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Curtailing Sabuni’s 72 years of fistula

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We never recognised she had a complication,” Margret Mlonya narrates while helping her 83-year-old mother, who had just woken up after an obstetric fistula operation, get up on her hospital bed at Mulanje District Hospital.

Her mother Alice Sabuni, she says, who could be heard jostling through some agony that comes with a fistula operation developed the condition almost 72 years ago.

Sabuni, ironically bore 8 children with the condition, according to Mlonya.

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“When we saw her leaking urine, we could not think of anything. Until recently when we heard from the radio that it was obstetric fistula,” explained the visibly happy and emotional 57 year old Mlonya, an accountant by profession working for the Department of Climate Change and Meteorological Services in Blantyre while standing next to her mother’s hospital bed.

Unlike other women who normally are proud to have their first born children, Sabuni’s ware accompanied by agony at it was at that time when she developed the urine leaking condition that also lead to men deserting her due to the unbearable smell associated with the condition.

Antimina, a Swedish brand that offers a range of products dedicated exclusively to all aspects of women’s intimate health puts the age at which women reach menopause, a stage of womanhood that marks the end of fertility at an average of 51.

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This means Sabuni developed the condition way before she stopped having her monthly periods.

According to World Health Organisation (WHO), an estimated 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa with between 50 000 to 100 000 women worldwide developing obstetric fistula each year.

Women who experience fistula, a preventable condition According to WHO, suffer constant urinary incontinence which often leads to social isolation, skin infections, kidney disorders and even death if left untreated.

Another woman, Modester Faduweki, 26, of Group Village Manjalende in Traditional Authority (T/A) Nkhumba in Phalombe who like Sabuni underwent a obstructive fistula repair at the first ever Mulanje District hospital fistula camp this month could not be happier of the time left before she reaches menopause following the operation.

“This opens another chapter in my life,” the 26 year old explained, “The six years that I have lived with the condition have all been torture and I am looking forward to a normal life just like any other women in the world.”

Faduweki who could not even lie on her hospital bed due to her condition before the fistula procedure developed obstructive fistula at the age of 17 due to obstructed labour.

“Trinity Hospital was just so far away from our village and to raise K600 for bicycle transport to the facility was just another mountain.

“I ended up delivering at home with the assistance of older women but unfortunately i bore a still born,” she explained while holding she checks in sorrow.

The condition, she says, developed when she sort medical assistance after noticing post delivery complications.

 

“I underwent Dilation and curettage (D and C) to remove leftover material from the inside of the uterus,” explains Faduweki who has never been in school since birth.

Uptodate.com identifies Faduweki’s procedure as Therapeutic D and C that is carried out to remove contents of the uterus following various circumstances among them, miscarriage where tissues from a pregnancy are removed to ensure that all of it has been passed.

She claims it was due to the medical procedure that she developed the condition.

Seth Cochran, Operation Fistula founder backs Faduweki’s claim.

77 percent of women with fistula, according to a study by Operation Fistula foundation carried out as a pilot obstructive fistula programme in countries like Malawi, Madagascar, Mauritania and Zambia which saw 752 women being treated, got the condition in assisted environments.

“27 percent of women with fistula in all the countries we have been to get the condition from caesarean operations.

“We discovered that surgical care was a timely or quality issue. In all the facilities that delivered the women,” says Cochran, adding that equipment in some of the hospitals targeted for the establishment of permanent fistula centres is very limited and in some cases inadequate in Malawi compared to the number of people they serve, hence the need for reinforcements.

The situation of women and their ability to seek maternal health care services is strongly influenced by local cultural beliefs, pregnancy at a young age, profound gender inequities and limited transportation options, according to findings from nine African Countries including Malawi in the 2003 Obstetric Fistula Needs Assessment Report conducted by United Nations Population Fund and Engender Health

In fact, the report uncovers existing gaps between some policy makers and the service delivery community in terms of perspectives on fistula and knowledge about the condition.

There was little knowledge about fistula, the study indicates among those who had not had the opportunity to spend a lot of time in treatment settings as a key reproductive morbidity in Malawi.

In April this year, the British medical journal, The Lancet released finding of a survey conducted by a group of experts who among others assessed the global state of surgery.

The report, according found a major gap between the need for surgery and what is available, especially in low- and middle-income countries like Malawi and other countries where Operation Fistula conducted its study.

People are dying, according to the report from conditions easily treated in the operating room such as hernia, appendicitis, obstructed labour, and serious fractures.

Stanford University surgery professor Thomas Weiser, a member of The Lancet commission, says the need is great.

According to the report, there are probably about 143 million operations a year that are needed just to meet basic needs in low- and middle-income countries.

It further indicates, there are probably about five billion people that don’t have access to safe, timely surgery with protection against catastrophic expenditure.

“You can’t achieve universal health care if you don’t incorporate surgery,” Harvard Medical School’s John Meara who is one of the lead authors of The Lancet paper according to Voice of America (VOA) website.

The report suggests spending an additional $300 to $420 billion on surgery between now and 2030.

According to Faduweki, fistula still is unavoidable for those who deliver in hospitals considering the capacity of the country’s health personal.

She says those running fistula camps should also look at the physibility of setting up such facilities in all the districts if more women are to be saved from the condition.

“We resolved to develop a project that would develop caesarean operation at district level while also empowering the African surgeons in medical leadership.

“When we discussed this with UNFPA, they suggested that Malawi should also be considered apart from Madagascar,” Cochran indicates.

Due to lack of a district hospital, Trinity Hospital in Phalombe’s and Mulanje district hospitals are being considered for permant fistula centres, according to Cochran.

Mulanje district health officer (DHO) Khuliena Kabwere says there is need for improved handling of women in labour to avert fistula.

“Health personal from the country are also part of the team that is repairing fistula. We hope with such a development, the locals will build the capacity on how to treat obstetric fistula,” notes Kabwere adding that problem of obstetric fistula is common in the district.

United Nations Population Fund (UNFPA) country representative Violet Kakyomya believes fistula can better be managed on a regular basis and not on a camp basis.

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