Feature Stories
Reborn at sixty
By Bishnu Kumari BK
Kapilavstu, March 2009
Sons from heaven
Dhana Kala Rokka Magar
i. from Shivgadhi village in Kapilvastu district
ii., now 60, was pregnant seven times. She was considered quite lucky as the first among her children was a boy but the following birth of daughter was a disappointment. Dhana Kala continued her quest for second son
iii. without giving a thought to whether it was what she really wanted. In Nepal women, especially women from traditional communities are discouraged from having their individual likes and dislikes, as a part of compound family they are expected to play their roles without questioning them. At the end, the expectations of the family often become their own beliefs. The other side of the story is that in the conservative sections of Nepalese society married daughters move to their husbands and in-laws house and couples with no sons remain alone or live with their siblings' children. In the absence of state provision for care or support for senior citizens, people may face hardship in their old age.
Dhana Kala's fear of being neglected one day was not her only problem. Dhana Kala's family migrated to Kapilvastu few years ago from Arghakhanchi, a hilly district where the access to health services is severely limited. There was one health post in her neighbouring village and it took 5 to 6 hours to get there on foot. She has had spent most of her life doing household chores like fetching water, collecting firewood and fodder and farming. She has never heard of antenatal check ups. She has never visited any health facility. She gave birth to seven children without having a single examination while pregnant. After the second child Dhana Kala's uterus muscles loosened causing slight fall of the womb. The state of her uterus was worsening with the frequent pregnancies and hard work.
Crippled at thirty-two
'I had experienced the uterine prolapse after my second child,' she said 'but because I was too shy and too poor I didn't tell anybody. I didn't know whether the problem is curable or not. I never had a chance to arrange for safe delivery. The seventh time I gave birth at home again. I was 32. Unfortunately, the new born was a daughter. That time the whole uterus came out with foetus. The neighbours, who helped during delivery, pushed uterus back into my body and wrapped my private parts in plastic. After delivery I did not have enough food, I didn't go to the doctor. My uterus kept falling out and I suffered a lot. I could not move, I was in pain while working.'
Dhana Kala was abused at home and by the community for many years since the completely fallen out uterus (third degree unterine prolapse) causes urination problems and accompanying bad smell is a result of frequent infections. 'My husband started to beat me and threatened to take second wife. My mother-in-law thought I was not working well enough and didn't take good care of my hygiene.'
Re-birth
One day Female Community Health Volunteer
v. from her village told Dhana Kala about uterine prolapse surgical camp
vi. to be held at the district hospital. She learnt for the first time that the problem like her could be cured through operation. That time Dhana Kala's husband was away and she was worried; even if the treatment was free of charge, she did not have money to travel to the district headquarters. Luckily for Dhana Kala the organizers covered the costs of transportation, food and follow-up.
The moment she got the additional information she contacted the Health Volunteer in her village to help her with the admission arrangements. She underwent complete hysterectomy without any complications. Now, for the first time, after 28 years she does not have any health complaints. She feels comfortable with her body and the family treats her again with respect. Even if, like the majority of women in Nepal, she still has to work hard, Dhana Kala says she enjoys her 'new life' and would like to forget the misery of the previous years.
Uterine prolapse among Nepalese women
The fallen womb is a truly socially inclusive problem existing in every social, ethnic and geographic group in Nepal. The roots can be traced to malnourishment during pregnancy, lack of pre and postnatal care, carrying heavy loads during and immediately after pregnancy, giving birth to children too early and too often. According to National Demographic and Health Survey 2006
vi. about seven per cent or 600 000 of women are suffering from various degrees of the condition
vii.. The ailment occurs as early as sixteen.
Thanks to the hard work and advocacy of various organizations for the third year running the government has provided funds for the free surgical uterine prolpase treatment for 12000 patients. Though this number is below the needs, the quota has been increased yearly. In support of this, surgical camps are organized periodically with support from the United Nations Population Fund and donors like ECHO, Danish, British and Japanese Governments. During surgical camps patients previously identified by health facilities are sent to the designated hospital where a team of specialists conducts the operations. The surgery and medication is free of charge and each patient, with one attendant is provided with a stipend to cover their travel and food expenses. The commercial price of the uterine prolapse operation is around 25,000 Rupees (USD 325
viii.). From 2005 till the end of 2008 UNFPA has supported 3,500 surgical corrections of uterine prolapse in Nepal.
Epilogue
Dhana Kala, like many women whose completely fallen out womb was removed became passionate advocate in her community: 'I'm going to convince all the women in my neighbourhood to have medical check ups and treat uterine prolapse. I'm going to tell them all how to protect themselves. No human being deserves to suffer like I did.'
Ms. Bishnu Kumari BK is Public Health Nurse working at UNFPA District Programme Support Unit in Kapilvastu
i. Magar is one of ethnic groups in Nepal
ii. Nepal is divided into 5 development regions, which are divided into 14 zones, and these in turn are divided into 75 districts. Each district is divided into municipalities and Village Development Committees that are further divided into wards.
iii. Eventually successful
iv. The Government of Nepal initiated Female Community Health Volunteer (FCHV) programme in 1988. FCHVs are local women voluntarily serving the community with provision of community-based health education and primary healthcare services.
v. The surgical camp took place in November 2008 at District Hospital Taulihawa, Kapilvastu with support from UNFPA
vi. Published by the Ministry of Health and Population
vii. Current population is estimated by the Population Reference Bureau to be 27,000,000. About 9,000,000 are women above the age of 14.
http://www.prb.org/
viii. Including transportation and lodging/food allowances for patient and attendant
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