A remote Nepal village with a health post on the left
The woman came to the health post suffering from abdominal discomfort, vaginal discharge and pain on passing water. The doctors said that all were symptomatic of a sexually transmitted disease. She was married and lived in a small village in rural Nepal. Affairs were uncommon – everyone knew your name and everyone knew your business. It turned out that she was probably the latest victim of a health problem that local doctors believe will just keep growing.
Some regions of Nepal are rural, with little opportunities for employment.
Her husband had returned five months earlier from working as a security guard in Qatar. Nepal’s level of unemployment was thought to be 46 percent in 2008, and – like many Nepalese men – the woman’s husband had been driven to work abroad. The men live for years in cramped conditions, thousands of miles from their wives – and many turn to sex workers. When they return home, they pass their diseases on to their unsuspecting partners.
Dr. Suman Kamarcharya from Tamakoshi Co-Operative Hospital
“They are getting HIV and bringing it back to the rural areas,” says Dr. Suman Kamarcharya, from Tamakoshi Co-Operative Hospital in Manthali, a rural, water-starved area in the eastern hills of Nepal. “I have only seen three cases of HIV until now, but they were all in men who had worked abroad.”
The hospital is in Ramechhap, a district where 2.5 to 5 percent of the population is working abroad. In some districts of Nepal, the figure is more than 10 percent. The people go seeking work, excitement and a future beyond the daily grind of planting crops and walking hours to the market. Flights from Kathmandu are full of young men seeking work, many still wearing the flowers and forehead tikka blessings they received from tearful families.
The hilly regions suffer from soil erosion and bad crop yields.
In Nepal’s hill areas, farming and overpopulation have resulted in severe erosion of the soil and diminishing crop yields. This, combined with the effects of climate change – which has brought both heavy rains and droughts – has forced many people to seek work abroad. Around 2.6 million Nepalese are overseas, and the money they send home is worth around 24 percent of the GDP.
More money can help lift people out of poverty.
HIV/Aids prevention worker Santosh Pandey has worked with Tamakoshi Co-Operative Hospital. “The men leave to work in India in places like Assam, Calcutta and Mumbai as laborers, miners and security guards,” he says. “People have poor knowledge of these [sexually transmitted] diseases. In one village, Bisulikhot, they believe AIDS is transmitted through physical weakness, when you are unwell.”
A woman receives a health screening.
By mid-2008 there were officially 11,000 cases of HIV in Nepal, but the UN estimated that the real figure was more than six times this thanks to insufficient public health monitoring. These figures are still low – only around 0.5 percent of the population – but migrant workers’ wives make up almost 22 percent of confirmed cases. A survey of migrant workers from Mid to Far Western Nepal found that 22 percent reported having had intercourse with sex workers while in India and that, of these, 67 percent had used a condom in their last sexual encounter.
Dr. Kamarcharya believes the time families spend apart will create a huge growth in mental health problems for the wives and mothers. “My thought is there will be more psychological problems. There are a lot of women here with depression,” he explains. “Their men are away for two or three years. They have to carry on working on the land – it’s a big problem.”
A woman receives a health check in the Nepal district of Rolpa.
The women who come into the hospital don’t initially complain of depression – they complain of “jam jam,” which is a general burning sensation. It’s only upon questioning that they admit to feeling upset or depressed. Many of them suffer from domestic violence, which is often fueled by alcohol. Others are overworked and lonely owing to the absence of male relatives. “For them, depression is a big problem and most of them do not want to talk about it,” says Dr. Kamarcharya.
Samita Maghi in her village
Apparently, the problems are often concentrated in certain villages. Samita Maghi, 20, lives in Kunuri, a Ramechhap village a 45-minute walk up a dry riverbed from Manthali. The village is home to people from the disadvantaged Majhi caste. She estimated that between 100 and 200 of the 800 residents of her small village and its two close neighbours were working and living away. The majority had migrated for six months to the brick kilns of Bhaktapur, near Kathmandu, or gone abroad to India.
Kamal Maghi with his mother Rita
Samita’s 18-year-old husband Kamal has just come back from his fourth six-month spell working in Bhaktapur’s brick kilns, laboring for 12 to 14 hours a day for around 750 rupees ($7.63). “It makes my wife unhappy because I am away,” Kamal says. “I have thought about India. There’s no other choice for me if I work here, maybe some housebuilding.”
Nepal has made great progress in public health. Life expectancy in the country is now almost 66 years, and villages have health posts offering 25 types of drugs for cases that are free to deal with where immediate treatment is needed. But the health problems caused by labor migration are felt right across the country.
Women have to do the heavy work when the men are away.
Take a walk into the villages beyond the roads and you see women buckling under huge loads toiling up mountain pathways and bathed in sweat. They often develop chronic back pain and osteoarthritis in their mid-30s. And the shops in many rural villages have a depressing main product, their shelves full of alcohol. “There’s domestic violence, husbands beating up wives, beating up sons – we get a lot of cases of this sort. Alcoholism is a major problem,” says Dr. Bipin Karki, a house officer at the district hospital just outside Liwang in southwestern Nepal. According to Dr. Karki, the district has just 44 cases of HIV, but the majority are men who went to work in India.
Sadly, alcoholism is a big problem in the region.
The money that men send home can help poverty-stricken areas. Nepalese migrants working in the Middle East can earn over seven times the wage they could get if they stayed home. This has lifted tens of thousands of families out of poverty.
Studies have shown that women experience some benefits when their husbands work away – for example, more autonomy. On the flipside, though, husbands don’t always send money, and wives can have affairs. A study of women in India found that they had to deal with insecurity, isolation, extra responsibilities and difficulties with parenting their children when their husbands left them behind.
Although women may gain more freedom, they have to work harder.
For the people who seek work, and the female relatives left back home, the money – however desperately needed – is not always worth it. Sambar Banadur Maghi, 34, spent five years working in Qatar. He came back last year. Now he runs a small shop and farms – but his wife has left him. “It was because I was away,” he says. “I wish I had not gone away now.”