KARACHI, April 30: Medical professionals called upon the government to fulfil its responsibility and provide emergency obstetric care at all rural health units and tertiary care hospitals. This step will prevent incidents of fistulae, which affect around 5,000 women every year in Pakistan and will reduce the increasing number of deaths due to pregnancy-related complications.
These views were expressed at a press conference at the PMA House, which was held after a lecture on fistulae prevention by a visiting health expert, Dr John Kelly, Emeritus Consultant Obstetrics and Gynaecology, Birmingham Women’s Hospital, and senior lecturer, University of Birmingham. The lecture was organised by the Pakistan National Forum on Women’s Health (PNFWH) and United Population Fund (UNFPA), in collaboration with the Pakistan Medical Association, Karachi (PMA).
Pointing out access to appropriate obstetric emergency care as the most important single factor in prevention of maternal mortality and morbidity, Dr Kelly said that prevention was the best strategy against fistula, a post-partum complication which resulted from prolonged labour.
He underlined the role of trained midwives and birth attendants in places where the services of doctors were not available, and said that with their support, maternal mortality and morbidity had been effectively reduced in many countries. Pointing out the causes of maternal deaths, he said they were haemorrhage, hypertensive disorders, sepsis, obstructed labour and abortions. Haemorrhage accounted for 30 per cent of maternal deaths in Asia.
Poverty and lack of awareness, he said, restrained women from seeking timely medical intervention for fistula, and they continued to suffer from it for years. He had treated many women in African countries, as well as in Pakistan, who had been suffering from fistulae for years.
He also commended the local doctors who had initiated, on a self-help basis, the treatment of fistulae repair in far-flung areas, and said their performance had improved over the years.
Explaining the disease, Dr Shershah Syed said that a fistula (hole) developed between either the rectum and vagina, or between the bladder and vagina after severe or failed childbirth, when adequate medical care was not available.
He said the complications during pregnancy and labour could be reduced by strengthening the primary health care infrastructure. “Prevention is our salvation. Access to emergency obstetric care and competent midwives are the solution to the increasing number of maternal deaths and morbidity,” he remarked.
Highlighting other related problems, Dr Nighat Shah said multiple pregnancies, underage marriages and most importantly unskilled birth attendants compounded problems in rural and slum areas. The five danger signs for pregnant women, she said, included excessive bleeding, fits, high grade fever, continued vomiting and severe headache.
She also spoke about the miseries of poor women who were shunned by society after falling victim to fistulae.
Dr Abdul Hakim Jokhio said that nine camps had been organised for fistulae repair in Nawabshah, Hyderabad, Sukkur and Larkana since 1999, where all patients were treated free of charge. From last year, a helpline had also been launched. He called upon the government to take up the issue of neglected births and make investment in primary healthcare.
For the past five years, Dr Kelly has been coming to Pakistan yearly and performs complicated fistula surgeries free of cost. He regularly visits Kenya, Tanzania, Uganda, Sudan, Ethiopia and Pakistan. This year, Dr Kelly repaired 25 fistulae at Sukkur, 17 at Hyderabad and 11 at Karachi.
