Dr Ray Hodgson – Prolapse Down Under

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Dr Ray Hodgson is a specialist obstetrician, gynaecologist and gynaecology surgeon based in Port Macquarie. He has founded the humanitarian organisations Prolapse Down Under and Australians for Women’s Health, that provide humanitarian assistance to women in East Asia…

Tell us about the organisations Prolapse Down Under and Australians for Women’s Health and the work they do.

Australians for Women’s Health (A4WH) is a not-for-profit organisation that provides humanitarian aid to women suffering in East Asian countries. The main two arms of A4WH are Prolapse Down Under, which provides surgical treatment to these women, and Maternal Care, which assists women experiencing pregnancy complications.

Genital prolapse is a condition where various pelvic organs fall through the vaginal opening. These prolapsing organs include the bladder, the bowel and the uterus. In its more severe forms, this is a terrible and disfiguring disease. It leads to all sorts of problems, including pelvic pain, incontinence, difficulties in working and walking, and the inability to have intercourse. The women who suffer these dreadful problems are usually subsistence farm workers whose families rely on them to continue working, simply to get food on the table. University studies have shown that there are 200,000 women in Nepal alone who suffer with severe genital prolapse and are in urgent need of surgery. At the moment, there are very few doctors in Nepal who can provide this surgery.

We set up the organisation Prolapse Down Under to provide surgical camps in countries like Nepal to correct these severe forms of genital prolapse. Teams of volunteer doctors and nurses and ancillary workers from Australia travel to these countries to provide the surgery in these camps.
This condition of prolapse sounds similar to the problem of genital fistulas in Africa …

Severe genital prolapse has many similarities to genital fistulas; they are both horrendous conditions affecting the genital areas of relatively young women, incontinence is a huge problem, and the social stigma is often devastating. These women often become isolated from their husbands and family.

Is childbirth responsible for the massive problems of genital prolapse in these countries?

In many cases, yes. And this is part of the reason for the other main arm of A4WH: Maternal Care. There are so many things we take for granted in our country, and this includes the safety of mothers in pregnancy and labour.

How dangerous is it to have a baby in places like Nepal?

Australia has one of the lowest maternal mortality rates in the world. By comparison, women in remote areas of Nepal have more than 100 times the chances of dying during pregnancy. And in the large majority, these deaths are preventable with relatively simple measures. Those women who do survive the dangers of pregnancy and labour in Nepal and other East Asian countries then have to negotiate the risk of genital prolapse. We would not stand for these medical risks in our country, and it’s outrageous and it’s shameful that we tolerate these risks in other countries.

What are some of the things you and your teams do over in Nepal?

We take teams of eight or ten volunteers and set up medical camps in remote regions of Nepal. These areas are usually on the sides of mountains in the spectacular Himalayas. We spend the first day or two cleaning and scrubbing rooms, to turn them into makeshift operating theatres. Then we spend the next two or three weeks screening and operating on women with various gynaecological and maternal problems.

And how would you describe the working conditions over there?

The first two words that come to mind are primitive and challenging. The team have to improvise a lot, because our equipment and supplies are really restricted. Electricity is fairly unreliable, and it’s not unusual that we need to operate under torch light. Last camp we ran out of swabs, so our nursing staff cut up some of the surgical gowns to make up artificial swabs.

But despite these conditions that are so difficult at times, you must understand that the morale of our volunteers is so very upbeat. We have some pretty special people who join us with each camp, and the buoyant mood is somehow infectious.

We hear you’ve even used a chicken incubator in surgery …

That’s true. It gets pretty cold up there in the mountains. We need to warm the intravenous fluids before we infuse them into the patients. The chickens get a bit aggressive with us sometimes, but they just have to cope!

What sorts of things are A4WH doing to help with maternal care?

One of the most important things we can do to improve maternal health is to increase the number of trained midwives. Currently the vast majority of births in rural and remote Nepal are not supervised by skilled labour attendants.

The Maternal Health arm of A4WH is training Nepalese midwives in a number of ways. And during our next trip, two of Port Macquarie’s local ultrasound specialists, Maryanne Smallwood and Jill Keating, will be training these midwives in the use of ultrasound. In this manner, high risk pregnancies will be identified in the remote villages. These mothers will then be transferred to the district hospital for safe delivery.

We’re also training local doctors to perform caesarean section and in the management of severe haemorrhage and infection in pregnant women.

We hear you’re heading off overseas again soon. Where will you be going, and what do you hope to achieve?

We’re off to Nepal again in June. This trip we’ll be based in the remote west of Nepal in a region in the Kaski district. The UN and the Nepal Government have been very helpful in assisting our efforts. We hope to screen several hundred patients, and we’ll be training 30 midwives and doctors in the area.

How can Australians help, even at the local level … are you in need of donations?

To be honest, we are in desperate need of donations. Our volunteers give up their holidays; they pay their way, their airfares and all of their living expenses. Donations do NOT contribute towards their expenses. But we do need to find ways to cover the costs of all of the medical and surgical equipment and supplies, the wages of the local health workers and the costs to transport and feed the patients. A donation of as little as 90 cents will buy 2 tablets of a drug called Misoprostol. This can be enough to prevent a potentially fatal post partum haemorrhage.

Where can people find out more about the work you and your medical teams are doing? How can they make a donation?

Please visit our website:
Thanks Dr Hodgson.

Interview by Jo Atkins.

This story was published in issue 79 Greater Port Macquarie Focus

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