Access to fistula treatment is a rare privilege for many Cambodian women who live in poor, remote areas and have suffered with this devastating childbirth injury in silence for decades. Now it is possible for them to regain their lives through services supported by UNFPA in partnership with the Children’s Surgical Center (CSC). For the women who endured the condition and their families, it is a blessing to be given back their lives with a renewed sense of hope and confidence.
After years of civil war, Cambodia is still rebuilding its infrastructure. As people struggle for survival, access to information and services remain a challenge, and fistula repairs have not been made available until recently.
In the past, many women had no access to maternal health information or care due to limited resources. Those who lived in rural areas often relied on traditional healers or untrained attendants as their only options.
Cambodian women are often marginalized by society. They have less access to education and public services, and fewer opportunities for employment and political participation. Women are expected to take care of the house, children, sick persons and the elderly -- most often, they do not attend to their own health, tolerating various burdens.
“Besides doing house work I have a very old and sick mother to take care of everyday,” said Met Yorm, 50, who lives in Trapean Veng Khang Lech, a small village about 60 km south of Kampot provincial town. She developed a fistula due to obstructed labour in her 4th pregnancy and suffered with the condition for 20 years.
Met Yorm, 50, sits on a hammock under her wooden house in Trapeang Veng Khang Lech village. The track to the main road wastes away during the rainy season and transportation remains a challenge.
The Children’s Surgical Center started a project to address obstetric fistula and help women in remote locations obtain treatment in a safe facility with international professional standards.
With support from UNFPA and in partnership with CSC, Dr. Claude Dumurgier, a fistula specialist from France, has taught Khmer surgeon Dr. Ou Cheng Ngiep his surgical techniques.
Poorer women living in rural areas, who were unaware of treatment or unable to afford services, can now receive free surgical repair facilitated by the joint-initiative toward ending fistula in Cambodia.
Outside of CSC, private surgeries are often a woman’s only alternative in the country. However, lack of resources for treatment or a simple bus fare for transportation to a clinic are major obstacles that often prevent women from seeking treatment.
Most women who suffer from fistula live in remote areas where roads, transportation, and health services remain a challenge. To add to this, poor women have little knowledge about reproductive health issues such as fistula.
Sah Sin at the CSC’s Chenda Poly Clinic in Phnom Penh learns that she is healed after a successful operation.
“This is what I lived with after having a baby,” said Sah Sin, 58, when interviewed at the CSC’s Chenda poly-clinic in Phnom Penh, where she underwent a free fistula surgery. “I am so happy to hear that the [urine] leakage is gone,” she added after follow-up visit at the Children’s Surgical Center.
Sah developed a fistula during her first pregnancy, in the early 1970’s, when she gave birth to a stillborn child during the country’s civil war. She was relocated under the new regime to live in a camp, where a traditional birth attendant delivered her baby.
A few weeks after delivery, she realized she was leaking urine uncontrollably. At the time, she was unaware of other women with the same problem and did not know how to manage the situation. Unable to consult with experts, she lived with the life shattering consequences of fistula for over 30 years.
“I avoided meeting people. I am so depressed to live with this condition.” Tak Eap, ready to undergo surgery at the CSC’s Chenda Poly Clinic in Phnom Penh.
Tak Eap, a 42-year-old fistula survivor from Kampot province, developed the condition in the late 1990s after delivering her first child. She was in labour for two days before her family decided to send her to a hospital. She lost consciousness while being transported from her village and woke the next day in a hospital bed to a stillborn baby and no concrete memory of the delivery process.
A few weeks later, her husband left her after finding out that she was leaking urine. She started to isolate herself from the other villagers because she could not control her bowel movements and could not manage to change her sarong in time.
“It was in 1999. I was in labour for days, then I was sent to a hospital and my baby was stillborn. After, my husband found out that I was leaking and wetting myself. He left me – it was embarrassing [because] my body [smelled],” said Tak.
Small family incomes, mainly from farming, go almost entirely to basic needs in Cambodia, giving women less opportunity to seek health care services such as fistula treatment. The CSC outreach team goes out to meet with these women in target provinces to raise awareness and disseminate information about fistula.
“We inform health workers and village chiefs about our upcoming trips and have found that, upon arrival, some of the women are already waiting for us,” said Sam Sitha, Outreach Coordinator for CSC.
Mass media is another effective way to reach patients, especially those living in remote areas where infrastructure is still a challenge. Radio is the most preferred form of communication in rural communities.
“After I heard about fistula on the radio, I talked to my husband and daughter. Then, I [went] to the CSC in Kean Kleang, Phnom Penh," said Sin.
As part of a pilot project started in December 2009, the Children’s Surgical Center targeted four provinces in northeastern Cambodia -- Ratanakiri, Mondulkiri, Preah Vihear and Stung Treng -- where free fistula treatment has already been provided to almost 30 fistula survivors.
Sam Ean and her grandson at home in Paur village, 75 km south of Phnom Penh, after a successful fistula surgery on July 2012.
Sam Ean and her family were in despair and reluctant to seek treatment after the previous attempts to repair her fistula failed. At the beginning, she was so depressed that she locked herself in the house for months.
For 28 years, she tried local healers suggested by friends, relatives and neighbors but found no relief. They all believed that her condition could not be healed. She ended up believing she would have to live with the problem forever.
“I didn’t know where to go for treatment, except seeking help from local healers and the district hospital. But they could not treat it,” said Ean. “I [underwent] two fistula surgeries before coming to CSC in mid-2011. I am so excited and [cannot] express … enough how happy I am now…” said Ean when sharing her experience with her neighbors.
“We are delighted to see that life restoring surgery is now being provided to the long neglected women with obstetric fistula in Cambodia,” commented Gillian Slinger, Campaign to End Fistula coordinator at UNFPA. ”This is a big step forward and perfectly reflects the power of partnerships that underpins the campaign, to ensure help reaches some of the poorest and most marginalized women and girls in the world.”
Reported by Sophanara Pen. Photos: UNFPA Cambodia.
The report, recently released by UN Secretary-General, Ban Ki-moon, calls for systematic notification of fistula cases and the creation of national registers to ensure proper care, follow up and support for all fistula patients.