Obstetric fistula acute in Malawi, experts call for help
Common in the developing world, particularly in parts of sub-Saharan Africa and much of South Asia, obstetric fistula (vaginal fistula) is a severe medical condition in which a hole develops between either the rectum or the bladder and the birth canal after severe or failed childbirth.
Medical experts indicate the fistula usually develops when a prolonged labour presses the unborn child so tightly in the birth canal that blood flow is cut off to the surrounding tissues, which kills the tissues that eventually rot away.
Further, health specialists say more rarely, the hole, which leads to uncontrollable leakage of urine, can be caused by female genital cutting, poorly performed abortions, or pelvic fractures.
Research has shown that obstetric fistula was very common throughout the entire world but virtually disappeared within advanced nations due to improvements in obstetrical care.
The prevalence of the condition is much lower in places that discourage early marriage, provide education of women and their bodies, and grant women access to family planning and skilled medical teams to assist during childbirth, cases that are not widespread in developing countries such as Malawi.
“Fistula is very severe. It brings numerous effects against women. Because of the leakage [of urine], a woman is always subjected to bad smell and this brings physical, social, mental or economic implications, among others,” points our Dr Frank Taulo, director of health at the Center for Reproductive Health (CRH) of the College of Medicine (CoM).
He adds: “Because they smell all the time, these women are isolated, stigmatized and sometimes deserted by their husbands or relatives; they become outcasts in their own communities.”
As indicated by the doctor, a person can live with obstetric fistula for a long time, for example 10 to 20 years. However, apart from the implications mentioned, a woman with fistula can neither give birth to a living baby nor conceive at all.
In 2007, with funding from the United Nations Population Fund (UNFPA), the Ministry of Health through the CRH instituted a study to find out the condition’s prevalence rate in Malawi.
So far, conducted in nine districts of the country namely Chikwawa, Thyolo, Mangochi, Mchinji, Salima, Nkhota-kota, Nkhata-Bay, Karonga and Rumphi, the research shows that 0.65 percent of every 1,000 pregnant women in Malawi are affected by fistula.
“Though it affects both the young and the old, research has shown that in the country, fistula is common in women who are not mature enough to give birth, especially teens.
“For instance in Mangochi, pregnancies are high among young girls and most deliveries are done at home with unskilled birth attendants, that’s why the condition is rampant there,” discloses Effie Chipeta, training coordinator for CRH.
Though other countries such as the United States of America discovered and started treating fistula in the 80s, Malawi started repairing people affected with the condition just recently, after the research was launched.
“Since 2007 we have identified 22 women living with fistula and to this point, we have repaired nine patients,” reveals Dr Tulipoka Soko, chief nursing officer at Queen Elizabeth Central Hospital (QECH).
Many women who suffer from this condition are living in very rural areas and do not consider local hospitals and clinics to be places where they could ever seek such medical care and therefore do not go when there is an obstetrical emergency.
In addition, according to Dr Taulo, because of ignorance, communities have for so long lived to believe that fistula starts through witchcraft and can only be healed by witchdoctors, instead of seeking antenatal assistance.
But Dr Taulo observes: “This is a medical condition that is treatable only through skilled personnel at the hospital, where proper operation and monitoring has to take place therefore, there’s need for different stakeholders to join hands to raise awareness in the communities.”
Though the availability and access to medical facilities that have a trained staff and specialized surgical equipment is needed for cesarean births, this is very limited in the south-east African state, leaving affected Malawian women more vulnerable.
“At the moment, there’s a limited medical personnel to repair fistula. For instance, there’s only one doctor at Queens, and this is a worrisome situation because the southern region barely has three hospitals offering the service,” says Dr Soko.
According to her, out of the 28 [state] district as well as Christian Health Association of Malawi (CHAM) and private hospitals across the country, there are just 9 hospitals that are able to treat fistula. They include Chikwawa, QECH, Zomba, Mangochi, Nkhoma, Kamuzu, Mzuzu and St. Martin’s hospitals.
“As a country, we need clinicians located in the local communities where fistula is prevalent,” points out the chief nursing officer.
“There are plans to increase intake of students [in fistula studies] at College of Medicine, Health Sciences, and other training schools to increase the number of skilled personnel that will increase service delivery across the country,” reveals Dr Soko.
Health experts advise that prevention of prolonged obstructed labour and fistula should preferably begin as early as possible in each female’s life.
They say improved nutrition and outreach programs to raise awareness about the nutritional needs of female children to prevent malnutrition as well as improve the physical maturity of young mothers, are important fistula prevention strategies.
Meanwhile, the director for CRH appeals well wishers in Malawi as well as international developmental partners to help the country build an obstetric fistula facility.
“In Ethiopia, they have a hospital that only treats fistula and we need such facility to fully tackle the problem here,” says Dr Taulo.
