19-06-13 Ugandas health facilities struggle with Fistula backlog Halima Athumani Ugandas health facilities are struggling

with the large backlog of fistula cases coupled with increasing new cases. Statistics show that Uganda gets 1900 cases each year and the number has surpassed the existing capacity if health facilities to repair the cases. Dr Amandua Jacinto the Commissioner Clinical Services at the Ministry of Health say they are only able to repair between 1300 to 1700 cases each year. However, a good proportion of women affected by fistula are not receiving the treatment required leaving a huge backlog in the communities. In Uganda an estimated 2 percent of women of reproductive health according to the Uganda Demographic Health Survey suffer from obstetric fistula which is a slight reduction from 2.6 percent. Fistula is defined as a hole between the vagina and the bladder or rectum of a woman that results in constant leakage of urine and feaces through the vagina. It is caused by prolonged labour lasting more than 24 hours and the pressure of the babys head injures the tissue in the birth canal creating a hole between the canal and the rectum or bladder. This means that there is an estimated 140,000 to 200,000 women with the problem in Uganda. Dr Amandua adds that the most common areas affected by Fistula are Western Uganda with 4.0 percent, Northern at 2.3 percent and the Central districts at 3.1 percent. The most vulnerable groups are the young, poor, illiterate and rural women who are economically disadvantaged. To what may come as good news to the rural women is that the Ministry of Health has trained a number of fistula surgeons and all 13 regional referral hospitals in the country are offering free fistula services. In some private and not for profit facilities, the cost of one operation and adjunct care of fistula costs between $ 300 to $ 400 which is prohibitive to wide scale availability and utilization of treatment services. UNFPA technical Expert on Fistula Dr Peter Mukasa reveals that in partnership with government a total of 23 fistula surgeons as well as nurses and anesthetists make up the repair team. The hospitals that provide free fistula services include Mulago, Hoima, Fort Portal, Mbale, Gulu, Arua, Jinja, Lira, Masaka, Kyenjojo, Mbarara and Kabale. Free Fistula services can also be accessed in the mission hospitals of Kagando in Kasese, Kitovu in Masaka, Kamuli, Lacor in Gulu, Kissizi in Rukungiri and Virika in Fort Portal. However, UNFPA currently has ongoing camps in Nebbi, Kagadi, Mityana, Kiboga, Kapchorwa, Karongo, Kayunga, Mubende, Kyenjojo, Gombe and Kitwe health cenbtre.

Dr Mukasa notes that the persistence of the problem reflects broader health inequities as well as wide challenges facing women and girls. These include gender and socio economic inequality, lack of schooling, child marriage and early child bearing. The main contributing factors to Fistula are the three days that are, delay in deciding to seek care at the household level, delay in accessing health facilities and delays in receiving health care at the facilities. He adds that inadequate funding for reproductive health specifically for fistula management and care, lack of essential equipment like beds, kits and lights and supplies like sutures, catheters and needles. Dr Amandua in response revealed that government has allocated 700,000 million shillings in the next financial year to treat Fistula. The Ministry has also developed a national obstetric Fistula Strategy to reduce the incident of Fistula, improve access and utilization of quality sexual and reproductive health and family planning services to prevent fistula. The other strategy is to strengthen the health capacity to provide high quality obstretic fistula treatment, strengthen community capacity and provide rehabilitation and support services to all women presenting with Fistula. Tomorrow Uganda ill mark the International Fistula Day under the theme, End the shame, end the isolation, end fistula.