WUNRN
COTE D'IVOIRE
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One of
the women who has received treatment for obstetric fistula in Korhogo,
northern Côte |
KORHOGO, 7 April 2009 (IRIN) - Women
ages 17 to 70 sit on vinyl mattresses, drainage bags on the floor next to their
hospital beds, catheter tubes stretching from under colourful skirts. Each one
has a serene, triumphant look.
The
women are recovering from an operation that lasted some two hours and repaired
tissue damage that made their urine flow uncontrollably – in one case for 50
years.
“I am
beside myself with joy,” one woman told IRIN, talking through an incessant
smile. She told IRIN she had lived with the condition for 20 years.
Through
a programme run by the UN Population Fund (UNFPA) specialists are training
local surgeons and gynaecologists in Korhogo, northern Côte d’Ivoire, in
repairing vesico-vaginal fistula – a hole in the birth canal caused by
complicated labour and a lack of medical intervention, which leaves a woman
leaking urine.
When
the soft tissues of the pelvis are compressed between the baby's head and the
mother's pelvic bone, the lack of blood flow causes tissue to die, creating a
hole between the vagina and bladder or between the vagina and rectum.
Cases
of recto-vaginal fistula are currently referred to other hospitals in the
country where UNFPA also works with local doctors.
Obstetric
fistula is preventable, yet some two million women around the world live with
the condition, according to UNFPA. “The persistence of fistula is a signal that
health systems are failing to meet the needs of women,” UNFPA says.
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More
on obstetric fistula |
For now 16 beds are available for
fistula patients at the Korhogo hospital, according to Mansaré Ladji, surgeon,
gynaecologist and one of the physicians being trained to perform fistula
operations. “There is a waiting list,” he said.
The
demand in Korhogo – 630km north of the commercial capital
Since
launching the project in February doctors in Korhogo have performed 25
operations to date.
“We are
giving these women a new life,” Mansaré told IRIN, recalling how some women
danced as they left the hospital. “It cannot be described, it must be
experienced.”
“This
operation changed everything,” said Silué Korotoum,
a 34-year-old woman who received the treatment. “I can thrive now. I can go
where I wish and do as I wish.”
As part
of the programme women are to receive assistance reintegrating into society and
finding work.
Mansaré
said one of the most important goals is long-term training for local health
workers to treat obstetric fistula. “We must set up something that will
continue after [trainers] are gone.”
In many
cases women are not aware a remedy exists, or if they are, cannot afford it,
according to UNFPA. Without subsidies the operation cost about US$300, about 10
times what most people in the region earn in a month, residents said.
In the
UNFPA centres – in the cities of Korhogo, Man and most recently Bouaké –
services are free; the programme will continue as long as funding is available
through the agency’s Thematic Fund for Maternal Health, UNFPA gynaecologist
Abou Pauline told IRIN. UNFPA is urging the Ministry of Health to maintain free
care for women with fistulas.
Simeon
N’da, Health Ministry spokesperson, told IRIN the ministry will study
whether obstetric fistula is a condition for which the government will ensure
free treatment, as it does for some other illnesses such as Buruli ulcer.
Preventable
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Some of the patients suffering
obstetric fistulas after complicated childbirth are in their teens |
In
the Korhogo recovery room were three young women ages 17 to 18, whose
fistulas were caused by difficult deliveries.
Doctors
told IRIN even more important than providing treatment is eliminating the
causes of fistula – including poor general health, lack of maternal health care
and practices such as early marriage and childbirth, lack of spacing between
births and women’s lack of power to make their own health care decisions.
“Obstetric
fistula is a condition resulting from complicated
childbirth,” gynaecologist Abou told IRIN. “If we reduced complications in
childbirth we would reduce fistulas.”
It is
essential that people have access to properly equipped medical facilities and
qualified medical personnel, she said.
But
even when facilities are available, cultural practices weigh on women’s health,
medical workers told IRIN.
At the
Korhogo hospital a health worker recounted a case in which a woman urgently
needed a caesarean section but family members would not consent without the
approval of her husband. He was traveling and out of reach.
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