himalayan policy research conference 2013

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The Value of Sustainable Protocol to Address Uterine Prolapse in NepalHealth Camp, Education, and Employment StrategyExcited to be here. 3rd yr @ HPRC-lunch-today share vision of project moving forward for UP in Nepal.150% of Women Who Give Birth 50% of Women in MenopausePOP Prevalence

POP-weakness in pelvic floor, organs in pelvic cavity shift downward

5 Types of POP

Millions of women in every country

Currently no accurate stat capture

POP basics-Global Prevalence significant -50/50 85+ million women had given birth in US as of 2009 US Census-childbirth leading cause.250% of Women Who Give Birth 50% of Women in MenopausePOP Prevalence

POP-weakness in pelvic floor, organs in pelvic cavity shift downward

5 Types of POP

Millions of women in every country

Currently no accurate stat capture

Define POP-Variety of reasons weak/damage to pelvic floor muscle, organs drop350% of Women Who Give Birth 50% of Women in MenopausePOP Prevalence

POP-weakness in pelvic floor, organs in pelvic cavity shift downward

5 Types of POP

Millions of women in every country

Currently no accurate stat capture

UTERUS, bladder, rectum, intestines, vagina450% of Women Who Give Birth 50% of Women in MenopausePOP Prevalence

POP-weakness in pelvic floor, organs in pelvic cavity shift downward

5 Types of POP

Millions of women in every country

Currently no accurate stat capture

POP prevalence grossly underestimated in all countries550% of Women Who Give Birth 50% of Women in MenopausePOP Prevalence

POP-weakness in pelvic floor, organs in pelvic cavity shift downward

5 Types of POP

Millions of women in every country

Currently no accurate stat capture

currently no routine screening protocol, no accurate stat capture6Nepal Government Initiative to Increase AwarenessNepal UP Statistics

600,000 Women with UP

44% of Women 20-29 have UP

14% of Women under 20 have UP

Nepal only country in world w/govt POP Awareness initiative7Nepal Government Initiative to Increase AwarenessNepal UP Statistics

600,000 Women with UP

44% of Women 20-29 have UP

14% of Women under 20 have UP

200,000 in need of immediate surgery8Nepal Government Initiative to Increase AwarenessNepal UP Statistics

600,000 Women with UP

44% of Women 20-29 have UP

14% of Women under 20 have UP

Guestimate-women dont disclose because of stigma9Nepal Government Initiative to Increase AwarenessNepal UP Statistics

600,000 Women with UP

44% of Women 20-29 have UP

14% of Women under 20 have UP

Damage sustained by young women giving birth is significant10STIGMAWomen Wont Admit UP

Physical & Emotional Impact

Social Impact

Intimate ImpactStigma keeps POP shrouded in secrecy in all countries11STIGMAWomen Wont Admit UP

Physical & Emotional Impact

Social Impact

Intimate ImpactVaginal/rectal pain & pressure, vaginal tissue bulge, urinary/fecal incontinence12STIGMAWomen Wont Admit UP

Physical & Emotional Impact

Social Impact

Intimate ImpactMother-in-law dynamic, family disgrace13STIGMAWomen Wont Admit UP

Physical & Emotional Impact

Social Impact

Intimate ImpactIntimacy can be painful, infection odorous, husband takes new wife14Causal FactorsHeavy Lifting

Early Pregnancy

Multiple Childbirths

Improper Birthing Practices

Inadequate Post Birthing Rest Period

Multiple causal factors, both global norms and cultural to area15Causal FactorsHeavy Lifting

Nepalese women predominantly farm labor16Causal FactorsEarly Pregnancy

Marriage at young age leads to pregnancy at young age pelvic structure not optimal for childbirth17Causal FactorsMultiple Childbirths

Impression when first saw pic-young girl18Causal FactorsImproper Birthing Practices

Foot massage, pushing on abdomen to expedite delivery, pulling baby out cause damage19Causal FactorsInadequate Post Birthing Rest Period

Body needs time to heal, early return to farm labor, heavy lifting causes damage 75% 20Status Quo Must ChangeHealthcamps Norm

**NO** FOLLOWUP CAREHealthcamp norm-screen, pessary/surgery-promo pics 4 sponsor org-no follow up21OBJECTIVESustainable Program

Found HCN-reputable NGO in Nepal to partner w- via HPRC 2012 + GIRHL-US womens reproductive nonprofit build SUSTAINABLE program

22Phase I-BhalayatarWHEN-Nepal; Palpa District, Bhalayatar

Phase 1 WOMENS HEALTH AND EMPOWERMENT NETWORK23One Multi-purposed Structure

UP SCREEN-pessary/surgery- Lumbini-MICRO FINANCE INCOME GENERATION for women-HEALTH EDU, reduce stigma, gender sensitization, shift causal factors24Additional Considerations

Water & sanitation-storage and purification+toileting facilities25Income Generation

Manufacture/marketing of product, sanitary pads from hemp plants, income generation for women & facility upkeep26Outcome MeasuresUP-Awareness, Diagnostics, Treatment, Followup

Village-Financial, Social, Health, Gender Balancing, Awareness Education, Stigma ReductionMultiple outcome measures tracked for UP and Village impact leave w/w/w/how/why to experts27

Resources:

Concept Note, Hamro Chahana Nepal, August 2013.Ministry of Health and Population, Nepal, New ERA, and ICF International,2012.Nepal Demographic and Health Survey (UNFPA & IoM), Katmandu, 2011.Uterine Prolapse, Mobile Camp Approach and Body Politics in Nepal, Madhusdan Subedi, Dhaulagiri Journel of Sociology and Anthropology, Vol 4, 2010.Uterine Prolapse: Experts Scorn Health Camp Surgeries, Ekantipur.com, 9/14/2011.

Project Team Members

Sherrie Palm*APOPSDeepali Thapa*HCNSuveckshya Shah*HCNPushkar Silwal*HCNPushpalata Panday*HCNSunita Sharma*HCNAli Borazjani*GIRHLLumbini Medical CollegeBhalayatar Community

feedback -village committee, we dont know what we dont know-POP on medical record 4000 years, still shrouded in silence-address 1 step at time28