Glyn Constantine, a Gynaecologist, and Brenda Gray, a theatre nurse, from Birmingham have successfully provided corrective fistula surgery to 75 patients during a 1 year undertaking, in Kamuli, Uganda.
Two percent of women of a reproductive age in Uganda have experienced fistula, according to the Uganda Demographic Health Survey 2011. This means there are an estimated 140,000 to 200,000 women with fistula in the country, the Ugandan Ministry of Health (MoH) highlighted in June. In fact, between 50,000 and 100,000 new cases of fistula, treatable through reconstructive surgery, occur globally each year, according to United Nations Population Fund (UNFPA)
The fistula project has, therefore, arisen from the need to help these vulnerable women with this fairly simple surgery. Conversely though, Uganda has a low number of surgeons available to assist with these difficulties.
“Uganda grapples with an incredibly low number of surgeons who have the required training to carry out fistula repairs. Currently there are only 24 in this East African nation. Twenty-four in a population of about 34 to 37 million. It’s like a drop in the ocean,” national fistula specialist and specialist in the MoH, Peter Mukasa reports.
As in other poor countries, Uganda comprises of many women who deliver at home or far from any medical help. ‘If a woman develops obstruction in labour she needs an emergency caesarean section. If this can’t be done she may die of a ruptured uterus or deliver a stillbirth after days of agony in labour’, reported the Uganda Childbirth Injuries Fund.
If this were not enough she may find that she has no control of her bladder or even her bowel. “The prolonged pressure of the baby’s head against the bony pelvis wears a hole between the bladder and vagina and sometimes the rectum. This is called a vesico-vaginal fistula. This will never heal, so she will be incontinent for life unless she can find someone to perform a surgical repair”, continued the Uganda Childbirth Injuries Fund.
Despite the high numbers of women in need of fistula surgery and the lack of skilled medical practisions, one successful recipient of the fistula surgery run by Glyn Constantine and Brenda Gray was Mary (name withheld).
“I’m happy to have the surgery. I have no problem going for it,” Mary stated.
Still, previously like others, she struggled with the day to day life of living with fistula. “I am home all the time. I don’t go out to the market, I don’t go to church,” said the 35-year-old.
For Mary, her labour lasted three days said in the field reporter from International Press Service, Amy Fallon. She went on to say that because the nearest hospital was too far away, Mubende District being over 144 km west of Kampala, a traditional birth attendant took Mary to a small health facility when she went into labour. For 48 hours she remained there, trying to give birth to her child. On the third day she was taken to a district hospital where she was able to deliver her stillborn baby.
This is the same for many women in this situation. After they visit a hospital they can rarely find anyone who can help with their fitsula repair, so ‘they return home to a life of misery and rejection’, stressed the Uganda Childbirth Injuries Fund.
One of the other main stumbling blocks is the fear of costs from the voluntary hospitals or private surgeons for the fistula repair, especially for many of these women who often earn $1 per day if any at all. In fact, ‘those most vulnerable to contracting fistula are young, illiterate and rural dwellers’, stressed Amy Fallon.
‘Fistula repair costs on average about 400 dollars, including the cost of transport to hospital, hospitalisation and other care. It is a lot of money,” disclosed Peter Mukasa, adding that ‘in Uganda the expense however, can be catered for by the United Nations Population Fund (UNFPA)’.
Until women in Uganda know about these programs, many will continue to be left to their own accord and continue to be shunned by their community. ‘They are usually abandoned by their husbands and give up all hope of being cured‘, highlighted Uganda Childbirth Injuries Fund.
“The true figures on women with fistula are not known because [women] do not come out, they are so stigmatised,” says Dr. Susan Obore, who specialises in urogynaecology at the Mulago National Referral Hospital. “So what we see is probably the tip of the iceberg.”
Despite the many problems faced by women in Uganda the success of the Uganda Village Project (UVP) fistula program stems from its approach and empowerment of women through local radio and repair camps.
Kait Maloney, managing director of UVP’s Iganga office, says that they run fistula repair camps three times a year at Kamuli Mission Hospital, in Kamuli, eastern Uganda. She highlights that Patients are identified through radio shows, village outreach programmes, health centre referrals and by word of mouth. Women are transported to hospital and operated on by surgeons from the Uganda Childbirth Injuries Fund, a United Kingdom-based organization.
Worldwide, there are over two million women in Africa, Asia and the Arab region living with untreated obstetric fistula, according to the global Campaign to End Fistula, a programme by UNFPA and various partners.
For the Uganda Childbirth Injuries fund. Their work continues to support local communities and are able to completely cure about 80% so that they can make a new start and have children again. They also encourage and teach national surgeons wherever possible so that they can take over this work in time and we work toward prevention though education and better provision of accessible obstetric services, highlighted Uganda Childbirth Injuries Fund.
“As we speak now there’s a fistula being formed, one or two or three or four hundred women are getting obstructed (in labour). Empowerment of women is one of the best ways to prevent fistula,” Obore adds.
‘We envision a future in which all Ugandan communities will have the means to effectively create and implement their own health and development solutions’, concluded The Uganda Village Project (UVP).
“Every hospital should be able to repair a woman with fistula.”
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