DHARAN, MAY 23 -
Pramila Chaurasiya, 40, decked in a bright yellow cotton sari, sits in
front of an area health post under a tree next to a hand pump. As she
talks, urine leaks out of her bladder through the vagina and drips to
ground, forming a little pool.
Chaurasiya has been living with the condition for the last twenty years
ever since her second pregnancy ended in an obstructed childbirth. She
had stayed home in Hanuman Nagar, Saptari, enduring the labour pain for
25 hours before she was taken to a hospital in Rajbiraj. At Sagarmatha
Zonal Hospital, doctors pulled a dead baby out of her stomach. Three
days later, urine started to leak out of her vagina constantly,
restricting her movement.
“I can’t go to village weddings and parties and stay for long. I never
go out and stay at a friend’s or a relative’s house overnight. The pool
of urine I leave behind embarrasses me,” says Chaurasiya in a mix of
Nepali and Maithili.
Each year hundreds of Nepali women like Chaurasiya survive a difficult
delivery only to live with a life-debilitating fistula (hole) between
their urinary bladders and vaginas or, in rare cases, between their
rectums and vaginas. Urine and/or stool passes through this hole to the
vagina and out, leaving behind a stinking symptom of the condition
medically known as obstetric fistula.
Obstetric fistula is a result of a prolonged labour lasting more than
15 hours. The hole appears when the unborn child cannot find an outlet
through the vagina or through a caesarean operation and starts pushing
against the vaginal walls, crushing the tissues of bladders and rectums
in the process.
Most mothers and their unborn children do not survive this prolonged
childbirth. A majority of the mothers who do survive develop a fistula.
Almost all with an obstetric fistula have to then battle social derision
and ostracism.
Thirty-year-old Dhani Devi Mukhiya, of Saptari, who developed this
condition after her strenuous second childbirth ten years ago, was not
allowed to sit near people. The husband of thirty-two-year-old Ranjana
Devi Mehta, also from Saptari, took in a second wife. Dhaka Maya
Ranapaheli, 36, from Jhapa, was not allowed to wash her clothes around
public hand-pumps.
Seventy-five-year-old Ran Maya Shrestha from Sankhuwasabha, who has
been living with the condition for the last 55 years, talks of ridicule
as the most obvious response from society.
According to the 2011 study by the United Nations Population Fund
(UNFPA), around 4,300 women in the country currently live with obstetric
fistulas, with an
estimated 200-400 new cases every year.
Fortunately, obstetric fistula is treatable. Unfortunately, it needs
gynaecologists trained specifically for the surgery and Nepal only has
seven of them: two in BP Koirala Institute of Health Sciences in Dharan
(BPKIHS), four in Patan Hospital and one in Surkhet Regional Hospital.
Even then, only 80 percent of the cases are successful in the first
attempt. Some, like Chaurasiya, need two or more surgeries.
“Some of the cases are not just about sewing close the holes, but about
anatomical restoration,” says Dr Mohan Regmi, national trainer of
obstetric fistula surgery.
“In some cases, the urinary bladder and the uterus
are fused together. In
others, the urethra is completely severed off from the bladder and is consumed by the body.”
But only a fraction of fistula patients have received medical
treatment. Since it started its fistula operation in 1997, the BPKIHS
has treated only around 100 cases.
Patan Hospital, even
with a history of more than 20 years, has treated 400 cases. Surkhet
Regional Hospital, on the other hand, started delivering services
through its mobile camps in 2010 after UNFPA launched its campaign to
end fistula in Nepal, and has treated 115 cases.
Since the launch of the campaign, the UN agency has been financially
supporting the operations in these three centres. Treatment there is
free. The patient and one of her caretakers do not even have to pay for
food. And when they return, they receive Rs 2,000 for transportation
costs.
“Financial assistance from a UN agency, however, is not sustainable,”
says Catherine Breen-Kamkong, deputy representative of UNFPA. “We need
to go back to preventing the condition, raising awareness, girls’
education, to child marriage and child pregnancy, to family planning and
to access to health centres.”
What Is Fistula ?
An obstetric fistula is a hole between the vagina and rectum or bladder
that is caused by prolonged obstructed labour. For women with
obstructed labour, labour that goes unattended, the labour can last up
to six or seven days. The labour produces contractions that push the
baby's head against the mother's pelvic bone. The soft tissues between
the baby's head and the pelvic bone are compressed and do not receive
adequate blood flow. The lack of blood flow causes this delicate tissue
to die, and where it dies holes are created between the labouring
mother's bladder and vagina and/or between the rectum and vagina.
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