The power of joining hands: Kicking fistula out of Uganda.

By Angela Kisakye

According to the 2011 Demographic and Health Survey (DHS), 438 women die of birth-related causes for every 100,000 live births in Uganda, and for every woman who dies, six survive with chronic and debilitating ill health (UBOS & ICF International, 2012). Obstetric fistula, a devastating and frequent outcome of prolonged or unattended labor, is an example of this chronic ill health and a significant public health problem in Uganda. Although detailed data about obstetric fistula in Uganda are limited, the 2011 DHS estimated that 2% of Ugandan women aged 15–49 had experienced the condition (UBOS & ICF International, 2012).  Obstetric fistula is a childbirth injury, usually occurring when a woman is in labor too long or when delivery is obstructed, and she has no access to a cesarean section. She endures internal injuries that leave her incontinent, trickling urine and sometimes feces through her vagina.

Obstetric fistula occurs when there has been a gap in maternal health care, preventive services, or community response. Addressing these gaps requires a concentrated and coordinated effort at the national and local levels (WHO, 2006). Surgeons, community leaders, hospital administrators, health care providers, nongovernmental organizations (NGOs), and women needing services are distinct groups with their own needs. Organizing these groups requires leadership, and the Ministry of Health (MOH) is often best placed to provide centralized coordination among the various players to ensure that quality services are available.

In countries where quality obstetric care is available, fistula was all but eradicated half a century ago. However, in developing settings where access to obstetric care is limited, large populations of women still experience fistula. As many as 130,000 new cases are occurring annually worldwide, and up to 3.5 million women may be living with the condition (Wall, 2006). In Uganda alone, an estimated 2.6% of women of reproductive age have experienced obstetric fistula (UBOS, 2007). Based on population data from the most recent census, this equates to a national prevalence of over 142,000 women. Indeed, the widespread incidence and prevalence of fistula (and maternal deaths and disabilities more broadly) can only be understood in the context of women’s acute socio-economic vulnerability in developing countries, which denies them access to timely and appropriate health care.

Underlying fistula’s medical presentation are its true determinants: the powerlessness of women to control their sexual and reproductive lives and to decide on their own healthcare; a lack of education on pregnancy and childbirth; poverty that denies families the means to afford health services; the severe shortage of qualified health workers and adequately equipped facilities; and the lack of transport and roads to reach facilities quickly when maternal emergencies arise.

This week, thousands of Ugandans generously contributed towards fistula treatment for women who would otherwise die in shame and social discrimination with the devastating effects of fistula.  The fundraising drive was organized as a run to celebrate the king of Buganda’s birthday. Kitovu Health Care Complex which is a  Catholic mission hospital situated in the Masaka region of southern Uganda and hosts four fistula camps per year,  wll be a beneficially of the funds that were raised during the king’s run

Thousand of people grace the Kabaka’s birthday run to fundraise for fistula patients

With over 25,000 runners sprinting the 5km, 10km and 21km races, in the fight against fistula in Uganda it cannot go without saying that Ugandans have moved towards the right step in saving mothers and improving maternal health outcomes.

Acknowledgements:

We acknowledge Engender Health for some of the materials in this article.