End of miseries

*Meera Kumar had been bearing untold miseries since childbirth. The denial of adequate medical help during labour resulted in obstructed labour, which resulted in a hole in urinary bladder and she had to bear perennial urinary incontinence. It was like living hell!

Meera underwent three surgeries in Gujarat to close the hole but the problem persisted. She had almost lost hope that she could get rid of urinary incontinence. However, her agonies came to an end when she visited PSRI hospital. She was diagnosed to have what is technically termed as persistent VVF (Vesico Vaginal Fistula). After examination and suitable investigations, Dr. Rajesh Taneja, senior consultant urologist decided to repair her urinary bladder. She underwent a tedious abdominal surgery, made difficult due to previous operations, and lasting almost 6 hours to repair the leak in her urinary bladder. But at last, this was the end of miseries for her and her family.

God has gifted woman with the ability to create. But, giving birth to a baby actually translates in the rebirth for the mother too, and for good reasons. For years obstetric fistula, which is an injury of childbearing has inflicted untold pain and miseries on the lives of mothers. In fact obstetric fistula is a hole between the birth canal and one or more of a woman’s internal organs, usually the bladder and/or the rectum. The hole develops after several days of obstructed labour when the pressure of the baby’s head against the mother’s pelvis cuts off the blood supply causing the tissue to die and the hole to form. Without treatment for obstetric fistula, the woman is left with chronic incontinence, unable to control her flow of urine or faeces, and is often ostracised by her family and community. Many women report feelings of humiliation, pain, loneliness, shame and mourning for the loss of their lives and the child they lost during delivery. Because of the constant leaking and smell, many women are isolated from food preparation and prayer ceremonies because they are thought to be constantly unclean.

Obstetric fistuala is in fact reflection of the status of women in the society. Proximal causes that can lead to the development of obstetric fistula concern issues of poverty, lack of education, early marriage and childbirth, the role and status of women in developing countries, and harmful traditional practices and sexual violence. Poverty, early marriage, and lack of education place women in positions of severe disadvantage and do not enable them to be advocates for their own health and wellbeing.

Again access to obstetric emergency care can prevent the development of obstetric fistula. This includes the availability and access to medical facilities that have a trained staff and specialized surgical equipment needed for cesarean births.

Surgical closure of the fistula is successful in about 90% of cases during the first repair in the best of hands. The prognosis worsens steeply if there have been any previous attempts at the repair. The biggest challenge in developing countries is, of course, prevention of obstetric fistulae. Successful surgery enables women to live normal lives and have more children, but it is recommended to have a cesarean section to prevent the fistula from recurring. Post operative care is vitally important to prevent infection.

Some women are not candidates for this surgery, but can seek out alternative treatment called a urostomy and a bag for the collection of urine is worn on a daily basis.

* Name of the patient has been changed to protect her identity

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