Poor health care system contributing to fistula cases, say victims 

Fistula patients in Kagadi District have revealed that delays in government facilities while in labour have contributed to infant mortality and increased fistula cases.
Uganda’s Ministry of Health estimates that at least 200,000 women in the country are living with fistula and 1,900 new cases occur each year.  
Currently, about a million women and girls live with fistula around the world. In Uganda at least one in every 100 women have obstetric fistula and 90 percent of women who suffer complications of fistula have lost their babies during birth according to reports from the United Nations Population Fund (UNFPA).
An interview with some fistula patients in Kagadi General Hospital on Friday revealed that delays to work on them during labour and poor attitude by health workers has partly contributed to the rising cases of the condition among women.
Ms Jackline Mawazo, 49, a Congolese refugee at Kyangwali Refugee Settlement in Kikuube District, who has lived with fistula for the last 27 years, said it happened while she was still in Congo when she had an obstructed labour before having a still birth.
“I started leaking immediately. I was advised to take six months and return to the hospital for an operation but by then, Congo was unstable with the conflicts so I couldn’t go back until we ran to Uganda,” Ms Mawazo narrated.
She added, “Here in Uganda, I hardly went to public or any gatherings. Normally, I would stay at home. One day I tried to seek medical attention but when I reached the facility, a nurse told me that it seems I am a prostitute and that’s how I got the condition. It disturbed me so much and I decided to go back home.” 
Ms Mawazo who was among the women who were operated on at Kagadi District General Hospital last week.
Another patient, a 16-year-old girl also had a still birth last year and immediately started leaking.
“I went to Nakitooma health center where I was referred to Kiryandongo and then to Hoima but all failed. I decided to go to a private health center because my stomach was very swollen. They managed to work on the stomach but the urine kept on leaking,” she narrated.
After three months, she was abandoned by the man who impregnated her. When learned about the Kagadi health camp, she attended and was successfully operated on last week.
Gynecologists warn that cases of obstetric fistula among women are likely to increase if the cases of teenage pregnancies are not addressed.
Ms Shakirah Nabutono, a Clinical Officer at Kagadi District General Hospital said that out of 54 women they screened, four had stress and fresh fistula.
Ms Nabutono explained that usually if the baby is not lying well, a mother can fail to push (natural birth). In that circumstance, if there is no skilled health worker to help, the woman will end up with fistula.
“The victims suffer uncontrolled leakage of urine or stool and they are smelly. As a result, they will not appear in public and even in their own homes, they will not sit with the rest,” she said.
While addressing Health Workers on World Fistula Day, Mr Daniel Alemu, the UNFPA Deputy Country Representative, said there are wider challenges facing women and girls, such as poverty, gender, and socio-economic inequality, child marriage and early childbearing that jeopardize opportunities for fistula survivors.
“Women and girls suffer life-shattering consequences including chronic incontinence, shame, social isolation and emotional health problems. The long uncomfortable wait before accessing fistula care. It is a pointer to existing gaps in the provision of quality care in the health system. At the moment, Uganda still has an unmet need for prevention and holistic fistula treatment,” he said.
Mr Alema also noted that UNFPA has invested in improving the quality of maternal care to make every child’s birth safe as well as reducing the unmet need for modern contraception.
Response from Ministry
Ms Anifa Kawooya, the State Minister for Health in charge of General Duties, said the government is emphasizing wealth creation as a key measure to fight all these problems.
“I take the honor to reiterate the government’s commitment to working with all the stakeholders to accelerate attainment of targets in maternal health. It is everyone’s responsibility starting with us the leaders to mobilise the community by providing the right information,” Ms Kawooya said.
Ms Kawooya blamed the increasing cases of fistula on child marriages but also urged mothers to regularly attend antenatal for early identification of the complications.