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Uganda: Fistula - a Death Sentence for Poor Women?
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New Vision (Kampala)
13 July 2008
Posted to the web 14 July 2008
Frederick Womakuyu
Kampala
Mary Ngwedo talks with long hesitant pauses as if she were still in the state of a disability she developed at the age of 16. Ngwedo got fistula after her first child, which left her leaking urine for 20 years.
Speaking from her home in Soroti district, the 45-year-old mother of seven, who recently recovered from the disability, plans to start sensitising women about the condition and help them seek medical help. More than 500 women in Soroti suffer from the condition.
What is obstetrics fistula?
According to EngenderHealth, an NGO sensitising the masses about the condition, obstetrics fistula is a medical condition where a woman develops a hole between the bladder or rectum and birth canal during childbirth.
It results from damage to the soft tissues of the vagina, the bladder or rectum, leaving a woman unable to control the flow of urine or faeces or both.
It is usually caused by prolonged obstructed labour or where the baby is too big for a mother's pelvis.
In Ngwedo's case, she developed the condition after three days of prolonged labour. During the labour, the pressure of the baby's head against her pelvis cut off blood supply to the tissue, causing it to rot. In the end Ngwedo's baby died. After the incident, Ngwedo started dripping urine uncontrollably, giving off a horrible stench.
Because of the condition, Ngwedo was stigmatised and her husband left her.
Teso region displays some of the worst health indicators in Uganda, particularly for women and children.
The maternal mortality rate in the region is about 650 deaths per 100,000 births, and neonatal mortality is more than 60 per 1,000 live births.
The national average is 435 deaths per 100,000 births and 29 per 1,000 live births.
What medics say
Although fistula is curable, women, especially those in rural areas, continue to suffer from it because of poverty and lack of health services. A surgical repair for each woman costs between sh350,000 and sh400,000, which many sufferers cannot afford.
Dr. Fred Kirya, a senior surgeon at Soroti Regional Referral Hospital, says because most of the health facilities are concentrated in urban areas, people in rural areas do not have access to health services.
"For fistula, it is like a death sentence because of lack of equipment and personnel specialised in treating it. It is also donor-dependent in terms of funding and little support comes from the Government," he adds.
Women also continue to give birth at home where they are attended to by unqualified personnel.
An assessment conducted by The Association for Re-orientation and Rehabilitation of Teso Women for Development (TERREWODE) in February 2005 revealed that less than 12% of the women sought to deliver in health centres due to a variety of factors, from poverty to a reliance on traditional birth attendants.
More so, lack of transportation prevents many from going to health centres.
"Ignorance and lack of awareness about fistula have also made the problem worse," Kirya said.
Ray of hope
On June 27, members of the Civil Society Capacity Building Programme, an NGO, and the Teso community gathered at Hotel Africana in Kampala to mark the successful reduction of fistula.
This follows a project under which the NGO sensitises rural women about fistula and encourages them to go for treatment.
The initiative, implemented by TERREWODE, has also improved health care and access to maternal health services in Teso.
"We have sensitised women on how to prevent fistula. This has seen more women with the problem identified and referred for surgical repairs," says Martha Ibeno, the programme officer of TERREWODE.
Since the project began, 200 women have had their fistulas repaired at Soroti and Kumi hospitals. About 70 women are waiting to receive treatment from flying doctors to come to Soroti this year.
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"However, the number of new patients has overwhelmed the funds," adds Ibeno.
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