Hope, healing and dignity for all

Female genital fistula is an important health concern for women in about fifty Asian and African nations. As the World Health Organization (WHO) estimates, in today's world some 10 to 20 million women are living with genital fistula. It is estimated that some 50,000 to 100,000 new cases are being added to this figure every year.

May 23 has been declared the International Day to End Obstetric Fistula by the United Nations, with this year's theme being "hope, healing and dignity for all." Bangladesh, like other South Asian and African nations, is celebrating the day in a befitting manner.

In Bangladesh there are uncertainties about the exact number of fistula cases. According to a survey carried out in 2003, done by 'EngenderHealth' and UNFPA, approximately 71,000 women were suffering from fistula-like symptoms at the time. In our experience, approximately 2,000 new cases per year are added to this number. About 900 to 1,100 cases of female genital fistula are treated by different hospitals at the present moment. We suspect that a similar number of such patients are shunning treatment even today. Thus it is fair to estimate that a large number of women are living with fistula in Bangladesh, taking the treated and the untreated together.

Female genital fistula is a devastating condition for women, characterised by continuous leaking of urine or stool or both through the vagina. It happens when in course of delivery a baby's head remains stuck in the birth canal for long hours (i.e. for longer than twelve hours). As a result, the vagina wall is destroyed in places and abnormal holes develop which connect the vagina with bladder, urethra and/or rectum. If the vagina gets connected with the urinary system (urethra, bladder or ureter) through abnormal holes, there will be continuous leaking of urine through the birth canal. If it gets connected with the rectum, then stool will be leaking through the same route.

A woman who suffers from fistula leads a very miserable life. Very often they have to deal with a foul odour coming from their body. They cannot sleep well because their bed gets soaked. They lose self-confidence. Very often, they are isolated from the community, shunned by the family, are divorced by their spouses and become further marginalised in society. 

Obstetric fistula had been eliminated from North America many years ago; in fact long before the discovery of antibiotics and modern contraceptive procedures. But it still prevails in many developing countries and in unacceptably high rates.

Fistula victims usually come from the very poor section of society, or one should say the 'ultra-poor'. Poorer families can hardly afford treatment or a safe delivery service during pregnancy, even when the baby gets obstructed in the birth canal for hours. Poverty, as is well-known, has many faces. Early marriage and malnutrition contribute to many health risks for women, including the increasing risk of fistula.

There is, however, a silver lining. Devastating obstetric morbidity, which still reigns supreme in poor developing nations even today, is largely preventable. If care is sought at the right time in case of obstetric labour, or if the woman is taken to a hospital during delivery where adequate obstetric care is available, there is a strong likelihood that fistula will not develop. Approximately five percent of all deliveries end up in obstructed labour, which happens to be the cause of eight percent of maternal deaths in today's Bangladesh. Prevention (or serious control) of early marriage is also an important way to prevent fistula for the population at large. Birth control measures, in case of unfortunate early marriages, could also help to prevent unwanted pregnancy before the appropriate age.

The Ministry of Health and Family Welfare is working in partnership with both international and local allies for the prevention and care of fistula in Bangladesh. The USAID, through its 'Fistula Care Plus' project with EngenderHealth, and the UNFPA are supporting leading public and private hospitals to conduct free fistula surgeries. The National Fistula Center at the Dhaka Medical College Hospital and the University Fistula Center at Bangabandhu Sheikh Mujib Medical University are two key institutions where quality fistula care is available free of charge. Travelling and subsistence expenses of patients and their companion(s) are also provided by the hospital authorities.

To make matters easier for fistula patients, we would like to mention that apart from these two institutions, free fistula repair surgery is also available at Ad-din Hospital, Moghbazar, Dhaka; Hope Foundation Hospital, Cox's Bazar; Kumudini Hospital, Mirzapore, Tangail; LAMB Hospital, Parbatipur, Dinajpur; Mamms Institute of Fistula and Women Health, Eskaton, Dhaka; and Dr. Muttalib Community Hospital, Bijoynagar, Dhaka. These hospitals also help in social rehabilitation of the women treated there by providing skill training and self-employment support.

In honour of the International Fistula Day, we want hope to prevail and allow everyone to have a fair chance for healing from this disease. All fistula victims, irrespective of the state of their ailment, should be guaranteed the human dignity they deserve. If fistula can be healed (it is possible to heal), let it be healed. Let women of all classes and of all sections have right access to safe motherhood services and fistula care without hassle. We need to let the word out that women with fistula, have a right to treatment, in an equal and respectful manner. Our collective support for a better life for fistula patients will help make having an international day in its name worth the effort.

Skeikh Nazmul Huda, PhD, is Country Manager at EngenderHealth, Bangladesh. Desdemona Khan, MPH, is an anthropologist and public health policy analyst.