Working with the Uterine Prolapse Alliance (UPA) has been, in some respects, an exercise in faith. Although the Alliance was formed over a year ago, they are still in the process of figuring out just who they are and what they want to do. As a coalition of over thirty NGOs of all sizes, the UPA struggles with competing agendas and perspectives, from different priorities (should they focus on curative efforts or prevention programs?) to different approaches (should they engage a services-based public health framework or one based on gender issues and equality?).

These kinds of problems are almost inherent in the concept of a coalition, but with the Alliance they are aggravated by the fact that, as of yet, the UPA remains for its members a voluntary association. The UPA has no funds for promotional activities, let alone for an office, a staff, or regular meetings. Without dedicated funds or staff people in the Alliance, it is a challenge to provide significant incentive for all thirty member NGOs to participate in an alliance that is still too new to carry any weight of its own.

To promote the decision-making ability and forward motion of the UPA, the Alliance has formed a task force composed of eight individuals representing various member NGOs from the Alliance. But because the members of the task force also have full time jobs with organizations such as the Safe Motherhood Network Foundation, the Rural Health and Development Program, and the Women’s Reproductive Rights Program, they have little time to devote solely to the UPA. As a result the Alliance is also afflicted by an inability to get everyone in one place at one time and proceed with policies and actions.

In the five weeks that I’ve spent in Nepal I have only met with the task force once (other meetings have been attempted but canceled or were attended by only one or two members). It was a startling introduction to the UPA–a meeting charged with the passions and convictions of eight women who are determined to see the eradication of uterine prolapse in Nepal. Voices were raised, proposals were put forth and immediately torn down by other members, and frustrations over lack of resources and commitment were expressed. Throughout the meeting I had to turn to Nicole (who has worked with the UPA for almost a year now) for explanations of terms, histories, relationships, and internal politics; by the end I still wasn’t sure what was going on, and I left feeling overwhelmed by the institutional complexities of the Alliance.

Though the UPA suffers from the inertia of an un-funded coalition, I have since my first meeting with the task force still found it possible to cultivate faith in the ultimate vision promoted by the Alliance. This is in large part because of Samita Pradhan, the secretariat of the UPA, the chairperson of the Women’s Reproductive Rights Program (WRRP), and my primary contact with the UPA. Although she is soft-spoken and often deferential to the more demanding voices of other task force members, Samita manages to keep the UPA moving forward with her persistent dedication to the issue and her willingness to take on the work of the whole task force herself when it seems like otherwise the task force will not be able to move forward. Her organization (WRRP, under the Center for Agro-Ecology and Development) is one of the most active of the Alliance, and her insistence on a multi-sectoral and collaborative approach to the problem on a national level is a major driving force for the continued existence of the Alliance.

Led by Samita, the task force as a whole is little-by-little striving to validate the idea that a coalition of NGOs in Nepal can promote a unified and more effective solution to uterine prolapse in the country. To this end, one of the primary tasks that Nicole and I (as AP Peace Fellows) have been set to this summer is the drafting of the objectives for the UPA and its international campaign (in partnership with AP). Given the competing perspectives and impossible schedules of the task force members, it is no surprise that this process has been somewhat trying. But the differing backgrounds and agendas of the members also keep the UPA balanced and well-rounded. When we need to know numbers related to surgeries and infrastructural capacities, for example, we can turn to Dr. Binjwala, a public health specialist with the Safe Motherhood Network Foundation. When we try to imagine the best way for facilitating nation-wide community-based educational programs, we can consult Samita, who has been working on such programs with WRRP for over ten years. The combined expertise and passions of the members are at once what hold back the UPA in the short-term and what make the future of the UPA seem strong and productive.

For an intern like me, only in Nepal for ten weeks, it can be difficult to appreciate the forward motion of the UPA and the ultimate fruits of our labor. Our progress has been incremental and the outcomes have been theoretical, rather than applied. Instead of running surgery camps and lobbying government ministries, we have been talking about how to craft program policies and advocacy strategies. The work is without question essential, as the UPA must reach a consensus and a firm set of objectives before it will receive funds or be able to move forward as a coalition. In addition, the experience has been a valuable lesson for me in the patience and imagination that are required in crafting a social justice campaign.

To counterbalance the administrative and theoretical work that I have been doing with the UPA on its campaign objectives, I have also been fortunate enough to conduct some field visits. The primary goal of these visits is to gather and then disseminate information about how women experience uterine prolapse in Nepal; through written profiles (see previous blogs) and photos, we hope to put a human face on the condition and gain a better understanding of what kinds of policies and programs are necessary to both treat and prevent it.

This weekend in the terai my field visit proved more valuable than usual, as it served as an unintended affirmation of the value of the UPA and the kind of work that it plans to do. For almost a week now I have been working with Nicole and members of the task force to define the future value and activities of the UPA, hoping that we can create an alliance and a campaign that will build the capacity of Nepali government and non-government institutions to address the issue of uterine prolapse. Yesterday, in the loft of a cowshed in rural Ramnagar VDC, I was given a glimpse into this possible future. Far away from the politics and whiteboards of Kathmandu offices, I saw the UPA for what it could be: a national body that can empower grassroots-level actors to eradicate uterine prolapse by providing resources and a unified approach to the issue. Read my next blog for a description of this experience and how it has renewed my faith and conviction in the powerful possibility of the UPA.