The following information has been compiled by the Nyaya Health Volunteer team and is designed to give new volunteers an orientation to our organization, our work, and all the logistics and information related to planning a volunteer trip with us in Nepal. Please note that, for volunteers interested in working with Nyaya outside of Nepal, much of this information will not be immediately relevant, but may be useful in terms of getting to know our work regardless. For all people interested in volunteering, regardless of location or type of work, please follow the protocol detailed below for applying to volunteer.
If reading this information online is too difficult due to bandwidth or time considerations, please download a pdf version using the link at the very bottom of this page.
Volunteering with Nyaya Health in Achham
Why volunteer with Nyaya Health?
Volunteering with Nyaya Health can be an immensely rewarding and challenging experience. As the district of Achham in the Far Western development region of Nepal moves forward with a vision of peace and security; Nyaya Health is fortuitously poised to be a piece of that hope. We commend you for your dedication to social justice and commitment to support our mission to help those with a great need.
Who should volunteer?
Volunteering with Nyaya Health may not be for everyone. We are a rapidly growing organization in the midst of recruiting extremely motivated volunteers with excellent technical skills, relevant experiences, and enthusiasm to take ownership of and develop new programs. These are particularly exciting times for us; however, we realize that such an environment may be a cause of frustration for many individuals who may benefit from discrete and formal positions offered by larger, more established organizations. Individuals who are highly self-motivated, self-directed, and willing to take on new challenges will appreciate our organizational culture.
Priority is given to those with skills needed for our programs in Achham (medical, engineering, public health, etc). As we do not always have interpreters available, volunteers involved in clinical or community health programs should have working knowledge or Nepali or Hindi, although exceptions are possible for individuals with skills that are in particular demand. There are numerous opportunities to volunteer with Nyaya Health in the US in technical assistance, operational planning, and fundraising. These activities make a tremendous impact on our programs in Nepal, and the majority of our volunteers work in this capacity. See our page regarding volunteering from outside Nepal.
What skills does a competitive volunteer applicant typically have?
Please note that volunteer opportunities in Achham are limited and available typically only to individuals with significant public health or medical skills, have some level of language skills in Nepali or Hindi, and can work in Achham for at least 12 weeks (longer is required if skill level is less). It will significantly increase the likelihood of acceptance for a Nepal trip, if you work with us on any of the outside-Achham volunteer opportunities. We strongly prioritize and encourage that all volunteers for Nyaya are involved in our work prior to their trip to Nepal with various US-based organizational work, development / fund-raising, etc. Furthermore, all volunteers in Nepal will be expected to continue supporting Nyaya after their time in Nepal; the strength of the applicant's proposal will weigh heavily upon how competitive their application is.
What kind of work do volunteers in Nepal do?
There are three main types of volunteers in Nepal:
- Achham-based program directors: Long-term (12 months or greater) volunteers inside Nepal. These volunteers help to lead or develop new programs, manage existing programs, or support current leadership in their on-going work. Due to the long-term nature of these volunteers, applications are extremely rigorous and competitive, and only those with skill-sets currently absent in Achham are considered.
- Clinical associates: Short-term volunteers in Nepal who have some technical background (e.g. doctors, nurses, bio-medical engineers, etc.). The main role of these volunteers is to act as consultants who assist in training staff and evaluating existing programs.
- Technical associates: Short-term volunteers in Nepal who have some technical background (e.g. bio-medical engineers, etc.) who assist with developing new technologies or programs, or managing the on-going work of pre-existing technologies / programs.
You can read more in detail about these different volunteer roles here.
How are volunteer trips to Nepal financed?
To maximize our supporters’ donations, we expect short-term volunteers to pay for all travel and living expenses related to their trips to Nepal. We enthusiastically provide grant writing, fundraising, and marketing support to any volunteers’ efforts to procure the resources necessary for their trip. Click here for more information about financing your work with Nyaya Health.
A note on collaboration and solidarity
The dynamics of between staff members living long-term in Achham and short-term volunteers visiting for a month or two can be extremely challenging. There are cultural issues, challenges in follow-up of short-term trips, interpersonal dynamics of consultants, difficulties in communicating effectively over email. This is in fact why many times such collaborative work fails, and it is our onus as an organization to work together to meet these challenges head-on. The writer of this subsection (Duncan Maru) has seen over the years numerous instances where quite frankly toxic relationships develop between on-site volunteers/staff and off-site ones. These can get into classic group dynamics of "us" vs "them". Note, interestingly, that over time, someone that is part of the "Achham" side may become on the "outside Achham" side and vice-versa. The sad part about these dynamics is that 1) truly amazing people aren't achieving their full potential as a team; 2) universally, in all cases, the individuals involved care passionately/deeply about health in Achham; 3) the organization simply can not survive without sustained collaboration between Achham-side staff and volunteers and US one. Our goal is to develop a partnership with each other throughout the organization, such that volunteers deeply respect the autonomy of on-site staff. Some concrete things we all can do:
- To the extent possible, we engage on-site staff on all relevant listserves, to keep them up-to-speed on what the outside-Achham team is doing
- Traveling volunteers come with concrete work-plans and view themselves as "accompaniers" to listen to staff and identify their needs and vision and then assist in Implementing them (getting resources, supplies, materials, trainings) rather than mandating/bossing them
- Traveling volunteers refrain from directly criticizing individuals, and rather focus on brainstorming systems-level changes to combat challenges and mistakes and weaknesses in our operations
- Nyaya leadership on-site and off-site emphasize the real value of all team members from Achham to Boston and beyond
- Nyaya leadership on-site and off-site communicate and appreciate the different needs from both sides, that for example, the grant that the oustide-Achham team is writing right now is to situate us in strong financial position in two years, and on the flip side that the outside-Achham team sees the acute, local needs that may be consonant with the needs of grant writing and marketing
- Everyone works together to realize that there is no Achham and outside Achham team, only one Nyaya team
Guidelines for volunteer applications (who we do take, who we generally don’t take)
In the tradition of honesty and transparency, here we offer some candid guidance about what kind of applicants we are typically able to accept, and which types we typically cannot accept. Please note that, despite these general principles, we rigorously review each and every application we receive, and we do encourage interested applicants to contact us directly at volunteers(at)nyayahealth.org if they have questions or would like to discuss their application further. We take our commitment to volunteers very seriously, and aim to offer nothing but the finest volunteer support for all accepted volunteers, and regardless of acceptance, a thorough and respectful application process for all applicants.
Some general guidelines:
- MD students / MPH students: Students who are not able to come to Achham for at least several months are rarely accepted given that they are rarely able to offer much benefit to our staff and patients for shorter visits, and even on longer visits, often struggle to provide tangible skill-sharing. It should be noted that while we are very committed to helping advance the field of global health delivery, and therefore are committed to providing educational opportunities for the next generation of global health practitioners, our first and foremost commitment is to Achham. We are not a CV-building organization, nor do we have the capacity to accommodate volunteers who we are not extremely confident will be helpful to our staff and patients in Achham.
- Medical Residents (of various specialties): Residents stand to offer more clinical benefit to our staff and patients but can usually only come for 3-4wks due to their clinical schedules. We recognize and understand these time constraints, and consequently, will still accept residents for short-term trips of approximately one month. With that being said, priority will always be given to those who can commit to longer periods of time or who are committed to supporting the organization's work in other ways from outside of Achham. All residents who are accepted to come to Achham, regardless of the time in Achham, will be expected to be engaged with Nyaya's work both pre- and post-trip, the details of which will be explicitly laid out and agreed to with the residents' academic advisers.
- Senior clinicians (called "Attendings" or "Consultants" depending on country of origin): We are very excited to offer our staff and patients senior-level experience, but even for very-experienced clinicians, Achham can be a very difficult place to work. Thus, we will likely not be able to accommodate all applicants, and as with all volunteers, will give priority to those who have experience that will be directly beneficial to our staff and patients.
- Non-clinical volunteer applicants: While we do accept non-clinical volunteers, these volunteers must come prepared with particular goals and objectives, and typically we are not in the habit of accepting applicants who "want to help in any way I can." Achham is a very difficult place to work, so we make every attempt to have rigorously-detailed work plans for all volunteers. Thus, for non-clinical volunteer applicants, we are very happy to receive your applications, but will expect you to propose specific work and to justify your qualifications for that particular work, demonstrating clearly how our staff and patients will benefit from your presence.
- Note about long-term Nyaya Health non-Nepal-based volunteers: As an organization that is dedicated to cultivating the careers and professional skillsets of our own volunteers, we recognize that some applicants may not have skillsets that are immediately beneficial to our staff and patients in Achham. Nevertheless, for almost all potential volunteers, there is work for the organization at large that can provide amazing benefit to our staff and patients (e.g. fundraising, development, managerial responsibilities, etc.). For those applicants who are committed to volunteering in these non-Nepal-based positions, we will always offer them priority to Nepal-based positions when available.
- Summary: Both because of the massive managerial and logistics investment that volunteers require, and also because we are an organization primarily concerned with our staff and patients in Achham, we maintain high standards for all volunteers to prove in advance of any time in Achham. "Seeing how it goes" is not our model, and if we are not confident that a volunteer will be helpful to our patients and staff in Achham, we are simply not able to offer them a position.
The application process
In order to standardize our volunteer application process, we ask that all applicants apply via our online application portal. We will not accept applications emailed outside of this portal, although we do encourage applicants to feel free to submit additional information via email to volunteers(at)nyayahealth.org if they feel that the online portal does not sufficiently cover all portions of their application.
For volunteers interested in volunteering in Nepal, please complete this application. For those interested in positions outside of Nepal, please complete this application. We encourage all applicants interested in positions in Nepal to apply no less than six months in advance of the desired volunteer trip, given the complicated logistics involved in reviewing applications and coordinating trips to Nepal.
Upon receipt of your online application, we will review the application and will contact you subsequently. We regret that we cannot interview all applicants due to the volume of applications we receive, but we make every attempt to arrange phone and / or in-person interviews with all applicants who seem to be a good fit for our work. Regardless of the status of your application, you will receive an email communication with us within several weeks.
For those applicants who are accepted for a volunteer position, we will work with you to complete your volunteer contract, in which we will detail the explicit goals and responsibilities of your planned volunteer trip in Nepal. Additionally, all volunteers must sign our Volunteer Release Statement, explicitly releasing Nyaya Health from responsibility of risks and / or damage to themselves or their property during their volunteer trip. Both of these documents must be completed, signed, and received by the Nyaya Health Volunteer Coordinator prior to departure or the volunteer will not be permitted to go.
Pre-trip Preparation
Organizational Support and Management Structures
You will hopefully work with several members of our dynamic and fun team. For your clarity and for efficiency's sake, you will work with the following types of organizational members. We will try to respect these boundaries and roles so that you have a clear sense of how you fit within the organization and to whom you report and ask questions. We ask that you review these carefully and respect these boundaries as well. In general, it is best that you cc volunteers(AT)nyayahealth(DOT)org on all correspondence (both the Volunteers Coordinator and Country Director, as well as additional support staff, are on this listserve).
Volunteer Coordinator
Role: The VC will provide pre- and post-trip logistical guidance.
Currently: Dan Schwarz
What to discuss with the VC: Trip planning, flights, in-country travel, visas, costs, organizational expectations, mental health issues, medical insurance, luggage/freight issues, any other logistics.
What not to discuss: The technical aspects of what you will be doing while on-site (see below for "Technical Accompaniment and Support Person")
Technical Accompaniment Point Person
Role: Assists in the technical aspects of volunteer job descriptions, especially in talking through the inevitable road blocks and barriers that can derail projects and in thinking through the vision as it pertains to the organization. They should help to accompany, remotely and sometimes on-site as well, the very difficult work of implementation and advocacy that you are doing.
Currently: Varies by project. This person is always a long-term member of Nyaya and will have technical expertise to provide insight into the longer arch of your work, implementation and vision. Typically, if you are an MD volunteer, you will discuss your work with one of our clinical team leaders; if you are an engineering volunteer, you will discuss with someone who has experience with regards to your proposed work, etc.
What to discuss: Pre-trip implementation and programmatic planning, including materials and equipment and human resources; on-site roadblocks, barriers and implementation issues.
What to not discuss: On-site micromanagement details, local interpersonal conflicts, travel/trip logistics, etc. It is very important that this individual, for efficiency's sake, not deal with any of the personal logistics of the work, since their information may be out of date (they are frequently not Achham-based team members) and also it is not a good use of this person's technical expertise. We encourage our technical accompaniers to always forward any logistics requests to volunteers(AT)nyaya to ensure appropriate focus and communication.
Country Director
Role: To provide in-country oversight and management while you are in Nepal / Achham
Currently: Gregory Karelas
What to discuss with the CD: Establishing a work plan, on-site vision and implementation, feedback for the organization and feedback for your own work, local interpersonal challenges.
What not to discuss: Anything that can be answered by either the VC or your technical support person. The CD is extremely busy on a day to day basis, and especially given the difference in time zones (for non-Nepali volunteers), it is more efficient to ask questions of the VC or the technical support person initially.
Learning about our work
In addition to your conversations with our Volunteer Coordinator and other Nyaya Health members, please be sure to peruse the following sites:
- Nyaya Health organizational website: http://www.nyayahealth.org
- Nyaya Health wiki: http://wiki.nyayahealth.org
- Nyaya Health blog: http://blog.nyayahealth.org
- For more detail about our Achham-based clinical and public health operations, including our online data repositories for our programs, please see here.
- For more history about our organization and to learn about the evolution of our work in Achham, please review our old Annual Reports here.
- For more information about our academic and research-oriented work and publications, please see here.
If, after reviewing the above information, you still have remaining questions, please do not hesitate to email the Volunteer Coordinator at volunteers(at)nyayahealth.org.
Learning about your work with us
While there are common themes in all of our various volunteers' work agendas, each and every volunteer's experience will be different. We try our best to develop specific and well-thought-out work agendas for all volunteers prior to their trip, so that we will be in the best position to provide them with the appropriate support to make their time in Achham the most effective it can be. We celebrate results, not just good intentions, and accordingly, we aim to ensure that each volunteer can positively contribute lasting impact to benefit our staff and patients in Achham.
Developing your own personal work agenda
First and foremost, you will be asked to help develop your volunteer contract, which will include your personalized work agenda. This will be developed by yourself, the Volunteer Coordinator, and various staff in Achham, depending on what particular work you will be involved in (e.g. the Country Director, the Medical Director, the Director of Community Health, et al.). From this work agenda and volunteer contract, the Volunteer Coordinator will work with you to identify any specific needs for your own pre-trip preparation, such as reviewing particular protocols, data sets, reports, etc. You may need to have further pre-trip conversations with some of our staff in Achham, via Skype or email, to comprehensively prepare for your work there.
A note about developing new programs or initiatives as part of your work
One of the great advantages of new volunteers working in Achham is that our volunteers are often able to identify new and useful initiatives or programs that can add substantial value to our patients and staff in Achham. Fresh sets of eyes and minds often have new perspectives on long-standing problems, and can offer great insight into addressing them. Furthermore, at times simply having a new person in Achham can add the extra energy and attention to a problem that our staff are aware of yet have not had the time or resources to work on previously. Examples of this are new tests that might be added to our laboratory capacity, new continuing medical education programs like weekly X-ray rounds, or a new community education program such as monthly public health radio sessions on the local radio stations. We are always very excited to work with our volunteers to find ways that their new ideas can be implemented, but with the caveat that many times, new ideas are not really so new, and that in fact, they may have been thought of or previously tried by our staff previously, but were unable to be implemented due to local circumstances or resource availability. Accordingly, we encourage volunteers who are interested in catalyzing new initiatives to think critically about all of the required resources for the initiative, and to the degree it is possible/feasible to measure, the actual impact of the proposed initiative on our patients’ lives. Notably, this process applies to all volunteers, whether it be a volunteer working with Nyaya for the first time, or a Board of Directors member visiting for a month. Here, we link to two forms that may be helpful to volunteers thinking about new initiatives:
- This form here is a generic template to propose new programs in Achham. We ask that all volunteers proposing a new initiative complete this form to the best of their ability, allowing subsequent discussions with staff and other team members to be better informed.
- This spreadsheet here, which was originally designed to assess the cost and impact of a proposed new laboratory test, may be helpful to volunteers proposing new initiatives that are clinically/diagnostically relevant. If possible based on available information / literature / epidemiological statistics, please complete this spreadsheet for your proposed new initiative as well. It will be helpful in guiding discussions about the implementation of the proposed new initiative.
We recognize it may not be possible to provide all of the information in these two forms, however we encourage volunteers to make their best attempt, either while in Achham or as follow-up to their trip, as it will ultimately help the Nyaya team make the most appropriate decision. While frustrating, Nyaya’s team works in an environment with limited resources and capacities, and while there are many programs we do hope to implement, we must make tough decisions given the limitations Achham offers, and thus your assistance in laying the groundwork for these discussions is of immense benefit to Nyaya’s team and patients and we greatly appreciate your hard work in developing such proposals.
Finally, a note about particular programs: there are many ways in which we are not adequately or appropriately providing care to our patients that we strive to address. Some are large endeavors, for instance developing the capacity to provide orthopedic surgical services for patients who have been in road traffic accidents. Others however may be low-cost, not resource intensive, and easy to implement, for example poster campaigns at the hospital and throughout the community about the importance of sanitation. We encourage our volunteers to think broadly and ambitiously about both of these domains as we recognize we have significant limitations across the spectrum. However, depending upon the breadth of the proposal, and in particular the long-term cost implications (i.e. costs entailed in the overall program implementation on an annual basis, accounting for both direct and indirect costs – see above spreadsheet for assistance), proposals will be vetted by Nyaya Health’s Financial Review Committee and may not be approved due to the resources required.
Broader organizational commitments
In addition to preparation for your specific work, you may be asked to contribute to our broader organizational work prior to your trip. We consider volunteering in Achham to be an extreme privilege for the volunteer, and given the overwhelming number of applications that we receive, we prioritize those volunteers who are truly committed to our work, e.g. those who are willing to contribute substantially outside of their own particular volunteer trip. This type of work may include working on grants to support the programs the volunteer is working on, helping to write publicity or development materials, or giving public presentations about our work. These broader organizational commitments will continue after the volunteer trip as well, and will be detailed in the volunteer contract. We take these commitments very seriously, and will not be willing to facilitate your volunteer experience (which will inevitably benefit you and your career) if you are not strongly committed to supporting our work.
Spreading the word
Finally, we ask that all volunteers help to spread the word about our work, and your work with us, via your own personal and social networks. Examples of this include using social media forums such as Facebook/Twitter/Tumblr, or by sending personalized emails. Additionally, we have experience in hosting "friendraisers" and "fundraisers" (the former more targeted at awareness raising; the latter targeted more at money-raising) and will be very happy to help you orchestrate such events. More information about personal awareness and money-raising can be found here. Questions about this should be directed to volunteers(at)nyayahealth.org or socialmedia(at)nyayahealth.org.
Preparing mentally and physically
Achham, as with many similar settings around the world, is an extremely difficult place to work. Especially for volunteers from wealthier societies such as the USA or Europe, many of the complications and challenges related to the overwhelming poverty, structural violence, gender discrimination, and worldly neglect, can be very difficult to deal with. Even for short-term volunteer trips, many of our volunteers are surprised to find how difficult of an environment Achham can be. Both with regards to their own mental health and their professional work with Nyaya, many of our volunteers and staff suffer from severe feelings of sadness, isolation, and frustration. Staff and volunteers will witness awful situations of deaths and indignities that would never occur in other areas of the world. There is often no justice, as the rule of law is limited. Many outsiders (whether Non-Nepali, Nepali-American, or non-Achhami-Nepali) will feel unwelcome at times. Such feelings are only to be expected in as challenging a work environment as Achham.
Being a woman in Achham carries additional challenges. The vast majority of Achhami women are illiterate, many are relegated to cow sheds during "impure" times of menstruation or childbirth, and many are subject to domestic violence. Such cultural norms will impact our female staff and volunteers, often in profound and deep ways. Nonetheless, we feel that it is a fundamental component of our mission and vision to counteract these gender norms by demonstrating positive female role models (vis-a-vis our staff and volunteers), while still maintaining sensitive and respectful culturally-relevant behaviors.
There are no simple solutions to these mental health challenges. Going into this work, we ask that you talk through the possibilities of isolation and potential solutions with your family members, friends, and partners. For Nyaya’s part, we are committed to talking through, in an open and reflective fashion, any mental health issues that you may face. On the part of Nyaya’s volunteers and employees, we have a duty to remain committed, determined, and professional through these challenges, so we do expect each other to work through these issues. Giving up is not an option for our patients, and it cannot be an option for the workers of a professional organization with serious commitments. So we must talk early and often about mental health issues before they impact the ability to get work done effectively.
Accordingly, we strongly recommend that all new volunteers speak extensively to both the Volunteer Coordinator and other previous volunteers who have worked in the particular domain that the volunteer proposes to work in (e.g. an emergency room doctor should try to speak with a previous ER doctor who has volunteered). It is important that new volunteers hear and think critically about both social/structural mental health challenges (e.g. poverty, discrimination, political violence and neglect) and professional challenges (e.g. different cultural expectations of quality, punctuality, time-lines, etc), as both components can greatly impact the mental health of new volunteers. The Volunteer Coordinator will try to pair new volunteers with previous volunteers to hear about different experiences and help to prepare themselves.
Online global health ethics and professionalism courses
While no on-line module could ever approximate the lived experience and challenges of working in Achham, some of our volunteers have found these online modules to be helpful. Especially for those new volunteers who have no / limited previous experience working in a developing-nation or otherwise similarly impoverished and neglected area such as Achham, we find that some of these mental exercises can be instructive. We do not claim responsibility for their content as they are authored by outside institutions, but do offer them to you for your own use if you find them to be helpful.
Nepali language preparation
You should achieve a working level of Nepali prior to your trip. Knowledge of other Sanskrit-based languages such as Hindi facilitate language learning. While many people in Achham do understand Hindi, it is not typically spoken by most patients and staff. See our LearningNepali page.
Orientation to Nyaya Online Collaborative Tools
All Nyaya volunteers, in the US and in Achham, are expected to utilize Nyaya's collaborative tools. Please read carefully the following:
Overview of all Nyaya Collaborative Tools and Culture
Using the Nyaya Health Wiki
Using the Nyaya Health Dropbox
Using the Nyaya Health Asana for Project Management
Please pay attention to your email account for your invitations to dropbox, wiki, and asana. It is the expectation that you as a volunteer should carefully read through all the documentation and make a good, strong, persistent effort to quickly integrate into Nyaya's organizational culture. Please note that, as with joining any organization, there will be some initial challenging aspects of changing your own habits to adapt. We do expect significant leadership and initiative on the part of all volunteers to be independent in their flexible, nimble, and timely integration of Nyaya's tools. Some examples of how you may have to change your work flow:
reducing lengthy emails and instead writing within dropbox or wiki documents
having clear subject lines on all emails
adhering to a project management system in managing your and others' time within the organization
Please do email any of us for any advice or challenges as they arise. Efficiency is a moral imperative, and we are all learning how to be more efficient together.
Travel Planning
In general, travel from the US or Europe to Achham is a long and sometimes complicated journey. It is imperative that all volunteers plan far in advance and have a detailed travel plan. Even with well-planned journeys, many of our volunteers have still encountered problems, and some have been delayed by as long as several days due to the complicated nature of in-Nepal travel to the remote Far Western Region where Achham is located. We offer basic guidelines for travel planning here, and encourage all volunteers to discuss their travel plans in great detail with the Volunteer Coordinator or Country Director to ensure that all relevant parties are aware of necessary travel details.
A note about travel via India
In the past, some of our volunteers have traveled to Achham overland from Delhi in India. While slightly cheaper than travel via Kathmandu, this route is fraught with complications, and we no longer recommend that our volunteers use it. If you feel strongly that, for some reason, you prefer to travel directly from Delhi rather than via Kathmandu, here is some information about that route (although it is largely outdated by now). We encourage you to discuss with the Volunteer Coordinator or Country Director before electing to use this travel route.
Recommended travel route to Achham from abroad
We recommend that our volunteers travel from their home country to Kathmandu, and then from Kathmandu to Achham. The steps are as follows:
- Fly into Kathmandu (costs vary, but volunteers should expect to pay at least $1500 USD for a round-trip flight to Kathmandu). Most flights to KTM from other countries fly via Delhi, but there are other options available as well. Delhi is notorious for losing luggage and causing flight delays, with very poor customer support. Many of our volunteers have had frustrating experiences in Delhi's airport. Mumbai's airport has flights to KTM as well, and volunteers have had fewer bad experiences there, so you may consider trying to fly via Mumbai instead of Delhi if feasible. There are some scant few other flights to KTM from other countries in the Middle East and other parts of Asia as well, but they tend to be more expensive than Indian connections.
- Overnight stay in KTM: Most volunteers will need to spend at least one night in KTM due to flight schedules (most flights to DHG leave only in the morning). There are many very cheap hotels/hostels in the Thamel area of KTM, but they are also very low quality. There are plenty of higher-quality and more expensive options in other areas of the city. To find lodging, we recommend using Lonely Planet or other similar travel guides, or simply Googling "Kathmandu hotel / hostel / etc". Cheap lodging is usually ~$10USD per person per night, whereas more expensive options can be in excess of $100 USD per person per night. If you have any problems finding lodging, feel free to email the Volunteer Coordinator for assistance. (*Note: While you are booking your hotel, it is usually a good idea to also book a reservation for KTM lodging for the nights in KTM on the end of your trip before you fly home.)
- Take plane from KTM to Dhangadi (~$240-300 roundtrip, or if you are Nepali ~25% of that). Reserve plane tickets in advance, but you typically can change them if need be. Please contact our Volunteer Coordinator or Country Director to arrange for your DHG tickets. If you will not be staying in KTM, try to arrange it so that you arrive in KTM about 4-6 hours before the flight to Dhangadi.
- Overland from DHG to Achham: Take a private jeep (cost ~$175 one way for up to four people plus luggage) or bus (cost: ~$5USD one-way per person) from Dhangadi to Sanfe Bagar (about 2km from Bayalpata Hospital). Jeep is much preferred for safety, convenience, and comfort. The cost does not increase with more passengers or cargo. If transporting expensive equipment, definitely take the jeep. Contact the on-site program director to discuss further and/or to arrange a jeep. If you do take the bus, the buses leave regularly (morning and evening) from Dhangadi to Sanfe. Go directly to the buspark from the airport (about 15-30 minutes away). Since most flights will arrive in DGH by around noon, it is possible to leave KTM and arrive at Bayalpata Hospital late night that same day if you use a private jeep (who will pick you up at the airport and drive directly to Achham). It is also possible to stay over in hotels in DHG (nice hotels with running water and electricity) or along the way (more modest hotels) and arrive at Bayalpata Hospital the following day.
- Return trip: The same route, just in reverse. Keep in mind that you should have a reservation for at least one night in KTM on your return journey so as to ensure that any delays in travel (due to landslides, strikes, etc) will not cause you to miss your international flight out of KTM.
In sum, travel time required is approximately:
- 20-30 hours to KTM from home country
- 1.5 hours flight to DHG from KTM
- 10-12 hours to Sanfe Bagar / Bayalpata Hospital via jeep/bus
Scheduling logistics
Regardless of the route, you will need to make arrangements to have about 1-3 days of flexibility in your arrival and departure dates to and from Achham. The roads and the air can be very unpredictable; thus it is best to include some buffer time on either end of your trip. This will mean leaving Achham to return to KTM for your return flight at least a couple days early, so as to avoid missing your departure flight from KTM.
Visas
Nepali Tourist visas
This is the visa that most volunteers will receive. If you are planning on staying for longer than 145 days in a calendar year (Jan 1 - Dec 31), we should make arrangements for a non-tourist visa (below).There are two mechanisms to obtain the visa:
- On entry to Nepal: This is a suitable option if you are going through Kathmandu. In Kathmandu, you will need to bring a photo ID for obtaining Nepali visa plus $40 USD visa fee. They will typically award you no more than 30 days in-country, but that can be renewed. If you intend to stay longer than 30 days, it may be better to arrange for a longer visa in advance from your home country (below).
- From your home country: This is preferable for volunteers who intend to stay longer than 30 days or for volunteers who plan to enter Nepal overland (ie. by bus/train) from a neighboring country. We recommend submitting this application at least 8 weeks in advance, but the embassy in your home country can advise you with specific deadlines. For Americans, you can apply online at http://www.nepalembassyusa.org/ and will be able to receive either a 30 or 90 day tourist visa.
Nepali Non-Tourist visas
This is for individuals who will stay longer than 90 days in Achham. Please discuss this with the Volunteer Coordinator or Country Director.
Indian Visas (for those who will travel through India to come to Nepal)
Indian visas are not necessary for all volunteers, but can be very complicated and can create travel problems when passing through India on your way to Nepal. Several volunteers in the past have had problems, so we recommend being very careful regarding your Indian lay-overs and visas.
Since December, 2009, new policies have been put into place that mandate a "two-month" gap policy between tourist visa entry and exits into/out of India. This affects all tourist visas, regardless of the number of entries (single/multiple), the date of issue (even those issued before December 2009), or duration (even the 10yr tourist visa is affected). This means that there must be two full calendar months (e.g. 7th March -- 7th May) between your last exit stamp and your re-arrival date. If there is not a full two months, you will not be allowed to re-enter the country. This has happened to several of our previous volunteers.
For those volunteers who are only flying through India and do not plan to leave the airport at all on either leg of their journey, you should not have problems. But if you plan to leave for even 12 hours and step onto Indian soil (ie. outside the international airport terminal) you must be very careful because you will risk not being able to re-enter the country after your time in Achham (if you're there for less than two full months). The most common solution to this problem is that you can arrange to fly from KTM back to India (Delhi/Mumbai) on the same day as your flight from India to your home country and then simply never leave the international terminal (i.e. sit and wait without going through customs). As long as you have a flight on that day, the Customs officials do not typically give you any problems.
If you require an Indian visa, you should start planning for this 8 weeks in advance. Go to https://indiavisa.travisaoutsourcing.com/ to apply. We recommend considering some of the longer-term visas (e.g. 5 or 10yr visa) if you plan to visit India ever again, especially considering that the prices are not significantly higher than the shorter-term visas.
For volunteers with parents of Indian descent, you should consider an overseas Indian citizenship since it is only slightly more expensive than a multi-entry visa and is life-long. Allow 5 months for processing: http://www.indianembassy.org/consular/Overseas_Citizen/OCI.html
Purchasing plane tickets
In general, Nepali travel agencies are often able to find better deals that you will be able to find by yourself, but sometimes communicating with them from abroad can be very difficult. kayak.com tends to be a very reliable and economical source of plane tickets from the US to Nepal. Similarly vayama.com can be very helpful.
If you plan to fly to India and then from India to KTM, we recommend JetAirways or KingFisher Airways (among others), both of which can be purchased on Kayak or Vayama or on their independent websites. Round-trip tickets are usually ~$250USD but prices vary throughout the year.
If you wish to research Nepal-specific travel agents, here is a list of outlets used by previous volunteers. Prices may vary and we cannot vouch for their reliability, but offer this list here for your reference should you choose to use it.
Customs concerns
You should be able to pass through customs without problem. Any donated medical equipment should be wrapped in discrete, non-descript packaging. If you will be carrying medicines or equipment, you should speak with the Volunteer Coordinator in advance and receive an official letter of donation from Nyaya so that the Customs Officials can review it. This will make the customs process much easier.
About the volunteer experience in Achham
Safety and security
Currently, there are no security concerns in Achham or in other areas of Nepal. The civil and political violence of the early and mid 2000s has ceased, guns have all been put down, and there have been no incidents for years. There are still occasional protests, but those are largely focused in urban / peri-urban areas, and do not affect our work in Achham. The primary concern for our volunteers are bandhs ("strikes"), which occur commonly all across the country, and regularly disrupt travel by shutting down roads. During bandhs, no vehicles are allowed to pass certain areas of roads, making transport to Achham nearly impossible. Generally speaking, we do not ever recommend volunteers attempting to travel during a bandh or interacting in any way with the strikers. Volunteers should be in contact with the Country Director and Volunteer Coordinator prior to their travel to Achham to get the most up-to-date information about strikes, and if there are strikes happening, should be prepared to delay their travel to ensure their safety.
As with any place in the world, there is always the risk of muggings / theft, especially in crowded urban areas such as KTM. Foreigners are targeted occasionally, but normal safe travel / tourist practices are usually sufficient, and our volunteers do not typically have any problems. Females should be especially careful, as they are often targeted more than males. In general, we recommend not traveling alone, and not walking alone after dark, especially for females.
Vaccinations
We recommend that all volunteers go to your local Travel Clinic or speak with your primary care clinician about your pending travel to Nepal. Check out the CDC's Nepali Health Information page for updated information. You need to have immunizations up-to-date including Typhoid and Hepatitis A/B. Consider Japenese Encephalitis Virus vaccine. Flu vaccine is also recommended for all volunteers.
Life in Achham
In this section we will attempt to outline the basics for volunteers who are new to Achham. We hope that this will be helpful to prepare for your time in Achham. Please ask any further questions to the Volunteer Coordinator.
Quarters
Our volunteers mostly stay at Bayalpata Hospital. Occasionally, for longer-term volunteers, we can arrange private housing in the village (~30mins walk from the hospital), but generally speaking we expect that all volunteers will stay at the hospital so as to be close to our day to day work and most involved. This is especially important for any clinical volunteers who expect to be participating in night-time work (e.g. overnight clinical needs).
The quarters are very basic in their construction and amenities. All quarters are on-site, within 100m of the hospital buildings, and are constructed of concrete block with tin-sheeting roofs. All quarters have windows in them, but many do not have glass in the windows, nor good insulation, so the temperature can fluctuate greatly depending on the season and weather (summers are hot, winters are cold). There is electricity in all quarters, wifi internet in all quarters (and in some of the other hospital buildings), a ceiling fan, a bed (blankets and sheets provided), table/chair, and carpet on most floors. Otherwise they are very plain and modest concrete-block buildings. Quarters are arranged into "blocks" with 2-4 rooms per block.
Each block has at least one (shared) toilet with sink and bathing area. All toilets in Achham are squat toilets (see here), which many foreigners are not familiar with; notably there is no toilet paper flushing capacity, so volunteers who wish to use toilet paper should be prepared to dispose of it outside of the toilet. Some of our quarters have traditional Western showers, while others have only spigots on the wall for bucket-bathing. There is no access to hot water anywhere in the hospital or quarters.
**All volunteers staying at Bayalpata Hospital will be expected to pay the current per day rate for housing and food. These rates change with the inflational economy of Nepal, and volunteers should check with the Volunteer Coordinator prior to their travel to get the most up-to-date rate. For general budgetary planning though, in January, 2012, the per day rate is approximately $5 USD per person for housing and fooding together.
Food
Volunteers living at the hospital will eat in our communal hospital kitchen. There is a cook who prepares three meals per day, and the volunteers will eat with other volunteers and staff at designated times. Food is traditional Nepali food. For those unfamiliar with Nepali food, foreigners should be aware that it is a relatively simple diet. See here for more details about Nepali diet. Generally, dal bhat is served twice per day in the afternoons and evenings, with roti and tarkari in the mornings. In the villages surrounding the hospital, other food is available for purchase, but only a relatively limited selection. Volunteers should be prepared to live entirely on this simple Nepali diet. Those with eating restrictions, allergies, etc, should discuss with the Volunteer Coordinator prior to their travel. Notably, vegetarians need not be concerned as all meals are / can be made vegetarian and commonly even vegan (nonetheless, please notify the Volunteer Coordinator prior to travel so our cook can be aware).
Water purification
Generally speaking, we do not recommend that volunteers drink non-purified water (e.g. straight from the tap, or found in nature) in Nepal or in Achham specifically. There water on-site at Bayalpata Hospital is purified by our staff and designated purified water containers are available in the kitchen and in the hospital for volunteers to use. We recommend that all volunteers carry water bottles (Nalgene, etc) to fill up at the kitchen and take back to their quarters with them. Water at the quarters is not regularly purified, but can be purified using normal means (e.g. iodine, pumps, etc); volunteers should carry those purification devices if they wish to not be reliant on the kitchen/hospital supply. Outside the hospital (in the village etc) bottled water is available for purchase, and we recommend that volunteers avoid drinking non-bottled water.
Availability of supplies in Achham
Volunteers should be aware that there is very little availability of even very 'common' items in Achham. While small snacks, bottle drinks (soda, water), and standard Nepali food can be purchased in the villages, most other commodities cannot be found. Some small stores may sell notebooks, pens, etc, but volunteers should expect to bring anything they expect to need from their home country, or to purchase it in KTM on their way to Achham.
Weather throughout the year
Achham has seasons with variable weather.
- January - March: winter, temperatures below freezing, but rarely any precipitation. No snow accumulation at Bayalpata Hospital or in the immediately surrounding areas (only in the distant mountains)
- April - May: spring / early summer; becomes much warmer, >30° C but mostly dry still
- June - September: monsoon; rains torrentially almost every day; floods common in the area and roads are regularly washed out. Temperatures get very hot and humid, frequently >37° C
- October - November: becomes much cooler, rains decrease / stop
- December: early winter, temperatures near / below freezing, especially at nights
Telecommunications in Achham
Telecommunications in Achham has historically been very poor, but is recently much improved. We still have regular problems and frequently our phones / internet go out for short periods of time, but generally speaking, communication between Achham and other areas of Nepal and other countries is very good these days. There are several different types of telecommunications:
Mobile phones: can be purchased in KTM, but most of our volunteers rely on internet communication or use phones at the hospital if necessary. If you wish to purchase a phone, please discuss with the Volunteer Coordinator or Country Director in advance to purchase the type of phone that will be most effective in terms of network/signal strength. There are two types of mobile phones in Nepal--GSM and CDMA (and several different companies for each type). Historically, only CDMA mobile phones worked in Achham, but the GSM signal has been improving. Of note, especially during monsoon season, mobile phone signal can be extremely weak or entirely non-functional for days/weeks at a time.
Land-line phones: Bayalpata Hospital has landline phones that are quite reliable with good domestic and international calling capacity. Volunteers should not rely on these lines for personal communication due to their business nature and need by staff, but these lines can be used in emergencies if necessary.
Internet: Historically Bayalpata Hospital relied on VSAT (satellite) technology to provide relatively slow internet. Recently, ADSL high-speed lines have been installed at the hospital, and consequently, we have much faster and more consistent internet. Skype calls, and depending on bandwidth, even video calls, are feasible, as is most other internet activity. Internet is wireless in all the quarters (unrestricted) and some of the hospital buildings.
Electricity and power outlets
It is very important for volunteers to be very careful with their internationally-made appliances such as laptops, phones, etc. The specific details of energy in Achham can be found here, but the day-to-day reality can vary a lot. Achham voltage is very inconsistent, varying from 80V to over 300V at times. This causes power surges that can and have burned out laptops, A/C adapters (for phones, laptops, etc), and other devices. Accordingly, we recommend that volunteers are very careful to a) ensure that their appliance is in accordance with the Nepali power specifications (check on the device itself), and b) to be especially careful during monsoon or storm season when power surges are most common (we recommend only plugging in when necessary, and never during storms). Plug converters to change the shape of the plug can be bought for less than $1USD in any market in KTM (and sometimes in Achham as well), but it is much more difficult to find converters that change the voltage itself. Volunteers may consider bringing their own, but the weight / cost of those devices is frequently prohibitive for many travelers.
Computers
We highly recommend that all volunteers bring with them a rugged laptop computer. This greatly facilitates the work of the volunteer, both while in Achham, and while travelling throughout Nepal and in KTM as well. Note that Bayalpata Hospital does not have extra computers for volunteers to use if they do not bring a laptop. We recommend that volunteers consider carrying an extra battery for their laptops as well. Historically, electricity was very problematic at Bayalpata Hospital and consequently, volunteers' computers often ran out of battery power when the electricity was out. Since 2011, our electricity is much improved, and this is not likely to be a problem, but having a spare battery can be helpful regardless. All volunteers should bring wifi-capable laptops because our internet at the hospital is wifi and CAT5 / WLAN cables are not easy to come by.
Of note, there are many computer viruses in Nepal, and many volunteers have found that by using files from Bayalpata Hospital computers, their computers get infected with local viruses. We strongly recommend installing both antivirus software and anti-spyware software prior to coming to Achham. For users who do not already have these software, we recommend AVIRA and SpyBot, both of which can be installed and updated for free.
Note about collaborative technology within Nyaya Health
Nyaya uses various internet-based technologies to help streamline its operations. While many volunteers may not need to utilize these tools depending on their focus of work, others may benefit from familiarizing themselves with them and using them regularly. The primary tools include:
- Nyaya Health email accounts: any volunteer who wishes to have an internal Nyaya Health email account can have one (typically: volunteername@nyayahealth.org); please contact the Volunteer Coordinator to get an account if you'd like
- Nyaya Health Wiki: publicly accessible at wiki.nyayahealth.org; volunteers who require editing permission will be given login/password information when necessary
- Nyaya Health Dropbox account: volunteers who require access will be given login/password information by the Volunteer Coordinator or Country Director; notes for installation are found at DropBox Management
Money in Achham
Volunteers should be aware that there is no way to get cash in Achham. There are no cash machines (ATMs), and even though there is a bank, it is not possible to get transfers from international accounts for personal volunteer use. Accordingly, volunteers should come prepared with a substantial amount of cash to last them through day to day needs while they are in Achham. Most volunteers spend no more than a few hundred ruppees per day (at most), but volunteers who might plan to travel to Mangalsen or other nearby towns might require more money for hotels etc.
Given the complicated nature of getting cash in Achham, Nyaya is accustomed to assisting volunteers when necessary by paying for various things on behalf of the volunteer, and then receiving reimbursement from the volunteer at a later date when the volunteer is able to access their bank account. Volunteers are expected to pay for all costs incurred by Nyaya Health on their behalf, and all volunteers will be expected to pay the daily housing and fooding fees (subject to change with inflation - please ask the Volunteer Coordinator for the up-to-date rate).
At the end of the volunteer's stay at Bayalpata, they will receive an invoice from the Hospital which will detail all costs incurred during their time in Achham. Volunteers will be expected to reimburse these costs within 2 weeks of leaving Achham (unless otherwise arranged previously), via Nyaya Health's online donation portal, which accepts all major credit cards. Failure to reimburse those costs will be viewed as a breach of the Volunteer Contract, and will result in the volunteer's professional or academic supervisor (when relevant) being contacted, and a formal letter being sent to their institution detailing this infraction. Especially in the case of students and residents, Nyaya Health will take these violations very seriously and all programs will be notified.
Dress code in Achham
For both cultural and professional reasons, all Nyaya Health volunteers are expected to dress conservatively and professionally while in Achham. Business casual attire should be worn when working at the hospital, and while casual clothing is fine for off-hours or on weekends etc, all volunteers should dress conservatively with respect to local traditions. Females especially should avoid revealing clothing (tank tops, short shorts/skirts, etc). Comfortable shoes and sandals are a must given the immense amount of walking that many of our volunteers do while at the hospital and on visits to the community.
What to pack
Here is a suggested list of items that most of our volunteers find helpful. Obviously you will need to tailor this to your personal needs, but hopefully it will be helpful.
- Water bottles
- Sunscreen
- Iodine tablets or other purification method (as backup in case you are outside of the hospital)
- Hand sanitizer if you prefer (soap and water are available at the hospital)
- Headlamp / flashlight / torch and extra batteries
- Watch / alarm clock
- Notepad, pens
- Laptop computer, extra laptop battery, charger
- USB flash stick
- Digital camera, other electronic devices as desired
- Clothing (see above for dress code)
- Lightweight towel (Nyaya cannot provide towels to volunteers)
- Sturdy and comfortable shoes for walking on rugged dirt trails in the community
- Sandals (weather-contingent)
- Basic toiletries (toothbrush, soap, etc.)
- Female hygiene products
- Toilet paper if desired (often not available for purchase in Achham and not used at Bayalpata Hospital by staff et al)
- Photocopies of all key travel documents, passport, etc
- Extra passport photos (occasionally required for local permits by police etc)
- Medical / travel / evacuation insurance -- as per the volunteer release agreement, Nyaya Health cannot provide international medical / travel / evacuation insurance; if desired, volunteers should provide their own
Info about in-kind donations
Volunteers are encouraged to bring medical equipment and other in-kind donations when they travel to Achham, but only with prior approval from the Volunteer Coordinator and Country Director. In the past, well-meaning volunteers have carried suitcases full of well-intented donations, only to find when they arrived in Achham that the donations were not needed or could not be used for various reasons. Thus, please discuss with us prior to bringing any donations. We are always very appreciative of donations, and have an endless list of items that we need, but want to make sure that we only bring things to Achham that are actually needed and useful.
Additionally, even if you do not have the ability to make donations, we may ask volunteers to carry items that we procure in the US (via donations from companies etc) to Achham when you go, so as to save on the costs and delays of international shipping.
Finally, all in-kind donations should be recorded on a formal donation letter that Nyaya Health will provide you with prior to your travel so that you will be able to show the letter to Customs when you enter Nepal, so that there are no problems with the importing of devices etc.
Info about monetary donations
Many volunteers wish to make monetary donations before, during, or after their trip to Achham. We are very happy to accept any monetary donation that you are able to make, and encourage you to do so via our online donation portal here.
Info about bringing gifts for staff and community members
This is a very sensitive issue; if you'd like to bring something please check in with the current Program Director onsite for appropriateness/suggestions. In the past, well-meaning volunteers have unknowingly and un-intentionally caused conflict amongst staff and community members by appearing to favor or give special treatment to particular person(s). Thus, while we greatly appreciate the sentiment to bring gifts, we encourage volunteers to be very cautious about this and always discuss with the Country Director on-site before giving any staff or community members anything at all.
We do recommend, for those volunteers who wish to bring something, bringing things like bags of chocolates / candies, which can be shared with all staff members at weekly staff meetings, etc.
Finally, we strongly recommend against ever providing monetary donations / support to any of our staff or community members. This generates great conflict, and despite the perceived need of many of the impoverished people of Achham, we feel that it is important to centralize all of our donations and support towards developing better long-terms systems to address the causative problems, rather than giving one-time (or even repetitive) donations to a particular person. Additionally, any monetary donations / gifts to any particular individual will (as above) be seen by other staff / community members as selective favortism, and in even worse cases, may be viewed along political lines as supporting the members of one party or another (which is a common problem in Achham). Thus, we strongly recommend against this in all situations.
During your time in Nepal
Ideally, if the volunteer preparation process is functioning well, your goals for your time in Achham should be laid out well in advance of your arrival in Achham. Nonetheless, Achham is a constantly-changing place that where even the best laid plans are often disrupted or made impossible by extenuating circumstances that simply cannot be planned for. Roads wash out during monsoon season, electricity fails (all year long), telecommunications are unreliable, staff shortages lead to project delays, etc etc. Oftentimes our volunteers arrive with huge amounts of excited energy, passionate and dedicated to accomplishing their goals, only to be crestfallen when they realize that our staff are frequently overwhelmed by their immense patient loads and the ever-present challenges of structural violence and poverty in Achham. This can lead to volunteer frustration when their expected projects do not proceed as desired, or in other situations, when they have to be changed or re-structured entirely. This is obviously not something that we, as managers, hope for, but it is a tangible and pragmatic reality of volunteer work (especially short-term) in Achham. Accordingly, we caution all volunteers to approach their work in Achham remembering that the primary goal is always to assist our staff and patients, and that sometimes (despite our best intentions) our initial plans have to change at the last minute because of the complicated circumstances in which we work.
Chain of command and supervision
While in Achham, all volunteers should have a proper chain of command established. For most volunteers, they will work most closely with some combination of our Country Director, Medical Director, Director of Community Health, Hospital Administrator, and various other hospital staff depending on their particular work agenda. The Country Director however, regardless of the volunteers' particular work agenda, should always be kept up to date about volunteers work, and should be seen as the volunteer's primary contact, liaison, and supervisor (even if there are also other close contacts involved in their work). Volunteers should meet regularly with the Country Director to debrief on their work and the volunteer experience in general. These meetings will occur at a frequency determined between the Country Director and the volunteer themselves, and should be conducted so as to augment and support the work and the volunteer experience; they should not be conducted simply for the purpose of having meetings.
The Volunteer Coordinator will tend to take a back-seat in supervision during the volunteer's time in Achham, but will always maintain contact with the volunteer. In the case that the volunteer wishes to discuss problems in Achham with someone other than the Country Director or other on-site team members, the Volunteer Coordinator will always be available to the volunteer via phone / Skype communication, and can serve as an extra source of support and guidance if needed. Given the complicated nature of work in Achham, Nyaya recognizes that some volunteers may not feel comfortable voicing concerns directly to on-site team members, and in so far as that is true, the Volunteer Coordinator can act as a liaison between the volunteer and other team members, confidentially if need be.
A note on interactions with Nyaya Health Nepal / Bayalpata Hospital Staff
We strongly encourage all of our volunteers to work very closely with our local staff, and indeed, to develop strong relationships with them both personally and professionally. However, we also ask that all volunteers maintain strict codes of professionalism with our staff, avoiding any conduct that you would not otherwise engage in with your professional colleagues in your home institution.
Furthermore, we must request that no volunteer ever agree to speak on behalf of one of our staff members as a personal or professional reference without first consulting the Achham senior leadership for their approval. We strive to maintain proper chain of command with regards to our long-term staff and our short-term volunteers; occasionally our staff may request a personal or professional favor or reference letter. This can be very problematic and challenging for our local managerial and leadership staff, who should always be in charge of any assistance, remuneration, or reference-writing for our staff. Thus, we request that no volunteer, under any circumstances, provide any long-term staff member with material, financial, or other assistance, including written or spoken personal/professional letters of reference. If any staff members request this of you during your time volunteering in Achham, the appropriate response is to discuss with the on-site senior leadership (most likely the Country Director) and seek their guidance. In some cases, it may be appropriate, but only after seeking the approval of the on-site leadership first.
Updates, reports, and blog posts
As per the specific volunteer contract of each volunteer, periodic update reports may be expected to be sent to the Volunteer Coordinator, Executive Director, or other non-Achham-based Nyaya Health members. Blogs posts will also commonly be expected of volunteers, as a way to spread the word about our work and also help the volunteer themselves to reflect and process their work experience (writing topics to be determined per the volunteer's interest, along with the Country Director et al).
After your trip to Nepal
Post-trip requirements
As per the volunteer contract, all volunteers will be required to submit their post-trip report (details discussed in the contract and/or agreed to between the volunteer and the Country Director / Volunteer Coordinator) within two weeks of departure from Achham. Nyaya Health takes these reports very seriously, and views them as an opportunity to evaluate both the volunteer / their work, and our organization and our support of the volunteer. We encourage volunteers to feel comfortable submitting frank and critical feedback, and will humbly and graciously receive constructive criticism of our own work and will work to improve those issues for future volunteers. Because of the importance of these post-trip reports, we will take very seriously any failure to submit them on time, and will view it as a breach of contract as previously agreed to between Nyaya Health and the volunteer.
In addition to the post-trip report, most volunteer contracts will specify other post-trip contractual items, such as donor support, public presentations / talks, grant writing, etc. As with the post-trip reports, Nyaya takes these items extremely seriously, and will expect that all volunteers will complete them based on the agreed-to timeline as expected. Any failure to complete these items (or to complete the post-trip report) will result in a letter of dis-satisfaction and a poor evaluation to the volunteer's supervisor / academic advisor. These volunteers will not be welcome to return to Achham again, regardless of previous plans that may have included follow-up visits as part of continued projects etc.
A note about Letters of Recommendation
Oftentimes, volunteers will request letters of recommendations for their pursuits of future employment and education. Nyaya Health is dedicated to supporting their volunteers in this regards. The letters of recommendation should be personalized and appropriate to the quality and extent of the volunteer's work. For example, we can write a much more detailed and meaningful letter for someone who has worked with us for 2 years than for 2 months. We will provide an honest assessment, as we are obligated to do. If we feel that we cannot give a wholly positive letter, then we will let the volunteer know the weaknesses that we would discuss in the letter and the volunteer would be empowered to decide whether the letter would be helpful or harmful to his/her application. The process for ALL letters of recommendation is as follows:
1] The volunteer discusses with the manager/director that s/he has worked most closely with.
2] Together, they identify if and who would best co-sign the letter (typically, this would be signed by the manager/director who worked most closely with the applicant, and, if appropriate, by an additional member who is familiar with the volunteer's work).
3] The volunteer him/herself will draft the letter of recommendation, and send the draft to the the signatory(ies) of the letter. We have the volunteer draft the letter as standard practice since this is very typical in academic circles and since it challenges the applicant to really conceptualize and advocate for their strengths. Ultimately, any content is the sole responsibility of the signer of the letter of recommendation, but the initial draft should always be written by the volunteer. We make no exceptions to this rule, since this is the best, most efficient practice for this.
4] The signatory(ies) then adapt the letter and send to the appropriate location.
Letters for graduate medical education (residency applications)
A primary consideration when thinking about GME/ERAS letters is that the letters are mostly expected to be clinical in nature. It is not necessarily the best idea to send in letters that are primarily about non-clinical work. ERAS tends to focus on clinical abilities, with non-clinical work as an secondary priority. There is a limit of 3 or 4 letters, and review committees expect those letters to mostly be about your clinical abilities. Thus, if the volunteer has other people who will be able to write a letter discussing his/her clinical work, it would be more advisable to get the letters from them, for the benefit of having the strongest application possible. Still, we can comment on the non-clinical/leadership skills (in the fashion of the above protocol) if the volunteer so desires.
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