Surgical Management of Uterine Prolapsed Cases of

Doti, Bajura and Achham

- Shyam Shrestha, Doti

 Uterine Prolapse is a common problem among women of rural Nepal and is in an increasing trend. Local organizations recently decided to collectively hold a camp to treat third degree prolapse cases of Doti, Bajura and Achham. With financial support from CARE Nepal, Cluster Office, Doti through ASHA project, Family Planning Association of Nepal (FPAN), Nepal Red Cross Society (NRCS), Shreejansheel Samaj spearheaded the process of identifying patients followed by communication and counseling services. A team of doctors from the nearby Nepalgunj Medical College agreed to conduct surgery in the camps. A video was also shown on uterine prolapse causes and prevention. A detailed plan was laid out for prevention awareness, cure and care for the operated patients.

Activities:

Volunteer Counseling Before Operation Following the proposal to organize the camp in coordination with District Health Office-Doti, District Hospital was unanimously identified as the most appropriate venue for operation. CARE Nepal Doti cluster was responsible for financial support, Shreejansheel Samaj was responsible for case collection, NRCS and FPAN were responsible for providing volunteers to run counseling section. DHO was responsible for coordination among doctors, other stake holders and Regional Health Directorate (RHD) for more patients from other adjoining districts like Bajura and Acham.

The operation continued from 24th March till 29th March 2009 with doctors looking not only at operation, but also at medication and post surgical care. The patients were screened for the degree of prolapse. Ring pressury were inserted in first and second degree prolapsed patients whereas the third degree patients were counseled on operation and post operation care before being taken for operation. Following the surgery, the patients were kept in a separate room for post operative care by nursing staff. It was mandatory for patient to be accompanied by her family member so there was someone to look after her. The patients also received travel allowance based on the distance from their home. Food was provided not only to prospective patients, but also to volunteers from NRCS and FPAN working for pre operation counseling and registration process.
Altogether 78 women received the surgery and some others had ring pressury inserted. The overall achievement, from management and technical perspective, was overwhelming.

 Challenges:

•  Clients were not able to arrive from Acham and Bajura as expected.
•  Food management for clients seemed complicated and chaotic.
•  The area was not sufficient with increasing number of patients. The camp had to refuse several cases due to this problem.

 Lesson learned:

• Coordination among local partners simplified the process of collecting possible uterine prolapsed patients.
•  It is better to provide cash (money) to the client/visitor as per rule for their meal rather than giving coupon.
• Appropriate place for post operative clients should be managed before making a plan of operation in future.