CAPTIONS FOR ABOVE PICS:
1. Examination Room
2. Examination Table
3. Pessary Rings
4. Hospital lab where women would go to have blood work done for surgery eligibility

The Udayapur District mobile gynecological camp was held for 7 days and staffed by a mobile team of doctors and residents who, along with much of their surgical equipment, had been trucked in. In addition to interviewing women on the grounds of the hospital, I spend a lot of my time in the examination room, as doctors & residents welcomed me in and offered unfettered observation to EVERYTHING.

Every day women amassed in the hospital corridors and crowded the doorway of the examination room, waiting endlessly for their names to be called. Once called, this signal, reminded me of the starting bell of a horse race as each woman bolted into action, let through the starting gate of the examination room, and steered at full speed around the crowded circuit.

After being approved for entry by the gate keeper guarding the doorway from the looming mob outside, she was directed to a newly vacated seat at the only table in the room where between 2-4 doctors sat simultaneously doing intakes. A brief and somewhat perfunctory interview was conducted. She was then ushered behind the green curtain suspended at one end of the room where she would climb on the table (whose sheet I never saw being changed) and be given the universal instructions to, “scoot down further…. No, further.” Her intake doctor would then pop behind the curtain look at whatever needed to be seen and return to the table. The embarrassing part over, she would again join the table to discuss her diagnosis, and a prescriptive course of action would be determined.

If it turned out a woman had “early stage” uterine prolapse that needed treatment but not surgery she would be offered a ring pessary during the examination. Upon receiving a woman’s consent, the doctor would reach into the nearby tub of available ring-pessaries, select one of the approximate size and insert the rubber donut that would hopefully fit appropriately and keep her uterus in place for 3 months until it would need to be changed.

If her case was severe enough for surgery a different discussion was had. A series of blood work would be done to determine if she could undergo surgery. When the results were back the following day, another consultation would be held. If she was a suitable candidate according to her overall level of health and blood type she would be slotted for surgery – assuming spots were still available.

Large numbers of women who had severe prolapse were determined ineligible for surgery due to such things as age/frailty, high blood pressure, their blood type not matching the blood stock available, or because an infection from the prolapse had to be cleared before undergoing surgery. Unfortunately, due to a shortage of time and staff (one of the surgeons couldn’t make it at the last minute), the list filled up pretty quickly. Ultimately less than half of the eligible women received operations. The ineligible ones were instructed to treat their secondary issue (if possible) and then find another camp or travel to a more equipped hospital facility.

After experiencing the examination process, what else could come but to witness the treatment…

CAPTIONS FOR ABOVE PICS:
1. The DJs/medical staff
2. Surgeons with serious focus
3. View of the operation
4. Finishing up with the power out

My first exposure to the “OT” was as I hung around in the hallway waiting to chat with some of the doctors. I saw them finishing up through the glass doors and to my shock watched the green-scrub mob pile out – after completing a round of group photos!

Later in the week, I donned a scrub uniform and a pair of communal plastic sandals, took my camera and notebook in hand, and walked into the OT. I was jovially welcomed in and instantly disoriented by the social atmosphere of the OT. I was met at the door by a doctor who, to my surprise, handed me one of the plastic cups of Coke that were being passed around and invited me to take a seat. People were lounging around chatting in one corner and two men on the other side of the room hovered over a laptop DJ-ing the green-themed party with an assortment of Hindi film songs. Though I tried to quickly quiet them, all sorts of judgments about ethics and safety and poor education and abuse of power flew into my mind (I have since learned that contrary to my expectations, such environments are not-uncommon in Western hospitals as well!).

Moving through my initial shock and impressions the more serious aspects of the scene came into focus. A subtle combined smell of blood, metal, and antiseptic filled my nose… A head moved and I noticed the woman on the table, sedated, but not unconscious, and barely recognizable in a contorted position and tiny under a pile of sheets… I noticed the intensity and focus of the 3 female doctors centered in the room under a pool of fluorescent light. Earlier in my life I couldn’t have been paid to watch a live operation. Yet now, motivated by some strange and growing desire to understand all aspects of this thing called “UP” I edged my way around the room, trying to get a good view and figure out exactly what was going on amidst the instruments and blood and tubes.

After far exceeding the bounds of what my squeamish self could handle and wondering what exactly I was doing there, I widened my focus again and started identifying some idiosyncrasies of the OT. Despite attempts to create a sterile environment through scrubs and flip-flops, the windows were open, letting sun, hot humid air, and anything else that wanted to, come right on in. I was shown the expensive new air conditioners primly sitting unopened in the corner unable to acclimatize the room because there wasn’t sufficient power in the hospital to run them. And I learned my biggest lesson of the day…. One reason there were so many people in the OT is because they were a living blood bank. Since there was no available blood supply, these medical students were not only observing the operation, but provided a secure source of blood in case a live transfusion was needed. In fact, only women whose blood types matched the regularly screened medical staff were permitted to have an operation, despite meeting other conditions for being good surgical candidates.

A bit later, just as things were starting to wind down, the power failed. The music went off along with the lights and monitors. But without a skipping a beat the green cast of characters switched modes, whipping out temporary lighting and taking charge of manually monitoring everything the machines previously covered. The operation was finished successfully by flashlight and the patient was unceremoniously whisked away to the recovery area. As the green team started to wind down, clean up, and de-robe, I couldn’t help but view their group picture taking with a new light… Perhaps with all the pressure and challenges lurking beneath the surface of their work, they deserved a moment to celebrate and document a job well done.

****

Witnessing the camp was, at times, an overwhelming and unbelievable lesson, revealing another layer of what it means to be a woman with UP in Nepal. The shocking lack of sanitation (lack of!!?!?) and the smell of sweat, bodily fluids, and sterilization solution are not things I will readily forget. The experience, though now months back is still as vivid for me as it was when I was there, and led to a new level of appreciation for the medical system we have in the US, despite the bureaucracy & challenges we often face. It also made abundantly clear the importance of preventative efforts and cemented my commitment to working for this condition, and maternal injury more generally, to receive international attention.

One of the greatest challenges Nepal faces to development is their lack of health infrastructure, and the not-so-proverbial mountains that stand in the way of creating one. With a country that is 80% “remote” a miracle solution to avail the scattered population of needed health services has not yet arisen. In the mean time, one of the most common mechanisms for providing needed services are “mobile camps.” These camps have traditionally been used for everything from vaccinations to cataract surgery, and are one main way surgical services are provided to some of the 200,000 women in Nepal who currently need hysterectomy due to UP.

In THEORY mobile camps work like this: the organizing body (either an NGO or the government) selects a site that is relatively central in an underserved area (often a district headquarters or a larger market center is selected). A date is set (usually lasting 2 days -1 week), the necessary team of doctors are contracted, and NGOs in the area are informed (unless they already know because they are organizing it) so they can start publicizing the camp and preparing women to attend. Then on the selected date, equipment is trucked in and set up, doctors arrive, and patients arrive and get in line for services. Unfortunately it rarely happens like this.

Women Crowding the Halls Outside the Gynecological Evaluation Room

The benefit of such set-ups is that crucial services get to people where facilities simply are not available. The downsides however, are many, and mostly revolve around the lack of availability of follow up care – both immediate and longer term. These challenges facing hysterectomy camps are particularly acute as post-surgical care needs are intense.

In my desire to know all things UP, I had eagerly searching for a UP camp to attend from the minute I had arrived in Nepal this summer – to no avail. Every camp I heard about was canceled for reasons ranging from roads being washed out preventing equipment transport to bureaucratic challenges. One was even canceled w/o any notice after women had arrived b/c the doctors just never showed up. Thus, during one of my visits to Gaighat my, former landlady/radical women’s health worker/political activist Savita Thamang told me there would be a UP camp beginning the following day in Gaighat, my jaw dropped and I could not believe the serendipity.

Despite my assumption that all such “mobile hysterectomy camps” were held in tents in open fields and the like, this camp was to be held at the district hospital. It turns out that government-sponsored camps are often held at district hospital facilities when available because they offer a basic level of support staff and facilities (such as hospital beds), thus reducing the load of things needing to be trucked in. However, they are still considered “camps” because specialized doctors (gynecologists and anesthesiologists) and equipment still have to be brought in. The fact that there are only 64 gynecologists in the entire country of Nepal, and an even fewer number of anesthesiologists illustrates this point, and belies much larger issues.

I held my breath until the next morning, and when I arrived at the hospital bright and early things actually were getting under way. My luck had held out and I was about to actually experience a mobile hysterectomy camp! Little did I know what I was in store for…..

Surgical Supplies Being Sorted and Cleaned

I had yet to see a cow or buffalo give birth during my stay in Nepal, though all my friends here knew that I had been trying. So when we arrived in Harridya one of the first things Parmila learned (and immediately told me) was that their buffalo had just given birth a day before and there was a new baby for me to meet. I of course grabbed my camera and started clicking away, taking pics of the mama and beautiful-blue eyed baby.

The New Mama

This exciting introduction quickly turned into a big crisis as it became apparent that the mamma buffalo was sick and that she wasn’t able to nurse her new little one. The typical calm of the house was replaced by an undercurrent of frantic-ness as the family ran around in a monsoon torrent and did everything they could to help heal the mother and get her milk to come in so she could start nursing. Baths were given to lower her temperature, she was tempted with special foods, she was walked in circles in the buffalo shed – but nothing was working. Then the local dhami or traditional healer was called as well as a vet – and each tried to worked their own version of magic.

Parmila’s Mother Bathing the Buffalo to Bring Down Her Fever

Not only would it be an incredibly sad event for the family to lose the baby and/or mother, but it also had major economic implications as the mother buffalo was a significant source of food and wealth for Parmila’s parents. She had been a major financial investment as well as one of many, many, resources of time and energy.

From all around the prognosis was bad. They did not think they could find enough milk to nurse the baby on their own, and even if they did, the baby being so young it would not have the ability to digest fat yet and needed it’s own mother’s milk first (akin to colostrums at that point). I of course, was at my wit’s end trying to understand what was going on without adding any additional tension. After another 24 hours or so (including an all night vigil) there was nothing to be done, and it was determined likely that both mother and baby would be lost.

Hungry Blue-Eyed Babe

I left Harridya with a resigned and heavy heart, glad to have the excuse of scheduling that required my departure. I felt a bit childish that I was praying for the buffalos, and that they were on my mind so much, but I really was quite upset by the whole affair.

Then the miracle happened.

A few days later, back in Kathmandu, I got a text from Parmila which read: back in Gaighat and brother came today from haridya. good news! Both amma (mother) and baby buf. ok!

I did a little dance of joy, and called her to confirm it was true. I didn’t get a chance to go back to Harridya, but I’ve continued to request regular updates, and so far, everyone continues to be stable and happy. Yet another profound lesson about the workings of the world without any lingering scars.

The Unofficial Hospital Waiting Area

One of the chapter’s of Raka battle with traveler’s diarrhea (mentioned in a previous blog) involved us being convinced to admit her to the district hospital so she could receive all night care in case of any emergency that might arise. We decided this was a very logical thing to do. However, as the overnight bag started to include bedsheets, a towel, and soap, the reality of our context and the realistic prospects of the district hospital set in and I became ready to abort the mission. Unfortunately, the momentum was already under way...

As we pulled into the compound dotted with trees encased by large cement donunts-cum-park benches and worked our way up to the “urgent care” ward, I realized I should have followed my instincts. The damp, stark rooms were littered with rickety hospital beds that evoke images of WWII. I was assured the bathroom was clean, but asked to see it anyway, knowing its state was crucial as we would be spending a considerable amount of time there. When I saw the stopped-up eastern toilet littered with a few discarded pieces of bloody gauze I quickly realized there was no way I was going to let Raka stay here.

Ward of District Hospital

In contrast to my typical efforts to be unconditionally accepting and to try to function from a place of “if it’s good enough for them, it’s good enough for me,” I mumbled a feeble excuse about “more privacy at home” and used the full strength of my will to put our entourage in reverse down the hill, through the center of town, and back home.

Once Raka’s crisis had passed, I reflected on this the significance of all this. First I felt really lucky that I hadn’t needed any medical assistance last summer. Then I spent some time integrating that this is, in fact, the most advanced medical facility in the district. Gaighat, unlike much of the rest of the country, is not very remote as it is completely accessible by road – so I can only being to imagine what the hospitals in such places would be like. I also spent time trying to reconcile the fact that I had refused to let Raka stay at a place that is a source of solace for so many - a place that some hill-bound district residents spend days traveling to for treatment.

Little did I know when I left the hospital compound that in the blink of an eye I would be spending quite a large amount of time there over several days attending a mobile gynecological/UP camp and getting to know the hospital in more intimate ways that I would have ever wished.

The "Clean" Eastern Style Toilet

She caught my eye and waved me over, patting the bench next to her. I sat down and we gave each other a “Namaste” in greeting. She patted her chest and introduced herself as Parvati Poudel. Once we got beyond my “easily doable” conversation including, “where are you from,” “how long have you been in Nepal,” etc, Parvati launched into a patient and persistent conversation, as one must if one wants to communicate with someone who barely speaks your language. She used repetition, enunciation, and lots of gestures, until she was confident I understood.

Parvati outside "gynecological examination room #2" (though I don't know what happened to #1!)

Realistically, she had no rush as she sat on the worn wooden bench of the top medical facility in Udayapur district and waited. She was just one among a throng of women in line to be evaluated for Uterine Prolapse (UP) and other gynecological problems by a team of qualified doctors in town for only 5 days. So our conversation was likely a welcome respite from the dim grayness and heavy air of the hospital’s unadorned cement atrium. Being one of the few unaccompanied women at the camp may have explained her more than a typical curiosity in me. During one of my rounds of picture taking, she indicated that she wanted me to take her picture, then she gave my camera to someone else so I could join her in front of the lens. When she re-initiated a conversation later, she would not end her insistence that I come to her home where she would feed me mangos right from the tree and milk fresh (not only from buffalo but the cow as well) until I took down her neighbor’s phone number and promised that if I was every anywhere near her hometown of Beltar that I would call and meet her.

Women in the hospital waiting to be seen

I also learned that despite the severity of her prolapse the doctors here would not be able to give her a hysterectomy during this free camp due to an infection she had from the small rubber pessary ring that was currently using to keep her uterus inside her body. Rather, she had been given a prescription for about 7 medications she should take for 15 days and told she should then travel to the private teaching hospital several hours away from Gaighat and pay for a hysterectomy from a location with permanent facilities. Realistically, as she would not likely be able to raise the money necessary for the operation (equivalent to $300-500) she likely have to wait until she heard of another free camp somewhere in the area and hope by the time she got there her infection would not have returned and she could receive an operation then.

Later that afternoon as I was leaving the hospital to walk back to NESPEC (the NGO where I spent last summer) Parvati decided to come along. At one point as we walked she put her hand on my arm, stopped me, and shoved a plastic bag with 2 mangos into my hand. I started to protest, feeling awkward taking food from this ill woman whose clothes hung on her wasting frame, but though better of hurting her pride or refusing her hospitality and tried to graciously put them in my bag. When we arrived at NESPEC she hung around the grounds for a bit, while I chatted with my colleagues there – many whom I had not seen since my return to Nepal. She would periodically make eye contact with me (possibly reassuring herself I was still there?) and smile, but mainly lurked in the periphery. Later in the evening, before she faded off into the dusk, she asked someone to confirm I had her number and that I had indeed promise to call her the next time I was in Beltar.

The next day when I returned to the camp Parvati was there again wearing the same clothes (as Nepalis typically do for several days – hand washing all one’s clothes is really tiring!) but looking surprisingly fresh despite the humidity. I was confused to see her, knowing that she was ineligible for surgery at this point, but also pleased since I had come armed with a voice recorder and a few friends who were going to help me translate so I could collect stories of the women at the camp. Instead of prioritizing questions about the futility of her return visit, I decided to capitalize on the rapport we had established yesterday and ask her to be my first interview.

Parvati telling me her story with the help of Parmila and Honey

The interview began much as one might expect. I learned that Parvati has 4 children, 3 daughters and 1 son. Her prolapse happened 7 years before, at the age of 37, just 1 year after her youngest child, her son, was born. For 3 years she struggled with the pain in her back and stomach and started eating much less – if she eats too much the pressure of the food “makes it hurt more, and can even make it come outside; even now with the ring if I eat too much both come out.”***

Four years ago she found her way to a women’s health clinic established by a local NGO who explained about her condition and inserted a pessary ring for the first time. Even with the pessary ring, which mostly keeps her uterus from falling out, she has difficulty walking and isn’t able to carry heavy loads. It’s likely that her operation-precluding infection, a symptom of which is the “bad blood” she describes coming out periodically, results from lack of proper routine care of this ring.

Then I learned that aside from the infections and pain she struggles with she hopes to have the surgery because of the “big, big problems” she is facing. “This disease is my enemy because it keeps me from doing my work,” she explains. Instead of the heavy manual labor required of Nepali women living a subsistence life she can only do “sitting work” now, “small things that are not very difficult.” Not being able to contribute in the expected way, she is left feeling like a burden on her family, not able to fulfill her duty (in the highest sense) or earn her keep.

We began to discuss how her condition is affecting relations with her family, and this is when the interview took a surprising turn. The open and smiling face proudly crested by a bright red sindur (worn by married women to bring luck to their husbands) I had become acquainted with cracked away, revealing a grief-stricken core… Her husband has apparently not reacted well to her condition. “This disease has driven a fracture between us... He has refused me any money for my disease or ANY help.” She reports that he is even turning her children against her, giving money to run the house to her oldest daughter along with instructions to not give Parvati any money at all.

Deeply Distraught

Compounding the situation her in-laws, who substitute for her own parents after marriage according to traditional Nepali custom, are very unhappy about her inability to work and are encouraging her husband to take a new wife. The peak of her difficulties occurred just a month before when, after being beaten, she was cast out of the house and told she could not return. She explains that she has been wandering around for the last month, staying with friends and relatives and trying to raise money from them as well as various women’s NGOs so she can pay for treatment.

After a few intense moments my friends helping me conduct the interview gradually change the subject, leading her away from this topic, and back into more generalized chatter of the group of women sitting around us. We ultimately moved on to interview other women, to hear more stories of struggle, and even some of hope by those scheduled to receive surgery the next morning. I didn’t get a chance to say goodbye to Parvati when I let that afternoon – perhaps that is why her sunken eyes continue to haunt me.

I have come up with any number of ways to reconcile her invitation for me to visit her home with the story of her own inability to return… a possible shield from a status symbol to enable a return… an escapist fantasy for a woman enduring too much suffering…. or even a story woven to tug at the heart or purse strings of a wealthy foreigner… If only her story were unique I would definitely settle into the convenience of the last. But alas, it isn’t. So instead, I offer a silent prayer that she will find the funds or another free camp that will allow her to end at least one of her forms of suffering, and I reaffirm my resolve to continue to support organizations in Nepal that are working to ensure other Parvati’s out there don’t needlessly suffer the same fate.

*** Once a uterus has prolapsed to stage 3 and comes outside the body, it is often possible, though it can be painful, to push the cervix and/or uterus back inside. However, any abdominal strain, including coughing, can cause it to come out again. If the prolapse reaches the 4th and last stage of “procedentia” both the cervix and uterus are permanently stuck entirely outside of the body cavity, hanging between a woman’s legs.

If you are interested to see what a 3rd & 4th stage prolapse actually looks like, please visit: http://picsofprolapse.wikispaces.com/
please note: these pictures are extremely graphic

Apparently I've unintentionally caused a lot of intrigue about the “business proposal” from Sanjita I mentioned in my last blog.

To answer the many questions I received, very roughly, her proposal is for us to start an import/export business – creating a market for her to sell her goods in the USA and creating a chance for us to sport the beautiful wares produced in her factory. There are a whole range of possibilities w/ that realm – they make items we designed in the US, or we buy wholesale the designs they have, through placing customized orders, the list goes on…

Any one have an interest or any idea how we would get this started?

This past week has been intense – to say the least… The plan was for my AP Partner Raka and I to leave Kathmandu and head out to Gaighat where I had spent last summer and she would spend this summer working with NESPEC. Then, after staying and visiting with my friends for a few days I would continue with my work on Uterine Prolapse. As is typical in Nepal, none of this happened the way it was planned.

We were prevented from leaving Kathmandu for almost a week (and what a strange, blister-filled week it was) as protest and strike after protest and strike prevented vehicles from moving on the streets of Kathmandu. The series of bandhas were conducted first by constituents of a local bureaucrat who had been shut in a toilet for 2 hours by a Maoist leader as punishment for his corruptness. They were then continued by members of the transportation sector protesting the hiked prices of oil and the government’s subsequent imposition of caps on the fares they were allowed to charge, followed by gas station owners who refused to sell any gas in protest to a cap the government was setting on the price at which they could sell oil. Finally they ended by student groups agitating to demand their student-fare reduction be increased to compensate for whatever fare hikes were enacted --- ah the blessing of oil dependency!

Students Burning Tires in Protest

After being stranded in Kathmandu for days and missing the first 12 hour window that passed due to some wet laundry, we forged ahead with a plan to leave at the next chance we got – in spite of Raka’s uneasy stomach. At 5:30 am we borded a bus bound for Gaighat, only to drive 20 feet and be stopped by a man waving a flag and telling us that again, the roads were closed. Thank goodness Sanjita’s house was only a 20 minute walk from the bus station, as not a taxi was able to be found.
We camped out at Sanjita’s until 6pm when we finally boarded the bus, resigned to spend the entire night working our way toward Gaighat. We arrived around 7am the next morning, having endured blaring Nepali music (doubtlessly necessary to keep the driver awake), 3 traffic jams (one accident induced – not us), a monsoon torrent that managed to make its way inside the bus (and onto the top of my head), and an increasingly alarming problem with Raka’s stomach.

I thought getting out of Kathmandu and then the bus ride almost killed me… but it ended up being nothing compared to the first 24 hours of being in Gaighat. By some miracle and previously unbelievable fortitude Raka managed to contain her diarrhea for the entire busride from Kathmandu – however once we arrived, the severity of the situation became readily apparent.

The joyful reunions I had anticipated with my friends were tempered by my anxiety about Raka’s frequent trips to the bathroom and the helplessness I felt in the face of her increasing state of weakness and dehydration. Luckily, due to several liters of saline, antibiotics prescribed via phone by the traveler’s clinic in Kathmandu, and an outpouring of love and care from our extended Gaighat family that ranged from massages, to vigils, to a volunteer nurse who stayed up all night changing medication in her IV, Raka was on the mend within about 24 hours.

Now that all the physical and emotional recovery (for both of us) is complete, and the Kathmandu strikes and bus ride are a distant memory, it is absolutely incredible to be back in Gaight.

PSYCHED TO EAT for the first time in days…..Raka never looked so good!

Within the first few days of my arrival last summer as I wandered in and out of shops along the winding streets of Thamel, Kathmandu’s tourist center, I had the fortune to meet Sanjita. She spends most of her days sitting in 9’ x 14’ shop crammed floor to ceiling with brightly colored knit goods of every imaginable ilk produced at her nearby factory. Through the business she and her brother established, that she now runs, she sells the reassurance of warmth to those heading off to trek in the Himalayas and souvenirs to tourists on their way home, as well as courting relationships with a range of wholesale buyers who frequent Kathmandu en route to stocking the stores and boutiques in Europe, Canada, and the USA.

Hats and scarves in Sanjita’s shop

She is a businesswoman who exemplifies the old school notion of having relationships with her clients, enjoys doing so, and has learned a lot about the world through these contacts - despite never having stepped outside Nepal in any of her 27 years. Her rapid-fire and self-taught broken English, engaging conversation, and good-natured forcefulness regularly lead her customers into spending hours in her small shop drinking tea and sharing their secrets.

Sanjita’s throaty laughs, playful punches, strong opinions, business acumen, and “frankness” (as she puts it) differentiate her from typical expectations of a Nepali woman from an agricultural village with no electricity or running water and a 12th grade education. All of this, combined with her proclamation that I was officially her “Didi” (older sister) left me little choice in the matter of becoming her close friend.

Sanjita

I met with Sanjita the day I landed in Kathmadu, and was surprised how small she looked, even though she was almost full term. Despite being upper-middle class, having good access to food and medical care, Sanjita looked smaller than many pregnant friends at home do in their 7th month… Within a week she had delivered – a tiny girl weighing 2.9kg (or 4.6 lbs).

The tiniest of tots

I visited Sanjita and the baby just hours after coming home from the hospital. She was exhausted, and in great spirits overall – though vowing never again to give birth. Sanjita and her daughter lay on a thin futon-like pad on the floor and we passed a mountain of swaddling containing the tiny infant back and forth as we talked.

We wrestled our way through her birth story, struggling to develop a previously irrelevant vocabulary – placenta, induced, labor, dilate... I was surprised by the strength she exhibited and the mix of “modern” and “traditional” that punctuated her experience. At a routine checkup, Sanjita’s female doctor decided to induce her a week before the due date out of a concern for limited amniotic fluid.

Having had no preparatory birthing class she spent the next 16 hours blindly suffering through artificially strong contractions in an austere maternity ward attended only by the rotating nursing staff and curious groups of medical students doing their rounds. Her husband periodically came to check on her from the hospital waiting room, where he was doubtlessly wearing a track in the floor. When I inquired about why he wasn’t with her the whole time, Sanjita explained, “because he loves me too much, and seeing him struggle with my pain would make me weak.”

Just after the naming ceremony

In the middle of our exchange, Sanjita suddenly turned to me with a business proposition. “I know you are busy with your studies right now, but when you are finished, and I am able to work again, I would like to discuss starting a business with you. I think I can teach you what you need to know, and I think we could be very successful.” I smiled, replying that of course we would talk about it later, and quietly marveled at the culture shock a new baby can be in any corner of the globe for women committed to juggling family and career.

11 days after the birth, following the custom of her family and caste, a naming ceremony was held. An astrologer came to select the appropriate name for the new baby and foretold a bit about the personality she would develop. She was named Parvati, after one of the major Hindu goddesses; and if the stars are right, she has quite a bright future.

Parvati

It feels surprisingly great to be back in Nepal - the key part of that phrase being “back.” This may not be a surprising twist for the logical among you, however, in the hectic buildup to my departure I had not thoroughly thought this through.

Last year I wrestled through eager taxi drivers on my way out of the airport, spent the first days trying to get my bearings, and visited tourist sights. Instead, this year I was met at the airport by my best Nepali friend, settled into the home of some ex-pats I know, and have spend my days reconnecting with folks from the various organizations I worked with last year, trying to help the other AP Fellows get situated, and working to re-activate the Nepali-language part of my brain.

BACK IN KATHMNANDU

I have also had the privilege of returning to “Naya Nepal” (the New Nepal) as everyone is fond of stating. Since I was last here there has been a lot going on:
* The Constitutional Assembly elections were finally held in April and received international praise for their fair and peaceful processes.
* The election results surprised everyone as the former rebel Maoists took a sweeping victory.
* Sarita Giri, the woman I worked closely with last fall, was elected to Parliament, along with roughly 10 other women who were involved in our projects on increasing political participation of Madeshi women.
* Nepal was officially declared a Republic in the first meeting of the new Assembly and the former king was transformed into an ordinary citizen.
* And finally, since I’ve been here, amid much celebration the King vacated his palace in Kathmandu (although he was granted temporary residence in one of the smaller palaces just outside of the Valley as, despite his billionaire status, he complained of having nowhere to go…)

It has been incredible treat to return to Nepal at a time of so much celebration and to be able to share in it with those who have played such an important role in making it come about.

And of course, there is still an enormous amount of work to do in this beautiful and complicated country to realize the vision of “Naya Nepal.”

A WWRP-CAED WORKSHOP ON UTERINE PROLAPSE

For my part, this summer I will be focusing my energy on the women’s health problem of Uterine Prolapse. I will be working the Uterine Prolapse Alliance (a group of Nepali NGOs, or non-governmental organizations) who are engaged in this issue as well as WWRP-CAED (the Women’s Reproductive Right’s Program of the Center for Agro-Ecological Development) which is a cutting-edge organization on this issue. We have already had several planning sessions, and throughout the summer we will be engage in a range of efforts intended to lay the groundwork for an international awareness campaign about UP that will be launched next year.

So…. Please cross your fingers for a productive 10 weeks that don’t fly by too fast… and… Welcome to “Naya Nepal!”

NAYA NEPAL