UGANDA: Kitovu Hospital takes on more fistula patients

December 10th 2008

Kitovu Hospital in Masaka District has enlarged its facilities with the construction of a new obstetric fistula repair theatre and is now in position to handle more fistula repair cases. The existent theatre building was also reconstructed and modernised, improving services for all surgical patients.

It was commissioned on Saturday, November 22 at the cost of about Shs60m contributed by both the Rotary Club of Guernsey in the UK and Africara of Ireland, says Sister Scholastic Nakachwa, the Kitovu Hospital Complex Director.

This is very important news for an estimated 140,000 women in Uganda who, scattered in different far off villages across the country, suffer in solitude with what is perhaps the most embarrassing medical condition for women �" obstetric fistula. The great majority of them live far away from hospitals, rejected, without money, and with no hope at all that there is a cure for their condition. Doctors describe obstetric fistula as “a devastating injury sustained by a woman during childbirth”.

Not all hospitals in Uganda can repair fistula sufferers and many victims keep going from one hospital to another, from one witch doctor to another, until they give up and try to learn to accept their situation. The country’s medical schools offer no training in fistula repair to their student doctors. Few hospitals including Kitovu Hospital have the equipment to carry out fistula repair operations. These include Mulago in Kampala, Kagando in Kasese, Kamuli and the Amref served hospitals of Lira and Lacor.

Fistula is a problem related to poverty, ignorance, and underdevelopment according to Dr Michael Bishop, a British Fistula surgeon who was at Kitovu at the time of commissioning the expanded theatre. Most families reserve no savings to turn to in case of childbirth emergencies. The woman gets labour pains but there is no money for her transportation to a suitable health facility. A delay occurs and when she finally gets there perhaps the facility too lacks the required equipment or the right personnel to handle her case and no ambulance is at hand to take her to a bigger health unit. Meanwhile, her pain continues, the baby fails to come out or even dies, and by the time she gets to the right facility, usually after a long journey on a rough road, the tissues in the vaginal and rectal area are damaged.

Dr Bishop also said fistula is common among teenage girls who become pregnant because their sexual organs are not yet fully developed for the rigours of childbirth. He however was quick to add that fistula complications can occur even to mature women who may have had a series of successful natural deliveries before. So he says all pregnant women must visit antenatal clinics for regular examination. “Most childbirth difficulties can be detected by well qualified medical personnel and the woman can be warned to deliver at a health facility where caesarean operation is possible to avoid such problems as fistula.”

Many women don’t go to hospitals for antenatal care services even where they are available because they have greater faith in traditional birth attendants. Others choose to take herbal medicine whose dosage they are not sure of instead of going to antenatal clinics to receive modern medication and advice. They solely depend on traditional birth attendants who are of no help when complications arise. According to surveys carried out by Kitovu Hospital and other fistula fighting institutions, in many cases it’s not even the pregnant woman who decides on where to go for medical help but rather her husband or in-laws.

Dr Maura Lynch, a consultant surgeon based in Kitovu, said that about 16 women die everyday in Uganda due to child delivery complications but surprisingly, people get more excited and concerned when occasionally, a mini-bus overturns on our bad roads and some 14 passengers aboard get killed. Child birth problems are far worse than the carnage on our roads, a fact that calls for political leaders to take immediate action to reverse the situation.

Dr Stuart Musisi, Masaka District director of medical services, who was also present at the commissioning, criticised the government for its failure to equip government dispensaries with sufficient drugs and equipment. “Although the population keeps increasing, the government continues to allocate less and less funds to the health budget. And so when pregnant women and other people go there for help, they get none. Hence, the increased cases of fistula and other medical complications that so often result in women’s deaths!”

It is encouraging to learn that as a result of the operation theatre enlargement Kitovu Hospital will, beginning next year, be in position to handle some 1,000 fistula repair operations according to Dr Lynch, an Irish missionary doctor, who started doing fistula repair surgical operations at the hospital in 1993. Up till now, she said the hospital has been doing between 250 to 500 operations every year due to limited operation theatre space and the absence of a resident fistula surgeon.

Dr Lynch, a Catholic nun of the Medical Missionaries of Mary, continues to head the Kitovu Hospital Fistula Unit but no longer performs fistula repairs. Volunteer surgeons from overseas have been visiting Kitovu Hospital for short periods about four times every year and carrying out fistula repairs as well as training local doctors, anaesthetic assistants, theatre nurses, and post-operation ward nurses �" a whole fistula repair team.

Fistula repair operations are carried out free of charge at Kitovu Hospital and fortunately, about 80 per cent of all the operations are successful. Nearly always, the women who go there for help have no money to pay for the expensive services that they demand. The unit is funded by United Nations Population Fund, Engender Health (US), Africara (Ireland), and the donor friends of Kitovu. Dr Lynch disclosed that a fistula repair operation costs $400 (Shs792,000).

After repair, the women are reimbursed with their transport expenses and facilitated to go back to the hospital for further medical check-ups. When fully repaired they get guidance on how to go about managing pregnancy. Kitovu Fistula Unit meets all their antenatal care costs and carries out a caesarean birth operation on them free of charge. Dr Lynch reported that some nine women have been helped this way and have got healthy babies after the trauma of fistula and now live normal lives back in their communities.

Source: Daily Monitor 10 December 2008