It was a fine morning, like most summer days, but I remember this morning more clearly. I woke up to my alarm, finished my morning routine, and headed to work. As usual, many patients waited outside my dental office, and as my assistant called their names one by one, I began to see them.
After I had finished with a few patients, I noticed a young lady – probably in her late twenties, with a thin build and unkempt appearance – standing by herself and looking lonely. She complained of severe pain in her lower jaw. After examining her, I was shocked to discover the pain was non-dental in origin. It was from blunt trauma. She was unwilling to tell me her story initially, but after encouragement, she burst into tears and described her husband’s physical abuse. Thankfully, her physical pain was not severe. But internally there lay a deep pain, torturing her every day.
I was emotionally touched by her story. I could help rid her of the external pain, but could not do the same for her excruciating internal pain. I compared my life with hers: we were about the same age, and lived in the same country. Other than that, there was an enormous contrast. She was already a mother of five; she was fully dependent on her husband financially. She was not empowered to change her situation. I imagined myself standing on one side of a bridge, where I have the basic rights and capabilities to live my life how I choose. On the other side stood this woman, who was suffering, but saw no alternatives. I often wonder, especially after encountering stories like hers, is my life so different from this woman’s simply because I come from the city, or received an education?
Her story is all-too common in rural Nepal, where each day women are physically, mentally and emotionally abused by husbands, in-laws, relatives and others. Underlying causes of this gender-based violence include poverty, illiteracy, lack of economic empowerment, and patriarchal values. Today in rural Nepal, few women are able to realize their basic rights. Social boundaries and cultural norms prohibit women from speaking out against those who abuse them. Families try to resolve domestic conflicts in private, but the decision is almost always the same: that the woman must continue living with her abusive husband or family.
Young girls engaged in household chores, a common practice in Accham. Source: Gettyimages
Early marriages and polygamy are manifestations of the patriarchal society in rural Nepal. Most girls drop out of school before the 10th grade and are pressured or forced to marry by age 14 or 15. Men are regarded as the “earning hands” for families. At the same time, women’s hard work in the community goes unrecognized and undervalued. In this setting, women lack empowerment. In addition, increased fertility rates, in combination with poor access to antenatal and emergency obstetrics service, threaten women’s health and contribute to high maternal mortality in rural Nepal.
A 19-year-old patient waits for antenatal checkup in Bayalpata Hospital. Teenage pregnancy is a common occurrence in Achham. (consent was taken for picture)
In addition to the economic and health disparities, cultural practices such as chaupadi also worsen women’s lives. Chaupadi tradition regards menstruation as impure. Women are required to live in cowsheds or huts while they are menstruating. This practice is very dangerous, and leads to exposure to cold weather, wild animals, and toxic inhalation in poorly ventilated sheds. Within the last year, two young women died due to chaupadi practice. Both incidents took place in the rural district of Accham, where I live and work.
A chaupadi (menstruation) hut where a young woman died from smoke inhalation, December 2016. Source: Achham Police
It has been 3 years since I first came to Achham. Working in such an underserved area has been one of the most important experiences of my life. I feel grateful to be part of an organization, Possible, which partners with the government to provide free health services in the district. I am happy to have witnessed the tremendous impact of the health services we provide. And yet, I have seen our contributions fall short when it comes to increasing women’s empowerment. In Nepal, many people worship the goddesses Lakshmi, Saraswati, and Parvati, as pathways to prosperity, knowledge and success. But while these goddesses – symbols of female power – are worshipped, the freedom and dignity of women in the community are neglected.
So what comes next in rural Nepal?
Women’s rights and gender equity are seen as fundamental to societal progress, and are represented in the United Nation’s Sustainable Development Goals (2015-2030). A commitment to gender equity is needed to help bring changes in rural Nepal.
At Possible, we recently formed a Gender Equity Committee, an example of how voices can be raised to promote justice for women. I take my membership in the committee to be a great responsibility, and it gives me a voice to help women in the region. Through this committee, doctors, nurses, therapists, psychologists and community health workers are collaborating on policy interventions and strategies to promote women’s rights.
Community health workers are an especially promising resource to build gender equity in rural Nepal. They are closely connected to the communities where they live and work, and have insights into understanding behaviors and attitudes around gender norms.
Gender Equity Committee meeting in Bayalpata Hospital to discuss plans and strategies to meet women’s needs.
The government of Nepal, in collaboration with national and international organizations, must play a role to promote gender equity by implementing programs aiming to improve women’s health. For women who are victims of domestic violence, resources need to be available to provide shelter and economic support. The criminal justice system needs to support women who come forward, and to take domestic violence investigation seriously. If such an environment were present, women living in rural Nepal could have a greater chance of being happy and healthy.
Being a female doctor in a privileged position of society, I feel in my heart that I have the ability to help women achieve their basic rights through advocacy and service. The Gender Equity Committee has been the initial medium through which I can generate and provide my insights to communities. I value the objectives of the Gender Equity Committee which can be utilized for the betterment of women living in rural areas. Visits to the communities and implementation of focus group discussions on gender rights and equity are the next steps which I plan to endeavor in the future. The start has begun from the organization, which would eventually expand to the local, regional and national level as we plan to work as a team. Cultural and traditional practices are always deeply rooted within society, but if every stakeholder knows the values of equity and justice, there can be a change. There can definitely be a remarkable change!