I once read somewhere that obstetric fistula was eliminated in the United States of America in the early 20th century. Now this is the 21st century and obstetric fistula continues to be a problem in many African countries including Malawi.
Firstly let me tell you all what obstetric fistula is. This condition is regarded as a birth defect or one of the complications of child birth. Obstetric fistula is a hole that is formed on the tissues of birth canal. This hole might be formed between the vagina and bladder (vesicovaginal) or between a vagina and rectum (rectovaginal) leaving a woman with uncontrollable leakage of urine and/or feces through the vagina. This usually happens as a result of obstructed labor where the baby is too big compared to the woman pelvic or when there is prolonged labor where by a woman labors for too long than expected.
Fistula is not a pleasant condition and many women suffer from devastated effects. Fistula women experience physical discomfort, bad smell from the continuous leakage of urine or feces, shame, embarrassment and humiliation in the society. These women feel rejected, stressed and have relationship problems with their partners. They are treated as social outcasts because of their condition.
Many women live with fistula for a while before they get treatment. Some up to two years or more, and some never even get treatment at all. Lack of information is one of the reasons these women delay in seeking treatment. Most people do not know that fistula is a medical condition and it can be treated. They think it a curse for being unfaithful to their partners hence they do not disclose this condition to anyone or go to the hospital in fear of being judged by the community. Access to health facilities and trained surgeons who are capable of repairing fistula is another big problem. More than 90% of facilities in Malawi are not well equipped or competent enough to conduct fistula surgery. I know of only two medical centers in Malawi (Queen Elizabeth central Hospital and Freedom from Fistula Foundation) that are able to do fistula repairs and once or twice a year there is a camp that happens for a week or so where doctors from outside come and do repairs.
I am writing this because I feel fistula is one of the neglected medical conditions in Malawi. I have worked as a clinician for five years and I think as a country we have a long way to go to eradicate obstetrics fistula. I learned about fistula and its treatment in college, but throughout my whole career I have only met two clinicians who are able to do repairs. Despite the knowledge that I, and other clinicians in this country, have there is no room to perfect our skills due to lack or resources in our health facilities to enable and expose clinicians to feel comfortable doing fistula surgeries. As much as effort is put to eradicate obstetric fistula, I still think as a nation we can do better. For example there is more work to be done to improve access to emergency obstetric care services at all levels. There is need for educating the masses about what causes fistula and where they can get treatment and, that just like any medical condition, fistula is nothing to be ashamed of. There is also need for political will, from both the national and international levels, to ensure adequate resources are available to train clinicians and nurses so they are competent enough to do repairs as well as availability of treatment and equipment in most health facilities across the country. There is no loss in investing in human capital. Let us restore these women’s dignity.