Two Sindh districts to become ‘fistula-free’

Why do women have to leak for thirty long years before finally finding their way to us?” said Dr Shershah Syed, president of the Pakistan National Forum on Women’s Health (PNFWH), at a meeting held in a hotel here on Wednesday.

“That is because,” said Dr Pushpa Srichar, a surgeon who has been repairing fistula now for over eight years, “most women are led to believe this cannot be healed and fewer still know there are centres where this condition can be repaired.” Dr Srichar, who has been repairing fistula in Hyderabad, said it’s impossible to explain the “extreme” satisfaction she got when a woman “goes home completely dry and stink-free”.

Conservatively speaking, Dr Syed estimates the number of women in Pakistan to be suffering from fistula — whose fate he finds “worse than death” — to be between 3,000 and 5,000. “We repair some 1,000 each year, but many suffer silently and remain under our radar,” he said. This may be about to change in Dr Syed’s and Dr Srichar’s lifetime if those involved with maternal health in their various capacities in the Sindh government (a vast majority of them are men) walk the talk and integrate prevention and treatment of obstetric fistula into the larger reproductive health spectrum.
Obstetric fistula, an entirely preventable condition, develops due to obstructed labour. During prolonged labour, the baby’s head puts pressure on the lining of the birth canal leading to perforation of the wall of the rectum and bladder resulting in urinary and/or faecal incontinence. The sense of shame, coupled with a woman not being able to make decision about her health and her body, lack of awareness among the health practitioners as well as the community, are some of the reasons for this injury to remain invisible. As a first step towards, what Dr Syed calls “fistula-free” Sindh, health secretary Inamullah Dharejo gave his approval to initiate a fistula surveillance programme with the help of community-based health teams and family practitioners in two districts of Sindh — Shaheed Benazirabad and Khairpur.
In addition to the surveillance programme, Dr Azra Pechuho, MNA and adviser to the Sindh chief minister on health, committed to setting up a national fistula training centre and drafting of a PC1 (a planning commission document that includes both the proposal and budgetary allocation) by the department of health for fistula integration in reproductive health.

“It’s not asking too much; all they have to do is keep their eyes open and if they detect any woman suffering from fistula refer her to the two centres in Sindh,”

While there was a need for a mammoth change in the socio-cultural practice (delaying child marriage, spacing pregnancy among others), the condition could be prevented if a brigade of trained community midwives were spread out across the province, said most experts at the meeting. But in the absence of skilled birth attendants, Dr Faaria Ahsan of the United Nations Population Fund (UNFPA) suggested “piggy-backing” on lady health workers (LHWs) to at least initiate awareness of the illness and where those women could find cure. In 2006, the PNFWH, in collaboration with the United Nations Population Fund, started the Fistula Prevention and Treatment Project with the aim of providing free treatment services to fistula patients all over the country and train service providers. In the last eight years since the UNFPA project started, 13 fistula repair centres have been set up all over Pakistan, all in government hospitals, but the number of trained doctors, which are not more than three dozen, had not increased proportionately.
( Daily Dawn , Karachi October 10,2013 )