The fistula link with Waldorf Astoria

America’s most expensive hotel the Waldorf Astoria is famous in health circles for some reason. Its present location is the site of the last fistula centre in the US in 1895. It has since closed down. Obstetric care has improved in the developed world, and with interventions like Cesarean sections, fistula is now rare in […]

America’s most expensive hotel the Waldorf Astoria is famous in health circles for some reason.

Its present location is the site of the last fistula centre in the US in 1895.

It has since closed down. Obstetric care has improved in the developed world, and with interventions like Cesarean sections, fistula is now rare in developed nations but “remains a problem of poverty,” says Iyeme Efem.

He is country manager for Engender Health, which runs a US-funded project to prevent, treat and rehabilitate women and girls living with fistula in Nigeria.

With collaboration from Nigerian authorities, it has helped support a handful of centres where surgeons pool their effort to repair women with fistula.

The teams have done more than 400 repairs at Vesico Vaginal Fistula centre at Ogoja General Hospital since 2011.

An obstetric fistula is a hole between the vagina and rectum or bladder that is caused by prolonged obstructed labour, leaving a woman incontinent of urine or faeces or both.

“Maybe one day, we will have the Fistula Centre in Ogoja as the most expensive research centre in the world,” he said, making the link between the centre and the Astoria.

“The fact that fistula occurs is a clear indication that we have a very poor health system. Fistula occurring in any country is an indictment of the health system of that country,” Efem said.

World Health Organisation suggests more than 2 million women live with fistula world over, and up to 100,000 women develop the condition each year.

In Nigeria, “About 100,000 to 150,000 have fistula presently with 12,000 new cases occurring every year,” said Efem.

“No matter how much we try, we can only repair 5,000 which means that 7,000 cases keep adding to the backlog. It’s as if we have a bucket filled with water and the tap still running and someone is given a teaspoon to empty,” he said.

Engender Health has been in talks with legislators in Cross River to garner support for fistula prevention and treatment work through policy and budgetary interventions.

The state assembly committee on health says it is ready to come up with laws and budget proposal to support fistula prevention, according to its chairman Ekpo Bassey.

Dr Bassey advised that obstetric fistula can largely be avoided by delaying the age of first pregnancy, by the cessation of harmful traditional practices and by timely access to quality obstetric care.

Medical experts say that obstetric fistula still exists because health care systems fail to provide accessible, quality maternal health care, including family planning, skilled care at birth, basic and comprehensive emergency obstetric care, and affordable treatment of fistula.