The Value of Sustainable
Protocol to Address
Uterine Prolapse in Nepal

Health
Camp, Education, and
Employment Strategy
POP Prevalence


POP-weakness in pelvic floor, organs
in pelvic cavity shift downward



5 Types of POP



Millions of ...
POP Prevalence




POP-weakness in pelvic floor, organs
in pelvic cavity shift downward
5 Types of POP

 Millions


of...
POP Prevalence




POP-weakness in pelvic floor, organs
in pelvic cavity shift downward
5 Types of POP

 Millions


of...
POP Prevalence




POP-weakness in pelvic floor, organs
in pelvic cavity shift downward
5 Types of POP

 Millions


of...
POP Prevalence




POP-weakness in pelvic floor, organs
in pelvic cavity shift downward
5 Types of POP

 Millions


of...
Nepal UP Statistics
 600,000

Women with UP

 44%

of Women 20-29 have UP

 14%

of Women under 20 have UP

Nepal Gover...
Nepal UP Statistics
 600,000

Women with UP

 44%

of Women 20-29 have UP

 14%

of Women under 20 have UP

Nepal Gover...
Nepal UP Statistics
 600,000

Women with UP

 44%

of Women 20-29 have UP

 14%

of Women under 20 have UP

Nepal Gover...
Nepal UP Statistics
 600,000

Women with UP

 44%

of Women 20-29 have UP

 14%

of Women under 20 have UP

Nepal Gover...
Women Won’t Admit UP
Physical
Social

& Emotional Impact

Impact

Intimate

Impact

STIGMA
Women Won’t Admit UP
Physical

Social

& Emotional Impact

Impact

Intimate

Impact

STIGMA
Women Won’t Admit UP
Physical
Social

& Emotional Impact

Impact

Intimate

Impact

STIGMA
Women Won’t Admit UP
Physical
Social

& Emotional Impact

Impact

Intimate

Impact

STIGMA
Heavy
Early

Lifting

Pregnancy

Multiple

Childbirths

Improper

Birthing Practices

Inadequate

Period

Post Birthi...
Heavy Lifting

Causal Factors
Early Pregnancy

Causal Factors
Multiple Childbirths

Causal Factors
Improper Birthing Practices

Causal Factors
Inadequate Post Birthing Rest
Period

Causal Factors
Healthcamps Norm
**NO**
FOLLOWUP
CARE

Status Quo Must Change
OBJECTIVE
Sustainable Program
WHEN-Nepal; Palpa District, Bhalayatar

Phase I-Bhalayatar
One Multi-purposed Structure
Additional Considerations
Income Generation
 UP-Awareness,

Diagnostics,
Treatment, Followup

 Village-Financial,

Social, Health,
Gender Balancing, Awareness
Educa...
Project Team Members
Sherrie Palm*APOPS
Deepali Thapa*HCN
Suveckshya Shah*HCN
Pushkar Silwal*HCN
Pushpalata Panday*HCN
Sun...
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Himalayan Policy Research Conference 2013

77
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HPRC 2013 conference, PP for presentation. Academic paper The Value of Sustainable Protocol to Address Uterine Prolapse in Nepal: Health Camp, Awareness, and Employment Strategy can be viewed on the APOPS website @
http://pelvicorganprolapsesupport.org/about_apops/apops_nepal

Published in: Health & Medicine, Technology
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  • Excited to be here. 3rd yr @ HPRC-lunch-today share vision of project moving forward for UP in Nepal.
  • POP basics-Global Prevalence significant -50/50 85+ million women had given birth in US as of 2009 US Census-childbirth leading cause.
  • Define POP-Variety of reasons weak/damage to pelvic floor muscle, organs drop
  • UTERUS, bladder, rectum, intestines, vagina
  • POP prevalence grossly underestimated in all countries
  • currently no routine screening protocol, no accurate stat capture
  • Nepal only country in world w/gov’t POP Awareness initiative
  • 200,000 in need of immediate surgery
  • Guestimate-women don’t disclose because of stigma
  • Damage sustained by young women giving birth is significant
  • Stigma keeps POP shrouded in secrecy in all countries
  • Vaginal/rectal pain & pressure, vaginal tissue bulge, urinary/fecal incontinence
  • Mother-in-law dynamic, family disgrace
  • Intimacy can be painful, infection odorous, husband takes new wife
  • Multiple causal factors, both global norms and cultural to area
  • Nepalese women predominantly farm labor
  • Marriage at young age leads to pregnancy at young age pelvic structure not optimal for childbirth
  • Impression when first saw pic-young girl
  • Foot massage, pushing on abdomen to expedite delivery, pulling baby out cause damage
  • Body needs time to heal, early return to farm labor, heavy lifting causes damage 75%
  • Healthcamp norm-screen, pessary/surgery-promo pics 4 sponsor org-no follow up
  • Found HCN-reputable NGO in Nepal to partner w- via HPRC 2012 + GIRHL-US women’s reproductive nonprofit build SUSTAINABLE program
  • Phase 1 WOMEN’S HEALTH AND EMPOWERMENT NETWORK
  • UP SCREEN-pessary/surgery- Lumbini-MICRO FINANCE INCOME GENERATION for women-HEALTH EDU, reduce stigma, gender sensitization, shift causal factors
  • Water & sanitation-storage and purification+toileting facilities
  • Manufacture/marketing of product, sanitary pads from hemp plants, income generation for women & facility upkeep
  • Multiple outcome measures tracked for UP and Village impact leave w/w/w/how/why to experts
  • feedback -village committee, we don’t know what we don’t know-POP on medical record 4000 years, still shrouded in silence-address 1 step at time
  • Himalayan Policy Research Conference 2013

    1. 1. The Value of Sustainable Protocol to Address Uterine Prolapse in Nepal Health Camp, Education, and Employment Strategy
    2. 2. POP Prevalence  POP-weakness in pelvic floor, organs in pelvic cavity shift downward  5 Types of POP  Millions of women in every country  Currently no accurate stat capture 50% of Women Who Give Birth 50% of Women in Menopause
    3. 3. POP Prevalence   POP-weakness in pelvic floor, organs in pelvic cavity shift downward 5 Types of POP  Millions  of women in every country Currently no accurate stat capture 50% of Women Who Give Birth 50% of Women in Menopause
    4. 4. POP Prevalence   POP-weakness in pelvic floor, organs in pelvic cavity shift downward 5 Types of POP  Millions  of women in every country Currently no accurate stat capture 50% of Women Who Give Birth 50% of Women in Menopause
    5. 5. POP Prevalence   POP-weakness in pelvic floor, organs in pelvic cavity shift downward 5 Types of POP  Millions  of women in every country Currently no accurate stat capture 50% of Women Who Give Birth 50% of Women in Menopause
    6. 6. POP Prevalence   POP-weakness in pelvic floor, organs in pelvic cavity shift downward 5 Types of POP  Millions  of women in every country Currently no accurate stat capture 50% of Women Who Give Birth 50% of Women in Menopause
    7. 7. Nepal UP Statistics  600,000 Women with UP  44% of Women 20-29 have UP  14% of Women under 20 have UP Nepal Government Initiative to Increase Awareness
    8. 8. Nepal UP Statistics  600,000 Women with UP  44% of Women 20-29 have UP  14% of Women under 20 have UP Nepal Government Initiative to Increase Awareness
    9. 9. Nepal UP Statistics  600,000 Women with UP  44% of Women 20-29 have UP  14% of Women under 20 have UP Nepal Government Initiative to Increase Awareness
    10. 10. Nepal UP Statistics  600,000 Women with UP  44% of Women 20-29 have UP  14% of Women under 20 have UP Nepal Government Initiative to Increase Awareness
    11. 11. Women Won’t Admit UP Physical Social & Emotional Impact Impact Intimate Impact STIGMA
    12. 12. Women Won’t Admit UP Physical Social & Emotional Impact Impact Intimate Impact STIGMA
    13. 13. Women Won’t Admit UP Physical Social & Emotional Impact Impact Intimate Impact STIGMA
    14. 14. Women Won’t Admit UP Physical Social & Emotional Impact Impact Intimate Impact STIGMA
    15. 15. Heavy Early Lifting Pregnancy Multiple Childbirths Improper Birthing Practices Inadequate Period Post Birthing Rest Causal Factors
    16. 16. Heavy Lifting Causal Factors
    17. 17. Early Pregnancy Causal Factors
    18. 18. Multiple Childbirths Causal Factors
    19. 19. Improper Birthing Practices Causal Factors
    20. 20. Inadequate Post Birthing Rest Period Causal Factors
    21. 21. Healthcamps Norm **NO** FOLLOWUP CARE Status Quo Must Change
    22. 22. OBJECTIVE Sustainable Program
    23. 23. WHEN-Nepal; Palpa District, Bhalayatar Phase I-Bhalayatar
    24. 24. One Multi-purposed Structure
    25. 25. Additional Considerations
    26. 26. Income Generation
    27. 27.  UP-Awareness, Diagnostics, Treatment, Followup  Village-Financial, Social, Health, Gender Balancing, Awareness Education, Stigma Reduction Outcome Measures
    28. 28. Project Team Members Sherrie Palm*APOPS Deepali Thapa*HCN Suveckshya Shah*HCN Pushkar Silwal*HCN Pushpalata Panday*HCN Sunita Sharma*HCN Ali Borazjani*GIRHL Lumbini Medical College Bhalayatar Community Resources: Concept Note, Hamro Chahana Nepal, August 2013. Ministry of Health and Population, Nepal, New ERA, and ICF International,2012. Nepal Demographic and Health Survey (UNFPA & IoM), Katmandu, 2011. Uterine Prolapse, Mobile Camp Approach and Body Politics in Nepal, Madhusdan Subedi, Dhaulagiri Journel of Sociology and Anthropology, Vol 4, 2010. Uterine Prolapse: Experts Scorn Health Camp Surgeries, Ekantipur.com, 9/14/2011.
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