Koohi Goth Hospital – International day to end obstetric fistula…

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he wept inconsolably, and the doctors at Koohi Goth Hospital Karachi could not understand why. They had treated this young woman in her 20s already, and they were ready to discharge her so that she could go back to her family near Pakistan’s border with Afghanistan.

By Farahnaz Zahidi

Photography by Faisal Sayani

A translator was brought in who told them the real problem. “My first born is with the money-lenders as girwi (mortgage). I developed the fistula during his birth. But I was so desperate to be healed of this constant leaking that I took the chance. I needed money to reach here to get treatment.” Doctors at the hospital raised the money and sent her home. One life saved out of the nearly 5,000 women that develop the fistula every year in Pakistan. But thousands await treatment.

For fistulas, precaution is the best cure. And the cure is simple: Women of Pakistan need to deliver babies into trained hands and with basic health care facilities. This cure is still a distant dream.

Koohi Goth Hospital is  a women-friendly space where women heal through sharing joys and sorrows, and are counselled to lead a better life once they leave here.
Koohi Goth Hospital is a women-friendly space where women heal through sharing joys and sorrows, and are counseled to lead a better life once they leave here.

Snuggled away in the outskirts of busy Karachi, Koohi Goth Hospital is Pakistan’s only hospital exclusively built to end the scourge of this preventable disease. Only, there should be not even one fistula hospital in Pakistan, because fistulas should no longer exist. “The last fistula case in England was in the 1920s. Here we are with 5,000 new cases every year,” says Dr Shershah Syed, founder of this hospital.

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For fistulas, precaution is the best cure. And the cure is simple: Women of Pakistan need to deliver babies into trained hands and with basic health care facilities. This cure is still a distant dream.

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“If the labour is prolonged, the baby’s head can get stuck in the birth canal. If it keeps pushing against the thin wall between the bladder or rectum and the wall of the birth canal, thereby causing strain,” says Dr Suboohi Mehdi, one of the surgeons at Koohi Goth Hospital.

Dr. Suboohi Mehdi is Pakistan's one of few surgeons trained to repair fistulas.
Dr. Suboohi Mehdi is Pakistan’s one of few surgeons trained to repair fistulas.

Another way a fistula may be formed is if, by mistake of an unskilled surgeon, a cut is caused in the bladder or rectum during surgery. “We are able to treat just 500—600 every year. Lack of awareness and no accessibility to treatment facilities is the reason,” says Dr Sajjad Ahmed, project manager Fistula Project. The project, run by Pakistan National Forum on Women’s Health (PNFWH) and UNFPA, has treated some 3,400 women since it started off in 2006.

Women suffering from fistulas leak urine or stool uncontrollably. Because of this, they are socially ostracised and lead isolated lives. The fear of leaking leads to them starving themselves, which in turn leads to malnourishment-related problems. They miss basic joys like socializing and traveling by public transport.

“I have forgotten what a normal life is. All I have done the last four lives is wash clothes,” says 40-year-old Rihana from interior Sindh. Rihana cries easily; she knows her case is a complicated one. “I don’t know how I will fix her. Sometimes, the cases are so messed up by the time they come to us that there is little we can do,” says Dr Mehdi.

40-years-old Rihana’s case is complicated. “I have forgotten what a normal life is. All I have done the last four years is wash clothes. Everyone told my husband to leave me but he did not”.  Her eyes well up in gratitude.
’40-years-old Rihana’s case is complicated. “I have forgotten what a normal life is. All I have done the last four years is wash clothes. Everyone told my husband to leave me but he did not”. Her eyes well up in gratitude.’

“The first thing we do when a lot of them reach here is give them a shower,” says the dedicated Noor Gul, a senior nurse at the hospital. Gul is now a trainer, helping train young girls who come to the Koohi Goth Midwifery School and Hostel. Once trained, these girls will go back to their communities and be able to help deliver babies safely, so that more women do not develop this disease.

“When they reach us they are drenched in urine. The first thing we do is give them a shower,” says the dedicated Noor Gul, a senior nurse at the hospital who is now trained enough to not only deliver simple cases of child birth, but also train others.
“When they reach us they are drenched in urine. The first thing we do is give them a shower,” says the dedicated Noor Gul, a senior nurse at the hospital who is now trained enough to not only deliver simple cases of child birth, but also train others.
These young girls in pink from the vicinity of the hospital are under training to eventually becomes midwives. “Baaji do you like Balochi people?” one of them asks. “Will you put our pictures on Facebook? Please do.”
These young girls in pink from the vicinity of the hospital are under training to eventually becomes midwives. “Baaji do you like Balochi people?” one of them asks. “Will you put our pictures on Facebook? Please do.”
These young girls in pink from the vicinity of the hospital are under training to eventually becomes midwives. “Baaji do you like Balochi people?” one of them asks. “Will you put our pictures on Facebook? Please do.”
This young midwife in the making from Koohi Goth area has learnt a lot since she came here. “I go back home and raise awareness among my people.”
This young midwife in the making from Koohi Goth area has learnt a lot since she came here. “I go back home and raise awareness among my people.”

In a message on this day, the President Society of Obstetricians and Gynecologists of Pakistan (SOGP), Dr Tasneem Ashraf correctly points out that doctors must identify high risk patients for fistula development, especially pregnant women below the age of 20 years or above the age of 40 years, women who have given birth to many children, those suffering from obesity or Anemia, or having larger than normal babies.

Sheher Bano doesn’t know her age but seems not older than 15. “Doctors say I will be cured soon,” she says, and giggles with excitement at the prospect of being dry.
Sheher Bano doesn’t know her age but seems not older than 15. “Doctors say I will be cured soon,” she says, and giggles with excitement at the prospect of being dry.
Six-years-old Salma has accompanied her elder sister  Sheher Bano from a small village in Thatta district, accompanied by their mother Jannat and sister 6 years. “We hope to go back home soon.”
Six-years-old Salma has accompanied her elder sister Sheher Bano from a small village in Thatta district, accompanied by their mother Jannat and sister 6 years. “We hope to go back home soon.”

Husbands on Board

Naz Bibi is tiny in stature but gives a resolute smile. Suffering from a fistula since the last nine years, this woman in her 40s has come to Karachi all the way from Goth Dera Bugti. She lies on a plastic sheet spread out under her, and can’t wait for the day when she will be dry once more. “Every one left me. Family, friends. I smelled all the time. I leaked non-stop. Yet, my husband was the only one in my life. He brought me here,” she says.

Naz Bibi from Dera Bugti, Balochistan, has been suffering from the condition for nine years. “Everyone left me but my husband. On way to Karachi, traveling was tough in the bus because fellow passengers were disgusted with my stench. I hope that will be over soon.”
Support and counselling is a part of the treatment for socially stigmatized fistula patients. A single touch and a kind word can heal.
Naz Bibi from Dera Bugti, Balochistan, has been suffering from the condition for nine years.

“We are seeing a definite positive change in the trend. More and more husbands now support their wives through the ordeal,” says Dr Ahmed.

“My husband brought me here all the way from Sialkot,” says Fozia, who developed a fistula during the birth of her first child. “I am so excited! Once I heal, I will be able to say my namaz. I have not been able to pray for the last seven years”.

Fouzia from Sialkot, developed a fistula in her first child’s birth, and has given birth to another 3 children since then. “I am so excited! Doctors say once I heal, I will be able to say my namaz. I have not been able to pray in the last 7 years”.
Fouzia from Sialkot, developed a fistula in her first child’s birth, and has given birth to another 3 children since then. “I am so excited! Doctors say once I heal, I will be able to say my namaz. I have not been able to pray in the last 7 years”.

Facts in numbers

Fistula is a poor women’s disease, and the patients are 99 per cent poor women who cannot afford to get their child delivered under proper medical care.

Every year, Pakistan has 4,500—5,000 new cases of fistula. Out of these, only 500—600 reach doctors for treatment.

Pakistan has an estimated 38 surgeons who can perform fistula repair surgeries, but because this is not a lucrative line of medicine, only an estimated 15 are regularly working in this field.

Life saving info:

For information, call 0800-76200

Pakistan National Forum on Women Health

PMA House, Sir Aga Khan III Road, Karachi.

Office number: 021-32231534

Published in The Express Tribune, May 24, 2014.

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