A Bethesda native works to improve dental care in Nepal
It was pouring rain in the Nepali village of Kaskikot, which was bad news for Laura Spero and the ceremony she had planned.
Mid-April was far too early for monsoon weather, but one thing the 33-year-old had learned since she began traveling regularly between Bethesda and Nepal 11 years ago was that nothing in Nepal happens on schedule.
Kaskikot is a village of roughly 12,000 on a mountainside beneath the Himalayan Annapurna range. Almost everyone is a member of a subsistence farming family; they eat what they grow, and daily life is difficult. Water must be hauled, buffalos milked and kitchen fires built so that when the power goes out — which it does daily — rice can still be cooked. People have little energy to trek 30 minutes to attend ceremonies at the local health post. Especially in the rain.
Spero’s ceremony was supposed to be a crowning achievement for Eva Nepal, the nonprofit group she founded in 2007 to provide the village with desperately needed oral health care. Today, for the first time, the health post would absorb responsibility for operating and funding the dental clinic. At least, it was supposed to. But the head clinician, Kamal Bhandari, who had been appointed by the national government in Kathmandu and goes by the title “health post in charge,” had made it clear he wanted nothing to do with Eva Nepal or Spero. “I will not touch your dental instruments with my two hands,” he had said. “Ever.”
Perhaps Bhandari believed his authority was being threatened, and worse, by a foreigner. Or maybe it was because Spero would not pay him an extra salary once the handover took place.
Whatever the reason, Eva Nepal’s program director, Nabaraj Sharma, had assured Spero that “not even a letter from the king” would make Bhandari change his mind. Clearly, because Nepal’s last king had been deposed in 2006. But if villagers came to the ceremony in force to show support, then Bhandari might be swayed.
And if nobody showed up?
“It’s quite possible that Kamal will ream me out,” Spero said the night before the ceremony. “Or maybe Kamal will sign the handover papers and then do absolutely nothing.”
The next morning, an hour past starting time, the Eva Nepal staff waited in the damp concrete local government headquarters. They had hung a banner that read “Kaski Oral Health Care Project.” Two elderly women arrived, followed by a couple of middle-aged men. A stray dog wandered in from the rain and slumped down in the doorway. There was no sign of the health post in charge.
Though Spero officially launched Eva Nepal in 2007, she had been raising money for oral health care in Kaskikot since 2006. Nearly all this money has come from Bethesda’s Greenwich Forest neighborhood, where Spero grew up. Her parents still live there, and each Thanksgiving, roughly 35 Bethesda families and 30 businesses participate in a race and fundraiser.
Ted Alden, 52, met Spero in 2007, when she knocked on his door to hand out literature about the race. Alden had long been fascinated with the Himalayas, but he was inspired by how Spero included his kids, then 7 and 9, in the event.
“Laura has a pizza party at her parents’ house the night before the race, and the kids make all of the decorations for the starting line,” he said. “She’s busy trying to strengthen the community in Nepal, but really she’s building and strengthening the neighborhood she grew up in.”
Alden says it wasn’t until recently that he truly came to understand the scope of Spero’s humanitarian ambitions. “Maybe she’s raising $10,000 a year, and that doesn’t begin to cover the scale of what she’s trying to do,” he said.
Dale Rosenthal, another Greenwich Forest resident, said Spero had been an important role model for her kids. “She didn’t want to be sitting around and doing nothing in the privilege of Bethesda,” she said. “She saw what needed to be done and actually carried through with it. But the beauty is that it’s so local. We’re not just writing a check and dropping it in the mail.”
This year, Spero has expanded her dental program. Now 13,000 more people in the villages of Lahachowk, Lwang Ghalel and Rivan have oral health coordinators leading daily brushing programs at school. There are also community education classes, regular dental clinics at the local health posts, and discounted rates offered to these villages at larger hospitals.
None of this could have been accomplished without Greenwich Forest. But people there don’t realize how much Spero has struggled for these successes; they don’t necessarily understand that money alone is not enough.
In recent years, aid has flooded to Nepal. Westerners drawn by the Himalayas’ remote beauty, the birthplace of Buddha and an impoverished population are eager to spend their euros and dollars there. In 1990, 220 nongovernmental organizations were registered with Nepal’s Social Welfare Council. Today, there are almost 40,000.
Some of this is short-term volunteerism, or “voluntourism.” But “if you really want to help the country, then you train local people,” said Erica Stone, president of the American Himalayan Foundation. This requires a long-term commitment, one that doesn’t ask the local population to house, feed and interpret for you.
David Citrin, professor of anthropology at the University of Washington, said voluntourists can often become unwitting pawns in local politics. “They help politicians look like they’re doing good stuff,” he said.
Spero’s relationship with Kaskikot is itself an implicit stand against voluntourism. Long ago, she decided to implement a self-sustaining, community-based program there that could run without a Westerner at the helm. She is accountable to this vision, even if the village, as stubborn as it is beautiful, struggles to budge.
Laura Spero is broad-shouldered and strong, at once muscular and lean from her days swimming and rowing college crew and competing in national taekwondo competitions.
“Laura wanted to go to the edge of what she thought she could do,” her mother, Nancy Chasen, said about her daughter’s desire to travel to Nepal. She was eager to flee the “life of privileged Bethesda.”
Spero grew up attending Georgetown Day School (full disclosure: we were in the same graduating class), and Chasen said she was looking for a place “where the rules weren’t already set about what you were supposed to be and what constituted success.”
But if Spero failed, her mother said, she didn’t want anyone to see it happen. Chasen is a public interest lawyer and consumer advocate who worked with Ralph Nader. Spero’s father, Don, is an entrepreneur who was previously on the U.S. Olympic rowing team. They had accomplished extraordinary things. Their daughter wanted the same for herself.
Spero first visited Nepal in 2001 on a three-week trip between her junior and senior year at Williams College in Massachusetts. Walking down a village road one day, she spotted a woman and her child in a doorway. Spero reached for her camera, then stopped herself. “It hit me that I’d come all the way there, but I wasn’t really there,” she said. “I wanted to stand where that woman was standing.”
In 2002, Spero returned to Nepal for two months, but she still wasn’t thinking long term. “I thought I’d come back to the U.S. and do something responsible,” she said.
But she discovered that the Nepali organization she had paid to facilitate a volunteering project had not organized any work for her and, worse, had placed her in the home of Bhim Subedi, an influential school principal. Spero was in danger of becoming a voluntourist.
She persuaded Subedi to let her change homes. He suggested Radhika, a widow who lived in a two-room mud house with her grown daughters, Bishnu and Malika. This would mark the start of a long relationship.
In 2003, she returned to Nepal a third time, independent of the volunteering organization, and lived with Radhika for nine months. Spero helped with chores and learned Nepali. (Bishnu and Malika spoke little English, and Radhika spoke none.) She moved from sleeping on the attic floor to sharing a bed with Bishnu. Spero was now the woman standing in the doorway.
Not that she fit in — or planned to live there permanently. Spero was more of a local attraction: the tall white woman who could fix things. There was a perception among villagers that Americans — or their money — could solve life’s daily frustrations. At the top of the list were toothaches. Many villagers came to Spero with horrible mouth pain, asking for medicine. The only dental tool at the health post was a rusty pair of pliers.
Spero learned that people expected their teeth to rot and fall out with age. They did own toothbrushes; they just didn’t use them often. “All the pieces were there,” she said. “The problem didn’t seem like it would be so difficult to fix.”
She had a lot to learn.
In 2004, the Nepali government drafted a National Oral Health Policy, which promised to bring dental hygiene to the country’s 4,000 villages. That program is nearly identical to Spero’s: daily brushing programs at school and regular clinics at village health posts. But nine years later, only a handful of villages offer any dental services.
Spero’s small organization is essentially doing the government’s work in a country where 58 percent of children and 69 percent of adults suffer from bacterial tooth decay. According to Shaili Pradhan, the chief oral health care focal point in Nepal’s Department of Health Services, the country’s high rate of heart disease and diabetes is likely linked to a lack of oral health care.
The National Oral Health Policy did introduce fluoridated toothpaste, especially important in a country without fluoridated water. But this doesn’t do much good unless people use it. Rural Nepalis brush with a finger and ashes, salt or sand. Some use abrasive tooth powders that strip enamel from teeth. In some places, people chew datiwan, a stick with antiseptic properties. Then there’s local lore about the dangers of dental care — deeply embedded myths that landed Spero in trouble when she started the dental program.