Obstetric Fistula - Treatment

Treatment

The nature of the injury varies depending on the size and location of the fistula, so a surgeon with experience is needed to improvise on the spot. Before the patient undergoes surgery, treatment and evaluation are needed for conditions including anemia, malnutrition, and malaria. Quality treatment in low-resource settings are possible (as in the cases of Nigeria and Ethiopia). Treatment is available through reconstructive surgery. For primary fistula repair, there is a 91% success rate. The corrective surgery alone costs about 100 - 400 USD, and the cost for the entire procedure, which includes the actual surgery, post-operative care and rehabilitation support, is estimated to cost 300 – 450 USD. Initial surgeries that are done by inadequately trained doctors and midwives increase the number of follow-up surgeries that must be performed in order to restore full continence. Successful surgery enables women to live normal lives and have more children, but it is recommended to have a Cesarean section to prevent the fistula from recurring. Post-operative care is vital to prevent infection.

Some women are not candidates for this surgery due to patient comorbidity or disease-related factors. In those cases, fecal diversion can help the patient but not necessarily cure them.

Challenges with regards to treatment include the very high number of women needing reconstructive surgery, access to facilities and trained surgeons, and the cost of treatment. For many women, 300 USD is an impossible price and they cannot afford the surgery. Access and availability of treatment also vary widely across different Sub-Saharan countries. Certain regions also do not have enough maternal care clinics that are equipped, willing to treat fistula patients, and adequately staffed. At the Evangelical Hospital of Bemberéke in Benin, there are only one expatriate volunteer obstetrics and gynecology doctor available a couple months per year, one certified nurse, and seven informal hospital workers. In all of Niger, there are two medical centers that treat fistula patients. In Nigeria, there are more dedicated health professionals who operate on up to 1,600 women with fistula per year. The world is currently severely under capacity for treating the problem; it would take up to 400 years to treat the backlog of patients. In order to prevent any new cases of obstetric fistula, approximately 75,000 new emergency obstetric care facilities would have to be built on the continent of Africa alone, plus the financial support and the even higher number of certified doctors, midwives, and nurses needed to fulfill capacity.

Besides physical treatment, mental health services are also needed to rehabilitate fistula patients, who experience a great deal of psychological trauma from being ostracized by her society and from fear of developing fistula again. Formal counseling services for fistula survivors in Eritrea show positive results.

The largest challenge that stands between women and fistula treatment is information. Most women have no idea that treatment is available. Because this is a condition of shame and embarrassment, most women hide themselves and their condition and suffer in silence with no relief. In addition, after receiving initial treatment, health education is important to prevent fistula in subsequent pregnancies.