By Kizito Makoye
DAR ES SALAAM (IDN) – Resting on her bed, Maimuna Saguti recalls the harrowing suffering she went through two months ago when she had to give birth under a mango tree while on her way to hospital.
“I don’t want to remember that day. The waters had broken hours before we reached the hospital,” she told IDN.
The 35-year-old food vendor from the village of Lukanga in Tanzania's coastal Pwani Region suffered childbirth-related complications that not only caused an obstetric fistula, she also lost her child a few hours after giving birth.
“I was perpetually leaking urine. I hardly felt the urge to relieve myself,” she said. “My pants were often smeared with faeces and I was ashamed.”
Saguti blames her problems on lack of transport and the distance to the hospital. “My baby would probably have survived if I had received urgent medical attention,” she said. “I had lost a lot of blood, I just couldn’t wait any longer.”
Obstetric fistula is caused by prolonged and complicated labour without timely medical intervention. It often affects young girls, whose bodies are not yet fully developed. Affected women are unable to control their flow of urine, faeces and blood. If not treated patients may not give birth to another healthy child.
Women with obstetric fistula are often abandoned by their husbands, rejected by their communities and forced to live in solitude and shame.
“I had to wear a discarded plastic bag in my pants to hold back leaking urine,” Saguti said.
Saguti, who is now recovering from a successful reconstruction operation at her sister’s home in Dar es Salaam, is one of the many rural women who often suffer due to lack of specialised treatment.
According to the UN Population Fund (UNFPA), there are almost 3,000 new cases of obstetric fistula in Tanzania every year.
Officials recognise that living in rural Tanzania can be deadly for pregnant women and very young children due to the shortage of doctors and the distance to a nearby health facility.
Seventy percent of the country’s population live in rural areas but there are only 0.3 doctors and 4.4 nurses and midwives for every 10,000 people, according to World Health Organization (WHO) 2014 data.
WHO reports that less than half (46.7 percent) of all births in Tanzania are attended by a skilled health worker of any kind, a reality that contributes to higher child mortality rate.
While the country has made significant progress towards improving its health services, major infrastructural challenges remain, including getting more health workers out to rural areas, which have only 9 percent of the country’s doctors and 28 percent of its workforce, according to the Service Delivery Indicators (SDI) 2016 report commissioned by the World Bank.
Tanzania’s maternal mortality rate is very high at 432 deaths per 100,000 live births, according to the report.
In an effort to relieve fistula survivors, Tanzania government has instructed all public hospitals to give free treatment to fistula patients seeking treatment.
Ummy Mwalimu, Minister for Health Community Development, Gender, Elderly and Children, said the fistula problem is on the rise, mostly affecting low-income poor women who often fail to get the right treatment.
Mwalimu said that although statistics show that roughly 2500-3000 women are left with a fistula each year, the number is much lower than the real situation on the ground where most cases go unreported because most patients are stigmatised by their families and the community in general
“The government is fully determined to serve marginalised people and, by virtue of my authority, I have exempted all fistula patients from paying for treatment,” she said. “I have instructed all referral and zonal hospitals to treat fistula patients seeking treatment free of charge.”
According to the minister, in order to ensure that the free service is used as widely as possible, all hospitals have been asked to conduct special clinics to raise awareness on the scale of the problem. “Most of these women are poor,” noted the minister. “When they get this problem they cannot carry out their activities.”
While health services for pregnant women are free in Tanzania, analysts say poor women in rural areas are still facing hurdles to access them due to logistical problems.
“Poverty is the root cause of this state of affairs, where decisions to give birth are taken by husbands or relatives who are unaware of the unsafe practices women often suffer,” said Eireen Darlington, a midwife and trainer at Kulangwa Printmat Nursing and Midwifery school in Dar es Salaam.
The Tanzanian government launched its National Fistula Programme in 2005 and it has helped raised awareness on prevention and treatment of obstetric fistula among thousands of women across the country, according to officials.
Various over initiatives have been taken to help fistula survivors in the last decade. In 2011, the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) programme, in conjunction with the Vodacom telecommunications company, launched a programme to provide fistula patients with transport costs for their repair surgery through the M-Pesa mobile banking system.
According to CCBRT, the money is sent via SMS to so-called “fistula ambassadors” who identify women suffering from the condition and buy tickets for them to be transported to hospital.
"Awareness-raising campaigns continue to help women and girls of Tanzania overcome this condition that leaves sufferers in isolation and shame," said Mwalimu. [IDN-InDepthNews – 24 August 2016]
Photo: A fistula patient. Credit: Kizito Makoye