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YOUNG WOMAN'S FUTURE IS BLEAK DUE TO OBSTETRIC FISTULA

“My dream of becoming a journalist was shuttered almost a year ago after giving birth to my cute baby boy,” a 24 year-old Mosotho living with Obstetric Fistula reveals with teary eyes.

According to World Health Organisation (WHO), an obstetric fistula is a hole between the vagina and rectum or bladder that is caused by prolonged obstructed labour, leaving a woman incontinent of urine or feces or both. 

WHO reveals that preventing and managing obstetric fistula contribute to the Sustainable Development Goal (SDG) three of improving maternal health.

'Mannana Phafa is a little girl from Mohlaka-oa- tuka in Machache, who was a journalist student in one of the tertiary institutions in the country. She fell pregnant in her second year of study. Though was still proceeding with her studies, she had to take a short break so to give birth to her first child.

She discloses that during one of the fateful days, her labour pains occurred and was rushed to one of the hospitals in the country where she delivered normally on November, 10, 2017 and was dismissed the following day without noticing any abnormality as was her first child. She however says she had already noticed some discharges which she thought was normal after giving birth but on the third day, she realised that the discharge continued and became more abnormal hence went back to the hospital.

She indicates that she later shamefully discovered that she has Obstetric Fistula, an abnormal opening between a woman’s genital tract and her urinary tract or rectum. “I was devastated, but had hope that it will be reversed shortly,” she states. 

“I was referred to Queen 'Mamohato Memorial Hospital, where I was examined and referred to Bloemfontein, South Africa for further examination and treatment. I was booked an appointment for May 29, 2018,” Phafa adds.

In the early hours of May 29, she discloses she took a trip to Bloemfontein for treatment at one of the hospital, where to her disappointment was sent back and told that the hospital was full and will be informed when there is space for her. Sadly as she puts it, she came back home but with the hope that she will be informed about her new appointment but has since never heard from those health workers.

“The only thing that helps me to be strong is the support of family especially my mother who has been with me through it all, without judging me,” she remarks, pleading with those in authority to assist her as she feels helpless following all efforts made to seek assistance.

Commenting on this issue, the Deputy Minister of Health, Mrs. 'Manthabiseng Phohleli says this is one of the unfortunate incidents that occur during labour as some of the health workers panic leading to similar challenges.

She says they are not aware of this specific case, noting that incidents of this nature need to be given priority they deserve. She therefore urges that the matter be reported to the office of the Director General (DG) in the Ministry of Health for intervention as she (DG) is the one responsible for linking Lesotho and South Africa’s health centres.

Mrs. Phohleli maintains that it is the Ministry of Health’s responsibility to communicate with their South African counterparts to speed-up the needed processes in order to deal with challenges of this nature.

Responding to the issue of Obstetric Fistula, Sexual and Reproductive Health Programme Manager, Ms. Montsoanku 'Mefane says in Lesotho, Obstetric Fistula is mainly caused by delayed and prolonged labour. She notes that it is always advisable for pregnant woman to attend prenatal classes in order to decide whether they have to go for normal labour or cesarean delivery.

She says the country is faced with various health challenges, singling out shortage of health staff that include anesthetic nurses as well as doctors to respond to the emergencies promptly, saying in some instances, health workers delay to provide services to patients hence putting their lives at risk.

Mrs. 'Mefane also believes that having foreign doctors also poses a challenge as they cannot do their best to provide care to Basotho patients. She therefore stresses that it is time for Basotho doctors to come back home to invest in the lives of Basotho and to establish health services that will respond to the needs of the nation.

She maintains that health system needs to be given priority it deserves by ensuring that there are advanced midwives and nurse clinicians who have expertise to attend to Basotho women in order to reduce maternal and child mortality. 

The Programme Manager says they do not have exact statistics to show the rate of Obstetric Fistula in Lesotho, adding that there is need to do assessment to avoid under-estimating the situation. 

Speaking in an interview, Women and Law Southern Africa (WLSA) Programme, Mrs. 'Mamosa Mohlabula-Nokana says every individual has a right to health thus commenting that Phafa was deprived of her right to health which put her live in danger.

She believes this issue should be dealt with instantly, as if delayed, the victim will also be deprived of her sexual right, saying her wellbeing is important as she needs to be healthy in order to proceed with her studies so that she can be in a state to provide for herself and her child.

Mrs. Mohlabula-Nokana says the incident shows that there is a problem with the linkage of health service providers in the country, commenting that Queen 'Mamohato Memorial Hospital as the referral hospital could have handled a matter better since the hospital in question has no capacity to execute a matter of this magnitude. 

Meanwhile, the management of the hospital in question has declined to comment on this issue, noting that the hospital cannot comment on the health of the patient to the media even if it is given permission to do so.

The hospital management’s failure to comment on the matter leaves many unanswered questions that include finding the real cause to the problem hence it will never be clear what led to this complication. 

According to United Nations Population Fund (UNFPA), more than two Million Women are estimated to be living with obstetric fistula. The Agency highlights that they were 39,217 Fistula repair surgeries from 2014-2016, supported by UNFPA’s Campaign to End Fistula. 

As the UNFPA Executive Director, Dr Natalia Kanem puts it in her statement during the commemoration of International Day to End Obstetric Fistula on May 23, 2018, fistula is a serious human rights violation, a reflection of health systems’ failures, and a tragic sign of global social injustice and inequity.

Since 2003, UNFPA, leader of the global Campaign to End Fistula and its partners supports nearly 100,000 life-transforming surgeries to heal the physical and psychological wounds of fistula survivors, she disclosed. 

The global Sustainable Development Goals as she states, are a bold and aspirational call to leave no one behind, especially the most marginalised, forgotten and voiceless. She stressed that pregnancy and childbirth should be among the happiest of occasions in a woman’s life, however commented that unfortunately, this is not the case for many of the world’s poorest and most marginalised women. 

Describing obstetric fistula, which is a childbirth injury caused by prolonged, obstructed labour without prompt medical attention, Dr Kanem sees it as silently robbing millions of women and girls of their health, hope and dignity.

'It is time we end the needless suffering caused by fistula, in keeping with the 2030 Agenda and the Sustainable Development Goals. Let us commit to putting the furthest behind first and ensuring human rights, well-being and dignity for all.' she concluded.

According to WHO, each year, between 50 000 to 100 000 women worldwide are affected by obstetric fistula. The development of obstetric fistula is directly linked to one of the major causes of maternal mortality: obstructed labour.

WHO states that women who experience obstetric fistula suffer constant incontinence, shame, social segregation and health problems. It is estimated that more than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa. 

WHO reveals that obstetric fistula is preventable and can largely be avoided by delaying the age of first pregnancy, the cessation of harmful traditional practices and timely access to obstetric care.

The question that remains is; How many Basotho women have knowledge about obstetric fistula and its risk factors? Studies show that many have misconceptions regarding its causes, clinical presentation and prevention, as they wrongly attribute fistula to misuse of family planning, having sex during the menstruation period, curses by relatives, sexually transmitted infections, rape and gender-based violence.

 

Source: LENA 08/10/2018

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