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HEALTH-SENEGAL: Fistula Sufferers Left To Their Fate

DAKAR, Jun 30 2009 (IPS) - In Senegal’s southern region, 58 percent of deliveries take place at home without any medical assistance, according to state reproductive health officials in Kolda, a town 425 km from the capital, Dakar. Women in the region suffer from exceptionally high rates of fistula.

There are just seven doctors for every 100,000 people in Senegal; just one midwife for every 400,000 people. Credit:  Dima Gavrysh/UNFPA

There are just seven doctors for every 100,000 people in Senegal; just one midwife for every 400,000 people. Credit: Dima Gavrysh/UNFPA

Obstetric fistula occurs when extended pressure damages the soft tissue in a woman’s pelvis during the process of giving birth. The tissue eventually dies from the lack of blood supply, and a hole develops between either the rectum and vagina or between the bladder and vagina, causing a woman to lose control of the flow of urine and sometimes faeces.

Dr Charles Antoine Diatta, president of the Medical Commission of Kolda’s regional hospital, says for every 20 deliveries at the hospital, at least nine women develop fistula. The cause, he says, is inadequate monitoring during pregnancy.

He explains to IPS, “In our southern regions, girls are married off between the ages of 13 and 15. They are right in the middle of adolescence and from a morphological perspective, their pelvic girdles are not yet fully developed. This is one of the causes of fistula because at delivery, labour is prolonged.”

According to Diatta, the cost of medical care for a fistula sufferer is between 70,000 and 150,000 CFA francs (up to $320).

“The extreme poverty in these communities means that fistula sufferers stay away from health facilities and often do not return after a consultation. Being ashamed of their condition also keeps them away, as well as their awareness of the odour they give off.”

Fatou Sow is aged 55 and comes from the village of Sarre Kemo in the Kolda region. She has fistula. Her lined, troubled face tells the story of the inner suffering of a woman burdened with the illness for over 15 years.

According to Sow, it was during her sixth delivery that fistula occurred. “My husband, who already has two other wives, left me. I felt bad and spent my days hiding from prying eyes,” she says.

She explains to IPS that it was one of her neighbours who told her about treatment for fistula. “I then went to the hospital in Kolda for medical examination. There I met the UNPFA awareness team (United Nations Population Fund). They took me in and I was successfully operated on – for free.”

But not all fistula sufferers in southern Senegal are so lucky. Roukhia Ba, a 24 year-old mother of one, developed fistula aged just 13.

“It was during my first delivery that I got fistula. My husband deserted me, my family too. I sometimes go to hospital, but often cannot for lack of money. We need the state to help us. So many of us are living with this condition,” she tells IPS.

According to Dr Jacques Diam Ndour, head doctor in Kolda district, the southern region of Senegal is very isolated and hospitals are in dire need of staff and equipment.

The World Health Organisation (WHO) reports that there are seven doctors in Senegal for every 100,000 people, and one midwife for every 400,000 people. In the Kolda region which comprises around 850,000 inhabitants, there are nine doctors and four midwives. And in the region of Ziguinchor in the south-west, five doctors and two midwives attend to a population of 550,000.

These ratios fall far short of WHO standards. The 2006 global health report estimates that countries with less than 2.28 doctors, nurses and midwives per 1,000 people, generally do not meet the target of 80 percent of births attended to by skilled personnel and 80 percent of children vaccinated.

“We have a skilled staff shortage in this area. One must consider that all of Senegal’s midwives are in Dakar, in Thies in the central region and in St. Louis, the former colonial capital to the far north. We need to send more midwives to remote areas in the south, thus reducing birth-related complications,” Ndour tells IPS.

Adama Ndoye, who heads up the UNPFA’s reproductive health bureau, believes that if there are many fistula sufferers in southern Senegal, it is because the region is seen as very conservative and very rooted in tradition.

Ousmane Baldé, imam at the Grand Mosque in Kolda, laments the quality of life of fistula sufferers in the region but says religious leaders cannot be held responsible for the situation.

He tells IPS, “If a parent wants to marry off their 10, 11 or 12 year-old daughter to an octogenarian, we cannot refuse it. We simply see the process through and make sure it is conducted as tradition demands. I believe it is the state which is at fault here. The nursing complement is inadequate.”

According to Assane Diagne, head of public health in Kolda, the government has often undertaken joint campaigns with the UNFPA to fight against and eliminate fistula in Senegal.

“Between January and March this year, the state organised awareness campaigns and treatment for fistula. Doctors treated around ten women in Ziguinchor, further south, and in St. Louis, to the north. These campaigns are also an opportunity to train surgeons and gynaecologists practicing in these areas,” he tells IPS.

Ousmane Diaw, a Kolda high school senior, believes it necessary to create greater awareness amongst both young people and their parents.

He tells IPS, “Here, girls don’t get to go to school. They are married off at an early age. I have classmates who were taken out of school to be married off. Some died during childbirth and others developed fistula. I think it is important for parents to change their thinking, but we must also severely punish women who carry out female circumcision.”

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