KARACHI: The most important step towards preventing obstetric fistula is to increase access to education; it will bring awareness about the care needed by prospective mothers, the risks pregnancy carries, as well as help eliminate stigmas and misconceptions linked to it, said Dr Thomas Raassen while speaking to Dawn at the PMA House on Monday.

Dr Raassen is among the world’s leading surgeons and has so far handled more than 6,000 fistula cases. He is at present visiting Karachi where he recently performed two major surgeries free-of-cost at a charity hospital in Landhi.

Born in Amsterdam, Dr Rassen, now in his mid-seventies, has primarily lived in Kenya and worked in Africa for more than three decades. In that time, he has been called on to operate in over 60 hospitals throughout Africa and Asia.

“I was nine when I decided to become a doctor. I don’t remember what inspired me at a young age to think like that. It [the decision] came out of the blue,” he said, when asked about how he entered the medical field.

His decision to work in low-resourced countries, however, was a result of his interaction, as a medical trainee in the early 1960s, with senior Dutch professionals working in developing countries. And to materialise this dream, he did a two-year specialised course in his home country.

He soon got an opportunity to serve in Nairobi, Kenya, where he worked at a Catholic mission hospital for five years. Later, he returned to his home country and did six years of postgraduate study in general surgery.

“Working in Nairobi was both an interesting and satisfying experience as I had the chance to handle all kinds of cases. My wife too, loved being there so we decided to go back,” he explained, adding that he had been associated with the African Medical and Research Foundation (an NGO involved in health development) since 1990 that provided him the opportunity to treat poor patients in a number of countries.

Treating fistula cases

It was during his stay in Kenya that he encountered women with the birthing injury that he came to know as obstetric fistula — a hole between the vagina and rectum or bladder that is caused by prolonged obstructed labour, leaving a woman incontinent of urine or feces, or both. The medical condition which can at times result in social ostracisation of the woman suffering from it is completely treatable through surgery.

He repeatedly saw such cases but didn’t know how to operate on them; fistula surgery is neither taught in the Netherlands nor in a vast majority of western hospitals because the injury is too rare in resource rich countries.

“Dr Reg Hamlin and his wife Catherine, both reputed surgeons, ran a fistula hospital in Addis Ababa, Ethiopia, and invited me for training,” he said.

Increasing access to education, according to Dr Rassen, is the key to preventing fistula. “Give girls the right to education and to make choices in life. If girls are educated, they will make sure that they get antenatal care during pregnancy and have their delivery at a hospital.

“Education will also remove the stigmas and devastating practices like treating women with fistula as social outcasts, and female genital mutilation,” he said, adding that some African tribal societies considered delivering the baby at a hospital as a sign of adultery.

He also emphasised the need to provide quality healthcare and build infrastructure in remote areas where most fistula cases occurred.

According to Dr Raassen, there has been a slow reduction in the number of fistula cases in some East African countries and this couldn’t have been possible without efforts by the government.

“But, what is worrisome is to see fistula cases being caused by medical doctors performing Caesarean section and hysterectomy (removal of uterus). Though this is also happening in the developed world, their number is high in low-resourced countries,” he said.

Dr Thomas Raassen is scheduled to speak on ureteric injuries at the PMA House today and then will fly to Islamabad to perform more fistula surgeries.

Published in Dawn September 6th, 2016