HOIMA – Mawazo Jackline 49, a Congolese refugee at Kyangwali Refugee Settlement in Kikuube District in Uganda has lived with fistula for the last 27 years. It happened when she was still in Congo when she had an obstructed labor before she gave birth to a dead child after being operated.
“I started leaking immediately. I was advised to take six months and return to the hospital for an operation but by then, Congo was unstable with the conflicts so I couldn’t go back until we ran to Uganda,” she narrated.
“Here in Uganda, I hardly went to public or any gatherings. Normally, I stayed at home. One day I tried to seek medical attention in Uganda but when I reached the facility, a nurse told me that it seems I am a prostitute and that’s how I got the condition. It disturbed me so much and I decided to go back home until today,” said Mawazo who was among the women that were operated at Kagadi District General Hospital last week.
She told PML Daily that, “Until recently, my sick granddaughter was seeking healing from a church and I went there to check on her. While there, a certain lady looked at me wet and asked another lady who knew about me and she explained to her that I had fistula. She approached me, told me about this (Kagadi) camp and I was successfully operated.”
Speaking at the Commemoration of the International Day to End Obstetric Fistula in Hoima City, Gynecologists warned that cases of obstetric fistula among women are likely to increase if the cases of teenage pregnancies are not addressed.
At only 16, Tuhaise Monday from Kibaale district got pregnant in February this year. Just like Mawazo, she gave birth to a dead child and immediately started leaking.
“I went to Nakitooma health center where I was referred to Kiryandongo and then to Hoima but all failed. I decided to go to a private health center because my stomach was very swollen. They managed to work on the stomach but the urine kept on leaking.”
After three months, Tuhaise was also abandoned by the man who impregnated her learned about the Kagadi camp and was successfully operated.
Experts say that usually if the baby is not lying well, a mother can fail to push. In that circumstance, if there is no skilled health worker to help, the woman will end in with a fistula.
The experts revealed that today, 30% of women in Uganda are still delivering on their own which has increased the risk of fistula.
Normally, doctors say, the condition victims suffer uncontrolled leakage of urine or stool and they are smelly. As a result, they will not appear in public and even in their own homes, they will not sit with the rest.
Nabutono Shakirah, a Clinical Officer at Kagadi District General Hospital told the journalists that in they managed to screen 54 women and send back home four who had stress and fresh fistula.
She said a told of 13 mothers were operated and were responding to the treatment.
“We started on the 21st with screening, and surgery on the 22nd. We started with the tears (third and fourth degree tears).”
Nabutono says that some women got fistula after delivering from the villages.
She thinks there is a need for continuous sensitization for mothers to deliver from the healthcare facilities.
“Of course, the midwives must be mentored. If you see a case refer in time, don’t overstay with a mother because the delays are the ones that cause fistula mainly.”
For young girls, Nabutono says they fear going to health facilities because of that stigma.
“They feel that if I go to the healthcare facility, maybe I’ll be segregated. So they first try birth attendants before they reach the facilities.”
According to the Ministry of Health, they conducted surgical camps in Moyo where 21 patients were operated, Mbarara 45, Kibaale and Kagadi.
The ministry also blamed the condition on child marriages but also urged mothers to regularly attend antenatal for early identification of the complications.
UNFPA Deputy Representative Mr Daniel Alemu commended Uganda for honoring UN resolution and putting women and girls’ reproductive health and rights on the national development agenda.
He said that significant progress has been made in the country but a lot needs to be done to achieve the elimination of Fistula by 2030.
“Currently, about half a million women and girls live with fistula around the world. In Uganda at least 1 in every 100 women has obstetric fistula.”
According to him, 90% of women who suffer complications of fistula have lost their babies during childbirth.
In Uganda data indicates, that up to three in ten fistula cases are caused by an intervention that was unsuccessful and poorly done by a healthcare provider. In 2022, about 1,700 fistula repair surgeries were done across the country.
Alemu noted that there are wider challenges facing women and girls, such as poverty, gender, and socioeconomic inequality, lack of schooling, child marriage, and early childbearing, that jeopardize opportunities for fistula survivors.
“Women and girls suffer life-shattering consequences including chronic incontinence, shame, social isolation, poverty, and physical, mental, and emotional health problems. The long uncomfortable wait before accessing fistula care is indeed a ‘wait of pain.’ It is a pointer to existing gaps in the provision of quality care in the health system. At the moment, Uganda still has an unmet need for prevention and holistic fistula treatment (surgical repair and social reintegration and rehabilitation).”
He added, “Ending obstetric fistula is a high priority for the United Nations Population Fund, and a must-achieve target of Sustainable Development Goals (by 2030). UNFPA leads the global Campaign to End Fistula to drive the commitment to fistula prevention and holistic treatment (surgical repair, social reintegration, and rehabilitation) to restore health and dignity. Despite progress, elimination by 2030 demands accelerated action starting now.”
He noted that UNFPA has invested in improving the quality of maternal care to make every child’s birth safe but also invested in reducing the unmet need for modern contraception.
Officiating at the event, Premier Robinah Babbanja acknowledged the challenge but noted that the Government is employing all possible measures to end the condition.
Represented by Minister of State for Health – Anifa Kawooya, Nabbanja said that her government is emphasizing wealth creation as a key measure to fight all these
“I take the honor to reiterate the government’s commitment to working with all the stakeholders to accelerate attainment of targets in the maternal health. It is everyone’s responsibility starting with us the leaders to mobilize the community by providing the right information.”
She encouraged the public to address the “regressive” social norms and cultural practices such as teenage pregnancies and child marriage, all which deny girls their education right.