Background
Methods
Study setting
Participant recruitment and data collection
Hospital | Number | Community | Number |
---|---|---|---|
Women admitted for surgical treatment of prolapse a | 8 | Follow-up of women having undergone surgical treatment at hospital | 8 |
Health care providers | 2 | Women who had undergone surgical treatment at the same facility and time period | 4 |
Representative from organization affiliated with the hospital | 1 | Health extension workers working at community level | 4 |
Health care providers working at health centre level | 2 | ||
Representatives from international NGO | 2 | ||
Representatives from the health authorities at district level | 2 | ||
Total interviews | 11 | 22 |
Analysis
Ethical considerations
Results
Mean age | 43.3 years [range 32–60] |
Marital status | |
Married | 8 |
Divorced | 3 |
Widowed | 1 |
Mean age at first marriage | 13 years [range 7–19] |
Education | |
No school / illiterate | 10 |
Literate | 2 |
Occupation | |
Housework | 6 |
Housework and farming activities | 5 |
Daily laborer | 1 |
Mean number of children | 3.6 children [range 0–8] |
Mean age at first delivery | 18.5 [range 13–24] |
Place of delivery | |
All deliveries at home | 10 |
One or two deliveries at health facility | 2 |
Recovery
I used to have to walk by holding the prolapse; I couldn’t walk like I wanted to. I had a lot of problems. But I’m thankful after the surgery; it was a big change. I had suffered for six years. (32-year-old married woman)
Until my [hospital follow-up] appointment was approaching, I lay on my bed while my neighbours fed my family and me and took turns doing my chores. (52-year-old married woman).
I don’t work at home much anymore. My daughter is cleaning the house, inside and outside. I used to help with the farming, but now I’ve stopped doing that too. My husband manages by himself. (40-year-old married woman).
I feel I am cured now. But I don’t doubt that if I start doing heavy work again I would feel sick. Now I fear to do heavy work. (32-year-old married woman).
I used to work as a labourer preparing food for people. I don’t feel good enough yet to start work. I can’t even walk long distances or lift anything, and I don’t have anyone to help me. I ask neighbourhood children to fetch water for me. I no longer have any money saved, and I feel that darkness has surrounded me. I had to send my two young children to work in other people’s houses. If I sit like this, how can I feed myself? I’m still waiting to recover, and then I’ll start working again. (39-year-old divorced woman).
We haven’t had sex for five months now, and he hasn’t forced me. He hasn’t asked me during this time—he can see the pain I’ve been in. (35-year-old married woman).
Disclosure
Once we travelled together to the hospital, we didn’t talk about anything but our conditions for five days. We didn’t know each other, but we still talked a lot. We laughed and discussed like mothers and daughters do. We all shared our experiences with the prolapse. (35-year-old married woman).
After the treatment, people asked me where I’d been and what had happened to me. I told them all about my condition and the treatment I’d received. (39-year-old divorced woman).
Why should I feel shame now? I’ve seen the light. I hid the condition for 20 years. But now that I’ve had the treatment, I’ve escaped the pain. I feel relaxed now. (40-year-old married woman).
Women have become more open to talk to us about their problems. We usually speak about prolapse when we get a chance in the Church or at community meetings. Then women come directly to us and say: “I have this problem. I kept it to myself.” (HEW 2).
Reintegration
It used to be embarrassing to sit with people outside or inside others’ homes. It was shameful for me to eat, drink and [suddenly] go outside to urinate. I stopped attending social gatherings because of that. That situation cannot be compared to the present. I urinate less frequently, and I can sit how I want to sit and talk with relatives without a problem. (35-year-old married woman).
I haven't started visiting relatives yet because the doctor told me not to go anywhere far for six months. I might start having long journeys and visit relatives soon, God willing. (45-year-old married woman).
One of these women is my neighbour. Now we drink coffee and fetch water together. Both of us trust each other. (40-year-old married woman) We all have a wish to meet after the surgery, and we have planned to meet at every holiday. (39-year-old divorced woman).
Engagement
If the new initiative goes on, women won’t be hiding this condition anymore. It is a way to avoid women’s discrimination. (Health-care provider, Health Clinic).
A lot of women out there haven’t yet received treatment [for prolapse]; they hide their condition and pain. One woman from my village came to my home—she had been too ashamed to tell anybody about her condition. I asked her why she felt ashamed. We don’t have to hide this condition these days. After our conversation, she talked to the health-extension worker and was sent to the hospital for surgery. She later became a very dear friend. (32-year-old married woman).
When mothers return home after being treated, we train them, and the health bureau also gives them a checklist. They mainly work alongside the community health workers (HEWs), and we encourage them to participate in different activities of the project. We also have a radio channel which facilitates the mobilization process. (NGO representative).
When I go to fetch water, I inform women [about prolapse]. I also tell their husbands to take their wives to the hospital if they are sick. I explain how I got better. I advise them to seek medical care because the government supports us now. Many women hide their problems, and that’s bad for their well-being. I suffered a lot because I concealed my problem. (40-year-old divorced woman).