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On the UP? Women’s health in Nepal

If I was talking about UP and the challenges so many women face because of it, would you know what I was talking about? I’ll be the first to admit that I didn’t know what UP was before I started working with our specialist partner organisation in Nepal. UP stands for uterine prolapse, a painful medical condition which afflicts an estimated 1 in 10 women of child-bearing age in Nepal. Uterine prolapse occurs when the womb sags or slips from its normal position and into the birth canal. Rare in the UK, it is exacerbated by multiple close childbirths, heavy manual labour, and allowing too little time for recovery after birth – all common features of women’s lives in mountainous rural Nepal. Even severe cases can usually be corrected with surgery, but the $200 cost is beyond the means of most families here. The condition also carries social stigma, so many women suffer in silence for years rather than seeking help.

All We Can’s long-standing partner organisation, the Interdependent Society of Surkhet (ISS), works with women in mid-western Nepal who suffer from UP, and helps them to access life-changing treatment. I use the word ‘suffer’ here advisedly, because it became clear when I met affected women on a visit to Nepal in March how much they really do suffer.

I was welcomed into the community with singing, laughter and garlands of flowers. As I sat in a small classroom surrounded by local women and children, I was astonished to hear how much these women had endured because of UP. The painful symptoms can force women to stay indoors away from their family and friends, unable to sit down or comfortably do housework or gather food. Women in Nepal are usually responsible for harvesting and buying the food and cooking for the family but if they cannot do this, it can leave the family without a meal. In this particular area of Nepal, a lot of men travel to India for work and leave their wives behind to take care of the home and family, a huge challenge if suffering from UP.

One of the first women I met was a vibrant 55 year old named Pasupati Rana, who first experienced UP as a result of resuming heavy manual farming work just ten days after giving birth. She suffered with UP for three years before meeting ISS field workers who were able to counsel and help her. They arranged her visit to hospital for surgery and discussed with her husband the importance of giving Pasupati time to rest and recover afterwards. Pasupati told me, “Before I had a pain, but now I don’t have any pain and I can sit with people. Also I can work. Everything is okay.”

Pasupati’s story was one of courage and perseverance; she had continued to farm, clean and cook for her children, even with pain and discomfort. Since the operation, she has become vocal in her community about the importance of overcoming the stigma and sharing personal health issues to ensure help is given to those who need it.

However, not all stories have a happy ending. It would not be right to share only the positive stories I heard, as life doesn’t always work that way. In Surkhet, I met an unforgettable woman called Dil Kumari Sunas. Aged 62, Dil has suffered with U.P for 40 years. Let that sink in for a moment. When I asked why she had not had the surgery, she told me that she was shy, so she didn’t tell people about having the condition. After giving birth to nine children and watching only three survive into adulthood, then seeing her husband pass away 20 years ago, she felt unable to ask for help. When she finally had surgery it was unsuccessful and only seemed to make life more difficult for her. She is now too scared to have another operation, but is in constant pain. An ISS member of staff told me, “She cannot sleep like this, she cannot sit like this, she cannot wash the clothes or do the housework.”

I was glad to hear that Dil has her daughter Usha to help take care of her, but Usha also suffers from UP. Usha is 40, and has been living with UP for 22 years. It is common in Nepalese culture to keep having children until a son is born. Usha experienced .P after having her first daughter but did not seek treatment as she wanted to give her husband a son, and the surgery may prevent her from having more children. Six daughters later, she has realised she cannot go on. ISS counsellors have been working with Usha and her husband to help them understand that waiting for a son is now too dangerous for her. Usha explained to me, “If I wait for a son, I might die.”

Throughout my entire discussion with both Dil and Usha, they did not smile once. Their eyes showed a pain and sadness that I could not even begin to understand. Despite hearing such stories of hardship, I feel privileged to have experienced the reality of what life can be like for so many in Nepal. Dil and Usha need our prayers and support to overcome the pain they live in and be brave enough to seek treatment. Women like Pasupati showed me the importance of overcoming shyness and stigma to seek early treatment and the hope that ISS is offering to many women here. It encourages women that have lived to tell the tale of successful operations to speak out so that other women might feel confident enough to seek treatment.

Uterus prolapse is a serious issue which affects many women across the world, especially in poor communities. Without the wonderful job ISS are doing to provide knowledge, guidance and support, the women I met would never have accessed the treatment they so desperately needed. For some there is still a long way to go, and barriers such as stigma, poverty and lack of family support continue to play a part in these stories. Now I have learnt about UP, I won’t easily forget the courageous women who endure pain for many years because of a problem that can often be solved in a matter of weeks at a cost of just a few hundred pounds.

Find out more about the work of All We Can’s local partners in Nepal www.awcdev.us/Nepal

About the Author Angela Richardson

Angela Richardson is the Assistant Programmes Manager for All We Can's International Programmes and Partnerships Team. Angela has travelled extensively in Africa and is passionate about women's rights and communities facing the challenge of HIV/AIDS. She moved to London three years ago and though she enjoys learning about the history of the city, misses the countryside and the sea. In her spare time she balances keeping fit with meeting friends for coffee and cake!

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