In November of 2022, three members of the Ubuntu team (Fiona, Annabelle and Sam) visited COSAN, one of the projects Ubuntu raises funds to support. COSAN run womens health camps throughout remote Nepal with a focus on cervical screening and prolapse identification, education and intervention.
On this trip we went to help run a 2 day health camp in a village called Saptari. Saptari is located in south east Nepal (an 11hour drive from Kathmandu!), right on the Indian border. In this area many of the people have no citizenship, being neither citizens of India nor Nepal. This makes it a particularly vulnerable population with poor access to health care.
When going into new areas COSAN reaches an agreement with the local government, working together to inform women in surrounding areas about the camp, encourage attendance and transport them to the health camps when they are running.
On the first day of the camp all the volunteers were welcomed with a lovely opening ceremony from the local town officials and Mayor. The team consisted of 3 nurses, a gynaecologist, us and a few other coordinating members.
Two rooms were utilised to see patients, one was with the gynaecologist - here she examined all patients for a presenting ‘women's health’ complaint, for prolapse or pain, wrote scripts, and referred those who were in need of surgery. The other room was with the nurses and purely for cervical screening and identification of STIs.
During the sessions, Sam mostly sat outside triaging the women, he took a brief history and blood pressures. Annabelle and Fiona rotated between the rooms, spending half the day helping in each. In the room with the nurses, they assisted with the speculum insertion, inspected the cervix with the nurses and performed the VIA tests - with the nurses making the final decision as to whether there were any pre-cancerous lesions. We performed thermocoagulation on those that had these lesions - where the outer layer of the cervix containing pre-cancerous cells is removed.
Cervical cancer is the leading cancer in women in Nepal. Around 30-40% of women who came in over these two days had precancerous lesions on their cervix and required thermocoagulation. The HPV vaccine has not yet been distributed throughout the country free of charge and therefore screening like this is vital.
Women are also examined for odour and discharge to diagnose and treat STIs with STAT treatment. Mostly candida, chlamydia, gonorrhoea and trichomonas. Other conditions seen were PID, cervicitis, narbothian cysts and incontinence. Any major cervical pathologies identified were referred to the hospital. Women are also educated about self breast checks and if women already have lumps and symptoms they get sent to the hospital.
The gynaecologist sees three women at a time. She takes a history from one, examines one (primarily looking for prolapse) and writes treatment for the other. Women were literally pushing at the door to get in. Many women had some form of prolapse, whether that be a mild rectocele, cystocele or uterine prolapse.
The nurse told us that 60% of women on average have some form of prolapse. Only patients with a 3rd or 4th degree and older than 40 and symptomatic are sent for surgery in Kathmandu as otherwise the demand is far too high. All women get advice and education, including pelvic floor exercises (using our pamphlets to assist with the education!!). Where mild prolapse is seen all are offered a pessary, although these are often declined (due to a negative stigma that exists around them).
A few women who were seen had been living with a 4th degree prolapse for over 20 years - rarely would you see a presentation like this in Australia. The discomfort and pain many of these women endure on a daily basis is unimaginable. And a rewarding experience to know that the funds we raised at the Ubuntu Annual Fundraising Dinner went directly to alleviating the suffering of these women. We were very excited to participate in the camp and were ecstatic to see the handouts Ubuntu created being given to every woman as well!
Over the 2 days we saw upwards of 600 women and had 10 on the list for surgery to be done the following Monday in Kathmandu.
One camp costs around $2500. When women have a severe enough prolapse to warrant surgery (hysterectomy), this costs an additional $350-$400/person. COSAN funds all of these, including transportation to Kathmandu for the surgery, along with accommodation and food.
In 2022 we donated $6000 to COSAN which will cover 1 x 2-day camp + 8-10 surgeries. They run several camps a year but are struggling to maintain this as they need more funding for the projects. Each camp has been in a different location in rural Nepal so far, and they are hoping to do follow up camps in the future for women who have been seen by them.
In a lot of the areas they are servicing, many of the women have never seen a doctor and the health issues they present with are very progressed. So, the screening and interventions done by these camps are very impactful.
The work we did at the camp was so incredibly fulfilling and purposeful and really highlighted to us just how much demand and need there is for this in Nepal. It was so great to be involved and get so much cultural education and hands-on clinical exposure. So much help was given over the two days that will be life changing for many. It has left us all feeling extremely satisfied and proud of how the funds Ubuntu have raised and continue to raise are being used by COSAN - every cent really makes a difference.
Thank you to everyone who has donated in the past or continues to donate. It really means so much to every woman that is seen.
