Libby Abbott

Libby Abbott (Center for Agro-Ecology and Development – CAED and Women's Reproductive Rights Program – WRRP): Libby lived and studied in North India for eight months as a college junior. She interned with a local NGO in Varanasi where she worked on reproductive health programs for girls living in slums. Libby also designed and conducted her own field research of a family planning service delivery model in a nearby rural district. After graduating from Brown University, Libby continued her work in public health in India as a research assistant on a tuberculosis treatment in Chennai, South India. Libby interned at The Advocacy Project in Washington before her fellowship.



Padma Kumari–Nothing to offer

16 Sep

The hardest thing about this job is not being able to do anything for the women I meet. As the representative of an organization that focuses on lobbying, capacity building, and networking between NGOs, I have nothing but abstract concepts and vague promises to make to women who have very real and immediate needs.

My interview with Padma Kumari was the last of fourteen interviews that I conducted with women across Nepal, and the stories seemed to only be getting more and more tragic. Perhaps it was not that the stories themselves were any more severe, but that I was suffering from the cumulative toll of so many interviews—so many interactions in which I could only take information (about their lives, their poverty, their symptoms, their pain) from women without being able to give anything in return.

I didn’t realize it, but Padma had been waiting at the clinic for over an hour. She sat on the edge of the clinic’s cement porch, simply waiting for the bideshi (foreigner) whom she had been told to see. She held her sleeping 18 month old son (half the size of another woman’s healthy eight month old boy) and her husband squatted in the nearby shade; all three waited.

The interview began, and Padma described her fifteen year story of prolapse. She had first experienced the condition six months after the birth of her first child, when she was only fourteen. Initially she travelled to a mission hospital in India, where she was able to receive a pessary ring to treat her early stage prolapse. She had the ring changed at the hospital twice, but after that she removed the ring herself. As the wife of a day laborer and an occasional day laborer herself, she could not afford the transportation or time costs of going to the hospital in India—the nearest facility that could provide prolapse services.

After removing her pessary ring herself, Padma spent the next thirteen or so years trying to ignore the symptoms. Heavy work was difficult and caused her severe back pain, but her husband told her he would not help. After the birth of her subsequent children Padma was back to work within ten days, because her husband refused to assist her with anything other than cooking.

Because of her prolapsed uterus, Padma also experienced sharp pain during sex. Her husband, however, did not believe that she was telling the truth. For thirteen years he ignored her pleas, and Padma was the victim of marital rape.

Fifteen days before the interview, Padma’s prolapse suddenly became worse. She began to suffer from fever and exhaustion, and she had so much discharge that her sari (wrapped several times around her waist) was visibly stained in the rear. She could not hide the signs of her condition, and as the neighbors began to talk about her health, she found that no one would hire her for day labor, making it harder for her to maintain a productive role in the household.

Padma says that she was only able to come to the clinic today because the local female community health volunteer (FCHV) convinced her husband to accompany her. She says that the FCHV—whom I had met the day before—was only able to successfully persuade her husband because she told him that a foreigner (me) would be there offering treatment. Otherwise her husband would not have taken a day off from earning wages in order to seek a treatment for his wife that he would probably not be able to afford.

So with the promise of a solution, Padma (carrying her year and a half old son) and her husband walked an hour from their village to the nearest health post, where I was conducting my interviews. This outing in the heat of the day clearly drained Padma. By the time I found her resting on the curb she was visibly exhausted, and her chest heaved with the effort of breathing. She looked up at me with dull eyes and searched my face for some promise of relief. All I could do was ask her to remember the first time she experienced symptoms

At the end of the interview, we called over Padma’s husband and explained to him the quickly deteriorating nature of his wife’s health. From her descriptions of the prolapse it sounded as if Padma was still in an early enough stage of prolapse that a pessary could reverse the damage, but we emphasized that if they didn’t do anything soon she would quickly be in a condition that required an expensive surgery. The husband protested that he had no money to spend on any kind of treatment, to which the FCHVs responded that if he didn’t make the investment now, before he knew it he would have a wife who was in so much pain she wouldn’t be able to do any work; then the family finances would truly suffer. He didn’t seem convinced by the concept of a preventive investment.

I was helpless to speak to the husband directly, but I thought that if he had been persuaded to come to the clinic because he thought a bideshi would help, perhaps he would consider my advice. So in between what were probably much more thoughtful and effective instructions from the FCHVs on how the husband should handle the situation, I interjected with inert tips like “let your wife rest” and “seek treatment now before she gets too sick.” He nodded unenthusiastically to the translated advice as Padma craned her neck to listen to the FCHVs.

I looked upon this scene of helplessness—helplessness on the part of the husband to provide treatment for his wife, helplessness on the part of the wife to make decisions about her own money or her own health, and helplessness on the part of the FCHVs to provide anything other than stern lectures—and I realized that I too, after ten weeks in Nepal, was still fairly helpless. I sat just feet away from a woman who suffered from domestic violence, poverty, malnutrition, and uterine prolapse, and all I could do was tell her to rest.

I try to remember that the work that AP and the UPA do on behalf of uterine prolapse in Nepal is on a much larger scale than this interview. Given the proper resources and institutional support, the Alliance will hopefully soon be able to lobby the government to implement wide-reaching policy changes, attract donors to fund surgery camps across the country, and coordinate national prevention and awareness efforts, thereby preventing and addressing the problem in a more effective and unified manner. But as Padma pulls her sari over her head and steps out on the road to walk back to her village, I can’t help but know that she has come all this way looking for someone who can help her feel better, and that all I have given her is a two hour round trip journey and another reason to expect that she will never be able to find an affordable treatment for her condition.

Posted By Libby Abbott

Posted Sep 16th, 2008

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