Pulse

Fistula: The Unknown Curse

Fistula patient. © Isabel Corthier/MSF

Obstetric fistula. It is a messy, humiliating and little discussed condition that still affects far too many women in the world; almost always poor women in poor countries. But they can be helped.

A fistula occurs when the soft tissue in the pelvis is compressed by the baby’s head. The lack of blood flow causes the tissue to die, creating a hole - called a fistula - between the vagina and bladder, the vagina and rectum, or both. The result is incontinence, the leaking of urine and/or faeces.

The term and the condition is little known in the developed world where the phenomenon all but disappeared half a century ago where there is universal access to obstetric care. But do you know that there are more than 2 million young women living with untreated obstetric fistula in Asia and sub-Saharan Africa?

Yes, there are still many expectant mothers in impoverished countries where they are in labour for many days – one, two or three days often at home and maybe alone or without a traditional birth attendant or a midwife. So the woman fights to deliver the baby during the prolonged and difficult obstructed labour and is then left childless and with incontinence because of the damage to her birth canal.

The incontinence makes it difficult for these women to do anything. They can smell so bad because of their condition that women with fistulas live in shame and are often abandoned by their husbands, their own families and shunned by their communities.

This problem is largely hidden because it often affects young women who live in poor, remote areas with very limited or no access to maternal health care. But of course if the condition is not treated, they have to live with fistula for many years.

But fistulas are largely preventable. In the developed world, women experiencing pregnancy complications or complications at birth will have a C-section before it gets to the point where a fistula could occur. However, in countries where the health system functions poorly, women have to endure this traumatising experience.

However, the operation to close a fistula is long and delicate and requires highly specialised surgical skills. It takes some time for a surgeon to master the technique.

Total treatment goes beyond the surgical aspect. Because of the flow of urine and feces, affected women can develop multiple infections or skin diseases. Some women try to stop drinking so they would not urinate. They may also have difficulty walking and, because of their exclusion from society, they are likely to suffer from malnutrition.

In some of the places where Medecins Sans Frontieres/Doctors Without Borders (MSF) is present, our specialists have been moving from one project to another carrying out free surgical care to fistula sufferers. A “Fistula Camp” is set up so that the women waiting for their surgical operations and during recovery they can have a private place to rest and share experiences with each other. After surgery patients often require physiotherapeutic rehabilitation. And psychosocial care is needed to help reintegrate the women into their communities.

For someone cut off and helpless in their own shame, the transforming effect of the operation can be dramatic. Women literally get their lives back.

by Remi Carrier, Executive Director of MSF Hong Kong

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