The need to operationalize the fistula strategy for Uganda
By Joan Kabayambi MakSPH/CDC follow- CEHURD
Fiona Bakantweka, was 16years when she was expelled from school for becoming pregnant. When time for giving birth reached, she was taken to a birth attendant in the village.Unfortunate Fiona’s labor lasted almost four days that when she finally pushed the baby out, it was dead. This however damaged the reproductive system that she “leaked” and smelled of urine and faeces all day, every day.
Fiona had developed obstetric fistula. Fistula is a preventable and treatable condition which occurs when a girl or woman has an obstructed labor and does not get a Caesarean section in time. The obstruction may occur because the mother’s pelvis is too small, the baby is badly positioned, or its head too big.The protracted labor threatens the life of both baby and mother. If the mother lives, the pressure by the baby against the woman’s pelvis damaged the soft tissues around her bladder, vagina, and rectum and caused holes, or fistulas, to develop. If the fistula is between her vagina and bladder (vesico-vaginal), she has urine leakage, and if it is between her vagina and rectum (recto-vaginal), she is unable to control her bowel movements.
Fistula in Uganda mostly affects young and poor women with little education and limited access to quality health care, including emergency obstetric care. According to the 2003 Baseline Assessment of Obstetric Fistula in Uganda done by WHO, patients lack the knowledge that the condition can be repaired and are too ashamed of their condition to seek help. Those who remain untreated may be shunned by their communities and relatives and must find new ways to support themselves.
“I live in shame,” says Bakantweka. “I am now out of school, and even my family blames me for the pregnancy. They say I am paying for my sins.”
It is risky to have babies in Uganda due to the fact that the maternal mortality ration is 438 per 100,000 live births Uganda Demographic and Health Survey (UDHS) 2011. With little access to health care and information about these kinds of risks, young people begin sexual activity and childbearing at an early age.
The WHO estimates that obstetric fistula affects 50,000 to 100,000 women every year, mainly in sub-Saharan Africa. In Uganda, the survey (Uganda Demographic and Health Survey 2011) shows that 2 percent of women have experienced obstetric fistula, making it 1,900 new cases each year.
Obstetric Fistula is a shameful and stigmatizing condition that very few women declare that they have the problem hence making it difficult to know the number of women with the condition.
In Uganda, the Ministry of Health has developed the National Obstetric Fistula Strategy 2010/2011-2014/2015 that has made Mulago and other government hospitals to start offering free treatment by surgery. There are also 25 fistula trained surgeons in Uganda and in all the referral Hospitals there is a surgeon or two.
However, there is need for raising awareness in communities on prevention and mobilize communities to look out for women with the condition to access treatment from the agonizing obstetric fistula. This can be done by Civil Society Organizations like the Center for Health Human Rights and Development (CEHURD) under Community empowerment programmes.
This can be made easier if the government collaborates with all the relevant stakeholders, such as the existing local initiatives and communities and, ensure that health facilities have the equipment and supplies specialized for fistula surgery, the surgeons are well remunerated, the environment they work in is conducive, and that they are motivated to work even in the not-easy- to- reach areas.