You are here

For over a decade, the Government of Zambia, in collaboration with UNFPA and other partners, has invested in life-transforming fistula surgeries, to heal the physical and psychological wounds of thousands of fistula survivors across Zambia.

In an interview with Dr. Paul Musoba, a young fistula surgeon at Solwezi General Hospital in North Western Province of Zambia, he shares his professional and personal insights into obstetric fistula and his work to surgically repair women and girls affected. Here are the excerpts:

What inspired you to become a fistula surgeon?

My inspiration is drawn from many aspects of the work I do. During the early stages of my practice as an obstetrician and gynecologist, I encountered many women and girls who had suffered so much from obstetric fistula - one of the most serious injuries of childbirth and an underlying common risk of prolonged, obstructed labour without access to timely, high-quality medical treatment. Observing women and girls being frequently abandoned and ostracized due to the constant leakage of urine, faeces, or sometimes both, was the starting point of my desire to change this narrative.

With inspiration and mentorship from some of Zambia’s well trained senior fistula surgeons, I first participated in a fistula camp in 2019. I was able to observe, assist and eventually undertake fistula surgeries. It is definitely a specialized skill that requires constant practice and exposure. With support from UNFPA, I was trained to become a fistula surgeon. Today, I am one of the 8 fistula surgeons in Zambia.

Briefly describe a typical day as a fistula surgeon

It is quite a fulfilling but at the same time challenging experience. As a fistula surgeon and an obstetrician and gynecologist, my daily tasks are focused on the key components of safe motherhood – from pregnancy, childbirth and postnatal care.

Pregnancy and childbirth should be among the happiest moments in a woman’s life. Sadly, this is not the case for thousands of women and girls not only in North Western Province where I am located, but Zambia at large. At Solwezi General Hospital, I often encounter women and girls who have developed obstetric fistula, some of whom have lived with the condition for years. 

My journey with a fistula client begins with my very first encounter with them, and getting to understand their current situation. The trauma suffered by many of my clients during delivery is very heartbreaking, as it goes beyond the physical. It is emotional and socially damaging. Throughout my journey with my client’s, I focus not only on healing their physical wounds, but also supporting their emotional and psychological healing as well.

As a surgeon, I immediately begin plotting my clients’ operative pathway, alongside its execution, sometimes with much difficulties.

During fistula camps, my surgical work would typically begin at 7:30am in the morning and end at 6:00pm in the evening, taking 15-minute intervals in theatre between each client, in order to maximize on time against the high demand.

This process, once concluded with a hospital discharge of a happy, “dry” and “continent” client, makes me proud to be a fistula surgeon.  enjoyable.

What are some of the challenges faced while working to save the lives of women and girls affected by Fistula?

Every year, I repair an average of 10 Fistula clients, at either Solwezi General Hospital or during fistula camps at other hospitals. However, I know there are many other women suffering with fistula but are not able to access treatment due to lack of information or challenges in accessing health care.

Having access to expectant mothers before their time of delivery, as well as during the period they are suffering from fistula in their communities, is therefore one of the biggest initial challenges faced. Many women in North Western Province live in remote areas located far from health facilities, often resulting in home deliveries – a key risk factor for obstetric fistula in the event of an obstructed labor.

For many fistula survivors, societal stigma still remains a major issue they face. Successful reintegration is a key priority post-surgery. My recent encounter with an 18-year-old fistula survivor particularly stands out to me. Resulting from an obstructed labour and delayed access to emergency health care, she developed obstetric fistula, alongside losing her baby. For 2 years she lived with fistula and could not continue with her education. With the help of community health workers, she was able to access surgical care, and I successfully repaired her fistula. Throughout this process, she was very jovial and optimistic, which definitely put a lot of pressure and confidence on the team. I personally made a follow up visit 4 months post her operation, and the optimistic 18-year-old girl we had discharged had an even brighter smile. “Dr Musoba, thanks to you, I have now gone back to school and looking forward to completing my education!”, she told me. It was quite an amazing story, says Dr Musoba.

Towards ending obstetric fistula by 2030

In Zambia, thousands of women and girls continue to experience maternal morbidities, such as obstetric fistula, with at least 33,400 women and girls having suffered from obstetric fistula by 2018. In keeping with the 2030 Agenda for Sustainable Development, UNFPA continues to provide support to the Government of Zambia towards fistula prevention, treatment and social reintegration programmes. UNFPA and partners also 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, including through availability of skilled health personnel.