to address this systemic problem of labor.

The resistance to changing conditions for low income workers follows another thought process:  what they have now must be better than the conditions they have in their home country. Why else would they come? Leaving aside the cultural relativism, bait and switch recruitment tactics and unethical work practices, like no overtime, are ignored in this logic loop.

Enforcing the law never makes the list as anyone’s chief concern.

The third common response: if they don’t like it, let them go home. Well: when you don’t have your passport and haven’t been paid for months, that is not the easy proposition it seems.

The real issue with kafala, and the absence of the application of the rule of law, is the numerous loopholes in the protection of low income laborers. No enforcement of a minimum standard of rights is rampant, particularly when it comes to domestic workers. And like the cockroaches that climb the walls of overcrowded labor housing, there are people who come out to take advantage of the unmonitored cracks in the system. They are not all nationals. In many cases, they are not even Arabs.

There is an underground network of people who prey on housemaids who are figuratively bound by their sponsors – some families even refer to themselves as owners. What has alarmed me in the two years I’ve been researching housemaids for my novel The Dohmestics is that they have no recourse. The labor law doesn’t apply to them. If they were hired through an agency, they have 3 months to report a problem. Like a middle age spinster, if they go back to the agency, the blame is with them, not the sponsor. They can jump the wall and flee to their employers but if their embassies won’t help them – and there are a lot of them that don’t have the political capital to be much help – then they are off the grid. Off the grid, needing to make money for children, mothers, fathers, siblings, husbands, and the most vulnerable.

What you won’t find out right away, but becomes readily apparent, is that there is an entire network of people from the domestics’ home countries waiting to make their cut off the exploitation of these undocumented workers.

5000 QR, about $1400 USD, and I can get a sponsorship transfer, or so the promise goes. But the guy, an acquaintance, takes much longer than the month he promises to deliver the papers. One turns into six and then suddenly, he can’t pay you back your money.  No visa either.

Or you talk at the playground with other domestics, women you see everyday, who you share recipes and festive occasion with, women who for all intents and purposes are as close to you as family. You talk to them as you watch your charge swing or slide. You mention how you’d like to get  a family member a job. Someone offers you help, saying they can get a visa. You accept. Once your relative arrives, the friend now becomes a broker. She wants thousands of riyals for the privilege of being the go-between. And she threatens to call the police if you don’t pay up. Your relative will be deported if you ignore her. The threats and intimidation carry over to your workplace; she works in your neighborhood, remember. She knows where you live.

I can vouch for the veracity of a few of these stories, having seen the scenarios play out first hand. There must be hundreds.

In all the coverage about low income labor, I haven’t seen anyone interview the agents themselves. The ones who poach men from villages in Nepal and India, promising lavish salaries and accommodation, procuring a year’s salary in advance. I want to ask them if they know the reality of the jobs they’re overselling. How much do they know about what really happens when they hand over the documents, and money, to travel?

Clearly the agencies know, otherwise they wouldn’t charge such an astronomical finder’s fee upfront. The commission on these contracts leaves many families wanting to make up the fee when they pass the sponsorship of the maid on. She can’t get another job unless her new sponsor is willing to pay 10000 QR to release her.

In any of the scenarios, the laborer incurs all the risk, financially, mentally, and physically.

The worst kind of trafficker has to be a same country informant. Like cockroaches, in an unmonitored system that doesn’t reward those who come forward, and punishes those who need justice the most, they thrive.


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150px-Mother Galanda

Mother Galanda (Wikipedia)

You’ve heard the expression – or used it yourself.

“Didn’t your mother teach you any manners?”

“Where is your mother?”

“What was his mother thinking?”

Whether good or bad – mostly in the bad instances – we call questions down on people’s upbringings. And that usually leads to questions about parenting. Which are directed most often at mothers.

The worst types of insults involve mothers: motherf*cker or son of a b*tch.

I can’t figure out if this pervasive reference to motherhood and by default women, means we are all powerful or if we are the bane of humanity. I ruminated on the toll mothering takes on a woman in my momoir for first time mothers, Mommy But Still Me.

In either case, until scientists really get that cloning thing going, you’re stuck with us.

Hope today you get a chance to shower some attention on a positive female figure in your life. After all, doesn’t she deserve some praise to go with all that blame?


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Barred from Jazz to Burning in Hell: Women, Qatar and Abayas

InstagramHajjaj.111If you alienate the middle, where the moderates are, all you’ll have left is the extreme. We’ve seen this happening in American politics as the Republicans and Democrats hurl insults at each other like parents at a toddler football game. And it’s happening in contemporary society in Qatar in the way people view or sanction behavior.

Take for example the decision banning of my paperback Love Comes Later in March. People in Doha, D.C. and everywhere in between, keep asking me why. Why was it banned? There are a few speculations based on the feedback my distributor gave me: “Because it’s about Qatar and Qataris.” A novel in English, about Qatar, written by an expat. A book that was researched for 3 years, in which the author attempts to represent Qatari life, as accurately as possible for an outsider, without the objectionable sex, politics or atheism, is still unpalatable.

Love Comes Later pops up among a list of titles that include Teaching Abdulla the Terrorist and If the Sun Doesn’t Kill You, the Washing Machine Will. Or more recently The Best Ever Book of Qatari Jokes: Specially Re-purposed for You Know Who. The description reads: “if you don’t burst out laughing from at least one Qatari joke in this book, there’s something wrong with you. This book has so many Qatari jokes; you won’t know where to start. For example: Why do Qataris wear slip-on shoes? You need an IQ of at least 4 to tie a shoelace.”

Take for another, the story of my friend Fatma. She is a dutiful Qatari daughter; she choose a mainstream major as a university student which is when I first met her. She wrote an essay for the Qatar Narratives anthology which was included in the book that became Qatari Voices. Fatma is not a rebel: “Many girls my age feel that they were born at the wrong time and in the wrong place—a place sealed with traditions and at a time that lies in between. But I could not be happier. I have traditions that keep me secure, definite, and relieved at a time that is full of risky choices.”

Fatma is proud of being Qatari. She wears her hijab “properly” (you can’t see any of her hair, her veil comes to her forehead). She’s so thin, Kate Moss would likely cut Fatma to avoid any chance of competition. But you’d never know because her abayas are not shaped to her body but hang loosely. She also loves jazz.

We exchanged a few messages about going out to Jazz at Lincoln Center Doha, the club at the St. Regis hotel in Qatar.

They don’t let Qatari women in I messaged.

I’ve taken off my abaya and they do she replied.

You did? I asked sounding like a shocked grandmother. Taking off your abaya is something Qatari women do when they want to go incognito. Ironically it’s a way of hiding in plain sight: Qataris scan crowds for other Qataris, skipping over expats. I’ve known other friends who have done this to go out with people their families would disapprove of. In Fatma’s case, she wasn’t hiding from family in public, she was doing the necessary, as mandated by law, in order to do something else she loved: listen to live jazz music with female friends.

The week was long, and the nights short with the baby, so I lost track of the conversation and went to bed early. The next day she told me what happened. And her intention to write about it. “I, a Qatari woman, was banned from an event that celebrated the women of jazz.  The obvious irony aside, I also was embarrassed when the guest relation’s manager politely, but firmly denied my entrance.  What really embarrassed me though was the thought that as a citizen of Qatar, I was banned from enjoying this unique art form…in Qatar!”

The first few days, people rallied to her cause. Other women agreed the rule that no Qatari women are allowed in the club – Qatari men not in national dress are – was unfair and silly. Men supported her for speaking out. All of this conversation was in English, on Facebook, or the original blog that posted her piece,

Not everyone appreciated the irony that jazz appreciation, like so many other specialized new activities in Qatar, cannot be enjoyed by half the citizens in the country. As Fatma says: “Nonetheless, I tolerated that no ‘national dress’ rule, donned a colorful hijab, modest shirt and skirt and went for one purpose: to enjoy jazz as it’s meant to be heard – live. Now, it would seem that ‘national dress’ is no longer an issue. Women are the issue. Qatari women.”

Others joined the conversation in full force, her critics posting under nicknames.

Commentators on an Arabic site asked how dare a Qatari woman go to a club that serves alcohol and take off her abaya.

She was called “an infidel, atheist, slut, will never get married, should burn in hell, ignorant, outcast who belongs to here on papers only, a shame to her tribe.” She was told she “should leave.” One commentator deduced “this is what studying abroad does to women.”

Fatma completed her degree at the national university that has separate campuses for male and female students.

There are multiple layers of conversation here; about what is acceptable behavior for women, either in written or physical form, whether expat or Qatar.  On both levels we see a society that has many ambivalent attitudes towards women’s place in the  public sphere.







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