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Choosing optimism and hope in the face of adversity

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I am envisioning the glorious day of January 11, 2021. Dressed in a neat formal shirt and chinos with fancy RM Williams boots, a sleek Littmann Classic III around my neck, a beeping pager, and a personalised Parker pen engraved with the text ‘Dr Khanal’ in my pocket; I will be ready for duty with the General Surgery team at 6 am; excited and anxious.

Behind that rosy picture, however, will swell a sea of emotions. I will feel privileged caring for my sick and vulnerable patients. I will question my competence and feel the burden of my responsibility. I will remember the pride of my family and friends who supported me on my long and arduous journey.

In 1992 I was a growing foetus unbeknownst to my 23-year-old mother Naina and my father Nila, already parents to my two older brothers Chida and Dilli; they faced an agonizing decision. They had to decide whether to stay in Bhutan while fearing torture, imprisonment and possibly death at the hands of its cruel autocratic ruler King Jigme Singye Wangchuck, or flee their beloved country seeking asylum. Like many others, they didn’t have a choice.

My family took a dangerous journey to Nepal, where they were declared refugees, and sheltered in a makeshift bamboo hut with a mud floor in Beldangi II refugee camp in eastern Nepal. There they relied on the mercy of the United Nations High Commissioner for Refugees (UNHCR) and their partner organisations for shelter, protection, and survival. My fate was sealed before I was even born.

Among the memories of my 16-year ordeal in the refugee camp, I remember visits to the basic healthcare unit (BHU). These small health centres were set up by the UNHCR and staffed by fellow Bhutanese who had received three months of medical training. I admired the skills of the health assistants and their fancy medical tools such as the mercury thermometer.

At the BHU and in the camps, I would see all kinds of sick people, young and old, many dying or dead. However, as a child, I didn’t quite grasp the bleak nature of my surroundings. 

I didn’t know anything beyond the confines of the refugee camp. The camp was my world, and I was happy and vigorous, but also vigilant of dangers around me.

My parents raised me with love and care. They portrayed optimism and hope despite their inner sufferings of separation, grief, and homelessness. They were resilient and resourceful in the face of adversity. They dreamed of repatriating back to Bhutan and a reunion with family members, their farmland, and the animals that were left behind.

As a teenager, I began to understand my plight. I saw malnourished children, witnessed the loss of life through the lack of healthcare, violence against women and children, and suicide. I began to connect some dots, and I felt helpless. Those dark experiences provided the motivation and the audacity to dream the impossible. I decided that, should the opportunity of a formal education ever arise, I would try to become a doctor.

After efforts for repatriation failed, the UNHCR unveiled third-country resettlement as a solution to the refugee crisis. My parents made a bold decision to accept resettlement to Australia in quest of a better future for their children.

In September 2009, I arrived in a generous Australia and the border town of Albury, New South Wales became my new home. That day enabled me to work on my dream.  

The journey since resettling in Australia has not been easy. There were significant initial language, financial, social and acculturation challenges. Health issues within my family made me feel helpless at times, but they also provided the motivation to persevere. Luckily, we had caring people looking after us.

My parents enrolled me at Murray High School (MHS). I was generally a happy chap there, but I was also confused, lost and outside of my comfort zone. I was loved by most and bullied by some. Deep inside I knew it was my only chance at life, and I had to make the most of it.

I worked diligently at school. My teachers and fellow students were interested in my story, and they provided the holistic help I needed to succeed. I worked multiple jobs to help my family financially during my high school years. I was chuffed to have a pushbike to go to work, to ride around town, and to the council library to access an hour of free internet.

Life was almost perfect, except when I had to carry my punctured/flat bike at nights from work, or when people yelled at me for wearing the Bombers T-shirt donated by the Vinnies. I never understood why people got mad at me until someone explained some years later how much the Essendon Football Club was hated by some locals. Bloody Vinnies.

I promise I have never worn that T-shirt since.

When I was named the dux of the year at the end of year 12, two years after enrolling at MHS, it gave me a glimmer of hope about achieving my childhood dream.

I moved away from home for the first-time in February 2012 to study at the Australian National University (ANU). It was challenging. Suddenly, I found myself among the brightest students in the country, many of whom had come from very privileged backgrounds.

After completing the Bachelor of Medical Science from ANU in 2014 I returned home, volunteering in leadership roles within the Bhutanese and the local community and working at MHS as a teacher’s aide helping students from refugee and migrant backgrounds.

In 2015, I became an Australian citizen, and some of my colleagues taught me how to do aShoey. Perhaps it was that brave performance more than my volunteer work that led to the Albury City Young Citizen of the Year award in 2016. I felt I truly belonged.

When not chucking pies at the local cricket club, or ‘going to the Bonnie Doon’ for a night in a swag, I was preparing applications for admission to graduate medical school – a long, complicated, and highly competitive process. It took a couple of attempts, but in 2016, I struck gold, and I was accepted into the MD program at the University of Wollongong.

I moved away from home for the second time in 2017. Medical school was a long, tiring, and challenging journey. It often tested my patience and strength, but I stayed motivated. I kept reminding myself of the ultimate reward.

At medical school, I often linked the symptoms and illnesses I had seen in the camps to diagnoses and prognoses I was learning. I also learnt how social determinants including refugee trauma, environment and living conditions, access to food, education and healthcare, and socio-economic status affects health.

I connected more dots. My childhood became vivid, and memories sharper. This time I didn’t feel helpless though. I felt empowered by the power of education and knowledge, and I started dreaming of my future as a doctor.

During my final year of medical school, I conducted research on mental health of fellow Bhutanese youth from a refugee background in Australia. The findings were concerning but not surprising. I felt a strong sense of responsibility and urgency for intervention.

When I passed my final exams, I was relieved but not overwhelmed with joy. I felt the weight of my new responsibility. That same day I wrote a three-page document outlining my short term, mid-term, and long-term goals.

My graduation as a doctor vindicated my parent’s bold decision to resettle. It helped them heal the scars of their traumatic past, and somewhat relieved their grief of separation from their family and home.

When my fellow resettled Bhutanese learnt of my graduation as a doctor, I received messages from acquaintances and strangers around the globe who felt that my success was a personal victory for them. Today, I want to recognise all those who were ahead of me and who might have had similar dreams and hopes, and goals they were not able to realise.

I might be one of the first few among hundreds of thousands of resettled former Bhutanese refugees to become a doctor in the West, but I certainly won’t be the last, and I hope to inspire and support many others in their pursuit of this incredible dream. There are numerous stories of people, who, like myself, make the most of opportunities that are hard to come by. Tragically, millions of similar dreams never see the light of the day.

I couldn’t have gotten this far without the blessings and support of my parents, family and friends, and the wisdom imparted by all my patients, fellow students, and teachers from both the refugee camp and Australia. I am indebted to all of them. I am also grateful for the generosity of the UNHCR and the Australian people. I hope to repay that debt by being a kind, caring and empathetic doctor.  

In addition to advancing my medical career, I intend to give back to my global Bhutanese community and my local community in Australia. I want to contribute towards improving health literacy and mental health of my people, and I want to help address the social inequalities and injustice in health present in modern Australia.

I could have died in the refugee camp like many fellow children, or lost my way along my difficult journey, but I persevered choosing optimism and hope and keeping my eyes open for new opportunities. I failed, learnt, and marched on. I learnt to be kind, resilient and grateful, and I found meaning in life through human struggles, hardships, and sufferings.

As I start a new chapter as a doctor, I have many more dreams and hopes, including making society a fairer and more just place for everyone and helping make the dreams of many others less fortunate a reality.

___

Dr Ram C. Khanal, MD, is a new medical graduate based in Albury, New South Wales, Australia, and is commencing work as a Junior Medical Officer with Albury Wodonga Health, Australia.

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