BUJUMBURA, November 24th (ABP) – “Even if obstetric fistula is a disgraceful disease in women, an odd and unexplainable illness, one should recognize that they are seriously ill because, who wants to cure the disease displays it,” underlined Mrs. Stephanie Nsavyimana, one of the women who were cured of obstetric fistula, from Musigati commune in Bubanza province, during an interview with a check by ABP.
For his part, the obstetrician-gynecologist at the Kamenge University Hospital Center (CHUK), Dr. Deogratias Ntukamazina, pointed out that when we talk of obstetric fistula, it is mainly a disease linked to childbirth. A woman with obstetric fistula is characterized by uncontrolled or involuntary and permanent loss of urine and/or sometimes feces wherever she is, whether sitting or standing, through an abnormal hole which has arisen between the bladder and the external genitalia. This hole results from a difficult, long and complicated labour (child delivery), to the extent that urine and/or feces no longer pass through the normal route, he explained.
To that end, the woman with fistula no longer dares go to the public, she no longer dares travel by public transport, she no longer dares go to the market or to church; she no longer dares go out, hence the name “backyard disease” or a shameful illness, he deplored, while specifying that any woman with fistula must now head to the center Urumuri based in Gitega province to undergo surgical treatment in order to be cured.
Taking into account the work he has carried out at CHUK and based on the fistulous women he has already treated since 2007, Dr. Ntukamazina pointed out that the most frequent cases are those of young women carrying their first babies. Given that the first pregnancy is considered a high-risk one, he advised young pregnant women to go to prenatal care checkups eight times throughout the course of the pregnancy, so that health professionals decide the path in which the child will be delivered, and especially to give birth in health facilities where they can have a Cesarean section (C-section), when necessary. Obstetric fistula also affects women in advanced age who give birth several times in a short period, he added.
In the same line of ideas, Dr. Ntukamazina pointed out that this disease can also be linked to non-pathological causes which are not frequent in the country such as surgery gone wrong when the bladder is injured; genital cancer which is already at the stage of metastasis which destroys part of the bladder, and the destroyed part creates, in turn, an abnormal passage of urine towards the genital tract of the woman; a woman with cancer who is trying to get treated with chemotherapy, which can destroy the bladder, and more rarely women growing rice who, at a certain point, can catch bilharziasis which can weaken the wall of the bladder.
Between 60 and 70% of women with fistula are chased away by their husbands instead of accompanying them to the disease treatment center. The majority of women who were affected by this disease in the first pregnancy gave birth to stillborns, while others became infertile, he deplored.
All pregnant women, old or young, must put an end to all the erroneous beliefs that prevent them from giving birth in hospital, and turn a deaf ear to their mothers or mothers-in-law who pose as midwives at home while they are not capable of helping them have a Cesarean section, when necessary. “Currently, with the policy of free healthcare related to pregnancy and childbirth, women are advised to give birth in health facilities, hence traditional midwives, who were trained in previous years, should not continue to assist pregnant women at home, except in cases of emergency for imminent deliveries,” obstetrician-gynecologist Ntukamazina insisted.
To those who believe that obstetric fistula is an illness linked to witchcraft, Dr. Ntukamazina did not mince words in emphasizing that no traditional medicine is capable of closing such a pathological hole which sets in after difficult and complicated labour.
“Prevention is better than cure. As soon as a woman becomes pregnant, she must go to prenatal care checkups to detect complications that could arise during the course of the pregnancy, which will help health professionals specialized in the matter to decide on the childbirth path for her pregnancy,” he advised. Otherwise, he added, the woman can die during labour, lose her newborn or suffer from fistula after childbirth, without forgetting that the mother and child can lose their lives on the site.
Concerning the history of treatment of obstetric fistula in Burundi, that health professional reported that treatment of the disease began in 2007. “At that time, I diagnosed approximately 500 cases of women with fistula throughout the country. With free healthcare starting in 2006, women giving birth in health facilities increased from 30 to 70% and in 2007 there were at least 1,000 new cases of fistula per year. The study carried out in 2012 showed that these cases had dropped to 700 new cases per year. Other studies have not yet been done,” he clarified.
The medical director of the Bubanza health province, Dr. Joelle Bigirimana, revealed to the check by ABP that obstetric fistula is a reality within the community. This disease mainly affects women who give birth at home and who undergo prolonged child delivery without the assistance of a health professional. “Health providers and Community Health Workers (CHWs) were trained on the identification and management of obstetric fistulas. If we receive a woman with this disease after diagnosis, we inform the National Reproductive Health Program (PNSR) to facilitate the patient’s travel or stay at the Urumuri center in Gitega,” she said.
Mrs. Bigirimana made a strong appeal to pregnant women to prevent themselves from that disease by having prenatal care, in order to find out if they can give birth vaginally or by Cesarean section, as well as the post-natal checkups necessary to know their post-natal health status. She also reaffirmed that obstetric fistula is curable if the advice given to the cured woman after surgical treatment is strictly respected. “For obstetric fistula to be eliminated in the health province of Bubanza, we will continue to raise awareness among all stakeholders, including men, so that everyone knows the signs and dangers of this disease,” she reassured.
According to the provincial coordinator for health promotion in Bubanza province, Athanase Nzeyimana, cases of obstetric fistulas are decreasing from a year to another because the fistulous women already identified have been treated at the Urumuri center and have been cured, except for a single case of a woman to whom the disease has recurred following non-compliance with the advice given to her after the first treatment in Gitega, such as having sexual intercourse after at least three or four months or more.
“We work closely with the CHWs in all the 461 sub-villages of the province to identify fistula patients and refer them to the Urumuri center for treatment. These CHWs communicate regularly with communal health promotion technicians or community health focal points, any health information that arises in the community,” he said, while calling on those CHWs to fully play their role in the community, given that they are considered ‘eye and hearing witnesses’ of the ministry in charge of public health.
Under the guide of the CHW of the Musigati sub-village in Musigati commune of the Bubanza province, Mrs. Esperance Girukwishaka, the check by ABP paid a visit to a fistulous and mentally ill mother. That woman was at the foot of the mountain on the banks of the river called Nyesiha, preparing her food. D.M. is no longer able to express herself as correctly as it should be, except the transmission of outrages.
“They tried to tie that widow up with a rope in order to transport her to the disease treatment center but they failed. When she finishes eating and her clothes are dry, she returns home, to a shelter that leaves something to be desired, opposite the Musigati commune’s market,” Mrs. Girukwishaka revealed. She pointed out that in that locality, this disease mainly affects mothers with advanced age living in remote areas because, she explained, young women have already understood the true merits of visiting health facilities in the event of pregnancy or any illness.
On the other hand, Mrs. Stephanie Nsavyimana confirmed that fistula is treatable and curable. “I suffered fistula at the age of 47 in 2021. From then on, my husband has abandoned me and left me with 4 children. So far, he has not returned yet. I tried to do everything possible to build a house on my own plot, even if I did not complete it well, and to meet the needs of my children. So, I went to Cibitoke province and Mudubugu in Gihanga commune (Bubanza) to undergo very expensive treatments, but nothing has changed. It was only at the center Urumuri in Gitega, from September 5 to October 20, 2023, that I underwent effective surgical treatment to be cured; I paid nothing and I was also given the return ticket,” she testified.
She advised other husbands that, before rejecting their wives when they get sick, they should remember that during the nuptial blessing they promised to always be by the side of their spouses every step of the way, on good days and bad days because, she explained, they too can get sick. She calls on them to consciousness and to accompany their wives in their suffering. She has, moreover, categorically denied that she is not ready to welcome her husband upon his return.
It is worth recalling that the all-out elimination of obstetric fistula in Burundi is one of the concerns that are close to the heart of the First Lady of the Republic of Burundi, Mrs. Angeline Ndayishimiye, the Ministry of Public Health and the fight against AIDS through the PNSR as well as Burundi’s partners in the health sector including the United Nations Population Fund (UNFPA).