Fistulas : two-hour operation corrects decades-long affliction in Cote D’Ivoire
Women ages 17 to 70 sit on vinyl mattresses, drainage bags on the floor next to their hospital beds, catheter tubes stretching from under colourful skirts. Each one has a serene, triumphant look.
The women are recovering from an operation that lasted some two hours and repaired tissue damage that made their urine flow uncontrollably – in one case for 50 years.
“I am beside myself with joy,” one woman told IRIN, talking through an incessant smile. She told IRIN she had lived with the condition for 20 years.
Through a programme run by the UN Population Fund (UNFPA) specialists are training local surgeons and gynaecologists in Korhogo, northern Côte d’Ivoire, in repairing obstetric fistula – a hole in the birth canal caused by complicated labour and a lack of medical intervention, which leaves a woman leaking urine or faeces or both.
When the soft tissues of the pelvis are compressed between the baby’s head and the mother’s pelvic bone, the lack of blood flow causes tissue to die, creating a hole between the vagina and bladder or between the vagina and rectum.
Obstetric fistula is preventable, yet some two million women around the world live with the condition, according to UNFPA. “The persistence of fistula is a signal that health systems are failing to meet the needs of women,” UNFPA says.
For now 16 beds are available for fistula patients at the Korhogo hospital, according to Mansaré Ladji, surgeon, gynaecologist and one of the physicians being trained to perform fistula operations. “There is a waiting list,” he said.
The demand in Korhogo – 630km north of the commercial capital Abidjan – exploded when partner NGOs in surrounding areas began informing communities of the free treatment, Mansaré said. “Women are coming from everywhere.”
Since launching the project in February doctors in Korhogo have performed 25 operations to date.
“We are giving these women a new life,” Mansaré told IRIN, recalling how some women danced as they left the hospital. “It cannot be described, it must be experienced.”
“This operation changed everything,” said Silué Korotoum, a 34-year-old woman who received the treatment. “I can thrive now. I can go where I wish and do as I wish.”
Mansaré said one of the most important goals is long-term training for local health workers to treat obstetric fistula. “We must set up something that will continue after [trainers] are gone.”
In many cases women are not aware a remedy exists, or if they are, cannot afford it, according to UNFPA. Without subsidies the operation cost about US$300, about 10 times what most people in the region earn in a month, residents said.
In the UNFPA centres – in Korhogo, Man and most recently Bouaké – services are free; the programme will continue as long as funding is available through the agency’s Thematic Fund for Maternal Health, UNFPA gynaecologist Abou Pauline told IRIN. UNFPA is urging the Ministry of Health to maintain free care for women with fistulas.
Simeon N’da, Health Ministry spokesperson, told IRIN the government will study whether obstetric fistula is a condition for which the government will ensure free treatment, as it does for some other illnesses such as Buruli ulcer.
In the Korhogo recovery room were three young women ages 17 to 18, whose fistulas were caused by difficult deliveries.
Doctors told IRIN even more important than providing treatment is eliminating the causes of fistula – including poor general health, lack of maternal health care and practices such as early marriage and childbirth, lack of spacing between births and women’s lack of power to make their own health care decisions.
“Obstetric fistula is a condition resulting from complicated childbirth,” gynecologist Abou told IRIN. “If we reduced complications in childbirth we would reduce fistulas.”
It is essential that people have access to properly equipped medical facilities and qualified medical personnel, she said.
But even when facilities are available, cultural practices weigh on women’s health, medical workers told IRIN.
At the Korhogo hospital a health worker recounted a case in which a woman urgently needed a caesarean section but family members would not consent without the approval of her husband. He was travelling and out of reach.