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Fistula: Neglected disease

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Derorah Nkrumah is one of the few women in the country who has survived the traumatic ailment that for the past five years has afflicted over 6,500 young women of reproductive age.

Fistula has devastating physical, social, economic, emotional and psychological consequences on a woman’s life.

The disease is curable.

However, only 500 out of the number of women affected by the condition have been able to receive treatment in the past five years.

 This means that 6,000 others are still wallowing in discomfort, stigma and shame in communities, dejected and ostracised.

In an interview with Ms Nkrumah during the launch of the ‘Partnership to end obstetric fistula in Ghana (PEFIG)’ in Accra, organised by the UNFPA and launched by the First Lady, Rebecca Akufo-Addo, she said she carried the condition for five years after she went through labour for her second child.

Although the baby did not survive, Deborah discovered to her horror that she was leaking urine and faeces after two weeks.

“I smelled like gutter water,” she recalled, adding that she could not go to public spaces.

Her husband left her.

With this, Deborah did not even,have the desire to give birth again due to the trauma she suffered.

After five years of enduring unspeakable shame, she finally had two surgeries at the Korle-Bu Teaching Hospital to repair and seal the gaping opening and she was finally healed.

Unfortunately, some 6,000 of such women still do not have any help in sight as it costs $1,000 to have surgery to repair and restore the deformed part of the body.

Due to the high cost involved, most of the women keep to themselves in their homes as they cannot even go to public spaces for fear of stigmatisation. 

What is Obstetric Fistula?

Obstetric fistula (OBF) occurs when there is an abnormal hole between the vagina, rectum and/or bladder, following prolonged labour during childbirth.

This causes the woman to leak urine, faeces or both.

Women with OBF can be found in all 16 regions of the country. However, most of the cases are identified in the northern sector of the country.

In an assessment of OBF, commissioned by the Ghana Health Service (GHS) and the United Nations Population Fund (UNFPA) in 2014 and 2015, about 560 OBF patient data were obtained and analysed.

Fifty-three per cent of patients were married and 35 per cent had, at least, primary school level education.

Women with OBF have lived with the condition between two weeks and 40 years.

The majority of OBF patients surveyed, that is 80 per cent, said that they felt helpless about their conditions due to the lack of information while about half of them felt rejected or shunned by their families.

Consequences

Many women who develop OBF may suffer from chronic skin condition, which is caused by the direct irritation of urine.

Some patients develop blisters and sores around their thighs, caused by the constant urinary incontinence and friction.

OBF is considered a “social calamity” in most parts of Africa.

Many women who suffer from this condition are unable to work outside the home or farm, thereby unable to generate income.

They are mostly shunned by their husbands, families and communities.

Eight out of 10 women who develop OBF lose their babies from their delivery due to prolonged or obstructed labour which results in the fistula in the first place. 

This situation is worsened by the fact that OBF patients often become isolated from their families.

Many women with OBF also lose their self-esteem and are easily depressed because of their helplessness.

One cannot easily tell if a woman has OBF just by looking at her.

The reason is that women with OBF often adopt various ways of coping with the condition.

These coping strategies include eating and drinking very little so that they will not leak too much urine. 

They keep themselves generally clean by bathing regularly, using perfume and powder to mask the offensive smell, putting calamine lotion on the blisters and sores around their thighs and using old pieces of cloth as diapers.

Can OBF be prevented?

In an interview with the National Obstetric Task Team (NOTT), Dr Gabriel Ganyaglo said OBF could certainly be prevented when a pregnant woman went through antenatal care throughout her pregnancy.

He called on pregnant women to seek medical help as soon as labour started and to make sure that the baby was delivered by a skilled birth attendant.

Dr Ganyaglo said OBF could be repaired through surgery, which yields a success rate of over 80 per cent when carried out by a trained provider with the proper medical equipment.

He said currently, there were two main fistula centres in the country which offer dedicated care.

They are the Mercy Women’s Catholic Hospital at Mankessim in the Central Region and the Tamale Fistula Centre at the Tamale Central Hospital in the Northern Region.

He mentioned other hospitals where women with fistula could also receive treatment to include the Korle Bu Teaching Hospital, the Komfo Anokye Teaching Hospital, the Tamale Teaching Hospital, the Upper East Regional Hospital, the Upper West Regional Hospital, and some district hospitals across the country.

Concerns

Dr Ganyaglo said one of the major factors that was keeping a lot of women from seeking treatment was the high cost involved, saying that although the National Health Insurance Scheme (NHIS) covered most of the costs, it was still expensive for the patients.

Also, because of the long period of stay in hospitals after surgery, which he said ranged from two weeks or more, most patients, because they are not being given food by the facilities, find it difficult to stay for that long.

He said most patients prefer hospitals that have feeding facilities but the hospitals that currently perform these surgeries do not feed patients, causing them to rather stay home and die slowly.

He said at the current rate of surgery and repairs, the country was far from reaching the global goal of ending OBF by 2030, unless a partnership that is aimed at pulling resources, such as the one formed by the UNFPA, with support from the Office of the First Lady, World Food Programme, Access Bank, Fidelity Bank, MTN and AT (Airtel/Tigo), is complimented by other corporate bodies and international partners.

SOURCE: GRAPHIC ONLINE