After enduring days of agonising of prolonged obstructed labour where the baby’s head constantly pushes against the mother’s pelvic bone, the tissue around dies due the lack of blood flowing. The result is a hole in the dead tissue. The medical term for this is obstetric fistula, if it occurs between the rectum and vagina rectovaginal fistula or vesicovaginal fistula if it occurs between the bladder and vagina.
In the worst case scenario occurs between the vagina and the rectum whereby incontinence leaking of urine and faeces follows. Genital sores, severe infections that at times cause kidney failure and paralysis are some of the devasting effects that the victim lives with. Many mothers mourn the baby who has been part of their lives for nine months.
A large percentage of babies are still born. Obstetric fistula is largely extinct in North America, Europe and other developed nations for over a century thanks to milestone developments in maternal health and care as well as sexual reproductive health systems. In sub-Saharan Africa, some parts of South American, Asia and the Arab nations it is a silent scourge claiming thousands of lives and maiming millions more.
The treatment and management of the fistula complications have severely over burdened and pressured the health care system in Africa. Concentrated and concerted efforts are needed to fight this problem. Other factors are the shortages of medical staff and supplies, the low number of specialist surgeons to perform fistula operations and also lacking is the necessary medical technology that is necessary to perform obstetric fistula surgeries thus causing serious backlog of fistula patients who keep growing by the day.
A survey covering nine African countries by United Nations Population Fund (UNFPA) states that most fistula patients are poor, uneducated teenagers, some as young as 12 years old, who develop fistula while giving birth to their first baby. Many of these victims come from very poor and almost forgotten rural communities. Barely into the teenage years, their bodies have barely matured and are still developing. Their pelvic bones are not strong or fully grown and birth passage is narrow.
Thrust into throes of child bearing, these teens are highly likely to develop fistula. Most live in communities that live by the adage ‘’women are to be seen, not heard’’. In these communities, women have no voice or power over their lives or bodies. Decisions of when to get married and to whom even where to give birth lies squarely on the decision makers: Father’s husbands and mothers-in-laws.
Logistical access to and availability of medical facilities, poor infrastructure and inadequate transportation are some of the challenges that plague third world nations. In some rural communities it takes three days to get to the nearest health centre. Fistula is shrouded by stigma and lack of awareness. As a result of the stigma many victims don’t speak out and never seek treatment because they don’t know what is wrong with them.
Myths like ‘’you’re bewitched, you’re promiscuous’’ surround fistula making it even harder for victims to speak out. The condition is treated with a lot of contempt, suspicion and ignorance making it a silent health emergency, as one victim said, ‘’Nobody wants a woman who passes stool all the time.’’ The psychological effects that the victims have to bear are enormous. To their communities, they are outcasts; women who stink.
Many live in depression and they are suicidal. Governments, policy makers, affected communities, the health sector have a critical role to play in the eradication of fistula. Communities must take the leading role in creating awareness and fighting stigma. Retrogressive practices like early marriages should be stamped out as it is the leading cause of fistula.
Parents, the youth and the community at large need to be educated on sexual and reproductive health and rights.And above all girls need to stay in school. The greatest challenge that stands between the victims and fistula treatment is correct and timely information on sexual and reproductive health which would go a long way in preventing fistula in the first place.