The fight against fistula is gaining ground in Liberia, where doctors and nurses at 48 health clinics have been trained to treat the condition.
Since the launch of the Liberia Fistula Program (LFP) in 2007, a government scheme supported by international network Zonta International and UNFPA, doctors have treated 1,026 fistula cases. All treatment is now free.
While only six doctors in the country are able to perform the surgery, 65 professional nurses have been trained to train colleagues in fistula management in rural health clinics. Some 300 trainees are currently enrolled.
Obstetric fistula is a medical condition that occurs when a foetus gets stuck in the birth canal during childbirth, thus causing a hole between the rectum and vagina.
Most at risk are teenagers whose bodies are not fully developed to give birth, according to LFP. Most patients treated thus far have been impoverished girls and women aged 11-20. Some 75 percent of Liberian females give birth without the supervision of a trained health worker, which leads to high levels of mortality and morbidity, including obstructed fistula, according to UNFPA.
The high level of fistula has also been linked to high rates of female circumcision, which can lead to birth complications and obstructed labour, and the high incidence of rape of teenage girls, according to the Gender Ministry, which cited 2,493 cases of reported rape of minors in 2012.
Part of LFP’s work has been to raise awareness of the presence of fistula treatment; encourage women to come forward; and prevent fistula from occurring by encouraging Liberians to practice family planning and seek assistance from a trained health worker when giving birth.
Public health messages have gone out in 25 local dialects. They try to break down common myths, including that fistula is caused by witchcraft and cannot be treated medically, said John Mulbah, lead surgeon with the LFP. Such beliefs have prevented many women from seeking treatment to date. Rejected by their families, “several have attempted suicide,” said Mulbah. “They think the situation is due to a curse from their ancestors.”
Steady increase in patients
According to the most recent situational analysis on fistula (2006), 57 percent of long-term sufferers are abandoned by their husbands or partners.
However, many women continue to be rejected by their communities, even once they have been treated: Doctors and government officials have recognized the need for an LFP rehabilitation and reintegration component.
With more people flocking to health clinics to treat fistula, LFP is struggling to keep up with demand. Staff need more vehicles to help bring patients to far-away clinics, and to monitor patients who have returned to their homes, said Mulbah.
But he welcomes the steady increase in patients. "We as doctors are proud that these women can start to see themselves as being important in Liberian society. Their hopes are being restored… the fight will continue to save more women.”
Hawa Soko, 15, a resident of Monrovia, recently received treatment, and has been trained to become a tailor. “I feel very happy with my new situation. I used to smell and people used to call me all names because of my condition. I used to cry every night and wonder why my life was like that… Today, my life is transformed. I am a new woman. I am very happy.”
Tenneh Jones, 19, also recently treated, told IRIN she dropped out of school because of her condition. Now she is back. “Today I have a new lover and things are fine with us,” she told IRIN.
UNFPA launched a campaign in 2003 to end fistula in 45 countries, focusing on treatment and prevention. It says two million women and girls in sub-Saharan Africa, South Asia and the Arab region live with fistula.