By Chandra Rai and Kunsang Sherpa
Kathmandu, Nepal – For 14 years, Sunita Limbu lived with the painful memory of a birth gone wrong. She suffered through four days of labor with no relief. Health services were far from her remote village in eastern Nepal, and traditional means to try and hasten childbirth only made the situation worse. Sunita’s baby died in her womb. As a result of the complications, the grieving mother suffered a bladder tear known as obstetric fistula that left her constantly leaking urine.
Sunita’s condition required her to fashion makeshift plastic undergarments to try and stay clean and dry. But neighbors kept her at a distance. The odor from the leaking made it difficult for Sunita to keep a job, and she went from one to another. Sunita feared her situation would never improve, but then she learned about the B.P. Koirala Institute of Health Sciences (BPKIHS) and the doctors and nurses there who were engaged in fistula repair work. With the support of Jhpiego and the United Nations Population Fund (UNFPA), the BPKIHS became the first medical institution in Nepal to be designated by the Ministry of Health’s National Health Training Centre (NHTC) as an on-the-job training center for repairing obstetric fistula.
Obstetric fistula develops as a result of obstructed labor. Pressure from the baby’s head creates a hole or “fistula” between the woman’s vagina and rectum or bladder, leaving her leaking urine, feces or both. An estimated 200 to 400 women suffer from this condition every year in Nepal. Women’s health experts say this number is low because stigma and shame associated with incontinence keep women from seeking help.
Dr. Mohan Chandra Regmi, an associate professor at BPKIHS trained two doctors and two nurses in the surgical repair of fistula using the NHTC-developed obstetric fistula training package. He and his team repaired Sunita’s fistula for free. She received nursing care and counseling from Binita Rai, who along with nurse Reeta Limbu, participated last year in the obstetric fistula repair training held by BPKIHS and NHTC with support of Jhpiego and UNFPA. Dr. Kusum Thapa, then Jhpiego’s Technical Advisor for the Asia and Near East Region, led the development of the on-the-job training package.
After her recovery, Sunita was released from the hospital with a new sense of well-being. “No one should suffer with this disease like me,” she said, in support of continued efforts to offer this specialized surgical care to women in need.
“People still believe this problem is a curse and destiny,” said Rai, an advocate for identifying women in need of obstetric fistula repair. “Large numbers of people don’t know that this can be preventable and treated.“
The BPKIHS hospital handled 23 obstetric fistula repair cases in 2015. Of those, more than half were women between the ages of 20 and 30, and most sought out help on their own.
Dr. Tarun Pradhan, one of the first physicians to learn how to repair obstetric fistula through the Jhpiego-UNFPA program, credits the hospital’s initial success to the team of nurses and doctors that has served women who have suffered alone from this condition for too long. A new training will be announced May 23 on International Day to End Obstetric Fistula.
“I am so happy to see women recovering after surgery who were soaked with urine and now they are dry. That happiness cannot be compared with anything,” said Rai. “Public awareness is needed to reach unreached women in their communities.”