Asia-Pacific, Development & Aid, Headlines, Health

HEALTH-PAKISTAN: Poverty, Poor Health Services Condemn Women to Disability

Zofeen Ebrahim

KARACHI, Feb 9 2004 (IPS) - ”It’s her misfortune that she’s alive. Those who die are luckier.” The words were those of a woman whose only daughter suffered from obstetric fistulae, a disability resulting from obstructed childbirth that experts have said afflicts tens of thousands of women per year in Pakistan and the rest of South Asia.

She wiped tears from the face of her daughter, 23-year-old Jannat, adding: ”She tells me to kill her. You tell me, can a mother do that?”

Prolonged and unrelieved obstructed labour had caused Jannat to deliver a dead infant, said Shershah Syed, the doctor in charge of the gynaecology department at this port city’s Qatar General Hospital, where Jannat’s family brought her for emergency care.

Although Jannat had survived, the obstructed labour had ruptured the internal passages of her bladder and rectum, leaving her permanently incontinent, unable to contain her urine or faeces. The waste matter leaked continuously through her vagina, leaving her constantly wet, filthy and smelly.

”I clean her all the time and yet the nurses scold me and say she stinks,” her mother said on condition she not be identified by name.

Rather than being comforted over the loss of her child, the woman with fistulae often is rejected by her husband and her surviving children can be consumed in caring for her.

Said Farida, another fistula sufferer: ”I gave birth to twins, one of whom died, and I developed this problem. I was completely on my own as my husband had to go for work. I not only had to take care of the newborn, but the older two. My 11-year-old helped me as much as she could but after a few days I had to take them off from school, as I just couldn’t manage. I had to continuously wash my soiled clothes and I smelled so much, I could barely keep myself sane. I remember crying all the time. So in between taking care of the home, the chores and nursing the young one, tell me, did I get time to miss my dead baby?”

Jannat faced additional pressure to get well: her marriage was on a ”watta satta” basis, meaning that when Jannats hand was given in marriage, her husbands sister was betrothed to Jannats brother. So if Jannats husband would not accept Jannat with her condition, the pact would be broken and her brother would not be able to marry his childhood sweetheart.

Surgery to repair obstetric fistulae is relatively simple and successful in about 95 percent of cases, but few people seem to know this despite years of awareness-raising efforts by U.N., aid, and government agencies, non-governmental organizations and individual doctors.

Yet, women who remain untreated not only face a life of shame and isolation, many also face a slow, premature death from infection and kidney failure.

However, Syed and his colleagues here and in other developing countries strive to improve the outlook for Jannat and others among the two million women worldwide said by the World Health Organization to be afflicted with fistulae.

Syed has run an annual ”fistula camp” in Sindh province’s rural interior in the decade since he received surgical training at the Addis Ababa Fistula Hospital in Ethiopia. Women who come to the camp are treated free of charge.

Many learn this too late: Syed recalled that one patient sold her two young daughters to come up with money for the surgery, only to learn that she did not need any money.

In Bangladesh, at the other end of the South Asian subcontinent, the government has announced plans to establish a National Fistula Center with assistance from the U.N. Population Fund (UNFPA).

Syed, a longtime advocate of improved emergency obstetric care and other measures to reduce the incidence of fistulae, said similar steps appeared unlikely in Pakistan. ”There is no reliable data available and nobody knows about this problem, and there is no place for such women in Pakistans national health policy,” he said.

And that, Syed said, is exactly the trouble: The problem receives scant attention because it afflicts mainly the poor.

”Do you see women from Nawaz Sharif, Benazir (Bhutto) and Pervez Musharrafs family suffering from this disease?” he asked, referring to the country’s last two elected prime ministers and its current president. Abdul Hakeem Jokhio, another doctor, termed it ”a disease of poor health provision.”

That seemed to have been the case with Jannat. ”After ten years of marriage Jannat had finally conceived, only to give birth to a dead child in the wilderness with the help of an untrained midwife,” Syed said.

In the absence of bold moves to improve health services for poor women, Syed and his colleagues are left to measure progress one woman at a time.

Nasreen, 25, from the northern city of Peshawar, said she had suffered from fistulae for six years. ”We left no stone unturned. I had tried homeopathy and indigenous herbal medicines, even gone to hakims (faith healers) for prayer. Then, when we had given up all hope, somebody told us about Dr. Shershah. Thank God Im cured,” she beamed.

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