ACCIH has been conducting interviews and focus group discussions with women either living with obstetric fistula or who had already undergone surgery at Chemolingot Sub-county Hospital. These interviews were completed in the hopes that we could learn more about women in Tiaty’s experience with fistula and propose plans for a fistula program in Chemolingot. the interviews have revealed that most of the women had never heard of fistula before they were diagnosed. Many women struggled to get treatment due to cost, transportation access, and proximity, with some taking up to ten years after birth to undergo surgery. Many also experienced instances of discrimination and stigma from their family and community members.
Chemolingot Sub-county Hospital has an operating theater where fistula surgery could be performed but is currently lacking the supplies, funding, and trained staff to do so. Making Chemolingot Sub-county Hospital a center for fistula surgery would greatly increase EmONC access and outcomes to the underserved population of this sub-county. It will reduce the number of fistula cases, reduce agony and stigma associated with fistula, and improve quality of maternal care through full utilization of the new maternity wing and theatre. These interviews demonstrate the real-life impact of this disease on members of the community who already shoulder a great deal of responsibility and hardship. No woman should endure a life of misery and isolation simply for trying to bring a child into the world.
ABOUT OBSTETRIC FISTULA
Obstetric Fistula is an injury usually caused by obstructed labor for three or four days (or longer)without timely medical attention and often results in a stillborn child. During prolonged labor, the constant pressure of the fetal head compresses the soft tissues between the bladder and the vagina and/or rectum, causing a hole, or fistula, as the tissue dies. An obstetric fistula is a hole in the wall of the vagina connecting to the bladder, and a hole to the rectum is known as a recto-vaginal fistula. If not treated the woman with obstetric fistula will experience constant and uncontrollable leakage of urine and/or feces, foul odor, chronic abrasion of the skin due to persistent leakage of urine; kidney disease; infertility; infection; and neurological injury, such as foot drop, due to nerve damage sustained during the prolonged labor.
The social injuries—the humiliation, isolation, and stigma—can be even more damaging. Obstetric fistula can be repaired with reconstructive surgery with a greater than 90% success rate. While fistula has virtually been eliminated in developed countries, currently available data by the World Health Organization (WHO) indicates that an estimated two million girls and women in developing countries are affected with between 50,000 and 100,000 women worldwide developing the condition annually [source]. Every year, there is a backlog of about 1,000 cases of women living with fistula awaiting surgery in Kenya, with a majority unable to afford the Ksh 30,000+ cost. While theatre equipment and supplies are not a major hindrance to fistula repair, routine repair remains rare and is mainly done at only two referral hospitals in Kenya, one in Nairobi and one in Eldoret.