Combatting Obstetric Fistula

By Julius Kirya, Uganda Village Project Global Health Corps Fellow

Obstetric fistula is one of the most devastating and serious of all childbirth injuries, yet it still remains one of the most neglected issues in women’s health and rights. There are also many misconceptions around fistula, particularly in more developed nations. One friend from china thought it was “one being dirty”, whereas an American colleague understood it as “abnormal connections between various parts of the body”.

    Obstetric fistula is a hole that forms between the bladder and the vagina or between the rectum and the vagina as a result of prolonged obstructed labor. The constant pressure during labor cuts off the blood supply to these tissues, causing the aforementioned hole, leaving urine and feces to leak continuously and uncontrollably through the vagina. In 90% of cases of obstetric fistula the baby dies.

Young, poor women living in rural areas account for most cases of obstetric fistula. These women are at high risk because they have limited power in making decisions that pertain to their reproductive health. Having children before the pelvis is fully developed, coupled with malnutrition, small stature, and generally poor health can all lead to obstructed labor.  Older women who have delivered many children are also at risk. 

If left untreated, fistula can lead to serious consequences such as frequent ulcerations and infections, kidney disease, and even death. Some women drink as little as possible to avoid leaking and become dehydrated. Damage to the nerves in the legs can leave some women unable to walk. Such medical consequences compound social and economic problems and ultimately contribute to a general decline in health and well-being. Misinformation and ignorance create stigma that often leads women with obstetric fistula to be ostracized from their homes or communities.

UVP has addressed this issue and significantly improved these women’s quality of life by organizing three fistula camps a year. This tireless effort has reached over 250 patients who have received fistula repairs, and seeks to reach all women identified with fistula within rural eastern Uganda. The program coordinator stays at the camp and provides support, counseling and guidance.  

UVP fistula program coordinator giving final instructions to patients before returning home after surgery

A fistula patient undergoing surgery

With funding from the Fistula Foundation, UVP supports the patients at the repair camp by providing food for them as well as their care-takers. After surgery, UVP transports the women back home  -which is crucial, because if they return home by motorcycle, bicycle, taxi or walk long distances they risk re-opening their healing fistula.

Patients after undergoing Surgery at Kamuli Mission Hospital, Uganda

In order to increase the probability of a patient completely healing, the Fistula Program Coordinator follows up with the women after the surgery to check on their healing and social integration as well as monitor for surgical complications. UVP also trains fistula survivors as Fistula Ambassadors who spread the word at the grass root community level, by mobilizing and conducting education sessions, a venture through which more patients are identified.

Fistula is a highly preventable medical condition and its prevalence is easily reducible. Making family planning available to all who want to use it would reduce maternal disability and death. It is also best for pregnant women to always attend antenatal services and give birth in the presence of a qualified medical professional. Emergency obstetric care should be available to mothers who suffer complications during child birth. We should address social issues in the communities where we come from, especially those that endanger women.