WUNRN
SIERRA LEONE - OBSTETRIC FISTULA
HOTLINE LAUNCHED
NurseZainab Blell and Mabel Kaitemoh, answer calls at the
Fistula Hotline
Photo: Felicity Thompson/IRIN
The woman on the phone is in a remote Sierra Leonean town. She says her sister
leaks urine uncontrollably, and suffers from rashes and peeling skin on her
inner thighs.
Blell
is one of three nurses answering calls on a newly launched “fistula hotline”, a
free phone number for women who suffer from this debilitating condition that is
seldom spoken about.
Fistula, also known as vesico-vaginal fistula or VVF, is a hole in the birth
canal that leaves women with chronic incontinence, and often a stillborn baby.
It is usually caused by several days of obstructed labour. It affects an
estimated two million women in developing countries; and 50,000-100,000 women worldwide each year.
Low
awareness
The fistula hotline, which is run by the
centre, is the result of a public-private partnership between the Gloag
Foundation, USAID, the United Nations Population Fund (UNFPA) and
telecommunications company Airtel.
In the last month more than 8,000 calls have been received, but so far just 0.1
percent have been about cases of fistula.
The Aberdeen Women’s Centre provides the only comprehensive fistula repair
service in the country. Despite the small number of calls concerning the
condition, Jude Holden, the centre’s Country Director, is pleased with the
result. “We have received 90 cases since the hotline opened, and this is a
great success,” she told IRIN.
Shortly after the hotline opened in October, radio messages were broadcast in
the local Krio language and in English, describing fistula and telling anyone
who thinks they are affected to call 555.
“There is very little awareness of fistula and why it happens. Women are
stigmatized and often blamed for their condition. Because of this we found it
difficult to get women with fistula to the centre for treatment.”
Fistula occur most often in young women (15 to 30 years old), most of whom come
from rural areas with poor access to healthcare, according to a 2005 Ministry
of Health survey.
Why
rates so high
In
Free healthcare services for lactating mothers and pregnant women were launched
in 2010, but the maternal health infrastructure is inadequate and the Ministry
of Health is struggling
to implement the policy. Only 137 trained midwives practice in the country,
and there are just 16 emergency obstetric facilities.
During and after
“Most of the women with fistula are uneducated farmers… They don’t have access
to any sort of healthcare, pre-natal or post-natal. We see it a lot in young
girls, mostly because their bodies are not developed yet, and so when they’re
in labour the child gets stuck in the pelvis,” said
In Njala town in the
“My baby died,” Ngegba says. “After the operation, the doctor pulled out the
catheter and I was covered in urine.”
When she got home, Ngegba’s first husband abandoned her and she was sent to
live with relatives. “I was really unhappy. Everyone made fun of me. I wanted
to go back to school but because of this problem I had, I couldn’t.”
Ngegba had fistula repair surgery in 2006, but when she gave birth to her
second child without a caesarean, the fistula reappeared.
Prevention
Experts say prevention, rather than treatment, is the key to ending fistula.
This means providing women with family planning, ante-natal care, skilled birth
attendants and emergency obstetric care, according to the UNFPA Campaign to End Fistula.
“We need a preventative as well as a therapeutic approach,” Sas Kargbo,
Director of Reproductive Health at Sierra Leone’s Ministry of Health, told
IRIN, adding that the free phone line is an important step to finding the women
and treating the problem.
At the Aberdeen Women’s Centre, almost 10 years after developing her first
fistula, Ngegba waits for surgery. She smiles and hugs Naomi, her two-year-old
daughter. “When I get well,” she says, “my husband will send me back to finish
school.”