Frequently my conversations in Nepal involve a lot of gesturing from both sides. The less English someone speaks, the more intense this gesturing becomes. One of the first evenings I was in Gaighat I had a particularly notable conversation of this sort where my landlady Sabita-ji tried to explain a pressing concern on her mind. The conversation began with the words “women, Nepal, health, and bad” repeated in various configurations as she tapped her chest and said “health worker” until she was sufficiently convinced that I understood her meaning.

She then moved on to repeating something I couldn’t understand at all followed by “dere samosia” (big problem) while pointing to her abdomen and making a number of other strange gestures that made me think of a baby being born. After about 15 repetitions I said “uterus prolapse?” taking a guess at what she was trying to communicate but having no idea what it meant. She confirmed that was correct and continued the conversation by dragging 11-year old Eliza into the kitchen to sit on the floor with us to interpret as best she could for a subject she clearly was uninterested in and didn’t understand.

Fast forward several weeks to the return from my business meeting in Jhapa. Binot-ji, the president of Community Development Forum (CDF) looked at me with a very serious expression and said “Come Lahan. Meeting. Important,” followed by a pause and then “uterus prolapse.” This caught me off guard, and I stammered “Ok…” After a subsequent conversation in Nepali Arjun-dai and Prakash-ji (the men I work most closely with at NESPEC) informed me that we would go to Lahan to meet them in a few days for this very important meeting.
(random picture of Prakash in Ilam).
Luckily in the intervening days during a trip to a tea plantation in the hills of Nepal I randomly came across some Dutch medical students completing one of their internships in the gynecology wing of a well reputed Nepali teaching Hospital and begged them to explain what the heck a prolapsed uterus was. Through a very graphic discussion, some drawings, and (believe it or not) some more gestures, they helped me get a basic technical understanding.

Essentially, they explained if the ligaments holding a woman’s uterus in place become weakened the uterus can fall into and begin to protrude out of her vagina. The extent of the problem is classified into 4 stages, the most extreme of which can only be addressed by surgery. The weakened ligaments can be caused by a combination of factors including early and repeated pregnancy throughout a woman’s life, excessive pressure on a woman’s stomach during birth (often applied by untrained birthing assistants as less than 10% of Nepali women give birth in hospitals by trained personnel), lack of sufficient rest and a return to heavy manual labor immediately following giving birth, along with other related factors.

Believe me, I was thanking my lucky stars I had come across those medical students when I walked into my meeting at CDF….