Fistula patients can recover with concerted efforts

Shamima Begum was far too young when she married in 1998, and faced an onslaught of oppression from her in-laws. They mistreated her and demanded dowry. In 2002 she got pregnant and, after three days of labour, gave birth to still-born child. After 13 days she recovered from the trauma, only to discover she had developed fistula. Her husband promptly remarried.

Shamima recovered after being treated at the National Fistula Centre of Dhaka Medical College Hospital. Now she herself is a community fistula advocate. She came all the way from Sunamganj to share her experience on Sunday at roundtable on Safe Mother and Fistula-free Bangladesh, held at the Prothom Alo office in Kawran Bazar, Dhaka. She has been working hard to bring other fistula patients to the medical centre since 2013.

Speakers at the roundtable said, fistula is not a disease. It is a childbirth injury and can be treated free of cost. However, patients with obstetric fistula are ostracized by the community and so tend to keep their condition secret. The general people lack awareness about the matter. Concerted efforts and an adequate budget are required to persuade these patients to come to hospital, receive treatment and be rehabilitated in the community.

The roundtable was organised by Prothom Alo and the United Nations Population Fund (UNFPA). Prothom Alo associate editor Abdul Qayyum was moderator of the programme.

Making the keynote presentation at the roundtable, UNFPA project technical officer Ayesha Siddiqua referred to a survey conducted by an NGO in 2003, pointing out that for every 1000 married women in Bangladesh, there are 1.69 women with obstetric fistula. And according to the World Health Organisation (WHO), every year 2000 women are newly developing fistula. However, there has not been any national survey on fistula so far.

From 2003, the government, UNFPA and various other donor agencies and non-government organisations have been placing importance on the treatment of fistula patients. There are 18 fistula centres being run by government and non-government organisations in additional to the National Fistula Centre at the Dhaka Medical College Hospital. A national work plan and work strategy has been drawn up.

According to the keynote paper and the specialists at the roundtable, fistula is caused by prolonged obstructed labour during childbirth, when pressure is placed on the rectum and bladder. This creates various complications. Fistula can also occur during childbirth operations.

Member of parliament and advisor to the inter-parliamentary union (maternal and child health) Mohammad Habib-e Millat placed importance on fistula-related data and information. He said that people’s representatives could convey information to many people at a time and so they should be involved in resolving all sorts of problems including that of fistula. He said a woman should avail maternity services at least five times during her pregnancy, the health budget should be increased, child marriage prevented and special programmes taken up for the youth who constitute 40 percent of the population. This would help in addressing the fistula issue and ensuring safe motherhood.

Public Health Director Habib Abdullah Sohel said all mothers must be ensured quality health services if fistula was to be eliminated. He said fistula corners would be set up in every district hospital which would provide screening, primary treatment and referral services.

Fistula specialist and Asia representative of the International Society of Obstetric Fistula Surgeons Asia Professor Sayeba Akhter expressed her gratitude towards the women who had the patience to undergo two or three surgeries for full recovery from fistula. She said that till now the international agencies were paying more attention to Africa and Asia when it came to fistula. She said, other than just opening fistula centres, plans required on how to make this sustainable. Unless awareness was raised within the community, the fistula mothers would never emerge. People representatives needed to be involved.

Director of the Family Planning Directorate (Mother and Child) Mohammed Sharif said that the six months’ training, provided to the doctors, midwives and others before sending them to the field, was not adequate. He said this training would be at least a year long. He also recommended separate ambulance service for expectant mothers in every upazila.

Secretary general of the Obstetrical and Gynaecological Society of Bangladesh (OGSB) Professor Farhana Dewan said delayed childbirth was being monitored by partograph, so that the mothers could be sent to hospital in time. She said that alongside treatment, prevention of fistula was also important.

Engender Health Bangladesh country representative Abu Jamil Faisel expressed his concern at the growing number of fistula cases, saying that 28 percent of such cases were due to accidents during operations at childbirth. He said over the past 10 years, about 300 doctors were provided special training in fistula treatment. However, they mostly could not use these skills due to lack of fistula treatment facilities at the hospitals.

The Director of the Welfare Directorate, Nilufar Farhad, said that 3000 posts for skilled midwives were inadequate. There was need for 20,000 to 22,000 midwives in the country. At present there were 600 midwives in the field and another 600 would be promoted  by June.

Professor of gynaecology and obstetrics at Sylhet Medical College Hospital, Shamsun Nahar, said that in the seven months she had been working there, 58 fistula operations had been carried out with a 72 percent success rate. Those who hadn’t fully recovered would have to undergo surgery again. The patients who had recovered were bringing others to the hospital for treatment.

Unicef health specialist Riad Mahmud recommended mapping to determine in which areas fistula was more prevalent and where more clinics were required.

Bangladesh Women’s Health Coalition executive director Sharif Mostafa Helal said their organisation dealt with both treatment of fistula and rehabilitation of the fistula patients.