Nepal, like many poor countries, is a country where women do not yet expect the treatment that we consider to be our right. Part of my goal in Nepal was to support the practice of the midwifery model of care both at the birth center and wherever midwives work. The midwifery model of care at its heart is about “Listen to women” (the motto of the American College of Nurse Midwives). How can this be activated among women who live in a culture where privacy is not highly valued, where consent for care is not standard, where respect for professionals seems sometimes to be greater than self respect for women?
I struggled in the Kathmandu Birth Center, to encourage care to take place in a closed private room, but often it took place in a corridor-like triage area with a curtained bed but both doors open and people walking through. This was persistent even though there were great private rooms elsewhere in the building.
If I was present for an intimate aspect of care, a vaginal exam for instance, I did not know the women personally and did not speak her language, so I always asked to be introduced and permission requested for my presence. The midwives found this not just amusing but weird and uncomfortable. It seemed that a white woman like a doctor, particularly a male, had assumed rights, and I was violating norms by suggesting acting differently.
Are violations of norms always unacceptable? What about norms like these, based on hierarchies which deny women self-respect and dignity? I believe these midwifery values to be absolutes and prerequisites for appropriate care. Can we share those values, as outsiders, now, in Nepal?