June is Pelvic Organ Prolapse (POP) month and is a great way to increase awareness and conversation around this common condition. POP effects women all around the world but there is a very high prevalence for young women in Nepal.
POP is a condition where the uterus, bowel and/or bladder fall into the vagina. A minor one may remain symptomless but a more advanced POP can cause considerable morbidity for women. Some symptoms include pain, heaviness, incontinence and difficulty with sexual relations. This reduces the ability for women to comfortably sit, stand, walk, lift, do housework, engage in paid work and engage socially. These symptoms have a devastating impact for a womans’ general physical and emotional wellbeing.
I have had the privilege of working alongside an NGO in Nepal who provide screening camps, education, conservative treatment and arrange surgeries for women who have POP. This is such important work and is making huge impact on the quality of life for the women they help.
I remember observing a local doctor assess a lady in her 80’s who had a POP for 40 years. It was a very advanced POP and she had been suffering considerably. Due to her age and comorbidities, surgery was not a good option for her. The doctor fitted a pessary ring for her and I will never forget the look on the womans’ face when she stood up. She had the biggest smile and tears in her eyes and couldn’t stop thanking the doctor. This simple and inexpensive intervention provided immediate impact to her quality of life. My heart filled with joy and hope watching the doctor give care and support to this lady.
Women in rural regions of Nepal are the primary caretakers of the home and farm. Every single day of the year they get up early to cook, clean and look after their family. Not only that, they do the physical labour required to maintain the farm. Often this involves collecting heavy bundles of foliage, carrying it on their backs for miles, so the goats can be fed. They also tend to the chickens and other livestock while maintaining the crops. This work never stops and is essential for their subsistence lifestyle.
One of the reasons for the high prevalence of POP in young women in Nepal is their role as primary caretaker of the home. Their husbands are often away for paid work leaving the housework entirely on their shoulders. I heard stories where the pregnant woman was out in the field working, delivers her own baby, wraps it up, then continued working. This may be an extreme example but is not far from the truth. The women can’t even take off one day to walk to the nearest health post for a medical check up because who will feed the goats?
The issue of POP in Nepal is complex and multifactorial. The government has identified it as being a priority and has assisted in funding screening camps and surgeries. This is a great start but far more work is needed. As with any medical condition, more attention is needed on prevention and education. I’m hoping I can do a small part in creating more awareness and resources around POP prevention for women living in remote regions of Nepal.
If you’d like to support an Australian NGO who fund a women’s health project in Nepal – visit: https://www.asianaid.org.au/health/