Findings of the Report
Cases of Obstetric Fistula are quite common in Hoima and Kibaale districts, but also from neighbouring districts as well as distant areas like Masindi, Bulisa, Kiryandongo, Kiboga, Apac, Wakiso etc in some incidences, cases come from neighbouring countries like DR Congo and Kenya.
Obstetric Fistula is as a result of failure to use Family Planning to prevent risky pregnancies as well as prolonged obstetric labour which has its root causes in three delays, which are:
· Delay to make a decision to visit a health facility during labour.
· Delay caused by distance from home to the health facility.
· Delay to be provided a service on reaching the health facility usually caused by long lines of women who need services.
Ordinarily, in Hoima-Kibaale region, there are no fistula operations taking place all year round. This is because there are many emergencies that require attention. In addition, the hospital has very few Doctors to attend to these emergencies and they have only one theatre. Furthermore, the doctors in these health units have no specialised skills in operating Obstetric Fistula. As a result, fistula cases have to wait for a long time because the camps are very infrequent, taking place either once or twice a year. Fistula cases are registered and have to wait for the next camp.
Since 2009 Hoima hospital aimed at running Obstetric Fistula camps twice a year, which were meant to be in May and September, but because of lack of adequate financial support, they have only managed to run one camp a year at best. The majority of the cases come from Hoima, Kibaale, Kiryandongo, Bulisa, Kiboga among others. The camps run for approximately two weeks. They are run by trained surgeons who come from outside the hospital.
In 2012, the EngenderHealth supported Fistula camp had 101 cases that attended. Among these, 53 had Rectal Vaginal Fistula (RVF) and 48 had Vesicle Vaginal Fistula (VVF) and where operated. Out of the 48 operated, 7 failed. This translates into a 93% success rate.
In May 2013, at similar EngenderHealth supported Fistula camp, 106 women turned up for screening. Out of these, 57 had Vesicle Vaginal Fistula (VVF) and were operated. Of those operated, 9 failed. Out of the 106, 49 had Rectal Vaginal Fistula (RVF) and all these were successfully operated. This translates into a 91.5% success rate. This is a remarkable success rate. It is noteworthy that the success rate is generally regarded to be about 80%. Inoperable fistula cases are normally referred to Kagando Hospital in Kasese district where there is more specialised fistula care.
In terms of Financial and technical support, fistula camps are supported by not only EngenderHealth, but also UNFPA and AMREF on the encouragement of Ministry Of Health. Such financial help supports Fistula camps (Doctors and fistula surgery teams) as well as the food, transportation and accommodation of the fistula cases. Thus, women are operated on free of charge, receive free transport, get free food and accommodation courtesy of these donors. Each fistula case is allowed to come with one attendant who is facilitated in the same way.
Challenges and areas recommended for action
· Too few trained surgeons to operate on the backlog of fistula cases in the region resulting in a long waiting list.
· Inadequate infrastructure in existing health facilities e.g. theatres, equipment, supplies etc.
· Financial constraints to support the surgical teams conducting the camps (training and facilitation).
· Financial constraints for fistula cases.
· Lack of general awareness by the public on the causes, prevention and treatment of fistula.
· Lack of adequate political and policy makers’ commitment to addressing fistula.
A. Terms of Reference (ToRs)/ Scope of Work (SoW) of the landscape consultancy
1. Assess prevalence and severity of Obstetric Fistula in Hoima- Kibaale region.
2. Assess health services available to Fistula cases in terms of accessibility, affordability and adequacy.
3. Assess whether fistula camps exist. Who runs them. How often and their duration.
4. Assess the support both technical and financial for the Fistula camps.
5. Assess the costs of transportation of Fistula cases, their healthcare fees as well as their feeding needs.
6. Determine the success rates of the operations, and how both the operable and inoperable cases are re-integrated in society.
7. Make recommendations to how Commat Uganda could be useful in the prevention, treatment and re-integration of fistula cases in the region.
The consultant, Dabtience Tumusiime interviewed Dr Hajjat Mastula Kasujja who is a Senior Gynaecologist at Hoima referral hospital in the preparation of this report.