HEALTH-MALAWI: Help for Women with Obstetric Fistula

A group of 138 unhappy and mostly destitute women from Malawi’s lake district of Mangochi have something to look forward to this week: They will have a chance to restore their dignity and pride by accessing a medical service usually not available to them.

Some of the women have been unable to control the flow of urine and faeces from their bodies for many years due to a medical condition known as obstetric fistula. Others are recent victims of this demeaning condition.

According to United Nations Population Fund (UNFPA) reproductive health officer, Dorothy Lazaro, obstetric fistula occurs during the process of giving birth and is caused by extended pressure of the child’s head against the soft tissue in the mother’s pelvis.

The tissue eventually dies from the lack of blood supply, and a hole develops between either the rectum and vagina or between the bladder and vagina. As a result, women lose control of the flow of urine and sometimes faeces.

UNFPA and Malawi’s Ministry of Health have jointly organised a "Fistula Week" where women with this condition will undergo operations and receive free medical services to reverse the condition.

Apart from medical complications, women suffering from obstetric fistula have to face numerous social obstacles. They are outcasts in their communities because their husbands abandon them when they fall ill. In addition, community members do not want to get close to them because of the smell that emanates from their bodies due to the continuous flow of excreta.

Malawi has no official statistics on how many women are afflicted with fistula but government, with UNFPA’s assistance, is currently carrying out a study to determine the scale of the problem.

Lazaro says that there is such a large number of fistula patients in Mangochi because early marriages abound in the district, which result in young women giving birth before their bodies are ready to endure the strains of pregnancy and birth.

She explains that young women often go through a prolonged labour process that causes the soft tissues between the pelvis to die, which then creates holes between the bladder and/or the rectum and the vagina. "We have come across girls as young as 13 giving birth, and this age group usually risks developing fistula," says Lazaro.

She also says that most women in Mangochi give birth at home with no medical care or follow up examinations.

The head of the national health ministry’s Reproductive Health Unit (RHU), Dr. Chisale Mhango, says Malawi lacks sufficient infrastructure for maternal care -- another contributing factor to fistula. The lack of health services is also responsible for the country’s high maternal mortality rate -– with 807 deaths per 100,000 live births -– the second-highest on the continent after war-torn Sierra Leone.

"It’s very difficult for us to cope with maternity cases because of the lack of medical personnel that the country continues to face," says Mhango.

The country’s efforts to attain Millennium Development Goal (MDG) number five, which aims to reduce the maternal mortality ratio by three quarters by 2015, are being severely hampered by these shortcomings.

There is only one doctor and four clinical officers in the whole of Malawi who are qualified to carry out fistula repairs, according to Lazaro. More than 100 registered nurses are reported to be leaving the country each year for the developed world in search of higher-paying jobs. Malawi’s Ministry of Health statistics indicate that one doctor takes care of up to 64,000 patients.

But this week, UNFPA has brought into the country two surgical specialists from Holland and Kenya to provide support to the existing local medical personnel in treating the women during fistula week.

"The specialists will also provide a refresher course on fistula repair to our local medical personnel," says Lazaro. She, however, worries that the efforts of fistula week might be hampered by a lack of bed space available in the health care facilities in Mangochi to treat the 138 women.

"The women have to be monitored for two weeks after the operation and it may not be feasible for the health facilities to have so many women hospitalised for such a long time," says Lazaro.

As a long-term plan developed locally to prevent fistula, UNFPA in Malawi is recommending fistula prevention programmes to be linked with education systems to ensure that girls remain in school for a longer time. The UN agency also recommends that youth-friendly health services be made widely available to prevent early pregnancies.

Malawi is not the only country faced with high maternal mortality rates. Globally, 99 percent of maternal deaths occur in the developing world and half of these take place in Africa, according to a joint statement released by UNFPA, World Bank, UNICEF and World Health Organisation in late September.

The agencies say the MDG goal on maternal mortality is showing the least progress compared to the other seven MDG goals, which aim to eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and empowerment of women, reduce child mortality, combat HIV/AIDS, malaria and other diseases and ensure environmental sustainability and develop a global partnership for development.

"Every minute a woman dies in pregnancy or childbirth in the world," says the statement.

The agencies pledged to enhance support to countries with the highest maternal mortality during the next five years and will work with governments and civil society to strengthen national capacity by conducting needs assessments and ensuring that health plans are MDG-driven.

The UN agencies have also promised to address the urgent need for skilled health workers, particularly midwives, reduce financial barriers to access health facilities, especially for the poorest, tackle the root causes of maternal mortality and morbidity which include gender inequality low access to education, especially for girls, child marriage and adolescent pregnancy.

Malawi is hoping to be one of the countries to benefit from this new pledge to scale up efforts to eliminate fistula and maternal deaths, says Lazaro.