She is 36. It is almost 14 years since her life changed for the worse. What was supposed to be the happiest moment of her life became the nightmare she had never imagined. She was in labour, about to give birth to her first baby.
The labour became prolonged. The daai kept saying it would be ok and that it happens to most women in the first delivery. Hours became a day. By the time it was over and she regained senses, she had lost more than she had gained.
She leaked urine uncontrollably at every step. She smelled bad. She felt impure. Eventually, she was isolated to a small shed on her family’s four acres of agricultural land.
No one wanted to meet her. She could no longer pray or attend social gatherings. She is a woman of Pakistan, a patient of Obstetric Fistula. The condition is treatable and reversible, yet every year some 5,000 cases are reported, and many go unreported.
As Pakistan joined other countries in observing the International Day to End Obstetric Fistula on Thursday, health experts lamented the lack of training that doctors in Pakistan and other developing countries have in fistula repair. Most hospitals and clinics are therefore unable to treat fistula successfully.
Despite its devastating impact on the lives of girls and women, the treatment of obstetric fistula is largely a neglected disorder in the developing world. It has remained a ‘hidden’ condition, because it affects some of the most marginalised members of the population.
What is obstetric fistula?
An obstetric fistula is a hole between either the bladder and the vagina or the bladder and the rectum, causing urine or faeces to leak continuously from the body. This kind of fistula is generally the result of a difficult birth, and can occur when pressure is exerted by the baby’s head on the mother’s pelvis stops blood flowing to the tissues for too long. Often the baby does not survive.
A treatable condition
Preventing and managing obstetric fistula is part of improving maternal health, the fifth Millennium Development Goal.
A senior surgeon of Médecins Sans Frontières/Doctors Without Borders (MSF) Dr Geert Morren says, “Unfortunately, repairing fistulas is not a procedure that many local surgeons wish to attend to. First of all, it is technically quite difficult to carry out; though it doesn’t require sophisticated equipment, it takes some time to master the technique. Secondly, it’s not well-remunerated because most of the patients are poor.”
Joy Phumaphi, Assistant Director-General Family and Community Health, World Health Organization (WHO) says: “Obstetric fistula still exists because health care systems fail to provide accessible, quality maternal health care, including family planning, skilled birth attendance, basic and emergency obstetric care, and affordable treatment of fistula”.
Obstetric fistulas usually cannot heal by themselves. Over 90% of women can be cured with one operation. However, many women and their families, especially those who lacked proper care during delivery, may not even know that a treatment exists for the disorder.
How to prevent it?
Obstructed labour occurs in 5% of live births and accounts for 8% of all maternal deaths. It is one of the four major causes of maternal mortality and morbidity. Obstetric fistulae can largely be avoided by delaying the age of first pregnancy, by the cessation of harmful traditional practices and by timely access to quality obstetric care.
Patients with uncomplicated fistulae can undergo a simple surgery to repair the hole in their bladder or rectum. The treatment cures up to 90% of obstetric fistula patients.
Published in The Express Tribune, May 25th, 2013.