Treating obstetric: Medical practitioner’s role fistula
In May last year, Ghana observed the first ever International Day to end Obstetric Fistula, a medical condition in which a devastating injury in the form of abnormal opening forms between a woman's bladder and female genital resulting in urinary incontinence.
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The focus of the celebration was on the need to ensure that patients are treated and re-integrated into society by ending the shame and isolation they suffer as a result of the disease.
The condition is further described as a severe medical condition in which a hole develops between either the rectum or vagina or between the bladder and vagina after severe or failed childbirth, due to the unavailability of adequate medical care.
Common complication
It is also a common complication of child-birth resulting from prolonged obstructed labour. It is generally considered a disease of poverty because of its tendency to occur in women in poor countries who do not have health resources comparable to developed nations.
The focus of the celebration was on the need to ensure that patients are treated and re-integrated into society by ending the shame and isolation they suffer as a result of the disease.
As part of the observation, the United Nations Population Fund, (UNFPA) revealed that a rapid needs Assessment it conducted in 2003 in Ghana showed that there was an unknown magnitude of fistulae cases and inadequate trained and experienced personnel to handle the cases. It is estimated that as many as two to three million women and girls live with obstetric fistula and more than 50,000 new cases develop each year, in the developing world.
Most women living with obstetric fistula also struggle with depression, abandonment by their partners, families and communities, and live in isolation because of the constant leaking and odour. Many women report feelings of humiliation, pain, loneliness, shame and mourning for the loss of their lives and the child they lost during delivery.
For some women in certain cultures, the situation is further worsened because of the constant leaking and smell they are isolated from food preparation and prayer ceremonies because they are perceived as unclean. This situation causes severe depression among some women leading to suicide and attempted suicide in some cases. Some also turn to commercial sex work and even begging.
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Studies
The situation should not continue to remain grim. Studies have shown that improved access to adequate antenatal and emergency obstetric care would allow many women to avoid days of obstructed labour, which often result in fistula. Other recommendations include strategies to address the problem, include education of men and women on safe motherhood practices, training of traditional birth attendants (TBAs), and improving access to health care.
Health facilities, especially private ones that are situated in poor communities should as a matter of necessity innovate ways of helping to arrest the situation. This is because the core of our female patient population falls into the category that is most vulnerable to the condition.
They are women typically between 15 and 30 years old, illiterate, poor and likely to suffer the complications that lead to obstetric fistula during childbirth. It also brings to the fore the realisation that most women who may at one time or the other access our health services for less “embarrassing conditions” could be suffering in silence from obstetric fistula.
Community education
We should, therefore, go beyond the comfort, of our consulting rooms and OPDs and go into the community to educate them on the condition. As women are urged to seek treatment, the men and other members of the community should be enlightened so as to accept that it is a medical condition and not a curse visited on any women for which reason she should be ostracised and made to face the pain alone.
Again, they should be made aware of the treatment options that are available so those who can afford, can access medical help quickly. Government should also adopt an aggressive advocacy intervention to complement efforts made in 2005 to address this health issue and human rights violation. By doing this, government will also be making inroads in the eradication of maternal mortality.
The writer is with the New Crystal Health Services