"Sometimes I wish it was an infectious disease", says a frustrated public health activist in Nepal, exasperated by the amount of attention, and consequently funds, that is directed at HIV/AIDS, when the problem of the prolapsed uterus continues to be ignored. In Kathmandu, one can still see the evidence of a high voltage AIDS awareness campaign from last autumn on looming billboards. Not less than NPR 30 million (approximately USD 400,000) was spent during the campaign on bringing the illness into the open. And, while 'Let's-talk-about-AIDS' messages dot the cityscape, utero-vaginal prolapse languishes on the closely typed pages of dusty journals.
Even by conservative estimates, it is thought that hundreds of thousands of women in Nepal suffer from prolapsed uterus, as compared to the 58,000 Nepalis that have tested positive for HIV. But such is the neglect of women with prolapsed uterus that one can only propose general estimates, referring to 'hundreds of thousands' of victims with no pretence of precision, an indicator of the degree of the neglect. On numbers is predicated a response, and without them, the problem remains unquantified and, thereby, untackled. In this disregard for the problem is the story of how Nepal has, along with funds, imported its public health priorities from overseas; in it is an indictment of health policy, NGO behaviour and media.
In the simplest terms, a prolapsed uterus is the condition when the uterus, a curved sack expanding at the top and narrowing towards the bottom, comes out through the vaginal opening. This happens when, due to a multitude of causes, the ligaments from the wall of the stomach cannot support the organ anymore and it falls through, inside out. A textbook case of uterine prolapse is a woman of about 50 years, who has had multiple childbirths, and who usually gives a history of a difficult confinement or of giving birth to large babies. However, in developing countries, it has been found that uterine prolapse affects a much younger population, with girls of as little years as 15 suffering from it.
There are three degrees of prolapse. In the first, the cervix appears at the vaginal opening only when a woman is bearing down. In prolapse of the second degree, the cervix has descended to the vulva. In third-degree prolapse, the cervix protrudes, and in the most severe cases, the entire uterus may extend beyond the vulva. Tragically, because the problem is generally under-appreciated, and the textbook case is not entirely representative, even doctors often fail to identify the condition in the first two stages.