Malawi doctors shun treating fistula cases: ‘it’s a disease of poverty’

Most Malawian medical personnel are shunning treating Obstetric Fistula condition despite being trained to conduct the operations largely because of the nature of the disease, Nyasa Times understands.

Obstetric Fistula is a medical condition which occurs due to prolonged pressure of the child’s head which tears a part soft tissue between the mother’s pelvis leading to continuous discharge of urine and feaces through vagina.

In Malawi the condition is considered the most neglected in terms of treatment resulting in some of affected women lose their marriages or live in isolation because of bad smell they produce.

However efforts to heal the women from the condition is hit by acute shortage of trained medical personnel to handle the cases, making most of them live with the treatable and degrading condition for a long time.

UNFPA Fistula camp at Zomba Central Hospital ... picture VOA.. UNFPA
UNFPA Fistula camp at Zomba Central Hospital … picture VOA.. UNFPA

It is not known how many obstetric fistula cases Malawi has since no major survey has been carried out to assess its prevalence.

But the 2009 study conducted in nine district of the country on Prevalence of Obstetric Fistula, by Malawi College of Medicine with funding from UNFPA, found a total of 1049 women suffering from the condition.

Recent statistics from the Ministry of Health indicate that there are only 15 medical personnel countrywide trained to repair routine cases in public hospitals with support of the United Nations Population Fund (UNFPA).

These comprise five medical doctors, and 10 clinical officers.  Out of the five trained medical doctors in the country, only two are doing the job.

And there is only one trained clinician doing the fistula repairs at the country’s referral health facility in Blantyre, Queen Elizabeth Central Hospital, out of several other who were trained.

This is the worrisome development to UNFPA which supports the training by hiring foreign medical consultants to train local medical personnel.

The UNFPA’s Acting Country Director Ms Gift Malunga says this is a drawback on the sustainability of its ongoing fistula camps where fistula patients from across the country are pulled together to be treated by the hired medical consultants.

“We are saying to ourselves as UNFPA ‘to what extent do we continue to bring in medical consultancy’? All the time the consultants are here they are training clinicians how to repair but now the challenge is on the dedication of the clinicians and doctors we have trained. That one now is beyond us as UNFPA,” she says.

The senior clinical officer in the department of Obstetrics and Gynecology at Queen Elizabeth Central Hospital, Alexander Sembo who is the only expert who handles fistula repairs at the referral hospital says there are various reasons which make some quit doing the repairs.

“Some people would say ‘what would I benefit from carrying out these operations which are difficult’. They are difficult operations in fact. It would take more than two hours to complete. So others would say ‘what can I get from operating these patients’? People now want to operate on patients they can get some money. And how many Fistula patients have got money to pay them.  So they will say ‘why should I waste my time operating on this patient who doesn’t have money, she is not on MASM and she is from village.”

Sembo also say some quit because of lack of skills.

“Some quit  because of lack skills because Fistula is a complicated operation and it needs more and more skills to operate on these patients otherwise, you would make the condition go worse if you don’t have skills,” he said.

Hans Katengeza of the Department of Reproductive Health in the Ministry of Health says the government is making effort to address the shortage of local medics to handle fistula condition.

“Initially there were only medical doctors who were actually doing the operations. But now we have seen that with the approach of task-shifting where clinical officers are also allowed and mandated to do operations. It is our wish that there will be more people who will be trained to do operations on obstetric fistulas,” he said.

However, expectations are high that more local medics will gain expertise in fistula repairs from the hired medical consultants during the Fistula camp which UNFPA is expected to conduct for three weeks from  early October at Queen Elizabeth Central Hospital in Blantyre.

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