De­mys­ti­fy­ing ob­stet­ric fis­tula

The Sunday Mail (Zimbabwe) - - SOCIETY - Em­manuel Kafe

ALTHOUGH ob­stet­ric fis­tula is one of the most se­ri­ous child­birth in­juries, the con­di­tion re­main largely un­known.

The United Na­tions Pop­u­la­tion Fund de­fines ob­stet­ric fis­tula as a hole be­tween the birth canal and blad­der or rec­tum, caused by pro­longed, ob­structed labour, with­out ac­cess to timely, high-qual­ity med­i­cal treat­ment.

The hole leaves women leak­ing urine, fae­ces, or both, and of­ten leads to chronic med­i­cal prob­lems, de­pres­sion and so­cial iso­la­tion.

While all women of child-bear­ing age can suf­fer from fis­tula, it is the un­der-aged girls, most of whom are vic­tims of child mar­riages, fe­male gen­i­tal mu­ti­la­tion and teenage preg­nan­cies, who face the high­est risk.

Dr Melba Sibanda, an ob­ste­tri­cian, ex­plained the med­i­cal con­di­tion.

“Ob­stet­ric fis­tula is an un­pleas­ant con­di­tion which re­sults in con­stant leak­age of urine and fae­ces through the pelvis.”

Dr Sibanda said those suf­fer­ing from the con­di­tion are of­ten alien­ated by so­ci­ety.

“In most in­stances, those with the con­di­tion are of­ten shunned by their hus­bands and fam­i­lies.”

Dr Richard Maku­nike, an­other ob­ste­tri­cian, said fis­tula oc­curs when a woman goes through ob­structed labour.

“The hole is cre­ated when a foe­tus’ head is con­stantly push­ing against the pelvic bone.

‘‘This pre­vents blood flow, re­sult­ing in the cre­ation of a hole,” Dr Maku­nike said.

Dr Maku­nike also spoke about the stigma and dis­crim­i­na­tion that women with the con­di­tion en­coun­ters.

“A woman with a fis­tula, who is per­pet­u­ally leak­ing urine and some­times fae­ces, is of­ten re­jected by her hus­band and shunned by her com­mu­nity be­cause of the foul smell she pro­duces as well as her in­abil­ity to bear more chil­dren,” ex­plained Dr Maku­nike.

Re­search has shown that the con­di­tion is most preva­lent among ru­ral girls where a lack of med­i­cal fa­cil­i­ties of­ten re­sults in ex­tended labour.

Health ex­perts have stressed the need to im­prove health ed­u­ca­tion and ante-natal care.

The ex­perts ar­gue that preven­tion is the key to end­ing fis­tula.

Ob­stet­ric fis­tula can be avoided by en­sur­ing that trained mid­wives are al­ways in at­ten­dance dur­ing child­birth.

There is also need for the pro­vi­sion of timely and high qual­ity emer­gency ob­stet­ric care for all women who de­velop com­pli­ca­tions dur­ing de­liv­ery.

It is es­ti­mated that two mil­lion young women are liv­ing with un­treated ob­stet­ric fis­tula in Asia and sub-Sa­ha­ran Africa.

Ac­cord­ing to the Fis­tula Foun­da­tion, be­tween 80 and 95 per­cent of vag­i­nal fis­tula can be closed with sim­ple surgery and in about 90 per­cent of ob­structed labour cases, the baby does not sur­vive.

Whilst the ex­tent of ob­stet­ric fis­tula in Zimbabwe is un­known, statistics from the United Na­tions show that for ev­ery woman who dies, ap­prox­i­mately 20 suf­fer se­ri­ous in­jury or dis­abil­ity, of which ob­stet­ric fis­tula is one of the se­ri­ous in­juries.

Fis­tula is a pre­ventable and treat­able med­i­cal con­di­tion that is oc­cur­ing due to weak health sys­tems, poverty and child mar­riages.

In the de­vel­oped world, cases of ob­stet­ric fis­tula are not com­mon.

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