The Association for the Rehabilitation and Re-orientation of Women for Development (TEREWODE), an NGO that cares for women with obstetric fistula has said no young girl or woman should suffer from fistula as it is preventable.

It is better and easier to prevent fistula because it is costly to treat. Effective and holistic treatment of fistula costs on average about 400 dollars, including the cost of transport to the hospital, hospitalization and care.

Holistic, meaning fixing the condition itself, leaving a woman incontinent of urine or feces or both, and also taking care and treating the psychological/ mental effects of the fistula victim, Alice Emasu Seruyange, the TERREWODE chief executive officer, said.

She said you also have to deal with the need for ongoing counseling for the family and the sufferer’s partner responsible for the pregnancy that resulted into fistula, and additionally, dealing with the victim’s spiritual disorientation, after abandoning her faith.

Emasu made the remarks during the Association of Obstetricians and Gynecologists of Uganda conference at Imperial Royale in Kampala, which attracted over 60 gynecologists from all districts of Uganda.

Dr. Irene Kahimakazi, a gynecologist from Mbalala Hospital defines Obstetric fistula as a medical condition in which a hole develops in the birth canal as a result of childbirth.

“This can be between the vagina and rectum, urethra or bladder of a woman that results in the constant leakage of urine and/ or faeces, a condition predominantly caused by prolonged or obstructed labour lasting more than 24 hours,” she says.

She adds that this condition most commonly occurs among women who live in remote rural areas, who give birth without access to medical help. If a woman’s labor becomes obstructed, she could remain in excruciating pain for days before her baby is finally dislodged. Her baby dies and she is often left with an obstetric fistula, a small hole created by constant pressure from the fetus, which renders her incontinent.

According to the 2018 Uganda Demographic and Health Survey, Uganda is a major public health problem, with over 140,000 women living with the condition, and 1,900 new cases reported every year. Uganda’s Ministry of Health says the country is ranked third in the world in terms of the number of obstetric fistula cases.

Emasu says when a young woman suffers fistula, the parents and all family members get traumatized seeing their own suffering, a holistic intervention to treat the minds of the patient, the family and the spouse needs to be developed.

“The other thing that makes fistula expensive is the medical need to treat other medical conditions that fistula often comes with, for example, foot drop-mobility challenges. On top of that, it leaves some women with conditions at secondary infertility,” says Emasu.

 Fistula also disempowers the victims and makes them become totally helpless, hopeless, impoverished, leaving them with no source of personal income and livelihood. It also leaves some women to lose interest in sexual activity, she adds.

For those who may have interest may experience pain during sexual activity yet they may remain desirous to have a child-give birth. Emasu says a survey TERREWODE conducted among young women and emancipated minors from selected study sites who recovered from obstetric fistula indicates that 95% of them fear to go back to their partners and families.

STUDY FINDINGS

The study also revealed that majority of the respondents, aged 21-26, 80% of them had not completed their primary school, 69.9% were unemployed at the time they got fistula and a slight majority of the participants were in the lowest income category (sh5000-1000).

The psychosocial burdens/needs include: uncertainty and fearfulness (95%), survivors return to parents (57%), returned to partner (25%), dispersed to guardian (2%) and uncertain about their plans (2%).

Alice Emasu speaking during the Association of Obstetricians and Gynecologists of Uganda conference.

And when it comes to sexual and reproductive health needs, the study indicates that after discharge 62% percent of the respondents were in an intimate relationship, 30% expressed a desire to be in a relationship, majority (51%) reported satisfactory sexual intercourse after surgery, 15% reported painful intercourse, 15% expressed fear concerning intercourse, 15% had lost interest in sex, 9% were not sexually active, 48% want to use a FP method and only 16 were using a FP.

Emasu has therefore called upon the government to come up with a specialized format for young women who have recovered from the disease. Fistula is preventable when all women and girls have access to high-quality, comprehensive sexual and reproductive health services.

TERREWODE has partnered with Ministry of Health to focus on a holistic approach to manage obstetric fistula and they support 600 affected women and girls for free surgeries countrywide annually.

RECOMMENDATIONS

 Support integration and provision of family planning (FP) during pre and post-fistula repair service, provision of FP Counseling and Education, contraceptives with consent and making effective referrals.

Also efforts to integrate physiotherapy during pre and post-fistula repair service, support and provision of specialized care during post-repair child birth for former Fistula patients and conducting deliberate screening for risk factors among survivors of fistula.

Other recommendations are making a better plan based on the fistula history and providing high-quality deliveries for former fistula patients (survivors), making quality referrals for former fistula patients presenting with ongoing medical concerns like HIV, cancers, COVID- 19 and others.