‘Heartbreak In The Himalayas’ by Dr Ray Hodgson. A Book Review.


‘Heartbreak In The Himalayas’ by Dr Ray Hodgson



If nothing else, reading ‘Heartbreak In The Himalayas’ by Dr Ray Hodgson has made me realise how lucky I was to have the best prenatal care and my children delivered by well qualified doctors and nurses in a modern New Zealand hospital, with the best equipment. Postnatal care for mothers and babies is vital for their ongoing health and to detect any abnormalities in the babies’ or their mothers’ recoveries.  Not having ever travelled to Nepal, a patriarchal country with appalling rates of death in childbirth of both mothers and babies, I had no idea of the primitive conditions mothers and their babies still have to endure, even in this 21st century, and it is not surprising that so many do die. There is very scant basic prenatal or post-natal care, and often when women and girls are seen by a doctor, or midwife, it is too late to save their babies.

But this inspiring book is so much more than a reminder of how lucky we are to live in a wealthy and largely egalitarian country, which we take for granted. It is an insight into the enduring spirit of poor rural Nepali women and girls who suffer debilitating pain and social stigma from the horrific effects of pregnancy and childbirth as a result of giving birth too young, too many pregnancies, and with little spacing between those pregnancies. The most common problem among these mothers is uterine prolapse estimated to affect 850,000 females in the country. Amnesty International suggests that the condition impacts around 10 percent of the country’s total female population of almost 14 million and it is considered to be a human rights issue as well as a health issue by Nepal’s Supreme Court. Cultural attitudes favour males over females and as a result, according to the World Economic Forum, the 2016 Global Gender Index ranks Nepal 110th out of 144 countries on gender parity. Girls receive a basic formal education, or none at all, while boys are encouraged to stay at school and later to travel to cities or overseas to further their tertiary studies.

Females grow and harvest crops, take care of children, cook meals. Mothers carry heavy loads while pregnant, and also immediately after giving birth; there is no relief from their punishing workloads.

By comparison, unless men travel to India for seasonal work, their light work load entails selling any excess crops grown and harvested by females.

Dr Ray Hodgson is an associate professor in Obstetrics and Gynaecology based in Australia. Following his discovery of the appalling state of women’s health in Nepal in 2010, he founded the humanitarian organisation ‘Australians For Women’s Health’. As a specialist gynaecological surgeon and obstetrician, Dr Hodgson leads teams of volunteers on medical camps to remote regions of Nepal where they provide surgical care, and treatment of general female health issues, to underprivileged woman and girls. During the temporary camps, each member of the medical team even manages to pass on their skills to Nepali doctors, nurses and midwives.  They often have to work in tents using flashlights during power failures, and at times have had to donate their own blood in order to save dying patients.

Uterine prolapse is a debilitating condition which can cause years of excruciating physical, emotional, not to mention, social pain.  Uterine prolapse is also commonly referred to as pelvic organ prolapse or genital prolapse. Nepali men are generally uninterested in what they perceive as ‘female problems’, comfortable as they are in their total ignorance of what women actually suffer and endure. Added to that, cultural norms dictate that education is ‘wasted’ on girls, because they are expected to work with their mothers in the fields and at home. Their formal education is basic and they often marry too young, before their bodies are fully grown and ready for sex, or for giving birth.

Menstruating women and girls are evicted from their homes, with their babies, and young children, and even exiled from their villages, adding humiliation to their extreme physical suffering.

Nothing demonstrates the disregard men have for their wives’ and daughters’ suffering more than the banishing of menstruating females to the windowless, doorless, menstrual huts or chhaupadi, due to Nepali cultural rituals of impurity or menstrual taboos and Nepal has one of the most brutal cultural practices of this type in the world. The use of chhaupadi continues to cause the deaths of hundreds of women and girls from exposure, dehydration, snake bites, smoke inhalation, starvation, blood loss and many other health issues. One is left to wonder how Nepali husbands and fathers can be so cruel and uncaring about what happens to their wives and daughters banished to the outdoors in one of the harshest climates around the globe. These unfortunate females are expected to walk for hours, sometimes days, with uterine prolapse, and other debilitating internal injuries, to get the most basic health care. The great majority of pregnant women and girls do not receive any prenatal or postnatal care at all, so that their own ignorance in caring for themselves is exasperated and passed on from generation to generation.

Dr Hodgson promises to change that. His camps have already improved the lives of hundreds of mothers and their babies, and he wants to do so much more. Sadly, each day the short-term camps operate, there are endless queues of desperate women who have to be turned away, and this in itself is heart-breaking.  The doctor goes on to say that the severe gender imbalance in rural Nepal is one of the reasons he believes his team’s work is so crucial.  When the first camps were implemented the team focused primarily on helping women with prolapse but the extent of the problem loomed so large, their life-saving work extended to include general women’s, and maternal, health.

The author’s aim is to raise enough money to build a permanent hospital for mothers and babies in remote Nepal, not only as a base for his team’s life-changing surgery and maternal healthcare, and to end the frustration, the inadequacy, of the short-term camps, but also to provide a teaching hospital to train more midwives and surgeons. Dr Ray Hodgson hopes that the sale of his book ‘Heartbreak In The Himalayas’ will generate enough funds to finance his hospital, and perhaps in the future his project will influence cultural change, but he is also realistic: “The challenges are both medical and cultural in what is a highly patriarchal country.”

Dr Ray Hodgson’s story details the adventures and challenges that present themselves during a four-week surgical camp in a remote area of Nepal. The story is based on, and contracts, actual events that he and his volunteer group have faced over the years. But ‘Heartbreak’ is not all about the suffering of women and girls…it is also about hope for a better life for all females in Nepal in the future and Dr Hodgson is right when he says that when girls are better educated, Nepal will become a more equal society. His views are supported by historical evidence that well educated women make better and healthier mothers who in turn are delivered of healthier babies who in their turn pass this on to future generations.

To illustrate his prediction, Dr Hodgson has cleverly incorporated in his beautifully written book, a thread running through the main events, which helps to alleviate the horror the reader finds within these pages; it features an intelligent and resourceful 12 year old girl called Poppy.  Poppy helps in the camp’s kitchen, before and after school, to provide meals for the medical team and its staff, who have all come to love her.  This young girl has a particularly difficult life, living with her brother and father, without her mother who tragically died giving birth to Poppy. By this process, we are given a closeup, insightful view into the hardship young girls face, and what life is like living in a primitive one room hut with no privacy. Poppy’s future appears bleak indeed, but there is hope that Dr Hodgson might find a way to convince Poppy’s father that she deserves a good education, with the help of a scholarship, and that she in turn will be able to help the people of her country appreciate the contribution women could make in transforming Nepal into a more modern and egalitarian society.


Please help author Dr Ray Hodgson raise enough funds to build his teaching hospital for mothers and babies in rural Nepal by buying his  book; you will not only be buying a great read, but most important  of all, you will be helping to save the lives of hundreds of mothers and babies which will in turn set rural Nepal on a path to a more equal society where females are valued  as much as males are.


-Anne Frandi-Coory 16  July 2019 



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