State should provide access to affordable treatment for fistula patients

Fistula strikes about 50,000 to 100,000 women and girls every year, mainly in resource poor countries in sub-Saharan Africa and Asia. [iStockphoto]

Wajir county conducted a free gynecology camp at the Wajir Referral Hospital between July 24 and 30, 2023. The event comes on the backdrop of a surge in the number of women suffering from varied reproductive and post-natal health complications.

It is estimated that in every 1,000 deliveries in Kenya, three or four will result in fistula complications. The condition leaves women and girls leaking urine, faeces or both, and often leads to chronic medical problems and social isolation.

These women suffer in silence due to stigma associated with their health condition, a situation largely contributed by a retrogressive local culture and insufficient awareness to undo it. On the first day of the camp- July 24- we were met by tales of women racked by physical pain that led them to be isolated from the community and even from seeking help, despite the availability of healthcare specialists at the county health facilities.

Globally, fistula strikes about 50,000 to 100,000 women and girls every year, mainly in resource poor countries in sub-Saharan Africa and Asia. The backlog of those living with untreated fistula is estimated to be between 30,000 and 300,000 cases. According to the World Health Organization(WHO), Kenya records an estimated 3,000 new cases of obstetric fistula every year.

Fistula victims are mostly young women and girls who come from remote and resource constrained areas where infrastructure is underdeveloped and access to healthcare, particularly emergency obstetric care, is lacking. In most cases, lack of awareness or minimal access to information is what increases the number of unattended obstetric fistula victims.

According to a recent survey, most of the women and girls lack the requisite information on reproductive health, family planning, potential complications during pregnancy and childbirth. They are also uninformed about the advantages of facility deliveries, what fistula is, the available interventions as well as the cost of fistula treatment and maternity-related services.

These women need access to information to make informed choices about their sexual and reproductive lives. They also need information about access to services that help ensure a healthy pregnancy and delivery, and for treating obstetric complications such as fistula.

Although obstetric fistula is preventable and treatable, reports show only 1,000 fistula surgeries (less than half of the cases) are done in Kenya yearly. This is because of the increased cost of living. Only 7.5 per cent of the girls and women can access fistula-related medical care, including surgery, which is too costly.

Additionally, less than 10 per cent of health facilities in the country can offer basic emergency obstetric care and only six per cent comprehensive emergency obstetric care. Obstetrics fistula is on the rise in Northern Kenya due the high levels of poverty, insufficient infrastructure, lack of specialised workforce, poor referral networks and over-reliance on donor support.

In line with achieving universal health coverage, there is need for the strengthening of primary health care, expansion of fistula treatment networks and post-repair support through multi-sectoral partnership, political goodwill and action for the patients. There is need to create awareness and start civic education in a-bid to ease access to fistula care services, reducing stigma and enhancing post-operative follow-up and reintegration support.

Until July 30, 2023, the free gynecology camp handled cases and offered free surgeries such as fistula repair for women who suffered prolonged labor or had difficult delivery, prolapses for those suffering from severe backache, feeling heaviness in the pelvic area or feeling that the uterus is protruding, perineal tears in those who suffered extensive birth tears and poorly repaired episiotomy.