Health Camp in Baiteshwor RM

Health Camp in Baiteshwor Rural Municipality on Uterine Prolapse

Background

Healthcare is a basic right of a human being that should be available for everyone and shouldn’t be treated as a commodity only for those who can spend money to buy the services. Even the poorest among us deserve the dignity of equal human rights which cannot be declined.

Uterine prolapse is a kind of hidden health issue of Nepali women, which can be seen high in numbers with women from the age of 40 to 70 years but women with UP may have from the age of 20 (. It is taken as a prestige issue so women, their husbands, and family members keep it hidden in society. The lack of early treatment causes severe problems even to the death of women. Uterine prolapse occurs when the muscles and tissue in your pelvis weaken. This allows the uterus to drop down into the vagina. Common symptoms include leakage of urine, fullness in the pelvis, bulging in the vagina, lower-back pain, and constipation. A study shows that the UP is an outcome of poverty that limits women’s ability to get food, rest, and health treatment timely. (Source: Tribhuvan University Teaching Hospital).

Stages of the UP and level of treatment

• First degree (mild)—the cervix (the lower opening of the uterus into the vagina) protrudes into the lower third of the vagina. The camp shall make women aware to be careful and not lift heavyweight.    
• Second degree (moderate)—the cervix protrudes past the vaginal opening. In this stage, a vaginal pessary ring can work for a short time till the woman is ready for the surgery. 
• Third-degree (severe)—the entire uterus protrudes past the vaginal opening. The women should go with the surgery immediately in such a situation. 

Objectives

The main objective of the health camp is to provide initial care to women suffering from uterine prolapse in all the awards of Baiteshwor RM. Other objectives are as stated below:

• Provide free and high-quality health services for the women of Baiteshor RM.
• Raise awareness about UP among women and men in the community and sensitize them to deal with UP. 
• Identifying the severe cases for further treatment including surgeries if needed to in next events immediately after a few weeks. 

Date and venue 

The health camp has been organized on 31 December 2021 in Mirge and 1 January 2022 in Maina. In order to organize the event, the doctor’s team moved to Maina from Kathmandu on 30 December 2021. The team moved early to Putalikath on 31 December 2021 and returned to Maina on the same date. The camp started at 10 am and ended at 5 pm in Putalikath. 

On 1 January 2022, the health camp was organized in Baiteshwor Hospital, located inward No 5 from 9 am to 4:15 pm. Two Gynecologists including Dr. Deep Mala Karki and Dr. Babita Yadav with medicine contributed to the HC.   

Geographical coverage and tentative numbers of patients: 

Although the health camp was organized in two locations, the women from almost every ward participated. All the 8 wards of Baiteshwor are focused on the health camp. Among roughly 355 women who were potential with UP-related issues, 115 (33%) got health services from the Camps. The following table gives the details. Considering the health-seeking behavior of Nepali women, UP is a health issue which Nepali women could not express easily, the number of participants is encouraging compared to other health camps.   

Detail of the Health Camp

The above table shows that the women from 50+ years have high numbers (43%) of UP affection. This shows that women of the age group above 50 are silent and need more attention in the future. The women from the age 30-50 years seem a little bit lower in numbers having coverage of 40%. The remaining, 17% of women are below 30 years.

While looking at the caste-based data, the number of women from Brahmin Chhetri (so-called higher caste) seemed high. This is realistic because the population of Brahmin/Chhetri is high in Baiteshwor RM followed by Janajati ( ethnic population) and Dalit.    

Reasons for the scenario: 

• Aged women have high numbers of affection due to the social taboo that blocks them from speaking. Cases were also seen from this age group.
• The numbers of younger women seem moderate due to early marriage. Some of the women of younger age came to the camp, being aware. Cases of the infection were not found. 
• Women from the age group 30-50 years seemed high because these women are active for reproduction and also workload is heavy for them. 

Cost estimate 

The total estimated cost for the HC is NRs. 390, 000.00. 

Participation/Sharing

Human Resources

Two Gynecologists and a Physician are proposed to be taken from Kathmandu. Baiteshwor hospital shall contribute a physician and nurses including other personnel as available. They will contribute the medicine free of cost. 

Activities 

• Briefed about Samundra Belgium and Samundra Nepal at the meeting with the Minister (Birodh Khatiwada) of the Ministry of Health. The Palika chairperson Chhabi Lama, Vice-Chairperson Rabi Chandra Acharya, and other personalities including the journalist visited the camp. But it is coincidental to have them in our health camp in Baiteshwor Hospital. 
• The minister was known about how Baiteshwor Hospital was established in support of the people from Belgium and the role of Himalayan Care Hands. 
• Noticed from FM (Jiri FM, Kalinchowk FM, and Sailung FM) published for a week (led by Samundra Nepal)
• Discussed and arranged Gyno doctors and equipment needed by Baiteshwor Hospital.
• Dissemination of the information using loudspeakers and Facebook and through community health workers (By Ward No 5).
• Purchased medicine and equipment (by Samundra Nepal)
• Arrangement of logistics by Samundra Nepal.
• The happiness form was filled up.
• The remaining medicine of the cost of about NRs 53,000.00 has been handed over to Baiteshwor Hospital. 

Outcomes

• 116 women were made aware through doctor’s counseling on the causes and consequences of UP and ways to prevent from being infected. 
• Distributed medicine free of as per doctor’s diagnosis
• Identified 9 affected women with UP in Ward No 5. Three women got the pessary ring. One case is seen as completely prolapsed but could not be treated due to the age factor. Five women were counseled and advised to take care ( Pessary ring not needed). 
• In Ward No 2, 7 cases of affected women (second degree) were identified who were already using the Pessary ring for 5 years. Their rings were almost ready to spread infection.
• Palika, wards, and community health workers were sensitized one more time and the camp helped them to realize ‘prevention is better than cure. 

Learning

The Health camp let us know for future replication:

• Uterine-related health issues in Baiteshwor RM still exist with the aged (<70 years) women whose surgery is not recommended by the doctors considering the age factor.  
• The impact of the previous initiatives by other donors has been seen clearly as women feel comparatively easy on talking about the issue. 
• Women from the younger generation are more open and feel easy to talk to. Women from younger ages are aware of UP so found very simple cases. These cases could be treated with a nominal dosage of medication. 
• Information given through Facebook seems effective. Mobilizing community health workers to disseminate and collect information is effective.   
• UP cases are seen high in Brahmin/Chhetri class people as poverty exists high with these groups.
• Two events: one inward No 8 (Chhetrapa) and one in Ward No 7 (Marbu) shall be organized.  
• No surgery cases to take up incoming events but awareness and curing first-degree cases can be expected.
• Health camps on focused issues do not allow to have quantity but quality services can be delivered.