Nepal Ceasefire Allows Mobile Team to Care for Women's Health

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Sharsaati Shaha, 34, is a female community health volunteer (FCHV) from Loli village, 10 kilometres east of Safebagar. She brought three uterine prolapse patients to the reproductive health camp; they had to walk because they did not have enough money for bus fare. Shasha’s unpaid work as an FCHV includes providing her neighbours with medicines for a variety of ailments, and counselling them on family planning. She has seen numerous women die of pregnancy-related complications over the past 15 years. One woman bled to death after trying to self-abort because she had too many children to feed. SAFEBAGAR, Accham District, Nepal — “May you live 100 years! You have given me my life back,” a beaming Guma Badela told the doctor and nurse examining her. She had come to a mobile health clinic for a post-surgery check-up.

In February visiting surgeons in Dadeldhura operated on Badela, 45, who suffered from uterine prolapse or fallen womb, a painful and debilitating condition that for three years had prevented her from walking or working normally.

At the hospital in neighboring Doti District, Nama Devi Khadkha was thankful to be alive. In her fourth month of pregnancy, the 31-year-old mother of two girls suffered an incomplete miscarriage. Khadkha might have bled to death if she had not been brought to the mobile clinic in Safebagar; and from there to Silgada, two hour away.

Restoring critically needed medical care to conflict-affected areas is an integral step in helping women all over the world.  Please support UNFPA’s efforts to help the women in conflict- affected areas by donating now.

Both women benefited from the recent agreement halting 10 years of civil conflict in Nepal. A ceasefire has made it possible to restore medical services in contested areas. Many health workers fled the fighting between government troops and Maoist rebels, and insecurity prevented residents from traveling to get needed treatment – including tens of thousands of women suffering from uterine prolapse and other complications stemming from unassisted labor.

The ADRA Nepal medical team packs staff, equipment and supplies in a powerful vehicle that travels over rough, often muddy, mountain roads to set up camp in isolated regions.Last November, a medical team from the Adventist Development and Relief Agency (ADRA Nepal) began a one-year tour of six conflict-affected mid-western and western districts, setting up camp for a few days at a time in remote towns and villages. They saw nearly 20,000 clients in the first four months.

Organized by UNFPA, the United Nations Population Fund, the camps focus on reproductive health care – including family planning, prenatal exams, and treatment for sexually transmitted infections – but no one is turned away.

An estimated 600,000 Nepalese women, one in ten, suffer from prolapsed uteruses. About two thirds of them need surgery, but very few have access to it.

Uterine prolapse can result from prolonged labor, early pregnancy, improper delivery techniques, resuming work too soon after childbirth, or births too closely spaced. All of these conditions are common in rural Nepal, where child marriage is common, family planning use is low, women typically carry firewood and other heavy loads, and nine out of ten give birth at home without a skilled birth attendant.

“Our biggest joy is when we a treat patient who has suffered for decades. That brings a big smile to our faces,” said James Pradhan, project manager of the ADRA camps.

The ECHO-supported camps can meet only a small fraction of the accumulated need for reproductive health services in Nepal’s impoverished far western and Midwestern districts. The government-run health system is beset with crippling shortages of skilled personnel, medicine and equipment. Most villages rely on barely trained female community health volunteers for medical care.

Women who experience problems in labour, for instance, typically have to be transported long distances over rough mountain roads to reach a health center with a doctor and a blood supply. Only one facility in all of western Nepal, the privately run Team Hospital in Dadeldhura, offers Caesarean sections.

The reproductive health camps are addressing a deep need at a critical juncture in Nepal’s history. “Now that the war has stopped, communities have high expectations that there will be a peace dividend,” said Junko Sazaki, UNPFA Representative in Nepal. “They want to have quick access to basic services, including reproductive health care.”

“Before the conflict made the situation worse, it was already hard to reach remote areas or to keep doctors at health posts,” Pradhan explained. “Even after peace is restored, it will take decades to restore good facilities in places like this.”

Improving the capacity of government-run health services is a goal of UN agencies working in Nepal.

“When we leave, local health workers will be able to do follow-up,” said Pradhan. “We can teach them to do lab tests, counseling and family planning services.”

This month Japan agreed to give UNFPA $400,000 to provide additional reproductive health camps in conflict-affected areas of Nepal.

Last year the Government and Maoist insurgents agreed to end a civil war that had killed some 15,000 people and displaced over 100,000 others. In January the United Nations established a Political Mission in Nepal (UNMIN) to help implement the peace deal and support this year’s planned elections. UNFPA is working to ensure that women will be part of the post-conflict political process and reconstruction efforts.