1 May 2014

Malawi: Obstetric Fistula Is Avoidable, Says UNFPA Malawi

Blantyre — Obstetric fistula is avoidable and can also be treated, says the United Nations Population Fund (UNFPA) Acting Country Representative, Dr. Rogaia Abdelrahim.

Dr. Abdelrahim made the remarks on Saturday at the Queen Elizabeth Central Hospital in Blantyre when she visited fistula patients who had been treated during a three-week camp at the referral hospital.

The UNFPA-sponsored camp, which started on April 28, brought 102 fistula patients from all the three regions. As of Saturday, 80 fistula cases had been repaired, with 22 referred to the next camp.

"I am happy that you came, but I am also sad that many women have fistula," Dr Abdelrahim told the patients in the Gogo Chatinkha maternity ward who were about to go home after the end of the camp.

She said that having been treated, they had a duty to go and spread the message in their communities that fistula was avoidable and that if one had the problem, they should go to hospital quickly to get help.

Dr. Abdelrahim urged them to go and speak out against early marriages to avoid the condition, and advised that the proper time for a woman to give birth was when she had at least reached the age of 21.

Since UNFPA Malawi started organizing the camps in 2007 in partnership with the government, they have so far repaired about 950 cases as part of the UN agency's campaign to end fistula worldwide.

During the camps, UNFPA brings skilled surgeons from outside the country who are assisted by local clinicians. The latest camp brought two surgeons, from Kenya and Tanzania and a pool of local clinicians.

Obstetric fistula is an injury caused during obstructed labour. During the prolonged labour, the soft tissues of the pelvis are compressed between the descending baby's head and the mother's pelvis bone.

The lack of blood flow causes tissue to die, thus creating a hole between the mother's vagina and bladder known as vesicovaginal fistula or VVF. The hole can also be created between the vagina and the rectum, causing a recto-vagina fistula (RVF) or both. The result is the leaking of urine or faeces, or both. Fistula develops in most cases when emergency obstetric care is not available to women who have complications during childbirth. Thus poor women living in remote areas are at great risk of developing fistula because of their lack of access to better medical care.

Although the shattering health condition can be treated, there is a myth in many communities in the country that fistula patients, who often suffer ostracism because of their bad smell, rarely recover. "Go and tell others that fistula can be avoided and is treatable," Dr. Abdelrahim said as she greeted the patients before giving them gifts. She encouraged them to take a leading role in the fight against fistula.

Dr. Abdelrahim also stressed the need for women to plan their families and space the birth of their children. She said practising family planning was another way of keeping away obstetric fistula.

Malawi's maternal mortality ratio currently stands at 460 per 100,000 live births, down from 1,220 between 1992 and 2000. The United Nations Millennium Development Goal (MDG) 5 calls for a 75 per cent reduction in maternal deaths by the year 2015 from the 1990 levels.

Prevalence studies of fistula from nine districts of Malawi by the Centre for Reproductive Health of the College of Medicine in 2002 and 2008 revealed a prevalence of 1.6 per 1,000 women.

The World Health Organisation (WHO) estimates that two million women throughout the world have untreated fistula. The WHO also says around 100, 000 women develop fistula each year worldwide.

Of the 102 fistula patients, 30 came from Mangochi alone. The district's early marriage and other cultural practices, plus the fact that many people live far from health facilities are contributing factors.

"Avoid early pregnancy. Tell your daughters that the right time to start giving birth is when they are 21 years of age and above," Dr Abdelrahim appealed to the patients and their guardians. UNFPA Malawi Reproductive Health Officer responsible for fistula, Grace Hiwa, told MANA in an earlier interview that the camps were proving very useful as many patients were going to seek repair.

"We are seeing a lot of patients coming to seek repair," Hiwa said. "UNFPA provided conservative treatment in 2013 to other patients with problems that are like fistula and have recovered."

"Fistula survivors have also been instrumental in mobilising fistula patients for repair by showcasing their successful operation results because of myths and lack of knowledge that they can be cured."

It is difficult to quantify the total amount of funds UNFPA has spent to date on the camps in the country, but the figure is in hundreds of millions of Kwacha as each fistula case costs about $1,000 to repair.

"UNFPA puts a lot of funds into the camps as hospitals do not have all the necessary [fistula] supplies, more so since we bring surgeons from abroad as a fistula operation requires special skills," Hiwa said.

The fistula camps are part of the global campaign UNFPA and its partners launched in 2003 to make the condition as rare in the southern hemisphere as it is in the north.

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