Unsettling the fistula narrative: cultural pathology, biomedical redemption, and inequities of health access in Niger and Ethiopia (original) (raw)
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Qualitative Health Research, 2018
Uganda has one of the highest obstetric fistula rates in the world with approximately 200,000 women currently suffering. Surgical closure successfully treats fistula in the majority of cases, yet there is a severe shortage of facilities and trained surgeons in low-resource countries. The purpose of this study was to examine Ugandan women's experiences of obstetric fistula with the aim of adding narrative depth to the clinical literature on this devastating birth injury. Data were collected through semistructured interviews, focus groups, and participant observation. Resulting narratives were consensus coded, and key themes were member-checked using reciprocal ethnography. Women who suffered from fistula described barriers in accessing essential obstetric care during labor-barriers that are consistent with the three delays framework developed by Thaddeus and Maine. In this article, we extend this scholarship to discuss a fourth, critical delay experienced by fistula survivors-the delay in the diagnosis and treatment of their birth injury.
BMC pregnancy and childbirth, 2017
The consequences of living with obstetric fistula are multifaceted and very devastating for women, especially those living in poor resource settings. Due to uncontrollable leakages of urine and/or feces, the condition leaves women with peeling of skin on their private parts, and the wetness and smell subject them to stigmatization, ridicule, shame and social isolation. We sought to gain a deeper understanding of lived experiences of women with obstetric fistula in Malawi, in order to recommend interventions that would both prevent new cases of obstetric fistula as well as improve the quality of life for those already affected. We conducted semi-structured interviews with 25 women with obstetric fistula at Bwaila Fistula Care Center in Lilongwe and in its surrounding districts. We interviewed twenty women at Bwaila Fistula Care Center; five additional women were identified through snowball sampling and were interviewed in their homes. We also interviewed twenty family members. To ana...
Reflections on Identity: Narratives of Obstetric Fistula Survivors in North Central Nigeria
Qualitative Health Research, 2019
Obstetric fistula is a condition that affects women and can lead to identity changes because of uncontrolled urinary and/or fecal incontinence symptom experiences. These symptoms along with different emerging identities lead to family and community displacement. Using narrative inquiry methodology that concentrates on the stories individuals tell about themselves; interviews were conducted for 15 fistula survivors to explore their perception of identities of living with obstetric fistula. Within a sociocultural context, these identities consist of the ‘Leaking’ identity, ‘Masu yoyon fitsari’ (leakers of urine) identity, and the ‘Spoiled’ identity, cause stigmatization and psychological trauma. The ‘Masu yoyon fitsari’ identity however built hope and resilience for a sustained search for a cure. Identity is a socially constructed phenomenon and the findings reveal positive community involvement which reduces obstetric fistula stigmatization and improves women’s identity. Sexual and reproductive health issues remain of grave concern within a contextualized societal identity of women’s role.
International Urogynecology Journal, 2006
The vesico-vaginal fistula from prolonged obstructed labor has become a rarity in the industrialized West but still continues to afflict millions of women in impoverished Third World countries. As awareness of this problem has grown more widespread, increasing numbers of American and European surgeons are volunteering to go on short-term medical mission trips to perform fistula repair operations in African and Asian countries. Although motivated by genuine humanitarian concerns, such projects may serve to promote 'fistula tourism' rather than significant improvements in the medical infrastructure of the countries where these problems exist. This article raises practical and ethical questions that ought to be asked about 'fistula trips' of this kind, and suggests strategies to help insure that unintended harm does not result from such projects. The importance of accurate data collection, thoughtful study design, critical ethical oversight, logistical and financial support systems, and the importance of nurturing local capacity are stressed. The most critical elements in the development of successful programs for treating obstetric vesico-vaginal fistulas are a commitment to developing holistic approaches that meet the multifaceted needs of the fistula victim and identifying and supporting a 'fistula champion' who can provide passionate advocacy for these women at the local level to sustain the momentum necessary to make long-term success a reality for such programs.
2015
Niger on Outcomes of Fistula Repair Surgeries, Closure Versus Continence………………………………….112 5.4 Clinical File of a Woman with a "Simple," Small Fistula……………………………...117 5.5 Clinical File of a Woman with a "Complex" VVF and RVF…………………………..117 5.6 Model of Methods Commonly Used to Inflate Success Outcomes………...…………..128 5.7 Clinical File of a Woman with Complex Fistula…………………………………….…132 6.1 Photographs of Women During Reintegration Activities………………………………162 6.2 Photograph of a Fistula Patient Wearing Fabric Advertising Fistula Awareness and Treatment……………………………………………..………..167 6.3 Photographs of Women with Fistula Publically Giving Thanks……………………….168 7.1 Marital Status of Women with Fistula…………...……………………………………..183 7.2 Current Marital Status by Type of Marriage……………………………………………187 7.3 Relationship Between Age and "Forced" Marriage…………………………………….191 7.4 Age at First Marriage of Women with Fistula…….……………………………………196 7.5 Age at First Birth of Women with Fistula……….……………………………………..197 7.6 Number of Co-Wives of Women with Fistula……….…………………………………205 8.1 Photographs of Wanzami and His Tools……………………………………………..…230 9.1 Mortality Percentage of Children of Women with Fistula Calculated by Number of Full-Term Pregnancies Brought to Parturition, Including and Excluding Stillbirths………………………..……………254 9.2 Materials Used to Educate Rural Villagers in Niger on Fistula Prevention…………....265 9.3 Length of Time During Labor Women with Fistula Waited Before Going to a Hospital or Clinic…………………………………..…….…266 vii 9.4 Materials Used to Educate Rural Villagers in Niger on
Frontiers in Global Women's Health, 2020
Each year an estimated 50,000 to 100,000 women worldwide are affected by obstetric fistula. This devastating but preventable maternal morbidity leaves women incontinent, stigmatized, isolated, and often with a still birth. While fistula rates in Ethiopia have declined in recent years, estimates range from 7 to 40 percent of women suffer from persistent urinary incontinence after successful closure of their fistula. Few studies have focused on the unique experiences and challenges that providers face treating fistula patients, particularly those who experience persistent urinary incontinence. The goal of this research is to characterize the fistula provider's accounts of how to manage, support, and understand their patient's experience. Semi-structured interviews were conducted with a purposive sample of fistula care providers in Mekelle and Addis Ababa, Ethiopia. The main themes that emerged were a perceived exacerbated impact on quality of life for women with persistent urinary incontinence; a "double hit" of isolation from both their community and from other recovered fistula patients; how the church both influences how patients internalize their injury and provides them with hope and support; and the need for comprehensive and compassionate fistula care. Understanding how providers perceive and relate to their patients provides valuable insight to the unique challenges of treating this population and may better inform treatment programmes to address the gap between patient needs and current fistula care models.
2019
Obstetric fistula, an abnormal connection between a woman's genital tract and urinary tract or rectum, can be physically and psychosocially debilitating. We describe a sustainable obstetric fistula surgical trip model that includes providers from Women and Infants Hospital at Brown University. These surgical trips provide pre-operative, surgical, and post-operative care to patients with fistulae at Kibagabaga Hospital in Kigali, Rwanda. To ensure patients are prepared for the recovery process after fistula surgery, the team created a post-operative education curriculum that includes illustrative visual aids and teaching guides translated into Kinyarwanda, focusing on topics including urinary catheter care, wound care, and pain management. Through this program, the team is committed to restoring women's dignity through fistula repair as well as providing a model for delivery of sustainable surgical care in low-resource settings. Involvement of trainees into a global health te...
2021
Background: Women in low-income countries, including Ethiopia, experience delays in seeking treatment and suffer from obstetric fistula and its consequences. To assess the consequences of obstetric fistula among women who were patient of the problem in Jimma University Medical Center, Southwest Ethiopia. Methods: An exploratory study was conducted among 24 women receiving obstetric fistula treatment from April 01-30, 2019 at Jimma University Medical Centre. Data were collected by in-depth interviews. Data analysis was done by using thematic framework analysis.Results: Most women with obstetric fistula face various physical challenges such as pain, body weakness, and numbness of legs. They also face various psychosocial problems such as humiliation, stigma, and discrimination, inability to participate in social events, divorce, stress, depression, and suicidal ideation. Conclusion: Obstetric fistula exerts tremendous physical, emotional, financial, and social trauma on those affected...
International journal for equity in health, 2018
Women living with obstetric fistula often live in poverty and in remote areas far from hospitals offering surgical repair. These women and their families face a range of costs while accessing fistula repair, some of which include: management of their condition, lost productivity and time, and transport to facilities. This study explores, through women's, communities', and providers' perspectives, the financial, transport, and opportunity cost barriers and enabling factors for seeking repair services. A qualitative approach was applied in Kano and Ebonyi in Nigeria and Hoima and Masaka in Uganda. Between June and December 2015, the study team conducted in-depth interviews (IDIs) with women affected by fistula (n = 52) - including those awaiting repair, living with fistula, and after repair, and their spouses and other family members (n = 17), along with health service providers involved in fistula repair and counseling (n = 38). Focus group discussions (FGDs) with male an...