Obstetric fistula is an injury that is caused by a prolonged labor. Obstetric relates to childbirth and the postpartum period, and fistula is Latin for hole. The hole occurs between the birth canal and the bladder or rectum. The side effects of the injury commonly result in uncontrollable leakage of urine and feces.

Uganda’s fertility rate is ranked 11th in the world. Although there has been a decrease in the fertility rate, maternal mortality remains high. Much of this is attributed to mothers suffering from obstetric fistula. There are an estimated 140,000 women living with obstetric fistula in Uganda. Ugandan women are at high risk due to limited access to quality maternal care, and transportation costs to the repair facilities also contribute to the prevalence of the pregnancy-related injury.

Hidden Costs of Repair

In 2015, USAID supported a research study to better understand the financial barriers that Ugandan women face when seeking fistula repair surgery. Aside from medical expenses for fistula care, Ugandan women struggle with the cost of food and water during their recovery period at the facilities. In addition, the cost of child care or hiring employees to manage businesses create a larger financial burden. Thus, this injury has a direct impact on women living in poverty.

Most of the mothers both interviewed and in focus groups struggled with loss of income, lack of quality health services and transportation expenses. The non-medical costs of care like transportation, food and lodging become expensive for surgical patients. Ugandan women spend up to $25 on one-way transportation to a fistula repair facility. For these reasons, even free surgery is rarely actually free.

Care for Repair

In 2004, the USAID created the Fistula Care Plus Project, which has supported more than 51,124 fistula repair surgeries around the world. A total of 3,534 of these repair surgeries were for women with obstetric fistula in Uganda. Along with providing care, Fistula Care Plus trained 26 doctors and 761 nurses to perform fistula repair surgery in the country.

The project focuses on expanding efforts for community awareness, family planning services and maternal health care. Fistula Care Plus is working with three private, faith-based hospitals: Hoima Hospital, Kitovu Mission Hospital and Kagando Mission Hospital. It also works with two government-run hospitals: Kamuli Mission Hospital and Jinja Hospital. There are also other projects that work to provide care for Ugandan women.

As an international nonprofit organization, the Uganda Village Project works directly with community based organizations and local government. This project educates the community and maximizes public health. The Uganda Village Project collaborates with Uganda Childbirth Injuries Fund to repair women with the injury.

Through village outreach, health center referrals, radio shows, and word-of-mouth communication, the Project is able to identify women with obstetric fistula in Uganda. After gathering groups of women, the Uganda Village Project transports them to repair camps at the Kamuli Mission Hospital. Once the women arrive, they are repaired by surgeons from the Uganda Childbirth Injuries Fund. These organizations are making an effort to maximize the aid and services that Ugandan women need.

– Francisco Benitez
Photo: Flickr