• Tue. Jun 18th, 2024

Obstetric fistula, a dangerous but treatable and curable pathology


Nov 16, 2023

BUJUMBURA, November 16th (ABP) – “Obstetric fistula is a dangerous but preventable, treatable and curable disease,” confirmed Dr. Éric Ndihokubwayo, director of the Gitega regional hospital, where the Urumuri Center is located, which is a center of care of women suffering from obstetric fistula. It was during an interview he gave to the Burundi News Agency (ABP), on Tuesday November 7, 2023 in Gitega.

Dr. Éric Ndihokubwayo recalled that obstetric fistula is a lesion resulting in abnormal communication between the vagina and the bladder or between the bladder and the rectum.

This disease occurs following a long and difficult childbirth, in the absence of qualified health personnel and emergency obstetric care such as cesarean section. In this case, the patient witnesses a permanent leak of urine and/or feces.

Dr. Ndihokubwayo pointed out other risk factors such as early pregnancies among adolescents aged under 18, explaining that in the latter, pregnancy and childbirth are particularly dangerous because the pelvic region has not yet reached its complete development. Early motherhood further increases the risk of complications leading to high levels of obstetric fistula cases and other maternal morbidities, he added.

For the consequences, he indicated that untreated obstetric fistula causes chronic urinary incontinence and can lead to various physical disorders, frequent infections, kidney disease, injuries, infertility, and painful injuries and can even lead to death.

The director of the Gitega regional hospital also stressed that most fistula sufferers give birth to stillbirths. In addition, they experience social stigma because they find themselves abandoned by their husbands, families and communities.

He took the opportunity to call on all women to go directly to the Urumuri Center in Gitega, when they notice the first signs of this disease, to be treated as soon as possible, while specifying that any patient with obstetric fistula receives full support.

Dr. Ndihokubwayo also asked pregnant women to undergo prenatal consultations from the first trimester of pregnancy and to give birth in health facilities. He also asked the staff of health facilities, especially midwives, to assess in time whether the woman is going to undergo a cesarean delivery and to transfer her directly to hospitals. Health facility managers are also urged to double their efforts by collaborating with community health workers and the administration, to raise awareness among local communities and see if there are women who suffer from that disease to inform them that it is treatable and curable.

He also asked the husbands of fistulous women not to isolate these women, but rather to support them, take them to the Urumuri Center, instead of taking other women, noting that after being cured, the woman resumes sexual activity and can also give birth to children but by cesarean section to prevent the obstetric fistula from returning.

The director of the Gitega regional hospital said that since the setting up of the Urumuri Center in 2010, 3,366 women have been operated on and cured.

Regarding the challenges that this Center encounters, he cited the financial means for the total care of women with fistula as this center is unique in Burundi, the lack of specialists in obstetric fistula and modern equipment to properly serve patients like in other countries. He asked the partners to always be by their side.

Mrs. Bénigne Niyubahwe, who plays the psycho-social role at the Urumuri Center, testified that the majority of women with fistula who manage to get there are poor women, living in the most remote areas of the country, unable to even buy soap, and who have lost hope of being treated and cured.

Mrs. Benigne Niyubahwe

Because of the social stigma they have suffered, she said, some display a state of despair, psychological trauma, depression and shame. For their psychosocial care, “we listen to them and reassure them to bring them back to their taste for life. In addition, we offer them everything they need, including sanitary napkins, food and loincloths. Afterwards, we show them those who are already cured of this pathology to give them testimonies so that they too have the hope of being cured after their treatment,” Mrs. Niyubahwe underlined.

Mrs. FB (for anonymity purpose), from Bwome village in Nyabitsinda commune of Ruyigi province, aged 32, hospitalized at the Urumuri Center, testified: “It was during the normal delivery of my fifth child that I presented an obstetric fistula and I began to see the first signs including the permanent flow of urine. She added: “The disease is not known much by the communities because some told me that it is witchcraft, that I had water poisoned (Bakuroze amazi) and that I have to resort to witchdoctor to give me medicine. I stayed in the room with my baby; my husband went to sleep in another room. I did not go to church to pray or to the market, or to cooperatives or other self-development associations, because of the permanent flow of urine. I could not get control of myself, it is a humiliating illness and I preferred to stay at home. It was only afterwards that the health professionals at the Kinyinya health center told me that it was obstetric fistula and that I had to go to the Urumuri Center to be treated. After arriving at the Urumuri Center, I received a warm welcome and I have already undergone surgery, I am gradually recovering from this pathology which had put me away from society”.

She took that opportunity to thank the entire team at the Urumuri Center and invited women to join this center as soon as the first signs appear instead of thinking about witchcraft.

Mrs. Donatienne Nduwayo, representative of community health workers at the Sumo health center in Rubaragaza village, Butezi commune of Ruyigi province, during the interview with a check by ABP on Saturday November 11, 2023, affirmed that obstetric fistula and early pregnancies are a reality in that locality. She indicated that community health workers work in collaboration with health facilities and local administration to transmit messages during awareness sessions on obstetric fistula which are organized for the people. Then, women with fistula take the opportunity to report having signs of obstetric fistula. They are immediately invited to go to the Urumuri Center in Gitega to be treated, while explaining to them that it is no longer witchcraft.

Mrs. Nduwayo said community health workers are already aware that obstetric fistula is a disease that is preventable, treatable and curable.

Pregnant women are encouraged to undergo prenatal consultations and give birth in health facilities because there are still cases of home births even if they are few in number.

She insisted on raising awareness about early pregnancies or early marriages among adolescents, explaining that this scourge occurs at a rate that she considers high. She asked the Ministry of Public Health and the Fight against AIDS and its partners to further organize capacity building sessions for community health workers as far as obstetric fistula is concerned and to increase the treatment centers for that pathology, explaining that it is not easy for poor fistula sufferers to arrive in Gitega from far away.

According to the WHO, to prevent obstetric fistula, it is enough to delay the age of first pregnancy, put an end to harmful practices and facilitate access to obstetric care.

For its part, the United Nations Population Fund (UNFPA) is leading the global campaign to end fistula by 2030, which aims to transform the lives of vulnerable women and girls. The campaign represents a global commitment to prevention, comprehensive treatment including surgical repair, social reintegration and rehabilitation.