Battling to end obstetric fistula as Covid-19 pandemic rages on As of December, 2019, a total of 717 women benefited from the repair surgery in Zimbabwe while the graph above shows the number of beneficiaries since 2009 to 2017 in Africa

Roselyne Sachiti Features, Health and Society Editor
The odour that came from uncontrollable urine and faeces kept Maria Mukume of Nyazura, in Zimbabwe’s Manicaland Province, away from most family gatherings. For 13 years, Maria thought she was the only one who had the problem of leaking urine and faeces. She faced all sorts of ridicule and society ostracised her.

“When I could attend funerals, I would lift my dress and sit on the ground with my panty so that when the urine came out, it would sink. I would be the last to stand up and made sure I covered the wet ground with sand. I learnt that my condition is obstetric fistula,” she told The Herald in June 2017, as she awaited her turn for a fistula repair operation.

Obstetric fistula is a condition in which an abnormal opening (hole) develops between either the rectum and birth canal, ureter and birth canal, bladder and birth canal due to prolonged obstructed labour.

Maria, who married aged 15, was one of the 60 women at Chinhoi Provincial Hospital, where Ministry of Health and Child Care’s fistula repair programme supported by the United Nations Population Fund (UNFPA) and Women and Health Alliance (WAHA), conducted free fistula repair surgeries.

Because of her condition, her husband divorced her and remarried “as he could not stay with a wife who leaked urine and faeces.”

Yesterday, Maria now 31 years old updated The Herald, that her first operation was unsuccessful because of the nature of her fistula which was also compounded by other complications that left her disabled when she gave birth.

“The second surgery in December last year was also not successful. I am supposed to return this year, but only if my leg is first operated on. The doctors feel my disability is making it difficult to repair my fistula,” Maria said.

A surgery can repair the fistula injury with success rates as high as 90 percent for less complex cases. Sadly,

Maria’s case is complex.

With Covid-19 lurking in the midst, Maria has no clue when the next repair camp will be conducted so that she can try again. This could be her last chance of returning to normalcy.

She hopes a vaccine for Covid-19 is found soon so that the camps can resume.

Today (May 23), Zimbabwe is one of the countries that commemorates the International Day to End obstetric fistula.

In 2020, the message is strong: “End gender inequality! End health inequities! End Fistula now!”.

The condition
Responding to The Herald, United Nations Population Fund (UNFPA) Country Representative to Zimbabwe, Dr Esther Muia said obstetric fistula is one of the most serious child birth injuries among women of child bearing age.

Direct causes of obstetric fistula are prolonged obstructed labour, pelvic fracture, cancer or radiation therapy to the pelvic area, which damages the tissues and sexual abuse and surgical trauma.

“When labour is prolonged or obstructed (e, g by fetal/baby’s head too big for pelvis), the constant pressure of the fetal head against the mother’s pelvis restricts the flow of blood to the soft tissues of the birth canal, bladder, urethra and/rectum. This leads to death of the tissues which causes a fistula to develop,” explained Dr Muia.

She cites indirect causes that include poverty, malnutrition leading to stunted growth and inadequate pelvis development.

Lack of knowledge on pregnancy complications and importance of seeking maternity services early are other indirect causes.

Dr Muia also points out early marriage, resulting in early child-birth and harmful traditional practices that damage the reproductive system as another contributing factor.

“The Covid-19 pandemic and national lockdown has affected many women who were lined up for fistula repairs as obstetric surgeries are not being conducted as generally non-emergency services are reduced. The lockdown measures also restrict movements,” she said.

Why end Fistula?
Obstetric fistula results in psycho-social humiliating experiences to women. These include continuous leakage of urine and faeces. Women who have fistulas also produce an offensive odour from the urine and faeces. They also have infection of urinary system and sexual dysfunction.

“Women with fistulas also suffer psychosocial effects that include abandonment by husband and family members due to loss of dignity. They also face stigma, depression and isolation within the community.”

“Economically, the women find it difficult to engage in economic activities as they are shunned by society,” added Dr Muia.

What Zimbabwe has done
Since 2015, the Ministry of Health and Child Care’s fistula repair programme supported by UNFPA and WAHA is bringing hope to many women and their families in Zimbabwe.

Several Zimbabwean doctors have now undergone training to conduct fistula repair surgeries and hopefully, more will receive such training that will help to restore the dignity of many affected women.

To date, more than 20 doctors have participated in the repair camps.

As of December, 2019, a total of 717 women benefited from the repair surgery, according to Dr Muia.

“In addition to Chinhoyi Provincial Hospital, United Bulawayo Hospitals (UBH) have been conducting some surgeries. Musiso Mission Hospital has also conducted some repairs with support of the WAHA surgeons. Mutare Provincial Hospital and Parirenyatwa Group of Hospitals are also ready to conduct the repairs,” Dr Muia revealed.

According to a message by the United Nations, the fight to end obstetric fistula, could be threatened by the current Covid-19 pandemic.

“Obstetric fistula is preventable; it can largely be avoided by delaying the age of first pregnancy; the cessation of harmful traditional practices; and timely access to obstetric care.”

Unfortunately, the UN adds, the current pandemic affects all these preventive measures in developing countries where obstetric fistula still exists — countries in which health care systems, even before the coronavirus outbreak, failed to provide accessible, quality maternal health care.

“The 2020 theme, ‘End gender inequality! End health inequities! End Fistula now!’ is befitting.

“Women and girls at risk of living with fistula faced structural and systemic barriers to care before the pandemic. As health systems across the globe struggle to cope with the COVID-19 response, sexual and reproductive health services risk being sidelined.”

The UN adds that denial or lack of access to sexual and reproductive health services is, especially devastating for women and girls who are already dealing with economic, social, cultural and logistical barriers.

In its message, the UN further warns that as pandemic is deepening pre-existing inequalities (including gender inequalities), exposing vulnerabilities in social and economic systems which are in turn amplifying the impacts of the pandemic.

It calls on continued efforts to end fistula as the battle against Covid-19 pandemic rages on.

“Provision of universal quality maternal health care services, including an adequate number of competent midwives and fistula surgeons to attend the woman already affected, should be a priority. Fistula prevention, treatment and follow-up services should be given high attention during pandemics.”

It adds that in response to the impact of Covid-19 on maternal health services (as health resources get diverted and maternity units shut down), UNFPA, the United Nations sexual and reproductive health agency, remains and will remain committed with its programmes in protecting the maternal health workforce, providing safe and effective maternity care to women and their babies and maintaining and protecting the maternal health systems.

As women like Maria suffer ostracism as a result of obstetric fistula during childbirth, it is important for society to spare a moment, put itself in their shoes, to better understand what such women are going through.

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Twitter @RoselyneSachiti

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