On my last day of site visits, I went to Nebbi General Hospital, headed by Dr. Wilfred, the Senior Medical Officer. He told us that they have a backlog of Obstetric Fistula repairs now, but the goal is to not have a need for them at all. The area this hospital serves is about 40,000. It’s the only public hospital in the area and borders the Democratic Republic of Congo, where many refugees come for care.
Dr. Wilfred told me a few days before I arrived, he did consultations for two elderly women who were living with their fistula tear for ‘as long as they can remember.’ So much so they didn’t even realize it was something that could be treated. Sister Anna, a nurse on staff, calls fistula the silent killer because victims are dealing with it but suffering inwardly. Dr. Patrick shares that finding fistula clients is hard because many are forced into hiding. He believes the number of cases they predict is even higher than they imagine. His dream is that we invest in fistula repair and prevention, and train staff on proper obstetric care.
Most fistulas occur because of pregnancy complications at home. As I’ve learned during the entire trip, health centers are far for most residents, so home births are frequent. Even in cases where women are getting C-sections, there might have been a tear present that goes unnoticed. They do their best to do repairs as soon as possible, but victims can be forced into hiding early because of the stigma.
The staff is grateful to Amref, a long-time supporter of the hospital, for helping with training, fistula repair funding, and VHTs who find fistula sufferers to get them into surgery. Dr. Patrick says the VHTs trained to find fistula sufferers also help them reintegrate into society. Amref provides counseling, and other victims who’ve been repaired have formed support groups to help with reintegration. After their repair, we give them start-up capital (a seed fund they do not have to pay back) and small business training so they can begin to get income again. For those who aren’t necessarily business-savvy (relatable because I’m not at all), we help them with training in a particular trade so they can get employment that way.
Dr. Patrick shares that another prevention method is teaching girls to get pregnant when they are ready so they will stay in school and save pregnancy for when their bodies are more mature. Many fistulas occur in young girls who, while they can get pregnant, have bodies that are not yet ready to host a baby. Their pelvises can’t yet handle the dynamics of the pregnancies. Staff also encourage expectant mothers or their families to do their best to keep our equivalent of $5 ready for transport so they can deliver their babies at a facility or reach a facility early if there are any complications.