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Produced for LMC-TVbyFran Snedeker |
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Produced for LMC-TVbyFran Snedeker |
EngenderHealth demonstrates that repairing a devastating childbirth injury can return women to their lives and their communities.
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At Uganda's Kitovu Mission Hospital, more than 60 women have responded to a radio announcement, some from as far away as the neighboring country of Tanzania. They range in age from 14 to over 50; some have suffered for decades, but those affected are mostly young. All are seeking relief from the pain and emotional distress of obstetric fistula, an injury sustained during childbirth. A common injury, obstetric fistula results when labor is obstructed, creating a hole in the vaginal wall. The damage leads to continuous leakage of urine and/or feces, chronic pain, and social ostracization.
The stories told at Kitovu Mission Hospital are typical and can be heard wherever women give birth under severely adverse conditions: in remote areas with no health infrastructure, and in places where still-maturing young women lack good nutrition and education.
Patience (not her real name) is 18 years old and had recently undergone a difficult delivery. "When I was in labor, I was taken to the dispensary while I was nearly unconscious. I had a cesarean section while unconscious and received 11 bottles of fluids. When I regained consciousness, I was told that my baby had died. The first time I stood up I found that I was leaking urine? The doctor did not know what to do, and he did not provide me with any referrals. He told me that I couldn't be cured by anyone, but that I should be patient, as someday God may cure me! I accepted what he said, because I had never heard of a fistula before."
Another teenage girl, still in school, kept her pregnancy a secret. She was in labor for two days without telling anyone. When she finally went to a clinic, it was too late; prolonged obstructed labor had resulted in a fistula. Told to return for repair surgery, she disappeared from her home, and traveled to the city to get a job. Eventually, she came back, but she did not have enough money for the surgery.
These women report fears and myths about how they got fistula: Curses and punishment for bad behavior are frequently the only explanation they have for their predicament. Furthermore, their low social status and lack of basic education leave them disempowered to make essential decisions about their health. They are often abandoned or mistreated by husbands and families, and suffer from low self-esteem. Such was the case for one woman, who, after a failed attempt at repair, was rejected by her family: They preferred that she die rather than return home.
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These women all look to Maureen for hope. Maureen developed a fistula when she tried to give birth in her village. But she heard about the repair surgery and came to Kitovu Mission Hospital. She received counseling both before and after her successful surgery. And because of the counseling she received, she knew to come to the hospital for her next delivery. Following a cesarean section, both mother and daughter are healthy.
With the proper care and support, women living in the shadows of their communities can finally return home, moving on to productive lives and families. Kitovu Mission Hospital is one of three hospitals that EngenderHealth supports in Uganda to improve services for women with obstetric fistula. The hospital recently celebrated the opening of a special fistula clinic. EngenderHealth provides training in surgical skills, enhances infection prevention and obstetric services, and helps build linkages to the broad range of reproductive health resources-from family planning to HIV/AIDS prevention-that clients need.
EngenderHealth also is developing a training course for health providers in counseling for obstetric fistula clients. A needs assessment that we conducted in Uganda and in 11 other countries in Africa and South Asia showed that counseling is an essential component of preventing and treating fistula. As EngenderHealth staff member Feddis Mumba put it, "Good counseling helps a fistula client become herself again." Yet there is a desperate need for standards and resources for appropriate counseling for women with fistula.
Quality counseling, which includes provision of information and education, can help a client better understand her condition and regain a sense of control over her life. Counseling that reaches clients-as well as their partners and families-also facilitates the social reintegration of women who have suffered isolation, rejection, and abandonment because of their condition. "Family members should receive counseling too, so they know that even if a woman's repair is not successful, she should be treated like a human being," says a woman seeking care at Kitovu Mission Hospital.
EngenderHealth has gathered international experts to share their global expertise on counseling fistula clients; this expertise will serve as the basis for a training program that responds to the clients' complex needs. The training will enable health providers and others who work with these clients in poor countries to avert the human tragedy associated with obstetric fistula.
A surgeon participating in EngenderHealth's fistula program observes that "[the client] is given information on ... cause and prevention. When cured, she becomes a primary health care provider in her village and plays an important role in fistula prevention." These community linkages make a big difference. Armed with accurate information and trained in counseling, health providers and peer educators can reach past the multiple obstacles that keep women with fistula suffering in hidden shame and bring them home again.