More than 200 women regain hope after fistula repair

A national campaign has given 211 Malagasy women hope for a normal life. Three hospitals on the country's South-eastern coast participated in the campaign from 19 August to 19 September 2013, providing fistula repairs free of charge.

Organized by the Ministry of Health in partnership with UNFPA, the International Society of Obstetric Fistula Surgeons (ISOFS), the non-profit organization OperationFISTULA and the University of Antananarivo, the effort was part of the global Campaign to End Fistula launched by UNFPA and its partners with the goal of making obstetric fistula as rare in developing countries as it is in the developed world.

Thousands of women and girls live with obstetric fistula in Madagascar. An estimated 2,000 women develop fistula every year in the country.

Women suffering from fistula before the surgery (photo: Guifty Banka/UNFPA)

“For every woman who dies, a family is broken. The surviving children are deprived of the care of their mother. These deaths represent the ultimate failure of maternal and reproductive health services. If the women are lucky enough to survive an obstructed labor, many will still develop debilitating childbirth injuries such as obstetric fistula,” said the UNFPA Representative in the country, Ms. Agathe Lawson.

Patients who benefited from the campaign included 19-year-old Viviane, who lived with fistula for six years before getting treatment. Viviane became pregnant at the age of 13, and although she went to see a doctor during her pregnancy, the childbirth took place at home with the assistance of a traditional birth attendant.

“After being in labour and extreme pain for three days, my parents decided to take me to the hospital. But it was too late, my baby was dead and I had developed a fistula,” Viviane said.

Another beneficiary, 46-year-old Therese, suffered from fistula for 30 years and had her sixth surgery during the campaign. “After the death of my first child, I had four pregnancies more, but all my babies were stillborn… I hope to return to a normal life after this surgery,” she said.

Malagasy surgeon-trainees with campaign organizers: Seth Cochran, founder of OperationFISTULA (third row), Dr. Edwige Ravaomanana, UNFPA Programme Officer for reproductive health (second row, third from left), Glendora Meikle, project director of OperationFISTULA (first row, first from left (Photo: OperationFISTULA)

Supporting the 2013 campaign, the World Food Programme (WFP) handed out meals to the hospitalized women and their families for the whole time they were away from home.

Three surgeons from ISOFS and the Ministry of Health trained nine Malagasy surgeons in fistula repair during the campaign. This 12-strong team of surgeons split over the three hospitals to conducted fistula repairs free of charge. “Every woman with an obstetric fistula is a failure of our health system. Girl-child education and women's empowerment are the most important contributions to prevent obstetric fistula,” said Dr. Thomas Raassen, President of ISOFS, one of the fistula surgery trainers.

Supporting skilled surgeons living in critically under-served areas in Africa and Asia, volunteer-led OperationFISTULA was also involved. "The goal of OperationFISTULA is to empower local surgeons and enable all women with fistula to be treated in a safe and high quality manner. We want to dramatically improve the lives of these women," said Seth Cochran, founder of OperationFISTULA.
 

Ten hospitals are currently offering fistula surgery in Madagascar, however there is a limited number of health care professionals with the necessary skills. Dr. Mahamat Koyalta, an experienced fistula surgeon from Chad, was among the international surgeons training Malagasy colleagues. He worked with two Malagasy surgeons who he started training two years ago. “The surgeons are excellent. In two or three years’ time, they will be able to train their colleagues,” Dr. Koyalta stressed.

Reported by Guifty Banka