Nepalese women suffering from uterine prolapse - A participant observational study in a maternity hospital in Nepal

Abstract: Background: Uterine prolapse is a condition in which the muscles and supporting ligaments holding the uterus in place gets too weak to keep the uterus in position. This causes the uterus to drop into the vaginal canal and results in a downward malposition of the uterus. Risk factors for uterine prolapse are among others pregnancy and delivery, improper delivery techniques, heavy work during and soon after pregnancy and heavy lifting. In Nepal uterine prolapse is one of the main causes for ill-health among women of reproductive and post-menopausal age. According to the United Nations Population Fund (UNFPA), the high number of affected women in Nepal is due to, among other reasons, the lack of skilled birth-attendants, women carrying heavy loads, lack of contraceptives and giving birth to many children. Aim: The aim of our study was to gain knowledge of how patients with uterine prolapse are cared for in a maternity hospital in Nepal. Method: An ethnographic approach was used to meet the aim of our study. Data was collected by four weeks of participant observations in a hospital in Kathmandu. The observations were complemented by interviews with patients and staff. Findings: The most striking part found in our material was the limited resources and their impact on the care provided to patients with uterine prolapse. The quality of the care was compromised by the lack of good facilities, material resources and manpower. This created a frustration among the staff as well as an unnecessary suffering for the patients. We identified three main categories in the data collected; Prerequisites for caregiving, Consequences for the patients and Consequences for the caregivers. These themes are presented in sixteen subheadings lifting different aspects of how the lack of resources affected the care.