Living With Fistula In Silence

Some 4,000 to 5,000 women suffer from fistula annually in Pakistan due to lack of awareness about the condition, the unavailability and high cost of treatment for it

Living With Fistula In Silence

In a remote village of Killa Saifullah, nestled deep within the rugged terrains of Balochistan, lives a woman named Shahzadi. At 32 years of age, she has suffered in silence for years due to a debilitating condition known as fistula. Unlike the tales one often hears about fistula, Shahzadi's plight did not stem from early marriage or the clumsiness of untrained midwives. Instead, her journey of despair began in the dimly lit corridors of a government hospital.

It was a stormy night when Shahzadi went into labour. The rain drummed relentlessly against the windows of the hospital, mirroring the turmoil within her body. The hours appeared to stretch into eternity as she writhed in agony on a stiff hospital bed; her cries echoed through its halls. Despite the best efforts of the medical staff, complications arose.

As dawn broke, Shahzadi's world shattered. The news was delivered with a clinical detachment, cutting through her like a knife. She had developed a fistula—a cruel tear that robbed her of dignity and condemned her to a life of anguish. The once vibrant woman became a shadow of her former self, burdened by the shame and helplessness of constant leakage of urine and faeces, a relentless reminder of her shattered dreams.

Returning to her home in the scarcely developed region of Nisai in Killa Saifullah, Shahzadi's existence became a cycle of pain and humiliation. Her husband, a humble labourer, struggled to provide for their meagre needs. The treatment that she desperately required for her new condition was far more than what he could afford. With each passing day, however, Shahzadi withdrew further into herself, her spirit eroded by the weight of her affliction.

A chance encounter with a travelling doctor reignited a flicker of hope within Shahzadi's heart. The doctor spoke of a distant hospital renowned for its expertise in treating fistula—a beacon of salvation amidst the darkness of her despair. With newfound determination, Shahzadi embarked on a journey fraught with uncertainty, guided only by a whisper of possibility.

After struggling with the affliction for years and travelling hundreds of miles, she finally found salvation at a hospital in Kohi Goth, Karachi. Skilled and compassionate doctors worked tirelessly to mend the broken pieces of her body and spirit. Shahzadi underwent surgery and rehabilitation, and finally, she emerged from the shadows of her affliction. 

The tears that once flowed in despair now sparkled with newfound hope, reflecting the light of a future reclaimed. With each step forward, she vowed to become a voice for the countless women still trapped in the silence of their suffering.

As Shahzadi returned to Nisai (Killa Saifullah), she carried with her more than just physical healing. Armed with the knowledge that women should not have to endure the agony and shame of fistula alone, she became a beacon of hope for her community. Through education and advocacy, she sought to shatter the stigma surrounding fistula, empowering women to seek the help they so desperately needed.

Similar to Shahzadi, Seema's journey into the depths of despair began on a scorching summer day. The difference is that the 24-year-old Seema had to contend with the unforgiving landscape of Dera Bugti. In the rustic confines of her humble home, surrounded by the echoes of her ancestors' struggles, Seema awaited the arrival of her first child with a mixture of hope and trepidation.

With each excruciating contraction, her world narrowed to a solitary point of pain, a relentless reminder of the fragile line between life and death. But amidst the chaos of childbirth, fate dealt a cruel blow.

When Seema's daughter finally emerged into the harsh light of day, she brought with her the promise of a new life and the cruel twist of fate that would forever alter Seema's existence. In the aftermath of labour, Seema discovered the silent spectre of fistula — a microscopic tear in the fabric of her being, leaving her broken and blemished.

After the birth of her baby, Seema's life became very hard. Like the ability to control when she had to take a bathroom break, she slowly felt like she had lost control of her life, plunging her into a constant state of indignity, unease and embarrassment. She didn't want to be around people anymore. 

In a region where access to healthcare was as scarce as water in the desert, Seema found herself trapped in a cycle of despair. With each passing day, her hopes of finding relief dwindled, swallowed by the vast expanse of indifference surrounding her.

What is fistula and its causes

A fistula is an opening that forms between the uterus (uterus), urinary bladder, vagina and the anus (rectum). This opening can challenge and even end human control over urine and stool.

Dr Tahira Kazmi, a gynecologist, says the main cause of a fistula forming in women is the head of the baby in the stomach. A small football-like round bone that travels between the uterus, bladder, and anus that is part of the baby to be born into the world.

Professor Dr Haq Nawaz, at the Fistula Foundation Balochistan, said that some 4,000 to 5,000 women suffer from fistula annually in Pakistan while some two million women are affected by it. 

He said three centres have been established in Balochistan to treat this affliction. These centres have registered 1,600 cases over the past ten years, while the number of fistula cases is increasing yearly. 

"[Traditional] Customs, poverty, lack of education, family planning, unavailability of medical facilities, lack of trained health workers and lack of facilities at the regional level are contributing to the spread of the affliction," he added.

He explained that fistulas occur due to prolonged periods of labour and because of the entrapment of the baby in the uterus, which tears a hole in the urinary and sometimes the faecal tracts.

Prof Nawaz said that thousands of women each year are excluded from society after developing this condition due to the lack of basic health principles or access to facilities. 

Solving the issue

Balochistan Health Secretary Abdullah Khan said that fistula is a treatable condition. He added that hundreds of women who had been suffering from this disease are now living a normal life after recovering from the operation.

He believes there is a need to focus on creating awareness regarding fistula, adding that the government is working on developing dedicated facilities to treat the condition. 

"Fistula Wards will be activated in Civil Hospital Quetta, Bolan Medical College (BMC), and the Urology Department at the Sheikh Zayed Hospital," he said.

Furthermore, he said measures will be taken to raise awareness about maternal health in the province and prevent fistulas from forming.