She came, she saw and helped women conquer the malaise

An inspiring story of Shirley Heywood, a British doctor, who contributed to saving lives of women from preventable disease of obstetric fistula in Nepal’s Karnali region.

Mahabir Paudyal

  • Read Time 6 min.

Kathmandu: She originally comes from across the seven seas—too far from Nepal—but her heart and mind is in Nepal’s Karnali, where people suffer the lack of proper health care system, where women have to bear the most brunt of it. It is the place where when she first came, her heart melted in pain. What pained her a lot was the suffering of women who, due to lack of proper medication facilities, were living with curable diseases for years on end, facing social and family ostracization, living with this thinking that the disease had no cure, and that it was in their fate to suffer.

She then started to work to try to change this situation. And it has paid off. Women are better off nowadays in terms of health than in the past and they are so grateful to her for what she did that they call her Aama, a mother, out of love and respect.

This is but one way of describing Dr Shirley Heywood, 67, the British gynecologist, who has lived and served in Nepal for over 20 years—such a long time Nepal feels like her first home.

It all started after Dr Shirley arrived in Nepal in 2003 for the first time as a fellow of International Nepal Fellowship (INF) International. She started to work in a health camp in Mugu district and what she saw there was so painful, she decided she would work to try to make the life of women better there, come what may.

The turning point was her encounter with an adolescent girl. Married at 13, one year later she had a stillborn baby after three days of labor pain alone at home.The girl had obstetric fistula, one of the most serious and tragic childbirth injuries, which creates a hole between the birth canal and bladder and/or rectum. It is caused by prolonged, obstructed labor without access to timely, high-quality medical treatment. It leaves women and girls leaking urine, faces or both, and often leads to chronic medical problems. 

“It was such an unfortunate situation the young girl was going through,” Dr Shirley told Nepal Live Today in a video conference from London. “She was in this condition because of complications during childbirth.” Normally, doctors in such health camps would refer fistula patients to Patan Hospital in Kathmandu but in her case, it was not possible because she was abandoned by all her family.

It is then that she thought if there was a dedicated hospital to treat fistula in Karnali itself, a number of women there would benefit. But back then, there was a lack of health professionals trained to perform surgery on fistula patients.  What would she do?  Then she went to Ethiopia, under INF fellowship, to take training on fistula treatment. She ran health camps with the support of the government hospital in Surkhet where operation was performed on a number of women. In 2011, she, along with other doctors, was able to perform 56 fistula operations. In one of these camps in Surkhet, the girl from Mugu was able to have the operation which cured her.

But running health camps was not only her ambition. She wanted to build a dedicated hospital for fistula treatment where local doctors could be trained.To that end, the INF continued to lobby and Karnali province availed land to build the hospital.So today, thanks to the initiative by Dr Shirley Heywood and INF, there is a 17-bed Fistula Centre in Province Hospital, Karnali, which can treat up to 300 women annually.

Dr Shirley has worked in major districts of Nepal’s Karnali—Surkhet, Dang, Jumla among others. She learned Nepali language here and speaks it fluently. Her obsession—to work for a cause for over a decade relentlessly can also be described as a positive obsession—to help women get rid of fistula has a strong reason. “Fistula is a very discomforting experience for women, since urine leaks all the time, the women smell badly and they do not tend to report the disease fearing that they would be shamed,” Dr Shirley told Nepal Live Today.

She has been working since 2009 to free women from disease and shame. “This is what I have been doing since 2009. I want to see the women being cured of this curable disease and live with dignity.”

She is thankful to Dr Nuchhe Man Dangal, Dr Bhola Ram Shrestha and Dr Dambar Khadka, the doctors she worked with in Surkhet who lent her all the encouragement and support she needed.

Dr Shirley also worked with the Family Health Division and encouraged the government body to run training on caesarian operation in 2006. “I was so happy when Advanced Skilled birth attendant training began. This was about training medical officers to perform cesarean operations. Nepal had few doctors at that time who could  do CS in remote areas. After the doctors were trained, I stayed in their hospitals for some weeks to help them set up the service in their hospitals.She said. “I have supported health professionals in CS training in districts like Dhankuta, Aghakanchi, Jumla and Baitadi.”

The development and positive changes that have taken place in Nepal’s health sector in recent years, however, have pleased her. “Nepal has made great progress. In every district, you see hospitals equipped with logistics and human resources who can do CS.”

What haunts her most is the memory of the suffering caused by fistulas to women in Karnali. She told of a woman, a fistula patient, whose disease she cured through surgery. The woman was 65. She had given birth to the baby when she was 25. And then she had obstetric fistula. “She came to our hospital. Her first child, the daughter, was already married off.  Her second child did not survive and her husband also died. She could not attend her daughter’s wedding, nor go to her house because her whole body stank,” Dr Shirley spoke of one of her patients. “She lived with that kind of health condition for 40 years.”

After surgery she was cured. Dr Shirley still recalls the sense of joy of that woman after surgery: Now she could sleep on a dry bed, go to visit her children, see her daughter and get reunited with the society. “But imagine the horror of living with disease for 40 years, to be secluded and excluded by the society because she had fistula.  Think about the forty years of loneliness, shame, ostracization and living with disease, being isolated.  You cannot imagine the horror. To see such women receiving treatment and returning home in happiness is a source of great joy for me,” she said.

Dr Shirley believes that Nepal’s communities can work to ensure safe motherhood, which is a precondition to preventing women from fistula. “Safe delivery and safe motherhood are the only ways to prevent women from facing the conditions of fistula. Nepal needs to work on this to ensure that Nepal will be free from fistula.”  This is her dream and from her side she will work for it as long as she can. “As long as Nepal will let me come and allow me a work visa, I will come to Nepal to do the fistula work.”

She has enjoyed working with the doctors and nurses in Nepal, with colleagues in INF and with people of the rural areas and in cities like Kathmandu. She has been fascinated by the country and people. She does not see why such a great country cannot have a robust health care system so that every Nepali benefits from it and is able to lead a healthy and happy life.

Dr Shirley comes to Nepal by raising funds from friends and organizations in England. She then stays in Nepal for up to three years and returns to the UK for about four months again to raise funds. The money she raises is given to INF which then spends it for the noble cause of providing care to the needy people in Nepal.

The people she served in Karnali reverently call her Aama, mother, that fills Shirley’s heart with emotions. “This gives me great joy. It is the most satisfying thing to hear from them.” Shirley was in England for the last few months to take care of her ailing mother.  Shirley, whom Nepalis called mother, lost her mother in July. 

Shirley will now come to Nepal to serve hundreds of mothers here and hundreds of women who regard her as a mother. “That depends on how long Nepal will allow me to come. But my heart is in Nepal and it will always remain there,” said Dr Shirley.

[Dr Shirley Heywood was honored by Nepal Live Group with the 11th Swasthya Khabar Health Award for her contribution to Nepal’s Health Sector on September 8, 2023.]