Medical shortcomings

Medical shortcomings

What makes the suffering of women with OF so tragic is the fact that their condition can be easily avoided by timely access to a maternal or obstetric care facility. If they receive timely care the baby will most likely be delivered through a caesarean section and both mother and child will probably survive without chronicle medical conditions.
 
The most urgent need of women in labour therefore is assistance of skilled medical staff before, during and after giving birth. Unfortunately less than half of the pregnant women who live in developing countries receives assistance from a skilled birth attendant[1]. Beside lacking assistance the availability of health care facilities is another problem. In rural areas and (post) conflict areas where the infrastructure is often severely substandard and financial means of families are low, reaching a facility that provides emergency obstetric care is often unaffordable or even transportation-wise impossible. Even when a woman manages to reach a facility on time this centre might not be equipped to provide more comprehensive obstetric care as a caesarean section or fistula repair operation.
 
If a fistula has already been developed a woman can be remedied with a surgery.  More than 90% of the OF cases can be cured through a surgical repair operation[2] which enables the woman to resume an active life, including having other children. Unless a woman has access to a hospital that provides subsidized treatment of the illness she may live with fistula until she dies, since it usually does not heal by itself. The life expectancy of these women is often significantly lower because of the complications fistula brings forth. 


International responses
Although interventions have been developed the last few years to enlighten the suffering of these women, the programmes have been rather patchy. In order to make interventions viable support of national governments and firm grounding within the social-economic context is essential. Three strategies can be discerned: Primary, secondary and tertiary prevention. Primary prevention aims at: “Ensuring that pregnancies are planned, wanted, and occur at an optimal time in the woman’s life” (WHO, 2006, p. 18). Education on the need to extend the age of first pregnancy and the benefits of birth spacing should be given to families. Secondary prevention is focussed on the care seeking behaviour of the pregnant woman and her family. Cultural barriers, like waiting to seek obstetric care till the family gives permission, are obstacles that should be dealt with, in order to lower the amount of women who develop an obstetric fistula. Hence, the Global action for skilled attendants for pregnant women from the WHO underscores the responsibilities to increase the access to skilled professionals. Here a great job is set aside for organizations to set up new infrastructures which are ultimately self sustainable and sufficient. Along the provision of health care facilities training and education should at any time be part of the solution and the services offered. Tertiary prevention, the final strategy, is to prevent a fistula from developing or to identify it timely. Monitoring every labour is one of the basic principles of this strategy. One significant issue here is the lack of specialized fistula hospitals and an absence of doctors trained in fistula repair. 
 

[1] AbouZahr C. Global burden of maternal death. British Medical Bulletin. Pregnancy: Reducing maternal death and disability. British Council. Oxford  University Press. 2003. pp.1-13. www.bmb.oupjournals.org., WHO analysis of causes of maternal deaths: a systematic review. K.S. Khan and al. Lancet 2006; 367: 1066-74


[2] WHO. (2006). Obstetric fistula. Guiding principles for clinical management and programme development. Obtained on September 25, 2013, from: http://whqlibdoc.who.int/publications/2006/9241593679_eng.pdf

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