Free treatment of fistulas of the birth canal

Fistulas of the birth canal can be a curse for any woman. An abnormal communication or canal forms as a result of dissolution of protective tissues lying between the urinary bladder and vagina or between the rectum and vagina causing stools or urine to pass involuntarily from the vagina. Every year two thousand women in our country are affected by fistulas of various kinds. According to the World Health Organization’s statistics as many as 2 million women have obstetric fistula and 1 hundred thousand women succumb to this curse every year.
Bangladesh and other third world countries have the highest number of obstetric fistulas and numbers are on the rise every year. In our country, the greatest number of fistula patients emerges from rural areas; postulating mismanagement of child birth and the lack of skilled birth attendants as chief contributing factors of this problem. Child marriage and teenage pregnancies are culpable factors as well.   But with awareness and expertise, obstetric fistula is curable in 95% of cases and moreover the treatment is free. According to recent statistics published by Engender Health Bangladesh, 2000 women are affected by fistulas of various types of which 169 women have obstetric fistulas in our country every year. If left untreated obstetric fistulas can cause irreversible damage to female reproductive organs and the urinary tract. A staggering 15% of all divorces in Bangladesh may be attributed to obstetric fistulas.
Of the 83% of home deliveries in our country, 10% of mothers may have prolonged labour. These mothers are most susceptible to developing obstetric fistulas.          
It is imperative for such mothers to be admitted to the nearest Health Complex for better management. In our country where 40% of our population live below the poverty line, child marriage and teenage pregnancies are extremely common. These girls have little or no knowledge about pregnancy or child birth. As a result these young mothers are most susceptible to developing fistulas of the genital tract. A possible mechanism of formation of genital fistulas is given below.
If the foetal head gets stuck in the birth canal, labour can easily get prolonged. Due to prolongation of labour, the lower portion of the uterus contracts relentlessly to expel the foetal head out of the uterus. Eventually this process leads to the development of high tension, not only within the walls of the uterus but also upon the adjacent bladder or rectum. When this process ensues for hours on end, the blood supply to certain compartments of the rectum or bladder closest to the uterus, may get compromised leading to the destruction of these tissues and the formation of leaks or holes in the bladder wall or rectum. These leaks or holes of the genital tract are known as obstetric fistulas, through which urine or faeces pass out through the birth canal and also through natural openings. The overwhelming inconvenience and stigma associated to obstetric fistulas distances women from their families, children and society. The physical, emotional and psychological trauma of such a catastrophe knows no consolation and desolation is a natural consequence.                 
In our country surgical repair for obstetric fistula is possible in 10 medical college hospitals and 8 private clinics and the National Fistula Centre is also operational in Dhaka Medical College Hospital. But the disparity between the number of patients and trained personnel is vast. Further research indicates that although there are several gynaecologists, only a handful of them have training in repairing obstetric fistulas. The reason behind this maybe thought of as a lack of financial incentive for such services. Since most patients with fistulas come from humble background it is difficult for them to pay for such procedures. The surgical procedure is also troublesome, arduous and has a high rate of recurrence even if the procedure is done with great precision.      
The World Fistula Day was observed on 23rd May internationally. To mark the occasion Bangabandhu Sheikh Mujib Medical University arranged a seminar and various programs were organized around the country by the UNFPA to raise awareness about obstetric fistulas.
The writer can be reached at [email protected]

 

Free treatment of fistulas of the birth canal

Fistulas of the birth canal can be a curse for any woman. An abnormal communication or canal forms as a result of dissolution of protective tissues lying between the urinary bladder and vagina or between the rectum and vagina causing stools or urine to pass involuntarily from the vagina. Every year two thousand women in our country are affected by fistulas of various kinds. According to the World Health Organizations statistics as many as 2 million women have obstetric fistula and 1 hundred thousand women succumb to this curse every year. Bangladesh and other third world countries have the highest number of obstetric fistulas and numbers are on the rise every year. In our country, the greatest number of fistula patients emerges from rural areas; postulating mismanagement of child birth and the lack of skilled birth attendants as chief contributing factors of this problem. Child marriage and teenage pregnancies are culpable factors as well. But with awareness and expertise, obstetric fistula is curable in 95% of cases and moreover the treatment is free. According to recent statistics published by Engender Health Bangladesh, 2000 women are affected by fistulas of various types of which 169 women have obstetric fistulas in our country every year. If left untreated obstetric fistulas can cause irreversible damage to female reproductive organs and the urinary tract. A staggering 15% of all divorces in Bangladesh may be attributed to obstetric fistulas. Of the 83% of home deliveries in our country, 10% of mothers may have prolonged labour. These mothers are most susceptible to developing obstetric fistulas. It is imperative for such mothers to be admitted to the nearest Health Complex for better management. In our country where 40% of our population live below the poverty line, child marriage and teenage pregnancies are extremely common. These girls have little or no knowledge about pregnancy or child birth. As a result these young mothers are most susceptible to developing fistulas of the genital tract. A possible mechanism of formation of genital fistulas is given below. If the foetal head gets stuck in the birth canal, labour can easily get prolonged. Due to prolongation of labour, the lower portion of the uterus contracts relentlessly to expel the foetal head out of the uterus. Eventually this process leads to the development of high tension, not only within the walls of the uterus but also upon the adjacent bladder or rectum. When this process ensues for hours on end, the blood supply to certain compartments of the rectum or bladder closest to the uterus, may get compromised leading to the destruction of these tissues and the formation of leaks or holes in the bladder wall or rectum. These leaks or holes of the genital tract are known as obstetric fistulas, through which urine or faeces pass out through the birth canal and also through natural openings. The overwhelming inconvenience and stigma associated to obstetric fistulas distances women from their families, children and society. The physical, emotional and psychological trauma of such a catastrophe knows no consolation and desolation is a natural consequence. In our country surgical repair for obstetric fistula is possible in 10 medical college hospitals and 8 private clinics and the National Fistula Centre is also operational in Dhaka Medical College Hospital. But the disparity between the number of patients and trained personnel is vast. Further research indicates that although there are several gynaecologists, only a handful of them have training in repairing obstetric fistulas. The reason behind this maybe thought of as a lack of financial incentive for such services. Since most patients with fistulas come from humble background it is difficult for them to pay for such procedures. The surgical procedure is also troublesome, arduous and has a high rate of recurrence even if the procedure is done with great precision. The World Fistula Day was observed on 23rd May internationally. To mark the occasion Bangabandhu Sheikh Mujib Medical University arranged a seminar and various programs were organized around the country by the UNFPA to raise awareness about obstetric fistulas. The writer can be reached at [email protected]