Fistula: A patient and a surgeon discuss the devastating condition

23 May 2013
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After Séverine gave birth to her seventh child, she knew something was wrong. She went to see a doctor at MSF’s health centre in Gitega, Burundi. Séverine was suffering from a fistula.

“The MSF team welcomed me to the women’s village. I feel good here; we dance together often. All the women here suffer from the same thing, and that helps us cope,” she says.

“I’m having the surgery in a week. I hope it will go well; I’m confident it will.”

Two million women

Séverine is one of two million women worldwide with an obstetric fistula – a hole between the vagina and the bladder or rectum, through which urine or faeces leaks continuously.

They are devastating injuries resulting from complicated childbirths. Often, the baby does not survive.

Trauma and treatment

MSF surgeon Dr Geert Morren explains the devastating impact: “For the mother, it’s a traumatising experience. Not only does she go through a long and difficult birth, but she also loses the baby and ends up with a fistula that makes her incontinent.”

The injury can impact the rest of her life; women with fistula are often excluded from social circles, sometimes rejected by friends and family.

Thankfully, most cases of fistula can be treated using surgical procedures. MSF teams treat hundreds of women every year, helping them return to their normal family lives.

Who is affected?

Poor women are the worst affected. Some estimate that 100 to150 women contract a fistula every day.

“Fistulas are most common in places where women don’t have access to healthcare,” says Dr Morren, adding that a woman is unlikely to contract a fistula if a skilled attendant is present when she gives birth.

“Unfortunately, repairing fistulas is not a procedure that many local surgeons wish to do,” admits Dr Morren.

“First of all, it is technically quite difficult to carry out. Though it doesn’t require sophisticated equipment, it takes some time to master the technique.

“Secondly, it’s not well-remunerated because most of the patients are poor.”

MSF in action

As there will never be enough surgeons to help all fistula sufferers, preventing fistulas from occurring in the first place – by providing quality obstetric services – is key.

This presents MSF with a difficult choice: should we train gynaecologists to treat fistulas, or should we focus on ensuring women have trained assistants present during childbirth?

In other words, should MSF prioritise prevention? How do we resolve this dilemma?

Preventing fistula

“MSF won’t open a project that treats fistula without also investing in prevention,” says Dr Morren.

“For example, in Burundi, our teams opened a specialist obstetric clinic in Kabezi and a centre for fistula treatment in Gitega. Since the beginning of the project, more than 1,000 patients have had surgery for fistula there.”#

Returning home

Séverine will soon be added to that number, and the given a chance to live a normal family life:

“I’d like to go back to my family as soon as possible. My husband supports me, as he feels just as responsible as I do for my pregnancy.

“That said, I do not hold it against my child. On the contrary – I am so happy that he survived. Many women die during a difficult labour.”

Success and hope

We can help many more women like Séverine as, according to Dr Morren, our teams can play a lead role in training gynaecologists to treat fistulas.  

“We have invested a great deal in training Burundian surgeons in Gitega. If we can train enough of them to allow us to hand over the caseload and leave, we’ll call this a success.”