Nurse Zainab Blell’s mobile phone has been ringing all morning at the Aberdeen Women’s Centre, a clinic in Freetown, Sierra Leone’s capital. After explaining to countless callers that this is a hospital line, Blell gets a genuine request for help and tries to get more details. “When did you give birth? When did you start having a problem?”
The woman on the phone is in a remote Sierra Leonean town. She says her sister leaks urine uncontrollably, and suffers from rashes and peeling skin on her inner thighs.
Blell is one of three nurses answering calls on a newly launched “fistula hotline”, a free phone number for women who suffer from this debilitating condition that is seldom spoken about.
Fistula, also known as vesico-vaginal fistula or VVF, is a hole in the birth canal that leaves women with chronic incontinence, and often a stillborn baby. It is usually caused by several days of obstructed labour. It affects an estimated two million women in developing countries; and 50,000-100,000 women worldwide each year.
The fistula hotline, which is run by the centre, is the result of a public-private partnership between the Gloag Foundation, USAID, the United Nations Population Fund (UNFPA) and telecommunications company Airtel.
In the last month more than 8,000 calls have been received, but so far just 0.1 percent have been about cases of fistula.
The Aberdeen Women’s Centre provides the only comprehensive fistula repair service in the country. Despite the small number of calls concerning the condition, Jude Holden, the centre’s Country Director, is pleased with the result. “We have received 90 cases since the hotline opened, and this is a great success,” she told IRIN.
Shortly after the hotline opened in October, radio messages were broadcast in the local Krio language and in English, describing fistula and telling anyone who thinks they are affected to call 555.
“There is very little awareness of fistula and why it happens. Women are stigmatized and often blamed for their condition. Because of this we found it difficult to get women with fistula to the centre for treatment.”
Fistula occur most often in young women (15 to 30 years old), most of whom come from rural areas with poor access to healthcare, according to a 2005 Ministry of Health survey.
Why rates so high
In Sierra Leone, some estimates put fistula prevalence at a similar rate to maternal mortality - one in eight women - but there is little research to back up these estimates.
Free healthcare services for lactating mothers and pregnant women were launched in 2010, but the maternal health infrastructure is inadequate and the Ministry of Health is struggling to implement the policy. Only 137 trained midwives practice in the country, and there are just 16 emergency obstetric facilities.
During and after Sierra Leone’s decade-long civil war, widespread rape trauma was a major cause of fistula, according to Sarah Walker, VVF programme manager at the Aberdeen Women’s Centre. Most of the resultant traumatic fistula cases have been dealt with, she said, and the problem now stems mainly from poor ante-natal care and a high level of teenage pregnancy.
“Most of the [women with fistula] are uneducated farmers… They don’t have access to any sort of healthcare, pre-natal or post-natal. We see it a lot in young girls, mostly because their bodies are not developed yet, and so when they’re in labour the child gets stuck in the pelvis,” said Walker.
In Njala town in the Southern Moyamba district, Kadiatu Ngegba’s husband heard the radio advert and called the number. Ngegba, now aged 24, developed a fistula when she was just 15 years old, after being in labour for two days before a doctor came to perform a caesarean section.
“My baby died,” Ngegba says. “After the operation, the doctor pulled out the catheter and I was covered in urine.”
When she got home, Ngegba’s first husband abandoned her and she was sent to live with relatives. “I was really unhappy. Everyone made fun of me. I wanted to go back to school but because of this problem I had, I couldn’t.”
Ngegba had fistula repair surgery in 2006, but when she gave birth to her second child without a caesarean, the fistula reappeared.
Experts say prevention, rather than treatment, is the key to ending fistula. This means providing women with family planning, ante-natal care, skilled birth attendants and emergency obstetric care, according to the UNFPA Campaign to End Fistula.
“We need a preventative as well as a therapeutic approach,” Sas Kargbo, Director of Reproductive Health at Sierra Leone’s Ministry of Health, told IRIN, adding that the free phone line is an important step to finding the women and treating the problem.
Sierra Leone is currently finalizing a strategic plan to tackle fistula and will appoint a focal person by the start of 2012.
At the Aberdeen Women’s Centre, almost 10 years after developing her first fistula, Ngegba waits for surgery. She smiles and hugs Naomi, her two-year-old daughter. “When I get well,” she says, “my husband will send me back to finish school.”