• women who bear children before their pelvis is fully developed risk having their pelvic tissues damaged.

By HLUPEKILE NKUNIKA –
WITHOUT surgery, Linda Moyo (pseudo name) has been leaking urine continuously for the past decade.
Because the odour of leaking body fluid is powerful, the social stigma is also harsh.
Her husband has abandoned her because of this condition which in the oral tradition has serious notion.
Obstetric fistula is a medical condition in which a hole develops between either the rectum or vagina or between the bladder and vagina after severe or failed childbirth when adequate medical care is not available.
But oral traditions claim that fistula is a curse on a woman associated with a belief that either she or her spouse had extramarital affairs whilst she was pregnant.
A vaginal fistula is an abnormal opening that connects female sexual organ to another organ, such as your bladder, colon or rectum.
According to fistula foundation.org, it can develop as a result of an injury, a surgery, and an infection or radiation treatment.
There are several types of vaginal fistulas which includes the vesicovaginal fistula.
Also called a bladder fistula, this opening occurs between the female sexual organ and urinary bladder and is the type that doctors see most often.
The Ureterovaginal fistula is the type of fistula which happens when the abnormal opening develops between the female sexual organ ducts that carry urine from your kidneys to your bladder (ureters).
Another fistula is the Urethrovaginal fistula which also called a urethral fistula, this occurs between female sexual organ and the tube that carries urine out of your body (urethra).
The Rectovaginal fistula also known as a rectal fistula is the opening between sexual organ and the lower portion of your large intestine (rectum).
Others include the Colovaginal fistula where the opening occurs between the sexual organ and colon while the Enterovaginal is where the opening is between the small intestine and the female sexual organ.
In most cases, fistula is referred to as a disease of the poor because
it is common among women in poor countries who do not have health resources comparable to developed nations.
The condition leads to uncontrollable urination or defecation and sometimes both.
According to experts, women are reluctant to seek health care services, especially rural areas because of stigma as there are a number of myths that surround the condition.
Christine Nkhoma 58, a Traditional Health Attendant of Lundazi says extra marital affairs among young couples are the causes of this punishment on women.
Ms Nkhoma says both a man and a woman should disclose if they have been having extra marital relations so that Traditional Birth Attendants can provide herbs to prevent the punishment.
She says fistula was not common in the olden days because couples were faithful and that men informed their spouses when they wanted to take a second wife before engaging in sexual activities.
“We have been practicing some of these things for a long time and we have never encountered such problems because we take precautions as advised by our forefathers,” she says.
Due to this belief, most fistula patients were considered as lepers and faced social segregation within their communities because it caused continuous leaking of urine, human excreta or both and this made life difficult for patients.
But Chipata Alangizi chairperson, Elizabeth Mapala 55, who believes in traditional birth practices, says fistula is a new condition that has been a result of a modern woman’s reluctance to follow traditional norms in safe delivery.
Ms Mapala says there are certain practices that need to be followed during pregnancy that a modern woman chooses to ignore.
She defines fistula as a condition that results from a rupture in the bladder which is caused by sexual intercourse in the last stage of pregnancy.
Ms Mapala says it is for this reason that, expectant women are advised not to have sexual intercourse after eight months of pregnancy, traditionally.
She says this is meant to ease the process of child bearing and to protect both the expectant mother and the unborn child from evil spells of witchcraft.
“To protect an unborn child from this curse, traditional and cultural beliefs demand that herbal medicine be administered on a woman during pregnancy,” Ms Mapala says The Alangizi chairperson explains that at eight months, the head of the unborn child is pushed into the birth canal as the body of its mother prepares for delivery.
“At this stage, a woman should not be allowed to have sexual intercourse because the vaginal passage cannot accommodate the penis,” she said.
Traditional delivery practices are carried out in most rural communities where people have limited access to health care services and depend on herbal treatment for a number of illnesses.
Chipata General Gynecologist Augustine Cyimana, who is also senior registrar said in Eastern Province, the condition is high among women in places where there are limited health facilities and qualified health personal.
Eastern Province medical officer Kennedy Malama says continued urination is the most common form of fistula in the province though he notes that there are minor cases of rectal fistula recorded.
He says that Lundazi and Chama account for the highest number of recorded cases though he states that the province has not been in a position to record all cases of the condition because a number of patients do not seek health services due to either traditional beliefs or stigmatisation by the locals.
“The cases are very common in areas where there is limited access to professional medical services,” he says.
The two rural districts, according to Dr Malama, account for more than 50 per cent of fistula cases that were recorded in the first fistula test undertaken at Chipata General Hospital under the sponsorship of United Nations Population Fund Agency (UNFPA) in 2008.
In 2010, 70 repairs were carried out with the sponsorship of UNPFA.
Such cases were previously referred to Lusaka for treatment as they are no specialists to attend to fistula in the region.
Dr Malama states that initially, there were only a few doctors in the country that are specialised in repairs of damaged organs that led to the condition.
Dr Malama also observes that in some areas patients may not be able to seek medical attention because they do not have access to medical facilities.
He adds that transport costs and the state of roads in some areas also pose a challenge to patients because they may either not have the resources to travel to Chipata General and St Francis Mission Hospitals that offered fistula repairs.
Dr Malama states that Government realises that this condition could lead to an increased maternal mortality if left unchecked.
“We realize that fistula cases are common among home deliveries, and those women who do not access professional medical services are more
at risk, for this reason, we also advise women to go for ante natal checkups for early detection of such complications” he says.
Dr Malama states that, government has been making tremendous achievements in encouraging women to seek professional health care services.
“At least 99 per  cent of our women seek antenatal care from health institutions and deliver there,” he said.
The medical professional emphasises the need for expectant women to seek professional medical services as soon as they discover they are pregnant.
“That way, the problem can be detected early and this can provide time for available alternatives, on how the condition can be treated,”he says.
Dr Malama points out that early childbearing increases the risk of fistula, women who bear children before their pelvis is fully developed risk having their pelvic tissues damaged, a situation that leaves a hole between adjacent organs.
He observes that there is much ignorance among women in the province who he says need to be sensitised on the causes of fistula and treatment.
The medical officer stresses that people need to understand the condition in order for them to be able to prevent it.
He also emphasises the need to ensure that medical facilities are accessible, especially that most fistula cases are recorded where there is limited access.
“Government is making a steady progress in the construction of health facilities and the number of rural health centres being built in all the districts of the province,”he said.
It is anticipated that the construction of more health facilities and sensitisation on fistula will help in creating awareness among rural communities who are the most affected.
Sensitisation will people make understand the real causes of fistula and seek medical attention as opposed to the myths which lead to stigma, especially among rural communities.