The agony of women with fistula

A GNA Feature by Linda Asante Agyei

Accra, Oct. 19, GNA - The scourge of fistula is unimaginable to the unfortunate victims whose future is blighted by the agony of living with the stench emanating from their genitals as a result of dripping urine or faeces.

Fistula occurs when the victims suffer prolonged and obstructed labour, which leads to the injury of their pelvic tissue and ruptured bladder causing the urine and faeces to drip. They are the least understood in society due to the unexplainable stench from their reproductive organ, which drives people away from them. Visco-Vagina Fistula (VVF), also known as Obstetric Fistula, is a critical and important reproductive health problem that is affecting and killing women quietly.

Fistula, or tear, happens during an obstructed labour when the tissue between a woman's genitals and bladder and/or rectum is torn. This results in the continuous leaking of urine or faeces. Though the condition is preventable and treatable, the bad smell associated with it drives many women to hide it without reporting to the hospital.

The most mar ginalized and impoverished groups of women and girls are the most affected because of the complications they experience during pregnancy. Adolescent girls are particularly susceptible because the pelvic is not fully developed.

It is sad to know that more than half a million African healthy young women die each year from complications of pregnancy and childbirth including obstetric fistula.

The World Health Organisation (WHO) estimates that globally over 300 million women are currently suffering from short or long-term complications, with 20 million new cases each year.

Obstetric fistula accounts for eight per cent of maternal deaths worldwide with millions more women and girls living with shame, isolation and abject poverty because of the stigma associated with their condition.

Most women, who develop untreated fistula, are those who gave birth at home with no assistance from a skilled birth attendant. An Obstetric Fistula Needs Assessment conducted in Ghana revealed that between 100,000 and 150,000 expectant women suffer from fistula each year with young girls being the most affected.

The rapid assessment conducted in 2003 for the UNFPA by Engender Health, a nongovernmental organization was designed to outline a basic picture of obstetric fistula and services in Ghana.

The assessment conducted at Korle-Bu and Komfo Anokye Teaching Hospitals, Battor Catholic Hospital, Nalerigu Baptist Medical Centre and Eikwe Catholic Catholic/Effia-Nkwanta Hospital revealed that data was scattered on the prevalence of the problem.

Dr Ali Samba, a Gynaecology Specialist at the Korle-Bu Teaching Hospital, says poverty; illiteracy; low status of women and gender inequality; malnutrition; adolescent pregnancy; lack of awareness; financial and socio-cultural problems; lack of access to family planning and emergency obstetric care are some of the contributing factors. He says the VVF occurs across the whole country but it is more prevalent in the Northern belt due to the poor health delivery system and lack of personnel.

Unfortunately, there is only one centre in the Northern Region repairing VVF while the rest are centred in the Southern belt but currently. There is no repair done in the Upper West and Upper East Regions.

The cost of repairing fistula is another factor preventing many deprived affected women form seeking treatment.

Whilst it will cost a fistula patient as much as two million cedis at Korle-Bu for its repair, it will cost 300,000 in the Nalerigu in the Northern Region. Because the condition affects mostly the poor, such women are unable to afford the cost and they live with it till they die. Dr Samba calls on policy makers to ensure that VVF was made a public health issue through awareness creation and training of more surgeons to fix VVF. The Ghana Medical Association should also include VVF in their campaign to improve maternal health and make it reportable.

The Ministry of Health should also institute programmes to educate the public on the condition and the fact that fistula is only an abnormality resulting from childbirth and not a curse on the victim. Care and support should, therefore, be given to help the victims who go through the trauma.

=93The repair of fistula should be included in the free treatment under the National Health Insurance Scheme,=94 he adds.

Just as Dr Makane Kane, Country Director of UNFPA, has been hammering, prevention and treatment are the key tools to end fistula to make pregnancy and childbirth moments of joy in the lives of women and families.

Mercy Ships, a global charity hospital ships providing specialized surgical care in developing nations in June this year docked at the Tema Port to bring hope, healing and smiles to the poor and needy. The Ship, which will stay in the country until February 2007, has repaired over 40 fistula cases with most victims from the three Northern regions.

These women, some of whom had lived with the disease for more than 10 years, thought there was no hope for them to live normal lives. Families, friends and society had deserted them simply because of their strange disease. Some patients have been accused of suffering the curse for their 93evil deeds'.

Alidu Abibata, 30, the second wife of a man from Bolgatanga in the Upper East Region, narrating her ordeal to the Ghana News Agency said she had fistula after going through three different surgeries and lost all the babies. The associated stench and other complications forced her husband to divorce her.

=93All relatives deserted me and I was in a total mess. It got to a time that I wanted to kill myself and leave this world. To live in an uncomfortable situation like this and lose all friends, relatives and most importantly a husband whom you think you could rely on in times of trouble was most unpleasant. But thanks to Mercy Ships I am well. I never thought I would be well again=94, she said with tears streaming down her cheeks.

Abdulah Abiba from Tamale in the Northern Region developed her fistula after prolonged labour during her sixth pregnancy, which later called for a surgery. She also complained bitterly about the ordeal she went through.

'My in-laws drove me out of the house. They said I have been cursed for being unfaithful to my husband and, therefore, must confess. It was a terrible experience to walk around with a catheter or wearing pampers at this age,' she said.

UNFPA has launched a project to end fistula globally which is currently covering 30 countries in the Sub-Saharan Africa, including Ghana.

The project dubbed 'Preventing the Harm' and 'Healing the Wounds' focuses on prevention and treatment of fistula to save the millions of lives of women who die from complications of pregnancy and childbirth each year.

Ending obstetric fistula is a long-term goal that demands commitment of financial resources, political will, strong partnerships and concerted efforts and there is the need for all to come on board to help.

Childbirth should be a joyous moment in every woman's life and not a moment of agony and regret. The health authorities and NGOs need to work to end the agony of fistula patients to bring the smiles back to their faces.