Women for Women foundation

Women for Women Foundation (WfWF) is a Non Governmental Organization (NGO), based in the Netherlands, committed to improve the wellbeing and health of women in Nepal with the focus on prevention and treatment of POP in rural Nepal. Transfer of knowledge about POP, transfer of skills in diagnosing and handling POP problems and discussing results of research in the field of POP are goals of WfWF. WfWF works closely with Nepalese NGOs, government and hospitals.

Are you familiar with the colorful images of hard-working Nepalese women in the rice fields? With 40 kg of freight in the basket on their backs down the mountain? Or with jugs of water from the valley the same way back up? Taking care of children, parents and in-laws, laboring on plots of land and caring for the cattle?

Generally, life isn’t easy in Nepal.... But what if you have to deal with a prolapse of the pelvic organs on top of that? Shame and lack of knowledge prevent you from sharing your burden with family and friends. You just keep on working, what else can you do? Health workers in the Nepalese mountains often lack a thorough knowledge of pelvic organ prolapse, and the suffering that comes with it. Let alone that they can offer solutions to this debilitating problem. And even if the woman with a severely prolapsed uterus finally finds the way to a hospital: who will help her if she has no money for medical care?

It is a challenging but also an inspiring problem. Solutions are available and often simple: good medical advice, a pessary or a surgical intervention.

With these solutions in mind, the Women for Women Foundation started in 2002 to help individual women in the mountains of Nepal. Helping to make life bearable and enabling women to take care of their life .

Despite the efforts of many willing physicians and nurses the question remains if our effort is enough. Often the first results are impressive, but soon thereafter reality kicks in. The problem is so big and there are so many women who need help. The sheer volume of women in need exceeds the capacity of the Nepalese government and the local aid workers have insufficient training and skills.

The only sensible answer is: education and training in Nepal in order to transfer knowledge and skills. Training is needed at all levels: starting with the women (and girls) in the villages of Nepal and continuing with health post staffs and gynecologists in Nepal. And last but not least the Nepalese government. Promoting self-reliance with regard to diagnostics and treatment of prolapse is the main goal of Women for Women with 16 years of experience. In addition, we continuously evaluate the efficacy of our interventions in Nepal. How are women doing after treatment? What is the recurrence rate? How is the position of the woman in her family and in her village before and after treatment of the prolapse? We turn to Nepalese anthropologists to answer these questions that are difficult for Western aid workers.

Complete self-reliance remains our ultimate goal, which eventually will make the Women for Women Foundation redundant. Until then, we continue our support to Nepal and greatly appreciate your help and financial aid to realize our goal…..

The strategy of WfWF is improving POP care in daily practice in remote areas of Nepal by transferring knowledge and skills at different levels and in a structured way. The used methods are focused on the Nepalese situation, evaluated and adjusted when useful and necessary. Where relevant information is missing for this work, additional research is carried out together with Nepalese organisations.

WfWF tries to achieve her goals by

  • providing POP training and POP education for rural health workers at all levels
  • training gynaecologists in performing POP-related surgery3
  • providing lectures and workshops
  • making pessary treatment widely available
  • evaluating both pessary and surgical treatment in follow-up studies
  • providing health education to women and girls through local organizations
  • enabling and stimulating POP research in Nepal
  • informing stakeholders through an annual report with an overview of WfWF activities

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.

Questions increase as more experience is gained. Some of these are:

POP prevalence

. more POP in (rural) Nepal? Relation to ethnicity, genetic aspects?

. more POP in lower casts?

. more POP in Terai than in hilly area of Nepal?

. is a retroverted uterus a factor in developing POP?1

POP severity

. more POP 3 – POP 4 in Nepal than in western countries?

. are there mortality figures in women with POP 3 – POP 4?

Contributing factors

. what is the role of age at first childbirth and development of POP?

. what is the role of specific aspects like heavy lifting

Prevention of POP

. what is the place of pelvic floor exercises in women with and without POP?

. how to measure the effect of preventive measures?

Treatment of POP

. what is a positive result for a woman?

. can POP stage diminish through pessary treatment?

. is there a place for pelvic floor exercises?

. what is the effect of pelvic floor exercises in women with a good/bad pelvic floor

. what is the result of pessary treatment after 1 year, after 2 years, after 5 years?

. what are the reasons to stop pessary treatment after successful fitting

. what is the recurrence rate of POP surgery in cases with Anterior Repair?

. what is the recurrence rate of POP surgery in cases with Vaginal hysterectomy?

. what are the results of different surgical interventions for vault prolapse?

. is carrying heavy loads a factor in developing a (vault) prolapse?

. is squatting a factor in developing a (vault) prolapse?

Other items

. the development of a questionnaire about POP validated for women in rural Nepal 2

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