My interviews with Yam Kumari Budha and Dilsara Chand happened almost accidentally. After meeting a group of thirty or so female community health volunteers (FCHVs) at a health post in rural Bardiya District, I had been sent hobbling down the road with the local FCHV coordinator in search of interviews. Shantidevi, the coordinator, was taking me to meet a nineteen year old girl who had recently developed uterine prolapse, six years after giving birth to her first child. After dragging my broken foot down the dusty road for ten minutes, however, we had to turn around. The young woman had gone off to the jungle to graze her water buffalo, and her neighbors didn’t expect her back for a few hours.
As we walked back to the health post to regroup and come up with a new interview plan, we were joined by a few of the FCHVs whom I had met earlier. Shantidevi, turned to me as she pointed to one of the FCHVs who walked with us: “She has this problem also. You can interview her.”
We were ushered back to the health post, where a dozen or so FCHVs—all dressed in their uniform blue saris with red sari blouses—crammed into the injection room to watch my interview with Yam Kumari Budha. Yam Kumari narrated what has become an almost predictable story: she gave birth to her first child as a teenager, never had a birth attendant present for the birth of any of her children, was forced back to work by her mother-in-law eleven days after the birth of her last child, prolapsed shortly thereafter, and has since lived with back pain and difficulty walking for twelve years.
Yam Kumari has told her fellow FCHVs and her husband about her condition, and while her husband is encouraging her to seek treatment, she says she is too shy to do so. As I listened to Yam Kumari try to answer my questions about why she was too shy to report to a doctor about her condition, another FCHV tapped me on the shoulder. She pointed to yet another FCHV, standing quietly in the corner: “She has this problem too.”
Before I knew it I was being told another story of a local woman forced to return to work within two weeks of each child delivery and now suffering from uterine prolapse. Dilsara Chand doesn’t know how long she has had this condition, but she remembers the day that she realized the problem she had was uterine prolapse. Like Yam Kumari, Dilsara Chand is an FCHV, and among her primary duties she is responsible for motivating local women to take advantage of local government health services. Five years ago Dilsara was accompanying one such patient to a general health camp that was being held in the area. As she listened to the doctor assess the patient’s symptoms and declare a case of uterine prolapse, Dilsara realized that she had many of the same problems. After the camp Dilsara went home to conduct a self-diagnosis, after which she confirmed that she too had uterine prolapse.
Although they both wear the uniforms of FCHVs, Yam Kumari and Dilsara are hardly model examples of health seeking behavior. Yam Kumari regularly stuffs a wad of cloth into her vaginal canal before doing heavy work so that her uterus will not fall, as it frequently does when she exerts herself. This is despite the fact that Yam Kumari knows that such self-administered treatments can lead to severe infections and accelerate stage progression of uterine prolapse.
Dilsara, as an FCHV, is supposed to be an agent of behavior change and a promoter of an open culture of health and health seeking behavior. But until the day of the interview, encouraged by Yam Kumari’s openness in front of the other FCHVs, Dilsara had never told a soul about her condition. Neither she nor Yam Kumari could explain to me why they were so shy to seek treatment for this condition, which they know is common and curable. And when I asked them how they were supposed to encourage other women to talk about health problems if they themselves couldn’t talk about their own issues, they just laughed shyly and turned away.
In their blue saris, with their government health bags hung from their shoulders, Yam Kumari and Dilsara are, above all, a testament to the great battle that lies ahead. Until women are confident enough to talk about their reproductive health and seek medical care for their problems, uterine prolapse will continue to plague communities at the high rate that it does in Baridya District. And while Yam Kumari and Dilsara have both promised me, in the presence of other FCHVs, that they will go to the district hospital to get pessary rings (which can prevent further progression of and even treat early stages of prolapse), it is evident that we are still in a stage in which behavior change is an individual and slow process.
Posted By Libby Abbott
Posted Sep 9th, 2008