It was not the three days of labour that caused Fatimata Guido the most pain, her urine-stained sheets or the five operations she has had to repair an obstetric fistula. “It is the fear of having sex again, since that is what got me into this situation in the first place.”
Obstetric or vaginal fistula – a tear in the birth canal caused by complicated labour and lack of medical intervention, which leaves a woman leaking urine or faeces or both – is common in poor countries, especially in young girls. A 2006 government survey found that 54 percent of births in Mali take place at home and one out of 10 women had pre-natal medical consultations.
Guido told IRIN she has not had sexual relations since diagnosed with obstetric fistula in 2002 after an unassisted delivery at home in which she lost her baby. “There is no way around the fear.”
There are some 600 cases of reported fistula every year in Mali, according to the International Association for Maternal and Neonatal Health, which estimates that only a fraction of fistulas are diagnosed because of the shame women feel in seeking treatment, or their not knowing such a treatment exists. “But why hide it?” asked Guido. “How can I cure what is hidden?”
Guido said she had never heard about fistula until her diagnosis at the regional hospital in Mopti, 200km west of her home village in the eastern region of Dogon. She is one of almost 800 women who have received treatment in a wing of the hospital created in 2001 to house women seeking treatment for fistula.
“Treating fistula does not begin or end with the operation,” said Ibrahim Sankaré, the secretary general of the NGO Delta Survie, which runs the hospital’s Reinsertion Centre for Women with Fistula. “The physical pain is one thing, but then they have also lost their ability to work, to have pain-free sexual relations, to hold their urine.”
Recovering from her first fistula operation at the centre, Gounam Boukou Niafunke told IRIN her millet, gumbo and peanut crops died while she was in treatment. “I do not think I can bring them back to life when I go back home.” Based on the size and nature of the vaginal tear, repair may require multiple operations.
Photo: Phuong Tran/IRIN
|Raising money to treat social cost of fistula|
Women in the Mopti centre can take classes in jewellery and soap making and are counselled before and after their surgeries. The average age of fistula patients is 30, said Delta Survie’s Sankaré. “We have had them as young as 14 up to 60 years old. Each one faces physical, psychological and economic costs of fistulas. People talk about the physical pain, but the struggle goes deeper.”
Since 2007 the NGO has trained 20 fistula patients to speak about treatment and prevention in their communities.
Fifteen percent of fistula patients in Mali are under 18 years old, most have never had formal schooling and most were married by age 18, Mali’s Health Director, Bouaré Mountaga, told IRIN. Of 163 women who have received services at the Mopti fistula treatment centre, two had attended school, said director Sankaré.
Mountaga told IRIN the government aims to expand free fistula treatments by 2015 and to reduce the psychosocial and economic consequences of the illness; the effort is expected to cost US$12.4 million. There are currently five donor-supported fistula treatment centres nationwide.
Delta Survie’s Sankaré told IRIN his wish is to create a solar-powered vegetable garden at the Mopti centre.
For fistula patient Guido, she would like to have a child. “I think I would be a good mother if God gave me the chance.”
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions