As the Dickey Center for International Understanding’s inaugural Lola Fellow, Abbey Savin ’24 is completing a year in Nepal moving from the world of global health policy into the realities of maternal health program implementation. Working alongside One Heart Worldwide’s Monitoring and Evaluation team, she brought a qualitative, policy-focused lens to the organization’s Network of Safety model, traveling from the lowland terai of Madhesh to the mountains of Karnali to see how care reaches mothers across the country’s geographic and cultural diversity.
At a moment of profound disruption in global health funding, her reflection captures both the humility and the insight that come from learning on the ground—and makes the case for the kind of in-country led, sustainable health systems work the fellowship was designed to support.
Every morning, as I weave through the humid streets of Kathmandu on my way to work, I find it hard to believe that this is my life. Dodging mopeds and tip-toeing around the pikhalakhu on the street, the city is a constant bombardment of the unfamiliar. When I first arrived, every day left me with a looming sense that I knew nothing, both in life and at work. From where to buy milk, to understanding the ins and outs of Nepal’s clinical referral systems, I was sure I was in over my head. Little did I know, growing out of and through this feeling would be one of the most fulfilling parts of this experience.
I didn’t come to Nepal under the delusional belief that I would feel like an expert in anything. I’d spent my first year after graduating working in policy and advocacy focused on the global health workforce. In Nepal, I was transitioning into maternal health program implementation. I went from drafting policy briefs summarizing data from the global context, to discussing program monitoring data down to the district-level of a national program. More importantly, a core value in my decision to pursue this opportunity has always been to center the decolonial lens. With the shockwaves of changes in the availability and priorities of global health funding still resounding across the world, in-country led, sustainable approaches to strengthening national health systems are more important than ever before.
It took a while for me to realize that the disorientation and overwhelm I was feeling wasn’t something to escape, but rather something to embrace. From an analytical standpoint, it mandated that I question everything as novel. And from a learning one, it meant that I was reliant upon the humble yet abundant expertise of my new coworkers and friends. It was my curiosity (and in some cases admittedly, naivety) that has allowed me to bring a new perspective to existing data in my role alongside One Heart’s Monitoring and Evaluation team. With robust data collection and quantitative analysis mechanisms already in place, I have the chance to apply a qualitative, policy-focused lens to evaluate the efficacy of programs falling under One Heart’s comprehensive approach to health systems strengthening, the Network of Safety model.
The Network of Safety model encompasses all components of networks of care for maternal and newborn health; from educated and enabled health workers that deliver services, to local and national level government actors who manage programs and financing, to the mothers at the core whose knowledge and behaviors shapes the frequency and quality of care they receive. Among the forms of technical assistance that fall under this approach are site monitoring visits and consultations with municipal government leaders. In my role, I’ve had the chance to shadow both in the Madhesh and Karnali provinces, nestled in the terai (lowland) and mountainous regions. Nepal’s geographic and cultural diversity presents seemingly endless microcosms of study for every variable that affects the consistent delivery and reception of high-quality health services for mothers. From transportation, material resourcing, staffing and training, to gendered power dynamics, religion, perceptions of healthcare services, and economic status (just to name a few), the recipe for reducing maternal mortality is ever-evolving and complexifying. Overwhelming– certainly, fascinating… also yes.
Some of my favorite learning moments have come when I am able to visit health facilities, to see the background research, the data sets, and the days on end of policy research coalesce in the physical reality of the places and people who deliver care. Each time, I am touched by the kindness and generosity of the health workers, government officials, and local programming leads. At this turbulent time in global health, it is a privilege to have the chance to learn on the ground and to bear witness to the kind of sustainable transformation that is possible when programs are rooted in the people, places, and perspectives of those who know them best.
The week I graduated from Dartmouth, I cried– a lot. I’d miss my friends, the place, my routine, the certainty of another term in sight. But, maybe most of all, I thought I’d miss learning. What a pleasant surprise it has been to be confronted with the thrilling and brutal reality that when learning in the real world, every answer is often accompanied by many, many more questions. This academic Hydra rears its head in every project, field visit, and (relatively) menial day of work here in Nepal. It turns out, when you’re not sure what you know, you have everything to gain, and every day I am grateful for it.
Abbey Savin ’24, Dickey Center Lola Fellow with One Heart Worldwide in Nepal 2025-26.
Learn more about the work of One Heart Worldwide here, and more about the Dickey Center’s Lola Fellowship here.
