Women In Nepal

My time volunteering has come to a close. I can't believe how fast it's gone and yet I'm very ready to move onward. I'll still be travelling a bit more before starting up my own clinic in Chatham, NY, but I am eager to serve the people, in particular women, there. In preparation to do so, I want to reflect a bit on the women of Nepal.

Some of my non-English speaking lady friends in the village!
The grandma on right is super awesome.

As I've mentioned before, life here is rough. Unfortunately, it's rougher on women than it is on men due to male-preferred culture. Boys are preferred over girls because boys stay in the family home and continue the family business. Girls get married off in an arranged marriage (love marriages are still rare in Nepal) and move into the husband's home. Since the males stay in the family, there is a stronger tendency to put resources into them; namely education. Luckily, things are changing and more and more women are growing up educated, but it is still largely disproportionate. Since boys are busy getting educated, girls are expected to do work around the house from a young age, and are constantly busy. Since the boys spend 6 days a week in school, the are not part of the 'chore wheel' and when they have a day off from school, it's truly a day off.

In a month long festival (not sure of the name),
women and men splash themselves in this 
holy water for blessings. The main purpose 
of this festival is for women to find a good husband.
 Older women dunk themselves in the water,
apparently to find a good husband for their daughters.

In my main clinic in Bhotechaur, all the staff are live-in, so I got to be friends with both the women and men that work there. In Chanaute (the second clinic), though, there is only one live-in staff. It just so happens that all of my friends there are male--since men are the only ones with free time. While men help with the family business and the family farm, women are the ones who do laundry (by hand) and cook--meaning they are busy from dawn until late in the evening since dinner is typically 7 or 8pm. When I ask my educated female friends (in Bhotechaur) what they did on their days off before moving into the clinic, it is always laundry and rest--maybe grabbing some spicy snacks with a friend.

Me and our 'retired' clinic blood pathologist
She still has a full day of work in her home!

Since women are married young, they also have a very long time in which they have to manage their reproductive years. It's great that the general population is being educated on the benefits of having fewer babies, but there aren't a whole lot of options in terms of reproductive control. Most women opt to use Depo shots--which completely stops menstruation--which is donated by the US government. I'm not a huge fan of any of the hormonal reproductive control options, but to stop menstruation by high doses of hormones is the worst of the bunch. Of course, it's better than having 10 or 15 babies.

Ladies cleaning up the big pots after a festival 
where Shiva hangs out around a bonfire
More specifically, women fast all day then gather in the evening
 to eat with the whole village, light a giant bonfire,
 then sing and dance. The festival is to ensure 
the health and long life of the women's husbands.

As a result of all the above factors, I have seen a lot of women with lower abdominal pain, burning urination, vaginal itching, white discharge with odor, and many, many women with uterus prolapse. Insertion of uterine mesh has been increasing, and while it helps in some ways, harms in others. While there are many people both men and women with burning and tingling in their hands, it is disproportionately female since women spend so much time with their hands in cold water washing laundry (in Chinese medicine we call this 'cold damp bi/obstruction'). I'm happy to offer some relief to these women, but a lifetime of hardship is hard to completely undo.

Nepali homes are big; because they house a lot of people!
That means a lot of laundry....

I've also noticed that postpartum Nepali women have significantly more abdominal stretching, even at a young age, than western women. I've discussed this with the other acupuncture volunteer and we suspect that this is due to the low-protein diet--less elastin in the skin. Nepali women often wear long pieces of fabric wrapped around and around their abdomen postpartum onward, possibly to help hold their organs in place!

While most of my patients are older, I feel very fortunate that I've had the opportunity to help some younger women as well, and help them avoid a lifetime of pain. I recently had patient age 23, postpartum with uterus prolapse. While prolapse is rare in someone so young--and rectal prolapse is more common than uterine postpartum--it can occur based on where the baby's head pressed into the vaginal wall on it's way down the birth canal. Some muscles are weakened by the pressure, and then prolapse can occur. She came in not for the prolapse itself, but because the pain in her abdomen was interfering with her ability to do farm work. I was able to do both internal pelvic care (I've been trained by Tami Kent in Portland) and acupuncture with her. I don't know how to assess uterus prolapse, but her pain has been greatly reduced! I'm so happy to have been able to serve her and many other women like her.