Radio Miraya
2742: International Day to End Obstetric Fistula: Increasing Awareness and Enhancing Access to Maternal Healthcare in South Sudan
Now, today is International Day to End Obstetric Festival and five days from now, on the 28th of May, we will be marking World Menstrual Hygiene Day. Now these are important issues that we want to talk about today and we want to look at these issues that are important for the health of women and girls. Girls and women's lives can be immensely improved by promoting health solutions and reducing stigma around menstrual hygiene and health. Now we want to demystify what obstetric fistula is and we want to talk about the importance of menstrual hygiene and in the studio we have Madong, a Manuela, gender, youth and women health practitioner working with Amrif Health Africa and from the Minister of Health we have Rev. Janet Michael who is the Director for Nursing and Midwifery at the National Ministry of Health. Good morning ladies. Thank you so much for making our time to speak to us. Good morning Irene, it's a pleasure to be here. Right, so I will start with you, Rev. Today is International Day to End Obstetric Fistula and we would like to understand what we are talking about here. Tell us more about this Obstetric Fistula. Yeah, good morning to you Irene and our listeners. The issue of obstetric fistula of course is a very big concern. When a fistula creates, we say it's near misdeath. Normally it occurs when the mother had gone through prolonged lepa and normally because it's obstructed labor, the baby cannot come out. The baby is either too big for the passage or the baby, the mother is having a contracted pelvis. Therefore, during the descent the head rubs between the area either between the bladder and the vagina and normally then it creates a hole. Of course there are several types of fistulas which are created. The most common one is the Vesco Vagina Fistula whereby the hole which is created, it depends. It may be small leakage, it may be more, so the urine that leaks through the vagina continuously. And of course when that leaking occurs, normally you find that this mother, the baby is already dead most of the time and when it is discovered later she found that there was a leakage. And of course that is one type of fistula, the other can be before you go to the other, so that leakage, is it because at that time the bladder has been affected? Yes, there is a pincher between the uterus and the bladder, so there is a hole which is the fistula which means a hole, fistula is a hole. And then the urine, instead of passing the urine that is leaking from the bladder to the vagina and maybe small drops, maybe more depending on the size of the fistula. So you find most of the time, most of these women, is first time pregnant, they are primarily gravidase, they are young and most of the time due to prolonged labor and this occur of course. So you are going to the second type before I interrupt you. The other one is also can be two you can have, but it's not a very common one, we are also from the back to the bowel, there is another one. So you have physis leaking also, that one is not very common, it's not very common, but can be very bad. Yes, Manuel, is there a way this can be avoided? Yes, definitely, and this obstetric fistula is actually preventable, and I mean just like a revrangian admission, it's due to the prolonged obstetric labor, and when you look at it, it basically shows us a tip of ice back of the poor quality care that we have, and a lot of contributing factors as to why we have so many young girls and women are having this condition. When you look at it, it's more like limited knowledge, access to health care and time, the weak referrals systems that we have, and of course culture and so on, and other factors contribute. And basically from what revrangian admission is, this happens to most women in their rural settings whereby they are poor health systems and others tend to probably deliver at home, or other so many conditions contribute to that, but I think there are a lot of prevention measures that we're looking at. One is doing a lot of awareness, letting the community know that it's important that you go for the ANC so that the health workers ascertain the type of when you will deliver, and you know, just prepare you for the labor period, and again it's also very important for both young girls and women to actually deliver from the facility, because then these issues can also be dealt with, because then if the baby is too big to pass through, then there is the option of, you know, a caesarean section, so many other options could come to issue that you do. So that can be seen beforehand that the baby is big and it cannot pass. Yes. Right. Okay. And again, again, you know, one of the great contributing factors to obstetically sterilize the issue of child marriage and allie pregnancy, just like Reverend said, it's common among the young girls, because obviously they're reproductive, you know, growth is not to the full capacity that we expect. So you find that in most of the cases that we've registered in the different campaigns, you find we have so many girls below 18 years and, you know, downwards, basically having this condition. Right. Yeah. Thank you so much, Manuela. And Reverend, yeah, and looking at the context where we have so many young girls being married off, how big of a problem is first to lay in South Sudan? Actually, at the moment, we have not yet estimated how much, at one stage, it was estimated to be about 6,000 people suffering with it, and of course, when we look at it, as Manuela has said, one, if these mothers are coming for antenatal care, one of the alias detection is to find out some of those which you can see that they are having problems. For example, contracted pelvis, then it can be put on a care that is, they are called the risk mothers. So the risk mothers can be identified. And of course, the others, it later appeared, but normally, if ultrasound is done, certain exemption, they can actually find out that the baby is too big to pass through that pelvis. And for them to come immediately as they start to labor, to be in a hospital. But what you're having is that these mothers, sometimes, are held by the elder women who thinks that every woman must deliver vaginally. And so they keep them at home. They say, don't run to the hospital, they will do a cistern section, deliver at home. So the fear is the cistern section, oh no, you must not be operated, deliver at home. By the time they reach the hospital, they have already spent three days. And this was unlucky, because with the obstructed labor, when it's so severe, my eyes have ended up with a rapture deuterus, which of course kills you immediately. That's why we say anybody who will develop a fistula is a mis-survived death. Yeah. It's a mis-death. So here is where we have a, for example, you actually see girls, I mean, I call them girls, 16-year-old, one time we found a 16-year-old, you know, and you really find that it is very miserable, very miserable, because when this happened, their husband's abandoned them immediately. Oh dear. Yeah. Right. They abandoned them. Yeah. And about the contracted pelvis, is it possible for one to know that the pelvis is contracted? That they will not be able to go through natural labor, or is that determined at the hospital? It's determined at the hospital. During labor. You cannot know, because some are marginal. Yeah. And depends on the baby, what you call the passage and the passenger. The baby, in this case, being the passenger. The passenger. Right. Passing through that passage. Okay. So with the, just one thing that I want to bring out is that, you know, we have always said nutrition is very important. When girls, that, I mean both boys and girls, when there is malnutrition, it affects the girl more, because later the reproductive growth of the pelvis, the pelvis bone already were affected. Right. And this is why they say, improve nutrition, so that the children grow well, including boys and girls. But at the end, it is the girls who are affected and developing a contracted pelvis. Not, of course, not every contracted pelvis is malnutrition, but it's a common factor. Right. Right. Thank you so much, Reverend. Now, Moderna, in your work with Amre, from Shua, you work with the communities, are attitudes changing in terms of people coming for international care? Yeah. Yeah, yeah, greatly. And I mean, I think South Sudan is on a great journey in terms of us embracing skill battle and it's going to the facilities and all that. And I think it's because of the great work from the ministries of health and the partners that we have. In terms of the meaningful engagements that are there with the community, you see a lot of engagements with communities to just, you know, let communities know that it's good to have NC. And again, most of the partners actually now doing what we call community self-motherhood outtriches. They actually go to the communities, have awareness on NC, we just, even fast-time mothers, who never go into the facility, give them cuts and then do their referrals. Right. And these are done, of course, with the nurses and midwife support. So for me, I see great change. And again, even the statistics has it when you look at the statistics that the National Ministry has, you see, NC reached out by quota, reaching like 5,000 from, for example, from Juba Teaching Hospital. Just last quote, I think we had about 4,000-something mothers coming for NC. So I think there's great improvement coming back to the previous, yes. Yeah, that sounds good. Yeah. At the end of this month, we'll be marking a menstrual hygiene day. Just tell us about the importance of menstrual hygiene. Thank you. Menstrual hygiene is very, very important, it's very, very important. And for the girls to be oriented earlier, before they start their administration. And of course, their hygiene place is very important, because when you look at this period when there is a menstruation, the chances of infection are very high. And when we look at the female anatomy, the urethra is very short, which is also near the vagina, they are all, if there is no proper hygiene, you will have urethra infection. And of course, you will have also infection, vaginal infection, which later can become very bad, therefore hygiene is really very, very important, that the washing that you are having your sanitary pads and changing them, also not keeping them for too long. Right. Why you need water, you need your sanitary pads. Right. At least. So you speak about orientation, people with girls in the families, daughters, when should they start? When should the talk about menstruation start? They should start earlier, because we are seeing now, girls having menstruation at the age of 9, so here maybe we need to start earlier 7, as early as 8, maybe trying to discuss about it, because the pattern is changing, the pattern is changing that now the age is lowering. And this is so dangerous when we see these young girls, because right now we have the allys pregnancy we had in South Sudan is 10 years, wow, and other places had 9, and this was in Kenya recorded, South Sudan has recorded 10 years. So as this pattern is changing, it's also creating another issue for us with having the allys pregnancy. So therefore, we need to start talking, actually schools, primary schools for example, the teachers need to start giving them the allys as early as possible. Yeah. Primary schools. And I think even at home. We are at home. At home. Yeah. At home, the mothers take them through, even you don't want to talk here, but you just have pictures, and say this is what happened. Creative. Yeah. Yeah. Right. And so then the pictures, what is going to happen, and then you've got to, I remember this girl who was 80 years, she came home and told her mother said, "I would like to have allys." Her mother said, "Why do you need allys?" She said, "Ah. In case my period comes." Oh, she knew about it before even the mother said. They have already talked about it as school, so she comes and she tells the mother to buy her. Just say. Wow. And then the mother said, "Well, small girl, 80 years old is asking you to buy for her. Always. You already know that, it's called "always." Yeah. Yeah. Wow. And Manuela, why are these topics very hard to talk about in our family? No, I think compared to previous years, it's now, it's becoming open. We're loosening up, eh? Yeah, people are not shy from it, and I think school has played a great role so far in terms of starting these compositions and letting parents know, but I think it's very important to own both men as well and boys, because again, we have families whereby it's basically fathers and men. Yeah. Yeah. Yeah. Yeah. Yeah. And also again, we need to remember our society. Still, it's the men who are the decision makers, you know, the breadwinners in many ways. So again, as much as women, we should open up again, we also need to allow our fathers and uncles to start the conversation, to see how the lot is. And I think great emphasis is basically from the government to support this agenda of menstrual hygiene in terms of ensuring that the products that are to support, you know, women at a cost that they can't afford, because it's a challenge that we're facing. It should be tax-free. It should be tax-free, possibly for free, not to be tax-free. Yeah. I mean, because when Reverend was speaking about, when you're using your pad, you need to change and I'm thinking how many of them can actually afford it. And it's now 1,500. So not everyone can afford. So again, you know, during the three days or five days, you being in your menstrual period. Yeah. That's like 3,000 for summer, that's depending on the flu. You might find some parents may not and not godly supposed to stay home instead of going to school. So it's a challenge. And I think the government needs to bring on common full-board to ensure that. Right. And speaking about challenges, Manuela, what are some of those challenges that women and girls face accessing menstrual hygiene products from, of course, them being expensive? Yeah. That, and I think also the quality of the products that are coming in country, the good ones are very, very expensive. You find them in the supermarkets and the ones that are there at a low cost. And, you know, we have recorded stories in the schools where kids are saying, you know, they're itching and all that, but of course we're encouraging them that you can also make the reusable products. Again, our fear is the maintenance and the hygiene attached to the reusable products that are there. Again, you see not all shops are everywhere, you go just not far, rock on, and you find there are no shops that have pads. So you might find the pads are just within the urban setting. Yeah, yeah. Far ends, you know, their girls have to find their own means to access the products. Right. Ladies, thank you so much for making our time to speak to us today. And before I let you go, final remarks, Reverend. Yeah, my final remarks is for our young girls to access antenatal care, they should be coming. And when the liver comes, they should come to the facility, the alias, when it starts. And of course, for menstrual hygiene, that is, of course, a challenge where we say it will need our government support. And of course, the minister of gender and social welfare, well, this one's also false on them and the minister of health and the minister of youth to look at the importance of hygiene, supplying free sanitary pads or towels so that every girl can access it. Right. Thank you. Yeah. Thank you. And not just to repeat what Reverend Janet has said, I think I want to emphasize to the public that once you have fistula, just it has been less on the looking, it's treatable. They are repairs that are ongoing in country. Of course, it's not routine, but there are certain campaigns that we hear of there is obstetric fistula campaign whereby an opportunity is given to those who have this condition to be repaired so they can go back, you know, to living their normal life. I know that there are a lot of outcomes when you have fistula, the low productivity, not now doing usual things, but there is an opportunity to be able to repair and it's important that you reach to your teaching hospital, your different facilities in your area to be part of the books to bring the registration book of those who would want to be repaired so that once the campaigns come, you can be called and then you are supported in that area. And then I think for me, lastly, on Ms. Reigen is to say it's a collective responsibility that starts from the family to community to the top to ensure that we support all women and girls to ensure that they live a dignified life. Madam Manuela and Reverend Janet Michael, thank you so much for your time. Thank you. All right. And Manuela is a gender, youth and women health practitioner working with Amriff Health Africa. Reverend Janet Michael is a director for nursing and midwifery at the National Ministry of Health.