BLANTYRE, MALAWI— Malawi and the United Nations are stepping up efforts to prevent obstetric fistula cases and to help more women already suffering with the condition.
Considered a condition born of poverty, obstetric fistula can occur in women during prolonged and difficult child birth or from sexual abuse. It stems from soft tissue tears, leaving women with urinary or fecal incontinence, in pain, prone to chronic infections and often isolated and abandoned by husbands, family and community.
The younger the woman is when she first gives birth, the greater her risk of fistula.
The United Nations Population Fund (UNFPA) is teaming up with the Malawi Ministry of Health to make medical care more accessible to women and to educate the public on the condition in order to prevent or treat it.
Gift Malunga, acting country director for the UNFPA in Malawi, says the group is conducting “fistula camps” twice a year in public hospitals where those afflicted by the condition can be treated, and they are conducting an outreach campaign to educate the public.
“We started with very few patients, because of the myths surrounding the area," said Malunga. "Some were saying that it is a curse, not a medical condition. But when we engaged the media to create awareness in the communities, we saw more and more patients coming to our camps to the extent that, last time, we could not treat all of them in the camp.”
Malunga says women leave the camp physically healed, and are given food items, soaps, a piece of cloth and counseling for easier re-integration into communities that shun them. She says so far the UNFPA program has helped more than 600 women with corrective surgeries.
The World Health Organization estimates some 2 to 3 million women and girls live with obstetrical fistula in developing countries, with 50,000 new fistula cases occurring each year.
In specific regions of Malawi, Malunga says, the prevalence of early marriage is one of fistula's major contributing factors.
“For example, in Mangochi [district], I think it’s more to do with early marriage because when someone is not fully matured and they have prolonged labor, it’s very easy for the tissues to die and then perforation takes place.”
Some communities are assisting U.N. and government efforts.
Chief Kwataine, a senior traditional leader who has acted as National Chairperson for Malawi's Presidential Initiative on Maternal Health and Safe Motherhood, has pushed for and passed bylaws to help prevent young women from being at risk for fistula.
“As traditional leaders, we have now ganged up to set some bylaws to ban traditional birth attendants from conducting deliveries in villages to prevent the fistula issue," she said. "The second one is to set stiffer penalties to bar parents from encouraging young girls to get married. We have set up 21 as age limit to make sure that every young girl or young boy should attain 21 before thinking of getting married.”
Kwataine says the penalties for breaking the bylaws include payment of chickens and goats to traditional leaders.
But despite these efforts to treat the afflicted, challenges remain, such as an acute shortage of trained and dedicated medical doctors to repair fistula's damage to the body. Malawi's Ministry of Health says of the 12 or so local doctors trained to handle repairs, only a few do the procedure.
According to Malunga, that means U.N.-funded fistula camps must rely on foreign doctors.
“We have always had this issue of sustainability," she said. "We are saying to ourselves as UNFPA ‘to what extent do we continue to bring in [medical] consultancy’? That’s why all the time the consultants are here — they are training clinicians how to repair, but now the challenge is on the dedication of the clinicians and doctors we have trained. That one now is beyond us as UNFPA.”
UNFPA is scheduled to conduct its second three-week fistula camp in early October at the Queen Elizabeth Central Hospital in Blantyre. About 100 women are expected to receive fistula repair.