BANGLADESH: NEW FISTULA CENTER IN 2010

Thanks to years of advocacy, awareness-raising, and capacity building, a new centre for fistula treatment is about to be completed in Bangladesh. Built with funds from the Islamic Development Bank and support from UNFPA, the United Nations Population Fund, the centre will be based on the premises of a public hospital in Dhaka and it is expected to house the surgical treatment of approximately 800 obstetric fistula patients annually.

Obstetric fistula is a severe condition caused by prolonged obstructed labour unrelieved by timely medical intervention. It exposes the challenges that persist in reducing maternal mortality and morbidity, especially in developing countries. With timely access to skilled assisted delivery and emergency obstetric care, these injuries can be avoided.

According to Dr. Hashina Begum, UNFPA Bangladesh Assistant Representative, while fistula incidence and prevalence data are not available, needs assessment data from six out of the country’s 64 districts point to at least 71,000 fistula cases. “This centre will provide services and also act as a referral facility for all the districts,” she says.

Major activities to be carried out at the centre include surgical procedures and pre and post-surgery counseling. The centre will also work closely with the nearby rehabilitation facility for fistula survivors who have received treatment.

Activities in the area of maternal health in Bangladesh started in 2003. At that time, there was nearly a complete absence of initiatives and opportunities for debate about obstetric fistula, then known only as a problem that leads women to be abandoned by their husbands and families, condemning them to ostracism in their own communities.

Hard Work

Since the beginning of the programme on fistula, some 2,050 fistula patients received surgical treatment in the country, with an average of 300 patients treated per year. Hashina lists other achievements: an increased capacity of service providers; increased access to quality services; and enhanced assistance to women, facilitating social reintegration.

“Fistula survivors work in the community as advocates,” she explains. Altogether 35 fistula advocates are providing counseling services on maternal health to prevent obstetric fistula and promote reproductive health at the community level.

This includes ante natal care, informing women about danger signs of pregnancy and delivery, how to access emergency obstetric care, birth planning and when and where to go in case of an emergency.

Community advocates also disseminate information and refer fistula patients to the ten medical college hospitals that already provide services on fistula and to the outreach campaigns that are organized by UNFPA in two districts of Bangladesh every year.

“Previously there was silence about fistula. Women didn’t talk about it. Now the advocates interact with them and initiate the discussion, encouraging fistula patients to look for the services,” says Hashina.

Dr. Hashina Begum, UNFPA Assistant Representative in Bangladesh, reported on the successes and challenges of the Fistula Programme in the country.

The country also invests strongly in advocacy and communication activities. In 2009, two documentaries were produced, one on obstetric fistula prevention, treatment and rehabilitation, and the other on the work of the community fistula advocates.

Behaviour change communication materials have also been developed, encouraging patients and policy makers to promote their support for fistula activities and the inclusion of fistula programming into national policies and programmes.

Advocacy meetings at community and national levels in 2009 drew more than 450 participants, including media professionals, high-level policy makers, government officials, development partners, religious leaders, professionals, NGO and civil society representatives.

As a result, national and private television channels telecasted fistula-related issues throughout the year, featuring interviews with fistula survivors. National newspapers in Bangla and English also covered the issue in news features and editorials.

But successes rarely come without challenges. The country dimensions make coverage and monitoring efforts difficult. Underlying cultural issues also hamper the efficiency of initiatives at the community level. For instance, women are not empowered to speak to community leaders and promote social change.

“I believe that most of our achievements are due to the commitment of UNFPA staff to the cause,” says Hashina. The focal point for fistula in the country is a man who has been working with the project since its inception in 2003. “His name is Dr. Mizanur Rahman, but he is so committed to the work he does that people used to call him Fistula Mizan,” she says.