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The poor woman’s disease: Living in pain for 25 years, Sursan Bibi smiles again

Published: May 22, 2015
The midwives of Koohi Goth Hospital. PHOTO: COURTESY FAISAL SAYANI

The midwives of Koohi Goth Hospital. PHOTO: COURTESY FAISAL SAYANI

QUETTA / KARACHI: For 25 long years, Sursan Bibi guarded a secret, one that she has only told her husband, Musa Khan, about. Sursan had an obstetric fistula, the pain of which is only exacerbated by the sense of shame that comes with leaking urine uncontrollably.

The prospect of treatment only came up recently, when a flyer about fistula and its treatment reached her village. Travelling 400 kilometres from Harnai district, her eldest son Hazrat brought her to Quetta. While her surgery was successful, Sursan, now 65, regrets the years of her life that were wasted.

Known as ‘the poor woman’s disease’, the obstetric fistula develops in prolonged labour when the mother cannot seek proper medical care or reach a trained midwife in time. “The baby’s head may get stuck in the birth canal and if it keeps pushing against the thin wall between the birth canal and the bladder or rectum, it causes a tear,” explains Dr Suboohi Mehdi, a surgeon at Karachi’s Koohi Goth Hospital, Pakistan’s most well-known hospital for the treatment of fistula. The result is urine or stool incontinence. For such women, who leak waste continually and are ostracised from society, normal life becomes a distant dream.

Sursan, married too early, gave birth to five children at home with the help of a dai (traditional birth attendant). In her village, the women are allowed to leave their homes only to visit relatives or take cattle for grazing; they are not allowed to seek medical help without being accompanied by their male relatives.

A day after her third child was born, she started to leak urine. The smell was unbearable. The dai told her husband that it would get better in a few days but days turned into decades, during which she bore two more children. Unlike most women suffering from this condition, Sursan’s husband didn’t abandon her.

Parts of Balochistan, like most underprivileged parts of Pakistan, have a high incidence of fistula. United Nations Population Fund (UNFPA) provincial coordinator Ahsan Tabasum, talking to The Express Tribunein Quetta, says that the UNFPA and Pakistan National Forum for Women Health (PNFWH) are working together to eradicate this disease from Balochistan.

“We have centres for fistula treatment in three hospitals in Quetta, where the patients are treated free of charge,” he discloses. Around 515 patients have received treatment here since 2006, with a success rate of over 90 per cent, while the UNFPA has helped over 5,000 women in Pakistan with surgical treatment for the disease through its seven regional centres in the country.

A lot of women travel all the way from all provinces to Karachi to get treatment at Koohi Goth Hospital. Surgeons here are trying to salvage 33-years-old Gulzada Zaman’s bladder. But for Gulzada, it may already be too late. “If only a skilled midwife would have told her in time that her next delivery should be surgically done, this girl’s life could have been saved,” laments Noor Gul, a midwife who has been serving at Koohi Goth since nine years. “The lack of awareness, and how easily the disease can be avoided, is very frustrating. Doctors cannot always reach far flung areas, so the key is having trained midwives in every part of Pakistan,” she says.

Noor and her colleagues have to not only bathe and clean the patients who arrive after strenuous journeys, but also have to psychologically counsel them and make them believe that they are not “unclean”. Complicated cases require more than one surgery, and treatment and rehabilitation can take months.

Another kind of fistula, fast increasing in number, is the iatrogenic fistula which develops when an unskilled surgeon performs a surgery poorly due to malpractice and lack of training.

UNFPA has supported more than 5000 women to receive surgical treatment for fistula in Pakistan through their seven regional centres in the country. The campaign involves three key strategies – prevention, treatment and social reintegration of survivors. Yet, more needs to be done. According to Tariq Nisar, Media Coordinator for PNFWH, “an estimated 3000 to 5000 year new cases develop each year in Pakistan.” Women like Sursan who suffer from obstetric fistula are usually among the hardest to reach, and are often illiterate and with limited access maternal and reproductive health care. With gender and socio-economic inequality, lack of schooling, child marriage and early child bearing already holding back Pakistan’s underprivileged women, patients smelling due to the fistula suffer from further marginalization. Even when cured, the psychological impacts remain, and many are abandoned by families too.

Meanwhile, Sursan Bibi’s smile has returned. “I will not advise any woman in my village to go to the dai,” she vows. “Instead, I will urge them to visit the gynaecologist.”

Published in The Express Tribune, May 23rd, 2015. 

International day to end obstetric fistula: ‘Help me stay dry’

Dr Saboohi Mehdi is one of Pakistan’s 38 surgeons who are trained to repair fistulas, but few of these 38 surgeons work in this field. “It pays no money, so most don’t want to pursue this. But I can’t do anything but this.”

Dr Saboohi Mehdi is one of Pakistan’s 38 surgeons who are
trained to repair fistulas, but few of these 38 surgeons work in this
field. “It pays no money, so most don’t want to pursue this. But I
can’t do anything but this.”


She wept inconsolably, and the doctors at Koohi Goth Hospital Karachi could not understand why. They had treated this young woman in her 20s already, and they were ready to discharge her so that she could go back to her family near Pakistan’s border with Afghanistan.

A translator was brought in who told them the real problem. “My first born is with the money-lenders as girwi (mortgage). I developed the fistula during his birth. But I was so desperate to be healed of this constant leaking that I took the chance. I needed money to reach here to get treatment.” Doctors at the hospital raised the money and sent her home. One life saved out of the nearly 5,000 women that develop the fistula every year in Pakistan. But thousands await treatment.

For fistulas, precaution is the best cure. And the cure is simple: Women of Pakistan need to deliver babies into trained hands and with basic health care facilities. This cure is still a distant dream.

Snuggled away in the outskirts of busy Karachi, Koohi Goth Hospital is Pakistan’s only hospital exclusively built to end the scourge of this preventable disease. Only, there should be not even one fistula hospital in Pakistan, because fistulas should no longer exist. “The last fistula case in England was in the 1920s. Here we are with 5,000 new cases every year,” says Dr Shershah Syed, founder of this hospital.

“If the labour is prolonged, the baby’s head can get stuck in the birth canal. If it keeps pushing against the thin wall between the bladder or rectum and the wall of the birth canal, thereby causing strain,” says Dr Suboohi Mehdi, one of the surgeons at Koohi Goth Hospital.

Another way a fistula may be formed is if, by mistake of an unskilled surgeon, a cut is caused in the bladder or rectum during surgery. “We are able to treat just 500—600 every year. Lack of awareness and no accessibility to treatment facilities is the reason,” says Dr Sajjad Ahmed, project manager Fistula Project. The project, run by Pakistan National Forum on Women’s Health (PNFWH) and UNFPA, has treated some 3,400 women since it started off in 2006.

Women suffering from fistulas leak urine or stool uncontrollably. Because of this, they are socially ostracised and lead isolated lives. The fear of leaking leads to them starving themselves, which in turn leads to malnourishment-related problems. They miss basic joys like socializing and traveling by public transport.

“I have forgotten what a normal life is. All I have done the last four lives is wash clothes,” says 40-year-old Rihana from interior Sindh. Rihana cries easily; she knows her case is a complicated one. “I don’t know how I will fix her. Sometimes, the cases are so messed up by the time they come to us that there is little we can do,” says Dr Mehdi.

“The first thing we do when a lot of them reach here is give them a shower,” says the dedicated Noor Gul, a senior nurse at the hospital. Gul is now a trainer, helping train young girls who come to the Koohi Goth Midwifery School and Hostel. Once trained, these girls will go back to their communities and be able to help deliver babies safely, so that more women do not develop this disease.

In a message on this day, the President Society of Obstetricians and Gynecologists of Pakistan (SOGP), Dr Tasneem Ashraf correctly points out that doctors must identify high risk patients for fistula development, especially pregnant women below the age of 20 years or above the age of 40 years, women who have given birth to many children, those suffering from obesity or Anemia, or having larger than normal babies.

Husbands on Board

Naz Bibi is tiny in stature but gives a resolute smile. Suffering from a fistula since the last nine years, this woman in her 40s has come to Karachi all the way from Goth Dera Bugti. She lies on a plastic sheet spread out under her, and can’t wait for the day when she will be dry once more. “Every one left me. Family, friends. I smelled all the time. I leaked non-stop. Yet, my husband was the only one in my life. He brought me here,” she says.

Naz Bibi from Dera Bugti, Balochistan, has been suffering from the condition for nine years. “Everyone left me but my husband. On way to Karachi, travelling was tough in the bus because fellow passengers were disgusted with my stench. I hope that will be over soon.”

Naz Bibi from Dera Bugti, Balochistan, has been suffering from
the condition for nine years. “Everyone left me but my husband. On way
to Karachi, travelling was tough in the bus because fellow passengers
were disgusted with my stench. I hope that will be over soon.”

“We are seeing a definite positive change in the trend. More and more husbands now support their wives through the ordeal,” says Dr Ahmed.

“My husband brought me here all the way from Sialkot,” says Fozia, who developed a fistula during the birth of her first child. “I am so excited! Once I heal, I will be able to say my namaz. I have not been able to pray for the last seven years”.

Facts in numbers

Fistula is a poor women’s disease, and the patients are 99 per cent poor women who cannot afford to get their child delivered under proper medical care.

Every year, Pakistan has 4,500—5,000 new cases of fistula. Out of these, only 500—600 reach doctors for treatment.

Pakistan has an estimated 38 surgeons who can perform fistula repair surgeries, but because this is not a lucrative line of medicine, only an estimated 15 are regularly working in this field.

Life saving info:

For information, call 0800-76200

Pakistan National Forum on Women Health

PMA House, Sir Aga Khan III Road, Karachi.

Office number: 021-32231534


Dr Sher Shah Syed

Koohi Goth Hospital




Maternal and Child Care Centre (Professor Dr Ghazala Mehmood, Dr Kausar Tasneem Bangash)

Pakistan Institute of Medical Sciences (PIMS)

Phone: 051-9260450   Mobile: 0300-5510525


Professor Yasmeen Rashid, Dr Tayyaba Majeed

Gynecology ward, Lady Willingdon Hospital

Mobile: 0300-9487305


Dr Rafeeq Anjum

Urology Ward

Mobile: 0300-6303574


Professor Nasreen Ruby and Dr Tanveer Shafqat

Gynecology ward, Lady Reading Hospital

Phone: 091-5810779  Mobile: 0300-6303574


Dr Sadrak Jalal

Christian Hospital, Mission Road.

Mobile: 0300-8381724

Professor Saadat Khan, Dr Haq Nawaz, Dr Masha Khan

Sandeman Civil Hospital.

Mobile: 0321-8198024


Professor Rafi Baloch, Dr Shaista Abro

Gynecology ward, Shaikh Zayed Women Hospital

Chandka Medical College

Mobile: 0300-3415322

Fistula relief centres


Professor Dr Nargis Soomro, Civil Hospital

Dr Azra Jameel, Sindh Government Qatar Hospital

Orangi Town, Karachi.


Professor Dr Pushpa Sri Chand

Isra University Hospital

Dr Nabeela Hassan

Liaquat University of Medical Health Sciences


Dr Rahat Ansa

Benazir Bhutto Shaheed Women and Children Health Centre


Dr Razia Bahadur

Peoples Medical College, Civil Hospital

0345-2750470; 0300-2162392

Published in The Express Tribune, May 24th, 2014.

Slide show:

Help me stay dry – Stories of hope in pictures (Photo credits: Faisal Sayani)