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…