Every time Dr Ray Hodgson visits Nepal to run a free health camp in some of the more remote parts of the country, he helps to treat women who have endured years of excruciating physical, emotional and social pain.
“Many of those women have been left humiliated and even thrown out of their homes”, says Dr Hodgson, a specialist gynaecology surgeon from the New South Wales city of Port Macquarie.
The reason, he explains, is because those women suffer from uterine prolapse – a debilitating condition estimated to be affecting more than 850,000 women in the country.
Amnesty International suggests that the condition impacts around 10 per cent of the country's total female population of almost 14 million.
In 2008, Nepal’s Supreme Court declared uterine prolapse not just a health issue but a human rights issue too.
Photo: Facebook (Australians for Women's Health) Source: Facebook (Australians for Women's Health)
What is Uterine Prolapse?
Dr Hodgson, an Associate Professor of Obstetrics and Gynecology at the University of NSW, says uterine prolapse is also commonly referred to as “pelvic organ prolapse” or “genital prolapse”.
“It occurs when various pelvic organs fall into the vagina or beyond the vagina – the pelvic organs are the uterus, bladder, and the bowel can fall out in any combination, sometimes all three”, he says.
“It’s not just the physical impact, but the social and emotional impacts of prolapse on women are devastating. We see women being thrown out of their home because they can’t work due to prolapse."
Some factors contribute to the problem, he says, including carrying heavy workloads during pregnancy or postnatal periods, poor diet and getting married at a young age.
All of these issues are commonly faced by many Nepali women living in remote and rural parts of the country.
Citing a patient of his who wrote a thesis on the issue, he says Nepal has more cases of uterine prolapse than any other parts of the world. For many women, the problem began when they were in their early twenties.
In 2010 he decided to go to Nepal and see if his experience could help.
LISTEN TO
Dr Ray Hodgson speaking about his book "Heartbreak in the Himalayas" and his work in Nepal
SBS Nepali
06/03/201916:19
‘Heartbreak in the Himalayas’
At the health camps in rural parts of Nepal, Dr Hodgson and his team of volunteers asses hundreds of women for problems not just limited to Uterine Prolapse but other preventable conditions such as haemorrhage, high blood pressure and infections.
One of the women he helped treat was Jumari, a 22-year-old, who lost her child at birth after painful three-day labour at home.
Three years since losing her child, Jumari’s life has taken a turn for the worse.
After suffering from a painful prolapse leading to urinary incontinence, she is now limited in her ability to perform too much physical work at home.
The problem also means she is unable to have a sexual relationship with her husband.
As a result, Jumari was thrown out of her family home and was shunned from society.
Dr Hodgson says stories like that are not uncommon.
Jumari (Supplied) Source: Supplied
“It’s not just the physical impact, but the social and emotional impacts of prolapse on women are devastating. We see women being thrown out of their home because they can’t work due to prolapse."
“Many rely on subsistence farming and physical work to put food on the table. If the husband sees the wife cannot work on the farm or can’t satisfy him in bed, then it’s not a rare thing to be thrown out of the home.”
For Nepali women the doctor has helped treat, many had been suffering from uterine prolapse for an average of seven years.
Maintaining Culture and Protecting Women
Women living in rural or remote parts of Nepal often have to walk long distances to get to their nearest health facility. This combined with the belief in traditional healers and Shamans, means many don’t have access to trained medical practitioners.
According to Dr Hodgson, because of cultural reasons, many women will not attend hospital for pregnancy or when suffering from severe prolapse.
“In some areas where we work, people are more likely to see a shaman before attending a health centre – they’re more likely to have a home birth with the help of a traditional birth attendant than at a hospital.”
“We wouldn’t stand for this in our country – there would be placards and marches in our country if women’s health was suffering in anywhere near this degree and so we shouldn’t allow this in other countries as well”, he says.
However, tackling existing cultural practices and protecting the rights of women accessing health care means medical teams can often face barriers in providing that care.
“How do we tackle the cultural issues, without imposing our own ideas?” he asks.
“What right do we have as people from another country coming to Nepal and wanting to change elements of their culture?
“But we should not allow the abuse of human rights either, the rights of women and babies to get healthcare.”
One way to address the delicate balance is by getting a group of local women to speak to villagers to help get the messages across. The women are trained on issues such as the benefits of attending antenatal care in the hospital.
“Nepal has a collectivist culture – more than an individualist one – so if we say to each “you must change your cultural ways” then we have no chance. We’ll have a better chance if we talk to groups of women, have street plays and radio dramas.”
The extent of the problems Dr Hodgson encountered during his first visit to Nepal almost a decade ago meant he felt the need to expand his work to help reduce maternal and neonatal deaths.
Source: Facebook (Australians for Women's Health)
“Initially our principal aim was to treat as many of these women as possible. But our mission gradually evolved over the years”, he says.
“When we were seeing patients at our camps and teaching the local doctors as well – we saw many mothers and babies dying as well”.
Now, he visits the country three times a year to provide medical care and teach local doctors, nurses and midwives through a charity he helped start called Australians for Women’s Health.
The organization is currently working to build a 35-bed hospital in Dolakha district in the eastern part of Nepal. The plan is to use the hospital to treat women and also to teach local doctors, nurses and midwives.
Source: Supplied
Dr Hodgson says it’s morally wrong to turn a blind eye to the plight of women on the other side of the world or who are from a different culture.
“We wouldn’t stand for this in our country – there would be placards and marches in our country if women’s health was suffering in anywhere near this degree and so we shouldn’t allow this in other countries as well”, he says.
He has written his experiences of working in Nepal into a book titled “Heartbreak in the Himalayas”, its launch taking place on International Women’s Day on March 8.
