Repairing obstetric fistula in remote Bangladesh

An obstetric fistula usually happens to poor, pregnant women in remote areas. If a dead baby stays inside the uterus for a long time, the blood flow to different parts of the reproductive organs is stopped, the different parts of the birth canal are damaged, resulting in a wound that creates a hole between the reproductive organs and the bladder and/or anus, resulting in the continuous leakage of urine or feces.

Fistula is a physically painful and psychologically damaging disorder. Women with fistulas are unable to have intercourse with their husbands due to the continuous leakage of urine and/or feces. They have bad body smells all the time. In almost all cases, their husbands abandon them, and they are even rejected by their parents or other close relatives.

Obstetric fistula is almost never seen in the developed world today due to improved obstetric care.  It remains a significant cause of morbidity in Bangladesh and other developing countries where maternal health is lagging. Generally, most women, before developing obstetric fistula, experience labour pain for three days or more. These women are often from poor communities and do not have access to good health care.

Often the deliveries are done by traditional birth attendants or family members. Many of them do not receive any prenatal care. Therefore, they have no prior knowledge of the size, position, and health risks of their unborn child and no prior preparation is made for delivery that may be obstructed or require cesarean section.

In rural areas where health awareness is low, obstetric fistula is not well understood and is considered a curse of fate and instead of helping they are blamed for the dreaded disease. Everyone considers them a social and family burden. The kinds of mental depression, anxiety and restlessness that a fistula patient experiences are terrible. Fistula-afflicted women have many other problems such as kidney disease, difficulty in walking due to nerve damage in legs etc.

Obstetric fistula is usually treated surgically. If an experienced physician is consulted within a short time after fistula develops, it can be cured without surgery with antibiotics. But for those who have fistula for a long time, only treatment is surgery. Fistula operation is complex and can only be performed by skilled surgeons.

Currently, fistula surgeries are performed in 17 hospitals across the country, among which Hope Hospital in Cox's Bazar is notable. Other institutions that perform fistula surgery in Bangladesh are Lamb Hospital, MAMM's Institute, Kumudini Hospital, Ad-din Hospital, BSMMU and some government medical college hospitals.

Fistula surgery is expensive. Almost all fistula surgeries done in the country, including those at Hope Hospital, are done free of charge, through help of donor agencies. In line with the Sustainable Development Goals, the Government of Bangladesh has undertaken a major initiative to make the country fistula free by 2030 with the technical support of UNFPA Bangladesh.

The Government of Bangladesh has made remarkable progress in maternal health and has received international recognition for the achievements. Now, it is the demand of the time to make the country free from fistula by 2030 by bringing all the fistula patients under treatment with the cooperation and collective efforts of all government and non-governmental organisations.

The writer is the Founder of Hope Foundation. E-mail: iumahmood@gmail.com