Dangers of fistula - Solomon Star News


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Dangers of fistula

29 May 2014

ABOUT 300,000 women die every year from pregnancy and childbirth-related complications.

Around the world, 5 per cent of pregnant women will face an obstructed labour, where the baby is stuck and cannot fit through the pelvic cavity.

In Australia when this happens, a caesarean section is performed, and the mother and the baby survive. In poorer countries, they have no such luxury — if the woman survives the birth, their baby does not, and they are left debilitating injuries.

"We have a patient with us at the moment who came to the hospital about three years ago," says Dr Catherine Hamlin, co-founder of the Addis Ababa Fistula Hospital and the Hamlin College of Midwives in Ethiopia.

"Her name is Azrebeb and she is from the far north of Ethiopia. She had lived in an isolated hut with obstetric fistula for six years after she lost her first baby in a very long obstructed labour. She only weighed 22kg and lost all her muscle mass by the time a missionary brought her to us. For many months she could not smile. She needed more than a year of physio before we could even attempt to operate on her fistula. Now she can walk with a walking frame, we have cured her rectal incontinence, but she has had to learn to live with an external bag because her bladder was destroyed. And now she smiles."

While Azrebeb's story is one of triumph, sadly, her story is not isolated. In Ethiopia alone, 9000 women die in obstructed labour each year. An additional 9000 women survive, but their babies usually don't, and they are left with massive internal injuries.

The medical name for these injuries is obstetric fistula, a condition in which a fistula — or a hole — develops between the rectum and vagina or between the bladder and vagina after prolonged obstructed childbirth, when adequate medical care has not been available.

Symptoms of obstetric fistula are urinary or fecal incontinence, which can lead to severe infections and ulcerations of the vaginal tract. Some patients suffer from paralysis caused by nerve damage. Sufferers are often subject to severe social stigma because of their smell, perceptions of uncleanliness, a mistaken assumption of venereal disease and, in some cases, infertility. Marriages break up, friendships wane, and women become isolated.

For Elfinesh, this scenario was only too true.

"Elfinesh lost her baby four years before she came to us, and was left with a fistula in both bladder and rectum," says Dr Hamlin.

"She told us that she lived with her old mother, mostly just sitting in the corner of the small tukul and only going out after dark to try to wash herself with the limited supply from the water pot. She was afraid to go to the river at night and too ashamed during the day to face ridicule and rejection by the village girls.

"'What was the worst thing about your life?' I asked her. She replied without hesitation: "The loneliness, never being able to mix with others, and the smell and the wetness which were with me constantly.

"Elfinesh needed extensive surgery as we had to rebuild her whole urethra, which was totally destroyed during labour. She shyly asked if she would be cured and I could tell her confidently that she would be."

Curing people like this is something Dr Hamlin has literally dedicated her life to. At 90 years of age, Dr Hamlin is still living and working in the Addis Ababa Fistula Hospital in Ethiopia, and in lieu of presents for her big 9-0, she asked for contributions to the hospital.

"My husband Reg and I originally went to Ethiopia to train midwives, but a leaving gynaecologist said to us "the fistula patients will break your hearts — and they did", she tells news.com.au of her move halfway across the world.

"We had never seen a fistula case in Australia at Sydney's Crown St Women's Hospital. We had only read about obstetric fistula in textbooks.

"All of the patients we saw were rural women reduced to abject poverty. Often they would walk for weeks to reach this city or would wait at bus stops begging for the fare. We had to raise money from friends and family so that they could be admitted to a hospital bed.

"The government was generous and gave us 10 free beds in a general hospital where we often put two patients in a bed! All were young, all had experienced a long labour of four to five days, all had delivered a stillborn baby — then discovering the awful consequences of such a labour: terrible internal injuries.

"There have been so many other memorable, sometimes shocking cases. There was a woman whose baby had survived the labour which caused her fistula, but the baby was stolen by a hyena. The mother was attacked also and came to us with horrific injuries to her legs as well as a fistula. She was terribly traumatised.

"There was another woman who lived for six years in a bus shelter, as this was how long it took to beg for the $20 bus fare to Addis Ababa. And I have met 20,000 more, just like her," she says.

But the most uncomfortable aspect of this condition is not the affect it has on a woman's body or the subsequent isolation — it's the fact that it is entirely preventable.

"The major reason for these catastrophic childbirth injuries is a lack of access to emergency obstetric services," says Lucy Perry, CEO of the Australian branch of Hamlin Fistula Ethiopia, an organisation which supports the notion that many maternal and newborn deaths can be prevented if competent midwives assist women before, during and after childbirth, and are able to refer them to emergency obstetric care when severe complications arise.

In Ethiopia, there is one midwife for every 14,000 pregnant women. By way of comparison, the World Health Organisation recommends a ratio of 1:5000. There's also a drastic shortage of hospitals, and with a population of almost 100 million, Ethiopia has less than 200 obstetrician or gynaecologists.

"While Australians are concerned about a new $7 tax to see the doctor, in Ethiopia there are so few midwives, obstetricians and properly equipped hospitals that there are women dying at the gates of government hospitals in the countryside every week! This is a tragedy we can prevent by funding the training of local midwives, treating injured women with specialist surgery and providing education to the far reaching villages," Perry says.

"The most common misconception we hear is that obstetric fistula is caused by child marriage or female genital mutilation. Research shows this simply not the case. They all share poverty as a common factor, but obstetric fistula can only be prevented by giving Ethiopian women access to a caesarean if they need it."

May 23, was the International Day to End Obstetric Fistula. Like Dr Hamlin, Perry, and many others, you too can take up the cause, and use the day as an excuse to contribute to either Dr Hamlin's hospital, or another charity working to support the eradication of obstetric fistula elsewhere in the world.