In three weeks I have been travelling with Dr Kees between four different fistula centers in 4 cities: Katsina – Kano – Zaira – Sokoto
We operate fistulas the whole day, we talk fistulas the whole evening and we dream fistulas the whole night. I have learned a lot, receiving the essence of Dr Kees’ lifelong and vast experience of fistula surgery all for free. I am extremely grateful for that.
The stereotypical picture of a fistula patient as a depressed, abandoned and socially outcast doesn’t fit with what we see here. In Aira 8-9 out of ten women with obstetric fistula come to the hospital with their husband as attendant. Those who are outcasts are usually unmarried women who end up in disgrace due to the fact that becoming pregnant as an unmarried woman is unaccepted in the society (as in the western world a little more than 50 years ago). It is the same picture what we see here. 60 % of the fistula patients are still living with their husbands, but that doesn’t mean that remaining 40 % are divorced. According to Hausa culture the first delivery has take place in the house of the woman’s parents, and if it is protracted and complicated with a fistula as end result she will remain with her parents until the problem is solved. However the husband will keep in contact and visit her regularly.
Not one of all the patients I have seen here is circumcised. That is because it is not in the culture of the Muslims who constitute more than 90 % of the population. That doesn’t surprises at all since we already know that circumcision does not contribute to the development of a fistula.
Many of the patients are very young since they marry at young age. But that doesn’t implicate that early marriage is causing obstructed labor and fistula. If the marriage were delayed some years the girls would only get their fistulas some years later. Just as in Ethiopia more than 50 % of the fistula patients are multipara (having delivered one or more times). Yesterday we operated a para 19 (a woman who delivered 19 times) who got her fistula at the 19’th delivery.
Always remember that a fistula is caused exclusively by lack of qualified obstetric service and nothing else!
What surprises me is that 70 % of all the fistula patients here have actually delivered in a hospital. That clearly implicates an obstetric service of unacceptable low quality.
The advertisements which the big and very rich international NGO’s are financing and distributing are therefore not only useless, but even discriminating and insulting to the women.
African women are not stupid! If they knew that delivering in the hospital would be safe and result in a live baby, they wouldn’t hesitate to go there to deliver. But when the sad fact is that in the hospital they are neglected as much - or maybe even more - as at home, why bother to go to the hospital? The advertisement is an insult to the highly intelligent African women.
Instead of wasting money and energy on glossy advertisements and other useless preventive health activities it would be far better to support so-called “curative” health care which includes obstetric service. I say so-called “curative” because one and every performed cesarean is a preventive measure, just as many other inpatient surgical procedures.
Enough for this time. I will be back!
In three weeks I have been travelling with Dr Kees between four different fistula centers in 4 cities: Katsina – Kano – Zaira – Sokoto
We operate fistulas the whole day, we talk fistulas the whole evening and we dream fistulas the whole night. I have learned a lot, receiving the essence of Dr Kees’ lifelong and vast experience of fistula surgery all for free. I am extremely grateful for that.
The stereotypical picture of a fistula patient as a depressed, abandoned and socially outcast doesn’t fit with what we see here. In Aira 8-9 out of ten women with obstetric fistula come to the hospital with their husband as attendant. Those who are outcasts are usually unmarried women who end up in disgrace due to the fact that becoming pregnant as an unmarried woman is unaccepted in the society (as in the western world a little more than 50 years ago). It is the same picture what we see here. 60 % of the fistula patients are still living with their husbands, but that doesn’t mean that remaining 40 % are divorced. According to Hausa culture the first delivery has take place in the house of the woman’s parents, and if it is protracted and complicated with a fistula as end result she will remain with her parents until the problem is solved. However the husband will keep in contact and visit her regularly.
Not one of all the patients I have seen here is circumcised. That is because it is not in the culture of the Muslims who constitute more than 90 % of the population. That doesn’t surprises at all since we already know that circumcision does not contribute to the development of a fistula.
Many of the patients are very young since they marry at young age. But that doesn’t implicate that early marriage is causing obstructed labor and fistula. If the marriage were delayed some years the girls would only get their fistulas some years later. Just as in Ethiopia more than 50 % of the fistula patients are multipara (having delivered one or more times). Yesterday we operated a para 19 (a woman who delivered 19 times) who got her fistula at the 19’th delivery.
Always remember that a fistula is caused exclusively by lack of qualified obstetric service and nothing else!
What surprises me is that 70 % of all the fistula patients here have actually delivered in a hospital. That clearly implicates an obstetric service of unacceptable low quality.
The advertisements which the big and very rich international NGO’s are financing and distributing are therefore not only useless, but even discriminating and insulting to the women.
African women are not stupid! If they knew that delivering in the hospital would be safe and result in a live baby, they wouldn’t hesitate to go there to deliver. But when the sad fact is that in the hospital they are neglected as much - or maybe even more - as at home, why bother to go to the hospital? The advertisement is an insult to the highly intelligent African women.
Instead of wasting money and energy on glossy advertisements and other useless preventive health activities it would be far better to support so-called “curative” health care which includes obstetric service. I say so-called “curative” because one and every performed cesarean is a preventive measure, just as many other inpatient surgical procedures.
Enough for this time. I will be back!