• Mon. Feb 26th, 2024

The fistulous woman is not to blame but to be supported and cared for


Dec 2, 2023

BUJUMBURA November 27th (ABP) – Obstetric fistula, a “backyard” disease, with several often-erroneous theories, developed by popular consciousness, a disease often discriminatory for those who suffer from it. During an interview with ABP, gyneco-obstetrician Dr Déogratias Ntukamazina, who treats cases of obstetric fistula, shed light on that disease which sometimes escapes the understanding of a large majority of the Burundians.

For that specialist who works at the Kamenge University Hospital Center (CHUK), obstetric fistula is linked “to pregnancy, especially to childbirth”. A woman with an obstetric fistula “is a woman who has a permanent uncontrolled or involuntary loss of urine wherever she is, whether she is sitting or standing, with permanent flow down her legs.”

It all starts during a long and complicated delivery, when a hole is created between the bladder and the external organs, especially the vagina, leading to permanent uncontrolled or involuntary loss of urine, said Dr Ntukamazina. The perforation could also be created between the bladder and the rectum, because according to the specialist, urine and/or feces pass at that time through the vaginal route. The women concerned are those who gave birth by cesarean section or vaginally, according to him.

Young women with their first pregnancies are most likely to develop fistula. He indicated that the first pregnancy is at risk during childbirth. Those women must consult the authorized structures so that they are monitored, with a view to deciding on the route of delivery and so that they give birth in an environment where a cesarean section can be done, if necessary,” he said. he hammered.

According to Dr Ntukamazina, “The majority of women with fistula give birth in structures where cesarean sections are not performed without means of transport to authorized structures. Those women are evacuated to those structures too late, their condition having become complicated, suffering the full brunt of the complications linked to their critical condition.”

He further noted that older women who have given birth multiple times may be targets for obstetric fistula in the case of “vicious presentations”: a complicated labor when the baby’s head is presented or in another form, a long labor which results in fistula after the baby comes out. Short women under 1m50 or a little above are also presented as people at risk. Dr Ntukamazina explained that women in those above categories have a narrowed pelvis, which makes vaginal delivery difficult.

The specialist in obstetric gynecology paints an alarming picture of the consequences linked to that disease. The affected person who experiences those streams of urine oozing down their body feels dirty, carrying the smell of urine in their wake. Among those around him, he notices discomfort felt during his passage because of a bad smell. The suffering person no longer dares to appear in public, travel by public transport, go to the market or church. She takes refuge in the “backyard” of her house, lamented the gynecologist.

The second consequence is infertility which results from that fistula and which sets in very early. Since young women are the most targeted, during their first pregnancies. To add insult to injury, Mr. Ntukamazina notes that the majority of those who become infertile, during their complicated childbirth, expel stillborn. Within households, even if husbands can assume the bad smell that their sick wives give off, they cannot tolerate that infertility, he regretted.

In light of the surveys carried out, Dr Ntukamazina suggests that between 60% and 70% of those husbands chase away their wives, who are forced to return to their parents.

Alongside obstetric fistula, which is observed in Burundi, linked to a difficult and complicated childbirth, the gyneco-obstetrics specialist mentioned other non-obstetric causes of urogenital fistula. Here, he noted the blunders during certain surgical operations. He cited the case of fibroid surgery where the surgeon, through clumsiness, injures the bladder and creates that unusual hole. Genital cancer that is in the metastasis stage can destroy part of the bladder and creates an abnormal passage of urine towards the genital tract.

Speaking of the same genital cancer, drugs used in chemotherapy can also destroy part of the bladder and cause fistula. In rarer cases, Dr Ntukamazina spoke about bilharziasis which can cause fistula by weakening the bladder wall.

Supporting figures, the gyneco-obstetrician informed that after the introduction of free care for pregnant women in 2006, the rate of women with fistulas increased from 30% to 70%, with some 1000 cases per year, since 2007. Figures which dropped to 700 cases of obstetric fistulas, in 2012, the year of the last study.

He thus called for a change in mentalities such that “childbirth is natural, physiological and must be done at home”. For him, all pregnant women must have a consultation, in a healthcare structure: prenatal consultation to detect complications during the pregnancy but also decide the route of delivery for that pregnancy.

                                                              View of the Urumuri Obstetric Fistula Management Center

The medical director of the National Reproductive Health Program (PNSR), Dr Ananie Ndacayisaba, echoes the same concerns, to prevent fistulas during childbirth. It invites pregnant women to use healthcare structures, have consultations, from the first signs of pregnancy and to respect the schedule preestablished by the providers because each consultation session has a package to offer the woman, examinations and medications. “We must respect those appointments,” he insisted.

At that level, the World Health Organization (WHO) recommends eight prenatal consultation visits. He subsequently called for giving birth in a health care setting, not at home because they cause cases of obstetric fistulas. To women who have already given birth, Dr Ndacayisaba calls on them to go to healthcare facilities within the first 20 days, after giving birth, for postnatal consultations: “to be examined, re-examined so that the woman can be reassured that there is There are no problems after childbirth.

If the fistula is confirmed, he directs patients to the specialized Urumuri center for treatment, a center located within the Gitega regional hospital.

With compliance with those measures, he expressed confidence that obstetric fistula will be eradicated, in accordance with the set objective of eliminating obstetric fistula by 2030, said the medical director of the PNSR. An achievable objective, according to him, in the light of encouraging indicators, namely the fistula diagnosis and operation campaigns which are organized each year throughout the country.

Nevertheless, to achieve the assigned objective, he appealed to the community, including the media, to help raise awareness and make that disease known to the population, “so that there is no one who stays at home with that disease.

As a reminder, the Urumuri Center, for the management of obstetric fistula, inaugurated by the presidential couple, on September 17, 2021, was built with funding from the Bonne Action Umugiraneza Foundation, initiated by the first lady Angéline Ndayishimiye, with the support of the United Nations Population Fund (UNFPA), committed to the fight against obstetric fistula.

While recalling that ensuring the health of the  people are  one of the Government’s priorities, the President of the Republic Mr. Evariste Ndayishimiye, during that inauguration, welcomed the important contribution that the UNFPA was making in the fight against obstetric fistulas in Burundi.