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Condition of

Women of
Balochistan
and Fistula

Prof. Saadat Khan


Head of Urology
Department
Sandeman Provincial
Hospital Quetta

Map Showing Pakistan


& Balochistan

The Province of
Balochistan

Balochistan is located at the southeastern edge of the Iranian plateau.

It strategically bridges the Middle East


and Southwest Asia to Central Asia and
South Asia, and forms the closest
oceanic frontage for the land-locked
countries of Central Asia.

The Province
Balochistan

Balochistan is the largest of the


provinces of Pakistan at 347,190 km
(134,051 mi),
which
composes
approximately 44% of the total land area
of Pakistan

The population density is very low due


to the mountainous terrain and scarcity
of water.

The Province of
Balochistan

Much of the province south of the Quetta


region is sparse desert terrain with pockets
of towns mostly near rivers and streams.

As per the 1998 census inhabitants of


Balochistan, were 5% of the Pakistani
population.

Culture in Balochistan is primarily tribal,


deeply patriarchal and conservative.

Women of
Balochistan

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Oppression and
Suppression

Women of Balochistan in a
snapshot..

Harsh reality

Balochistan has highest infant and maternal


mortality ratio (MMR).

Many women in rural areas are not allowed to even


visit a doctor.

Majority of women give birth to child at their homes.

Doctors are considered outsiders and are thought


of breaching the PARDA system.

Harsh Reality

In Balochistan province more then 90%


deliveries (in rural areas) are conducted by
traditional birth attendants at home.
This exposes women to a high risk for
obstetric fistulae
Majority of our fistula patients are young in
child bearing age, with 50% being below 30
years of age
Most common cause is the obstetrical
trauma.

Harsh Reality

In rural areas the only people who are


allowed near women are either
husbands or family members or TBAs
who act as physicians and the one who
assist the women in giving birth to child.

The concept that Doctors breach the


privacy and PARDA system , is more
prone in remote rural areas.

Harsh Reality

Majority of fistula cases are still


undiscovered and many women are living a
life which they consider worse than being
dead.
Fistula is more prone in the following
districts
Chaghi
Panjgor
Loralai
Harnai
Awaran

Causes of fistula in
province

Lack of health facilities.


Early Marriages
Teen pregnancies.

Traditional Birth Attendants.


Immaturely trained gynecologists.
Misconceptions about doctors and
hospitals.
Illiteracy and lack of information.

Causes of fistula in
province

Women here are oppressed by not only


the family members but also by the
culture or we can say they are
oppressed by default.
Almost all of the women in rural areas
get married around the age of 14 or 15
years.
Average marriage here in the province is
when the girl reaches her puberty.

Causes of fistula in
province

Traditional birth attendants or Dais as they


are commonly referred to, are the major cause
of fistula.

They neither have proper tools nor have skills


to conduct deliveries.

Women themselves are another cause as they


dont feel comfortable in going to or asking
their husbands to take them to hospitals.

Causes of fistula in province

Many of the fistulae were developed because


of the less trained doctors.

Obstetric as well as iatrogenic fistulae patients


were discovered whose deliveries were done
by gynecologists.

A large number of doctors need to be under


supervision
of
senior
surgeons
and
gynecologists to gain more experience.

Causes of fistula in
province

Only when the patient is at the verge of


dying, is brought to a doctor.

TBAs also create a negative image of


doctors as they consider doctors as
threat to their business.

Causes of fistula in
province

Majority of women here in province cant


even write their own names.
Women since their birth are taught to follow
the instructions of the men of the house and
later their husbands.
A place where women are not even properly
nurtured cant access the basic health care.
Men decide when to take their women to
hospitals or even to let a doctor visit them.

Causes of fistula in
province
Women are not aware of their rights and
thus are forced to do what they dont wish.
Women in rural areas are treated as child
bearing machines.
An average child count per woman is five.
Average age for a girl getting married is 15
and a girl gets pregnant as soon as she
gets married.

Causes of fistula in
province

Women in other parts of the world at-least


can decide whether they wish to have a child
or not but here they are under the command
of their husbands.

Teens are fragile and when they get


pregnant and give births to children at home
under the supervision of TBA , the end result
is devastating FISTULA

Causes of fistula in
province

Women once under the devastating condition fistula


dont know that what caused this condition t o occur;
They consider the leakage normal till they keep on leaking

even after months of delivery.


Their husbands dont know where to take them for
treatment.

Some get divorced and some are forced to live like


outcastes.

Children, husband and even parents seldom go near


such women.

Causes of fistula in
province

Many patients dont even know whether


its a curable disease or chronic.

As they are not allowed to seek medical


attention therefore they dont know that
its a minor glitch in their body and can
be repaired.

Doctors unaware of
fistula???

Some of the doctors working in remote areas


dont know where to refer the fistula patient.

They really dont know why the woman is


leaking.

Medicines ?? Yes they give the patients


medicines and after months of treatment they
declare their patients incurable.

How does the information


reach the patient???

Before the year 2006 the only source of


information, for women with fistula, were
doctors or the lucky ones who got treated.

In 2006, UNFPA started a project on fistula


and it has been the major source of
information for the people.

Our team has already repaired a large


number of fistulae.

Patients and Us

The number of patients is gradually


exponentially increasing per year.

and

Even with the limited equipment and OT facilities


we managed to bring smiles back to the faces of
many women.

Many of the patients didnt even know whether


they will get cured or will have to spend their
whole lives in misery and consider it as a part of
life.

Patients and us

God willingly we will continue to support


the patients and will continue to bring
smiles to oppressed women of
Balochistan.

Plans

Conducting seminars and disseminating the


information about fistula and its cure.

Keeping coordination with regional center


and PNFWH-UNFPA and supporting them in
helping the patients get a new life.

Disseminating the information through


meetings with other doctors.

Plans for rehabilitation of


patients..

Unfortunately there is no facility for rehab of


fistula patients in Baluchistan.
Assisting the regional center in Developing a

counseling center for patient and her relatives.


Providing psychological treatment along with the

fistula treatment.
Motivating patients and telling them that they are

just like normal beings and the condition they are


in, is not because of being cursed or punished.

Construction of
Fistula ward

PNFWH-UNFPA are providing support and


are providing funds for construction of fistula
ward at DHQ Quetta.

It will develop the Government sector to


provide better care to fistula patients.

When the project ends, the patients, will still


be getting free treatment.

Fistula Ward being constructed


at Sandeman Provincial Hospital

Fistula Ward at Sandeman


Provincial Hospital.

Message

To educate the masses regarding the importance of


disease in relation to child birth.

To eradicate the fear of the patient and the family


that the disease is not a curse and it is curable.

To conduct classes and workshops inorder to train


the gynecologists and junior doctors .

Reduction in occurrence of fistulae is better than to


increase the number of fistulae repair

Thank you for your time and


attention