From development aid to self-reliance

Are you familiar with images of Nepalese women working in the rice fields, carrying loads weighing up to 40 kg in baskets on their backs as they descend mountain paths? Or carrying water jugs up from the valley? They also care for children, parents and parents-in-law, tend small plots of land, and look after livestock.

Life in Nepal is not easy for many women. But what happens when a woman also has to cope with pelvic organ prolapse? Shame and lack of awareness may prevent her from sharing her difficulties with family and friends. She keeps working—what else can she do? Health workers in Nepal’s mountainous regions may have limited knowledge of pelvic organ prolapse and the suffering it can cause, let alone the training needed to offer effective treatment. And even when a woman with severe uterine prolapse manages to reach a hospital, who will help if she cannot afford care?

This is a serious challenge, but there is reason for hope. Solutions are available and are often straightforward: medical advice, a pessary, or surgery.

With these solutions in mind, the Women for Women Foundation Netherlands was established in 2002 to support individual women in Nepal’s mountain communities—helping them improve their quality of life and continue caring for themselves and their families.

Despite the dedication of many physicians and nurses, we must ask whether our efforts are enough. Initial results are often encouraging, but the scale of the problem soon becomes clear. So many women need help that demand exceeds the capacity of the Nepalese healthcare system, while local health workers often lack the training and skills they need.

The most sustainable response is education and training in Nepal, so that knowledge and skills can be shared locally. Training is needed at every level: among women and girls in villages, among health-post staff and gynecologists, and, last but not least, within the Nepalese government. After 16 years of experience, the Women for Women Foundation’s main goal is to strengthen local capacity to diagnose and treat prolapse independently.

We also continually evaluate the effectiveness of our work in Nepal. How are women doing after treatment? How often does prolapse recur? And how does treatment affect a woman’s position within her family and village? We work with Nepalese anthropologists to explore these questions, which can be difficult for international aid workers to answer.

Strategy

Projects

From 2002 onwards many projects in different districts in Nepal have been accomplished. WfWF has carried out fieldwork in rural areas in Sindhupalchowk, Kavre, Dhading, Parbat, Rasuwa, Ilam, Sunsari and Gorkha. In Dhading a four-year project has been done, in Parbat a three-year project. WfWF started POP surgery support in 2004 in Dhulikhel Hospital. From 2006 onwards POP surgery has been carried out and supported in Scheer Memorial Hospital in Banepa. In Man Mohan Teaching Hospital POP surgery with WfWF support has been carried out since 2013.The cooperation with Maternity Paropakar Hospital in Kathmandu dates back to 2008. Since then, WfWF has contributed to the training of residents in gynaecology and provided training for senior gynaecologists in complex surgical techniques.

Key topics

References

1. Functional pelvic floor anatomy in Nepali women attending a general gynaecology clinic, Turel F, Caagbay D, Dietz HP. Int Urogynecology Journalisms, (2018) 29:1435-1440

2. Epidemiology of prolapse and incontinence questionnaire validation of a new epidemiologic survey. Lukacz E, Lawrence JM, Buckwater JG, Burchette JR, Nager CW, Luber KM. Int Urogynecol J (2005) 16: 272-284

3. Pelvic organ prolapse surgical training program in Bangladesh and Nepal improves objective patient outcomes.Hall B,Goh J,Islam M,Rawat A.Int Urogyn J (2021) 32:1031–1036