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.

To the West

08 Sep

We’ve been talking about this trip to Nepalgunj for weeks now. This would be my last chance to go the field before I left the country, and this would be the only chance that either Nicole or I would have to visit the west—Nepal’s frontier where development indicators are lower and cultural practices are more conservative. This was going to be the trip during which I would get the crucial information that we had been after for months—insight into the cultural and familial practices that both facilitate and aggravate the condition of uterine prolapse. This was to be the culmination of all the work that Nicole and I did this summer.

Advocacy Project and Nicole and I projected so much hope into this trip, I almost have to wonder if we forgot that I was in Nepal—a country where it is nearly futile to invest so much hope and expectation into events that are never entirely in your hands.

It started with a hairline fracture in my right foot, which not only delayed my original departure date but also made it fairly difficult to move about once I arrived. Thankfully through a contact at GTZ (the German aid agency) I was able to hitch a ride to a rural area outside of Nepalgunj. Once I was there, however, the list of potential women with uterine prolapse whom I could interview was limited to a half mile radius—the greatest distance that I could hobble down dirt roads within a reasonable time.

A translator who didn’t speak English and a schedule dictated by the comings and goings of the GTZ vehicle (fixed to someone else’s agenda) also wreaked havoc on my plans for detailed and in-depth interviews. I’ve found, however, that when you’re working for a new and un-funded NGO like the UPA you have to take whatever resources you can get. Without the help of GTZ and with no other contacts available through the UPA, I would have been limited to interviewing women in the nearby medical college, where I found only two older women from far away districts recovering from hysterectomies. So I made do with what I could get and got by with Hindi-medium translation and fixed windows of time in the field.

A Nepali friend once told me that there is no point in planning anything in Nepal, because there are so many variables that are bound to get in the way of your plans. While this trip has probably once again proven his point, it was in no way a failure. In just two days in Bardiya District and one morning in the hospital I was able to interview a handful of women with uterine prolapse. Their stories illustrate the great range of women’s experiences with this condition, but they also highlight the underlying theme: that this is problem that affects women who are already marginalized and without resources and leaves them in a state of further social and medical vulnerability.

After adjusting my original expectations (as I have learned to do here), I might even call this trip a success. From a personal perspective, anyway, it was an incredibly valuable way to end my time in Nepal with the UPA. Field visits are what kept me going in Nepal and provided me with the interactions and outcomes to make my work with the UPA real and grounded. This trip was no exception, and I met, as usual, a number of incredibly warm and accommodating women. On my last day in the field, I sat on a woven cot on a shaded porch during the heat of the day and chatted with many of these women: one auxiliary nurse midwife (ANM), one female community health volunteer (FCHV), the woman who cooked our dal-bhat, the wife of the local doctor, and a few other unidentified women who had managed to find a place on the porch and just listen in on our conversations out of curiosity. They made fun of my broken foot and my runny nose, and assailed me with the usual questions: Why aren’t you married yet? Why do you wear slippers (flip-flops) outside? Why don’t children in your country live with their parents when they are older? Is it true that women in America can just get rid of their husbands if they don’t like them?

Female community health volunteers (FCHVs) gather in Bardiya District for a training on an upcoming measles campaign. The women are also trained to identify uterine prolapse, though no local facilities for treatment are available.

The women laughed at my answers (because I’m too young; because they’re comfortable; because adults take care of themselves; yes) and continued to fan themselves and me with hand-sewn bamboo and fabric fans until eventually the GTZ vehicle arrived. They escorted me to the car, gave their respect to the GTZ officials (who support the local health post), and waved goodbye. For all the help that they had given me (identifying women with UP, dragging me through town, making me tea and translating between Nepali and Hindi),they asked only that I make sure that the stories I had taken would be heard and turned into action of some kind. I had already had to explain to them that the organization I worked for was not a service providing agency—that I was not doing the groundwork for a uterine prolapse screening or surgery camp, which is the only hope that such women (without money to pay for surgeries and without local facilities to provide the services) would ever have for treatment. I had to explain that instead I was taking information that would hopefully be translated into effective advocacy and awareness campaigns at some point in the future.

It is a stretch for women who live with uterine prolapse as a fact of daily life to imagine the long-term benefits of story-telling and lobbying campaigns, but they accepted my promises. Now I can only hope that someday these stories and the voices of other women (sufferers and activists) will reach someone somewhere, and that the women of Bardiya District will eventually have access to treatment for a painful and demoralizing condition that they will otherwise have to live with for the rest of their lives.

Posted By Libby Abbott

Posted Sep 8th, 2008

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