Assuming responsibility for an event or action described as terrible is not something many people prefer to do.
There is something terrible in the society and that is obstetric fistula. And in Ghana, every citizen that makes up the government is culpable; directly or indirectly, and there is no running away from it.
This is based on Abraham Lincoln definition for government which is as one of the people, by the people and for the people.
The World Health Organisation (WHO) and health experts explain that obstetric fistula, which is a hole between the birth canal and bladder and/or rectum, occurs when there is prolonged or obstructed labour.
Obstructed labour according to Dr Gabriel Yao-Kumah Ganyaglo, an Obstetrician, Gynaecolologist, Urogynaecologist & Fistula Surgeon at the Korle Bu Teaching Hospital, is simply labour that is difficult or encounters several challenges.
“In the female, the birth canal is in between the two reservoirs (rectum and bladder) and the on top of the birth canal is the uterus (womb) and that is where the baby will normally be lying. When it is time to give birth, the baby is pushed out of the womb through the birth canal to the outside. By design, there has to be a good ratio of the birth canal and the size of the baby for the baby to come out smoothly without any problem.
“In the event that the baby is bigger than the birth canal, then the baby becomes stuck into the birth canal and it becomes difficult. That is obstructed labour.”
Obstructed labour without access to timely, high-quality medical treatment is said to be the key factor of obstetric fistula. About 50,000 to 100,000 new cases of fistula are reported annually, the WHO says. And it is most prevalent in Africa, the Organisation adds.
But then one would ask, upon all places and continents in the world, why Africa? Does everything negative naturally find its way in Africa? The answer is no, but for the structure of some African societies, the continent records a majority of the most serious and tragic childbirth injuries.
In societies were fistula is reported, the victims tend to suffer from chronic medical problems, depression, social isolation and deepening poverty because of the discharge of urine or faecal matter.
Dr Ganyaglo explains why there is a continuous discharge of urine or faeces as follows:
“The reservoir for faecal matter is the rectum and that for urine is the bladder. So these two are separate and each of these has a valve, otherwise without the valve, urine will continuously come out – it won’t stay in the reservoir and faeces will also continuously come out without the valve.
“When the baby stays in there for too long (about 6 hours), the tissues that are between the baby and the urine or faeces, those tissues die. Because the pressure of the baby cuts the blood supply so there is no blood going into those parts of the reservoir. When there is no blood going into a tissue, the tissue will die. So when the tissue dies, it leaves a hole. Reservoirs are supposed to have a valve (since there is a hole) whatever is supposed to stay in there until the brain says it is time to go (won’t so) the pee will not stay in there.”
In a conversation with The Independent Ghana via Zoom, Dr Ganyaglo points out that in Ghana, 1,300 new cases of obstetric fistula are recorded yearly.
He maintains that an obstructed labor may result in fistula, and there is more to it. As stated earlier, timely access to high-quality medical treatment for pregnant women is what fuels this very preventable disease.
“All of these are clearly not the fault of the woman,” Dr Ganyaglo admits.
Fistula is a “hydra-headed problem” and this is the point where every Ghanaian comes into the picture and must accept blame for directly or indirectly promoting the growth of this disease and the maltreatment meted out to victims.
The Government
The Government is partly to blame for the increase in obstetric fistula in Ghana. Most of the cases are recorded in the rural parts of the country, Dr Ganyaglo confirms.
This is due to the following reasons: lack of health facilities and bad roads to health facilities in neighbouring towns.
- Bad roads
In Sampa in the Jaman North District of the Bono Region, where residents, this year, have complained about bad roads, a woman in labor will find it uncomfortable moving from home to the hospital.
The potholes a driver would have to swerve, will ensure that the woman in need of healthcare never gets to the hospital in time.
In January this year, the Northern Regional Minister, Shani Alhassan Shaibu indicated that a total number of 141 roads are currently under construction in the Northern region by the road ministry. Until these roads are constructed, what happens to pregnant women who require healthcare?
In ModernGhana’s report, it is clear government is working on bad roads in the area and government must be doing more in other areas in the country.
“If the woman even went into antenatal care regularly and she goes into labour in the middle of the night but has not managed to pick transportation to the hospital, she will not be able to make it to the hospital in time.
There are several parts of rural Ghana that are cut off in the rainy season so even if you hit the road, you will not be able to make it to the hospital in good time.”
- Inadequate health facilities
The lack of health facilities in rural areas is of major concern. At Kantaga in the Bolgatanga East District of the Upper East Region, residents are not able to access the hospital.
But government has stepped in with its ‘Agenda 111’ Hospital project is yet to present the community a fully construction edifice. The project, expected to be completed by end of 2022, comprises male, female, paediatric and surgical wards, laundry, laboratory, physiotherapy and pharmacy units, administration block, an Out-Patients Department and mortuary.
Traditional Authorities and Government
The role of Traditional Authorities in ending fistula is also key. Dr Ganyaglo points out that early child marriages and some cultural practices are adding on to the number of cases in the country.
- Child marriage
With regards to child marriage, UNICEF says in Ghana, 1 in 5 girls aged 20-24 years are married before the age of 18. Gender inequality, poverty, social norms, cultural and traditional practices are reasons child marriage continues to exist.
The health professional explains that before a woman can conceive her body must be matured in order to withstand whatever comes with pregnancy. But that is not the case for girls forced into child marriages.
“You have to grow to a certain age so you can have adequate pelvis capacity to develop a baby. So if pregnancy comes in too soon when the woman is growing, it can be difficult. Even the average size baby (19 -20 inches) may not be able to come through,” says Dr Ganyago.
In March this year, Graphic Online told the story of one Maame Esi (not her real name) who became a victim of fistula because she had been forced into early child marriage.
Maame Esi comes from a small farming community in the Nanumba North District of Ghana’s Northern Region. She assumed the role of a wife at the age of 16 when forced to stop school.
“According to her, her pleas to her parents to allow her to continue her education fell on deaf ears as both mother and father, agreed to marry her off to a man who she claims was almost her father’s age. The man was about 48 years. Left with no option, she truncated her education and went to live with her husband in a different village. She was his second wife.
Not too long after she went to live with her husband, she took seed and was very optimistic of starting her own family. Maame Esi’s troubles started when she was made to deliver at home. Delivering at home was not a new phenomenon in the village. However, unlike other women in the village who delivered safely and without much rancour at home, Maame Esi’s delivery took several hours and nearly caused her life. There was no car immediately available to take her to the hospital,” the report added.
- Lack of women empowerment
Also, the patriarchal system where the woman is unable to decide for herself is another condition worsening fistula cases.
For Dr Ganyaglo, women must be empowered and to do that a conscious effort must be made to unlearn what has been learnt. The traditional authorities who “command a lot of respect” are to help change the narrative to enable the world rid itself of fistula by 2030.
“Most of our communities are also patriarchal so she cannot on her own go to the hospital. She has to get permission from her husband or the mother-in-law. So if these people are not available, she cannot go on her own.
So if you look at the lack of empowerment of women and the way we always consider women as inferior commodities to men, then it becomes difficult to end fistula by 2030.
The Ministry of Gender, Children and Social Protection has a responsibility and it must ensure that it coordinates and ensures gender equality and equity, promotes the survival, social protection and development of children, vulnerable and excluded and persons with disability and integrate fulfilment of their rights, empowerment and full participation into national development, as stated in Executive Instrument 1 (E.I. 1).
Dr Ganyaglo is calling for policy formulation to protect the girl child and women in the society.
“In many places, women don’t feel empowered to take decisions and this is where the Gender Ministry has a role to play. If you cannot educate the community to respect women, then you can expect the situation that affects women to continue to recur.”
“It is never up to the woman who has fistula alone,” he stressed.
You and I
- Stigma
Stigmatisation is preventing many victims from reporting to the hospitals to be treated, Dr Ganyaglo reveals.
In Ghana, victims of fistula are ostracised from society and those who are cured of the illness still receive maltreatment from members of the community. Rehabilitation is difficult for fistula survivors.
“They can’t just get up and board transport because they are smelling to start with and nobody will sit in a vehicle that is smelling of urine and faeces. We don’t really know how many women have fistula because they don’t come out”.
- Myths
It is believed that a woman suffers from fistula because she has been cursed by the gods or is being punished for being unfaithful. But interactions with Dr Ganyaglo prove that these are myths and have no truth behind them.
Due to such believes, victims are deserted and according to Dr Ganyaglo, some victims attempt suicide because they have been ostracised.
If victims are treated with compassion and love, many will be able to emerge from the shadows they are hiding and get the medical attention they need. Also, survivors will be able to muster the courage to share their experiences to encourage others that there is light at the end of the tunnel.
The way forward
Fortunately, in Ghana, surgery for treating obstetric fistula (vaginal surgery) is free since it is covered by the National Health Insurance Scheme.
But because most victims are financially unstable, they are unable to cater for their stay in the hospital days after their surgery. This is of concern and Dr Ganyaglo holds this assertion.
He therefore has called on government and organisations to support such victims.
Although International Fistula Day was held on May 23, with the theme “End Fistula Now: Invest in Quality Healthcare, Empower Communities!”, the fight against the menace must be resounded each day because every single day, a victim may be hiding in the shadows left to cater for herself.
Few tips on how obstretic Fistula victims can take care of themselves
- Bath at least three times a day
- Keep on sanitary napkins or pad
- Change your clothes frequently
- Wash your clothes and pad with soap regualry
Source: The Independent Ghana
