Obstetric Fistula: A silent cause of Depression.
For so many years, I have gained so much curiosity concerning what obstetric fistula is, and as to why it has traumatize women, chastising them to feel ashamed, isolated, marginalized and in some extreme cases, cursed out of their matrimonial homes. I have heard and read of many intriguing lived in experiences of women who have suffered horribly from this condition. In my pursuit to find out what this condition is, what causes it and how it can be prevented, I have came across some baffling information that are heartbreaking especially the literacy level of obstetric fistula. The affected women do not realize that this condition can be treated through a constructive surgery. It is indeed disheartening to learn that even for those who have knowledge of treatments, fear for their reputation in the community and/or they do not have finances and lack access health care services.
What is obstetric fistula?
Fistula, which is pronounced is “fis(h)-chə-lə”, has been considered as one cause of maternal mortality especially in developing countries. The Medical Dictionary (2012) defines it as “an abnormal passage that leads from an abscess, or hollow organ or part to the body surface, or from one hollow organ or part to another, and that may be surgically created to permit passage of fluids or secretions”. In the lay man’s terminology, it is a hole in the birth canal that is developed due to child birth injury. Wong, Perry & Hockenberry (2002), defines it as an “abnormal communication between one hallow viscous and another, or from one hallow viscous to the outside”. According to World Health Organizations, there are about 50 000 to 100 000 women worldwide who are affected by obstetric fistula.There are several women suffering from this condition without knowing what to do or where to get help. Improving maternal health is among the goals set by Millennium Development. It is fairly known in the industrialized countries but not in the developing countries. The industrialized countries have more skilled prenatal health care services that constantly monitor the health status of expectant mothers. This has helped the health care professionals to take care of situations before moere complications arise. In some remote parts of the world, women suffer in silence for fear of humiliation, and excommunication from the society. The affected women are scared of coming forward because of stigmatization related to this condition and lack access and finances to seek treatment. Fortunately, this condition is both preventable and treatable.
The Types of Fistula as listed by MelinePlus (2012).
- Blind – This is the type that opens on one end only, but connects to two structures.
- Complete – It is the type that has both external and internal openings.
- Horseshoe – It connects the anus to the surface of the skin after going around the rectum.
- Incomplete – A tube from the skin that is closed on the inside and does not connect to any internal structure.
The symptoms and signs of fistula.
- Fecal or urinary incontinence – This can be continuous or can happen only during the day or night.
- Abscess or pus drainage with has foul smell.
Effects of fistula
- Severe Pelvic infections or ulcerations of the vaginal tract- this causes a lot of pain which affects sexual relationships thus straining marriages.
- May result in neurological damage that can affect their ability to work (USAID, 2009)
- Severe social stigma due to foul odor – Affected women will avoid public places because their odor is too strong and they can be humiliated in public.
- Perception of uncleanliness by others.
- A mistaken assumption of venereal diseases.
- May lead to inability to have a child.
- Medical complications resulting from obstructed labor which include fetal loss, pelvic nerve damage and amenorrhea (Weston, et al., 2011).
- It can lead to women being isolated and stigmatized by their loved ones (Weston, et al., 2011)
- Mental depression due to feelings of shame, blame which may in turn leads affected women to having suicide thoughts (Weston, et al., 2011).
The causes of Fistula
- Prolonged labor or obstructed labor.
- Sexual abuse and rape
- Surgical trauma
- Gynecological cancers
- Malnutrition and childhood illness.
- Lack of education – Some affected women believes that is a cursed condition or that some evil spirits are angry.
- Early marriage and childbirth – The high prevalence of this is seen in cultures whose arranged marriage between young girls and old men is acceptable and is highly practiced.
- The role and statues of women in developing country.
- Harmful tradition practices e.g. some use of traditional medicine.
- Delaying the age of first pregnancy.
- The cessation of harmful traditional practices.
- Timely access to obstetric care – The availability, affordability and accessibility are critical and can prevent causes of fistula.
- Education and family planning initiatives– Initiating obstetric fistula programs; what they are, the signs and symptoms, prevention and treatments that are available.
- Women’s empowerment and autonomy – Women should be empowered to take advantages of the services available for them.
Reconstructive surgery – This include the actual surgery, post operative care and rehabilitation. After the treatment the woman can live a normal life again.
Voices of Women who have experience obstetric fistula
Ms Sarah, recounted her story to the Women Deliver Conference as to how after losing both parents, she ran away to live with her sister. There she encountered “beastly rape by her religious leader”. She got pregnancy and when the time came, she labored for 20 hours at home and waited for 18 hrs to be attended by a gynecologist. She delivered a still born through a caesarian section. After 3 days, she noticed the leaking of urine. The health facility discharged her without help, and told her that she can only be treated by a specialist from abroad. Back home, she endured a wet bed from leaking urine and a wet pillow from tears of painful genital sores, humiliation and rejection. She lived with fistula for 12 years.
Ms. Awatif shared her story about being married at age 16. Delivered a still born after she could not get the assistance on time. Two attempts to repair her fistula failed. On her way to try it again for the third time, they were stopped and robbed of all they had by bandits. She had to go back home without operation. She got pregnant again and her husband abandoned her, young, pregnant, sick and no money.
Dr. Hamlin, an Australian gynecologist, shared a story of a young girl named Mahabouba Mohammed. She was sold to virtual slavery at 8 years old, raped by her master at 12; send by the heartless master to deliver the baby at the bushes at age 13, all by herself. She suffered internal injuries including fistula. Coming back, the master could not stand the foul smell. So he confined her in a faraway hut and removed the door so that she could be devoured by hyenas. She fought the hyenas off, and was finally rescued by the American missionary.
Mrs. Gouroukoye, was married off at age 13 due to an arranged marriage and got pregnant after her first period. She developed fistula after a difficult birth. Her culture prefers traditional medicine and home delivery. After laboring for two days at home, she went to the clinic where she was advised that she needed a caesarian section. The family had to pay first before the surgery is done. She labored for days until the family got the money. Caesarian was finally carried out but the baby was dead and the mother became incontinent. She was send home without reconstructive surgery. She didn’t tell her husband. She went to stay with her parents and hide the condition from anyone in the neighborhood. She shared the news with her husband only after she had, had the surgery done and was doing well.
Ms. Singi had two complications at two different childbirths that resulted into losing both children. This was followed by 8 years of being an outcast, because she developed a hole between her bladder and the vagina. She got frustrated, stigmatized, uncomfortable and embarrassed. She finally had a successful operation.
British Broadcasting Cooperation. (2007). ‘They thought I was cursed’. Retrieved from http://news.bbc.co.uk/2/hi/7050934.stm
Franca, E. (2010). Women deliver: Empowered women and their powerful stories. Retrieved from http://www.unfpa.org/public/news/pid/5859
Krisof, N. D. (2003). Alone and ashamed. Retrieved from http://www.nytimes.com/2003/05/16/opinion/alone-and-ashamed.html
Medical Dictionary MedlinePlus (2012). Fistula. Retrieved from http://www.merriam- webster.com/medlineplus/fistula
Reid Hospital & Health Care Services. (2012). What is fistula?. Retrieved from http://www.bing.com/images/search?q=What+Is+A+Fistula&view=detail&id=D74C5C7 A55A26EE318B4BE7B1161DE1BE1E2CDEC&first=31&FORM=IDFRIR
USAID, From the American People. (2009). Maternal and child health. Retrieved from http://transition.usaid.gov/our_work/global_health/mch/mh/fistula_strategy.html
Weston, K., Mutiso, S., Mwangi, J. W., Qureshi, Z., Beard, J., & Venkat, P. (2011). Depression among women with fistula in Kenya. International Journal of Gynecology and Obstetrics, 115 (2011), 31-33. doi:10.1016/j.ijgo.2011.04.015
Wong, D. L., Perry, S. E., & Hockenberry, M. J. (2002). Maternal Child Nursing Care. Philadelphia; Mosby, A Harcourt Health Science Company.
World Health Organizations (2012). 10 facts on obstetric fistula. Retrieved from http://www.who.int/features/factfiles/obstetric_fistula/en/