Nepalese Hill Women embark on Life Changing Journey

By Rosalie Hughes, Reuters 

January 27, 2009

Nepal

Tomorrow Mandari Buddha will leave her home in a remote village of the Himalayan foothills for the first time in her life. She'll say goodbye to her young children, an aging buffalo and the two-room mud house she helped build. She'll walk 10 hours to a town where the first bus she has ever seen will take her to an urban hospital. 

Mandari suffers from uterine prolapse, a condition in which a woman's uterus loses its moorings inside the body and drops, leaving it hanging out of the vagina. She is travelling to the city for a hysterectomy, an operation to remove her uterus. 

According to some estimates, uterine prolapse afflicts nearly one in three women in rural Nepal. Its causes - poor nutrition, multiple and closely spaced childbirths and years of carrying heavy loads - are facts of life in this country of subsistence farmers. 

Women here spend their days fetching water and firewood and gathering grass for their animals, often walking hours with loads that weigh up to three-quarters of their body. To help with all the work, they have more children. 

The onset of uterine prolapse is gradual. If caught early, pelvic floor exercises or the insertion of a vaginal ring can help. But left untreated, the uterus can fall out of the body. When this happens, only surgery can fix it. 

According to a study by the United Nations Population Fund, 200,000 women in Nepal who suffer from uterine prolapse are in immediate need of surgery. Until now, no one in rural Nepal has had access to such treatment. Long-term systemic problems aggravated by a decade-long civil war have left most government clinics in Nepal's hills without drugs, staff and in some cases, walls.

 
Last summer, the International Rescue Committee (IRC), a humanitarian organization, received funds from the European Commission to improve healthcare in Jajarkot, a district in midwest Nepal and one of the poorest parts of the country. 

IRC and its local partner, ISS, train health workers, deliver medicine, fix broken walls and improve water and sanitation facilities in 10 rural clinics. The team also runs reproductive health clinics. Now they are helping women with the most advanced cases of uterine prolapse to travel to the city for surgery, a trip they could not have otherwise afforded, much less imagined. 

I am following Mandari from her village in Jajarkot to a hospital in the region's largest city, Nepalgunj. The journey involves climbing up and down a mountain and a bus ride. With luck it will take two days. If protestors block the roads, the bus breaks down, or the road is out, it may take longer. 

The day before we depart I meet Mandari, a small woman with high cheekbones, two heavy copper nose-rings and a bright red swathe of cloth wrapped around her tiny body. Mandari speaks of her fears. She's worried about leaving her buffalo behind. "She's feisty," Mandari tells me. "She doesn't let anyone but me milk her." 

"And cars," she says. She sticks out her tongue and makes a rasped "blahhh" noise. A neighbour told her that cars make you vomit. 

She sticks her tongue out again and clasps her bony hands to her neck. "She's afraid she'll die," says Rajan, an IRC public health worker who is translating for us. 

Mandari thinks she is 35. An orphan at four, she grew up with seven siblings in a one-room mud house. Her childhood was spent fetching water, cooking chapatti, and carrying grass for the animals. She married at 17 and had six children - five survived. Her oldest is now 10. 

Mandari's day starts at four in the morning. She lights a fire, milks the buffalo, then makes tea and chapatti for her family. She leaves by eight for a four-hour hike to the jungle to collect firewood and grass. By eight in the evening she has cooked dinner, cleaned up, and, exhausted, is ready for bed. 

Last July her routine changed. Something started coming out of her vagina. It became painful to walk, lift heavy loads and milk her buffalo. She could no longer make love to her husband. Only he knew about her problem. She could not tell anyone. 

In October she sought help as the pain became unbearable. At an IRC-sponsored clinic in her village, she found out that the bulge was her uterus. 
She was told it would become even more painful if left unattended. In time, ulcers would form and fester on the exposed sensitive tissue that belonged inside her body. Eventually the condition could kill her. The only way to fix it was through surgery. 

"You're lucky," she was told. "The IRC will pay for your surgery." Mandari was not sure she was lucky. She was afraid to leave home, and afraid the surgery would kill her. 

But the pain was so bad. Her husband insisted she go. "Who will take care of our children if you die?" he said. 

Tomorrow she will embark on the most frightening journey of her life.

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