Fistula is a shame to the medical field — health ministry
Sep 25, 2023
Fistula, Bahatungire said, is a devastating childbirth injury that leaves women and girls stigmatised and isolated from their families and communities.
TWICH survivors Mr. Okech and his wife, Rose Achan, who reunited. (Photos by Elvis Basudde)
Elvis Basudde
Journalist @New Vision
_________________ Beatrice Okillan, Policy and Advocacy Coordinator, MGLSD, speaking during the meeting. Dr. Bahatungire Ronny, Acting Commissioner in charge of Clinical Services, MOH, speaking during the workshop
The prevalence of obstetric fistula in communities is a big shame to the medical field in Uganda and reflects a vacuum, the health ministry has said.
Ministry acting commissioner in charge of clinical services Dr Ronny Bahatungire has, therefore, called upon medical practitioners and all the stakeholders to double their efforts and devise more aggressive ways to eliminate fistula. He has also urged them to ensure that every health worker contributes to reducing the burden of fistula in communities.
Fistula, Bahatungire said, is a devastating childbirth injury that leaves women and girls stigmatised and isolated from their families and communities.
The condition is caused by prolonged and obstructed labor, which can result in a hole between the birth canal and the bladder or rectum, thus causing the woman to continuously leak urine or feces, resulting in severe physical and emotional trauma, including social isolation and stigma.
“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,” he said.
Some of the social consequences of obstetric fistula include women losing their source of income due to their incontinence, thus becoming an economic burden to their families. This pushes them into poverty, leaving them in bitterness, trauma, depression, and suffering disappointment.
Bahatungire delivered a keynote address during the stakeholder’s national conference on revamping efforts towards the elimination of obstetric fistula and improving maternal health outcomes for women and girls at Terrewode Women’s Community Hospital (TWCH) in Soroti City on Thursday.
Among other stakeholders present development partners including FGHR and local government leaders including Resident District Commissioners, district chairpersons, chief administrative officers, district health officers, and district community development officers, from Serere, Ngora, Bukedea, Kumi and Kapelebyong.
TWCH is the first and only specialised obstetric fistula hospital in Uganda, more so in East Africa, and the third in the continent. TWCH was at the same time celebrating four years of existence.
Bahatungeri said that fistula is one of the key sections that the ministry has given affirmative action.
“Thank you TWICH and the entire leadership for the work you have done in establishing this specialised facility for women and girls as well as for pioneering rehabilitation, reintegration, and awareness and advocacy on fistula,” he said.
Responding to the concerns, the gender ministry (MGLSD) pledged to integrate obstetric fistula on the list of all three diseases: Malaria, HIV, and TB, including epilepsy and nodding, for social protection intervention.
Beatrice Okillan, policy and advocacy co-ordinator, MGLSD, said they were developing a social protection strategy, in consultation with various stakeholders including the Ministry of Health, which thinks there are diseases like fistula, TB, HIV and others they need to consider under social protection.
“We are also told that there are women in incurable fistula conditions. As a ministry, when we get there, we commit to ensuring that we get this category into those we target in social protection intervention,” Okillan said.
Adding, “The government development agenda is to achieve social economic transformation for all, pursued under the vision 2040. This is the third national development plan as well as various development programs, improved maternal health care is a priority in the effort to address the health needs of Ugandan women and a trend to indicate that there is an improvement.”
Okillan thanked the board of executives of TWCH for allowing them to witness the work and achievement that the hospital has made over the last four years of operation. She also requested for maximum support of all partners to make this the most successful start process of engaging the voiceless through their organizations, the CSOs, saying the objectives for which the hospital was established have been met and the impact of the local community that it serves have been significant.
She congratulated and extended MGLSD’s sincere appreciation to all those who have contributed successfully to the hard work they put in to ensure the health services of these women not only in this region but across the country.
“There is about 20% improvement in maternal health over the year with a declining mortality rate coupled with the percentage of women attending antenatal care going up. Despite this, however, women's reproductive health outcome remains below the global standard, Uganda being that low, a situation that must be addressed by all stakeholders including household communities and the nation as a whole,” she said.
Okillan hailed TWCH for having regard for women with fistula, caring about them, and encouraging them to continue to fly the flag high in contributing to the health and wellbeing of women of Uganda, saying the Government has established partnerships with CSOs and the private sector to address the diverse needs of the population, within this framework of collaboration with TWCH.
“MGLSD, as a ministry responsible for women's affairs, we look forward to stronger collaboration with TWCH in addressing the critical needs of the affected women, particularly looking at the social aspect of this condition,” she noted
Adding, “From the presentations, we see that women who get treated and thereafter re-integrated need to be supported. As a ministry, we commit to identifying those categories as targets for our income-generating intervention for women in communities.”
Alice Emasu Seruyange, TWICH Executive Director said that while the hospital was commissioned four years ago to provide holistic management of fistula and other childbirth injuries, The Association for Rehabilitation and Re-orientation of Women for Development (TERREWODE), an NGO, has for over 20 years contributed to the social and economic reintegration and rehabilitation of former fistula patients through a partnership with MOH.
Emasu remarked that the war against obstetric fistula requires more effort to be placed on prevention by addressing, not just the healthcare service delivery systems, but also unlocking the barriers that are still promoting the three delays at all levels- gender inequality, poverty, and a greater need for women empowerment- which often result in teenage pregnancies and child marriages.
“We shouldn’t just celebrate having a specialized hospital with the capacity to provide routine treatment for women and girls suffering from obstetric fistula, but we should embrace it so that it functions and allows these women to access care. For the hospital to function all stakeholders must come together and contribute resources for the sake of vulnerable women and girls in our communities,” she said.
According to the 2020 Uganda Demographic and Health Survey, two percent of Ugandan women of reproductive age have experienced fistula, meaning over 140,000 women are living with the condition, and 1,900 new cases are reported every year. Uganda is ranked third in the world in terms of the number of obstetric fistula cases.
Emasu reminisces about having had the dream of TERREWODE at barely 16 years old, after seeing four of her former school girlfriends dying during labour and two others incontinent of urine, a condition she later learned was an obstetric fistula.
“Though I was still a teenager, I needed to do something instead of just sitting and watching young women dying at the hands of a preventable condition. TERREWODE started by creating awareness and raising on the issue and mobilizing suffering women to receive treatment at fistula organized treatment camps,” she said.
Adding, “Through collaboration with MOH, over 5,000 women were supported. TWCH is an expansion of TERREWODE’s fistula program and has enabled over 1000 women to receive treatment in the last four years of its existence.”
While showcasing the hospital experience, achievements, and lessons learned within the four years, the Medical Director, Dr. Mary Aono, said on top of fistula, the facility also manages other childbirth injuries such as perineal tears and pelvic organic disorders.
Since its inception, they have provided holistic treatment and care to over 1000 patients. The services provided to all these women during treatment and rehabilitation include counselling psychosocial support and routine physiotherapy among others.
Aono revealed the hospital receives a significant number of women with incurable fistula and therefore they have established an initiative of specialized clinics for effective medical management utilizing modern technology.
TWCH survivors sharing experience
More than three-quarters of the families that suffer fistula separate due to undesirable fistula conditions. Okech and his 31-year-old wife, Rose Achan, from Serere district in Kadungule town council, is one of TWCH’s model couples, among the few couples that have peacefully reunited following the incidence over obstetric fistula in the family.
Achan says that the problem started after she got married and together with her husband produced four children. At first, they never had any problems. Trouble started with their fifth born, where she laboured for two days, an experience she had never had before.
She was transferred to a health facility where her baby was pronounced dead in her womb but was able to push it. She was rushed to the theatre in a critical condition, where she stayed for nearly three months, with deteriorated condition. The urine was passing out and even the wound where she was operated upon kept on opening.
She was later discharged but still leaking and kept on increasing to leak. As days passed by her condition worsened, making her husband too much affected. They sold all they had including three cows to get treatment and sustain themselves, but still nothing was done.
Her husband started becoming reserved. Whenever she saw people coming towards their home she would hide. That is how traumatizing this condition had put her in. Then in the process, they came to learn about the existence of TWICH in Sorori where they called and she was advised to go for completely free treatment.
That is how she finally got a new lease of life, after undergoing surgery. Initially, she could not have sex with her husband because she was flowing urine all the time. Whenever the man expresses desire in having sex she always shuns away.
Her husband subsequently got fed up with what was happening and got another woman.
After treatment, she became relieved that her husband was no longer suffering sexually. She confessed it was she who had caused her husband to get another woman, given her fistula condition. Before her fistula condition, her husband had never got involved in being unfaithful.
Today, they are together again. Thanks to God, and to TWICH that gave me treatment. Today, she shows no signs of fistula.
The challenge
Whenever I demanded sex, she would shun me. But even if she had accepted, I do not think I would have done it, the smell was unbearable because of the fistula. I decided to get another person who would fulfill my desires as a man.
Even when it came to food, I could hardly eat it, because the smell was too much for me even when my wife tried to prepare food for me, I still felt it smelt in her food. So, I had to look for somebody who could at least wash my clothes, prepare for me food, and also fulfill my sexual desires, but with dwindling income, I couldn’t support both. Because of hardships and confusion, I moved on to another woman. But that was wrong and is history today, I regret what I did, to separate from my wife at the time she earnestly wanted me. I have let the concubine go and have happily settled with my wife.
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