Today, as the world commemorates the 2018 International Day to End Obstetric Fistula, pregnancy, childbirth, and postnatal care grab our attention once again. Should we actually only focus on these key components of safe motherhood only around commemorations? Definitely not!

Pregnancy and childbirth should be among the happiest moments in a woman’s life. Sadly, this is not the case for thousands of women across the world, including in Zambia where an estimated 33,400 women and young girls have suffered from one of the serious injuries that can occur during childbirth – known as Obstetric Fistula. Obstetric Fistula is an abnormal opening in the birth canal caused by prolonged, obstructed labor due to the lack of timely and adequate medical care. The condition often leaves the woman with chronic incontinence (meaning leaking of urine and/or stool) and usually results in the death of the child.

Through the voices and representation of some of these women, the “National Safe Motherhood Week” observed in Zambia from 14-18 May 2018, as well as the national commemoration of the “International Day to End Obstetric Fistula” on 18 May 2018 underscored the stark reality that occurs from limited efforts to eliminate Obstetric Fistula in Zambia. Heart wrenching stories could be heard in the hospital wards at Lundazi District Hospital in Eastern Province; where women – young and old – with cases of Obstetric Fistula were being screened and repaired by a dedicated team of Fistula Surgeons and Nurses.

The story of Nachilima* typifies the stories of these women and young girls.

Nachilima had traveled 45 kilometers from her village to the nearest rural health facility in Lundazi District, after enduring two days of labor at home. Having developed complications during labour at the rural health facility, she stayed 4 hours waiting for transport to take her to a referral hospital, where a caesarean section was finally undertaken. Unfortunately, she gave birth to a stillborn baby and two days following her discharge from the hospital, Nachilima began leaking urine and stool.

“Everywhere I sat, I left a mark, and people would come to see, and gossip about my condition. I was helpless and could not do anything about it. My life has been hell,” says Nachilima.

She underwent several surgeries at a nearby hospital located at the Zambia-Malawi border to repair the damage, but none were successful. Heartbroken, she returned home to her five children and her husband, who has now taken a second wife because of her condition. Though with her consent, her husband’s decision was clearly not her wish.

For 9 years, Nachilima endured the shame and discomfort of having Fistula, until May 2018, when she heard a radio announcement that gave her hope. The District Hospital in Lundazi would be setting up a Fistula Camp supported by the United Nations Population Fund (UNFPA) to treat women with symptoms of Obstetric Fistula. So, she started the 2 hours walk to seek the much needed treatment and for the first time in close to a decade, she was hopeful about her prospects to regain her health and dignity.

Restoring Womens Health and Dignity

When I go back to my village, I am sure people will ask who this amazing traditional healer is. But I will tell them it’s the hospital, and it is a condition that can be cured, and more important, a condition that can be prevented

Nachilima is among thousands of women and girls who have recounted the utmost joy and exhilaration following successful Fistula repair. One can only imagine their sense of restored hope, healing, and restored dignity, first and foremost to themselves, but also to their families. The question is how can Government and its partners, including community actors, end the occurrence of Fistula in Zambia? Can it be done? Is it possible?

Reflecting on his 21-year experience as a Fistula Surgeon, Dr. Lackson Kasonka from the University Teaching Hospital in Lusaka highlights: “Many fistula clients arrive at the Fistula Repair Camps with lost self-esteem and mental depression after years of rejection and social exclusion. They look to me as their last hope. Following successful surgery, the smiles and exhilaration on these women’s faces - which reflect restored health and dignity – motivates me to do even more for thousands of other women and girls suffering from Fistula, who are often the most marginalized, vulnerable and poorest in our communities”.

Dr. Kasonka is among less than 10 surgeons whose passion to ensure every woman and adolescent girl enjoys a healthy and productive life contributed to thousands of Fistula repair surgeries since 2005. He undertakes fistula repair outreach camps several times a year. During these camps, his surgical work would typically begin at 7:30 in the morning and end at 6:00 in the evening, taking 15-minute intervals in theatre between each client, in order to maximize on time against the high demand.

However, much more needs to be done, as an estimated 2,000 fistula patients in Zambia await surgery each year – which is a mammoth task for the few fistula health experts available in-country.

Survivors like Nachilima are also helping to spread the word that Fistula treatment is available.

 “When I go back to my village, I am sure people will ask who this amazing traditional healer is”, says Nachilima, “but I will tell them it’s the hospital, and it is a condition that can be cured, and more important, a condition that can be prevented.”

Addressing Fistula Towards Attainment of SDGs and Vision 2030 in Zambia

As underscored by the First Lady of the Republic of Zambia, Mrs. Esther Lungu, during the national commemoration of the “International Day to End Obstetric Fistula”, the prevention and treatment of Obstetric Fistula is central towards achieving Zambia’s Vision 2030 – by putting the furthest behind first and securing the human rights, wellbeing and dignity for all.

Through the Global Campaign to End Fistula, UNFPA, the United Nations Population Fund has supported nearly 100,000 Fistula surgeries globally. For over a decade, the Government of Zambia, in collaboration with partners such as UNFPA, has invested in over 2,300 life-transforming surgeries, to heal the physical and psychological wounds of Fistula survivors.

However, Fistula repair services are not enough. In Zambia, UNFPA and partners continue to draw the attention of policymakers, communities and individuals, to key actions and investments required to end the needless suffering caused by Obstetric Fistula, in keeping with the 2030 Agenda and the Sustainable Development Goals. Priority actions aimed at ensuring all women and girls are able to access key components of safe motherhood – before, during and after pregnancy include:

• Before pregnancy, by providing family planning commodities for spacing and delaying pregnancy;
• During pregnancy, by facilitating access to at least 8 contacts with a health care provider;
• During childbirth, by supporting efforts aimed at ensuring skilled attendance for all births; and more importantly, facilitating availability of skilled staff, medicines and supplies to bolster Emergency Obstetric Care for all women who develop complications during delivery, especially in remote areas around the world. UNFPA also supports national efforts to prevent Fistula;
• After child birth – by providing postnatal care, including family planning, as well as addressing underlying factors that contribute to women’s and girls’ marginalization – including lack of access to quality health services and education, gender and socioeconomic inequality, child marriage and adolescent pregnancy.

Government, and all stakeholders, including UNFPA have reaffirmed commitment to collectively end Fistula within a generation!