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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.”

KARACHI: 

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

Karachi:

Dr Sher Shah Syed

Koohi Goth Hospital

0315-8230856

0333-3026437

Islamabad:

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

Lahore:

Professor Yasmeen Rashid, Dr Tayyaba Majeed

Gynecology ward, Lady Willingdon Hospital

Mobile: 0300-9487305

Multan:

Dr Rafeeq Anjum

Urology Ward

Mobile: 0300-6303574

Peshawar:

Professor Nasreen Ruby and Dr Tanveer Shafqat

Gynecology ward, Lady Reading Hospital

Phone: 091-5810779  Mobile: 0300-6303574

Quetta:

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

Larkana:

Professor Rafi Baloch, Dr Shaista Abro

Gynecology ward, Shaikh Zayed Women Hospital

Chandka Medical College

Mobile: 0300-3415322

Fistula relief centres

Karachi:

Professor Dr Nargis Soomro, Civil Hospital

Dr Azra Jameel, Sindh Government Qatar Hospital

Orangi Town, Karachi.

Hyderabad:

Professor Dr Pushpa Sri Chand

Isra University Hospital

Dr Nabeela Hassan

Liaquat University of Medical Health Sciences

Abbottabad:

Dr Rahat Ansa

Benazir Bhutto Shaheed Women and Children Health Centre

Nawabshah:

Dr Razia Bahadur

Peoples Medical College, Civil Hospital

0345-2750470; 0300-2162392

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

http://tribune.com.pk/story/712365/international-day-to-end-obstetric-fistula-help-me-stay-dry/

Slide show: http://tribune.com.pk/multimedia/slideshows/712507/

Dignity restored: The blessing of being ‘dry’

Read this & realize your blessings! You can save a woman’s life by donating to Koohi goth Fistula Hospital Karachi.

https://www.facebook.com/pages/Koohi-Goth-Hospital/460865483924659

Published: June 30, 2013

Only 30 surgeons in Pakistan can treat the condition. PHOTO: SARAH MUNIR

KARACHI: It is 99.9% a disease of extremely poor women. Nobody from the affluent families will suffer from it. So long as its poor women, no one cares, says Dr Shershah Syed, the man responsible for setting up Koohi Goth Hospital, the only primary healthcare facility for women suffering from the condition called fistula.

He has made possible the treatment of 10,000 women suffering from the unthinkable medical condition. Yet, it’s not enough. Every year, the list of women who are suffering from a fistula increases by 5,000 approximately, and trained surgeons in Pakistan who can perform the surgery that can cure them are just 30! Yet, there is light at the end of the tunnel.

Selling goats to get treatment

Nineteen-year-old Noorbano from Khuzdar, Balochistan, is one such woman. She walks slowly towards the dining area from her bed in the recovery ward of the Koohi Goth Hospital. Her wounds are still raw. She has had three surgeries and has three more to go. “I developed the fistula during the birth of my second baby who did not survive. I would keep leaking all the time. Nobody even wanted to sit next to me,” she explains with the help of a translator. “It’s my husband who supported me. He had a few goats which he sold for my treatment. We travelled from Khuzdar to Hub and from there to Karachi. It was worth it,” she says with a smile.

As fistula is directly related to poverty and lack of resources, Balochistan has the most patients, followed by rural areas of Khyber-Pakhtunkhwa and Sindh.

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Pakistan’s understated scandal

“Is it not the biggest scandal that 30,000 young women are dying every year due to pregnancy-related causes and no one cares?” says Dr Shershah.

The women suffering from obstetric fistula develop the condition when child birth is not done by trained medical persons and the nearest hospital is at times hours away in rural Pakistan with no infrastructure or money to travel. “If the labour is prolonged, which is mostly when the woman is having her first baby, the baby’s head may get stuck in the birth canal in a way that it keeps pushing against the thin wall between the bladder or rectum and the wall of the birth canal, thereby causing and tear,” says Dr Suboohi Mehdi, one of the surgeons at Koohi Goth Hospital.

Another way a fistula may be formed is when an unskilled surgeon performs a surgery and by mistake causes a cut in the bladder or rectum.

Apart from treating women at the Koohi Goth facility, completely free of cost, a midwifery school is training midwives to help women deliver safely. Surgeons are trained to perform the surgeries, and teams then setup small units all over Pakistan. The patients are taught life skills and vocations during the long rehabilitation process. The hospital relies on donations for its running.

The answer lies in efforts for better maternal health for the women of Pakistan.

“The dream is very simple – that every woman has a right  to basic obstetric care, in case of an emergency, at her doorstep, free of charge. And it can be done,” says a hopeful Dr Shershah.

Published in The Express Tribune, June 30th, 2013.

http://tribune.com.pk/story/570321/dignity-restored-the-blessing-of-being-dry/