Obstetric fistula: Sharing the untold stories
Obstetric fistula, considered an accident of childbirth, continues to plague this country, despite the considerable improvement in health indices countrywide.
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A result of prolonged obstructed labour, the condition leaves many women uncontrollably leaking urine or faeces as a result of which they are stigmatised or ostracised by society.
Last Friday, Ghana observed the second World Fistula Day to highlight the untold hardships faced by women who end up with the condition just because, as women, they must perform their reproductive function of childbearing.
Many of these women start a pregnancy expecting the happy ending of a healthy child, not realising that they will end up with fistula, says Dr Gabriel Ganyaglo, a member of the obstetric fistula care team at the Korle-Bu Teaching Hospital.
Victims
“Fistula patients are best described as victims and not patients. Victims of a healthcare system that failed to meet their specific needs; victims of an educational system that failed to keep them in school long enough; victims of social inequities culminating in lower status; victims of poverty due to lack of economic empowerment, and victims of cultures that marry them off too early,” he said.
His conviction that fistula sufferers are victims of a system that has failed them is based on his personal encounter with fistula patients, being an active member of a health team that makes periodic trips to designated centres to repair fistula cases.
First story
Dr Ganyaglo recounts the story of a fistula patient. Married at the age of 18, the labour that ended up in fistula occurred at 19. Now, at 21, after three separate surgeries, she is maimed for life.
“I went into labour around 7 p.m. and went to the clinic about 10 p.m. After examination, I was told I was not in labour and sent back home to return when the labour is strong,” she said.
Around 2 a.m., she went back but was sent back home again.
“At 6 a.m. the following day, I went back and was admitted but was not examined till about 4 p.m.,” she said.
“Then they said I could not deliver in the clinic so I should go to hospital. Eventually, I was transferred to a bigger hospital at 10 p.m. There was a long queue. By the second day when it finally got to my turn, the baby had died. An instrument was used to pull my dead baby out. I could not walk,” she added.
The third day after delivery, she was leaking urine and her beddings were soiled with faeces.
Eventually, she was referred to Korle-Bu.
What is noteworthy is that this labour event occurred between Tema and Accra in the Greater Accra Region where women are supposed to have access to skilled delivery at well-equipped facilities.
Dr Ganyaglo said that story line ran through narratives from a number of fistula patients.
“They are often sent back and forth from the same facilities that eventually send them elsewhere. The opportunity to save this 19-year-old girl and her baby was lost at the first facility she made contact with,” he stressed.
This brings to question the cadre of health workers who should be allowed to diagnose labour.
He emphasised that health workers who were trained and given the responsibility to diagnose labour must religiously ensure strict adherence to the diagnosing parameters.
In addition, health facilities must have a surveillance system for monitoring women in labour.
Second story
Dr Ganyaglo said in another instance, a 22-year-old regular antenatal attendant who live within 20 minutes walk from the Korle-Bu Teaching Hospital also ended up with fistula because when she went into labour, she was advised by her sister to first go to a priestess for prayers.
“After the priestess had prayed and smeared my belly with oil, she proceeded to examine me and then said she could deliver me. So I stayed with her till nightfall. I had pushed for several hours and the baby was not coming. Around midnight, I could no longer feel my baby,” she narrated.
She said she ended up being transferred to Korle-Bu and “by the time I got to Korle-Bu my dead baby’s head was between my legs. The midwife pulled it out and I started limping after the delivery”.
On the fifth day of admission, she noticed that her bed was wet with urine.
“Since then, I am not able to control my urine. The doctors inserted a tube. After two months of no improvement, it was removed. They have promised to operate on me. God willing, I may be dry again,” she said.
Dr Ganyaglo said despite this young lady’s predicament, she was still indebted to the priestess who expects her delivery fee of GHc100 to be paid.
When counselled to report the matter to the police, he said the patient refused for fear of retribution.
In her own words, “The priestess is ‘awoyo’ and powerful. She will wipe out my family.”
Dr Ganyaglo stressed that as the country marked another World Fistula Day, many issues that contributed to women becoming victims of fistula must be addressed.
Educate health workers
For starters, he advised that there must be sustained efforts at ensuring that all health workers managing pregnancy and labour had adequate knowledge of the impact of prolonged obstructed labour, particularly obstetric fistula, including even the lowest in the ranks in facilities.
“As our actions and/or inaction could result in untold hardships on our patients, there must be a threshold to the try-and-see attitude to labour in health institutions,” he suggested.
In addition, he said, the present circumstances called for increased awareness creation among health workers across the country through Information, Education and Communication (IE&C), such as had been done with programmes such as immunisation, breastfeeding, sexually transmitted diseases and family planning.
He noted that despite a decade of the United Nations Population Fund’s (UNFPA) campaign to end obstetric fistula, the country was plagued with the condition and called on Ghanaians of all facets of life to use whatever means or channels to increase public education to save “our women from this plague”.