Ignorance Of Obstetric Fistula Repair Persists Despite Campaigns
By Leocadia Bongben
Despite progress witnessed in the last years with obstetric fistulas repair some women are yet not aware that their situation can change from shame to shine if they speak out and consult.
Obstetric Fistulas Prof. Tebeu Pierre Marie, Gynecologist and Obstetrician at the University Teaching Hospital, CHU, says is a communication between the bladder and the vagina or between the rectum and the vagina meaning that urine comes to the urine bag and flows directly outside because there is a hole between the urine bag and the vagina and same for stool.
Obstetric fistula occurs at childbirth in a facility where there is no skilled staff or deliveries at home and there might have been need for a caesarian section and when this cannot be done, the head of the baby can compress the bladder or rectum for a long time, in the long run the tissue loses blood supply and dies off. Within five days to one week the dead tissue falls off creating a hole, Tebeu explains.
Pulcherie Maboulle like Manka Ernestine both operated at the Yaounde University Teaching hospital did not know obstetric fistulas could be repaired.
“It was complicated because we did not know the illness can be cured. I never knew that I could come to the hospital and get repaired”, Maboulle and Manka all say respectively.
Maboulle has just been operated upon and has spent only three days in the hospital, as she says, the operation went well. “I can move around, I was even in the other block and I pass urine normally now”, Maboulle says.
For Mankaa who has had three children living with condition of having stool pass through vagina with risk of infection, all is now well after the repair.
Maboulle narrates here ordeal with the disease of shame prior her operation. “It was hell and if your man does not really like you, then be sure to be abandoned. Even within the family, any time you sit with your sisters it is either the odor of urine or feces. It is discouraging, not a life to expose in society”.
It all started in 2014 when she delivered her baby in the hospital and thought after taking antibiotics everything was going to be normal, but after two years she had to come back to the hospital.
“I went to the Gyneco-obstetric hospital but I was told repairs were only done at CHU in the whole of central Africa, I did not even know such an illness exists, so when I got CHU and was consulted I was told the free surgery campaign was over and that I could come back in May”, she said.
Since 2009, CHU has been carrying out free obstetric fistula repairs twice per year to give women a new hope in life and this year the second campaign was on from May 26 –June 6. During the free obstetric repairs the women only have to buy drugs.
As Maboulle says, “Everywhere I went I was asked about FCFA 700,000 but with the free surgery campaign at CHU I have not spent any-money except to buy drugs after the free operation as even hospitalization is free”.
According to Prof. Tebeu, the patient will spend about 300,000 to 500000 to get the fistula repaired outside the free campaign but CHU has reduced the amount by half and humanitarian organizations can help easily now because if they have to spend to operate ten women that same amount can be used to operate 20 women.
Obstetric Fistulas are a public health problem worldwide, with about 2 million women affected and in Cameroon at least 10,000 women live with fistulas and since the campaign started in 2009 more than 200 women have been operated, 20 during each campaign and twice a year but not enough.
There are more women suffering from fistulas and it is estimated that there are 1000 new cases every year, Tebeu stated.
Initially fistulas were thought to affect mostly the northern part of Cameroon due to early marriage, but there are equally women who come from the centre region with fistulas. The Domestic and Health Survey, DHS 2011 indicate that 37 percent of women in the centre region still deliver at home.
Obstetric fistula repair is a technical procedure, the gyaenacologist-Obsterician closes the hole and the woman is able to contain stool or urine and pass it out when she wants.
The percentage of complete repair is estimated at 80 percent and Tebeu says the surgery can be repeated adding that a few women can get their fistula closed but have the flow of urine through the normal channel, a condition known as post fistulas urinary incontinence which can still be operated.
But, If the hole is so big or fibrosis too much and everything is destroyed with only bones left there is a palliative measure, “remove the pipe that take urine from the kidney to the bladder and put directly to the intestine and the urine is passed out with stool”, the expert says.
Women who have been repaired of fistula say after this shameful illness there is a life with a God-sent doctor at CHU. This illness comes in childbirth, which is complicated and difficult too. It is not witchcraft but a natural illness like malaria and they encourage women to get treatment in the hospital.
After about five years of free fistula repairs there is change, women came to consult after a long time after about 30 years of bondage with fistulas, but the time lapse is now about six months and a few years.
But, there is still need for more sensitization; send the information villages to bring more women out for consultation and repairs.