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No more isolation and shame, fistula is curable
2005-11-26 08:53:31
By BILAL ABDUL-AZIZ
Victims of fistula need not worry about being isolated and rejected by their families for the disease can be cured and there are organizations funding it.
Married at the age of 13 years, Maria Peter of a remote village in Singida Region, became pregnant soon after.
When her baby was due, she was to endure a complicated labour and doctors were forced to perform an operation. Unfortunately, the baby died.
But Maria’s sadness and trauma did not end there. Something terrible had happened. From then, she found herself leaking urine and faeces. ’What a horrible thing to experience?’ She wondered.
A short while later, her husband, unable to endure the abominable smell, divorced her. Maria was suffering from a condition known as fistula. She lived with it for about 11 years.
The World Health Organisation (WHO) estimates that up to 4 million girls and women world-wide may be living with this devastating childbirth injury clinically known as fistula.
WHO also estimates that an additional 50,000 to 100,000 girls and women are affected each year, and most of these girls and women live in Africa and South Asia.
A gynaecologist who prefers anonymity says fistula is caused by a prolonged and obstructed labour, when the head of the baby cannot pass safely through the birth canal of the mother.
The constant pressure of the baby’s head normally creates a hole between the woman’s vagina and bladder, and sometimes the rectum.
She further explains that when the hole tears through to the bladder, urine passes through the vagina and this is called Vesico-Vaginal Fistula (VVF).
When a hole occurs between the vagina and rectum, the woman leaks faeces and this is called Recto-Vaginal Fistula (RVF).
The continuous leaking of urine or faeces caused by fistula results in constant wetness and smell.
Many girls and women with the disorder are forced to live a life of shame, and some are abandoned by their husbands, families and society.
Research carried out in Tanzania a couple of years ago, revealed that over three quarters of fistula patients interviewed felt ashamed of themselves and had their lives seriously impaired by the stigmatization caused by their condition.
’It is a shame that one endures, each time. You cannot run away from it or hide from people. You are ostracized and ridiculed.
Nobody, including your closest relative wants to be with you, says Mariamu Ramadhani,’ once a fistula patient.
However, with the Women Dignity Project (WDP), an NGO, devoted to mobilise action for prevention and management of fistula, there is light at the end of the tunnel.
The lives of Maria and other girls and women in the country, will never be the same again.
Maria, is now working hard on her family’s farm and her child is not only healthy, but is going to school, thanks to the Women Dignity Project (WDP) Utu Mwanamke.
Her dignity has been restored and she can smile again.
The WDP, according to…… grew out of Tanzania’s first comprehensive fistula initiative that began in the mid 1990s at Bugando Hospital in Mwanza.
It supports coalition building to mobilize action on fistula in the country, in the East African region, and internationally.
To fulfill its obligations the WDP has established links with the Ministry of Health, hospitals, research organisations, women’s rights and development organisations and international agencies such as WHO, UNFPA and UNICEF.
In 2002, the WDP documented and analysed fistula care throughout Tanzania. That was the first attempt of its kind in the country.
Basing on the survey, the project is presently collaborating with the Ministry of Health and key hospitals to establish a National Fistula Referral System.
As a result of the fistula survey, the Health Ministry has allocated funds for 1,000 fistula repairs in the 2003/04 fiscal year.
’This is good support. It strengthens our on-going efforts to ensure no girl or woman is denied services because of her inability to pay,’ said the WDP Project Manager, Maggie Bangser.
WDP, which undertakes to prevent and manage the disorder within a framework of human rights, gender and health equity, bases its work on the understanding that health conditions affecting poor people result from social, economic and political factors that underlie poverty.
’WDP seeks to promote the health and well-being of the poor through community based research, organisational capacity development and policy analysis and debate,’ she said.
Maggie said that WDP has a distinct approach to fistula based on two convictions.
First, that girls and women with fistula are survivors, not victims.
’Most portrayals of those living with fistula present them as powerless and defeated,’ she said.
In WDP’s experience, she finds, they are often strong and resilient, ’girls and women with fistula galvanize scarce resources and family support to get a surgical repair and carry on with life,’ she said, adding that, ’girls and women with fistula deserve our praise, not our pity.’
Maggie also notes that WDP explicitly links the disorder to broader issues of gender and health equity.
’WDP believes that fistula will continue to exist until fundamental inequalities affecting the health of the poor are redressed.’
The project works in close collaboration with hospitals and health care providers, those doing fistula care.
’Importantly...WDP is also involved in policy analysis and coalition building to promote ’pro-poor’ development. This includes analysis of health sector budgets, expenditure tracking and strategic involvement in national poverty reduction processes,’ she said.
The project specifically supports a process of community based research, analysis and planning on fistula and social vulnerability, which includes working with local researchers and Community Based Organisations to understand the causes and impacts of the disorder to mobilise action for the health and well-being of the poor.
According to Maggie, WDP strengthens organisations to take action on fistula and gender health equity, supports hospitals and health care providers to strengthen fistula prevention and care, and also get involved in the Public Expenditure Review and Poverty Reduction Strategy processes in order to monitor policy commitments and allocations.
’We raise funds to ensure that girls and women living with fistula are able to get surgical repair. Even at highly subsidized rates provided by hospitals, the cost of a repair makes it impossible for most girls and women to undergo surgery,’ said the Project Manager.
WDP also works with partners to secure funding for surgical repair, train local surgeons to do the operations and make the required supplies and equipment available, she added.
Currently, the Project has surgeons who operate on people with fistula at Selian Lutheran Hospital in Arusha, CCBRT Hospital in Dar es Salaam, St Walburg’s Hospital in Lindi-rural, KCMC Hospital in Moshi and Mbesa Mission Hospital in Mtwara.
Fistula experts also are available at Bugando Hospital in Mwanza, St Benedict’s Hospital in Ndanda, Nkinga Hospital in Nzega-Tabora, Sumbawanga Hospital in Rukwa region and Peramiho Mission Hospital in Songea.
There are a number of hospitals across the country which provide fistula treatment occasionally with the help of a specialist doctor from outside.
These include, Muhimbili Hospital in Dar es Salaam, Mvumi Hospital in Dodoma, Consolata lkonda Hospital in Iringa and Biharamulo, Isingiro, Nyakahanga and Rubya Hospital in Kagera region.
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