NAMAYINGO – Ozera Sunday 33 is a resident of Nebbi district who has been battling obstetric fistula for about 12 years. She says she got the condition in 2012 when her firstborn baby died in the womb.
According to her, she was advised by the medics at Pakwach health center IV to go home and wait for three months when they expected a fistula camp in order for her to be operated.
“While at home, I would just hide in the house. My husband abandoned me immediately after knowing about it and I had to return to my mother’s house,” she said during the commemoration of the international day to end obstetric fistula in Namayingo district on Wednesday.
Ozera would later learn about an operation camp in DR Congo where she ran to and had her first operation but never got cured. “I returned there for the second time after another three months but still I didn’t get cured. I have since done nine operations including in Arua, Masaka and Nebbi.”
She, however, feels better after her ninth operation although she is yet to be fully cured.
“I was so discouraged to do more operations since it wasn’t bearing any fruits. I lost my first and second husband because of my condition and now I have a third husband who isn’t aware of my condition because it isn’t as worse as in the beginning.”
Many women are in same condition like Ozera.
Mrs Ajambo Eunice 42, a mother of six, a resident of Bugali village, Mutumba Sub County, Namayingo District is a survivor of fistula after having an obstructed labour on her seventh child whom she lost in the process.
She narrates that in the year 2019, she failed to deliver normally and was operated. After two days, the catheter was removed and she started leaking mixed urine and stool.
“I went back to the health center where I was told I had a fistula and was advised to go home and wait until the surgeons come for fistula operation camp.”
“I feared so much that I wanted to commit suicide. My children were peace-less because everyone could backbite me in the community. I was segregated, even my husband left me.”
Unlike Ozera, a year later (2020), Ajambo’s smile was restored after she was successfully operated and treated.
“Even my husband who had left me returned,” she said.
These are among over 100,000 women living with fistula condition in Uganda and 1900 cases registered every year
Dr. Ronnie Bahatungire, Commissioner, Clinical Service at the Ministry of Health noted that during their visit to Nmayingo district, they realised that there was very high teenage pregnancy which, a key driver of obstetric fistula.
He explained the burden of fistula in Uganda stands at 1% of the reproductive age group. “This is something we should be putting intentions to eliminate,” he said while representing Minister of State for Health, Anifa Kawooya Bangirana.
At the ministry, he said, efforts are geared towards improving services through highlighting challenges of specialised care services and ensuring that they close the gap and ensure that they have accurate profiling of maternal services across the country.
Dr. Bahatungire, however, cautioned the public of delays which puts mothers and their babies at life risk.
“Let’s make sure that when a mother gets pregnant we link them into care, and start accessing antenatal care services.”
In her part, Ms. Gift Malunga – Country Representative, United Nations Population Fund – UNFPA Uganda explained that she was moved by the stories of pain, resilience and hope by the fistula survivors while launching the Survivors Treatment and Obstetric Fistula Prevention (STOP) Programme in the same district three months ago.
“The survivors painted a picture of gaps in timely response and the pain they had to endure, but also one where hope and recovery are possible – they had since accessed corrective surgery and were well on their way to full recovery.”
She noted that while Uganda made significant progress, there is much to be done to achieve the elimination of fistula by 2030.
The recent Uganda Demographic and Health Survey 2022 highlighted the reduction in maternal mortality ratio by 44%, however, Fistula remained unchanged at 1% over the past 6 years.
Reflecting on the figures, Malunga says less women are dying due to pregnancy-related causes, however, the proportion of those suffering complications remains unchanged.
“We should note that for every maternal death, there are 20 – 30 women that survive with life-changing complications, such as fistula. Worse still, our young girls are particularly vulnerable: 1 in every 4 teenagers is pregnant or has had childbirth before their bodies mature and are ready.”
Malunga decried life-shattering consequences including chronic incontinence, shame, social isolation, poverty, and physical, mental, and emotional health problems women and girls suffer.
Besides, she highlighted wider challenges facing women and girls, such as poverty, gender, and socioeconomic inequality, lack of schooling, child marriage, and early childbearing, that jeopardize opportunities for fistula survivors.
“Unfortunately, Uganda still has an unmet need for prevention and holistic fistula treatment (surgical repair and social reintegration and rehabilitation) and prevention. The estimated repairs of about 1,700 women annually have not yet addressed the annual deficit of pending new cases and the backlog. The estimated waiting time before surgery is about 5 years, which is 1,825 days of torture, and discrimination, for the woman with having the condition.”
As UNFPA, she said they lead the global Campaign to End Fistula to drive the commitment to fistula prevention and holistic treatment to restore health and dignity.
“We have invested in improving the quality of maternal health care to make every child’s birth safe and in reducing the unmet need for modern contraception; but accelerating progress is paramount toward ending this preventable condition.”
Through the STOP programme, Malunga said they intend to change the face of maternal care in Namayingo district.
“UNFPA reiterates its commitment to supporting the Government to ensure every pregnancy is wanted and every childbirth is safe. Through partnerships, stronger political leadership, investments, and leadership, we can end fistula in one generation.”
Ms Hilda Engilbertsdóttir, Head of Mission, Embassy of Iceland blamed the challenge on lack of quality health care.
“Pregnant women need to have access to quality prenatal and antenatal care and be able to access emergency obstetrics. But prevention is also key. So we see that teenage pregnancies are also quite linked to obstetric fistula. So, reducing the teenage pregnancy rates in this country is key in preventing the high frequency of obstetric fistula.”
Officiating at the event, Rebecca Kadaga – first Deputy Prime Minister commended the partners and reminded that the main issue is to create awareness of the importance of preventing fistula for good health but also to increase recognition of teenage pregnancy prevention as one the lead causes of fistula.
“It is our duty to give attention to the public health burden of fistula, its negative social and economic effects.”
