Obstetric Fistulas: SOMETHING ALL WOMEN SHOULD BE WARY ABOUT.

Earlier this week we got to meet up with Andrew Strang, an English Social Worker who has been in the country for a year now working for Whinfield Charitable Trust. The Trust is involved with a number of activities, including the Stomaltherapy Clinic in Harare. What took our interest is the Fistula outreach they have going on, which is doing so much for the women in the country.

What is an obstetric fistula? 

It is a hole between the bladder and the vagina or the rectum, or both. It is a childbirth injury caused by prolonged obstructed labour, without timely medical intervention; typically, a Caesarean section. The baby almost always dies during labour.

How and why does a fistula occur? 

During unassisted prolonged labour, the sustained pressure of the baby’s head on the mother’s pelvic bone damages her soft tissues, creating a hole—or fistula—between the vagina and the bladder and/or rectum. The pressure prevents blood flow to the tissue, leading to necrosis (a form of cell injury that results in the premature death of cells in living tissue). Eventually, the dead tissue sloughs off, damaging the original structure of the vagina. The result is a constant leaking of urine and/or faeces through the vagina.

Fistulas occur when emergency obstetric care is unavailable to women who develop complications during childbirth. This is why women living in remote rural areas with little access to medical care are mostly at risk.

Are fistulas anything to worry about?

They are most common in poor communities in sub-Saharan Africa and Asia where access to obstetric care is limited. About two million women remain untreated in developing countries and between 50,000 and 100,000 new cases occur each year. If left untreated, fistula can lead to frequent ulcerations and infections, kidney diseases, and sometimes death. Some women drink minimally to avoid leakages. As a result, they become dehydrated. In addition, damage to the nerves in the legs leaves fistula patients unable to walk, creating the need for extensive physical rehabilitation.

Why do so few people know about fistula?

Fistula is a relatively hidden problem, largely because it affects the most marginalized members of society: young, poor, illiterate women in remote areas. Many never present themselves for treatment. Because of the shame and stigma associated with the condition, they often chose to suffer alone, remaining ignored.

How can fistula be prevented?

Prevention, rather than treatment, is the key to ending fistula. Making family planning available to all those who desire it would considerably reduce maternal deaths and disabilities. Complementing that with skilled birth attendance and emergency obstetric care for women who may develop complications during delivery would reduce the rate of fistula in developing countries.

Whinfield Trust

So what the Whinfield Trust has been doing is fund raise to help with surgical treatment for the women suffering from this problem. Their presence has not only been felt in Zimbabwe only but also in a few more African countries. Right now, it has been confirmed that an Ethiopian surgeon will be flying in from Paris and stay here for a week. She has performed over 5000 operations and now she is going to operate on a number of obstetric fistula patients in the country.

Hearing Andrew talk about these women was so sad, it had me thinking how anyone can handle dealing with sad stories every day. And what is even sadder is that the most affected are teens, some as young as 12! They have lost a number of patients who they had become almost family with. “Mostly satisfaction comes from being able to help and see someone benefiting. When you see children suffering though, it’s more difficult”, Andrew said. We are just glad something positive is being done to deal with this hidden problem.