[afro-nets] Shame and Pain Torment Fistula Sufferers

[Jawad Asghar <jawad@alumni.washington.edu>]

Shame and Pain Torment Fistula Sufferers
----------------------------------------
Mithre J. Sandrasagra
http://www.ipsnews.net/news.asp?idnews=32362

UNITED NATIONS, Mar 3 (IPS) - Obstetric fistula is a preventable
and treatable injury caused by several days of obstructed la-
bour, without timely medical intervention. But the consequences
of the pervasive disability are life shattering -- the baby usu-
ally dies, and the woman is left with chronic incontinence.

According to the World Health Organisation (WHO) estimates that
more than two million women are living with fistula in develop-
ing countries and an additional 50,000 to 100,000 new cases oc-
cur each year.

These WHO estimates are based on the number of women seeking
treatment, and are likely to be gross underestimates.

The estimates were also made in 1989.

There are no new statistics because "the problem of fistula is a
neglected, under-prioritised issue", Kate Ramsey, project ana-
lyst of the Reproductive Health Branch of the United Nations
Population Fund (UNFPA), told IPS.

"We suspect the number of victims is much higher," Ramsey
stressed, following a panel discussion on efforts to eliminate
fistula that took place here on the sidelines of the 50th Ses-
sion of the Commission on the Status of Women.

"Every day in Burkina Faso, approximately 236 severe obstetric
complications occur," stressed Chantal Compaore, First Lady of
Burkina Faso, during the panel.

"Most people still don't know what fistula is even though it af-
fects so many," a Kenyan diplomat told IPS.

During prolonged labour, soft tissues of the pelvis are com-
pressed between the descending baby's head and the mother's pel-
vic bone, explained Sayeba Akhter, head of the Obstetrics and
Gynecology Department of the Dhaka Medical College Hospital in
Bangladesh.

The lack of blood flow causes tissue to die, creating a hole be-
tween the mother's vagina and bladder, or between the vagina and
rectum or both. The result is a leaking of urine or feces or
both.

Affected women are often abandoned or neglected by their hus-
bands and family and ostracised by their communities. Without
treatment, their prospects for work and family life are greatly
diminished, and they are often left to rely on charity.

Compaore recounted to the panel the words of a 40-year-old woman
from her country: "When I could no longer stay dry and control
my feces, my husband told me that he would not take me anywhere.
My husband does not give me food. Since this illness, he has not
come near me. If my three daughters were boys, if they had the
means, they would have taken me to Ouagadougou so that I can be
treated."

Poverty, malnutrition, poor health services, early marriage and
gender discrimination are interlinked root causes of obstetric
fistula, according to UNFPA. Poverty is the main social risk
factor because it is associated with early marriage and malnu-
trition and because poverty reduces a woman's chances of getting
timely obstetric care.

Because of their low status in many communities, women often
lack the power to choose when to start bearing children or where
to give birth. Childbearing before the pelvis is fully devel-
oped, as well as malnutrition, small stature and general poor
health, are contributing physiological factors to obstructed la-
bour.

In 2003, UNFPA launched the first-ever global Campaign to End
Fistula. Its overall goal is to make the condition as rare in
the developing South as it is in the industrialised North.

Fistula is a relatively hidden problem because it affects the
"most marginalised members of society" -- young, poor, illiter-
ate women in remote areas, said Akhter, who has been treating
fistula for more than 20 years.

In Bangladesh, some 71,000 women are living with fistula. Before
the UNFPA programme, there was no organised fistula treatment in
the country and very few doctors were interested in treating the
illness because the procedure was difficult and it was not lu-
crative. Today, a Fistula Repair Centre at the Dhaka Medical
College has been established and 45 doctors and 30 nurses have
been trained to treat the disability.

In Niger, 140 fistula repairs were performed in 2004, 600 commu-
nity health workers received special training on fistula and a
concert was organised to raise funds for the construction of a
fistula centre in Tahoua.

A national campaign was launched in Sudan under the slogan "We
MUST Care." UNFPA has purchased medical equipment and supplies
for the Fistula Centre in Khartoum. Eight volunteer doctors man-
age the centre, which relies on one operating room and faces a
chronic shortage of medical equipment.

"The existence of fistula is the barometre of maternal health in
the country. If year by year fistula decreases, we know that ma-
ternal health is improving," according to Kalilou Ouattara, a
fistula surgeon in Mali.

Prevention, rather than treatment, is the key to ending fistula,
according to Ouattara. Making family planning available to all
who want to use it would reduce maternal disability and death by
at least 20 percent. Complementing that with skilled attendance
at all births and emergency obstetric care for those women who
develop complications during delivery would make fistula as rare
in the developing world as it is in the developed world, accord-
ing to UNFPA.

"Ninety percent of women in Bangladesh deliver at home," Akhter
said.

The average cost of fistula treatment -- including surgery,
post-operative care and rehabilitation support -- is 300 dol-
lars, well beyond the reach of most women with the condition.

"Many women cannot even afford to travel to where they can get
treatment," Akhter stressed.

The success rate of fistula repair for experienced surgeons can
be as high as 90 percent. After successful treatment, most women
can resume full lives.

Left untreated, fistula can lead to frequent ulcerations and in-
fections, kidney disease and even death. Some women drink as
little as possible to avoid leakage and become dehydrated. Dam-
age to the nerves in the legs leaves some women with fistula un-
able to walk, and after treatment they may need extensive physi-
cal rehabilitation.

These medical consequences, coupled with social and economic
problems, often contribute to a general decline in health and
well being that results in early death. Some victims commit sui-
cide, according to UNFPA.

All the world's governments committed at the 2000 Millennium
Summit to achieving the Millennium Development Goal (MDG) of a
75 percent reduction in maternal mortality and universal access
to reproductive health by 2015.

Those commitments were reaffirmed at the 2005 World Summit.

"To ensure these targets are met we need to scale up program-
matic and financial support," said Arletty Pinel, chief of UN-
FPA's Reproductive Health Branch.

UNFPA is requesting 78 million dollars for the next five-year
period of its campaign. "Seventy-eight million cannot end fis-
tula, but it will mobilise a response on the national level to
combat the problem," Pinel said. (END/2006)

--
Rana Jawad Asghar MD. MPH.
Coordinator South Asian Public Health Forum
mailto:jawad@alumni.washington.edu
http://www.DrJawad.com
Typhoid Net http://www.typhoid.net


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