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Obstetric fistula: A double tragedy

By Miriam Mukama

When a woman gives birth, usually it is joy. The newly born baby makes the mother a heroine of sorts and, she is thanked, given gifts and praised even in the humblest of communities where life hardships are too many.

But Catherine Namukasa, 22, despite giving birth is going through the exact opposite. She is loathed and ignored. Even her husband abandoned her. It started on a sad night of November 5, 2010, when she was rushed to hospital after failing to  give birth with the assistance of her two aunts. But even when she reached the hospital, she was not attended to quickly enough.

Unable to control it, her baby’s head apparently too big for the vaginal canal, ruptured her rectum and bladder. She now suffers from Obstetric fistula which is scientifically known as obstetric vesicovaginal fistula (VVF).

“From then shame is all I have known for the past years due to uncontrollable flow of urine and feaces all through my birth canal (vagina),” she told The Independent, “Can you imagine having to pass both urine and stool from the vaginal opening without even knowing it and everybody hating you because they associate your condition with witchcraft and being cursed.”

This condition describes a tear or hole in the birth canal, caused by prolonged labour and other social implications like sexual violence that leads to the continuous flow of urine and feaces from the birth canal. It haunts a number of women in Uganda which has been reported to have the third highest rank of fistula in the world.

Anthony Sikyatta, a doctor and National Program Officer of United Nations Population Fund Activities (Uganda’s Obstetric fistula program) , says fistula is a hole of varying size between the vaginal opening and the urinary bladder that is caused by  prolonged obstructed labour.

“This happens during delivery when it’s time for the baby to come out and there is no immediate attention accorded to the mother,” Sikyatta says, “the head raptures the walls and other pipes that help control the flow of stool hence creating a short cut leading to the uncontrolled continuous flow of urine and in most cases feaces from the vagina.”

The Uganda Demographic and Health Survey 2006 estimated that over 200,000 girls and women of 15 to 49 years in Uganda are affected with the fistula condition and they cannot easily be established since most of them are scared to come out publicly due to their condition.

In a research by the Association for Re-orientation and Rehabilitation of Teso Women for Development (TERREWODE), 6000 women are reported to have died as a result of reproductive complications associated with fistula.

The situation is worsened because 95 percent of babies born from such women usually die. Experts say that for these women, sometimes take five days trying to push baby during delivery due to various factors.

Namukasa says her troubles started when she first visited a traditional doctor in order to deliver, a few days after her two aunts had attempted to help her in vain “This made me two days late,” she narrates ruefully.

Brian Hancock, a British surgeon who has carried out about 1,300 Fistula repairs in his 40 years career in Africa and is the chairman Uganda Child Birth Injury Fund reports the average age of fistula survivors seen by health facilities was 28, and most women attended to had lived with the condition for an average of about six years before accessing repair surgery.

Joan kabayambi, the executive director of Hope Again Fistula Support Organization Uganda (HASFO) says that when fistula reaches its higher stages, most women don’t know how to overcome it.

Sikyatta also says that women with fistula may fear to come to the hospital since they are leaking urine, feaces and smelling at the same time. This makes life hard for them because most of them are chased away from home and cannot access transport to their particular hospitals.“There is still a challenge with the fact that most women are not aware that fistula can be treated,” Sikyatta says, “Only 1500 patients are treated per year but the number would be bigger if most women were not shy to come out and receive treatment.”The reason it continues to torment thousands of women in Uganda leaving them rejected by society and their families is the lack of faith and reluctance to admit the condition. As if Namukasa’s pain was not enough, her husband was the first to leave her for another woman.

Kabayambi says that the fistula campaign has just started but people don’t even talk about it because they think it’s only a women issue. Reports indicate that in districts like manafwa, fistula affected women are not aware of the treatment at all. “Most of them have even lost hope” says Kabayambi. What associates the fistula condition is that it is misconceived and attached to witchcraft and bad luck. Despite this, the morbidity can be treated person repaired but many women remain unaware.

However, Fistula medical experts say that when one is repaired, they can no longer give birth normally again. It has to be by caesarian section and this is done to prevent the same problem from reoccurring because it is a painful condition. Unfortunately, Uganda has only about 10 surgeons who can repair the condition, limited medical supplies and many traditional birth attendants who are not fully equipped with birth delivery necessities. These tend to be the nearest traditional personnel in rural areas to help mothers deliver hence increasing the risks of poor delivery. The hospitals that repair fistula in Uganda are few.

There are only 13 referral hospitals that have fistula facilities in them and only eight are able to repair the patients unlike three in the past years, Sikyatta says. Health activists say that more advocacy and awareness is needed to reduce the numbers of women affected.

Kabahita urges women to seek medical care in time and always go for frequent checkups during pregnancy. Finally, people need to be sensitized to stop stigmatising such women with fistula and instead love and care for them by bringing them for treatment.

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