'It is an amazing thing to be delivered from this illness'

In February Silué Korotoum, 34, was the first woman to have obstetric fistulas repaired under a UN Population Fund (UNFPA)-sponsored programme at the regional hospital in Korhogo, northern Côte d’Ivoire.

In 2005 she had difficulties in childbirth; the infant was stillborn, and Silué was left with an internal tear that let urine flow uncontrollably from her vagina. “This condition causes enormous shame and embarrassment. People would see my clothes wet from urine and they would mock me.

“Mentally I was deeply affected. Whenever I was around people, I was constantly thinking that they were noticing the bad smell. I was dramatically limited in my activities.

“I used to sell things in the market. One day another vendor told people about my condition. She told people I kept my soiled tissues near my merchandise, but this was not the case at all. I was always meticulous about disposing of them. After that no one would buy from me so I had to abandon that work.

“I was imprisoned by this illness that I was sure could never be cured. I have seen a lot of women chased away by their husbands because of fistulas.

“A friend had heard on the radio that the hospital was providing free operations for this condition. At first I did not believe it; I thought perhaps only women who had influential friends or relatives could come and receive such treatment for free. But eventually I came. The doctors told me it was a condition called fistulas. All I knew was that I had abnormal holes in me and this made my urine flow constantly.

“Since the operation, it is as if I am just now joining society. My mother says ever since I had the operation, I am never at home. Now I can go out and engage with people and seek a job.”

“I visit the women in the hospital who are awaiting operations for fistulas. They are nervous about the operation but they are encouraged when they see me. They hug me.

“I have to thank the doctors and all those who made this operation possible. It is an amazing thing to be delivered from this illness.”

This story, entitled COTE D'IVOIRE: Silué Korotoum, “I was imprisoned by this illness”, datelined Korhogo 7 April 2009, was written and distributed by IRIN News, the humanitarian news agency. The beautiful photograph of Silué Korotoum was taken by Nancy Palus of IRIN News, and accompanied the story.

Demand for fistula operation skyrockets in Korhogo as news spreads

The demand for the fistula operation in Korhogo is skyrocketing as women learn through local NGOs that the operation is free. Through a programme run by the UN Population Fund (UNFPA), specialists are training local surgeons and gynaecologists in Korhogo, northern Côte d’Ivoire, in repairing vesico-vaginal fistula – a hole in the birth canal caused by complicated labour and a lack of medical intervention, which leaves a woman leaking urine.

For now, 16 beds are available for fistula patients at Korhogo hospital, according to Mansaré Ladji, surgeon, gynaecologist and one of the physicians being trained to perform fistula operations. “There is a waiting list,” he said. “Women are coming from everywhere.” Since February, doctors in Korhogo have performed 25 operations.

Without subsidies the operation cost about US$300, about 10 times what most people in the region earn in a month, residents said. In the UNFPA centres – in the cities of Korhogo, Man and most recently Bouaké – services are free; the programme will continue as long as funding is available through the agency’s Thematic Fund for Maternal Health, UNFPA gynaecologist Abou Pauline told IRIN. UNFPA is urging the Ministry of Health to maintain free care for women with fistulas.

Mansaré said one of the most important goals is long-term training for local health workers to treat obstetric fistula. “We must set up something that will continue after [trainers] are gone.” In many cases women are not aware a remedy exists, or if they are, cannot afford it, according to UNFPA.

There are two types of fistula - obstetric, caused in childbirth, and traumatic gynaecologic fistula, a vaginal injury resulting from violent sexual assault or when objects are forcibly inserted into the vagina.
This is excerpted from an April 7, 2009 IRIN News story entitled COTE D'IVOIRE: Fistula – two-hour operation corrects decades-long affliction. For other stories on fistula writen and distributed by IRIN News, the humanitarian news agency, see:

PAKISTAN: Education key to preventing fistula;

BURKINA FASO: Fistula in Sahel region highlighted;

LIBERIA: Living with fistula;

MAURITANIA: Fistula - a medical and cultural problem

UNFPA's Campaign to End Fistula aims for 2015, works in 45 countries

In 2003, UNFPA and partners launched a global Campaign to End Fistula with the goal of making obstetric fistula as rare in developing countries as it is in the industrialized world. Our target date for fistula elimination is 2015, in line with MDG targets to improve maternal health. The Campaign is now working in more than 45 countries in Africa, Asia and the Arab region and involves a range of partners. In each country, it focuses on three key areas:

Prevention - The most effective way to prevent fistula is to ensure access to quality maternal health care services, including family planning, skilled birth attendance and emergency obstetric care. In the long run, prevention also entails tackling underlying social and economic inequities through efforts aimed at empowering women and girls, enhancing their life opportunities and delaying marriage and childbirth.

Treatment - While prevention is our focus, there is a strong commitment to treating women who are already affected. In most cases, a simple surgery can repair the injury, with success rates as high as 90 per cent for experienced surgeons. The average cost of fistula treatment is US $300. The Campaign supports all areas of treatment, from training doctors in fistula surgery to equipping and upgrading fistula centres.

Rehabilitation - Fistula treatment goes far beyond repairing the hole in a woman’s tissue. Many patients – especially those who have lived with the condition for years – will need emotional, economic and social support to fully recover from their ordeal. Through the Campaign, women receive counselling and skills training to help them get back on their feet after surgery. Working with communities is also key to help reduce stigma surrounding the condition and ensure women are welcomed back into society

In just three years, the Campaign has brought fistula to the attention of a wide audience, including the general public, policymakers, health officials and affected communities. More than US $25 million has been mobilized from a variety of donors. The Campaign has made remarkable progress with relatively modest funding. But the needs are great. Ending fistula worldwide will demand political will, additional resources, and strengthened collaboration between governments, community groups, NGOs and health professionals.

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