From December 2016 until December 2017, over 60 women made their way to Khema Nepal’s Pelvic Organ Prolapse Correction Program at Nepal Medical College Teaching Hospital (NMCTH) in Kathmandu from as far away as Mustang and Lumbini and Khotang, for treatment for advanced pelvic organ prolapse.  These women are from many different ethnic groups and live in vastly different types of terrain, but a common thread runs through their stories of hardship and poverty and suffering. 

Identifying Patients

Many of our patients suffered in silence with pelvic organ prolapse until the problem became too severe and they had to seek medical care.  A few sought help early and were given medicines and fitted with pessaries, but the problem worsened. 

There are a variety of organizations and institutions where women can be examined by medical professionals:: district hospitals, village health posts, private and government hospitals, and screening camps conducted by NMCTH, Lion’s Club, Rotary Club, and other social welfare organizations.  The poorest and neediest women for whom surgery is the only option are then referred to Khema Nepal.

These women must be willing to stay in Kathmandu for up to 21 days to allow for adequate recovery, and they must be accompanied by a caretaker.

Treatment for Patients

Once they are admitted to NMCTH, a variety of tests, including cervical cancer screening, are done.  If the woman is otherwise fine, or if she has other ailments that can be managed with medication in a few days, she is cleared for surgery.  She must stay at NMCTH for 14 days following surgery.  We insist on this, as the women go home and have no choice but to get back to work, and this complicates and delays recovery.  

Khema Nepal has created a truly comprehensive treatment package to help women with advanced pelvic organ prolapse who want surgery but are unable to pay. 

We provide the following services free of charge to the women :

  • Transport to and from hospital
  • Pre-operative investigations, including cervical cancer screening
  • Surgical procedure
  • Post-operative care
  • Operative and post-operative medications
  • Hospital bed and nutritious food for 21 days
  • Counseling by health care professional on reproductive health, nutrition, causes of illness and cultural barriers to seeking care. (Patients and caretakers who receive counseling are encouraged to share this information with their communities on their return home to increase awareness, and ways to prevent pelvic organ prolapse and other reproductive health problems.)
  • Food and board for the caretaker
  • Each woman is discharged from the hospital with a 6 months’ course of vitamin and protein supplements. 

Patients who have other complications that prevent them from having surgery are fitted with a silicone ring pessary, and NMCTH offers treatment for the other illness at a discounted rate. Khema Nepal may pick up this cost for the treatment of the other illnesses on a case-by-case basis.

Expected Outcomes

Women who receive treatment experience relief and an increasing ability to participate in daily activities with their families and in society. They report feeling happier and healthier than they have in a long time.

A study by Dhital, et al in 2013 showed that Nepalese women receiving surgical correction of pelvic organ prolapse had statistically significant improvement in Quality of Life (QOL) with respect to psychological, physical and social health.

Patients and caretakers are counseled on reproductive health, nutrition, cultural and traditional factors that lead to the high prevalence of pelvic organ prolapse in Nepal and also the availability of services such as Khema Nepal’s POP program. They are encouraged to share this information with their communities on their return home. This information-sharing creates awareness about the health issue, its causes and the available treatment options. An informed community will gradually adopt preventive measures which eventually will lead to lower incidences and prevalence of pelvic organ prolapse.

Evaluation and Post-treatment Follow-up

The prognosis for patients is largely based on their lifestyle choices after discharge, over which Khema Nepal has no control. Therefore, Khema Nepal focuses on education about post-operative care during the hospitalization which is critical for a positive long-term outcome. Khema Nepal will be able to evaluate the immediate success of the procedure by utilizing a questionnaire. At the time of the hospital presentation, patients will be given a questionnaire to assess their symptoms as well as to document personal and lifestyle details. They will be asked to complete the same questionnaire 6 months, and again 12 months after discharge. The comparison of the questionnaires will be used to evaluate success of the surgery and to assess the improvement in their quality of life.

It is important to note that many patients may not be reachable for follow up or evaluation as they live in remote areas with no access to roads. However, most patients or their relatives have access to phone and they are provided with Khema Nepal and NMCTH’s contact information at the time of discharge, in case they need help with complications that they face as a result of the hysterectomy.