Corinna Heiberg’s Public Health Perspective (Vol. II)
In my final semester at Berkeley before interning at Chisang Clinic I gave a presentation on uterine prolapse to a group of graduate students. Standing before the class I nervously repeated the lines I had already practiced countless times, saying “Uterine prolapse is a serious reproductive health condition that occurs when the uterus descends out of its usual position and falls out of the vagina. It has been estimated that approximately 200,000 women of all ages in Nepal are currently in need of immediate surgical treatment. Many of these women are unable to access medical care to get diagnosed or treated, and live for years with various symptoms that seriously affect their quality of life.” Though I had read extensively about UP in articles and online publications for classes before traveling to Nepal, I was not prepared and didn’t expect the number of women suffering from UP that I would meet in the village willing to candidly tell me their story. I was deeply affected by what I heard, and decided to share to raise awareness and reduce stigma surrounding the issue.
I met Nirmala, a young and energetic 28 year old woman, during my first week at the clinic. Over the summer all of the interns grew to love her and her eight year old son as they frequently stopped by just to chat and help out with anything the clinic needed. I came to find out that she had come into the clinic months earlier explaining that she felt as though “something is falling out when she strains”, finally revealing something she had kept secret for years. Through interviews and examinations I found out that since her son’s birth, which occurred at home before she was rushed to the hospital for post partum hemorrhage, she has suffered from many of the symptoms of UP, including irregular menstruation, stress incontinence, painful intercourse, and pain sitting, walking or riding a bicycle. It has also affected her ability to work in the fields, her relationship with her husband, and her ability to interact with the community. She is only in the early stages of anterior wall prolapse and doesn’t yet need a hysterectomy, but the clinic does not have the facilities or medical supplies at this time to provide treatment. Though the clinic could not help her physically without more resources, she was extremely relieved that she finally had people to talk to and could receive some counseling about home remedies and exercises she could try.
I also met women like Rita, a 67 year old woman with severe pain and the feeling of “something coming down” her vagina. Rita is more characteristic of women suffering from uterine prolapse because she had six children all born at home at a very young age. A combination of these factors likely led to her anterior uterine wall falling down and many debilitating symptoms. Unlike Nirmala, she was very ashamed by her condition, and agreed to an examination only after lengthy discussion and reassurance, though she remained visibly distressed and uncomfortable. Without the privacy and accessibility of the clinic, it is likely that she would never have had the confidence to seek medical care.
These two women, along with the others who came to Chisang Clinic seeking relief from the symptoms of uterine prolapse, cited many potential causes for their condition, such as strenuous manual labor, lack of trained assistance during delivery, lack of post-partum rest, and inadequate spacing between births. Most of these are completely preventable. The Clinic is working to increase awareness about the risks of prolapse, but unfortunately at this time has neither the surgeons nor resources to help the women, and no knowledge of facilities near enough to refer women that are accessible and affordable. The birthing center is a great first step at preventing future uterine prolapse cases by providing facility births, administering a checklist developed to screen patients, and increasing counseling about uterine prolapse during routine ANC and gynecological visits. The clinic also welcomes any aid in setting up a temporary uterine prolapse clinic with trained medical professionals who could provide treatment for women in the area and train the clinic staff to insert pessaries. With some outside help, the clinic has a great opportunity to improve the lives of countless women in Bhaunne and many other regions of Nepal.
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