Introduction:

The breast center is the initiative of Dr. Bhim Nath Kharel, MBBS, MS (Surgical Oncology), who has lot of experience in dealing with all kinds of breast disease. It is envisioned to the one it’s first kind in the whole country in an attempt to provide all services related to breast health. It has the main aim of helping patients with breast diseases and increase awareness in the general public.

Objectives:

1. To provide best diagnostic, risk assessment and breast screening facilities.
2. To increase public awareness in the form of breast health and breast cancer risk classes and in the form of brochures, flakes, magazines and seminars.
3. To provide best treatment for breast diseases including breast cancer and help patients with rehabilitation.
4. To organize breast cancer survivor and breast cancer patients and relatives interaction programs.
5. To provide breast health and breast feeding classes for pregnant and lactating mothers.
6. To provide and develop breast cosmetic surgery facilities.
7. To co-ordinate with national and international organizations to increase skill, co-operation and research.

 Future Aims:

1. Immediately purchase digital mammography machine.
2. Install mammotome biopsy service.
3. Develop breast reconstruction services.
4. Engage in research related to breast cancer.
5. Develop national breast cancer database, through co-ordination with other stakeholders

The Endocrine Center is the initiation of Dr. Tirtha Lal Upadhyaya, MBBS, MD ( Endocrinology), who is one of the pioneer endocrinologist in Nepal. The center is envisioned to provide all kinds of services ranging from diagnosis to treatment in most of the common diseases in endocrinology and metabolism. The focus will be on diabetes, thyroid diseases, obesity and reproductive endocrinology.

Nepal has recently seen an unprecedented surge in focus on women’s health, especially related to maternal and child health and uterine prolapse. Misconceptions about women’s health, cultural biases, socioeconomic status, traditional values, illiteracy, poverty and low access of women in available facilities are widely believed to be the factors behind the poor health condition of women in Nepal.

During our regular health camps for uterine prolapse, we were often confronted with questions like “why do you people think that men do not have problem”, after several such encounters we finally sat with the male stakeholders and ask them about their, surgical problems. To our surprise they told us that like women men too are suffering from surgical problems like hernia, hydrocele which has impacted the working potential of many men. Then we decided to conduct a camp for hernia, hydrocele together with that for uterine prolapse. To our surprise almost similar number of men were living with these condition as women with uterine prolapse. When we asked these men why they were not seeking surgical treatment, majority of the men that financial reasons were the major concern.

Then our hospital with the initiation of Dr. Bhim Nath Kharel decided to work on the surgical outreach program which aims to performing minor surgeries in camp settings.

Our focus is in hernia, hydrocele, banding for haemorrhoids and minor breast procedures, together with basic surgical skills training program for the local health workers to improve their surgical skills.

We are presently looking for national and international partners or volunteers to work with us in implementing this surgical outreach program. Donations of surgical materials will also help us greatly.

We welcome your support, and like to thank your for your concern towards the health of needy Nepalese people.

Background and extent of the problem

In Nepal, Uterine Prolapse is a reproductive health condition distinguished by the protruding of the womb out of the genitals. This disease has spread massively; a study has identified the need of treatment for 6,00,000 women who are affected by the disease, out of which two hundred thousand require immediate treatment. Uterine Prolapse, is widespread across the country and has affected women in the mountains, hills, plains and the valleys of Nepal. In addition, Uterine Prolapse makes no distinction between young and old women, and women as old as eighty have been found to be among the sufferers But families and communities still refuse to speak about the disease and it is often a secret kept within the home.

According to the latest statistics of the Government of Nepal, 85 percent of the population lives in rural areas where basic health services are very limited due to geographical, economic, social and cultural barriers. In addition, Nepal’s health services were further pushed back after the decade-long people’s war in which basic health services, treatment centres, machineries, and treatments were targeted.  Even the health services that have reached the rural community have not been sufficient.

The reality for most Nepali women is even harsher. They are deprived of their basic rights to choose their own sexual partner, when to become pregnant, security from any kind of violence, eating when they desire food, education, treatment facilities, etc. Only a limited number of women know about their physical and mental health rights and the Government of Nepal has not effectively addressed this issue. Awareness-raising programmes on health rights have not been effectively implemented and the State has also been unable to address issues related to Uterine Prolapse despite the fact that this disease affects the lives of hundreds of thousands of women throughout the country. The Government has recently come up with a public private partnership program, but it has not been implemented yet

Rationale

Health of the Nepalese people is taken care not only by public sector, private practitioners, of both modern and alternatives medicine as well as by drug retailers, health volunteers and traditional healers. Most health care providers at rural level are inadequately trained and lack facilities for carrying out uterine prolapse prevention and control activities. Most of the local and international non governmental organizations that are involved are carrying out the screening activities and identify the problem, but due to lack of proper technical back-up they leave most of the women with double dilemma of living with the disease and searching for suitable treatment facility.

How is Samaj Hospital Involved.

Samaj Hospital is a private 55 bedded general hospital located in New Baneshwor, Kathmandu, Nepal. It was started with the objective of providing ” Affordable service, Prompt service and Quality service”. Hospital is already involved in Uterine Prolapse prevention and control activities and is also successfully carrying out surgery for uterine prolapse. It has a team of experienced Gynaecologists, Anaesthetists, OT staff and Nursing staff.

We have divided the program into two stage:

1. The first is the preventive stage, we with the supporting organizations organize the health camp, screen the women to assess the extent of the prolapse and provide pelvic floor exercise for those with 1^st and 2^nd degree prolapse. Ring pessary and pelvic floor exercise are needed in some cases. It is a joint programme with  HELP-Nepal a non-governmental organization.
2. The second is the curative stage, in which women with 3^rd degree uterine prolapse undergo surgery. Partial support is being provided by COSAN, FDP-Nepal and HELP-Nepal for surgery. The hospital is doing these surgeries at a very subsidized rate.  Basic pelvic floor exercises are also being taught to the patients after surgery. So far we have carried out more than eighty surgeries.

So far we have been involved in treatment of patients from: Kathmandu, Lalitpur, Bhaktapur, Kavre, Nuwakot, Gorkha, Dhading, Makwanpur, Sindhuli, Ramechap, Sindhupalchowk and other districts.

We have also MOU with HELP-Nepal to jointly work with national and international doctors for best management of cystocele and rectocele.

Objectives:

Overall general objective to carryout integrated women health awareness activity, and uterine prolapse prevention and control activities in rural Nepal.

 Specifically the objectives are to :

1. To provide orientation to local stakeholder of health promotion at the proposed Districts.
2. Carryout women health and uterine prolapse awareness activity in close collaboration and cooperation of local health care provider at the programmatic districts.
3. Carryout Uterine Prolapse screening camps and carryout surgery for uterine prolapse at the local Hospital or at Samaj Hospital. Make arrangements for pelvic floor exercise for those with 1^st and 2^nd degree prolapse.
4. Document the disease prevalence for evidence so that major health stakeholders pay attention in future.
5. Disseminate disease scenario information at various political and administrative levels.
6. To establish link and co-ordination with line agency and local CBO, NGOs and INGO’s at the programmatic district.

 Methodology:

1. Orientation and workshop meeting of executive committee and Project team.
2. Develop and finalize orientation materials for the Programmatic District.
3. Development of women health awareness, Uterine prolapse awareness and information brochures and pamphlets and awareness documentary.
4. Selection of health camp sites ( 2~3 health camps in one district)
5. Fixing of dates to organize health camps.
6. Local information dissemination at and around selected heath camp site about the health camp.
7. Organize health camps.
8. Prepare for surgery of the needful cases and make provisions for pelvic floor exercise.
9. Follow up of treated case.
10. Record, analyze, and prepare report for dissemination