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Uganda: Obstetric Fistula Queues Grow Longer by the Day

Uganda: Obstetric Fistula Queues Grow Longer by the Day

Joyce Ingwedo’s neighbours in Oderai village, Soroti district called her ‘urine’ from when she was 17. This was because of urine incontinence that left her with a bad smell.

Ingwedo had suffered Obstetric Fistula (OF), a condition caused by prolonged labour that led to a tearing between her vagina and anus.

Luckily, Ingwedo, 45, was among 215 women that were treated in the last three years courtesy of AMREF (African Medical and Research Foundation), which paid $150 (250,000) per patient.

But over 70 other women will have to wait a little longer.

Dr. Fred Kirya, a surgeon met at Soroti Hospital in June during the winding up of the Civil Society Capacity Building Program (CSCBP) told The Weekly Observer, “Of course it can be reduced greatly if we have more medical workers and mid-wives deep down in the villages to help in efficient child delivery.” It is obvious that delay in labour occurs due to inaccessibility to expert medical workers,” he said.

Every year, Makerere University graduates 120 doctors while Mbarara and Gulu Universities graduate 60 and 50 respectively. Many of these are left floating around while mothers in the rural areas like Soroti continue to face such consequences as fistula.

Many of the Health Centre IVs in Soroti that are by standard supposed to have surgeons do not have any. Some residents in Soroti told The Weekly Observer that between June 2007 and July 2008, many health centre IVs were not functioning to standard.

For starters they were not conducting child deliveries because of the absence of medical personnel.

This left Soroti Hospital to fight it alone with 760 caesarean operations in one year. This means that women who could not go to Soroti Hospital or even access a midwife at the lowest level were doomed and likely to suffer fistula.

Clearly as one doctor said, “The conditions set for health practitioners in this country are not good right from the urban centres. What do you expect in the rural areas then?” As a result, no medical practitioner is ready to sacrifice to work in remote areas without good lodging, transport, drugs, medical equipment and a suitable pay.

In addition, medical sensitisation of the communities about the dangers of delay in labour is a way of preventing the occurrence of fistula.

The Association for Re-orientation and Rehabilitation for Teso Women (TERREWODE) is now involved in training communities on the dangers of delayed labour. The association benefited from the European Union’s 9th European Development Fund of Shs 99 million for 18 months that ended in June 2008 to carry out civic education on OF and how to prevent it.

During the same CSCBP tour, Martha Ibeno, the Programme Officer of TERREWODE, told The Weekly Observer that the programme will go a long way in changing the rural women’s perception of fistula as many of them have been living in denial or blaming it on witchcraft.

Mary Alyao, 20, has had fistula since she was 17. She says: “All my relatives disserted me. I stay in an Internally Displaced People’s camp where I have no friends either. People say they don’t want me because of my smell due to the urine that flows uncontrollably. I even go to the well alone, very late when there is hardly anyone. People don’t want me to go to the well because they say I will contaminate their water. I live a very lonely life,” said Alyao.

Treatment like prevention has been a big problem for fistula patients. Kirya said that he repairs over 50 fistula patients per year. But the number of patients keeps growing yet the hospital is limited in terms of facilities and funds.

According to Ibeno, AMREF used to flow in surgeons to repair fistula twice every year but, “with the overwhelming number of patients, the surgeons couldn’t repair all the patients in the queue due to the little time they spend here,” said Ibeno.

Although the need for surgeons seems to be high, Soroti Hospital has only two. Other hospitals that have surgeons with this expertise include: Kitovu Hospital in Masaka, Lacor Hospital in Gulu, Arua Hospital, Kagando Hospital in Kasese and Mulago in Kampala.

Because fistula affects mostly the poor who won’t afford to pay for the surgeon’s services, very few medicine graduates are willing to specialize in treating the problem.

Ibeno said that for fistula to be repaired, a woman has to pay Shs 350,000, which many cannot afford and therefore live with the problem for long.

Since poverty seems to be the biggest cause of fistula, improving the economic conditions of citizens might be one of the ways to combat the crisis.

That way, women will be able to visit hospitals and deliver their children under medical supervision.

Article by John Vianney Nsimbe

Source: The Weekly Observer – 13 August 2008

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