Obstetric fistula is a neglected tropical disease (NTD). NTD is used to refer to a baker’s dozen of infectious conditions prevalent in resource-poor tropical countries. Dr. Shershah Syed, the man behind Koohi Goth Hospital in Pakistan, where scores of cases are treated on a regular basis, described obstetric fistula as an abnormal opening between a woman’s genital tract and her rectum.

To be able to get a fair idea about what can be done to overcome this life-taking disease, I reached out to doctors in Pakistan, who are actively working against obstetric fistula.

An obstetric fistula occurs when a mother has a prolonged, obstructed labor but does not have access to emergency medical care such as a C-section. She often labors in excruciating pain for days. Tragically, the baby usually dies.

The development of obstetric fistula is directly linked to one of the major causes of maternal mortality: obstructed labor. Maternal mortality is unacceptably high. About 295,000 women died during and following pregnancy and childbirth in 2017, as per the World Health Organization (WHO) recent data. For the women who leak waste continuously due to this disease and are ostracized from society, normal life and regaining their health becomes a distant dream.

“[The Koohi Goth Hospital] is a 200-bed health care center where all obstetrics and gynecology services are provided free of cost,” said Dr. Syed. Additionally, he states, although they cover just 10% of the country, they act as a bridge between rural populations and urban-based care providers.

According to the WHO, each year, between 50,000 to 100,000 women worldwide are affected by obstetric fistula. In Pakistan, an estimated 5,000 women contract obstetric fistula every year as per the Pakistan National Forum on Women’s Health. Identifying patients has been difficult as many women with fistula live in abject poverty in isolated areas where education and awareness are low, according to extensive research in collaboration with the United Nations Populations Fund Association (UNFPA), which was funding initiatives for obstetric fistula treatments in Pakistan since 2005 but gave up in 2016 due to resource constraints.

Dr. Syed cited the case of a 28-year-old woman, a resident of the Khuzdar district in Baluchistan, Pakistan, who suffered from obstetric fistula for 16 years before she was finally operated on.

“She had a stillbirth and was left by her husband soon after her surgery,” he said.

Doctors were shocked to see the burnt skin of her abdomen and thighs. When they asked her family members, they said she was under ‘treatment’ by a faith-healer as they suspected she was a victim of evil spirits. Dr. Syed said that all the girl really needed was a simple 30-minute surgery that she got at the Koohi Goth Hospital in 2018.

To circumvent the problem, hospitals have mobilized Lady Health Workers – women who go door-to-door in remote areas delivering information on sexual reproductive health and rights, said Dr. Samina Naz, an obstetric gynecologist at the Murshid Hospital in Karachi, Pakistan.

Sharing her concerns over the lack of government efforts regarding the prevention and treatment of fistulas, Dr. Naz said the government needed to take responsibility for and compensate the women who developed an obstetric fistula due to the state’s failure in providing obstetric emergency services at state-run hospitals.

Considering the intensity of the disease, a state-of-the-art neonatal intensive care unit (ICU) has been providing free obstetrics and gynecologic services at the Koohi Goth Hospital since 2019.

“Fistula patients are 99% poor women, who cannot afford to get their child delivered under proper medical care facilities,” said Dr. Masood A. Shaikh, a urologist at the Orthopedic and Medical Institute (OMI) Hospital in Karachi.

For obstetric fistula, precaution is the best cure, and the cure is simple. Women in Pakistan need to deliver babies under the supervision of trained hands and with basic health care facilities. This cure is still a distant dream looking at the state’s negligence to the current conditions of government hospitals.

“By and large, you do not witness obstetric fistula among upper or middle-class women,” said Dr. Syed.

Dr. Syed stresses the importance of training midwives to battle obstetric fistula. He said that there is a need for at least 400,000 midwives across the country, but improved obstetric care in general and the proper use of C-sections when needed can make a massive dent in preventing obstructed labor in Pakistan.

According to the Koohi Goth Hospital’s website, more than 1,000 patients out of the about 6,000 fistula cases which are reported in the country are at the hospital. Dr. Syed says that obstetric fistula remains one of the most under-reported and hushed-up health problems in Pakistan.

A lot of women with this condition lose bladder control and are disturbed by the odor that emanates from them.

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Patients come to the Koohi Goth Hospital from areas where even basic health facilities are hard to find in a country like Pakistan. Besides treatment, the hospital also has a rehabilitation center for its patients who are often admitted for months.

The sense of shame, coupled with a woman not being able to decide about her health and body, and lack of awareness among health practitioners as well as the community are some of the reasons for this injury to remain invisible to many. The disease, however, is preventable and largely avoidable by delaying the age of first pregnancy, the cessation of harmful traditional practices, and providing timely care to obstetric fistula.

Countries around the world celebrate International Day to End Obstetric Fistula on May 23, with a variety of events to raise awareness of this neglected health and human rights challenge. Last year, ahead of the day, UNFPA coauthored a commentary in The Lancet Global Health, which underscored the critical role of universal access to skilled care at birth for ending preventable maternal and newborn mortality and morbidity.

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  • Haddiqua Siddiqui

    Haddiqua Siddiqui is a Multimedia Journalist based in Karachi, Pakistan. Haddo, as her close friends call her, identifies as food-sensitive and stays away from anyone who does not have a sweet tooth. Currently, her wandering soul is on a quest of unlearning and relearning life. Send help!!