More than 70 Afghan mothers to receive obstetric fistula surgical repairs

With the technical and financial support of UNFPA, Ministry of Public Health of Afghanistan established its second obstetric fistula treatment centre in Herat regional hospital. UNFPA provided trainings for 9 health workers including surgeons, midwives and an anaesthesiologist. In this centre, 27 patients with pelvic floor disorder including obstetric fistula have received successful repair surgeries.

Obstetric Fistula is a childbirth injury, a hole or fistula from the urinary bladder and/or the rectum to the birth canal. Mainly caused by prolonged obstructed labor, the condition devastates lives of women, leaving them with constant leakage of urine or faeces or both.

Three per cent of women in Afghanistan have had symptoms of fistula, both in urban (4 per cent) and rural areas (3 per cent), however, more than half of these mothers did not seek treatment, (Afghanistan Demographic and Health Survey, 2015).

“I think I am reborn after the surgery. I am going to start a new and clean life when I go home”, said Jamila, 30, mother of one girl got a surgical repair for obstetric fistula at the UNFPA supported Obstetric Fistula Treatment Centre in Herat.

At the fistula treatment centre in Malalai Maternity Hospital an average of 5 patients receive repair surgeries every month.

The condition can be simple and repairable with one surgery session or it can be very complicated and require multiple surgeries to heal. However, the good news is that the condition is repairable and with UNFPA support there are 2 treatment centres in the Country, one in Kabul, at Malalai Maternity Hospital and another in Herat regional hospital. UNFPA plans to support the establishment of three more Fistula Treatment Centres in Nangarhar, Kandahar and Balkh.

UNFPA hired an international fistula surgeon in November 2017 to provide practical on the job training to surgeons from Herat and also Nangarhar regional hospital. Around 90 Afghan mothers living with obstetric fistula will be operated and rehabilitated to regain their normal lives.

The patients will receive repair surgeries during a period of more than one month. In the meantime, national surgeons will have enough time and clinical volume to acquire the delicate and very unique skill to repair obstetric fistula. They will observe and participate in the 90 surgical repair processes under the close mentorship and technical supervision of the international recognized surgeon.

Fistula – The affliction destroying Afghan women’s lives


A female-run clinic in Afghanistan is providing free, life-changing surgery to women suffering from fistula. (Kobra, far right, has had fistula for seven years [Picture: Mariam Alimi/Al Jazeera]

Kabul, Afghanistan – With 2,000 babies delivered each month, the Malalai Maternity Hospital in Kabul buzzes with a joyous kind of bedlam.  

Clipboard-wielding nurses power walk through the hallways. New mothers coo at tiny newborns. Every so often, a woman in labour is rushed through the throng towards the delivery room.

Writes  Danielle Moylan  – @danielle_jenni  a freelancer writing living in Kabul

 But at the end of a long hallway, away from the chaos, is a wing where women lie silent and downcast, swaddled in heavy blankets, and the only laughter comes from a Turkish soap opera playing on a television set.

Over the entrance a sign reads: Fistula Clinic.

Inside, 44-year-old Kobra, who has beautiful, strong features worn by years of tough rural living, sits on a bed covered with a plastic sheet.

“I have thought to myself every night,” she says, stretching her hands out, palms up, “why did this happen to me?”

Explained in medical terms, fistula, as dealt with at Malalai Hospital, is a hole between the vagina and the bladder or rectum, or sometimes both. It is often, but not always, obstetric – the result of a difficult, lengthy childbirth. There are many other causes too, including trauma from sexual assault and prolonged infections.

It has been all but eliminated in developed countries. When it does occur, it can nearly always be cured by inexpensive, uncomplicated surgery.

But in countries such as Afghanistan, it is destroying thousands of women’s lives.

Psychological trauma

A woman with fistula suffers chronic incontinence. She constantly leaks urine or faeces through her vagina, forcing her into a never-ending, futile battle to stay clean, made all the more difficult for the many without ready access to clean water. Some endure burns on their legs from acid in the urine.

But above all, fistula’s greatest impact is psychological. The chronic incontinence emits a foul smell, bringing the woman intense, constant shame.

Kobra has had fistula for seven years. She has iatrogenic fistula from a botched hysterectomy.

She counts herself lucky to have a supportive family, but has not held her young children in her arms for years: she’s afraid they’ll recoil from her – her clothes are often soiled and wet.

Her poverty has only exacerbated the toll of her fistula. With incontinence, she is unemployable. Her husband earns only a small daily labourer’s wage – just enough to cover the basics for a family of seven, but not for a modicum of comfort.

Unable to afford incontinence pads, she would make three trips to the bathroom every night, but would still soak her sheets. “I would wake up ashamed,” Kobra says.

Maternal health

“Ninety percent of the fistula cases I see are because of poverty,” says Dr Nafiza, the chief surgeon at the Malalai fistula clinic. Malalai is Afghanistan’s only public hospital providing fistula surgery. For those who can afford it, there are a few private clinics providing treatment for fistula.

Afghanistan’s limited access to healthcare, lack of skilled birth attendants such as midwives, and poor education create a perfect storm for fistula, Nafiza explains.

Other factors are cultural: Women in Afghanistan are often deprived of choice in family planning and even their own healthcare.

Early marriage is another problem.

Despite laws banning marriage under the age of 16, many Afghan girls are married in their early teens, often before their pelvises are fully developed to cope with childbirth.

See full article by Danielle Moylan for Al Jazeera HERE.

Woman of Courage 2014

2014-oryakhil-604-608x300_cDr. Nasrin Oryakhil, a gynecologist and obstetrician, has been recognized for her work in the field of medicine as one of the State Department’s Women of Courage for 2014. She has both improved the quality and range of health care options available to women and opened doors for other women to enter medical professions, within her home country of Afghanistan.

In 2014, Dr. Oryakhil became the Director of the Malalai Maternity Hospital in Kabul, and founded within it the first center for obstetric fistula repair in Afghanistan. With her support, the Afghan Midwives Association was established. She is the president of the Afghan Family Health Association and a member of the Afghan Women’s Network. She is currently working with a group to establish a medical council in Afghanistan.

See full report HERE.