Accra, May 20, – ‘No baby, no home,’ is Marian Tuffour’s opening statement in recounting the traumatic experiences of her last prency and childbirth, which resulted in an Obstetric Fistula (OBF), and her survival through the awfulness of this ailment.

She is currently 43 years old, a mother of three and a fistula survivor at the Mercy Women’s Catholic Hospital in Mankessim in the Central region, which is Ghana’s major health facility for OBF repairs.

Background

Madam Tuffour said she spent the last five months of her prency on admission at the Trauma Hospital at Winneba, due to a high Blood Pressure (BP) until her baby was delivered at 32 weeks after a difficult labour.

She had to undergo a caesarian session to remove her womb to save her life due to further complications and excessive bleeding.

‘After recovering from the surgery, I woke up from bed one day feeling wet and realised that I was soaked in urine, but after complaining to the doctor, I was given some medication to treat infection and discharged from the hospital’.

She was readmitted into the hospital some months later with serious urine incontinence and urinary tract infection.

‘I was supported with a catheter to prevent me from soiling myself, and then referred to a specialist at the Korle-bu Teaching Hospital, where I was later diagnosed to my horror as suffering from OBF.

WHAT IS OBF?

OBF is one of the most serious and tragic childbirth injuries. It is a hole between the birth canal and bladder and or rectum. It occurs because of prolonged, obstructed labour without timely access to, high-quality emergency obstetric care.

Without emergency intervention, obstructed labour can last for days, resulting in death or severe disability, because the obstruction can cut off blood supply to tissues in the woman’s pelvis, and when the dead tissue falls away it leaves a hole (a fistula) in the birth canal.

BURDEN OF OBF ON WOMEN AND GIRLS

OBF?is associated with devastating lifelong illness with severe medical, social, psychological and economic consequences.

Affected persons uncontrollably leaking urine, faeces or both, and can lead to chronic medical problems such as frequent infections, kidney disease, painful sores, infertility and death if left untreated.

The physical injuries combined with misconceptions about the cause of fistula often results in?spousal abandonment,?societal stigma and discrimination, leading to social isolation, psychological harm and mental health issues including?depression.

Their ill-health and accompanying stench that often announces their presence pushes them deeper into poverty because they are unable to work.

Madam Susana Ankrah, a petty trader at Kasoa in the Central region, says she has undergone four surgeries to repair a fistula that left her leaking faeces for nearly a year and six months after experiencing a difficult childbirth.

‘Three of the surgeries have been unsuccessful because of the multiple holes, but luck smiled at me when I discovered the Mercy Women’s Catholic Hospital through a local television programme on free surgery for the condition,’ she said.

‘I have been branded a witch, bad luck, cursed, and shunned by my husband, family and best friends because of the stench that always accompany my presence, so I stopped attending all public functions and went into hiding,’ Susana said.

SUCCESSES

Both women, on behalf of all other OBF survivors were thankful to the Mercy Women’s Catholic Hospital for their free treatment, applauded the medical personnel for their patience, selfless services, counselling skills, show of love and great expertise.

They also thanked the United Nations Population Fund (UNFPA) for the sustainable care financing and training of specialists to help restore the dignity and human rights of OBF patients.

They pleaded with the government to provide sustainable funding for fistula repairs, skills training for OBF survivors and facilitate their reintegration into their respective societies, so that they can also contribute to the socio-economic and national development.

STATISTICS

UNFPA data shows that there?are half a million women and girls in Sub-Saharan Africa, Asia, the Arab States region, Latin America and the Caribbean living with fistula, with new cases developing each year.

Nevertheless, fistula has almost entirely been eliminated in industrialised countries through the availability of timely, high-quality obstetric care for prolonged and obstructed labour using caesarean section.

SOME CONTRIBUTORY FACTORS TO OBF

OBF occur mostly among the poorest and most marginalised women and girls, especially those living far from medical services and those for whom services are not accessible, affordable or acceptable.

Other research indicates that childbirth in adolescent girls before the pelvis is fully developed, twin prency, breech position of the baby, malnutrition, negative cultural practices like female genital mutilation and child marriages small stature and generally poor health conditions of women, are among the physiological contributory factors, although any woman can experience obstructed labour.

The persistence of OBF in developing countries is a human rights violation reflecting the marginalisation of affected persons and the failure of health systems to meet their needs, while policymakers fail to notice, or little action is taken to prevent their condition. As a result, women and girls suffer needlessly, often for years, with no hope in sight.

AWARENESS

Annually on?May 23, the global community commemorates the International Day to End Obstetric Fistula (IDEOF) and the theme for 2023 is: ‘End Fistula Now,’ to raise awareness about fistula prevention and the need to provide the right medical assistance to improve maternal and child health.

UNFPA SUPPORT

As the leader of the global Campaign to End Fistula, UNFPA provides strategic vision, technical guidance and support, medical supplies, training and capacity building?for specialised healthcare professionals.

It provides funding for fistula prevention, treatment and social reintegration of OBF survivors, as well as spearhead various advocacy and educational programmes for active local level participation.

?

In Ghana UNFPA, has been working fervently with the Ministry of Health, Ghana Health Service, key partners including health-related NGOs, Civil Society Organisations, traditional leaders, communities and survivors to prevent OBF from occurring.

Their engagements among other things are geared towards enhancing education and the importance of timely access to quality emergency obstetric services and strengthening the provision of SRH services for all irrespective of their geographical location, financial, cultural or racial statuses.

Dr Wilfred Ochan, the UNFPA Country Representative, at a recent presentation of equipment to the Mercy Women’s Catholic Hospital, called for the integration of fistula repairs at all regional and district hospitals to enable patients to access all year-round surgical services.

He said the Hospital is currently the major specialised facility for OBF repairs in Ghana aside the Tamale Central Hospital in the Northern region, Korle-bu Teaching Hospital among a few others that provide similar services.

Dr Ochan explained that the 45,000-dollar worth of equipment, forms part of UNFPA’s efforts to enhance the resource capacity of the?Hospital, to ensure efficient service provision to restore the dignity of affected women and girls through free surgeries.

The UNFPA’s gesture is a small contribution that adds up to the pool of things that need to be done to address fistula in Ghana and to support marginalised and dejected women and girls to live meaningful lives, Dr Ochan said.

Prevention

On the prevention side however, it is essential to ensure the presence of trained midwives at every birth, and the continuous enhancement of skills of healthcare professionals for the management of the different complex fistula cases that sometimes need advanced care, he said.

To achieve an integration of fistula care, Dr Ochan, suggested the inclusion of specialists in neighbouring hospitals in the regular UNFPA training at the Mercy Women’s Catholic Hospital to be replicated these repair services within their facilities.

‘In this way we will be able to address the backlog of fistula cases in Ghana’.

Dr Joseph Berko, a Specialist at the Hospital, said fistula is not a spiritual condition nor anything shameful, as sufferers never not ask for it or create it themselves, so they must have the courage to come out for help.

‘We want them to get their lives back and if they feel isolated and stigmatised, we want to motivate them that they are not the only people in this, but several women are going through it,’ he said.

Acknowledgement

Ms Rose Mantey, the Principal Nursing Officer (PNO) in Charge of the fistula Unit at Mankessim facility, acknowledged the UNFPA’s tremendous contributions towards OBF treatment and care in Ghana.

She said the Centre could afford surgery for only one patient among 11 others in 2022 due to the lack of funds, however, they have since been able to raise some small funding to hopefully cater for the surgeries of six more patients this year.

Appeal

The Centre currently has a total of 25 outstanding fistula cases that need urgent repairs and pleads for support from Ghanaians and corporate organisations as government funding alone is inadequate treat the backlog of patients in waiting for their turn and the daily additions.

‘We still have a backlog of patients, with others still being isolated by their societies due to the stench that often accompany their presence, and this causes them to hide from the public,’ Ms Mantey said.

The PNO appeals for continuous public support and collaboration with the Centre to encourage sufferers to come out to access the healthcare and surgery, and for the media to intensify education on OBF and to improve maternal health.

Source: Ghana News Agency