KARACHI: Sakina was married before she reached adolescence, perhaps 12 or 13, but her marriage was not consummated till she was ready to conceive at 15. Three pregnancies followed of which two ended in miscarriages leaving her with an injury that caused her “to leak stools and urine”. She had developed what doctors call obstetric fistula and began to suffer silently and in shame. She was then sent to her mother by her in-laws.

A preventable and treatable condition, fistula is caused by prolonged labour, explains Dr Shershah Syed, a leading gynaecologist. “The pressure caused by the baby’s head against the lining of the birth canal perforates the wall of the rectum and bladder leaving the mother unable to control her excretory functions.” The woman becomes incontinent causing unimaginable psychological trauma and social ostracism. He has seen scores of women who were abandoned by their husbands or become outcasts.

Skina’s fistula was repaired recently, free of charge at Koohi Goth Maternity Centre.

The man behind this centre, with squeaky clean wards and a cheerful ambience for the really poor, 12 kms from the city centre is Dr Syed himself. The centre is located within the confines of a katchi abadi in Malir. For well over a decade, he and his team of doctors have been organising free camps all over remote Pakistan for women having obstetric and gynecological problems. Fistula was one of the disabilities he noticed increasingly women complain of.

To stop fistula from occurring, there is need for bringing change in certain risky traditional practices. Foremost, is stopping child marriages and delaying the age of first pregnancy. Along with that access to timely emergency obstetric care (EmOC) is as important.

In January 2006, the UNFPA launched a national campaign to end fistula in Pakistan. Seven regional centres -- at Karachi, Islamabad, Multan, Quetta, Larkana, Lahore and Peshawar – were set up where repair of fistula is carried out free. Koohi Goth is one, where since March 2006, 86 successful procedures have been done. The biggest hurdle in getting the women to come to the centre is men, according to Dr Ayesha Haq, who works at the centre. ''Although we provide free transport, treatment, accommodation and food, men are unwilling to let their women live away from home for extended periods.” The procedures may sometimes take months, even as long as six months where multiple injuries need to be closed.