Kajunde is a depressed, illiterate, poor, divorcee, married young, developed fistula at her first delivery.
Five years ago she had a long labour; this was followed by a longer trip to the hospital on a papyrus stretcher, resulting in a cesarean section, with only her life left to save. Years later, it is not the absence of a child that lingers, but rather the sorrow of a life debased by shame, wasted by pain and disability, and despairing isolation.
She is living with obstetric fistula (OF). OF is characterised by an abnormal passageway between the vagina (VVF) or uterus and internal organs such as the bladder or rectum (RVF), leading to persistent leakage of urine and/or faeces through the vagina.
The best solution to OF is to put in place appropriate integrated development programmes that are community based and sustainable.
Such an approach should be one that will strengthen the local capacity available to women to improve their health and social environment through the implementation of co-ordinate model programmes; including focus on girl-child education, adult literacy and income generating skills development for women of childbearing age.
Today as we mark the International Day of OF with a theme “End fistula, restore women’s dignity” it is necessary that, appropriate, affordable and accessible health services are provided at the grassroot level.
Interventions that will integrate the socio-economic aspects of women‘s health, total involvement and community participation to address the integrated relationship between the health of women and their social environment. This would go a long way to restore women’s dignity.
In Uganda, however, despite the availability of OF repair facilities for almost a decade, the problem persists.
This is associated with general under-development of community health services structures and widespread poverty, lack of education and culture traditions that are entrenched in the lives of majority of Ugandans. In rural areas, the prevalence rate is higher due to inadequate facilities for pre and post-natal care.
In addition, long distances, high cost of care; ignorance and poor nutrition make women more vulnerable to OF. Although it is certain that victims of this most preventable condition can be found across the length and breadth of the country, there appears to be a concentration of victims in rural hard to reach areas.
There is need for residential setup, campaigns to prevent VVF in young women through creating a culture of female empowerment and education, raising awareness of general reproductive health and rights issues, and integrating the role of women in mainstream community development programmes.
Empower village health teams to work in the communities, strengthening provisions and delivery services, adult literacy, vocational training to develop and build skills for income generating activities, improve counselling (peer and professional), surgical treatment and appropriate pre- and post surgery nursing care, subsequent follow-up and monitoring of re-assimilation.
In conclusion the problems of women’s health and their low socio-economic status have been of great concern to a number of different international, regional and National organisations including the Kabaka foundation.
There is increased awareness about the fistula but the best approach is to adopt a comprehensive programme that examines all key periods in a woman’s life cycle: childhood to old age.
There is growing evidence that interrelated projects focused on efforts to improve the health and overall status of women will provide substantial benefits in term of human welfare, poverty alleviation and economic growth.
Ms Kabayambi the executive director of Hope Again Fistula Support Organisation.