<i>Rubina’s moan of agony</i>

Fistula patient Rubina Begum became a virtual outcast for no fault of her own. She developed the condition during childbirth 16 years ago.Photo: STAR

It does not make any sense to Rubina Begum that she is being ostracised for something she is not responsible for at all.
"You can't call it a life," the 30-year-old obstetric fistula patient, who became a persona non grata among her family and neighbours, said with a sigh.
Her silence, her posture and hopeless utterances give her a demeanour of someone who has lost everything.
Her husband left her after she had developed the condition, nobody would marry her because of it, and her peace of mind has been gone for many years now, said Rubina who developed the condition during childbirth 16 year ago, due to an underage pregnancy and a lack of appropriate medical attention.
To save Rubina from her stepmother's wrath, her father Bashir Uddin of Piroldanga village in Dhamurhat of Naogaon wedded her off to a farmer when she was only 13.
"During my delivery next year, three village birth attendants tried but failed to bring out the baby," Rubina recalled the incident that had caused her the fistula.
She was later taken to Joypurhat hospital where the childbirth had to be aborted to save Rubina's life, but she was left with the obstetric fistula, a severe medical condition in which a hole develops between the rectum and vagina, or between the bladder and vagina after difficult or obstructed labour resulting from lack of proper medical care during delivery.
"People don't want to give me any job, don't want to see me around," Rubina said, sitting on her bed in the fistula observation room in Dhaka Medical Colleges Hospital (DMCH) where she has been undergoing treatment for four years.
During a visit Wednesday, The Daily Star correspondents saw in the observation room 10 other patients suffering from the same condition.
The condition among women remains a challenge in Bangladesh, where only 18 percent of births are attended by skilled medical workers and the number of child marriages is still quite high.
When Rubina went back to her husband's house in Jahanpur village a month after the abortion already having the fistula, the villagers started to avoid her and tease her saying she would no more be able to give birth to children, Rubina complained to these correspondents, adding that the villagers also asked her not to become a burden on her husband and to go back to her father instead.
She later learned that her husband himself had asked the villagers to say those to her, so she would leave him free to marry another woman.
As Rubina refused to go back to her father's, fearing torture by her stepmother again, her husband arranged an arbitration by the elders of the village.
"The elders forced me to accept a divorce from my husband, and sent me back to my father's without a penny in my hands," she said.
Returning to her father's, Rubina started working at rice mills while suffering from the fistula.
She worked at the mills for 12 years with the condition until learning about the fistula treatment facility in DMCH four years ago.
After a year of continuous treatment she returned home just to be back to the hospital again for a few more months. She had six operations so far.
During her treatment in DMCH, Rubina received training in sewing and a sewing machine from the United Nations Population Fund (UNFPA) eight months ago.
"But people don't want to mix with me and don't want to give me work," she said adding that she is passing a very hard time.
Since the condition results in constant leaking of urine or faeces or both, women with fistula are often abandoned by their husbands and their own families, said some NGO activists who are working with fistula patients.
Three months ago, Rubina got admitted to DMCH again as her condition deteriorated.
"A 2003 study by Engender Health, an NGO, found 70,000 women in the country with obstetric fistula," said Dr Sayeba Akhter who started the fistula centre in Bangladesh with UNFPA assistance.
Fistula tends to affect the most powerless members of society -- young, poor, illiterate women and girls living in rural areas or urban slums, and is aggravated by poverty, gender discrimination, early marriages, underage pregnancies, and poor health services.
With the National Fistula Centre in DMCH, the rehabilitation training programme has been extended to 10 other medical college hospitals, she said.
Noting that awareness is the best weapon for eradicating obstetric fistula, Dr Sayeba said, "We have to keep in mind that the affected women are suffering due to no fault of their own. They deserve better treatment than what they're getting now."