LIBERIA: Living with fistula

Thursday, May 15, 2008
Of 600 rape victims recently interviewed by a Liberian non-governmental organisation, 90 percent of the women were found to be suffering from fistulas – a vaginal tear which results in loss of bladder control and social stigmatisation.

Aid workers say the statistic, provided by the Women of Liberia Peace Network (WOLPNET) from surveys conducted in April 2008, shows the horrifying prevalence of rape and of a phenomenon which Liberian medical officials say they are ill-equipped to respond to.

“These women are living with a serious scar and they are not getting access to treatment,” said Una Thompson, head of WOLPNET.

According to local health workers two types of fistula cases are prevalent in Liberia.

One is obstetric fistula, which is a vaginal tear resulting from prolonged obstructed labour.

A recent health survey showed that over average 994 women die for every 100,000 who give birth, a higher rate than was estimated during Liberia’s civil war. Doctors say the most common cause of death is vaginal haemorrhaging following childbirth.

Some health workers and officials say the spike is a result of improved data collecting. However others say fewer births are being attended by trained medical professionals, who diminished in numbers through the end of the 1990-2003 war, partly because of migration. Read an IRIN report on maternal mortality in Liberia

The other common cause of fistula in Liberia is traumatic gynaecologic fistula that is a vaginal injury resulting from violent sexual assault or when objects are forcibly inserted into the vagina.

Violent crime and rape especially of children are common in Liberia, and police and justice systems have proven ineffectual at ending impunity for these crimes. Read an IRIN report on crime in post-conflict Liberia

Dr. John Mulbah, head of the maternity centre of Liberia's biggest referral hospital, the John F. Kennedy Hospital in Monrovia, said resources are limited to repair the damage.

“We have only five staff trained to conducted fistula treatment and all of them are based in Monrovia [the capital]", he told IRIN.

"The unit only has 30 beds… our facility is overwhelmed with patients and some have to wait for a long time before being attended to.”

The unit was created in February 2007 after the UN sponsored a survey which identified 351 women suffering from fistulas in rural Liberia. The unit is 100 percent funded by international donors, not the government, Mulbah said.

"The drugs and supplies and the only vehicle conducting outreach in rural parts of the country were provided by the UN Population Fund (UNFPA). Treatment at the unit is free," Mulbah said.

Liberia's health minister, Walter Gwenigale, told IRIN that transporting fistula patients from rural areas to Monrovia for the treatment is a major constraint on broading treatment.

"Bringing those patients to Monrovia requires funds. We are aware that there are lots of fistula cases upcountry but the national health budget for Liberia is just US$11 million which is totally inadequate to deal with all health problems," Gwenigale said.