Dr. Aruna Uprety
Doti- March 2001. I am in Doti district, one of
the most remote areas of Nepal, about 700km west of the capital. I
am coordinating a health programme organised by GTZ, the German
International Development Organisation. We are running a special
gynaecological camp in the Doti district hospital, designed
especially for women of the far-western region.
A woman is brought in. Her brother carried her to
the hospital, and her mother and two small children accompany
them. Her name is Kamala. The family reports that seven days ago,
Kamala had a spontaneous abortion. She has been bleeding
continuously since then. Kamala is pale as a sheet. She cannot
even open her eyes.
A senior gynaecologist examines her and says, “
She has lost a lot of blood and has an infection. We need to
transfuse blood immediately, but it is not possible here. It would
be best if we send her to another hospital where transfusion
facilites are available.” We research the cost of an ambulance and
discover it will be around Rs. 1700. We discuss this with Kamala’s
brother and mother. They answer; “We do not have money to take her
to the hospital. If you can treat her here, please do so.
Otherwise, she will die here and we will not blame anyone.”
We doctors talk among ourselves and decide that we
will collect the money and hire an ambulance to take her to the
closest hospital- a seven-hour drive away. But after assessing the
patients condition again, the gynaecologist, Dr Veena Rani
Shriwastav says, “Even if we could arrange the money and
ambulance, it is not advisable to send her to Dhangadi hospital as
she is really in very serious condition. It would be better if we
could do the surgery right away.”
So Kamala does not go to Dhangadi Hospital. She is
not operated on that night either, as the lights in the hospital
are out. We pray that she survives the night. In the morning, we
are happy to see that she is still alive. Dr Shriwastav says, “Now
I will operate on her. I know it is a risk, but if all of you
support me, I am ready to take the risk”.
Time passes. At ten in the morning, I asked Dr.
Shriwastav about Kamala’s condition. She replies, sounding very
sad: “ I have not operated on her because her mother did not allow
me”. I was surprised and angry.
I go to find Kamala’s mother; she is feeding her
two grandchildren rice and salt. I ask her, in a mixture of local
dialect and Nepali, “Why did not you allow the doctor to operate
on Kamala?” The old woman looks at me with sad eyes and starts
crying. “I do not know what to do,” she says, “Kamala’s husband is
not here. She has five girls and only one son. If you will
operate, you will take out her uterus and she will have no more
children. Her husband will be very angry with me and will leave
Kamala.”
I am confused. I wonder why she needs more
children, after six. Then, with a shudder, I understand what this
woman means. She is saying children but she does not mean
children, she means son. How pathetic it is to hear such logic.
The old woman was more worried about an unborn grandson than the
life of her own daughter. I collect myself and explain to her that
we will not take out the uterus and that after she heals, Kamala
can have as many children as she wants.
Then, local health workers explain to the family
the surgery in their local dialect. Finally, the mother is
convinced that her daughter will be able to bear more children
(sons). She says, “Do as you like, but please save my girl.”
Within half an hour, Kamala is undergoing the surgery she needs.
Though very weak, she is finally out of danger and we are happy.
We congratulate Dr. Shriwastav, who took a great risk to save
Kamala’s life
This is only one of the many sad stories of women
in the remote areas of far-western Nepal. Even though all over
Nepal a woman’s status is much less than a man’s in all matters—
familial, social, cultural, political and legal. In the
far-western regions, it is even worse. A woman’s life is valuable
only if she gives birth to sons and is fit for arduous work. Many
times she has to give her life to make her family and society
happy. At others, she sacrifices her happiness and health to the
will of others.
The human development index (HDI) in Nepal is one
of the worst in the world and in the far-western region has the
lowest HDI in Nepal. Although no one is actually healthy here, the
burden of disease tends to be heavier for women, because of lack
of access to health care. Not only because there are fewer health
personnel and fewer health posts and hospitals, but also because
they face traditional taboos based on cultural practices and
religious beliefs. In Achham, where the female literacy rate is
only nine-percent (according to government statistics, which
generally try to paint a rosy picture), a woman’s life is valued
less than that of a mule. From the very day she learns to walk, a
woman in Achham-as in most far-western regions- starts to work.
She will work until the last day of her life. Women here are lucky
if they do not die in labour or from postpartum complications, or
due domestic violence and countless other preventable reasons.
In many regions in the
far-west, women must go to a cowshed or to an outside room, called
a chaupati (usually a small bare room with no windows), for labour
and delivery, and during menstruation. When she has her period, a
woman is “polluted” and must isolate herself. Because of such
pollution, she must also stay in the cowshed for 11 days after
delivering a child. Even if she suffering from heavy bleeding or
infection she is not touched or treated, and many times, simply
dies. Her death is not recorded and the government does not know
that a woman has had a maternal death.
We were told many sad events,
recounting times when women died in the chaupati because of health
problems just because no one dared touch a polluted woman. After
spending three weeks in Doti and Achham, and discussing with women
about their lives, I started questioning who is to blame for
women’s appalling status.
When I discussed the harmful
cultural practices of keeping women in chaupati and in cowsheds
with local political leaders and health workers, I asked them if
their wives also follow this practice. They all answered, “Oh yes,
they do. We know that it is not a good practice but if our wives
do not follow these rituals, we will be ostracised by society.
People will stop coming to us.” So no political parties, no
government employees and no health workers have come forward to
talk openly against this practice.
How long will the mothers,
daughters and granddaughters of far-western Nepal continue to die
and suffer in the name of culture, religion and social norms? We
in Kathmandu talk a lot about safe motherhood and make grand plans
and programmes to reduce the country’s maternal mortality rate by
half in the next five years. We give presentations in regional and
national workshops, but we never think about the fact that
motherhood can never be safe if womanhood remains in danger.
(Source: Nepali Times)
Back to Contents
