Nurse Cath Nixon spent two years volunteering in Nepal to tackle challenging issues facing women living there. She tells AASMA DAY about the life changing trip.
When a woman gives birth to a boy in Nepal, it heralds a time of celebration and joy.
However, when a daughter arrives, the birth is not celebrated.
Cath Nixon, 30, of Hoghton, near Preston, who has returned after two years and three months volunteering in Nepal as a public health nurse as a placement with Voluntary Services Overseas (VSO), explains: “Women in Nepal are generally treated like second class citizens.
“It beings at birth where the birth of a son is celebrated, but the birth of a daughter is not. Girls are also expected to drop out of school and help out with household chores.”
Cath, who is a health visitor working in the community, first heard about the work of Voluntary Service Overseas about 10 years ago while she was studying nursing at university in Manchester.
She knew it was something she would like to do but knew she needed to acquire skills and training before she did it. After becoming a community public health nurse in 2009, Cath felt she had the relevant skills to embark on a VSO placement.
Cath says: “During my training as a health visitor, I went to health conventions and was keen to put my skills to use in an international health capacity. I learnt about the position of health globally and the comparisons between the developed and developing world.
“It was inspiring to hear how you could use the skills learnt in the UK to help in developing countries.”
Cath and partner Gareth George, 33, who is a secondary school teacher at Lytham High School, both decided to apply to VSO and were accepted.
A place became available in Nepal with VSO’s partner organisation Women’s Empowerment Forum for Cath and Gareth went with her as her accompanying partner.
Cath was posted to Nepal as a public health nurse at the district hospital in Dailekh, which is in the foothills of the Himalayas.
Cath says: “The country is beautiful, however poverty was rife. My work was varied, but it was focused on improving standards and raising awareness of the care vulnerable women receive before and after pregnancy.
“My day started very differently to in the UK. I would wake up early, around 5am and as I didn’t start work until 10am, I would go for a cycle, wash clothes or chat with a neighbour.
“After cycling a short distance to the hospital, I would meet with the nurses in the antenatal clinic, where we would discuss any problems from the day before.
“I would then observe how nurses interacted with patients and provided feedback and training.
“As part of my placement, I also worked with Women Empowerment Action Forum as a community mobiliser. I would visit communities and villages, educating them about women’s health rights and empowering them to make positive changes as well as involving them in the decision making process.”
Moving from the UK to Nepal was a huge change for Cath and even though she went there with partner Gareth, the couple did not really see each other during the week as Gareth got work with VSO with district schools and it took them between three and six hours to get together.
Cath recalls: “It was completely different from life in the UK as I went from to living and working in a busy place to a rural area where no one spoke English.
“It was a small community and most people had never met a foreigner before.Everyone would stop and stare at you. You couldn’t be anonymous. However, it was nice to be part of a community and know your neighbours around you.”
The language barrier was the first hurdle Cath had to overcome.
She had three weeks of language training before going to Nepal and after that, she just picked Nepali up while she lived there.
Cath explains: “I committed the first three months I lived there to learning the language. It became my everyday language and although I was not 100 per cent fluent, I got to know it well and could have conversations.
“That in itself was a challenge because I had never learnt a language before apart from what I learnt at school.”
Women’s Empowerment Action Forum were unhappy with the way women were treated in the area and their status in society and they worked to re-educate women.
Topics they discussed included violence against women and sexual and reproductive health as well as early marriage.
Cath says: “There is a high rate of child marriage in Nepal and girls tend to be married off earlier on.
“Even though there is a law in place to prevent girls getting married until they are 17 with consent or 18 without consent, it is not really implemented and there were no repercussions.
“Quite a lot of girls in Nepal were getting married at 15 or 16, especially in the villages - sometimes a lot younger than that. Their destiny is then in the hands of the family they marry into.
“The girls are in the hands of their in-laws and they are sometimes right back to being at the bottom in status and are viewed as lower than everyone else in the family.
“It depends on how the in-laws value the status of women as to whether they will invest in their education.
“Women also have children quite early on and if often depends on whether they have a boy or a girl on whether they regain status within the family.”
When it comes to pregnancy and childbirth, Cath learnt of the different health issues facing women, mainly to do with girls having children early before their young bodies are ready to bear the brunt of pregnancy.
Cath says: “What struck me most from my placement was that women in rural Nepal face challenges throughout their lives.
“They start working very early and finish very late at night and are expected to do a lot of the heavy labour such as carrying water and grass even when they are pregnant.
“This, combined with early marriage and home births, contributes to health problems in women in Nepal such as uterine prolapse - the bulging of one or more of the pelvic organs into the vagina.
“This dangerous and often unreported problem in Nepal usually happens after the birth of a child.
“It is caused by a variety of problems and is exacerbated as women in Nepal don’t always give birth in hospitals and inexperienced people will have to deliver the baby.
“This leads to problems if the placenta is pulled out too quickly or if too much pressure is put on someone’s stomach during labour.
“There are also other issues that can lead to uterine prolapse such as domestic violence and malnutrition.
“In the case of malnutrition, women will wait until after their husband and children have eaten making do with the leftovers while their day-to-day duties such as carrying water, churning rice and squatting to wash clothes, can also put pressure on the uterus.”
Cath learnt there are also cultural procedures in Nepal to keep women in their place.
She says: “There is a cultural practice in Nepal called ‘Chau Paddy’ where women are seen to be unclean during their menstrual period.
“During that time, they are expected to sleep in a cow shed separate to everyone else and they are not able to drink from the same tap or be allowed to eat the same food as other people. The practices are changing, but it takes a long time.
“There have been changes in the law in Nepal in the last decade to improve the status of women. Unfortunately, it does not always filter down to the villages where cultural practices speak louder than the written law.”
Despite hearing some shocking stories and learning about the challenges faces by women in Nepal, Cath was amazed and humbled by the women she met and believes she learnt a lot from them as well as sharing her skills and knowledge.
She explains: “The spirit of the women out there despite everything they were going through was amazing.
“Collectively, they had a great voice and I met some really strong and inspiring women. If I had been in their situation, I do not think I could have been as strong.
“The women I met all seemed so positive about life and were happy living in the here and now.
“In the West, people are always looking to the future and worrying about where they are going to go next or what they are going to do.
“However, the people I met in Nepal were content to live in the moment and we can learn from them.
“It was a two-way learning curve and I made a lot of friends who I bonded with.
“One lady in particular I got on really well with was Dil Kuman. She married at 14 as she and her husband had been promised to each other when they were young. She did not finish her education and experienced violence in the home.
“She told me her husband had a second wife but she did not want to get a divorce because of the children. At first I thought: ‘Why would she do that? Why not just leave?’
“But as I got to know her, I realised her story was an inspiring one. Despite having had such a challenging time, she looked at the future with such optimism.
“Even though she knew she could not change things for herself, she wanted to change things for women in the future.”
After her career break, Cath has returned to her job as a health visitor working in Oldham, Manchester and feels that her time in Nepal has enhanced her work.
She says: ““I have gained such an insight into South Asian communities .My time in Nepal was truly invaluable and I have learnt so much.”