Zambia: Victims of Easily Treatable Obstetric Fistula Shunned

Queen Makayi recovers from the obstetric fistula operation.

SOLWEZI, 1 Sep 2006 (IRIN) - Obstetric or maternity fistula occurs when the birth canal is too narrow and there are no qualified medical personnel to perform a caesarean operation. For 27 years Queen Makayi, 43, lived in shame and isolation after the resultant incontinence caused her husband to leave her and the community to humiliate her.

"It happens because the sustained pressure of the baby's head on the mother's bladder or rectum damages the soft tissues, thereby creating a hole, or what we call fistula," said Lackson Kasonka, a consultant urogynaecologist at Lusaka's University Teaching Hospital.

"I started leaking urine at 16 years [of age] after my first pregnancy ended in a miscarriage. My husband immediately left me and my family started shunning me. Since then, everyone in the village has been calling me many names because of my bad smell," Makayi told IRIN.

She was one of 31 women in Northwestern Province who underwent surgical correction of maternity fistula. After the procedure she said, "I am in pain just now, but if my problem can finish and I walk home without leaking or smelling urine once more, then this pain will be nothing to me."

The World Health Organisation estimates that globally about two million women, mostly in Africa and eastern Asia, suffer from the condition.

"Nobody ever wants to associate or eat with me. My family has even bought me specific plates that no one else uses, and I have to wash them myself after eating. I am never invited to be part of any family meeting because of this condition," said Doreen Kyambaomba, 36, who has lived with obstetric fistula since 1988.

"Above all, what hurts me most is that my husband, who married me when I was 17 years old, had to divorce me soon after I developed this condition and he has now married a close friend of mine."

Several studies in Zambia pinpointed poverty, illiteracy, gender inequality, poor nutrition, lack of access to family planning and high teenage pregnancy rates as the major causes for obstetric fistula. Women aged under 20 are most affected, as their physical development is usually not mature enough to accommodate pregnancy.

Obstetric fistula is also linked to a high rate of maternal mortality - the rate in Zambia is 800 deaths per 100,000 live births. About 56 percent of pregnant women have home births, usually assisted by an untrained relative or traditional birth attendant.

Weak Health Systems

The exodus of medical staff seeking better wages and working conditions in other more developed countries has affected the quality of medical care.

"The occurrence of fistula is an indication of the weak health delivery service, and in some Zambian clinics in rural areas the health service workers are actually unskilled labourers known as the non-classified daily employees. Therefore, in case of prolonged labour or any obstetric pregnancy complication, fistula will develop," said Deji Popoola, country representative for the United Nations Population Fund (UNFPA).

The population fund has been spearheading a campaign since 2003 to promote sound reproductive health, using community groups and safe motherhood organisations to raise awareness about the condition and support sufferers, but a shortage of funds has stalled the programme.

"We are seeking to restore the full functionalities of the effected women. They should be able to bear children after the repair and enjoy a normal sexual life like any other woman, because obstetric fistula is treatable," Popoola said.

Organizations Related to This Article

The Fistula Foundation
Addis Ababa Fistula Hospital
www.fistulafoundation.org/

UNFPA Campaign to End Fistula
www.endfistula.org/
Outstanding Fistula Treatment Pioneers:
www.endfistula.org/pioneers.htm

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