Ill-trained surgeons blamed for fistula cases

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Ill-trained surgeons and inadequate obstetric care facilities at government hospitals can be blamed for about 30 per cent of fistula cases — genital tract complications due to obstructed labour —reported every year in the country. This was stated by the president of the Pakistan National Forum on Women`s Health (PNFWH), Dr Shershah Syed, at a press conference on Thursday at the Karachi Press Club on the issue of fistula and women dying in pregnancy and during childbirth. He said that genital tract fistula was a problem which destroyed women`s lives and made them unable to live life like a normal person in society. General secretary of the Society of Obstetrics and Gynaecologists Pakistan (SOGP) Dr Nighat Shah, programme officer of the UNFPA Dr Faria Ahsan and Dr Lauri J. Romanzi from the US — who is included among the foreign delegates of a three-day international conference on the issues related to fistula complications starting on March 4 — spoke at the press conference. Dr Shershah said that the PNFWH was concerned about fistula formed by untrained surgeons and gynaecologists. With a rate of 4,000-6,000 new fistula cases every year, it is estimated that there were about 150,000 fistula patients in the country, he said, adding that 2,000-2,500 fistula cases were given treatment every year. He said that fistula related situation was indeed not good, but it was encouraging that almost 97 per cent of the women brought to different centres for free treatment returned after successful surgical management. Only a proactive role of the government towards provision of basic health facilities in all government healthcare centres, training of relevant staff and safe motherhood and emergency obstetrical care could help timely alleviate the plight of thousands of women suffering from fistula, he said. The obstetric fistula is considered a disease of the people who did not know about the problem or have no access to hospitals for a timely intervention, the senior health practitioner added. He stressed the need for awareness of the fistula and elimination of misconceptions and stigma related to childbirth to help stop new formation of fistula and reduce maternal mortality and morbidity. He urged the government to give the maximum priority to women suffering from pregnancy related complications and ensure that the existing fistula treatment centres run with the support of the UNFPA were owned by it and continued in the years to come as well. Dr Nighat Shah of the SOGP discussed the case of a fistula formation in a 13-year-old patient and remarked that it was cultural taboos, unmatched and early-age marriages and malnutrition among pregnant women that generated the cases of fistula. About 15 per cent of all delivery cases needed emergency hospital obstetrical care and if that were not met, then chances of complication remained there, she said. She said that sometimes the lack of awareness and poverty also caused a preventable fistula. Dr Ahsan of the UNFPA said that under the “campaign to end fistula” programme with the support of the UNFPA and the government of Pakistan seven regional centres had been established for free treatment of fistula patients. “These centres are also providing training facilities to postgraduate students interested in fistula repair surgery.” Dr Romanzi said that fistula treatment centres had been closed in the US in late 19th century as it had become preventable by that time.