Psychosocial experiences of women with vesicovaginal fistula: a qualitative approach.

Vesicovaginal fistula (VVF) is a condition associated with a number of physical and psychological consequences. In order to gain a deeper understanding of the issues faced by women diagnosed with VVF, a qualitative exploratory study was carried out to explore the experiences of women suffering from VVF. The study included 8 women hospitalized with the diagnosis of vesicovaginal fistula at Kohi Goth Women's Hospital, Karachi, Pakistan. Semi structured interviews of each participant were conducted, recorded, and transcribed. Five major themes were identified, among which all of the participants experienced physical discomforts, psychological disturbances, issues with social and interpersonal relationships and financial constraints. However, concerns with religious practices were experienced by 87.5% of the participants. Pakistani women who are suffering through VVF face many challenges. Combined efforts should be made to offer supportive services to women suffering from this condition.

Lived experiences of Ghanaian women with obstetric fistula.

Obstetric fistula is a worldwide problem that is devastating for women. This qualitative descriptive study explores the experiences of Ghanaian women who sustained obstetric fistula during childbirth. In-depth interviews were conducted with 10 participants. The resultant themes include cultural beliefs and practices surrounding prolonged labor in childbirth, barriers to delivering at a health care facility, and the challenges of living with obstetric fistula, including psychosocial, socioeconomic, physical, and health care access issues. Recommendations include strategies to address this complex problem, including education of men and women on safe motherhood practices, training of traditional birth attendants (TBAs), and improving access to health care.

Fistula campaigns--are they of any benefit?

OBJECTIVE: Evaluation of the problems encountered during a voluntarily fistula campaign in a regional hospital of Niger (Africa). MATERIALS AND METHODS: Women underwent basic gynecological examination, methylene blue testing, and/or direct cystoscopy as necessary. According to their clinical condition, women were informed and surgical options offered as appropriate. Operations were performed under spinal or epidural anesthesia. Immediate postoperative outcomes were followed during the stay of the surgical team in the country. RESULTS: A total of 62 women were examined and 11 had causes of incontinence other than obstetric fistula. In 9.8% of the women, severe local infection precluding any surgical intervention was evident. In 58.8% of patients, the trigonal region and/or urethra were irreversibly damaged. A proportion of patients (9.8%) with large lesions and intact urethra that were offered vaginal layered closure refused the intervention. Of the women that were operated on (21.6%), six underwent vaginal layered closure with Martius fat flap and five women underwent a combined abdomino-vaginal approach. CONCLUSION: It is extremely difficult to meet the needs of this global problem with short term programs and volunteers. Directing these efforts to specialist fistula centers and creating reliable scientific evidence should be the main goal.

Ethical issues in vesico-vaginal fistula care and research.

The plight of women in poor nonindustrialized countries who have incurred catastrophic childbirth injuries, such as vesico-vaginal and recto-vaginal fistulas, from prolonged obstructed labor is receiving increased attention from the world medical community. While the good intentions that have prompted this greater concern are not in doubt, intentions by themselves are insufficient guarantees of ethical conduct in programs developed to repair these injuries. Clinical proposals put forward to deal with the problem of fistula must undergo critical analysis to insure that basic ethical requirements are met. This article emphasizes the vulnerability to exploitation of women with obstetric fistulas and reviews the basic principles of medical ethics relevant to fistula care.

Did J. Marion Sims deliberately addict his first fistula patients to opium?

American surgeon J. Marion Sims (1813-83) is regarded by many modern authors as a controversial figure because he carried out a series of experimental surgeries on enslaved African American women between 1846 and 1849 in an attempt to cure them of vesicovaginal fistulas, which they had all developed as a result of prolonged obstructed labor. He operated on one woman, Anarcha Westcott, thirty times before he successfully closed her fistula. Sims performed these fistula repair operations without benefit of anesthesia but gave these women substantial doses of opium afterwards. Several modern writers have alleged that Sims did this in order to addict them to the drug and thereby to enhance his control over them. This article examines the controversy surrounding Sims' use of postoperative opium in these enslaved surgical patients. The evidence suggests that although these women were probably tolerant to the doses of opium that he used, there is no evidence that he deliberately tried to addict them to this drug. Sims' use of postoperative opium appears to have been well supported by the therapeutic practices of his day, and the regimen that he used was enthusiastically supported by many contemporary surgeons.

Women of the courtyard. A nurse's journey to treat obstetric fistulae in Niger.

Obstetric fistula is a devastating condition that results from prolonged or unassisted labor. It produces debilitating physical and emotional consequences caused by constant leaking of urine and/or feces. Because high-quality medical care is available throughout the developed world, unrepaired obstetric fistulae are virtually nonexistent in developed nations. However, the condition is rampant in many developing countries, including Niger, a nation in West Africa. This article explains what obstetric fistula is, why it is such a problem, and what nurses and other health care professionals can do to help improve the situation worldwide. It also tells the story of one nurse who went on a volunteer mission to treat obstetric fistulae in Niger, where she met a courtyard full of women she will never forget.

Vesico-vaginal fistula in Eastern Nigeria.

Our objective was to examine the epidemiological determinants of vesico-vaginal fistula in Eastern Nigeria, and maternal characteristics and sociocultural factors predisposing to vesico-vaginal fistula. The case-records of 74 patients with vesico-vaginal fistula were reviewed. The mean age of the patients was 34.1 years and the mean age at occurrence of fistula was 30.1 years. A total of 24 women (32.4%) presented within 6 months of fistula formation. They were mainly multipara, housewives, subsistence farmers and still living with their husbands. A total of 68 (91.9%) developed a fistula following prolonged obstructed labour. Juxta-cervical fistula was the most common, 33 (44.6%) followed by juxta-urethral 11 (14.9%). The other associated morbidity included chronic vulval excoriation, cervical damage and amenorrhoea. Fetal wastage was high with 53 (77.9%) stillbirths and four (5.9%) early neonatal deaths. Vesico-vaginal fistula is still a major problem in the developing countries and a reflection of standard of obstetric care currently available to our women.

Characteristics of VVF patients as seen at the specialist hospital Sokoto, Nigeria.

This paper is a preliminary report of a longitudinal study of VVF patients seen at the specialist hospital Sokoto, Nigeria. Thirty-one (31) patients admitted into the VVF ward during the period, May 1996 to April 1997 were studied. The patients were mainly Hausa/Fulani Muslims (100%), short-statured (mean height, 149 cm), full-time house wives (100%) and were married at the mean age of 13 years. Only 6% of the patients could read or write in English while 81% had Quranic school education only. 60% of the women live in rural communities which lacked, or remotely located to appropriate health care services. Most of the cases developed the disease at the mean age of 15 years. Majority of the cases (77%) did not receive antenatal care while the mean duration of labour for all the patients was 4 days. 84% of the patients were eventually referred to hospital for delivery. Pregnancy wastage rate was 87%. Averagely, twenty-six, (84%) of the patients have had 3 surgical repairs done. Divorce rate following the occurrence of the disease was 55%. Our recommendations include: the integration of maternal and child health (MCH) education in the curriculum of Quranic schools, and advocacy for free antenatal care and delivery services at the primary and secondary levels of health care, special health education programs on maternal health for religious leaders, training of more personnel, and bringing MCH services closer to the grassroots.