Heartbreak in the Himalayas
Tuesday May 31st, 2022
At a combined meeting of the Rotary and Rotaract clubs in Sydney’s Northern Beaches: a highly informative and totally moving presentation was given by Dr Ray Hodgson. Dr Ray is an Associate Professor in Obstetrics and Gynaecology. He is a specialist genecology surgeon and obstetrician and is based in Port Macquarie.
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| Dr Ray Hodgson |
The night was opened by Rotary Balgowlah President, Rick van Brugge and
Dr Ray was formally introduced by David Mayne who is the DG of District 9650 and a member of Ray’s Rotary club – Port Macquarie.
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| David Mayne, DG District 9650.introducing Dr Ray |
The Crisis of Women’s Health in Nepal.
Dr Ray outlined that Nepal; especially in the mountainous remote areas, has an alarmingly high incidence of Maternal Mortality compared to many other countries. Rurally most people deliver their babies at home - with very little medical support or expertise available.
This horrible situation is only one factor; Nepal also has the highest incidence of genital prolapse in any country. Frequently presenting in severe cases where the bladder, bowel and uterus burst through the vaginal entrance and sit painfully between the mother’s upper thighs; often ulcers and infections are present.
Cases by the thousands of this severity were seen by Dr Ray and his team on each trip and few Nepalese doctors could perform the operation that resolved the problem. Many patients often travel days over almost impossible terrain to attend the clinics.
Symptoms include with chronic pain, incontinence, and the inability to perform any physical work on their farms. Their clothing is often smelly and frequently urine soaked. The devastating affliction faced by these women is further worsened and have a miserable existence since frequently is ostracised as a wife and mother by her husband and family. Unfortunately, most go untreated, and in cases where help and treatment is available the average wait is seven years.
The incidence of this medical problem in mountainous rural areas is higher since mothers are in their early teens, frequently expected to have many children with little space between them and poor obstetric care. Another key factor is that most women in Nepal carry very heavy loads and perform heavy physical labour each day on the farms.
Treatment & Prevention.
“In severe forms of prolapse where pelvic organs have fallen well past the vaginal opening, surgery may be necessary. This may involve a vaginal repair where the damaged pelvic floor ligaments are tightened, or a partial or total hysterectomy, where the cervix or entire uterus is removed through the vagina.”
Dr Ray said of the 150 people presenting in his most recent trip only about 7 could be operated on in the one day by the team.
"The secret is to tackle the problem in its very early stages, or better yet, prevent prolapse from occurring in the first place. If it is detected early enough, we can prevent the pelvic organs from falling further into the vaginal canal and beyond. In these early stages it’s all about lifestyle.
In the West, most women are aware of the importance of pelvic floor exercises. Those seeking treatment for early stage prolapse will be advised to avoid heavy lifting and constipation, and to brace their pelvic floor with any strenuous activities. But in developing countries most women are ignorant of these really important lifestyle changes. And even if these women do receive advice, the chances of them taking this on board are remote."
From :Heartbreak in the Himalayas, Dr Ray Hodgson, Busybird Publishing, 2020
The message of Hope.
Dr Ray’s passion for facilitating a resolution this devastating situation and provide a workable and sustainable workable medical solution to the two enormous and horrible problems of genital prolapse and maternal mortality in Nepal commenced with the launch of the founding of Australians for Women’s Health ( www.A4WH.org) .
It started with teams of volunteers (mostly from Australia) being assembled 3-4 times a year. Teams of up to a dozen people would fly into Kathmandu and after acclimatising then fly (in a very small, scary plane) to a camp that they would set up in remote mountainous places in the foothills of the Himalayas in Eastern Nepal.
The equipment and conditions were very primitive; but despite the severe cold and the very basic hospital set-up, equipment, and power outages; the team would treat patients - many who had travelled for days to reach the medical camp. patients would queue up overnight; often two nights.
After about 4 -5 years Ray and the team realised that this Band-Aid approach was only partly addressing the problem - despite some successes and inroads to the problems; many patients, especially those with multiple medical conditions could not be properly treated.
In 2014 it was decided that the team would concentrate on one area of Nepal, build a dedicated hospital for mothers and babies. A facility with modern reliable equipment; and a blood bank located in Dholakia. (North-eastern Nepal). Six months later the disastrous earthquake in Nepal, which caused the loss of 9.000 lives and facilities across the country - destroyed the buildings, supplies and equipment of the hospital. The surviving building(s) needed to be demolished.
Following this devastating earthquake, more social complications and medical problems arose. More malnutrition among women occurred; increased sexual abuse; more pregnancy complications and an increased lack of medical care. This overlayed the acute tragedy in women’s health that was present earlier. Temporary tent hospitals were then setup over the next 18 months. The reason to build a dedicated hospital was now even more apparent.
The future:
The plan is to now build a modern 35- bed facility for mothers and babies, with an operating theatre, intensive care, and a blood bank; plus provide services such as family planning and state of the art ultrasound equipment. A key factor to its sustainability is the teaching facilities. - the top floor of the proposed hospital will be dedicated to teaching, with computer modelling facilities just like those for local medical students, doctors, and midwives.
The outcome from Covid19 in Nepal was both urgent and serious – more than many other countries. Records are almost non-existent but cremations which increased dramatically gave an indication of the devastation there. Moreover, maternal mortality doubled over the last 2 years doubled. Neonatal deaths in the period quadrupled.
Covid has also reduced fund raising capabilities in Australia over in the last two years, so the setback to achieving the goal of the dedicated maternity hospital was notably delayed. $1.8 million is the target to build the facility. This has been achieved much though the support and endorsement of Rotary in Australia and internationally, only a further 20% needs to be raised to reach the target.
Building the hospital in Dholakia will not only address this urgent need, but also provide a model for other facilities in other parts of Nepal.
Dr Ray Hodgson’s book Heartbreak in the Himalayas is on sale via the website www.A4WH.org. All profits will fund the construction of a Mothers and Babies Hospital in rural Nepal.
Donations can also be made using the website.
Mina Howard, GD elect of District 9685, thanked Ray for an extremely moving and informative talk.
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| Left to Right - Back Row: Ruth Vumbaca (Pres Dee Why Warringah), David Mayne (DG, Dist 9650), Mina Howard (DG Elect, Dist 9685), Rick Van Brugge (Pres Balgowlah), John Power (Pres Upper Northern Beaches); Front Row: Dr Ray Hodgson. | |
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