The beautiful and strange reproductive system...

Recently, I’ve learned all about the joys of the reproductive system here in Nepal.  It started with a yearly family planning program at my health post.  This program had several parts.  The first was just general information.  The second, a screening for uterus collapse.  The third, birth control injections for women who volunteer for it, and lastly, a vasectomy for any male volunteers.

Many women came for the screening which was good.  I didn’t take part in that because I think the screening was a bit invasive, and the women probably wouldn’t be too comfortable with a random guy watching, even though they all pretty much think I’m a doctor.  I don’t think they found any collapsed uteruses, and I don’t even know what that is exactly, but it sounds bad and I’ve been told it requires surgery.

This next bit I am very proud of myself for doing, especially if you know how good I am at dealing with needles.  I watched the birth control implants being injected.  It took me a couple tries for me to make it all the way through the procedure without feeling bad and having to take a break.  The first one, I watched the numbing injection go into the arm.  This wasn’t quick; the lady doing the procedure inserted the needle and the moved it around a whole bunch under the skin until she found where she wanted it and then slowly injected the numbing agent.  Needles to say (pun intended) I got light headed watching that thing being moved around under the skin.  I took a break and came back to watch the lady cut a small slit in the arm with a scalpel and then she took this big ass needle with a small (about half the length of a toothpick, but same width) implant in it, and stuck that into the slit.  She started moving this around a whole bunch to get it positioned just right.  At this point I had to leave again.  I took a longer break and came back to watch the next procedure.  This time I made it all the way through.  The numbing, cutting, and then inserting the implant… but wait there was not just one implant, but two!!  The first, the lady pushed out of the huge needle with the plunger part of the needle thing, and then she moved that needle a whole bunch more under the skin to get the second implant lined up.  I could see that huge needle moving around under the skin very clearly.  But basically, I just really need to nut up when it comes to needles so I forced myself to watch.  Then the plunger was removed, and the second implant slid into the needle, and then plunged in just under the skin.  Then the cut was patched up, and the lady was told to sit for a minute or two, and then out the door and time for the next lady.  The implants are good for five years, and the women were told all about it before they signed up for the procedure.

This program seems pretty good to me.  All of the women who came were a bit older; like late twenties or early thirties, and I think they just don’t want any more kids.  Also, the surgery conditions weren’t ideal, but a very good effort was made to keep everything as sterile as possible.  They had big sterilization pressure cookers that all the instruments came out of before being used.  All of the doctors came up in a truck from the district capital with mobile medical supplies so all of the complicated procedures (the screening and vasectomy) were done by actual MDs, and the insert was done by trained nurses.  I was impressed.

I also watched a vasectomy…or at least half of one (meaning the tubes of one testicle being tied).  I was standing outside and this guy walks up who has no idea who I am, and asks me if a vasectomy is a good procedure.  I say, “Yes.”  And he says, “Okay, thanks for that.”  Then he walks into the “surgery room” takes his pants off and the process begins.  First, he gets his testicles shaved, which I was still outside for, then lies down on the table.  At this point, someone asks me if I want to watch, and I’m thinking, “Hell NO!!”  And say, “Yes.”  So I walk in, and stand back against the wall at the patient’s feet which meant that the patient could see me, since his head was propped up a little bit.  This put quite a bit of pressure on me not to cringe because I think the guy was already pretty nervous about the procedure, so the last thing he needed to see was someone who he thought is a fancy western doctor making horrible faces.  This was really tough for me because the first thing the doctor does is whip out a big ass numbing needle and put it into the guy’s testicle.  I assure you every part of my brain was screaming, so I just narrowed my eyes in what I hoped was a very critical and thoughtful look.  It probably looked like a cringe though. One of the assistants turns on a mag-lite and shines it on the testicle at this point, and holds it for the rest of the procedure.  Next, the doctor cut open the testicle, uses a hook thing to pull out the tube, ties string around it in two places, and then cuts in between.  After that, he cleans up the string, and puts the tube back in.  That was it.  I decided to bail for the second testicle because watching that go down wasn’t that awesome, but good for my pansy-ass tendencies to be light headed around needles, and also a good learning experience.

Overall, we put implants in four women, and four guys volunteered to be snipped.  That’s not too bad for rural Nepal, and considering neither of procedures looked very fun.

Then, another day I had a “Nepali culture experience.”  It was something we were made aware of in training, but I still found parts a bit shocking.  My host sister got home late from work, said hi, and then sat down on a stool outside the kitchen.  Then my sister’s friend, who stays at our house all the time, hands me a plate of food and says, “Give this to Sarmilla.”  (Sarmilla is my sister’s name).  I thought this was pretty strange they never have me bring people food.  Sometimes I’ll go fetch someone from their room when it is dinner time, but I don’t usually bring food.  I walk out of the kitchen, and I figure it out: She is menstruating.  We had learned that it is not uncommon for women to have to eat separately when menstruating, and in very traditional families the women have to go to a shack for the duration.  Earlier my sister was sitting by herself and I walked up and asked, “What’s up?”

“I’m sick,” she said.

“With what?”

“Typhoid.”  After which I laughed and then she said, “Blood cancer.”

At that point, I thought that she was being really weird, or she was using a very disturbing code for being on her period.  But then I put it from my mind until I brought her food.  When she was done, she went into the bathroom and washed her dish, and when I went to grab the plate to bring back to the kitchen she yelled, “NO! You can’t touch my plate!! It’s Nepali culture.”  I asked a few questions to make sure I knew what was going on, and then said I thought it was strange because in America things are different.  I made sure to express my displeasure at her being forced to eat alone, and also I was a bit saddened because the way she almost panicked when I went to grab her plate makes me think that she truly believes that she is dirty or that something is wrong with her when on her period.

I also found it strange that they draw so much attention to something that they are all clearly think is somewhat disturbing.  Why make her eat outside?  Do they think they are going to catch her menstruation?  In training we were told that people just think it is unclean, but they all wipe their asses with their hands…I am definitely missing something when it comes to this.  Yes, Americans can also be very weird when it comes to menstruation, but here in Nepal it is just one more way that women are kept down.

Maybe I found this such a bummer because I feel so bad for my host sister.  She is (as far as I can tell with my limited Nepal) a very, very nice person.  She works super hard in the house, and also has a regular job.  She cooks, cleans, and is generally smiling while doing it.  And one day she was working in the kitchen and this little Indian man, who is the local carpenter, walked in and started having a conversation with her.  She laughed and then shook her finger at him and pretended to hit him.  I thought they were joking around.  The Indian man is not Hindu, but Muslim; however he is also very influenced by the Hindu culture, and both religions have some very anti-woman tendencies.  The man who is renting a room for several months and speaks English very well translated for me: “He was telling her how he was brought up to believe and now believes that women are the dirt on the bottom of your shoe.”  (A big insult in a culture where even showing someone the bottom of your shoe is an insult).  Anyways, she laughed at him, but I could see in her eyes just how much that cut.  I mean, to be told in all seriousness that you are worthless must really suck.  And when your whole culture backs up a statement like that…ugh.  Just the disappointment that people have when they give birth to a girl must be so detrimental to every girl’s psyche. 

Recently I went to a local school and taught for a day which was very fun so I’ll be back.  A student in the 10^th grade class I taught for a period asked me what is the most important thing Nepal should do to develop.  I thought for a second, and then with my sister in mind I said, “Eat a lot of vegetables, and send every girl to school.”

At the school I managed to get some good stuff into my lectures.  I taught 8^th, 9^th and 10^th graders.  In 10^th grade English class we talked about AIDS and trash cleanup along with learning some new vocabulary.  In 8^th grade Health class I was handed the health textbook which mostly contained statistics about how many hospitals there are in Nepal…really useful stuff.  As I was scanning through I noticed a discussion question that said to talk about health problems in the community, so I skipped right to that question.  They listed a bunch of problems and diseases, and then I asked,” Which of these diseases and problems is preventable?”  I helped them figure that out, and then we talked about how to prevent them, and I hurried us along to diarrhea because I decided I wanted to focus the class on handwashing.  I asked how many children under 5 die from diarrhea in Nepal each year, and they gave a few guesses from 200 up to 1000.  I told them,” 75,000!!”  This really blew their minds, and then I asked the best way to prevent diarrhea.  We arrived at handwashing eventually, and as statistics suggest I told them, “Handwashing can prevent 90% of deaths from diarrhea in children.”  I then had them do the math themselves and discover that just by washing hands properly 67,500 children’s lives could be saved each year in Nepal.  This is where class ended, and I felt pretty good about the lecture.

Also, at the Health Post I’ve become the wound care guy since I know a fair amount about that.  It started when a kid came in with a dog bite, and one of the workers dabbed some iodine on it and was getting ready to bandage it up when I stopped him.  “No, no, no.  Dog bites are very dangerous.  This has to be well cleaned,” I said.  And then brought the boy to the water tap and asked for some cleaning pads and some soap.  Then I told the boy, “This is going to hurt.”  I scrubbed the shit out of the bite, and discovered that the dog had actually pierced pretty deep.  I had the workers ask the mother if the dog looked rabid (No, thank goodness).  Then I bandaged up the cut with some iodine (which is the only wound treatment antibiotic we have), and told him to come back in two days.  But first he got a tetanus shot.  The kid was brave.  He cried a bit with the shot, but the whole time I was digging broken chunks of skin out of his blood he really nutted up.