Uganda still grappling with patient backlog
A patient undergoes a fistula checkup. Photo by Rachel Mabala.
Despite the continuous publicity on fistula, the problem is occurring and still wide spread.
The 2011 demographic health survey estimated that two per cent of Ugandan women aged between 15 and 49 had experienced the condition. About 1,900 new cases recorded every year.
Fistula is a condition which renders a person, mostly women, have a continuous leakage of either urine or stool.
Dr Babatunde Osotimehin the United Nations Under-Secretary-General and Executive Director of the United Nations Population Fund says the ‘condition is considered to be for the poor because of its tendency to occur in women in poor countries who do not have health resources comparable to developed nations’.
“Obstetric fistula is almost exclusively a condition of the poorest, most vulnerable and most marginalized women and girls. It afflicts those who lack access to the timely, high-quality, and life-saving maternal health care that they so desperately need and deserve, and that is their basic human right,” he said.
So how does it occur?
Dr Fred Kirya, a senior consultant surgeon and urologist at Soroti Referral Hospital, says fistula occurs during obstructed child birth.
“When a woman is giving birth, the vagina opens up to allow the passage of the baby. In case the baby is too big for the passage, a midwife is supposed to allow for caesarean section but you find that there is no capacity to carry it out and the mother is forced to push the baby. Because the baby is already too big, its head will press the vaginal walls to allow the passage of the baby and will end up pressing the bladder and rectum,” he explains before adding.
“Since the pressure is too much, it may cause a tear at the bladder or the rectum depending on how much is exerted on each side. Ideally, this condition can easily be identified during labor and the surgeon can rectify it immediately before the woman leaves the hospital but because of our health services, it is often not recognized and the woman goes home with the tear.”
The same happens to teenage mothers who are asked to push the baby despite sometimes having a small vaginal opening. Once there is a hole on the bladder or rectum, he adds, urine or feces can no longer be contained and will continuously drip. The most common occurrence however is urine.
Women and girls who suffer from fistula are excluded from daily community life and often abandoned by their husbands and families, isolating them socially and emotionally, making it also difficult to maintain a source of income or support, thus deepening their poverty and magnifying their suffering.
Of the women living with the condition, only 2,500 are lucky to undergo the corrective surgery every year leaving a back log of an estimated 200,000.
Each patient needs around $400, which is approximately Shs1m to undergo the corrective surgery.
“This amounts to Shs800b, which means that Uganda may take close to 100 years to clear this backlog,” Dr Elioda Tumwesigye, the minister of Health said.
However, Dr Kirya calls for a complete overhaul to completely eradicate the new cases.
“If you do not go to school, you are prone to getting pregnant as early as 13 years of age. You and your parents want to reduce the burden of a big family while at the same time helping you get a better life. When you get pregnant, because of the poor state of maternal health services in the country, the services are not good enough to prevent you from not getting the condition,” he says.
He adds; “All these revolve around each other and if we are to beat fistula, we have to tackle all of them There is need to improve maternal health, girl child education, the economy, family planning, antenatal care and emergency response because all these contribute to the development of fistula.”
To continue raising awareness on the condition which disgraces the dignity of women, Uganda today joins the rest of the world to mark International Day of Obstetric Fistula. As of last year, more than 12,000 women living with fistula had been operated on in the last five years according to the Health state minister Sarah Opendi.
This year, the day is going to be commemorated under the theme “End fistula within a generation”.
