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Obstetric Fistula: treating the secret disease that kills Africa´s child marriage victims.

Author: Ray Mwareya in Zimbabwe and Addis Ababa. Date Published: 2017-10-31 20:42:27
  • Obstetric Fistula: treating the secret disease that kills Africa´s child marriage victims.

    Nyasha Musandu, 15, (name changed to protect identity) was just 12 years old when she was forced into a brutal marriage. At 13 she fell pregnant, suffering a still birth and double obstetric fistula; a debilitating condition caused by a grueling four day labour rendering her completely incontinent.

    Although scarred from the trauma of child marriage and teenage pregnancy, Nyasha’s hope has been restored and she has begun healing after receiving free fistula repair surgery under UNFPA’s Campaign to End Fistula in Zimbabwe.

    As the world commemorates International Day to End Fistula under the theme “Hope, healing and dignity for all”, UNFPA aims to put an end to this neglected health condition that affects an estimated 2 million women in the developing world.

    Obstetric fistula occurs mostly among women and girls living in extreme poverty, such as Nyasha whose parents died when she was very young. She was only 12 years old when her sister sold her into a child marriage to a much older man. “She owed him $20 and she could not pay so he took me as his wife.”

    One year later, at the age of 13, Nyasha fell pregnant and her husband threw her out. She was sent to live with her blind grandmother in Chimanimani in Zimbabwe’s eastern province. During a grueling four day labour at her grandmother’s rural homestead, Nyasha suffered a still birth and developed fistula. “The child was dead, I was leaking urine and feces all the time and no one wanted me anymore,” said Nyasha.

    Doctors say this birth injury is more likely to afflict girls like Nyasha who become pregnant while still physically immature, as their underdeveloped bodies are unable to cope with the trauma of labour. Women and girls with fistula are often unable to participate in society, ostracized by their families and communities driving them further into poverty.

    However, Nyasha has avoided this lifelong plight receiving free fistula repair surgery after Child Line Zimbabwe connected her to Women and Health Alliance International (WAHA), UNFPA’s technical partner in the Campaign to End Fistula which has repaired over 300 women to date through five repair camps at the country´s Chinhoyi Provincial Hospital under the Health Development Fund, supported by the governments of Britain, Ireland, Sweden and the European Union.

    Nyasha was scheduled to receive two fistula repair surgeries as she had both Vesicovaginal Fistula (VVF) and Rectovaginal Fistula (RVF), the first of which she received in July 2016, returning again in January 2017 for her second and final surgery.

    “I was scared for anyone to touch or examine me but the doctors and staff were all so kind and patient with me.”

    Nyasha is now safe in the protetion of Child Line Zimbabwe who have placed her with a foster family. She is healing and has high hopes of returning to school. “I am now fully recovered and I wish to go back and finish to school if I can get enough help.”

    While Zimbabwe pins it hopes on UNFPA led efforts to treat Obstetric Fistula, Ethiopia has been more direct.

    Ethiopia world biggest efforts to treat Obstetric Fistula,

    In Ethiopia, East Africa, one Hamlin Fistula Clinic is the world biggest hospital for such treatments.

    The clinic is the world’s first existing obstetric fistula free treatment center. It has now become a center of excellence in the region. Various institutions from neighboring African countries interested in working on obstetric fistula repeatedly visit its facilities. “We are 100% donation based charitable organization where we have Trustees in about 8 developed countries  including Australia where our biggest source of income come from, that exclusively raising funds to Hamlin Fistula Ethiopia’s holistic work,” says  Aschalew Tadesse, Communications Officer at Hamlin Fistula Clinic.

    “We also are internationally certified in training obstetrics and gynecology doctors coming from many African countries and Asia through the training program funded by FIGO where all of the trained doctors will go back to their country and treat the same problem,” says Aschalew.

    The hospital facilities is remarkable for offering free surgeries to women who undergo obstetric Fistula surgery.

    “Almost all of our patients are from rural Ethiopia where women living in such rural villages are totally dependent on their husband. When these women faced the problem most husbands will left away and married to another, which as a result, they left lonely and economically poor as well. They sometimes suffer in getting bus fare even after they hear the service is free. So for such poor women paying 600USD for the simplest surgery remains totally unaffordable. The above facts highly justifies that the service should be free and we don’t ask any payment from patients and the whole service at our facilities is completely free of charge. We also cover their transportation cost for those in need,” adds Aschalew.

    Fistula patients endure stigma in Ethiopia,

    Most ordinary people in Ethiopia don’t know much about this problem says Aschalew. The ignorance is more acute in rural villages where the majority patients came from, the community may even consider the condition as a curse and incurable which as a result most families hide the victims somewhere for not to be blamed as a cursed families.

    “Sometimes stigma begins from families where most families hide the fistula victims somewhere isolated and won’t disclose what has happened to them to anyone in the village fearing not to be blamed as a cursed family.”

    On the other hand the women with fistula stigmatize themselves with the fear of the stench which is inevitable in such rural villages with no access to water or walk long to get it to clean themselves. Such women withdraw from any social gatherings out of intense shame.

    He sees a positive turnaround, “In fact, in the past few years, government intensively worked in letting the rural villagers have access to health facilities and professionals leading the attitude towards obstetric fistula continuing to be changing through time. These days, fistula patients won’t stay long with the problem because of lack of information compared with the before 10 years where we regularly used to receive patients who had been stayed for many years before treatment situation.”

    The government of Ethiopia has offered tremendous support to Hamlin clinic efforts to treat Fistula. “The 5 outreach hospitals, the rehabilitation center and the college, I am happy to says are built on the land we got from the state.”

    Aschalew adds, “In recent years the Ethiopia government has set a goal of discarding obstetric fistula from the country’s major health problems in 2020. The goal is to identify fistula victims and send to Hamlin hospitals for treatment.”

    Cost of training Fistula doctors,

    Scholarships are at the forefront of Hamlin clinic rollout training of surgeons and nurses to treat Obstetric Fistula. Levying tuition fee on aspiring nurses will put the cost of medical education beyond reach of many in Ethiopia.

    “We have two types of trainees, one is of midwifery students where we have been giving a free scholarship for female students screened from rural high schools with B.Sc. degree in midwifery at our Hamlin collage of Midwives,” says Aschalew.

    With its limited intake, only 25 per year, the collage has produced 125 skilled female midwives since 2007 and deployed them into rural government health centers sited in the same areas they came from. As these midwives don’t pay for their four year stay at the college, to receive their diploma/license, he says.

    “We put an obligation of serving for a minimum of 4 years at the clinics they are assigned on. In the other training program we have is of obstetrician and gynecologist surgeons coming from all of the world to specialize on obstetric fistula surgery.”

    As a cap in its reputation, Hamlin clinic is now certified internationally in training doctors from overseas mainly from developing countries of Africa, Middle East and Asia. “This training program is totally funded by FIGO, an international organization based in London responsible in screening and sending the trainee doctors. We got paid from FIGO for this training program.”

    Volumes of surgeries per year,

    In its six treatment facilities over Ethiopia including the main hospital in Addis Ababa, the capital city, Hamlin Clinic now has the capacity of treating 4000 patients yearly.

    The task could be difficult sometimes. Aschalew reveals, “The fact that the poor women needs to be treated lives in a remote rural villages with no access to communications means such as radio, tv and/or cellphone, makes the identification a very tough work which as a result our annual treatment statistics falls between 2500 to 3000 cases.”

    Thankfully, the outcomes of treatment are impressive. “According to our treatment report the current surgery success rate in all Hamlin facilities is 90%.”

    Length of cure,

    For 85% of women treated at Hamlin Fistula clinic, it takes an average of one month to get totally cured and discharged. The patients stay put in the clinic dormitories while obtaining specialized psychosocial and basic skills trainings of post-cure diet needs.

    “But 15% women with difficult cases such as a damaged bladder must stay with us for long time under treatment named diversion surgeries,” says Aschalew.

    Child marriage – especially when underage girls fall pregnant – is cited by UNFPA as a leading cause of Obstetric Fistula condition. Is child marriage a common feature in some parts of Ethiopia we ask the Hamlin Clinic?

    “The main cause for obstetric fistula is prolonged obstructed labor which, by itself, has many reasons/causes. Among these causes teenage pregnancy resulted from early marriage is mentioned to be one of the majors,” reveals Aschalew.

    In Ethiopia’s case, early marriage below 18 is banned by law. However child marriages have been a traditional feature for most rural community and through time becomes tradition to most communities, it still is happening in some of the remote rural villages of Ethiopia.

    “In our over 40 years’ experience most of our patients coming to us for treatment are aged 14 to 24 and faced the problem on their first pregnancy. From this fact it would be easy to learn how big teenage pregnancy contributing to obstetric fistula to happen.”

    Hamlin Fistula Clinic Ethiopia has candid advice to corporates, foundations and governments in Africa wishing to copy its astonishing success in treating Obstetric Fistula.

    “Thanks to the founder Drs. Reg and Catherine Hamlin we are now the world’s first and best free fistula treatment center. As our vision is to see a world free from obstetric fistula and other childbirth injuries we are always more than happy to share our experience to others interested in the area, ” sums Aschalew.

    (Picture caption: The picture shows medics attending to a woman blighted by Fistula condition at a hospital in Zimbabwe)

    (Picture credit: Ray Mwareya)  

    (Story funding credit: The research and production of this story was made possible by a generous funding from the Swedish Alternative Nobel Right Livelihood Journalism Grant Prize)

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