Have you ever lost a loved one as a result of an obstetric fistula? Have you ever witnessed or experienced the suffering that moms go through as a result of this? This experience and feeling are precisely what the World Health Organization W.H.O, United Nations U.N and other organizations are trying actively to put an end to obstetric fistula so that circumstances like these never happen again.
Obstetric fistula (OBF) is a significant problem in low-resource countries, it has been identified as one of the most visible indicators of maternal morbidity on a global scale. Obstetric fistula is linked to protracted and obstructed labour, especially when emergency obstetrical care is unavailable (Swain et al., 2020). It is caused by protracted and obstructed labour without access to early and high-quality medical treatment (Obstetric fistula, 2020). it affects between 50,000 and 100,000 women globally each year (World Health Organization: WHO, 2018).
Obstetric fistula occurs when the unborn baby is unable to pass through the pelvis due to prolonged or obstructed (blocked) labour, which can last several days. The infant could be too huge or in the wrong position for the pelvis, or the pelvis could be badly formed or underdeveloped. In industrialized countries, a woman with this type of blocked labour would be scheduled for a caesarean section. However, this may not be readily available in developing countries. As a result, the pressure of the baby's head on the blood vessels supplying the tissue of the vagina, bladder, urethra, and rectum for an abnormally long time cuts off the supply of oxygen (ischemia) and causes the affected tissue to die (necrosis). After then, the dead tissue sloughs away, leaving a gap between the organs (OBSTETRIC FISTULA IN THE DEVELOPING WORLD: AN INTRODUCTION, 2021).
Obstetric fistula is a potentially fatal injury that can happen during childbirth. It renders the mother incontinent, humiliated, and frequently rejected by her community (What Is Fistula? | Fistula Foundation, 2021). it is particularly common in impoverished rural areas of Africa and Asia, where women live in dirt-floored homes with no running water or incontinence pads (What Is Fistula? | Fistula Foundation, 2021).
There are several types of obstetric fistulas: vesicovaginal fistula (VVF), which occurs between the bladder and the vagina; ureterovaginal fistula (UVF), which occurs between the urethra (bladder outlet) and the vagina; rectovaginal fistula (RVF), which occurs between the rectum and vagina; ureterovaginal fistula, which occurs between the ureters (kidney tubes) and the vagina; vesicouterine fistula, which occurs between the bladder and the uterus (womb) (OBSTETRIC FISTULA IN THE DEVELOPING WORLD: AN INTRODUCTION, 2021).
Obstetric fistula is a common occurrence in Ghana. It is a pretty regular occurrence that can be highly dangerous. In Ghana, 1538 cases of OBF were reported between 2011 and 2014 (Ghana Health Service, 2015) (Mantey et al., 2020). Fistula patients in Ghana's Central Region (CRG) are believed to number between 3,000 and 5,000, with an annual incidence of 200 cases (Modern Ghana, 2013). My goal in this paper is to examine how Ghana can eliminate obstetric fistula.
To accomplish this, I have divided my paper into three sections. In the first part, I will cover the main causes of obstetric fistula, and in the second part, I will discuss the effects of obstetric fistula. The third part of my paper is broken down into three major subsections, each discussing approaches to prevent, treat and repair obstetric fistula and how recovered obstetric fistula women can be rehabilitated and assimilated back into their communities respectively, I will conclude with a wake-up call, imploring everyone to join in the fight against this fatal disease, and it is in this context that I begin my discussion.
CAUSES OF OBSTETRIC FISTULA
Poverty, early marriages, lack of education, and hazardous traditional practices are only a few of the reasons for obstetric fistula.
To begin with, one of the leading causes of obstetric fistula in Ghana is poverty. Most poor people are malnourished due to their low intake of healthy and nutritious foods. Poverty makes us vulnerable to diseases that are present in impoverished communities in Ghana due to limited access to basic health care and disease prevention strategies, this results in stunted growth among residents of these places. Expectant mothers with stunted growth have skeletons that are not ready for birth, such as a pelvis that is not fully grown. Because of the weak and immature bone structure, the infant is more likely to become caught in the pelvis during birth, cutting off circulation and causing tissue necrosis. Due to poverty, most expectant mothers are not able to access quality maternal health education and care. The ignorance and misinformation coupled with poverty are some of the hurdles preventing rural women from simply travelling to and from hospital to seek antenatal care, of which many women end up giving birth at home or without receiving prenatal care
Poverty also contributes to limited access to high-quality medical treatment. With other major health crises such as malaria, AIDS, preeclampsia pneumonia, among others, the already overburdened medical centre is frequently overloaded, resulting in a significant breakdown in the healthcare system. Many people, particularly women, are at risk as a result of this breakdown. Many hospitals in these areas are short on personnel, materials, and other medical technologies that would be required to undertake reconstructive obstetric fistula repair (Wikipedia Contributors, 2021).
Early childbirth is another cause of obstetric fistula. In Ghana, one out of every five girls between the ages of 20 and 24 is married before they reach the age of 18 (Ending Child Marriage, 2018). early marriages result in early births, which in turn raise the risk factors of contracting obstructed labour. Consequently, young mothers who are poor and malnourished may have undeveloped pelvises which cause obstructed labour which then results in obstetric fistula (Wikipedia Contributors, 2021).
In Ghana, harmful traditional practices such as female genital mutilation, infibulation, or Gishiri cutting, which is a cut through the vaginal entrance into the front wall of the vagina against the pubis, is also another cause of obstetric fistula (OBSTETRIC FISTULA IN THE DEVELOPING WORLD: AN INTRODUCTION, 2021), These practices cause labour to be prolonged and obstructed, resulting in an obstetric fistula.
EFFECTS OF OBSTETRIC FISTULA
Obstetric fistula has a massive effect on the woman. she is badly affected physically, socially and psychologically.
First and foremost, an obstetric fistula has a physical consequence for the woman. The most obvious effect of an obstetric fistula is urinary incontinence (continual urine), faecal incontinence and blood leakage caused by a hole that grows between the vagina and the bladder or rectum. The consequences of this leaking are both bodily and societal. Because of the continuous soaking, the acid in the urine, faeces, and blood creates severe burn injuries on the legs from the continuous dripping of urine. Women limit their intake of water and fluids to minimize leaking, which can lead to hazardous cases of dehydration. Infertility is another issue that arises as a result of an obstetric fistula, just a quarter of women who have a fistula during their first pregnancy can produce a live baby, and so have slim prospects of having a healthy baby later on (Wikipedia Contributors, 2021).
An obstetric fistula has social consequences on the woman. The woman is always wet and filthy with an unpleasant odour due to the continuous flow of urine or faeces. Isolation, stigmatization, and discrimination may befall the mother, she may be shunned from community activities, religious rites and others as unclean, and maybe shunned by both her family and the community (OBSTETRIC FISTULA IN THE DEVELOPING WORLD: AN INTRODUCTION, 2021). As a result, many women are divorced or abandoned by their husbands or partners, ostracized by family, mocked by friends, and even isolated by health care providers.
Having an obstetric fistula can also cause psychological issues for mothers. Despair from the loss of their child, embarrassment from their odour, inability to execute family obligations and the fear of getting another fistula in future pregnancies are some of the psychological difficulties that women with a fistula endure. Inability to work, social stigmatization, and solitude all contribute to depression and anxiety which then leads to series of mental health problems (Wikipedia Contributors, 2021). Mothers commit suicide as a result of these repercussions.
PREVENTION
The large number of obstetric fistulas that occur in Ghana is alarming, we must make much effort to prevent obstetric fistulas from forming because preventing an obstetric fistula contributes to the third Sustainable Development Goal of enhancing maternal health.
There are four primary methods for preventing an obstetric fistula in Ghana: access to early and high-quality medical care, provision of proper nutrition to adolescent and pregnant women, delaying marriage and childbirth and educating and empowering women.
To begin with, one of the most important ways to prevent obstetric fistula is to provide free quality medical care. The Ghanaian government, the Ministry of Health, and other stakeholders must work together to guarantee that all women have access to qualified birth attendants who can offer emergency obstetric care in case there is prolonged or obstructed labour (Obstetric fistula, 2020). Access to obstetrical care, assistance from qualified health care providers during pregnancy, offering access to family planning, and encouraging the practice of spacing births are all ways of providing free quality medical care. Nurses, doctors, and midwives should be trained in emergency cesarean sections to avoid vaginal birth for young moms with undeveloped pelvises (Wikipedia Contributors, 2021).
Adequate nutrition for teenage and pregnant women is another method to prevent obstetric fistula. Education on how to prevent obstetric fistulae should begin as early in a woman's life as possible. Improved nutrition and outreach campaigns to raise awareness of children's nutritional needs to prevent malnutrition and increase the strength of young mothers. Mothers should be taught how to prepare a balanced meal. The Ghanaian government, as well as other stakeholders, should provide potable water to the country's rural communities. This will aid in the prevention of obstetric fistulas (Wikipedia Contributors, 2021). The government should provide citizens in disadvantaged areas with free food. Rice, yam, oil, plantain, fish, milk, and a variety of other foods are among them. Well-meaning Ghanaians and philanthropists could help individuals in rural regions by donating nutritious food items to them.
Another approach to avoid obstetric fistula is to delay one’s first pregnancy. This situation is relevant to people who married very young. The goal is to avoid obstructed and prolonged labour due to an underdeveloped pelvis, which can lead to an obstetric fistula. Early marriage can be avoided in a variety of ways. People who engage in child marriage should be reported and punished by traditional councils, the police, and Ghanaian citizens. Mothers under the age of eighteen should be taught how to postpone the birth of their first child.
Educating and empowering women is the final approach to prevent obstetric fistula. More initiatives can be undertaken to educate local people about the cultural, social, and physiological variables that contribute to the risk factors of obstetric fistulae. This can also be used in fistula prevention. Organizing community-level awareness campaigns to teach women about preventative approaches such as adequate cleanliness and care during pregnancy and childbirth is one of these strategies (Wikipedia Contributors, 2021). Parents and children should be informed about the negative consequences of certain traditional cultural practices. Nurses, midwives, and doctors should be encouraged to educate mothers on topics such as family planning, child marriage, and good nutrition, among other things. This education should take place in schools, hospitals, and religious institutions, among other places. Open discussions about the cause, prevention, and treatment of obstetric fistula should be held in schools. On themes like obstetric fistula, essay competitions, debates, and poetry competitions should be arranged. This goes a long way towards informing our youngsters about the deadly consequences of these diseases.
TREATMENT AND REPAIR OF OBSTETRIC FISTULA
Any prevention and treatment strategy for obstetric fistula should be a component of the national maternal and neonatal health strategy in Ghana. Corrective surgery can be used to close an obstetric fistula. A woman with a fistula can often return to a normal life with her continence and hope restored if the operation is performed by a qualified surgeon (What Is Fistula? | Fistula Foundation, 2021). The Ghanaian government and other stakeholders should merge in providing free medical treatment for obstetric fistula patients because mothers and teenage girls usually cannot afford the costly therapy. Thus, providing free medical care for obstetric fistula patients will go a long way towards healing and treating the damage that has already been done.
Reconstructive surgery for women should be performed by doctors, surgeons, and nurses who have had extensive training. The nature of the injury varies depending on the size and location of the fistula, so a surgeon with experience is required to improvise on the spot. Treatment and evaluation for conditions such as anaemia, malnutrition, and malaria are required before the person undergoes surgery (Obstetric fistula, 2021).
The government should implement a "fistula fortnight" project in which fistula professionals will treat fistula patients for free. In February and March 2005, this initiative took place in the northern Nigerian states of Kano, Katsina, Kebbi, and Sokoto. To make this effort a success, the government can work with organizations such as the United Nations Population Fund (UNFPA), the World Health Organization (WHO), and others to supply equipment, trained staff, medications, food, and clothing, among other things. Bed rest, analgesics, oral fluids, visual monitoring of urination by nurses, a catheter, catheter removal, and an assessment and discharge from the hospital at a minimum of four weeks must all be provided, along with instructions to prevent sexual intercourse. Nurses and social workers must provide preoperative and postoperative counselling during the Fistula Fortnight (Wikipedia Contributors, 2021).
The Government should collaborate with international organizations to set up a fistula treatment centre. This comprehensive fistula treatment centre must have investigation services such as laboratory testing, radiography, and a blood bank to ensure that patients' medical histories are thoroughly known before treatment choices are considered. Operating rooms, post-operative wards, and anaesthetic treatments must be included in the surgical services. Physiotherapy and social reintegration programs must also be available there to provide women with obstetric fistulas with the tools they need to reintegrate into a society that has shunned them (Wikipedia Contributors, 2021).
REHABILITATION AND ASSIMILATION INTO THE COMMUNITY.
Ending obstetric fistula requires developing strategies to rehabilitate and assist women who have recovered from obstetric fistula in reintegrating into society. Rehabilitation is a combination of interventions meant to optimize functioning and reduce disability in individuals with health conditions in contact with their environment (World Health Organization: WHO, 2020). Women who have recovered from an obstetric fistula must be rehabilitated to prevent depression, mental illness, maternal discomfort, and mortality. The rehabilitation and assimilation stage is not only the responsibility of the government. Everyone should endeavour to assist in this process.
Rehabilitation services for women recuperating from obstetric fistula should be established in medical centres. This curriculum must teach women how to be strong in the face of criticism, rejection, and discrimination.
To assist these women in earning money, the government and other stakeholders should establish skill training programs such as sewing, hairdressing, and jewellery manufacturing. This method helps to prevent poverty, which is a contributing factor in an obstetric fistula.
Family, friends, and neighbours must provide psychological support to these women by using nice words, empathizing with them, and treating them with respect. These women will be able to engage in their social and religious life once again. They may be able to remarry and start a family, restore their social standing and live happily. Rehabilitation projects will assist the patient in regaining control of her life, restoring her self-esteem, and equipping her with the tools and skills she needs to support herself and her family (OBSTETRIC FISTULA IN THE DEVELOPING WORLD: AN INTRODUCTION, 2021).
The loss of a child is unlike any other. The sadness of losing a child lasts a lifetime. Mothers go through this ordeal, only to be confronted with the physical consequences of an obstetric fistula. They are despised by their communities, they are stigmatized and discriminated against, they have suicidal ideas in their heads, and they eventually commit suicide. this can happen to everyone and when a preventable death takes away your mother, it steals joy for the rest of your life. Obstetric fistula is an illness that not only affects the mother, but also the child, who witnesses the mother's agony, humiliation, and stigmatization. Because he sees his wife in anguish and grief, it also affects the husband. It has an impact on the community since it results in the loss of active women who can contribute to making the community better. Finally, it has an impact on the entire country, because it loses future leaders, doctors, nurses, and teachers, among others, who will assist the country create more revenue, train new people, and make Ghana a better place to live. Fighting this deadly disease will take a lot of effort, but with everyone on board, we can employ the above-mentioned strategies to eliminate obstetric fistulas.
References
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OBSTETRIC FISTULA IN THE DEVELOPING WORLD: AN INTRODUCTION. (2021). ICS. https://www.ics.org/committees/developingworld/publicawareness/obstetricfistulaanintroduction
World Health Organization: WHO. (2018, February 19). Obstetric fistula. Who.int; World Health Organization: WHO. https://www.who.int/news-room/facts-in-pictures/detail/10-facts-on-obstetric-fistula
What Is Fistula? | Fistula Foundation. (2021, March 10). Fistula Foundation. https://fistulafoundation.org/what-is-fistula/
Obstetric fistula. (2020). Unfpa.org. https://www.unfpa.org/obstetric-fistula
Modern Ghana. (2013, August 23). Obstetric Fistula, The Enemy Of Women In Ghana. Modern Ghana; Modern Ghana. https://www.modernghana.com/news/484317/obstetric-fistula-the-enemy-of-women-in-ghana.html
Mantey, R., Kotoh, A. M., Barry, M., & Redington, W. (2020). Womens’ experiences of living with obstetric fistula in Ghana–time for the establishment of a fistula centre of excellence. Midwifery, 82, 102594. https://doi.org/10.1016/j.midw.2019.102594
Wikipedia Contributors. (2021, January 1). Obstetric fistula. Wikipedia; Wikimedia Foundation. https://en.wikipedia.org/wiki/Obstetric_fistula
Ending Child Marriage. (2018). Unicef.org. https://www.unicef.org/ghana/ending-child-marriage
World Health Organization: WHO. (2020, October 26). Rehabilitation. Who. int; World Health Organization: WHO. https://www.who.int/news-room/fact-sheets/detail/rehabilitation
